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 peopleĂ­s 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.

Research update – Chiropractic treatment for lumbar spinal stenosis gains traction

Spinal stenosis can be relieved with flexion-distraction chiropractic treatment

 

As a follow up to our previous article on the benefit of chiropractic care for lumbar spinal stenosis, this article highlights a specific technique called flexion-distraction manipulation. In this technique, a special treatment table is used that is designed to distract, or gently separate, the joints of the spine. When used, it feels like a gentle stretching or lengthening of the spine, which has been shown to decrease the pressure inside the intervertebral discs, relieve stress on other vertebral joints called facets joints, and reduce pressure on pinched nerves in the lower back. It is a gentle treatment that uses less force and more gradual pressure than the typical chiropractic adjustment and is tolerated quite well by most patients. At this time, Catalyst Chiropractic is not offering this specific treatment, but contact us for a local recommendation if you are interested in flexion-distraction therapy for your spinal stenosis treatment.

Where does whiplash pain come from?

sore neck?

When the cervical spine (neck) is subject to whiplash, there is usually a combination of factors that contribute to whiplash pain in the neck and back, and ultimately need to be addressed individually by a chiropractor, who maintains a “holistic” view of the patient’s whiplash pain. This article explains how chiropractors approach treating neck pain, back pain, and/or other whiplash symptoms, and help patients prevent chronic whiplash pain.

Whiplash Pain Management for Joint Dysfunction

Joint dysfunction from whiplash occurs when one of the joints in the spine or limbs loses its normal joint play (resiliency and shock absorption). A chiropractic technique called motion palpation gently moves the joint in different directions and assesses its joint play. When a joint develops dysfunction, its normal range of movement may be affected and it can become painful.

Muscle Dysfunction from Whiplash Injuries

When joint dysfunction develops, muscles are affected by becoming tense and overactive or inhibited and underactive. In either case, these muscles can develop trigger points that may necessitate whiplash treatment involving muscle relaxation or stimulation. Trigger points are areas of congestion within the muscle where toxins accumulate and can irritate the nerve endings within the muscle and produce pain. This whiplash pain can occur in the muscle itself or can be referred pain (perceived in other areas of the body). The muscle can also send abnormal neurological signals into the nervous system, which can then cause disruption of the ability of the nervous system to properly regulate muscles in other parts of the body, leading to the development of faulty movement patterns.

Faulty Movement Patterns and Whiplash Pain

It is thought that the intense barrage of pain signals from a traumatic whiplash injury to the cervical spine can change the way the nervous system controls the coordinated function of muscles. The disruption of coordinated, stable movement is known as faulty movement patterns which cause increased strain in the muscles and joints, leading to neck pain and back pain. They can involve the neck itself or can arise from dysfunction in other areas of the body such as the foot or pelvis. Instability is also considered part of faulty movement patterns. There are two types of instability that can occur in whiplash: Passive—the ligaments of the neck are loosened, making it more susceptible to whiplash pain; and Dynamic—the nervous system disruption causes a disturbance in the body’s natural muscular response to common, everyday forces. Instability can cause even mild, innocuous activities difficult to perform as they often exacerbate the whiplash pain.

Whiplash Pain from a Herniated Disc

The force of whiplash can cause injury to the discs between the vertebrae, and small tears can develop. If the gelatinous middle of the disc seeps out, it can irritate the nerve endings in this area. This is known as disc derangement. Occasionally, the gel can seep all the way out and press on a nerve root exiting the spinal cord behind the disc, known as disc herniation. A herniated disc may involve whiplash pain in the neck as well as sharp, shooting pain down the arm and possibly neurological symptoms such as numbness, tingling and muscle weakness.

Chiropractic Treatments for Whiplash

Each case of whiplash is different so it’s not possible to generalize about the chiropractic whiplash treatment. Chiropractors commonly employ different chiropractic treatments for whiplash, often including:

  • Manipulation
  • Muscle relaxation and/or stimulation
  • Various exercises
  • Ergonomic and lifestyle changes.
Preventing Chronic Pain from Whiplash

After sustaining whiplash injuries, it is fairly common for people to suffer from chronic neck pain. Chiropractors can detect certain factors in a patient’s history and chiropractic exam to better determine patients who may be more susceptible to chronic pain from a whiplash injury. This process will identify when aggressive preventative measures should be taken for patients who may be at a greater risk of developing chronic neck pain from whiplash injuries.

Research update: Which neck pain treatments work?

Which chiropractic treatment works best for neck pain

Research shows chiropractic care relieves both chronic and acute neck pain

Manipulation, or chiropractic adjustments, of the neck are a polarizing topic. There are some in the medical profession who denounce it as unnecessary and unsafe. On the other hand are the millions of chiropractic, osteopathic, and physical therapy patients who have benefitted greatly from cervical spine (neck) adjustments. The good thing is that as the chiropractic profession advances, more and more research is coming out to give scientific backing to the millions of personal anecdotes of successful treatment of neck pain with chiropractic care. There is already a plethora of evidence regarding the safety of chiropractic adjustments to dispute the claim that it is unsafe. Thankfully there is also mounting evidence, such as the study above, to prove that it actually works. The great thing about this paper is that it is a systematic review. In the hierarchy of scientific evidence, the systematic review is the top dog. What I find significant are two things in particular:

  1. It found a moderate-strong recommendation through a search of 41 high quality random trials that both chronic and acute neck pain respond well to chiropractic adjustments. This is significant because it has long been believed (I don’t know why) that only acute neck and back pain respond well to manipulation. This search found that chronic neck pain may even be more likely to improve with treatment.
  2. It’s not all about the adjustment. It lists other common treatments of neck pain, which can all be performed our chiropractor in Beaverton, Oregon! Even more awesome is that it lists which ones have shown good evidence of effectiveness and which have not. Many of you may recognize these therapies and have received them on multiple occasions, and it may surprise you that some of them are not effective! You’ll be happy to know that those therapies found in the “Weak Recommendation” or “No recommendation” are not therapies that we use much at Catalyst Chiropractic and Rehabilitation. The ones we use the most, and excel at, are those in the moderate-strong recommendation categories. They are not flashy, fancy, gimmicks, but they are tried and true methods that will get you out of pain and keep you feeling better for the long term.

Please contact us if you have questions about how we can help you find relief from your acute or chronic neck pain. 503-526-8782

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.

More evidence for positive outcomes for chiropractic treatment of lumbar disc herniations

Lumbar disc herniation and chiropractic adjustments

This study adds to the preponderance of evidence that chiropractic care is both a.) viable and effective as an initial option for conservative treatment of lumbar disc herniations, and b.) safe. Now, I’m not selling chiropractic as a magic bullet, one hit wonder, walk in the park, sure-fire quick fix for disc herniations. I try to give my patients realistic expectations and goals. The discs between your vertebrae do not heal quickly. They, like other ligamentous tissue, do not have a great blood supply, therefore they heal predictably slower than other tissues of the body. Thus recovery is inherently not as quick as most people would like. It is not realistic to expect a few adjustments to reduce a bulging disc or put a bone back into place and for all to be well again. Recovery is a process that involves multiple aspects, such as:

1. Education: Spine-sparing strategies are taught in order to avoid movements and positions that create more strain on the injured disc(s). This aspect of treatment is extremely important. When you have a herniated disc and a pinched nerve, there are some stretches that feel good in the short term, but in the long term are inhibiting the healing process. The first step is to educate to remove any barriers to a successful outcome.

2. Passive care: Passive care includes any external interventions, or those that don’t involve any effort on your part. This includes chiropractic adjustments (only one tool in our bag), joint mobilizations, traction, electrotherapy, low level laser, and kinesiotaping. Passive therapies are effective (as shown in the study above), but have their limitations and are not always as powerful as #1 and/or #3.

3. Active care: This includes anything that requires effort on your part, which is basically any of the stretches and exercises that you will be taught to perform in the office and at home to complement the passive portion of your treatment. This can make or break your recovery from lumbar disc herniation. No matter what condition we see in the office, the patients who see the best results and are happiest with the outcome of their treatment are those who are the most involved in their care and the most consistent with active care.