Category Archives: Back pain

Our new table is here!

Chiropractic table | Low back pain treatment in BeavertonIntroducing our new Flexion-Distraction table from Hilllabs.com! Our chiropractor, Dr. Thompson, will be using this table for all of the usual treatments and adjustments he does in his routine chiropractic visits, but he will now have the ability to provide flexion-distraction therapy to patients with certain conditions.

Flexion-distraction is a method of adjusting the spine by gently stretching the lower back or neck as the table flexes. This movement creates space between specific vertebrae in the back or neck, which can reduce pressure on any pinched nerves, decrease the size of disc herniations, lessen the effects of stenosis (a narrowing of the space around the spinal cord and/or nerve roots), and forces vital nutrients into injured disc tissue to facilitate healing.

Conditions that can benefit from flexion-distraction treatment can range from neck and radiating arm pain to sciatica, stenosis, herniated discs, failed back surgery, and even the everyday mechanical back and neck pain that almost everybody has had at some point in their life.

Many people consider chiropractors to just be “back crackers.” Flexion-distraction therapy is just one of the many tools in our tool belt in addition to traditional manual adjustments (the twisting and “popping” that most people think of). A typical treatment plan at Catalyst will include education about your condition and what to do/what not to do to aid in recovery; adjustments to joints that aren’t moving well or are misaligned; soft tissue massage to relax tight muscles; and therapeutic exercises and stretches to stabilize affected area and make you more resilient to re-injury. Research is showing us that this type of multi-modal approach achieves superior results when compared to treatment involving just adjustments. Take spinal stenosis, for example. This is a condition that is commonly treated in chiropractic offices. In one study posted previously on the blog, stenosis symptoms responded better to flexion distraction therapy combined with an exercise program compared to flexion distraction alone. In another study, flexion distraction combined with typical therapeutic modalities (heat, e-stim, ultrasound), achieved larger reductions in pain and disability than the therapies alone. Studies like these are important because they show that there is not one silver bullet that works better than all other treatments, but it is usually a combination of treatments that achieves the greatest effect.

At Catalyst Chiropractic and Rehabilitation, your treatment is guided by the best available evidence combined with our chiropractor’s clinical experience in order to deliver you the most effective solution for your individual condition. Contact us today to get started on your comprehensive path to recovery.

How to prevent back pain

Personal Injury Back Pain (2)

Around 80% of people will have a significant back pain episode at some point in their life. Once you have an episode of back pain, it is likely to recur, oftentimes within 1 year of first onset. What a horrible thing! It’s no wonder that billions of dollars are spent on back pain treatment every year, and that professions such as chiropractors have a good outlook for job growth in the near future – everybody is getting back pain and not getting rid of it very effectively. So, what about those billions of dollars? Are they being well spent? Are they curing the pain with the expensive drugs, surgeries, and devices they are paying for? In general, no. The rising costs of back pain treatment have not been directly associated with lower occurrences of back pain. On the contrary, the problem just keeps getting worse. Thus the need for studies such as this one, which investigates the usefulness of several methods of back pain prevention. It compared exercise, education, back belts, and shoe insoles and found that the only decent evidence of ability to reduce risk of low back pain episodes came from exercise combined with education. By education, I mean in-office education from the healthcare provider about what causes low back pain and strategies to avoid re-injuring the spine.

Knowledge is power. When you come to our office, our goal is not to just deliver expert, personalized treatment, but to give you tools through proper education to avoid what harms your back and help it to heal properly. I will not just put you on a table, adjust you, and send you on your way, because if I don’t tell you how to take care of your spine you will be right back in my office for the same reason wondering why treatment isn’t helping. I will help empower you to make better choices and start better habits to help you stay out of my office and stay feeling well. You’ll also notice that I don’t push a lot of products on my patients, or prescribe back belts and insoles very often. That is because they have limited utility in preventing back pain. We only use them when absolutely necessary. If you continue to injure your back time and time again and are looking for more answers, contact us to set up an appointment.

 

Photo credit: www.sandiegopersonalinjuryattorney.net 

Why sneezes cause back pain

I remember several years ago I was watching Sports Center and the anchor reported that Sammy Sosa was not going to play that day due to back pain caused by a sneeze. It was reported in a way that made light of the subject, and I even got a good chuckle out of it. You may have laughed as well if this had never happened to you, but whether they make the headlines or not, sneezes often result in back or neck pain. As a chiropractor, I see this frequently and my patients are often embarrassed when they tell me how it happened. I believe sneezing is risky for two reasons:

1. When you sneeze you often turn your head in order to aim it away from people near you and to cover it with your arm or hand. Sneezing causes a very violent contraction of the diaphragm and many of the muscles that support the neck and spine. When creating such a violent contraction with your neck twisted, it is easy to see how a muscle could be pulled or even a joint in the spine sprained as the tissues are put under such intense stress.

2. Sneezing causes a rapid rise in intra-abdominal pressure. The pressure builds as all the air taken in during the “ahh” part of the sneeze gets restricted momentarily before the “choo” part. Raising intra-abdominal pressure also causes an increase in intra-thecal pressure, or the pressure inside the spinal canal, as well as the pressure inside the intervertebral discs, the soft cushions between each of your vertebrae. A sudden spike in pressure in these areas can cause a disc injury and/or a pinched nerve sensation in the back or neck.

One way to avoid injury when sneezing is to reduce the stress on your spine by slightly extending your neck and your lower back. As I discuss in the video below, we tend to bend forward when we cough or sneeze. Bending forward can place more pressure on the spine even when not sneezing, so it is best to avoid that position then next time you feel a tickle in your nose. See the video for more details. Until next time, take care and sneeze safely 🙂

-Dr. Thompson

 

Choosing the right mattress for lower back pain

Proper mattress selection for lower back pain

Which mattress is best for your back?

Sleeping on the wrong mattress can cause or worsen lower back pain. Lack of support from a mattress reinforces poor sleeping posture, strains muscles and does not help keep the spine in alignment, all of which contribute to low back pain.
Sleep comfort is also sacrificed if a mattress does not match one’s individual preferences. A mattress that provides both comfort and back support helps reduce low back pain, allowing the structures in the spine to really rest and rejuvenate during the night.
Choosing the right mattress can be difficult. The following practical guidelines are designed to help patients with low back pain choose the best mattress for both back support and sleep comfort:

  1.  Personal preference should ultimately determine what mattress is best. There is no single mattress style or type that works for all people with low back pain. Any mattress that helps someone sleep without pain and stiffness is the best mattress for that individual. Patients with low back pain should choose the mattress that meets their standards for comfort and support and allows them to get a good nightís sleep.
  2. Understand and inquire about the physical components of the mattress. The coils or inner springs of a mattress provide the support. Different mattresses vary in their number and arrangement of coils. Padding on top of the mattress comes in many different thicknesses. Mattress depths typically range anywhere from 7 to 18 inches deep. Choosing the number of coils, type of padding and mattress depth should be determined by individual preferences.
  3. Find a mattress with back support. A good mattress should provide support for the natural curves and alignment of the spine. The right amount of back support also helps the patient avoid muscle soreness in the morning. While there is not much clinical data about mattresses, one study found that medium-firm mattresses usually provide more back pain relief than firm mattresses.
  4. Achieve a balance between back support and comfort. Overall comfort while sleeping on the mattress is equally important as sufficient back support. Sleeping on a mattress that is too firm can cause aches and pains on pressure points. A medium-firm mattress may be more comfortable because it allows the shoulder and hips to sink in slightly. Patients who want a firmer mattress for back support can get one with thicker padding for greater comfort.
  5.  Know when it’s time to get a new mattress. If an old mattress sags visibly in the middle or is no longer comfortable, it is probably time to purchase a new one. Putting boards under a sagging mattress to keep it from sagging in the middle is only a short-term fix for the sagging; a new mattress is still needed.

Some Considerations

  • Shop for the best value and quality of the mattress, not price. Mattresses with more coils and thicker padding tend to be higher quality and also more expensive; however, a higher price does not guarantee that the mattress is more comfortable or more supportive. Mattress stores often have sales and promotions, so it is a good idea to comparison-shop for the best price after finding the right mattress.
  • Be aware of mattress advertising gimmicks. Claims that a mattress is orthopedic or medically-approved should be viewed skeptically. There has not been extensive medical research or controlled clinical trials on the topic of mattresses and low back pain. The individual must determine whether or not extra features on a mattress make it more comfortable or supportive.
  • Give the mattress a test-run before buying. To sample mattresses, people can try sleeping on different makes and models in hotels or at other peopleís homes before going to a mattress store. When shopping at the store, shoppers should lie on the mattress for several minutes to decide if it is a good fit. If two people will be sleeping on the mattress, both should test it at the same time to make sure they have enough space and are both comfortable on the same style of mattress.
  • Purchase mattresses from stores and companies that are trustworthy. Consider the customer service offered by the mattress store, such as delivery options, warranty, and removal of old mattresses and the store’s return policy. Look for mattress stores where customers can return a mattress if they are not satisfied with the quality or comfort after sleeping on it for a significant amount of time (i.e. a couple of weeks to a month).
  • To help preserve the quality of a new mattress, it should be repositioned every six months to ensure that the mattress is evenly worn. This includes rotating 180 degrees and flipping the mattress lengthwise on a regular basis. The Better Sleep Council advises against putting a mattress on a box spring/foundation that is not made to go with the mattress, as this may decrease the life of the new mattress.

How to Support Your Back Every Day

Bad posture

When you’re living with chronic back or neck pain, your daily routine can get complex – appointments, insurance paperwork, time off work, treatment regimens to follow, etc. While these are important aspects of managing your pain and recovery process, there are simple things you can do (or stop doing) on a daily basis to help your condition.

Good posture and body mechanics (the way you perform your activities all day, everyday) can substantially improve the way you feel at the end of your day.

Support your spine while sitting at your desk or in your car

Sitting for prolonged periods of time can be a major cause of back pain. Sitting is a static posture, which can add a tremendous amount of pressure to the back muscles and spinal discs. Additionally, sitting in a slouched-over or slouched-down position can overstretch the spinal ligaments and increase the pressure on your spinal discs.

Sitting with your back relatively straight and with good support is essential to minimize the load (strain) on your back. Especially when you sit for prolonged periods of time, you need to provide your lower back with support for the inward curve of the lumbar spine (lordosis). Here are a few tips for good posture and support for your lower spine while sitting at a desk or while driving:

  • Make sure your chair is set up so your knees are bent at about a 90 degree angle. Two fingers should slip easily between the bottom of your thigh and the chair.
  • The backrest of your chair should push your lower back forward slightly. Place a small pillow, rolled up towel, or orthopedic support on your chair to accomplish this or get a new office chair that provides support if you can.
  • Your buttocks should be pressed against the back of the chair, and your back should be straight.
  • It’s a good idea to have arm rests on your office chair that place your elbows at a 90-degree angle.
  • Place some support under your feet to elevate them slightly and take some of the load off of your lower spine. Sit with your knees slightly higher than your hips to eliminate much of the pressure on your lumbar spine.
  • Don’t sit on anything that would throw your spine out of alignment (i.e., a wallet in your back pocket).
  • Don’t slouch or slump in your office or car seat; this puts extra pressure on your spine and stress on the lumbar discs. Use the back of the chair to provide support for your back.
  • Sit up straight and keep your chin pulled in (avoid keeping your chin and head thrust forward).
  • Sit as close to your desk as possible.
  • Your computer screen or reading materials should be at eye level.

Some people prefer furniture that promotes more muscle activity, such as a Swedish kneeling chair, standing desk, or a Swiss exercise ball, rather than a chair that provides complete support. Purchasing a good ergonomic office chair that provides optimal back support may also be helpful.

On the phone a lot?  Consider investing in a headset to take the strain off your neck, or try using the speakerphone. Avoid cradling the phone on your shoulder.

If you are in a great deal of pain, try to avoid driving. If possible, have someone else drive, and lie down in the back seat with your knees slightly bent. You can place a blanket or pillow under your knees to support them, as well as a small pillow under your head.

Move about during the day

A healthy body can only tolerate staying in one position for relatively short periods of time. You may have noticed this on an airplane, at your desk, or at a movie theater when sitting is uncomfortable after just a short time. Even with correct posture, holding the same position slowly takes the elasticity out of the tissues, and stress builds up and causes discomfort.

Keep your joints, ligaments, muscles, and tendons loose by moving about and stretching on a regular basis throughout the day:

  • Stand up while talking on the phone. Be sure to stand with one foot slightly in front of the other, or place one foot on something a few inches off the ground; avoid standing straight with your knees locked.
  • Stretch your hamstrings twice each day. To help you remember to do this on a regular basis, link the stretching to a part of your daily routine, such as when you brush your teeth in the morning and evening, or when you first get to work and before you head home. Flexible hamstrings will significantly reduce the stress on your lower back.
  • When you return to your seat after moving around, use an alternate posture for just a few moments and some of the tissue elasticity needed to protect your joints will return.

Paying attention to your posture and movement throughout the day and while sleeping at night will help you manage your pain and maintain good spine health.

Learn more about supporting your back, both day and night. Visit http://www.spine-health.com/blog/new-health-epidemic-sitting-disease

For a personal chiropractic consultation to review your ergonomics and learn about solutions for your back pain, contact us at (503) 526-8782

 

 

Introducing our Back to Basics series

 

This is the first in a series of videos that we will be posting to introduce you to some simple spine-sparing strategies. These are designed to be used by those who are recovering from back pain, neck pain, headaches, or other ailments. In reality, though, these are basic skills to be used to form a foundation for a healthy spine and pain-free living.

The first step in the recovery process and one of my first goals when I first meet with a patient is to identify what is causing the pain. Sometimes it is a traumatic injury, other times it is due to repetitive stress, but no matter what the cause, your body needs the best chance it can get to heal correctly. In order to facilitate that, you need to learn which movements and positions to avoid  and which ones to adopt to take stress off of injured joints and tissues. I like using this explanation: Pretend your back injury has a scab, and try to avoid “picking” at that scab so that it can heal as quickly as possible. To avoid picking the scab, it is important to be able to learn how to maintain a “neutral” spinal alignment as you perform certain movements during your daily activities. As you well know if you have thrown your back out, even the simplest of movements can be extremely challenging .

The first basic movement covered in this video is getting into and out of a chair. This is perhaps the most common complaint I get from people with low back pain – that it hurts when getting up out of a chair. To make this movement less threatening, it is important to “preserve the curve.” In other words, don’t lose track of that little backwards curve in the small of your back. If you let it flatten out or flex it forward, that’s when you get into trouble. As the video shows, scoot forward to the edge of your seat, and stand straight up when getting out of the chair, and reverse the process when sitting down.

Stay tuned for more basic spine care tips from Dr. Kip Thompson at Catalyst Chiropractic and Rehabilitation. If you are reading this because you are in pain, don’t hesitate to contact us to schedule your first assessment with Dr. Thompson.

Quick posture fixes

As a chiropractor in Beaverton, Oregon, I see patients all day long with sedentary desk jobs. Without exception, all of them would agree that their posture has something to do with their back pain. I am very sensitive to negative self talk and try to encourage my patients that it isn’t all their fault and there is something they can do about it.

Contrary to popular belief, having good posture isn’t just about sitting up straight all day long. In fact according to Pr. Stuart McGill, a leading spine researcher, even sitting in an upright position that we would consider a “good posture” can be taxing on the spine if it is done for prolonged periods of time (see “Ultimate Back Fitness and Performance”) . His suggestion is to vary your posture throughout the day so that different muscles and spinal joints are stressed at different times to more evenly distribute the cumulative stress that prolonged sitting (or standing) places on your back.

Various seated postures both good and bad
Any of these postures are acceptable, as long as they are not sustained for too long, although the one on the right is not advisable.
(Photo source and license info)
 

Another strategy to decrease stress on the spine is to increase your back’s capacity to bear the burden of repetitive stress. A sedentary lifestyle and prolonged stationary postures will sap the strength of the muscles in your back and abdomen (your “core”), effectively leaving your spine with no support other than tissues called ligaments to keep it from buckling. If ligaments have to support the spine for too long, they will become stretched out and then they can be both a source of pain themselves or leave your back unstable and susceptible to injury. For a quick, easy way to break the monotony of sitting all day, try using the follow stretch intermittently throughout the day. This is called Brugger’s relief posture and can be done at any type of workstation. I also included a simple strengthening exercise to help you start to increase your capacity to deal with repetitive postural stress.

 

 

For additional core exercises, I would suggest starting with McGill’s “Big 3” exercises for core strength and low back stability, seen in the following video (plus an extra one called “Stir the Pot”). These exercises are simple, don’t take much time, and will give you a great bang for your back…I mean buck.

 

 

Research update – Chiropractic care for spinal stenosis

Stenosis research summary

Stenosis is a word that a lot of people have heard of and might even relate it to some sort of spinal condition, but it is not often well understood. In short, the word stenosis means “narrowing.” In the lumbar spine, it implies the narrowing of a canal where either the spinal cord itself runs or where the spinal nerve exits the spine to travel down into the leg. The canals that these neural structures run through can become narrowed either by overgrowth of the bone that makes up the canal or by a nearby bulging disc. It is not the stenosis itself that causes symptoms, but the pressure that the narrowed canal puts on the nerves. That pressure can cause pain, numbness, tingling, or weakness in the back and legs, or disturbed bowel or bladder function. Symptoms often worsen with prolonged standing or walking and may improve when sitting or bending forward. It occurs most often in people over the age of 50 and can have a significant impact on the quality of life.

In my practice stenosis is a particularly concerning finding, because it often discourages people from being active since they can’t walk or be on their feet for any significant length of time. It engenders inactivity, which further perpetuates poor health and physical fitness, which in turn lead to more back problems. The beauty of this study is that it gives hope to those who suffer from lumbar spinal stenosis. What I like about it is that it advocates a multimodal approach, attacking the problem from multiple directions to produce a long term, effective solution. It is similar to the way we approach each of our patients’ concerns – through education , simple, progressive home care stretches and exercises, and effective chiropractic adjustments and manual therapies. We believe that the best results are achieved when both the healthcare provider and the patient take appropriate action to treat pain and prevent further injury and disability and this study is a fantastic example of this approach.

Research update: Surgery vs chiropractic care for sciatica

Surgery vs chiropractic care for sciatica

In this month’s research update we review a study that compares the success of spinal manipulation (chiropractic adjustments) vs that of surgery for sciatic pain. Sciatic pain is nerve pain that courses down the back of your leg due to a pinched nerve in your low back. The nerve is often pinched by a bulging or herniated disc and can cause severe pain, numbness, tingling, and weakness in your leg. If you have any of these symptoms and show up at your doctor’s office, you could end up undergoing a whole spectrum of treatments and tests. A common protocol is to treat a problem like this with conservative care first, unless immediate surgery is warranted. Then consider surgery as a last option if all else fails. As this study demonstrates, “conservative care” can mean any number of things. From the medical perspective, a course of conservative care can go as follows: Oral pain medications, muscle relaxants, and a physical therapy referral. If this fails, steroid injections may be ordered as a final “conservative” approach prior to surgery.

The beauty of this study is that the group that underwent chiropractic treatment had already received at least three months of other conservative treatments that had failed to resolve their pain. After all was said and done, chiropractic care out performed the other non-operative treatments and showed very similar results as surgery, as shown in the graph above. This demonstrates that, while not the only option, chiropractic care should be considered as a valid first option  in the treatment of sciatica. Surgery can be quite effective, but one should note the potential risks and failure rate associated with surgery. If there is another option, it should be taken, especially if it is natural and has fewer potential risks and side effects. Be an educated consumer and patient. Advocate for yourself and ask your doctor what other options there are besides drugs and surgery. If those are necessary options, then ask what the risks and side effects are so you are clear about what you can expect.

Why your back pain diagnosis may be overrated

Low back pain x-ray diagnosis
Lumbar spine x-ray

In the most recent issue of “The Back Letter” the author summarizes findings of a task force employed by the National Institutes of Health (NIH) to set new research standards on low back pain. Their principle goal was to establish a classification system of chronic low back pain based on the anatomical causes of the pain. What was the result? They failed. The problem is that low back pain is too complex to just file it nicely into different categories. Here are some key points highlighted by the article:

  • It would seem easy to classify low back pain based off of diagnoses such as sciatica, disc herniations, and stenosis, but researchers and clinicians often have differing definitions of these conditions. This means that your stenosis may not look anything like the next guy’s stenosis, and they may not respond similarly to the same treatment.
  • Even with the amazing imaging technology available to us (MRI, CT scan, x-ray, ultrasound), the actual cause of your pain is not always clear. Numerous studies have shown that imaging findings do not correlate to symptoms as well as we think.

And the kicker…

  • “Tens of thousands of patients every year receive powerful medications and undergo physical treatments, injections, and surgery for spinal conditions that have never been proven to be primary causes of low back pain (The Back Letter, Vol. 29, No. 8, 2014. Lippincot, Williams & Wilkins).”

The bottom line is, don’t take your low back pain diagnosis at face value, and definitely don’t jump into anything that you are unsure of (injections, lumbar fusion, etc) without trying more conservative options first.

This is the fight that chiropractors have been fighting since the profession’s inception. Chiropractic is a safe, non-surgical, drug-free way to treat many of these common low back pain diagnoses that the medical world is having such a difficult time classifying and researching. I always tell my patients on their first visit that unless I really feel it is necessary, I probably won’t take x-rays.  We will proceed with a series of treatments to address the misalignments and joint restrictions I find in their physical exam and if their pain doesn’t improve, then we will take x-rays or order an MRI. More often than not, they will get better before we ever need any imaging. What a great model of spine care! This is why chiropractic has been shown in multiple studies to be so cost effective; the treatments are very affordable and fewer advanced tests and invasive procedures are needed when people see their chiropractor first.

Rant over. Have a healthy day!

-Dr. T