Lower Back Pain
Research suggests that up to 80% of people will at some point experience back pain. Because of this it is one of the most common reasons for days off work. For some the back pain is due to a specific incident, such as lifting something heavy, which immediately caused an injury and will leave them in pain. However, for a large majority of people it can be an accumulation of everyday stressors which can cause the condition. Things such as
- Poor posture – often when we aren’t thinking about our posture, we tend to adopt a slouched posture[
- Prolonged sitting – very common for many people at work
- Incorrect bending and lifting – how many times have you been told to bend at the knees not the back?
- Sleeping posture – if you are in a twisted position all night, this can cause some stress on your joints
- Prolonged bending such as when gardening can stress the joints and muscles in your lower back
- Limping due to an injury or pain in your leg – will put an uneven stress on your lower back
Your pelvis is the broadest structure in your back. It is the foundation for the rest of your body. If your spine has compensated and moved your centre of gravity away from your pelvis, it may put more stress on the much smaller vertebrae in your spine. This may then lead to greater wear in these areas coping with greater stress than they are designed to bear.
While pain relief and anti-inflammatories may seem to decrease your pain levels, they are simply masking an underlying problem which should be fixed.
More than 50 reviews over the past 40 years have been published evaluating the effectiveness of chiropractic treatment on lower back pain. The conclusions of these reviews have been relatively consistent, with evidence supporting the short term use of chiropractic care for back pain. Chiropractic is effective as it releases tension in the muscles and joints and allows your spine to move freely as it is designed to.
A study by Meade TW et al showed the Chiropractic treatment was more effective than hospital outpatient management mainly for patients with chronic or severe back pain. It proved to have a better long term benefit than what the outpatient management had to offer. Another study by Paul G Shekelle showed that Chiropractic was the therapy of choice for patients with non-complicated acute low back pain.
What can you do to prevent your lower back pain from returning?
- Strengthen your core so that you have more support for your lower back when you try to do heavier tasks
- Have your spine checked by a chiropractor
- Have your work station ergonomically assessed
- Start moving: exercise such as walking and swimming are a great start
- Limit the time you wear high heels
- Maintain proper posture
Neck pain is one of the 2 most common reasons people seek chiropractic treatment. With our current busy lifestyle of more work and less play, no wonder we often find ourselves stiff and sore. A test to see how well your neck is moving is to turn it from side to side. If your nose can reach your shoulder, you have great movement in your neck. If it is painful, tight or feels locked, you may need to see someone to loosen the muscles and free the spinal joints which may be causing you irritation.
Possible causes of neck pain include:
- Poor Posture
- Poor sustained posture- often seen in office workers
- Arthritis or degeneration
- Injury (such as whiplash)
- Sleeping awkwardly or sleeping on a non-supportive pillow
A recent study, Bronfort et al, showed that chiropractic adjustments combined with rehabilitation exercises produced long term pain reduction for chronic neck pain patients. Hoving et al found that the patients receiving chiropractic care had faster relief in symptoms than the other groups.
How can Chiropractic help me?
After a thorough examination Dr Paije will tailor her treatment to what is best for you. Some people will require a combination of gentle chiropractic adjustments, soft tissue treatments, rehabilitation exercises and stretches. She can also provide you with advice on a pillow that is right for you, proper work station arrangements, and postural advice.
Headaches are the third most common reason people seek chiropractic care. This is because the top three segments in your spine (C1-C3) are the nerve supply to muscles, joints and connective tissue in your neck as well as branches supplying the vertex of the skull and occiput (at the base of your head). There are many trigger points in these muscles supplied by C1-3, which can refer into your head from the temporal region, in a heat band distribution, to the vertex of your head and right around to the base.
How do these areas become so tight?
There are a number of things which can cause a headache and they include:
- Over use of your muscles
- Muscle injury (such as whiplash)
- Poor posture (particularly common in those who sit at a desk most of the day)
- Food triggers
- Grinding your teeth
How is a headache treated by the Chiropractor?
Dr Paije uses a variety of techniques which include soft tissue therapy to the tight muscles in the upper cervical region of your neck, mobilisation of the joints and a specific chiropractic adjustment to an area in your neck which may be irritated. This adjustment can be a gentle low-force non-manipulative adjustment if you prefer. She can also give you advice on possible triggering factors for you and help you improve your work station, give postural advice and exercises to help combat this common problem.
Two randomized controlled trials dating back to 1995 showed both chiropractic adjustments and soft tissue treatment were effective in reducing cervicogenic headaches (headaches originating in the neck) in both severity and frequency. Another study in 2001 found that the chiropractic adjustment lead to an almost immediate improvement in symptoms for those suffering from a headache originating in the neck.
What things can you do to help the situation?
- Take a break – if you sit for long periods of time throughout the day, take a break every 30 minutes
- If you are prone to stress you may be grinding or clenching your teeth and you may need to have your jaw looked at
- Drink 2L of water every day
- Have your spine checked by a Chiropractor
There are two common types of migraine headaches. One has an aura associated, the other does not. The aura is often described as zig zag lines or spots in the vision prior to the pain of the headache beginning. Other warning signs include thirst, cravings, feeling tired or depression leading up to the migraine.
Migraines are vascular headaches. The aura occurs during the vasoconstriction phase (where the blood vessels become smaller so less blood can flow through). After this phase the blood vessels dilate. This increases the blood flow to the tissues and causes the strong throbbing headache.
Migraines are often described as throbbing and frequently, but not always, begin on one side of the head. They can last anywhere from 4 to 72 hours and are relieved by resting in a dark room. Some people have other associated symptoms such as
- Nausea and vomiting
- Visual disturbance
- Numbness in parts of the body
- Sensitivity to light and sound
There are many things which can help decrease the frequency and severity of migraine headaches. They include:
- Avoiding Triggers: Often people who suffer migraines know of triggers such as chocolate, oranges, MSG or dairy.
- Exercising regularly
- Reducing stress
- Supplementing the diet with: Magnesium[i], Coenzyme Q10[ii] [iii]and/or Vit B2[iv] (check with your pharmacist if any of these supplements will interfere with your medication)
Many studies have looked at how effective chiropractic treatment is with treating migraines. One study revealed 22% of people receiving chiropractic care had a 90% reduction in migraines. As well as 49% reduction in intensity of migraine when they did have an attack.[v] Another group of researchers reviewed the efficacy of chiropractic treatment across 9 separate studies. They found that chiropractic treatment was as effective as medications in prevention of migraines and tension headaches.[vi]
[i] Trauninger A, Pfund Z, Koszegi T, Czopf J. Oral magnesium load test in patients with migraine. Headache. 2002;42(2):114-119
[ii] Rozen TD, Oshinsky ML, Gebeline CA, et al. Open label trial of coenzyme Q10 as a migraine preventive. Cephalalgia. 2002;22:137-41.
[iii] Sandor PS, Di Clemente L, Coppola G, et al. Efficacy of coenzyme Q10 in migraine prophylaxis: A randomized controlled trial. Neurology. 2005;64:713-5.
[iv] Boehnke C, Reuter U, Flach U, et al. High-dose riboflavin treatment is efficacious in migraine prophylaxis: an open study in a tertiary care centre. Eur J Neurol. 2004;11:475-7.
[v] Tuchin PJ, Pollard H, Bonello R. A randomized controlled trial of spinal manipulative therapy for migraine. J Manipulative Physiol Ther. 2000;23(2):91-95.
[vi] Astin JA., Ernst E. The effectiveness of spinal manipulation for the treatment of headache disorders: a systematic review of randomized clinical trials. Cephalagia. 2002;22(8):617-623.
Bronfort G, Assendelft WJ, Evans R, Haas M, Bouter L. Efficacy of spinal manipulation for chronic headache: a systematic review. J Manipulative Physiol Ther. 2001;24(7):457-466.
Dagenais S. Haldeman S. Chiropractic. Prim Care. 2002;29(2):419-437.
Mauskop A. Alternative therapies in headache. Is there a role? [Review] Med Clin North Am. 2001;85(4):1077-1084.
Stress can be good for you in small doses. However, in our busy modern lifestyle full of deadlines the constant flight/fight reaction can be detrimental to your health. Stress is one of the body’s protective mechanisms inbuilt to keep you energetic and alert in the case of an emergency. It is important to deal with stress as it can show in many different ways affecting your mind body and behaviour.
Some signs and symptoms of too much stress include:
- Memory problems
- Poor concentration
- Poor judgement
- Feeling lonely or isolated
- Eating more or less
- Using alcohol, cigarettes or drugs to relax
Some physical signs and symptoms include
- Aches and Pains due to prolonged muscle tension (back, neck, jaw etc)
- Nausea or dizziness
- Chest pain or rapid heart beat
- Low immunity – frequent colds
- Loss of sex drive
- Skin conditions such as eczema
- Heart disease
Your body responds the same to physical and emotional stress. Chronic stress can be detrimental to your health. It can raise blood pressure, lower immunity, contribute to infertility, and speed up the aging process.
How to deal with stress:
- Visit your chiropractor: Stress can cause a build-up of tension in your muscles as well as nerve irritation. A chiropractor will often work on the soft tissue structures to increase circulation and to release tension. The adjustment will release endorphins[i][ii] which calm the nervous system as well as increasing blood circulation[iii]. In many cases this will switch off the constant flight/fight response in the brain, alleviating stress.
- Be organised, write lists. These may help with time management
- Exercise: physical activity can reduce tension in your muscles
- Relaxation exercises: yoga or breathing techniques can be helpful to release tension
- Communicate: Talk to someone about your struggles
- Spend time with positive people
- Eat healthy: it helps your body cope with stress better
- Reduce caffeine and sugar: they will give you a temporary high and a crash in mood and energy will follow
[i] Vernon HT, Dhami MS, Howley TP, Annett R. Spinal manipulation and beta-endorphin: a controlled study of the effect of a spinal manipulation on plasma beta-endorphin levels in normal males. J Man Phyiol Ther. 1986
[ii] Cassidy JD, Lopes AA, et al: The immediate effect of manipulation versus mobilisation on pain and range of motion in the cervical spine; a pilot study. J Manip Physiol ther, 1992; 15:495-500
[iii] Harris W, Wagnon RJ: The effects of chiropractic adjustments on distal skin temperature. J Manip Physiol Ther 1987; 10:57-60
Many elite sporting people seek chiropractic care. Why is chiropractic popular in athletes? Athletes use chiropractic because they know the importance of having all your body systems working together as best they can. Chiropractic helps improve and enhance athletic performance and prevents minor injuries from becoming major ones.[iii]
In one study a group of 50 athletes were divided into 2 groups. One received chiropractic care, the other did not. They were tested on balance, agility, power, speed and reaction time. After 12 weeks the chiropractic group had an overall improvement of 16.7%, their reaction time scoring the highest level of improvement of 30%. [i]
Another study involved 16 injured female long distance runners placed under chiropractic care. The recovery time was reported to be quicker than expected and 7 recorded “personal best” performances following the treatment plan. [ii]
By enabling your joints to move optimally, your chiropractor is able to relieve stress on your muscles, ligaments, tendons and nerves. Many sports cause a jarring effect on several joints of the body, particularly the spine. Dr Paije has been involved with sporting clubs, particularly football clubs, over the past 10 years and will often look for possible causes of recurrent issues in sports people, making sure the body is functioning at its optimum.
Many children also participate in activity. Usually their driving factor is simply fun. But there are some other considerations for encouraging your children to participate in active games.
- It may increase their confidence
- Alleviate boredom
- Increase and encourage socialisation
- Produce further life goals
- Increase their health (often not high on a child’s list of reasons)
- Increase co-ordination
- Get rid of some energy (energy in vs energy out)
A common problem in the child is the effect physical growth has when combined with exercise. There is a difference in the growth of the muscles compared to the skeleton, with the muscles lagging behind. During growth spurts children will often feel tighter in their muscles, particularly around the long bones as seen in the legs. This may make the child more susceptible to on overuse injury.
[i] Lauro BM. Chiropractic effects on athletic ability. Chiropractic: The Journal of Chiropractic Research and Clinical Investigations. 1991;6(4):84-87
[ii] Grimston SK, Engsberg JR, Shaw L & Vetane NW. Rehabilitation prescribed in coordination with prior chiropractic therapy as a treatment for Sacroiliac Subluxation in female distance runners. Chiropractic Sports Medicine. 1990; 4: 2-9
[iii] Halderman S. Spinal Manipulative therapy in Sports Medicine. Clinics in Sports medicine. 1986; 5:277
Aging and Arthritis
Dr Paije tailors the treatment to the needs of her patients. Often people in this category will require a much gentler approach to treatment and Dr Paije will often use a combination of soft tissue treatment and activator low force non-manipulative treatment to improve joint movement.
Spinal pain is a significant musculoskeletal problem among older patients[vi], and can also be the result of osteoarthritis. Studies show that chiropractic care may play an important role in the management of patients with spinal and peripheral joint (musculoskeletal) pain and associated joint dysfunction.[vii] Pain-related to musculoskeletal dysfunction can have an influence on balance, walking and the ability to achieve daily activities, and therefore may contribute to an individual’s risk of falling. There is considerable evidence showing the positive effects of Chiropractic care for spine-related pain.[viii] Studies also suggests a possible positive effect of Chiropractic care on some types of vertigo. There is limited, although promising, evidence that manual therapies may be beneficial for vertigo of cervicogenic origin.[i] [ii] [iii] [iv] [v] (vertigo originating from the neck).
Chiropractic treatment and advice is a safe, health-effective, and cost–effective way to treat many musculoskeletal conditions.[ix] Chiropractic also has a high patient satisfaction rate among its patients.[x] Due to the nature of chiropractic, the combination of hands-on manipulative treatment often builds a strong practitioner–patient relationship in which appropriate health and lifestyle recommendations can be discussed in a comfortable, supportive, and effective way.[xi]Advice on diet and exercises to improve balance, mobility and function can also be discussed openly between patient and practitioner.
[i] Hawk C, Cambron JA: Chiropractic care for older adults: effects on balance, dizziness and chronic pain. J Manipulative Physiol Ther 2009, 32:438-447
[ii] Hawk C, Cambron JA, Pfefer MT: Pilot study of the effect of a limited and extended course of chiropractic care on balance, chronic pain, and dizziness in older adults. J Manipulative Physiol Ther 2009, 32:438-447
[iii] Hawk C, Khorsan R, Lisi AJ, Ferrance RJ, Evans MW: Chiropractic care for nonmusculoskeletal conditions: a systematic review with implications for whole systems research. J Altern Complement Med 2007, 13:491-512
[iv] Reid SA, Rivett DA: Manual therapy treatment of cervicogenic dizziness: a systematic review. Man Ther 2005, 10:4-13
[v] Hawk C, Pfefer M, Strunk R, Ramcharan M, Uhl N: Feasibility study of short-term effects of chiropractic manipulation on older adults with impaired balance. J Chiropr Med 2007, 6:121-131
[vi] Weiner DK, Sakamoto S, Perera S, Breuer P: Chronic low back pain in older adults: prevalence, reliability, and validity of physical examination findings. J Am Geriatr Soc 2006, 54:11-20
[vii] Bokarius AV, Bokarius V: Evidence-based review of manual therapy efficacy in treatment of chronic musculoskeletal pain. Pain Pract 2010, 10:451-458
[viii] Bronfort G, Haas M, Evans R, Leiniger B, Triano J: Effectiveness of manual therapies: the UK evidence report. Chiropr Osteopat 2010, 18:3
[ix] Carey T., Garret J., Jackman A. (1995). The outcomes and costs of care for acute low back pain among patients seen by their primary care practitioners, chiropractors and orthopaedic surgeons. N. Engl. J. Med. 333, 913–917. doi: 10.1056/NEJM199510053331406.
[x] Smith M., Stano M. (1996). Cost and recurrences of chiropractic and medical episodes of low back care. J. Manipulative Physiol. Ther. 20, 5–12.
[xi] Hunnisett A. Cunliffe C. (2012). Chiropractic Care as Primary Care Intervention for Better Muscluloskeletal Health in the Aging Population in the United Kingdom. An Opinion and Positioning paper. Front Physiol 3:87
Muscle Spasms and Trigger Points
Trigger points are known areas which spasm within a muscle. These tight spots may also be known as knots in your muscles. When pressed they can be very tender and may even refer pain to other areas of the body. They can even mimic symptoms of more serious conditions such as Sciatica and can also be the cause of some headaches. The cause of trigger point formation is unknown but it may be overuse, stress, poor posture, or injury that can make them worse. If there is dysfunction in your muscles they will often test weak when specifically tested.
Muscle spasms can happen either to protect your body from further injury or it may happen in the form of a cramping sensation if you are low in magnesium. Magnesium is an important tissue salt which helps your muscles function. If you are prone to sweating and experience cramps or wrestles legs, it is possible your body may be low in magnesium. Back in Balance offers magnesium and also a range of practitioner standard supplements.
Back in Balance Chiropractic is now offering Dry Needling.
What is dry needling and how does it work?
Dry Needling is similar to acupuncture but instead of using meridians to find the points, the needles are inserted into myofascial trigger points. When the fine needle is inserted, it sends injury signals to the brain so that the body replaces the injured tissue with new healthy tissue. When the needle is inserted it often causes a twitch response. This twitch causes the muscle fibres to relax, inflammation is reduced and circulation is improved. As a result it is very useful for treating muscle and tendon conditions.
What can you do to help your condition?
- Dry Needling