Joel P. Carmichael, DC, DACBSP President of The Center for Spine Pain®

The Greatest Success

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Issue February 7

in Chiropractic Medicine in the last century is the consistent effectiveness of mechanical therapy (also known as manipulation or adjustments) in the treatment of back pain.

2008

Health Coach EDITOR

HOT FOCUS: Back Pain

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Mechanical Therapy for a Mechanical Problem Joel Carmichael, DC, DACBSP

Growing up we learned that “sticks and stones may break our bones.” Twists and falls, wrestling with brothers or sisters, sleeping on the couch, and contact sports confirmed the reality of “mechanical” pain. We, as a nation, are prone to pill-popping, aren’t we? There is no doubt that some of the greatest advances in medicine over the last 200 years have come on the heals of a greater understanding of chemistry, and in the last half century, in genetics. And yet the idea that all health and disease can be understood in the context of chemistry and chemicals and pharmaceuticals is wrong. If you walk around with one shoe on and the other shoe off for a day, your low back may prove my point to you. When it starts hurting it is not because it lacked aspirin, Vitamin “I” (ibuprofen) or something stronger. The problem is that you’re walking around on an unbalanced foundation. The cause of your pain is mechanical, not chemical. A wry neck. An acute locked back. A frozen shoulder. A locked knee or a locked jaw. All of these are examples of pain that is primarily mechanical in nature. In over 80% of cases, back pain is mechanical in nature, not chemical in nature. The reason why skilled chiropractic methods Continued on the top of page 2

Failure to Use Movement in Postural Strategies Leads to Increased Spinal Displacement in Low Back Pain SPINE Volume 32, Number 19, pp E537–E543 Contributor: Craig Kozak, DC, DABCO

Have you ever felt stiff, awkward, or imbalanced when you had back pain? Most people associate low back problems with pain in joints, discs, nerves, and muscles. At the same time, that pain causes problems with the way those joints, discs, and muscles work. Here’s the problem: if you’re stiff you can’t move but if you move you can have pain! So, what’s the answer? It’s a careful balance of motion and stability that happens at the same time called “MoStability.” A recent article in the journal Spine (see reference above) explains some of what’s going on to cause your feeling of being stiff, awkward, or imbalanced. The researchers looked at low back and hip movement during a quick forward raise of both arms. Here’s what they found: people without back pain subconsciously prepared their back for the arm movement by using muscles to gently extend the low back to counterbalance the anticipated load. These people maintained good, stable, balanced posture. They used “Mo-Stability.” People with back pain, however, didn’t prepare their back and were pulled forward and unbalanced. Remember, these people were only moving their arms -- with no additional weight! Think of it this way: a person without pain leans to the left when getting ready to pick up a gallon of water in the right hand while the person in pain is pulled off balance to the right under the weight of the water. Continued on the bottom of page 3

Trusted. Preferred. Experts.

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Health Coach

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Mechanical Therapy for a Mechanical Problem

Volume Issue February 7 2008

Continued from Page 1

are so effective is that they are mechanical solutions to a mechanical problem. Chiropractic adjustments unlock joints that are stiff and stuck and locked and restricted from moving through their normal range of motion. This is such a simple, logical concept it is almost self-evident. Spinal manipulation, once dismissed as unscientific, is now the most well-researched, well-documented treatment for back pain. Governmental agencies in North America,1 Denmark, Sweden and Europe, 2,3,4 including highly respected medical journals such as Spine Journal, 5 have reported evidence in support of spinal manipulation as a first-line treatment of choice for acute and chronic low back pain. For this special edition of Health Coach we’ve chosen to focus on back pain because this is something that affects 80% of all Coloradans and because there is so much confusion out there. For example, the standard treatment for back pain (without fracture, trauma, high fever, malignancy, etc.) at local hospital emergency rooms still includes heat rather than ice. This hasn’t changed in decades, despite new information. ® If you are a patient at “Spinal manipulation, once The Center for Spine Pain , you know that applying ICE for pain and acute dismissed as unscientific, is inflammation is far superior now the MOST well- to heat, and that heat can detrimentally promote swelling, the accumulation r e s e a r c h e d , w e l l - in the injured tissue, and a of inflammatory exudates documented treatment for Imagine a heating pad to a longer episode of pain. sprained ankle. The ankle back pain.” would blow up like a balloon! And yet many in our community recommend a heating pad for a sprained back. Here’s our rule of thumb: apply ICE 15 minutes every half hour for back pain. Only use moist heat (never a dry heating pad) for joint stiffness or known degenerative arthritis. If your pain does not resolve in 48 hours, seek a competent evaluation by someone who can diagnose and treat mechanical back pain, and who will refer you when a mechanical disorder is not the problem. Thank you for telling others about your experience at The Center for Spine Pain! We offer a fully integrated, multidisciplinary, no-nonsense approach to pain, injury, stress and tension that is evidence-based and effective. We don’t keep people coming back unnecessarily. Feel free to forward a copy of this newsletter with a friend, colleague or loved one. They can see for themselves what the CSP buzz is all about. An online version of this newsletter can be downloaded from our website. Click the link from our homepage, www.center4spine.com, to “CSP Patient Info Central.”

References 1 Bigos

S, Bowyer O, Braen G, Brown K, Deyo R, Haldeman S. Acute low back problems in adults. Clinical Practice Guideline Number 14. AHCPR Pub. No. 95-0642. Rockville: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research; 1994. Report No.: AHCPR Publication no. 95-0642. 2 Arkuszewski Z. The efficacy of manual treatment in low back pain: a clinical trial. Man Med 1986; 2:68-71.

3Beyerman

KL, Palmerino MB, Zohn LE, Kane GM, Foster KA. Efficacy of treating low back pain and dysfunction secondary to osteoarthritis: chiropractic care compared with moist heat alone. J Manipulative Physiol Ther 2006; 29:107-14. 4 Airaksinen O, Brox JI, Cedraschi C, et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J 2006; 15:S192-300.

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Volume Issue February 7 2008

Low Back Pain in Pregnancy

J Midwifery Womens Health, Jan-Feb;51(1):e7-10, 2006. Contributor: Hang Nguyen, DC, DABCO

Low back pain in pregnancy is common, ranging from 57-69% of all pregnant women. At any moment in time 61% of all pregnant women have low back pain! Only 32% of women report these back pain symptoms to their prenatal provider. Only 25% of providers recommend any treatment for back pain. There is little data regarding the treatment of pregnant patients with low back pain. An interesting 2006 study reports the results of a group of pregnant women who received chiropractic treatment for low back pain, reporting results for 17 women. Pain scores on the Numerical Rating Scale decreased from 5.9 (with 10 being maximum pain) at the beginning of care to 1.5 at the completion of care. Sixteen of 17 (94.1%) cases demonstrated clinically important improvement. The average time to initial clinically important pain relief was 4.5 days (range 0-13), and the average number of visits to achieve that pain relief was just under 2 visits. (1.8 visits with a range of 1-5 visits provided in this study). No adverse effects were reported in any of the 17 cases. Although this was a limited study with a low number of patients, results show that chiropractic treatment may be effective for reducing back pain intensity in pregnant women. What are the causes of low back pain during pregnancy? First, there are mechanical alterations. As the uterus expands with the growth of the baby, the belly shifts your center of gravity forward. You compensate by leaning backward, increasing stress on small joints in your low back called facet joints. Pain from facet joints responds better to chiropractic treatment than any other kind of treatment. Over-stretched, weaker abdominal muscles contribute to the increased straining force on the low back and the facet joints.

Postural Strategies in Low Back Pain Continued from Page 1

That’s not how your body thinks. Your exercises should mimic positions and motions Addressing pain should be the initial goal of your that you use and safely challenge your ability to care. (See “Mechanical Therapy for a Mechanical move, stabilize, and balance. You need Problem” in this issue.) The Center for Spine training in “Mo-Stability.” Pain has a variety of techniques that are safe These are two of the most important and effective. Sometimes we’ll even things to do for mechanical back pain. At recommend using a low back brace to increase The Center for Spine Pain we have long list stiffness, but only in the very short term. of options to help you get better. Long term, daily use of a brace won’t allow your back to move in preparation and can Dr. Craig Kozak specializes in rehabilitation, exercise, increase the overall stress on your body, muscle activation and prevention strategies for low back possibly leading to future injury. pain. He will be relocating to Fraser, Colorado in 2008. So what? Here’s what it means to you:

Next, once your pain is under control, it is imperative to retrain your movement patterns.

The providers at the Center for Spine Pain are ready to This doesn’t mean hundreds of reps of sit-ups diagnose your problems and guide you on a path to or other single muscle-focused exercises. your goals. Call 303.382.3616 today!

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Volume Issue February 7 2008

Low Back Pain in Pregnancy In addition, hormonal changes, particularly the release of the hormone relaxin, cause muscle and ligament relaxation, which can loosen the joints and ligaments that attach your pelvic bones to the spine (the sacroiliac -- or SI -joints). This can make you feel less stable and cause pain with prolonged standing, walking, rolling over in bed or getting up and down from a chair. When low back pain radiates into the buttocks and thighs during pregnancy, it is usually resulting from the growing uterus pressing on the piriformis muscle (one of the pelvic floor muscles) and the sciatic nerve that runs beneath it. This is often confused with “sciatica” (sigh-AT-ik-kah). True sciatica, which can be caused by a herniated or bulging disk in the lower part of the spine, affects only about 1 percent of pregnant women. If you have sciatica, your leg pain will usually be more severe than your back pain. You're likely to feel it below the knee as well, and it may even radiate to your foot and toes. And you'll probably feel a tingling, pins-and-needles sensation in your legs or possibly some numbness. Are some women more likely to develop low back pain during pregnancy than others? Yes. Not surprisingly, people who have experienced low back pain previously will likely have low back pain during pregnancy. You're also at higher risk if you've led a very sedentary lifestyle and have poor flexibility and weak back and abdominal muscles. What can I do to avoid back pain during my pregnancy? Start an exercise program to stretch and strengthen muscles that support the back and legs, including your abdominal muscles. Stretching gently and cautiously will prevent further strain joints which have been made looser by pregnancy. Swimming is a great exercise option for pregnant women because it strengthens your abdominal and lower back muscles, and the buoyancy of the water takes the strain off your joints and ligaments. If you sit all day, be sure to sit up straight and take frequent breaks from sitting. Get up and walk around at least every hour or so. Avoiding prolonged standing is equally important. If you need to stand all day, try to take a midday break and rest lying on your side while supporting your upper leg and abdomen with pillows. Wear comfortable shoes and avoid high heels. As your belly grows and your balance shifts, high heels will throw your posture even more out of whack and increase your chances of stumbling and falling. Avoid heavy lifting. If you do lift, always bend from your knees and lift things from a crouching position to minimize the stress on your back. Listen to your body. If you find that a particular activity or exercise makes your back hurt, then avoid doing it! Try heat or cold. If muscles or joints feel tender to the touch and has a sensation of being “hot.” Apply an ice pack to the affected area for 15 minutes every half our or hour. If the muscles feel tense or deep aching sensation, apply a moist heating pad. What can I do to get relief when my back pain won’t go away? Because back pain during pregnancy is mechanical in nature, mechanical treatment with gentle, skillfully applied chiropractic adjustments by an experienced Doctors of Chiropractic is your first treatment of choice. Chiropractic adjustments can alleviate the uncomfortable symptoms arising from the muscular, ligamentous, and biomechanical stresses encountered during pregnancy. Other highly specialized procedures and techniques are used at The Center for Spine Pain, but only when necessary. Prenatal massage by a trained therapist may provide great relief. Acupuncture can be extremely effective for acute pain relief. Dr. Hang Nguyen specializes in the treatment of mechanical back and neck pain, headache disorders, and pregnant women. She is the Director of Clinical Research at The Center for Spine Pain and has published numerous papers in professional journals.

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Volume Issue February 7 2008

Ergonomics 101: A key to faster recovery! Contributor: Susan Ha, DC

We have all heard our parents tell us to “sit up straight” only to ignore their commands. Many of us have experienced low back pain from sitting due to poor posture. How many times do you find yourself hunched over your computer for hours only to find yourself stiff, sore, and aching when you finally up? We try to stretch as much as we can if we’re able to move and swear to ourselves that you’ll remember to get up more often the next time. How can we avoid the slouching, the hunched shoulders, and more importantly the aching back? GOOD POSTURE! What is good posture? Our body has natural curves in the neck, the mid back and in the lower back. As we stand and look at our profile we should be able to draw a line from the center of our head to the shoulder down to our hips, knees and through our ankle. When everything is aligned properly the stress on our joints are balanced. With poor posture, especially in sitting, we add more stress upon our joints, fatigue the muscles and ligaments leading to injuries in our lower back. How do we maintain good posture? Be Aware! Many times we find ourselves sitting more often than we want to. We’re not expected to have good posture throughout the whole day but being mindful of what position we are in and correcting it by “sitting up straight” is key. When you are sitting make sure you sit completely into the chair with your back properly supported. If the chair doesn’t come with a lumbar support use a small pillow or a rolled up towel to fill the space between the curve of your back and the chair. Make sure that your knees are slightly higher than your hips and your feet are fully supported on the floor or on a foot rest. Move Around! We, as humans, were not meant to stay in one position for prolonged periods of time. Shift your position if you are in your chair or even get out of your chair and walk around if you can. If you are bound to your desk, try kneeling at your desk if you are able. By frequently changing positions you remove the stress from your joints and muscles. If you need more help or are concerned about your posture seek professional help from one of our chiropractors at The Center for Spine Pain. Dr. Susan Ha currently practices at The Center for Spine Pain’s Highlands Ranch Clinic in the Town Center off Lucent Blvd. and Highlands Ranch Parkway: 9325 Dorchester, Suite 127, Highlands Ranch, 80129

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Health Coach For more information or to schedule an appointment at our Denver Tech Center or Highlands Ranch location, please contact us at: 303.382.3616 or visit our clinical services webpage at www.center4spine.com Inquiries, contact: Rhonda Hurley 303.382.3616 [email protected] ©2008,

The Center for Spine Pain® All rights reserved.

2 1 Excerpted from the Annals of Internal Medicine, 2007...

Volume Issue February 7 2008

Contributor: Jon Seeman, DC

“Therapies with good evidence of moderate efficacy for chronic or subacute low back pain are cognitivebehavioral therapy, exercise, spinal manipulation, and interdisciplinary rehabilitation.”

Other studies have proven the effectiveness of chiropractic care for acute low back pain. This recent article, published in a widely respected journal, indicate that two of our core interventions at The Center for Spine Pain-- spinal manipulation and exercise -- are effective for sub-acute and chronic low back pain as well. Dr. Jon Seeman specializes in spinal disorders, sports injuries, and orthotics for running and walking. He joined The Center for Spine Pain in 2006 and is currently co-authoring a paper on Invertebral Disc Decompression.

SPECIAL OFFER TO YOUR FRIENDS & FAMILY DURING FEBRUARY!! During the month of February we’re offering a FREE consultation for friends, neighbors, loved ones and co-workers you refer to us. There’s no risk or obligation -- just a chance for people suffering with back pain to meet us learn about the many treatment options we provide. Those you refer will learn what you, our patient, already know: our aim is to achieve the fastest results possible! We provide gentle, effective care for spine pain, as well as acupuncture, massage, wellness care and nutritional counseling, non-surgical spinal decompression and rehabilitation. For more information, visit www.center4spine.com. Please give us your feedback! Post on our blog (http://c4sp.blogspot.com), shoot us an email ([email protected]) or let us know what you think when you’re here for care!

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