Once you have an understanding of where the pain is coming from and why it hurts so bad, then you can be reassured that it’s not life threatening or dangerous. Also, at this acute point of time, the patient often unknowingly puts heat on the back, often for hours. This is the WORST thing you can do as the area is already swollen and putting heat on a swollen area draws more blood and fluids into the area.  It’s literally like throwing gas on a fire. So, receiving proper information from us such as, put ice on the area for 15-20 minutes on and off several times in a row to “PUMP” the swelling out of the area will make complete sense.

Also, did you know that 2/3rds of our body’s weight is above the waist? That means, when a 150# person bends over, they are “lifting” 100#! That’s one of several reasons why bending over can be so dangerous. To “fix” that, squat by bending the knees keeping the back straight and keep objects that you might be lifting close to your body as that weight literally weighs 10x more when your arms are straight and you’re lifting. When you can’t squat and have to bend over, bend the knees, arch your back (literally “stick your butt out”), and bend over at your hip joints – DON’T use your back. You’ll need to practice that one a few times before it’s fully understood.

As your back pain improves, we will review these important self-help approaches and add new “tricks of the trade” like certain stretches, some strengthening and perhaps some balance exercises.  Did you know that your thigh muscles shrink just by sleeping overnight?  It’s true!  When you wake up in the morning, your thigh muscles are smaller than when you went to bed. Well, this same muscle shrinkage (technically called “atrophy”) occurs in the lower back and hips, so strengthening exercises are REALLY IMPORTANT! Just think, if your muscles shrink overnight just from laying in bed, what about when you might have been told to use bed rest for several days or more? There potentially is a lot of muscle shrinkage and weakness that can occur in a relatively short amount of time and therefore, strengthening exercises also need to be taught in order to regain your strength so you can more safely do your activities.

Now what about back pain prevention? What methods to you think will help us NOT get low back pain? That’s right – managing weight! If your BMI (body mass index or, the ratio between your height and weight) is >25, you need to trim down a bit (or more). Go on line and SEARCH BMI, and pick one of many “BMI Calculators” to figure out your BMI. So, what do chiropractors know about weight loss?  Did you know the chiropractic college curriculum includes more nutritional courses than most medical schools? We will help you find a way to lose weight – whether its calorie restriction, a special diet like no/low salt, gluten-free, or a diabetes-specific diet. Another prevention trick for the low back (actually, whole body!) is to STAY FIT! Make aerobic exercise and even a light weight lifting program part or your daily ritual. Other methods help too, so come in and let us guide you in this journey to better health!

Blessings,

Dr. Troy Don, DC QME

Often, traumatic isthmic spondylolisthesis occurs during the adolescent years and in fact, is the most common cause of low back pain at this stage of life. Sports most commonly resulting in spondylolisthesis include gymnastics, football (lineman), weightlifting (from squats or dead lifts) and diving (from over arching the back). Excessive backward bending is the force that overloads the back of the vertebra resulting in the fracture sometimes referred to as a stress fracture, which is a fracture that occurs as a result of repetitive overloading over time, usually weeks to months.

If the spondylolisthesis lesions do not heal either by cartilage or by bone replacement, the front half of the vertebra can slip or slide forwards and become unstable. Fortunately, most of these heal and become stable and don’t progress. The diagnosis is a simple x-ray, but to determine the degree of stability, “stress x-rays” or x-rays taken at endpoints of bending over and backwards are needed. Sometimes, a bone scan is needed to determine if it’s a new injury verses an old isthmic spondylolisthesis.

Another very common type is called degenerative spondylolisthesis and occurs in 30% of Caucasian and 60% of African-American woman (3:1 women to men). This usually occurs at L4 and is more prevalent in aging females. It is sometimes referred to as “pseudospondylolisthesis” as it does not include defects in the posterior arch but rather, results from a degeneration of the disk and facet joints. As the disk space narrows, the vertebra slides forwards. The problem here is that the spinal canal, where the spinal cord travels, gets crimped or distorted by the forward sliding vertebra and causes compression of the spinal nerve root(s), resulting pain and/or numbness in one or both legs. The good news about spondylolisthesis is that non-surgical approaches, like spinal manipulation in particular, work well and chiropractic is a logical treatment approach!

Blessings,

Dr. Troy Don, DC QME

1. Red flags – These include dangerous conditions such as cancer, infection, fracture, cauda equina syndrome (which is a severe neurological condition where bowel and bladder function is impaired). These conditions generally require emergency care due to the life threatening and/or surgical potential.
2. Mechanical back pain – These diagnoses include facet syndromes, ligament and joint capsule sprains, muscle strains, degenerative joint disease (also called osteoarthritis), and spondylolisthesis.
3. Nerve Root compression – These conditions include pinching of the nerve roots, most frequently from herniated disks. This category can include spinal stenosis (SS) or, combinations of both, but if severe enough where the spinal cord is compromised (more commonly in the neck), SS might then be placed in the 1st of the 3 categories described above.

The most common category is mechanical back pain of which “facet syndrome” is the most common condition. This is the classic patient who over did it (“The Weekend Warrior”) and can hardly get out of bed the next day. These conditions can include tearing or stretching of the capsule surrounding the facet joint due to performing too many bending, lifting, or twisting related activities. The back pain is usually localized to the area of injury but can radiate down into the buttocks or back of the thigh and can be mild to very severe.

That’s it for now.

Blessings,

Dr. Troy Don, DC QME

Today I’d like to share with you some interesting findings in some studies that have been done that pertain to movement and back pain.

I’m sure you’ve heard it before – “my back hurts… I just want to rest” or perhaps “oh boy my back has been a problem for so long that I’m afraid to do anything for fear that I’ll hurt my back.”  Or maybe you’ve heard “my back hurts all the time now even though I don’t do anything!”

If you have had back pain you know what I’m talking about.  If you have had severe pain, you know realize how easy it is to put limitations on yourself and on your activities.

This is the trap…

Your pain conditions you to be less active… so much so that you become de-conditioned or even worse yet, sedentary.  That decrease in activity and movement leads to something called spinal wind-up.  This spinal wind-up leads to a neurological self feeding spiral of more and more pain, EVEN THOUGH you are not active or moving.

In other words, if you don’t move your joints you are destine to have more and more pain!

How do we fix this?

Easy. Get moving!

Will this hurt? Maybe… BUT it will start the process for breaking the cycle of spinal windup.

Chiropractic is fantastic at getting the joints moving.  The chiropractic adjustment floods the nervous system with positive nerve message to seize spinal windup.  Exercise and movement is great at helping to fall into the trap.

If you are hurting “even though you’re not doing anything”, I strongly encourage you to seek chiropractic care.  Then start some type of EASY movement program to help you get more years out of your life and more life out of your years.

That’s it for now…

Blessings,

Dr. Troy Don, DC QME

Education is related to experience. Stop and think about how a child manages pain. When they fall down and skin their knees, the intensity of their crying can be deafening! It’s obvious the child’s the reaction is exaggerated, as exemplified by that blood curdling scream. The reason for this heightened reaction is due to the lack of experience or, “knowledge” about this type of injury – they don’t realize the pain will dissipate with a few minutes and as a result, they over react. As we age, skinning our knees is more irritating mentally than it is painful – we look at it, after muttering a few words under our breath (which won’t be repeated here), and then we go about our daily routine, knowing fully well that it will hurt for a while and eventually get better. Studies have shown that people who have graduated from high school or college have a higher pain threshold than those who have not. This may be because, through learning about the body in science class, they understand the anatomy and physiology (structure and function) behind a cut on the skin. As a result, there is no overreaction, just a “reaction.”

So, when can this educational process start? The answer is simple – as soon as possible; and actually, before we become patients! A recent study published in the journal “SPINE,” found 8 year old school children were capable of out-performing a similar aged “control” group that were not educated on management and prevention of low back pain. Tests were administered initially, at 15 days and at 98 days after beginning the education process. They used a comic book as the method to educate the 266 member group of 8 year olds while a “control” group of 231 kids did not receive the comic book educational tool. Initially, the 2 groups scored similarly (about 73% correct answers for both groups). The comic book was given to the 266 kid group at day 8 and both groups were retested again at the 15 and 98 day time points. The results showed the group receiving the comic book education about LBP scored significantly higher at 15 days and retained the information at 3 months. Though no one will know if the educated kids will be less prone to develop chronic pain due to this gain of knowledge, the increased likelihood certainly exists.

The take home message is, use the internet and all other resources to learn as much as you can about your back condition. Of course you’re doing that already if you’re reading this online. 

Blessings,

Troy Don, DC QME
Advanced Health Source

You may think it’s odd to discuss low back pain (LBP) from the perspective of spinal fusion because as chiropractors, we do not perform surgery and so, why discuss it?  It is important that we discuss research such as this so we can make the informed treatment decisions with our patients after we’ve considered all the facts in each specific case.  Now, there are certainly times when a surgical procedure for back and leg pain is necessary and appropriate for some patients, but the problem is, there are also some patients who have been told they need spinal surgery when, in fact, they may be better off NOT proceeding with surgery. So, the question is, what happens to those patients who elect not, vs. those who do choose to proceed with surgery?

That question was addressed in a study where a total of 1450 patients injured at work were followed over a 2-year time frame. There were a total of 725 patients who proceeded with the fusion surgery and the other 750 elected NOT to have the surgery. A fusion surgery can be described as when two or more vertebra are fused together, usually because there are neurological problems such as shooting leg pain, weakness and/or numbness in one or both legs.  The conditions treated in this study included herniated disks, degeneration of the disk, and radiating leg pain. There were primarily 3 factors that were compared between the two groups, namely, 1) ability to return to work; 2) disability (the inability to work), and 3) opiate (narcotic) drug use. Other factors compared included the need for re-operations, complications, and death.

The results showed, in general, those who proceeded with surgery had significantly more problems compared to those who did not have surgery.  For example, only 26% returned to work, compared to 67% returned to work.  The total number of days off work were 1140 vs. 316 days, respectively.  There were 17 vs. 11 deaths, respectively and, 27% of the surgical group required re-operations with a 36% complication rate. Also, there was a 41% increase in the use of narcotic medication with 76% continuing the use after surgery.

Again, there are times when surgery is absolutely the right choice.  Those times include when there is a loss of bladder or bowel control, progressively worsening neurological symptoms in spite of non-surgical care, and of course, unstable fractures, cancer/tumor and infections, but that’s about it! In other words, if you don’t have one of the before mentioned conditions which do require surgery, don’t be too quick to jump at the chance of “getting it fixed” with surgery. As the study suggests, the post-surgical results favor those who elected NOT to have surgery.  Also, when in doubt, don’t trust the opinion of only one surgeon – always get a 2nd or even 3rd opinion.  It is also very important to consider your current level of function or, your ability to do your desired tasks and, unless there is a significant loss in that ability, consider additional time with non-surgical treatment.  The non-surgical treatment you can expect to receive from chiropractic includes (but may not be limited to) spinal manipulation, spinal decompression, exercise training, physical therapy modalities (ice, heat, electrical stimulation, ultrasound, traction, etc.), dietary counseling, and job modification information.

Unfortunately too often patients elect to have surgery without all the answer to make an informed decision.  I hope this helps you.

Blessings,

Dr. Troy Don, DC QME

In 1995, the Quebec Task Force recognized the importance of this distinction and recommended all health care providers concentrate on differentiating the nerve root / herniated disk case from what is called “mechanical low back pain.” As noted in the model below, the arrow and pen point to the two most common structures that cause nerve root pain (the herniated disk) and mechanical low back pain (the facet joint).

The facet joint, when sprained / injured, hurts worse when bending backwards and feels good bending forwards.  This is exactly the opposite for the herniated disk where bending backwards helps reduce pain and often reduces the shooting leg pain as well, while bending over even a little can create a sharp stabling pain in the back that may shoot down the leg. Of course, there are variations of this and, to make matters more complicated, BOTH the disk and the facet can generate pain at the same time, so it’s not always this cut and dry.

Blessings,

Troy Don, DC QME

So here are some exercises that I recommend for keeping the back loose.  I hope to get some more videos up so that I can simply show you the exercises.  In any event… here are 5 great flexibility stretches.

Alternating Knee to Chest
Lie on your back with legs straight. Bring your right leg up placing your hands behind your thigh and pulling with your arms so that your bent knee comes toward your chest.  Hold this for 10 seconds.  Relax the pull for 5 seconds, pull again for 10 seconds. Repeat this 5 times.  Then switch to the left leg.  As this gets easier, maintain the hold for a longer time.

You should feel a stretching in the low back.

Both Knees to Chest
Ly on your back with legs straight.  Bring both legs up placing your hands behind your thighs and pulling with your arms so that your bent knees comes toward your chest.  Hold this for 10 seconds.  Relax the pull for 5 seconds, pull again for 10 seconds. Repeat this 5 times.  Then switch to the left leg.  As this gets easier, maintain the hold for a longer time.

You should feel a stretching in the low back.

Alternating Knee To Opposite Chest
Ly on your back with legs straight. Bring your right leg up placing your hands behind your thigh and pulling with your arms so that your bent knee comes toward the left side of your chest or shoulder.  Hold this for 10 seconds.  Relax the pull for 5 seconds, pull again for 10 seconds. Repeat this 5 times.  Then switch to the left leg.  As this gets easier, maintain the hold for a longer time.

You should feel a stretching in your buttock.

Cat/Cow Stretch
Get on your hands and knees so that your hands are on the floor directly under your shoulders at arms length and your knees are on the floor directly underneath your hips with your knees bent.  Begin to arch your back so that your stomach goes toward the floor and your head rises up and your buttock points up. Hold this position for 2 seconds. Go back to the starting position. Next, curl your back so that your back goes toward the sky, your head and neck relaxes toward the floor and your buttock points down.  Hold this position for 2 seconds.  That’s one rep.  Perform 6 to 10 reps.  Through out this stretch be sure to maintain the position of your hands and knees and to slowly go through the motion.  If you are very stiff, you’ll improve, but slowly, do not force it or get frustrated.

Standing Hamstring Stretch
Standing near a wall or stable furnishing (for support and balance), place the heel of your right leg on a stool or chair.  Bring your toes toward your head and maintain a straight right leg, keeping you head and spine upright (no bending to touch the toes).  Hold for 60 seconds.  Switch to the left leg and repeat.

Notes: If the height of the chair is too much, your stretch will be painful.  Find a lower stool to accommodate.  The stretch should be felt but not painful.

Hamstring stretches can be done many ways.  We recommend this stretch because it is the least risk to the low back.  However, if you cannot stand because of your pain, then seek an alternate position to stretch your hamstrings.  Why are hamstrings important to stretch for patients with low back pain?  If you back is in pain, not only do your back muscles tighten up, but so do you the muscles in the buttock and the back of the legs.  If these muscles are too tight, they will pull your spine in the wrong direction, creating a bigger problem.

This is a great start, but tune in again to see the video versions of these exercises.

Blessings,

Dr. Troy Don, DC QME

So today I decided to walk you though one of the most important “back” exercises you’ll ever do…

The Abdominal Crunch

I know what you are thinking… “how can an abdominal crunch, help my back?”  The answer is simple.  Your abdominal muscles are part of your core muscles.  These are the muscles in an around your waist that support and protect your back.  Weak core leads to weak back.  Weak back means increase chance of back problems.  I told you it was simple.

Here’s the video.  Also, if you have questions, you can simply comment under this blog and then I’ll respond there to your comment or question.

Remember, this exercise is not difficult.  It simply needs to be performed regularly.  Stay tuned for more exercises.

Blessings,

Dr. Troy Don, DC QME

Explore All Options
You have to live knowing that you have tried everything.  If you have not explored some of the things discussed on this website or in our book, those are great places to start looking for help.  If you have, keep looking.  The internet and medical journals are packed full of stuff.  Plus, try a different doctor/chiropractor/therapist.  You don’t give up on yourself when others have failed to help you.  Remember, no one will care more about your health than you.  You are in the driver’s seat, keep driving.

Be Engaged in Your Recovery
When you begin a new treatment or if you are currently in a program of care, get even more engaged.  Engaged does not simply mean showing up, but it starts there.  Ask your doctor questions about what you can do at home.  Be sure of anything they suggest you avoid.  Ask if there is anything you can read to know how to get to your destination faster.  If you are given restriction follow them.  If you are given homework, such as ice, rest, or exercises do them.  Show the doctor that you are doing what you are told and the you are hungry for more.  Be excited about improvements.  And don’t get down with set backs.

You are responsible for getting yourself better.  The doctor does not have to life with it. You do.

During a consultation with a prospective patient, if we see that are looking for us to do everything and are not will to cooperate, we will not accept them as a patient.  And if they show themselves to disengaged, we will terminate their care.  It is that important.

Day Dream and Imagine
As strange as it sounds, it pays to day dream.  Studies show that the brain’s electrical patterns are the same for things that actually are experienced by the body and things that are imagined in vivid detail.  So, start imagining what it will be like when you are feeling better.  Imagine how you will feel.  Imagine how happy your friends and family will be.

Plan on Success – Expect the Best
As fun as it is to imagine or day dream about success, it is another level of mental health to actually on plan it.  Give yourself a dead line.  Plan a vacation that you have been avoiding for that last couple of years.  Consider it a reward for your success.  We know patients’ prognosis is better when they are looking forward to something – a vacation, a child’s wedding, etc.  Reward yourself with a new toy.  Put that carrot out there.

Persevere
Planning is critical, but even more critical is execution of the plan.  Go for it and don’t give up.

Be Thankful
Above all, be thankful for what you have.  Every step of the way.  Even in the middle of the storm. Remember that as bad as you have it, there is someone out there who has got it worse.  Remember that though you have this trial and difficulty, you have hundreds of reasons to be thankful.

I had one patient who was in the military that from his duties and work from the military while in Iraq got a herniated disc of 8 mm that was pinching the nerve in his low back, causing extreme low back pain and debilitating shooting leg pain.  He’s not even 30 years old. And during the examination, as I saw the intense pain he was experiencing and I asked him how he was doing and if he could go on.  I’ll never forget what happened next.  He stopped, looked at me and sincerely smiled and said “I’m doing great!”  Realizing that what he was saying and what his body was expressing were two different things, I said, “What do you mean?” And he said, “I’d rather be here right now, like this… than be in a sandbox getting shot at.” Having a brother who served in Iraq, Afghanistan, Bosnia, and God knows where else, I completely understood what he was talking about. (Peter Don, I love ya bro! And thank you for doing what you do!)

So be thankful, things could always be worse.

Yes, We Know…
Yes, we know that this sounds a little strange at first glance, but these are things that we have observed time and time again.  And if you are bad enough, and if you are willing to approach your severe low back pain with a different attitude, your life will be better. You have absolutely nothing to lose, and you sure would be a lot more pleasant to be around.

Blessings,

Troy Don, DC, QME