Prevention of Low Back Pain

There are a number of things that each of us can do to help prevent episodes of low back pain.  Here is a basic list that can keep your back healthy.

1. Increase your core stability.  Strengthen the muscles of your trunk to keep your spine and body stable.  Benefits include better posture, a balanced body, more efficient and powerful movement, and less likelihood of  becoming injured.
2. Follow an exercise program that includes aerobic conditioning and strengthening exercises.
3. Maintain good posture when standing or sitting.
4. Monitor your sleeping position.  Don't sleep on your stomach, use a pillow between your legs or under your knees if you sleep on your side or back.
5. Maintain a healthy weight.
6. Lift properly.
7. Quit smoking.

Schubbe Resch's Six Weeks to Wellness Program was designed to meet the specific health and wellness needs of our patients.  We can design a program just for you to help you prevent back pain and keep exercising.  Talk to one of our chiropractors if you are interested.

Six Weeks To Wellness

Are you suffering from back, neck, or other musculoskeletal pain that is preventing you from meeting your fitness goals?  Are you missing workouts because of pain?  Have you been told to stop running or exercising because of your pain?  If so, we think we have the program for you - Six Weeks To Wellness.


This program is designed to offer our patients a comprehensive program of chiropractic adjustments and therapeutic exercise designed specifically for them.  The program typically lasts six weeks and includes 2 chiropractic visits and 2 hour long exercise therapy visits per week. The chiropractic portion of the program will focus on manipulation, while the therapeutic exercise portion of the program will focus on the patient’s physical fitness concerns.

Six Weeks to Wellness asks for a commitment from the patient for the 6 weeks. The program addresses the patient as a whole rather than focusing on a specific body part as is common with regular physical therapy.  If you have an injury, we'll work with you to make your injury better, but also to keep the rest of your body healthy while you heal. This program works really well for patients with chronic conditions that cannot get into an exercise program on their own, as well as patients recovering from a specific injury.  The goal is to keep exercising while also respecting and treating the patient's pain  The combination of the chiropractic and the specific exercises allows patients to get healthy faster and stay healthy.

Patients will have a  flexibility and strength assessment performed by our therapists to  determine areas of weakness and instability.  A customized exercise program will then be determined with 3-4 exercises for each area of concern.

Reassessments will be performed midway through and at the
end of the program so patients can see their progress.  Many patients lose weight, and everyone feels better when the program is finished.  If you think you may benefit from our Six Weeks to Wellness, talk to one of our chiropractors!

Low Back Pain Symptoms and Causes

There is a difference between low back pain symptoms and causes.  While the symptoms may be similar, the causes can be varied.  That is why it is important to consult with a medical specialist if you are experiencing low back pain symptoms.

Common low back pain symptoms are as follows:

• Pain in the low back
• Pain that radiates down the front, side or back of the leg
• Pain that worsens with activity
• Pain that increases overnight or with prolonged sitting
• Numbness or weakness in the leg
• Inability to stand on toes or flex foot downward
• Inability to raise the big toe

So what might be causing these symptom?  Common low back pain causes may be as follows:

• Abnormalities of organs in the abdomen, pelvis, or chest such as appendicitis, kidney disease or infection, or bladder infection
• Nerve root syndromes such as herniated disc, sciatica, spondylosis, or disc degeneration
• Musculoskeletal pain syndromes such as myofacial pain or fibromyalgia
• Bone infections
• Tumors
• Shingles

Obviously your back pain symptoms can be from a variety of causes.  Your chiropractor is qualified to diagnose the cause of your back pain and either treat you or refer you to other medical providers.

Sitting At The Computer

From the June 2011 Chiropractic Journal

Millions of people work with computers everyday.  This article explains simple, inexpensive principles that will help you create a safe and comfortable computer workstation.  There is no single "correct" posture or arrangement of components that will fit everyone.  However, there are basic design goals to consider when setting up a computer workstation or performing computer related tasks.

To understand the best way to set up a computer workstation, it is helpful to understand the concept of neutral body positioning.  This is a comfortable working posture in which your joints are naturally aligned.  Working with the body in a neutral position reduces strain and stress on the muscles, tendons, and skeletal system and reduces your risk of developing a musculoskeletal disorder (MSD).  the following are important considerations when attempting to maintain neutral body postures while working at the computer workstation.

• Hands, wrists, and forearms are straight, in-line, and roughly parallel to the floor.
• Head is level, or bent slightly forward, forward facing, and balanced.  Generally it is in-line with the torso.
• Shoulders are relaxed and upper arms hang normally at the side of the body.
• Elbows stay in close to the body and are bent between 90 and 120 degrees.
• Feet are fully supported by the floor or a footrest may be used if the desk height is not adjustable.
• Back is fully supported with appropriate lumbar support when sitting vertical or leaning back slightly.
• Thighs and hips are supported by a well-padded seat and generally parallel to the floor.

Regardless of how good your working posture is, working in the same position or sitting still for prolonged periods isn't healthy.  You should change your working position frequently throughout the day by:

1. making small adjustments to your chair or backrest;
2. stretching your fingers, hands, arms, and torso;
3. standing and  walking around for a few minutes periodically.

If you would like more help in determining how to set up your computer workstation, please ask one of our chiropractors or physical therapists.

Understanding Idiopathic Scoliosis

The term scoliosis is used to describe a condition, which represents an abnormal curvature of the spine, but it is not a disease or a diagnosis. Scoliosis can be caused by congenital, developmental or degenerative problems, but most cases of scoliosis actually have no known cause, and this is known as idiopathic scoliosis.

Scoliosis usually develops in the thoracic spine (upper back) or the thoraco-lumbar area of the spine, which is between the thoracic spine and lumbar spine (lower back). It may also occur just in the lower back. The curvature of the spine from scoliosis may develop as a single curve (shaped like the letter C) or as two curves (shaped like the letter S).

While there are many forms of scoliosis, four of the most common ones include:

• Congenital scoliosis. This is a relatively rare form of congenital malformation of the spine. These patients will often develop scoliotic deformities in their infancy.
• Neuromuscular scoliosis. This may occur when the spine curves to the side due to weakness of the spinal muscles or neurologic problems.  This form of scoliosis is especially common for individuals who cannot walk due to their underlying neurolomuscular condition (such as muscular dystrophy or cerebral palsy).  This may also be called myopathic scoliosis.
• Degenerative scoliosis. Scoliosis can also develop later in life, as joints in the spine degenerate and create a bend in the back. This condition is sometimes called adult scoliosis.
• Idiopathic scoliosis. By far the most common form of scoliosis is idiopathic scoliosis, which most often develops in adolescents and typically progresses during the adolescent growth spurt.  Because it most often occurs during adolescence, this condition is sometimes called adolescent scoliosis.

Idiopathic scoliosis

This is by far the most prevalent form of scoliosis and occurs to some degree in approximately one half million adolescents in the US. There is no known cause of idiopathic scoliosis (“idiopathic” refers to a disease or condition or unknown origin) although it does tend to occur in families.
Idiopathic scoliosis is usually categorized into three age groups:

• From birth to 3 years old - called infantile scoliosis.
• From 3 to 9 years old - called juvenile scoliosis.
• From 10 to 18 years old – called adolescent scoliosis.

This last category, from 10 to 18 years old, comprises approximately 80 percent of all cases of idiopathic scoliosis.

The risk of curvature progression is increased during puberty, when the growth rate of the body is the fastest.  Scoliosis with significant curvature of the spine is much more prevalent in girls than in boys, and girls are eight times more likely to need treatment for scoliosis, because they tend to have curves that are much more likely to progress. Still, the majority of all cases of scoliosis do not require treatment.

It is important to note that idiopathic scoliosis results in spinal deformity, and is not typically a cause of back pain. Of course, people with scoliosis can develop back pain, just as most of the adult population can develop back pain. However, it has never been found that people with idiopathic scoliosis are any more likely to develop back pain than the rest of the population.

Symptoms and diagnosis of idiopathic scoliosis

People with a family history of spinal deformity are at greater risk for developing scoliosis. Early detection is essential.

There are several common physical symptoms that may indicate scoliosis. Any type of back pain is not usually considered a scoliosis symptom. Most typically, symptoms of scoliosis may include one or several of the following:

• One shoulder is higher than the other
• One shoulder blade sticks out more than the other
• One side of the rib cage appears higher than the other
• One hip appears higher or more prominent than the other
• The waist appears uneven

Frequently, a scoliosis curve in the spine is first diagnosed in school exams or in a regular check up with a pediatrician. Most students are given the Adam’s forward bend test routinely in school to determine whether or not they may have scoliosis. The test involves the student bending forward with arms stretched downward toward the floor and knees straight, while being observed by a healthcare professional. This angle most clearly shows any asymmetry in the spine and/or trunk of the adolescent’s body.

Because a scoliosis curvature is usually in the thoracic or thoracolumbar spine (upper back or mid back), if a rib hump or asymetry of the lumbar spine is found, or if the shoulders are different heights, it is possible that the patient has scoliosis. If this is the case, follow-up with a physician for a clinical evaluation and an x-ray is the next step.

• Physician’s exam. The clinical evaluation with the physician will usually include a physical exam, during which the physician will also test to make sure that there are no neurological deficits, which are uncommon but necessary to check for.
• X-ray. The x-ray is ordered to both confirm the diagnosis and check on the magnitude of the curvature. The x-ray will also give some indication as to the skeletal maturity of the patient.

In rare instances a physician may also request an MRI scan of the thoracic and/or cervical spine. If there are any neurological deficits that would indicate impingement of the spinal cord (e.g. hyperactive reflexes), if there is a left-sided thoracic curvature (they are almost always right sided), or if the child is very young (8 to 11 years old), an MRI scan is advisable to examine the possibility of an intracanal spinal lesion, which can cause scoliosis.

Depending on the results of the physician’s clinical evaluation and the diagnostic tests, a treatment plan will be recommended that may include observation, bracing, or possibly surgery.

Non-surgical treatment options for idiopathic scoliosis

Treatment decisions are primarily based on the skeletal maturity of the patient (or rather, how much more growth can be expected) as well as the degree of curvature. The cause of idiopathic scoliosis is unknown (idiopathic literally means "cause unknown"), but the way curves behave is fairly well understood. The younger the patient and the bigger the curve, the more likely the curve is to progress.

There are essentially three treatment options for adolescents with scoliosis: observation, bracing, and scoliosis surgery. There have been large trials of other forms of treatments, none of which have been shown to be effective. Electrical stimulation, physical therapy, chiropractic manipulation, osteopathic manipulation, or other manual treatments have not been shown to reduce the curvature or to prevent progression.

There is no reason to require a child to modify their activities, such as wearing their book bag on one shoulder or another, or to limit their activities, since activity does not affect the curve.

Because idiopathic scoliosis is considered a deformity, scoliosis treatment is largely centered on reducing or limiting the progression of the deformity and is not focused on treatment of pain.

Observation

The curvature is measured on x-rays by what is known as the Cobb method, and this form of measurement is accurate to within 3 to 5 degrees.

Curves that are less than 10 degrees are not considered to even represent scoliosis but rather spinal asymmetry. These types of curves are extremely unlikely to progress and generally do not need any treatment. If the child is very young and physically immature, then the progress of the curve can be followed during the child's regular check up with his or her pediatrician. If the curve is noticed to progress beyond 20 degrees, then the child should be referred to an orthopedic surgeon for continued treatment.

Curves that are between 20 to 30 degrees in a growing child can be observed at 4 to 6 month intervals. Any progression that is less than 5 degrees is not considered significant. If the curve progresses more than 5 degrees, then the curve will need treatment. Any curve over 30 degrees in a skeletally immature patient (child who is still growing) will need treatment.

Treatment for patients with progressing curves, or curves over 30 degrees in a skeletally immature patient, is usually centered on use of a back brace.

Back braces

Bracing is designed to stop the progression of the spinal curve, but it does not reduce the amount of angulation already present. The majority of curve progression happens during a child's growth phase, and once the growth has ended, there is little likelihood of progression of a curve. Therefore, bracing is continued until the child is skeletally mature and finished growing.

The only curves that tend to continue to progress after skeletal maturity are those that are greater than 50 degrees in angulation, so the treatment objective is to try to get the child into adulthood with less than a 50 degree curvature.

There are two types of commonly used scoliosis braces: a thoracolumbar sacral orthosis (TLSO) and a Charleston bending brace.

• The TLSO is a custom molded back brace that applies three-point pressure to the curvature to prevent its progression. It can be worn under loose fitting clothing, and is usually worn 23 hours a day. It can be taken off to swim or to play sports.
• A Charleston bending back brace applies more pressure and bends the child against the curve. It is worn only at night while the child is asleep.

Since bracing only works to stop the progression of the curvature in a growing child, it is not used for those children who are already skeletally mature or almost mature. It is only used for younger children (girls who are about 11 to 13 years old, and boys who are about 12 to 14 years). If an older child has a curve greater than 30 degrees and is almost mature, his or her curvature will be treated with observation only, as there is little growth left and bracing will be unlikely to do much good.

Unfortunately, even with appropriate bracing, some spinal curves will continue to progress. For these cases, especially if the child is very young, bracing may still be continued to allow the child to grow before fusing the spine. Many times it is very difficult to predict which curves will continue to progress and need surgery later, especially if the child is young and skeletally immature. When in doubt, many physicians will recommend treatment with a brace.

Physical Therapy Techniques

Before beginning any type of physical therapy, the practitioner usually performs a full assessment of the blood and nerve supply in the area, as well as a bone and muscle assessment, in order to decide whether or not there is an increased risk of complications from the use of these back pain management techniques. Depending on the results of that assessment and each individual back pain patient’s particular situation, the health care provider may perform some or a combination of the following types of  physical therapy:

Soft tissue mobilization

It is important to recognize the role of muscles and their attachments around the joints. Muscle tension can often decrease once joint motion is restored, but many times the spasm will continue to be present. In such cases, muscle tension should be addressed or the joint dysfunction may return. The goal of soft tissue mobilization (STM) is to break up inelastic or fibrous muscle tissue (called ‘myofascial adhesions’) such as scar tissue from a back injury, move tissue fluids, and relax muscle tension. This procedure is commonly applied to the musculature surrounding the spine, and consists of rhythmic stretching and deep pressure. The therapist will localize the area of greatest tissue restriction through layer-by-layer assessment. Once identified, these restrictions can be mobilized with a wide variety of techniques. These techniques often involve placing a traction force on the tight area with an attempt to restore normal texture to tissue and reduce associated pain.

Strain-counterstrain

This technique focuses on correcting abnormal neuromuscular reflexes that cause structural and postural problems, resulting in painful ‘tenderpoints’. The therapist finds the patient’s position of comfort by asking the patient at what point the tenderness diminishes. The patient is held in this position of comfort for about 90 seconds, during which time asymptomatic strain is induced through mild stretching, and then slowly brought out of this position, allowing the body to reset its muscles to a normal level of tension. This normal tension in the muscles sets the stage for healing. This technique is gentle enough to be useful for back problems that are too acute or too delicate to treat with other procedures. Strain-counterstrain is tolerated quite well, especially in the acute stage, because it positions the patient opposite of the restricted barrier and towards the position of greatest comfort.

Muscle energy techniques

Muscle energy techniques (MET’S) are designed to mobilize restricted joints and lengthen shortened muscles. This procedure is defined as utilizing a voluntary contraction of the patient’s muscles against a distinctly controlled  counter force  applied from the practitioner from a precise position and in a specific direction. Following a 3-5 second contraction, the operator takes the joint to its new barrier where the patient again performs a muscle contraction. This may be repeated two or more times. This technique is considered an active procedure as opposed to a passive procedure where the operator does all the work (such as joint mobilizations). Muscle energy techniques are generally tolerated well by the patient and do not stress the joint.

Maintaining back pain relief long-term

To continue the healing process and prevent recurring pain, back pain patients are encouraged to engage in other appropriate treatments (including an exercise program) during and after physical therapy treatment. Exercise programs for back pain usually include stretching and strengthening exercises and low-impact aerobic conditioning, and should include a reasonable maintenance exercise program for patients to do on their own. The goal is to maintain the right type and level of activity to prevent the pain from re-occurring and avoid the need for frequent return visits to the therapist.