The Multiple Causes of Low Back Pain

Today, I will focus on one specific presentation of low back problems. But before we turn our attention to only one, I would like for the reader to understand that every low back is different. Truly examining the function of the system and being able to pick out where it breaks down and for what reason is the beginning of the road to recovery. Find a practitioner with the knowledge and skill to repair it once they've found it and you're set. Since every case is different, the treatment should be unique to every patient. Dr. Terry Elder said it perfectly, "never make a patient fit your style of treating; make your treatment fit the patient." 

One common cause of low back pain is facet syndrome. The facets are synovial joints, just like the knuckles of your fingers, that slide along each other and both allow for movement and limit it, and they are innervated, which means that they can feel pain. The person with "facet syndrome" overloads these structures too much of the time and creates injury and an inflammatory process within these joints. The natural load of gravity should be shared by the disc, the front of the vertebra, and facet joints, at the back. This person carries a much larger percentage of the load on the facet joints due to their posture. They have a deep curve in their spine when standing naturally, and the situation gets worse when walking or participating in other activities. Why? Because, this person has tight muscles that are pulling their pelvis and spine into extension while other weak muscles are not stopping it. Why? Maybe because they had a small injury that has altered which muscles the brain picks to accomplish certain tasks for avoiding pain, or maybe this person sits all day and shortens/tightens those muscles and inhibits the others, or there could be a lot of reasons. Why? Don't worry about it, because we know what it is, how to fix it, and the main ingredient….how to avoid it. 

Muscles that get too tight in this case are usually the hip flexors (psoas, rectus femoris, or tensor fascia lata) and the erector spinae (simply the erectors). The former pull the pelvis and lumbar spine into extension and the latter crunches the low back into extension and compression. The tension in these muscles must be manually released.

The weak muscle is the gluteus maximus (according to Body by Jake, the "butticimo"). It should be the main extensor of the hips, but in this case cannot be isolated from the overactive erectors. This muscle must be trained to work in isolation, not strengthened but woken up.

And finally, going right to the source, the chiropractic portion of the story, tension must be released from those facet joints. The adjustment should be careful to avoid extension and provide flexion to the spine. For this person, nothing is better than the right adjustment.

Exercises should focus on lengthening the hip flexors, isolating the glutes, and bracing the low back by addressing the core musculature. Teaching this patient how to maintain a neutral spine is also very helpful.

This is only one out of so many causes of low back pain, and even this type of low back must be treated uniquely from another person with the same type. There is never a cookie cutter answer to fixing low back problems. To speak with someone about this or other topics, please contact In Motion Spine and Joint Center at (615) 302-4747.

Are You Getting Worked Out or Worked Over?

Logical Thoughts on Resistance Training

Many people know about the positive effects of a resistance training program on weight control, muscle tone, strength, and overall health. Some even take action and get into the gym or wipe off the dusty weight set in the basement. I am a huge fan of resistance training and do so myself, but there are a few considerations to help avoid injury, especially if you don’t spend the money to have a personal trainer’s instruction.

We will not go into different spine types for fear of boring The Informer’s audience to tears, but all low backs are different and could use a customized program to strengthen their weaknesses. But regardless of the spine, its function on everyone is the same. We need to think of the spine and muscles directly around it as stabilizers more than movers. It is the solid foundation or “core” for the extremities to move off of. This is proven by how short, paper-thin, or overly attached to adjacent bones all of the spinal muscles are. If the spine were supposed to be a mover it would have long and thick muscles like the hamstrings or biceps pulling all around it.

With this in mind, we should train the spine as a stabilizer. Stability is being able to not move and withstand a force being applied. Exercises such as Bird Dogs, Dead Bugs, Side Bridges, Front Planks, Push Ups, etc. are all great for training spine stability.

When we train the “movers” of our bodies, from the shoulder to the hand and hip to the toes, we train for strength. Strength is the ability to move an object or apply a force. When we train our extremities for strength move them while you stabilize your spine. A great way to do this is to put on a weight belt fairly loosely and around your belly not your hips. Then, tense up your abdominals on the sides, front and back so the belt becomes tight. Now you are much safer during each lift, even safer than starting with a tight weight belt!

As an experiment, stop doing your sit-ups, ab flexion / extension machines, decline crunches, etc. for two months, do the weight belt trick, and core stabilizing exercises. I bet your back will feel better than ever, and you will not lose “one can out of your six-pack” if you had it in the first place. If you should have any question about your spine or how to improve its health, feel free to call In Motion Spine & Joint at 615-302-4747 or read more on www.imsjc.com.

Does Your Warm-Up Stack Up

Most everyone either warms-up or thinks after starting whatever activity they do that they should have warmed-up. The question is….how effective is your warm up? Or would it be if you did one?

Let's go over a little bit of the current research about stretching to start since so many include it in their warm-up. Behm and others (Medicine & Science in Sports & Exercise; Aug. 2004) found that stretching actually impairs balance and reaction/movement time of the legs. Obviously we don't want this during a demanding activity. Other studies have suggested that too much focus is placed on stretching and that it could actually create joint laxity, making that joint more susceptible to injury. Many experts have found that long isolated events of stretching are much less effective than stretching for only 30 seconds one time per day.

The objectives of a proper warm-up should include: raising the core body temperature 1-2 degrees, slightly increasing heart rate and blood flow to and from the body's tissues, "waking up" the central nervous system, preparing muscles and joints for sport specific motions.

Clicking and Pain and Headaches, Oh My!

A Conservative Approach to TMJ Problems

The TMJ is the joint between the jaw or mandible and the skull, specifically the temporal bone (hence temporomandibular joint). It is a very mobile joint, not only providing rotation but also gliding motion during mouth opening and closing. It is used every time we chew, talk, or even swallow. Its anatomy as well as movements are very complex and very often become dysfunctional. This dysfunction can cause pain in the jaw or face, popping or clicking during chewing, limitation of jaw movement, and even headaches/migraines.

The conservative approach taken to temporomandibular dysfunction at In Motion Spine & Joint Center consists of a detailed examination of the joint and its function, as well as function of the upper cervical (neck) spine and head/neck posture, due to their direct relationship. Treatment focuses on first releasing the tension of the proper soft tissues, in some cases mobilizing the jaw or manipulating the neck, and then teaching the patient how to retrain proper jaw motion with rehabilitation exercises. Following treatment, very small lifestyle changes must be implemented to avoid further injury to this joint. The goal of treatment is to restore proper function of the joint and stabilize its motion.

Some cases of TMJ dysfunction may require consult with a dentist for fitting of an orthopedic appliance, and still some cases may require surgery if joint derangement or pathology is present. However, specific, prior testing should be performed on each patient to rule in or out the need for non-conservative treatment. The current literature suggests that a brief trial of conservative care should be tried even before probable arthroscopic or microsurgery cases.

There is hope for a clicking jaw, painful joint, or headaches even if a patient has been dealing with the problem for years.

For more information information about TMJ dysfunction or treatment options, please contact In Motion Spine and Joint Center at (615) 302-4747.

Tension Headaches

Many patients come into the office with headaches that have been diagnosed as migraines, cluster headaches, sinus headaches, etc. and end up getting great relief under our care. The reason I feel that they benefit so greatly is because most headaches have multiple causes and commonly, one of those causes is muscle and joint dysfunction.

In this article I will go over a few of the musculoskeletal conditions that contribute to headaches and what symptoms you may feel with that condition.

TMJ or Jaw Dysfunction is a common cause of tension headaches. Pain is usually just in front of the ear and can radiate around the ear or toward the temples. It can be associated with chewing, or get worse at night for those that “clinch.”

Those with shoulder trouble can get tension headaches as well. Problems in the shoulder force the neck muscles to work overtime to accomplish tasks at or above shoulder level. The overworked muscles tug on their sensitive attachments at the skull and cause the headache and referral of pain. Pain is often around the base of the skull to the forehead or temple.

Poor posture is another heavy hitter. Desk workers or anyone that spends a lot of time with their neck and shoulders forward are the main target. They get sort of “locked” into this position and repetitively strain their upper back and neck muscles from fighting gravity. This person’s headache often starts at the base of the neck and goes in a band around the head or behind the eye.

If you are a headache sufferer and get great results with your current treatment, wonderful; but if your relief is less than ideal you may have a tension component to your headaches. You have nothing to lose but your headaches by consulting with Dr. Hawkins or Dr. House, who treat these conditions with high success rates. At In Motion Spine & Joint Center, these problems are addressed through specific muscle stretching, joint manipulation, rehab exercises, and proper advice. For more information please visit WWW.IMSJC.COM or call 615-302-4747 and as always, Get In Motion Spring Hill.

Corticosteriod Injection VS. Soft Tissue Manipulation

It is often asked whether a patient should get a “cortisone shot” or receive some other form of treatment for certain conditions such as tennis elbow, shoulder pain, etc. This a decision that should be made by the patient and their doctor after examining the risks, benefits and alternative forms of treatment.

When comparing the success of Soft Tissue Manipulation to Corticosteriod injections, the British Medical Journal found that the injections have been shown to be more effective for short-term relief. Corticosteriod injections, however, have a much higher reoccurrence rate of injury/ pain and also have poorer outcomes in the long term when compared to soft tissue manipulation. Also, those who received soft tissue manipulation for their initial treatment sought significantly less other forms of treatment.

The study concluded that the corticosteriod injection does not aid in the healing of the tissue and does not correct any flaws in the biomechanics. This being said, a conservative approach to many soft tissue injuries would be to apply soft tissue manipulation and/or therapeutic exercises. This treatment would be aimed at releasing the structures that are tight and rehabbing the structures that are weak. If these are unsuccessful the use of corticosteroid injections is still an option that can be considered. Some of the risks associated with corticosteroid injections are avascular necrosis (especially of the hip) and the inhibition of certain connective tissue that aids in the healing process which therefore increases the risk of tendon rupture.

As with any form of treatment, there is "A Time and A Place" for everything, and this decision should be made collectively between you and your doctor.

If you would like the references used in the article or more information on Soft Tissue Manipulation performed at In Motion Spine and Joint Center, please contact us at (615) 302-4747.

Heel Pain Slowing You Down?

Logical Considerations for Plantar Fascitis

Summer weather has set in, and so have summer activities. Flip flops and sandals are on every other foot you see. When feet get challenged each year by wearing unsupportive footwear and increasing activity, many of us fail the test. Heel pain becomes a very common problem.

Plantar fascitis, cited by many to be the most common cause of heel pain, is an inflammation of the soft tissues on the underside of the foot, the "plantar fascia." Pain is commonly at its worst during the first few steps after a night’s sleep. It occurs in about 10% of the general population, and may show a peak incidence among women 40–60 years of age. It is caused by repetitive faulty function of the foot placing excessive tension on the plantar fascia.

Every step we take is a complicated process requiring control and timing. If any part of this process breaks down, the foot takes a beating.

There are two foot types that are predisposed to this problem, "flat feet" and "highly-arched" feet. They both place excessive tension on the foot’s structures; however they must be treated very differently.

"Highly-arched" feet suffer because their tissues and joints are too tight to begin with. Each step instantly places tension on this tight plantar fascia. "Flat footed" people have a foot that is too sloppy. Through every step the plantar fascia and foot joints are stressed from too much motion. These conditions should be treated individually and not lumped together.

Many people associate plantar fascitis with heel spurs. Heel spurs result from increased traction on the heel stimulating bone growth. However, the heel spur is not the cause of pain, it is the result of a long standing foot problem. The change within the plantar fascia causes the pain. This is very promising because soft tissues can be treated non-invasively but bony spurs can’t.

Rest and avoiding the problem will help decrease the pain, but the problem, foot dysfunction will persist. Treatment with Active Release Technique® and specific rehabilitative exercises are very effective at addressing this problem. Don’t let heel pain slow you down this summer season. If you have any questions, please contact In Motion Spine and Joint Center, please contact us at (615) 302-4747.

An Update On Active Release Technique for Soft Tissue Injuries

Dr. Mark Hawkins of In Motion Spine & Joint Center recently traveled to St. Louis, Missouri to study the latest research in soft tissue treatments.

Patented as Active Release Technique (ART), the doctors spent February 22nd -25th with leaders of the manual care field honing their skills with this particular treatment protocol.

ART is performed on specific structures on the body that may have formed scar tissue due to over-use, acute injuries or inflammation. This scar tissue can increase and keep tissues from moving freely. As the scar tissue builds up, muscles will become shorter and weaker, the increased tension on the tendons causes tendonitis, and nerves can become trapped. This can cause reduced range of motion, loss of strength, and pain. If a nerve is trapped you may also feel tingling, numbness, and weakness. By palpating, or “exploring” the area in question, doctors can find these areas of scar tissue, also known as adhesions, and help remodel the tissue and reduce the scar tissue. This can often increase the range of motion, decrease pain and help prevent other areas of the body from becoming "over-worked".

ART consists of more than 500 specific clinical applications for the effective treatment of various soft tissue conditions ranging from headaches, back and joint pain to carpal tunnel, sciatica and plantar fascitis. The benefits of ART are increased when used in conjunction with joint mobilization/manipulation and therapeutic exercises. ART is so effective, that it has been used on U.S. Olympic Teams, Ironman participants, and professional teams, including the Tennessee Titans. For questions about Active Release Technique, please contact In Motion Spine and Joint Center, please contact us at (615) 302-4747.

What is Manual Therapy?

By definition Manual Therapy is a clinical approach utilizing skilled, specific hands-on techniques to diagnose and treat soft tissues and joint structures for the purpose of decreasing pain and inflammation; increasing range of motion (ROM); improving tissue repair and improving function. These therapies include, but are not limited to, joint mobilization, joint manipulation, soft tissue manipulation, myofascial release (ART®), therapeutic exercises, and neural mobilization techniques.

The term applied to the use of several of these techniques together is a "multi-modal approach". The reason this is so effective is simple, but often overlooked. A multi-modal approach allows the practitioner to treat the function of the individual. The function of the neuromuscular system is as true as anatomy. How an individual walks, moves, bends or lifts can determine which structures are susceptible to being over-loaded, under-loaded or injured.

Another reason a "multi-modal" manual therapy approach should be taken is because the most current research in the field of neuromuscular treatment has exposed it to be the most effective. The combination of muscle work (myofascial release), therapeutic exercise (correcting abhorrent movement patterns) and joint mobilization/manipulation (joint restrictions) gives superior results when compared to performing just one of these forms of treatment.

The long and the short of how a manual therapy clinic works would be: Treat tight/short muscles with a myofascial release technique; Treat a weak muscle with a therapeutic exercise; Treat a joint restriction with a joint mobilization or a manipulation – and this would be performed on an individual basis, because your problem is probably a little different than your neighbors.

For more information about Manual Therapy, please contact In Motion Spine and Joint Center, please contact us at (615) 302-4747.