Short-Term Care For Your Neck & Back Pain
Low back pain (LBP) occurs all over the world. Between 2004 and 2008, an estimated 2.06 million EPISODES of LBP occurred in the United States (US) alone! Each year, LBP accounts for 3.15% of all emergency visits with 65% of LB injuries occurring at home. According to estimates, two-thirds of all Americans will experience at least one episode of back pain during their lifetime. Interestingly, according to one study, LBP peaks two times during life: between 25-29 years of age and 95-99 years of age, regardless of cause. Looking at gender differences, when analyzed by five year age groups, males aged 10-49 and females aged 65-94 had a greater risk for LBP when compared with the opposite gender. Those with European or African ancestry have significantly higher rates of LBP when compared with those of Asian ancestry. Also, older patients have the greatest risk of hospital admission for LBP.
In order to study the incidence of LBP among active duty US military service members, a 2012 study investigated the US Defense Medical Epidemiology Database and looked at 13,754,261 person-years of data (100 25-year-olds would equal 2,500 person-years, for example). The authors of the study report that women have a 45% higher incidence rate than men, and personnel over age 40 are 1.28 times more likely to experience back pain than those who are 25-29 years old. Looking at single vs. married service members, married personnel have a higher incidence rate (1.21) than non-married personnel, though there is no consensus as to why this is the case. In conclusion, the female gender, age >40 years, and those who are married have the greater risk for LBP in the military.
One study looked at alcohol consumption and the incidence of LBP to see if there was a causal relationship between the two. After searching the literature, no positive link between alcohol consumption and LBP was found. On the other hand, smoking clearly contributes to the incidence of LBP (yet another reason to quit smoking!). One study looked at daily use, number of years smoked, and total cigarette use during the years of smoking in relation to LBP in 29,424 monozygotic (identical) twin pairs where only one of the two twins smoked. Researchers determined how many days in the past year LBP was present (1-7 days, 8-30 days, and >30 days) and age, gender, and size/body mass index for each participant. The results revealed a positive association with smoking and the duration of LBP at 1-7 days (1.4 odds ratio), 8-30 days (2.1), and >30 days (3.0) during the past year.
We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend, or family member requires care for back pain, we would be honored to render our services.

Content Courtesy of Chiro-Trust.org. All Rights Reserved.


Who Gets Low Back Pain?
Low back pain (LBP) is one of the most common reasons patients seek out Chiropractic care, and they appreciate being told what is causing their back pain. This is why doctors gather a careful and complete history from new patients and perform a physical examination. Once the “pain generator” is determined, a doctor can discuss various treatment options and develop a plan for managing the patient. Let’s review some causes of LBP!

If we divide the various conditions into three categories, it significantly improves diagnostic accuracy. These include: 1) Mechanical LBP; 2) Nerve root pain; and 3) “Red Flags” (serious conditions). The most common conditions are those belonging to the first group. The following is a partial list of conditions that belong to each category:

1) Mechanical LBP: Causes of mechanical LBP include Lumbar and sacroiliac (SI) sprains, lumbar muscle strains, facet syndrome, degenerative disk disease (DDD) and/or injury to the disk without nerve pinch, osteoarthritis (this can affect different parts of the spine), spinal instability, spondylolysis and/or spondylolisthesis, and more. The pain pattern is usually localized to the low back and may spread into the buttocks, hips, thighs, but rarely extends past the knee. Usually, there is NO numbness or weakness in the leg or foot because that symptom suggests a spinal nerve pinch.

2) Nerve root pain can result from herniated disk (from either direct nerve pinching and/or chemical irritation inflaming the nerve), central or lateral spinal stenosis (usually caused by a combination of things including DDD), arthritis, and/or calcification of ligaments near the nerve. These can be managed very successfully without surgery but the careful monitoring of numbness, muscle weakness, and treatment satisfaction is important!

3) Red Flags: These are the potentially dangerous conditions such as cancer, fracture, infections, cauda equina syndrome (spinal cord pinch creating bowel and/or bladder weakness). Referred pain from organs may be included here as well. As you can see, these carry potentially lethal consequences and require immediate referral and specialty management.

The majority of patients suffering from LBP fall into the first two categories, and the HISTORY can tell us a lot! If the patient complains of pain that stays mostly in the low back but may spread into the buttocks or thigh without numbness/weakness in the leg and feels better with leaning forwards or curling up in a ball, it probably is a Group 1 (mechanical) diagnosis. If there is numbness, tingling, and/or weakness in the leg to the foot and bending over hurts, it’s most likely disk derangement (bulge, herniated, etc.) with a nerve pinch. If there is unexplained weight loss, a past history of cancer, non-responding LBP to treatment, sleep interruptions, and age >50 years old, we may now be in category three and further tests are needed!

The IMPORTANT point is that spinal manipulation (chiropractic) can manage the most common causes of LBP as a non-surgical, low-risk form of care.

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend, or family member requires care for back pain, we would be honored to render our services.

Content Courtesy of Chiro-Trust.org. All Rights Reserved.
​What's Causing My Back Pain?
Low back pain (LBP) is one of the most common ailments that chiropractors treat. That’s probably because MOST of us will suffer from low back pain that requires outside help at some point in our lives! Posture has long been studied as a potential cause of low back pain, and this month’s topic will take a closer look at some recent research discussing this issue.

A December 2014 study looked at low back posture in two groups of LBP patients and its relationship with problems associated with intervertebral disk diseases. Looking at a person from the side, have you noticed that the low back area has an arched or inward curve? This is called the “lumbar lordosis” (or, the “sway back” area), and this can be highly variable in terms of the angle or amount of arch. It normally differs between males and females. Degenerative disk disease (DDD) is a common condition affecting virtually all of us at some point in time. DDD results in narrowing of the disk spaces, which there are five total in the lumbar spine (twelve in the thoracic spine/mid-back, and six in the cervical spine/neck). One particular study evaluated a group of 50 patients with long-term intractable (chronic) low back pain with intervertebral disk disease and a group of 50 chronic LBP patients without DDD that served as a “control group.” Researchers measured the degrees of lordosis, or amount of curve (lumbar lordosis), by looking at the person from the side using two different methods in the two patient groups and compared the data. The group with degenerative disk disease had an overall reduction in the lumbar lordosis curve (less arched) using both methods of measuring. The authors concluded that the patients with intervertebral disk lesions had a straighter, or more flat curve (less sway back), when compared to those without disk degeneration. What they were unable to determine was which came first, the disk degeneration or the reduction in the lumbar lordosis?

This study points out several important points. When treating patients with low back pain, some patients feel better when placed in a bent forwards position, or they favor a flat low back curve. Others have the opposite response, or their position of preference favors a more curved (arched) lower spine. The reason for this difference is that LBP is generated from different tissues in the low back, and some tissues favor or feel better in one position and typically feels worse in the opposite direction when injured. The intervertebral disks in the spine lie between the vertebral bodies and serve as “shock absorbers” for the spine and trunk. The center, or “nucleus,” of the disk is liquid-like and is usually well contained inside the disk, held by a tough, outer fibrocartilage material (the “annulus”). The disk is approximately 80% water, and as we age, the water content gradually reduces and the disk spaces narrow, thus limiting the mobility of that part of the spine. More importantly, DDD usually narrows the size of the canals through which the spinal cord and nerve roots travel. When we bend forward, these canals open up wider placing less pressure on the nerves and/or spinal cord. This is why we often see elderly people leaning on grocery carts when shopping, as it hurts less and they can walk longer / farther. Those with herniated disks tend to be the opposite, as they favor bending backwards as this position shifts the nucleus or liquid center forwards and away from the nerve root thus reducing the pinched nerve resulting in less or complete elimination of radiating leg pain.

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend, or family member requires care for back pain, we would be honored to render our services.

Content Courtesy of Chiro-Trust.org. All Rights Reserved.


​Back Pain and Posture
What's This Tingling in My Leg?
When you think of low back pain, you may visualize a person half-bent over with their hand on the sore spot of their back. Since many of us have experienced low back pain during our lifetime, we can usually relate to a personal experience and recall how limited we were during the acute phase of our last LBP episode. However, when the symptoms associated with LBP are different, such as tingling or a shooting pain down one leg, it can be both confusing and worrisome – hence the content of this month’s article!

Let’s look at the anatomy of the low back to better understand where these symptoms originate. In the front of the spine (or the part more inside of the body), we have the big vertebral bodies and shock absorbing disks that support about 80% of our weight. At the back of each vertebrae you’ll find the spinous and transverse processes that connect to the muscles and ligaments in the back to the spine. Between the vertebral body and these processes are the tiny boney pieces called the pedicles. The length of the pedicle partially determines the size of the holes where the nerves exit the spine.

When the pedicles are short (commonly a genetic cause), the exiting nerves can be compressed due to the narrowed opening. This is called foraminal spinal stenosis. This compression usually occurs later in life when osteoarthritis and/or degenerative disk disease further crowds these “foramen” where the nerves exit the spine. Similarly, short pedicles can narrow the “central canal” where the spinal cord travels up and down the spine from the brain. Later in life, the combined effects of the narrow canal plus disk bulging, osteoarthritic spurs, and/or thickening or calcification of ligaments can add up to “central spinal stenosis.” The symptoms associated with spinal stenosis (whether it’s foraminal or central) include difficulty walking due to a gradual increase in tingling, heavy, crampy, achy and/or sore feeling in one or both legs. The tingling in the legs associated with spinal stenosis is called “neurogenic claudication” and must be differentiated from “vascular claudication”, which feels similar but is caused from lack of blood flow to the leg(s) as opposed to nerve flow.

At a younger age, tingling in the legs can be caused by either a bulging or herniated lumbar disk or it can be referred pain from a joint – usually a facet or sacroiliac joint. The main difference in symptoms between nerve vs. joint leg tingling symptoms is that nerve pinching from a deranged disk is located in a specific area in the leg such as the inside or outside of the foot. In other words, the tingling can be traced fairly specifically in the leg. Tingling from a joint is often described as a deep, “inside the leg,” generalized achy-tingling that can affect the whole leg and/or foot or it may stop at the knee, but it’s more difficult to describe by the patient as it’s less geographic or specific in its location. Chiropractic management of all these conditions offers a non-invasive, effective form of non-surgical, non-drug care and is the recommended in LBP guidelines as an option when treating these conditions.

We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend, or family member requires care for back pain, we would be honored to render our services.

Content Courtesy of Chiro-Trust.org. All Rights Reserved.

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San Diego, CA 92109
858-869-1949

ChiroTrust
ChiroTrust™ Member Chiropractor
San Diego, CA 92109
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