Lower Back Exercises

Many patients have asked what exercises do I need to do to keep my back pain from returning? Current research indicates that lower back pain has a very high rate of reoccurrence about 60-80% within a two year period. Doing daily core exercises can lower this rate to under 30%.

Remember I suffered from a ruptured disc in 2009 and have been doing some daily stretches/exercise since. I do them in the morning and they take about 10-15 minutes to do so they do not take very long. So if you are in acute pain something that you can do is the knees to the chest stretch which is demonstrated above. Pulling your knees to your chest will take tension off of the sciatic nerve and this may give some people relief. Some people find that knees to the chest is to uncomfortable so they need to try this back extension stretch.

Try to hold for 10-15 seconds and then relax. Repeat this several times and then several times during the day. When not in acute pain you can try some "core" exercises. I like using the exercise ball because in my personal research I have found that the "balancing" type of exercises seems to strengthen smaller muscles in-between the vertebrae. So I start out on a ball doing the dog pointer. That would be laying on your stomach with the ball underneath and lifting your left arm and right leg off and holding that position for 15-30 seconds and then do the other arm and leg.

Another one is to lie on your back and put the ball under your heels and straighten the back and hold for 30 or more seconds.

. One of the last ball exercises that I do it to lie on my back on the ball with knees bent. Then straighten one leg at a time holding for 15-30 seconds and then do the other leg. I then do two more exercises without the ball. The first is called a plank. You get on your elbows and on your toes and hold your body straight in that position for 30-60 seconds. This one, for me, is one of the harder ones to do. I had to build up to this exercise because at first it did bother my back.

The last exercise that I do is a side plank with is up on the elbow on your side like this picture. I hold this one for 30 seconds.

So these are the exercises that I do each morning before work. I have found out with the ball exercises that you do not notice an increase in strength but you will notice your balance getting better. As always if a certain exercises is sore you can continue to do it, but if you have an exercise which "ouch" hurt you must stop immediately.

Evidence based Healthcare

Evidenced based healthcare is the new buzz word in healthcare. What it means is that you are treated according to the latest researched evidence for that condition. Basically it is trying to give you the most "bang for your buck." Many conditions have been researched to find the best "evidence based" treatment approach. Well what about back pain? What does the evidence show? First off we have found out the number one disabling condition the WORLD today is lower back pain. More people miss more work or are laid up due to back pain than due to any other single condition followed by major depression and then other musculoskeletal disorders. So what has the research "proved" is the best treatment? You may be surprised to find that spinal manipulation (which is mostly performed by chiropractors) has one of the highest levels of research associated with successful treatment of lower back pain. The research also demonstrated that NSAID (non steroid anti-inflammatory drugs), such as aspirin, Advil, Aleve, Tylenol are effective. These medicines, in research, have been shown to do as well as the stronger medications like Vicodin, Flexeril, and those types of medications which have potentially severe side effects. The third recommendation for the treatment of back pain was exercise. These are the three most "evidence based" treatments for lower back pain. (Rand 1992, AHCPR 1994,) Those with questionable research were epidural steroid injections and lower back surgery. A recent study has demonstrated that if you saw a chiropractor as your first doctor for lower back pain you had a 1.5% chance of lower back surgery. If you saw a surgeon as the first person that you saw for your lower back pain you had a 42.7% chance of surgery (Spine December 12, 2012). The average cost of a chiropractic treatment program is about $552 (Health Affairs, 2013: 32 (1): 45-52) and the average cost of lower back surgery is around $50,000. $50,000 for a treatment that is not very effective. So the research suggests that you try NSAID and if that does not help you condition you should consider seeing a chiropractor. Several studies also indicate that lower back pain has a very high rate of reoccurrence 60-80% within a two year period. Exercises can lower that reoccurrence to below 30%. We treat our patients using the latest evidence based guidelines. We use spinal manipulation coupled with exercise therapy and we have had very good success. It is now time for the rest of the U.S. to catch up to this treatment. Here is a link to an algorithm for the treatment of back pain. http://www.tihcij.com/Articles/Algorithms-for-the-Chiropractic-Management-of-Acute-and-Chronic-Spine-Related-Pain.aspx?id=0000381

Mechanical Lower Back Pain

Mechanical Lower Back Pain

There are three types of lower back pain; sprain/stains, mechanical, and compressive. 85% of Americans will suffer some form of mechanical lower back pain sometime in their lifetimes. It is by far the most common and the most disabling.

Mechanical back problems often have multiple problems of the muscles, ligaments, discs, and facet joints. It is also most common in ages 25-60. A lot of studies believe that the problem is cumulative trauma mostly from work related problems. I don’t buy that, I believe it is more likely related to deconditioning of the body as we age. Most Americans sit all day which is the worst position for your back and puts more stress on the lower back area then most other activities. The more will sit the more our core muscles weaken which is supposed to support and hold the spine. I think this is exactly what happened to me when I hurt my back. I have no history of trauma and all I did was take a nap on the couch and roll off. Well everyone knows that rolling off a couch should not cause severe back pain, but it did. The question for me is why it did. My conclusion over the years I allowed myself to get out of shape and my muscles that support the spine (core muscles) had also become weak. This had happened over many years and probably many decades. When I twisted to get off of the couch these muscles did not support the spine and it moved pinching a nerve.

With mechanical types of injuries it is my opinion that physical medicine (such as chiropractic) is much more effective than treating it with pharmacological medicine and research has continually shown this to be true. So you can take all the medications that you want, but until you address some of these underlying mechanical and strength and weakness problems the pain will most like return.

Whiplash

Whiplash what is it and how to treat It

With all of the construction on Key Ave I thought discussing “whiplash" would be a good topic. Whiplash is a term that was coined in around 1928 which describes the injuries an individual gets to his neck and back following a motor vehicle accident. Up until the advent of the automobile “whiplash” was not a very common occurrence. The easiest way to describe whiplash is a sprain or strain to the neck. It can cause a variety of symptoms such as neck pain, neck stiffness, headaches, arm/shoulder pain, back pain and numbness and tingling into the extremities. It can take 24 hours to several days for these symptoms to show up. Many times people believe that injury is related to automobile damage; the more damage the more injury. This is not always the case. Many times severe injuries can occur with little to no vehicle damage. One of the reasons that this can occur is if the accident caused rapid acceleration (moving very quickly) that can cause more damage to the structures of the neck. Generally getting hit from behind by another vehicle on wet pavement causes more damage to the neck than dry pavement due to acceleration. Getting hit on snow or ice will cause more damage than being hit on wet pavement. I read somewhere that being hit by a Volkswagen on ice is about the same as being hit by a city bus on dry pavement. Here is link to an animation of a whiplash injury

http://www.youtube.com/watch?v=b5Bv_gtPu-8&feature=related

So what do you do if you have pain associated with a “whiplash”? One the most highly regarded studies to date was the Quebec Task Force on Guidelines for the Management of Whiplash-Associated disorders. They really did not do any new research they just reviewed all the current research and their findings. They found the most effective treatment to be manipulation and mobilization and range of motion exercises. Medications can be used but should be limited to no more than 3 weeks. A cervical collar should not be worn for longer than 72 hours. So if you are unfortunate enough to have a “whiplash” disorder give our office a call and we will get you back on your feet ASAP, and most automobile insurance companies will pay 100% of the medical costs.

Pain

As a person who has dedicated his life to helping others attain better health it can be frustrating, and heartwrentching as you see patients suffer needlessly. Too many times I see people letting go of a life they were meant to live, I mean to truely live. A life interrupted. A muted version of what life has in store.

I believe that God made us to enjoy and live life to the fullest not to just putter around in first or second gear, but to go through all the gears in life like a fine tuned sports car. Make sure that you don't make pain become a normal part of you life.

What can be done, how about diet and exercise? We keep hearing about how this helps blood pressure, cholestrol, arthritis, etc. Corporations can't bottle it and sell it for a profit so it gets put on the back burner. It is the easiest and least expensive way to become a healthier you.

National Healthcare

Once again National Healthcare is in the forefront of topics on the news. I have not heard many good arguments from Republicans about why we should not have a national health system. They talk about preserving the right to choose your doctor. Today most health plans already have some control over who you can see from a PPO to the HMO's. They talk about quality care, well care is rationed right now. Go to any emergency room and tell them that you don't have insurance and see what kind of quality treatment that you will get. They talk about the government taking over healthcare and the doctors/hospitals will get cuts in reimbursment and taxes will go up. This is just what is happening with insurance companies right now they cut doctors reimbursments and raise premiums. They talk about the government prescribing treatments. Well that is occurring with private health insurance right now, in fact one of the worst examples is the Texas Workers Compensation System. The most recent rules were adopted by Republicans, and the system is the most bureaucratic, heavily paperworked system I have seen, all run through private insurance.



The only good argument against national healthcare is the cost. Americans have been unwilling to deal with the cost of healthcare for a long time. I believe that the reason is that the choices that we will have to make are very difficult. It will be easy to eliminate chiropractic coverage or dental or podiatric coverage but that is just playing around the edges of the cost. Chiropractic healthcare accounts for 0.5% of the total Medicare expenditures. The question becomes that if chiropractic care is eliminated where do patients go for back and neck pain? And is it more costly than chiropractic? But real cost drivers in the American Healthcare System are treatment of the very young (neonatal) and the treatment of the very old. We have yet to have the discussion on when is too much medical care for an individual. Until we have that discussion costs will continue to rise and healthcare spending will continue to sky rocket.

I pick on the Republicans on this issue, and I use to be one. I am an independent now because in my opinion the Republicans are too much in the pocket of insurance companies. And as you can probably tell I don't care very much for insurance companies and how they do business.

Preventative Health

I have been reading a lot about how we can improve our health with preventative measures. Eating right, exercising, and stopping smoking. I agree with all of this except the Government talked about this for Medicare patients. I believe, while it will help, it is too late to begin preventative medicine when you become 65 years old. I believe that it should start much earlier. I have found out that people in their 30-40 who need to make these changes, are not interested in making these changes. The older patients of mine have health issues where they are developing serious health problems, yet in many cases it is too late to make needed changes. Do you know that in the U.S. most people will exercise not to become healthier but to look better. Health is not a real priority.

So how do we become healthier people? There are three things everyone can do very easily to improve their health. I think the first thing we can do is turn off the TV or computer for awhile. These both have a way of “numbing “the mind. How many times have you been on a computer and never realized how much time you were there? I look at it as being brainless entertainment, we do not have to think or do anything while the TV or computer entertains us. We can also get off our butts and walk for about 20 minutes each evening after it cools off. Getting the heart pumping a little faster will give you more energy and help to burn more calories. After a month of walking I can guarantee that you will be feeling better. Make sure you have good supportive shoes. And last try drinking more water instead of cokes, tea, or coffee. You will actually fill up on water and there are zero calories.

Now these ideas are nothing new, they are not flashy, I could not do an infomercial on TV and expect to make lots of money on these recommendations. But these are good, easy, inexpensive recommendations that will help you become a healthy you. I challenge you to try it.