The Quick Fix: The "Magic Pill" How come it takes me so long to get better?

"How come this is taking so long to get better."  Its a question I get asked all the time.

I realize that sometimes it is difficult to understand because we cannot "see" what the problem really is. 

This is common for back and neck pain.  The pain generator is generally something you cannot see.  For example, the joints may have become restricted, or there may be a mild muscle strain.  You feel SUBJECTIVE (what you feel) symptoms such as tightness, ache, pinching, stabbing.  However, you cannot OBJECTIVELY (what you can see or measure) determine the cause of the pain (and this is where people google their symptoms and come up with a hilarious number of possible causes!) 

I like to describe it in a way that most people would understand:

Imagine you cut your finger.  If it is a small cut, self care may be an option, but it does require care and (depending on the size of the cut) time to heal.  It will not heal overnight.

If you were to cut your finger with a larger cut, you would likely seek a professional to help (ie. may need stitches.)  This would require close (acute) care for several days to weeks (depending on the size of the cut) with numerous follow up visits to ensure that healing continues on the correct path.  

There are numerous factors involved in healing of the cut, as well as healing of the things that you cannot see.  Some of the aggravating factors can include work and daily activities, sleep and nutritional status. 

So unfortunately with injury, there is no "Magic Pill"  However, if you do take good care of yourself (and with a bit of treatment) injuries will improve much more quickly.  

 

Low Back Pain 101: The Mechanics of Low Back Pain

Most of us will have suffered some type of low back pain in our life time, no matter how old you are (if you haven't I'd love to hear from you and find out what your secret is!) 

Not all low back pain is the same, but I do see some presentations of low back pain that are very common.  Here is one of the more common types of low back pain that I see:

PATIENT DESCRIBES:
-sometimes insidious (not sure how it happened) or felt something "pinch" deep in their low back
-most likely mechanism of injury is flexion or bending the back (ie. picking up something off the floor)
-described as dull/achy constant pain, with intermittent episodes of sharp stabbing pain with sudden movement
-usually worse in the morning and feels very stiff getting out of bed
-hard to put on shoes and socks on in the morning, but easier taking them off at the end of the day
-usually feels better with movement
-worse in prolonged positions such as sitting (particularly in flexion) or standing
-feels like it is "deep" or on my spine, but feels like a pulled muscle
-no pain going down leg(s) but ache into buttocks 

WHAT IS IT???

When a patient presents with these symptoms, and all other sinister causes of low back pain have been ruled out, I diagnose these patients with what I call "discogenic" low back pain.  Sometimes it freaks patients out to hear that a disc is involved.  They usually think the worst such as a herniated or bulging disc, but it isn't quite the case.

For me, discogenic pain means that the disc it self is the cause of the pain (here is where some of my colleagues would disagree with me, but I could settle my argument in another forum with them).  When I describe to patients what this type of pain is, I explain it as if the disc was "bruised."

REASONS FOR SYMPTOMS:

When the disc gets "bruised" it causes the deep/achy pain in the low back because that is where the disc is located.  Most people feel that their back gets "tight" because surrounding musculature will "brace" to help to prevent movement and pain.  The sharp/stab with sudden movement can be explained when the tissue around the disc gets pinched between the vertebrae with a rapid movement (especially sneezing or coughing.)

The difficult one for people to understand is why it typically feels worse in the morning.  Disc are made up of collagen.  Collagen is what is called hydrophilic (which means water loving.)  The discs will absorb water over night when they are non weight bearing and tend to swell or become superhydrated.  This is why we are taller in the morning (before we stand up and squeeze some of the fluid out.)  This is similar to a dish sponge that you add water to.  You can see the dish sponge increase in size.   After a few minutes of walking around, it squishes some of the fluid out of the discs and "normalizes" the size of the discs and makes it easier to move. 

WHY DOES IT TAKE SO LONG TO GET BETTER?

I try to explain this to patients that "bruises" take time to heal.  Depending on how bad the bruise is, it may take longer to heal.  If the "bruise" becomes reaggravated it may take a bit longer to heal.  Unfortunately it can take days to weeks to get better.

WHAT SHOULD I DO WHEN THIS HAPPENS?

Discogenic pain may subside on its own.  However, I always recommend a course of treatment as I have had a ton of success getting people back on track much faster than if you let it run its course.  

The ONE Thing that would STOP BACK PAIN and DEGENERATION

Yes, this is a bold statement, but hear me out for a second. 

Our spines are essentially a long, flexible rod.  The vertebrae are designed to withstand forces through the spine, and the discs between them allow for movement and mobility.  This is wonderful for us because it offers us the ability to tie our shoes, brush our teeth, pick up things off the ground, etc.  However, most of us abuse our privilege by spending too much time bending (even sitting), lifting and twisting.  Over years this abuse contributes to degeneration in our spine (usually after the age of 20-25 years old). You can also suffer back pain from the "blow up" or the bad lift/bend.    

The ONE thing that would STOP BACK PAIN and DEGENERATION is simple:

DO NOT BEND YOUR BACK

Now, I never said that this would be reasonable, but it is an answer to the problem.

Imagine our back was a long steel rod instead of the flexible one we have.  It would be near impossible to degenerate (or may take years of severe abuse) before the rod would break.   Of course this scenario is unreasonable because it would be impossible to bend to tie our shoes, pick up items off the ground, and would likely cause degeneration of other joints in the body due to changing movement patterns. 

If you have ever talked to someone who has had spinal fusion surgery (usually done to relieve back pain and neurological symptoms), it is impossible to have degeneration at that segment (however, the segments above and below usually take more abuse in an attempt to pick of the slack for the lack of movement at the fused segment). The same occurs with someone who has had such bad degeneration that the segments fuse themselves.  It takes many years and most suffer a fair bit of pain as the degenerative process takes place, but pain tends to resolve over the long term as the segments fuse and stabilize (this is the same as surgery, but free!) 

The morale of the story is that if you can minimize bending of the back, you will decrease the degenerative process, and minimize the likelihood of back pain. 

Healthy Holiday Tips!

As 2014 comes to a close, you can expect a number of people with resolutions for the New Year.  Here are some health tips you can focus on:

1.  Focus on GOOD MOVEMENT

There are tons of training techniques and exercises with too narrow a focus (ie. biceps curl.)  Think more about the types of things you are doing in life and use those as your training tools.  Practicing good lifting, carrying, pushing and pulling will help guide your program for the New Year!

2. Always keep practicing

Some people do the same exercise program and find that they get bored after a while with the same exercises.  If you find you are bored of the same exercises, focus on improving technique, tweak a few things with these exercises and you will find it will improve your performance.  In my program, I am always looking to improve my pull ups, my squats, my deadlifts.  I know when I do a bad rep and when I do a great rep. 

3. Have a bit of fun with your exercise

No need to go to the gym and be intimidated by all the fancy equipment and all the people there.  No need to rely on an expensive machine that limits you to one defined movement.  You can use stairs, dumbbells, kettlebells, weighted vests, or even just using your own body weight.  This equipment (or lack of it) gives you more freedom to do thing that you would do in sport or for your daily activities.  If the gym isn't for you, try an exercise class, or yoga, or swimming.  Do something active with friends.  Whatever you choose, make sure you are enjoying it! 

4. Try something you aren't good at

Its always good to try something new.  How will you know whether you like it or not if you don't try it?  It can be scary trying something new, but once you take the first step the rest of the journey gets a lot shorter!

5. Take care of yourself

Everyone gets busy, but make sure you are taking time to take care of yourself.  Whether it is chiropractic, massage, acupuncture, or meditation, make sure you are taking some time for yourself through the year.  It is really a small investment in time and money that will have a huge impact on your future and your ability to remain healthy.


All the best for the holiday season! Looking forward to 2015!

The Crowbar Effect and Low Back Pain

Sometimes I like going back through some of the research articles I have previously read.  I find that I can always refresh or learn something new/again from many of these articles.

One of my favorite articles explains a "Crowbar Effect" that occurs in the low back with slouching.  This is exactly what most people experience when they sit! 

When we sit in a slouched position, the pelvis rotates posterior (hips roll backwards) and spine moves forward as we lose the lumbar curvature in the back.  As the curvature is reduced, the back stiffens and is akin to a "bar."  Ligaments that attach from the spine to the pelvis act as a fulcrum around L5 causing the proposed "Crowbar" effect.



They also propose that two conditions must be fulfilled for the crowbar effect to occur:

1.  Loss of lumbar lordosis (lumbar curvature)

2.  Body weight placed behind the ischial tuberosities (those bony bumps you sit on).

If you look at figure 4 in the article, it has some great diagrams to show "good" and "bad" sittinng.

If you work at a desk job, or you happen to do a lot of driving (sitting) this article pertains to you! 

The article can be viewed for free here

3 Exercises You Should be Doing Every Day to Improve Your Health

These are my 3 exercises to improve or maintain your health

1.  "Shoulder Blades in back pockets"  

Most people tell you to "sit up straight" or "stand up straight" by sticking your chest out and putting your shoulders back.  The problem with this is that most people tend to over-correct and reduce or minimize the curve in their thoracic spine (mid back).  In fact, if you have "pinched your shoulder blades together" you can sometimes feel stiffness or pinching in the mid back. 

I prefer showing people to slide their shoulder blades towards their back pocket.  Like magic, their shoulder blades flush against their rib cage (reducing scapular winging), and their mid back slouching automatically becomes corrected.  Most people even notice the curve in their neck becomes more normal with this exercise. 

2. "Pick up something off the ground"  ie. Deadlift

When most people pick stuff up off the ground, they tend to do so by bending the back (typically forward flexion of the lumbar spine). 

I aim to show people how to minimize bending of the back and maximize bending of the hip.  The hips are an ideal joint to use as they have a tremendous range of motion.  They also have large muscles (glutes) attached to them which are much more efficient at lifting (heavy) items as opposed to the low back muscles. 

3.  Deep Squat

Deep Squatting is very important for maintaining range of motion as we age.  You don't have to lift heavy weights to go into a deep squat (although if you are weight training, it is good to develop strength through full range.)  For range of motion (particularly the hip joint), if we don't use it, we can lose it.  This is a great way to defend against arthritis of the hip.  Cartilage in the hip (and the rest of the body) does not have a blood supply and thus needs to be "squished" to bring fluid/nutrients into and out of it.  For this to happen, we need to put joints through full ranges of motion. 

The Simple Cure for "Text Neck"

There has been an explosion over the topic "Text Neck."  There is a (scientific?) article that stated that people who text are at risk for putting their neck under undue stress.  This model crunches numbers and states that every inch we move our heads forward we put increasing force through our neck. 

The good news!  There is a simple cure!  Move your head and neck (and don't text for hours!) No need to sit up straight, keep your shoulders back, keep your eyes level.   JUST MOVE!  Don't be one position for a prolonged period of time!I have no doubt that the text neck posture does put some increased stress through cervical facets (the joints in your neck).  The cervical facets are angled like shingles on a roof.  When our neck is bent forward (such as reading a book, or when staring at a computer for hours, which is probably worse than texting) the joints get compressed.  Over a significant amount of time, this may cause degenerative conditions through the cervical spine. 


I would agree that the text neck posture is not a good position for your neck to be in, and if you minimize the time your neck is bent forward, it will reduce forces through your neck.  I think people are more at risk for other serious issues with texting such as texting and driving, or not paying attention to where you are walking while texting.

Please don't text and drive!