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Pregnancy and Low Back Pain

Did you know that between 50% of all pregnant women suffer from back pain and 50-75% experience back pain during labor?

There are MANY reasons why back pain becomes an issue for women during their pregnancy. The first and most obvious reason is the displaced weight gain of 25-35 pounds (on average) resulting in pain in both the upper quarter (often from the increase in breast volume and weight) and lower quarter (from the growing baby). As the baby develops, an expectant mother’s center of gravity moves forward causing her to sway back, which can overload the lower region of the spine. The women most at risk for pregnancy-related back pain include those who are overweight prior to their pregnancy, those who perform physically strenuous work, and those with a history of back pain.

Another factor that can increase a woman’s risk for back pain during pregnancy is water retention. Not only does retaining water increase the load the body must carry, placing added stress on the musculoskeletal system, but water retention has also been associated with stiffer joints throughout the body, which can increase the risk for musculoskeletal pain—including back pain.

The body requires more fluid during pregnancy to maintain the health of a growing baby, and drinking water is one of the best ways to hydrate. The American Pregnancy Association (APA) reports that the body produces 50% more body fluids during pregnancy.

Fluid retention is a common complaint during pregnancy. By the third month of pregnancy, approximately 50% of women notice swelling in their hands and feet and most have significant swelling by the third trimester. Sudden and new swelling in the face, hands, and eyes accompanied by blurred vision, severe headache, painful urination, and/or the inability to urinate with abdominal pain and hypertension (>140/90) may represent a medical emergency called pre-eclampsia. This occurs later in the pregnancy, usually after the twentieth week. If this is suspected, don’t delay in obtaining emergent medical care!

To combat fluid retention, avoid constrictive clothing around the wrists and ankles, rest with the feet elevated (especially when temperatures exceed 75-85º F / 25-30º C), use ice packs, wear comfortable shoes, and try support tights or stockings. Dietary options for reducing fluid retention includes the use of certain herbs and vitamins, and foods such as celery, onions, eggplant, garlic, parsley, mint, bananas, coconut, dandelion, melons, salmon (omega-3 fatty acids), cucumber, and more.

The Mysterious Sacroiliac Joint

Low back pain (LBP) can arise from a number of structures that comprise the lower back like the intervertebral disk, the facet joints, the muscles and/or tendon attachments, the ligaments that hold bone to bone, the hip, and the sacroiliac joint (SIJ). Though several of these can generate pain simultaneously, the focus of this month will center on the SIJ.

The role of the SIJ is quite unique, as it has a big job: it is the transition point between the flexible axial skeleton (our spine) and the pelvis, below which are the lower extremities or legs. The pelvis supports the weight of the torso, which usually accounts for about two-thirds of our body weight. The SIJ is shaped at an oblique angle that diverges or opens at the front and converges inwards at the back of the joint in order to support the weight on top of it. Because the sacrum/tailbone is “V” shaped, it fits like a wedge and is held together with very strong ligaments, making it an inflexible but sturdy joint.

Making a diagnosis of SIJ syndrome or identifying it as a pain generator can be a challenge. Your chiropractor may depend on several types of examinations in order to arrive at an SIJ syndrome diagnosis, such as palpation looking for pain directly over the SIJ; compression tests of the pelvis; front-to-back hip movements to stretch the joint; and imaging, such as x-ray, CT scans, and MRI.

Since the SIJ is NOT a flat and smooth oblique joint, x-ray has many limitations. However, the pubic bone called the “symphysis pubis” (SP), which is located in the front of the pelvis, can be easily seen on x-ray. Because the pelvis is a ring-like structure, an SP that is out of alignment may indicate SIJ dysfunction.

In a recent study, two independent orthopedic surgeons analyzed the x-rays of 20 consecutive patients (17 women and 3 men) with proven SIJ dysfunction and LBP (confirmed by SIJ injection testing), which resulted in the findings of osteoarthritic degeneration and subluxation (misalignment) in 18 of the 20 subjects.

When they assessed the SP in 20 non-SIJ LBP control subjects (16 women and 4 men), 7 had abnormal SP findings (35%) versus 18 of 20 with SIJ-LBP mentioned above (90%). A review of the patients’ past radiology reports found that only three reports mentioned this in the SIJ-LBP group and none reported this in the control group. The authors concluded that SP findings are underreported by radiologists, and because SP is much easier to “read” or assess than the SIJ itself, it NEEDS to be looked at!

Is Fibromyalgia-Type Pain Caused by Disk Herniations?

Disorders such as fibromyalgia, whiplash, and irritable bowel syndrome share the common symptom of muscle hyperalgesia (more sensitive to painful pressures and stimulation). Obviously, more sensitive patients may find it more difficult to stress their bodies with stretching or physical exercise. If you are more sensitive to pain, you may be more likely to consume pain relief or anti-inflammatory medications. These drugs can have unwanted side effects when taken over the long term.

In May 2007, the European Journal of Pain reported on a scientific study of the muscle dysfunction called muscular hyperalgesia in patients with disk herniations. The researcher team, based in Denmark, studied whether generalized deep-tissue hyperalgesia could be demonstrated in a group of patients with chronic low-back pain and intervertebral disk herniation. Twelve patients and twelve controls were exposed to painful stimulation at a shoulder and a leg muscle. They used deep pressure and injections of salt water to test how the patient reacted.

Patients with chronic low back pain and disk herniations demonstrated significantly higher pain intensity, duration, and larger areas of pain referral following such stimulation.

Whether consuming pain medications over many years is a wise option is certainly debatable. Studies of chiropractic care to treat back pain have shown good results with extremely rare risks/side effects. The adjustments are directed at the spinal joints and disks to affect the movement of the vertebrae and decrease pain.

It’s important to understand that fibromyalgia is a complex disease with many theories as to its cause. It’s unlikely taking a pill will be the total solution to the problem. We know that muscle pains are very common and exercises seem to improve the pain. There are also other issues to consider. The structures of the spine (such as the disks) help to guide and restrict movement, but when injured can be a significant source of pain. Making sure the spine is flexible from daily stretching, and not under undue stress (such as from excess weight) are important adjuncts of care.

 

Back Pain and Running

The first question with a back problem should be should I seek medical advice? The aim of this article is to help you answer this question.

Pain from the lower back can be severe and distressing but in most cases it is not due to serious disease or damage. The spine is a strong, stable structure that is unlikely to be harmed by normal everyday activities.

It is always recommended to seek medical advice for injuries, and this is especially true with back pain. That said, approximately 80-90% of us will have back pain at some point and not everyone will choose to see the GP. Ultimately it’s always your decision, but here is some guidance;

Likely to resolve with self management

  • Pain is only in the lower back and doesn’t spread into the buttocks, legs or feet
  • Pain is mild to moderate in intensity (if rated out of 10 where 10 is the worst possible pain, you’d rate it 1-6)
  • No pins and needles, numbness or unusual symptoms
  • You can ease your pain in certain positions or using medications
  • You’re generally well in yourself

Action – general back pain management advice (below) consult with GP/ Health Professional if pain worsens or doesn’t settle in 6-8 weeks. If in doubt get it checked out.

Definitely see GP/ Health Professional if…

  • Pain is more severe (you’d rate it 5-10 out of 10)
  • Symptoms spread into buttocks, legs or feet
  • You experience pins and needles or numbness in one or both legs or feet
  • Leg/s feels weak or heavy.
  • Pain is constant or harder to settle
  • Your pain started following a mild/ moderate trauma – heavy lifting, turning in bed
  • You have any previous history of cancer, TB or rheumatological conditions or your general health has deteriorated since your back pain started (especially if you have weight loss, night sweats, nausea or vomiting)

Action – see your GP or a health professional. Back pain with leg pain is a sign of inflammation around a nerve, especially if accompanied with pins and needles or numbness or weakness in the leg.

Attend A&E if along with back pain you experience…

  • Urine retention – feeling the need to pass urine but being unable to go
  • Faecal incontinence – losing control of bowel movements
  • Saddle paraesthesia – pins and needles or numbness in the groin and between your legs, may also include erectile or sexual dysfunction.
  • Gait disturbance – legs feel wobbly or unsteady and it’s affecting your walking.
  • Your pain started after serious trauma – RTA, fall from height, heavy collision during sport etc.

Action – head to Accident and Emergency (A&E) immediately. The above symptoms suggest more serious injury that needs immediate medical attention. There are a group of nerves in the lower back called ‘cauda equina’ these nerves supply the parts of the bladder and bowel involved in passing urine and feces. If there is compression to these nerves and it’s not addressed quickly it can have long term implications on bladder, bowel and sexual function. Thankfully this is rare, a study in 2007 estimated that it affects just 3.4 people per 1.5 million of the population. In my 10 year career I’ve only had to send 1 patient to A&E with suspected cauda equina compression.

General Back Pain Management Advice

Stay active – try and stay active where possible, this might include walking, cycling, gentle gym work or swimming you can do this by pacing yourself…

Pace yourself – often the key to managing pain is doing the right amount of activity, too much and you can get sore, too little and you can get stiff and weak. Pacing means doing as much activity as you can manage, usually this means ‘little and often’ rather than lots at a time. Gritting your teeth and pushing on through pain will often make pain worse. If you can run without pain (during or after) then you can continue to do so but don’t over do it – stick with gentle comfortable runs. Ideally you should be within the first category mentioned above (‘Likely to resolve with self management’) if not then consult your GP or health professional before returning to running.

Stay positive – the majority of low back pain settles in 6-8 weeks and can still be treated well beyond this stage. Keep a positive attitude and bare in mind severe pain doesn’t mean severe damage. The back is a sensitive area with multiple nerves which mean you can get severe pain there, even in the absence of significant damage.

Continue working – taking prolonged periods of time off work doesn’t always help back pain. When off work we tend to be less active and spend more time sat and the back stiffens and gets worse as a result. People that continue working usually tend to do better than those that stop. That said, jobs that involve very heavy lifting may prove very difficult – in which case request a period of time on light duties rather than stopping work altogether.

Avoid bed rest and prolonged periods of inactivity – the old advice of taking to your bed or sleeping on cupboard door has been shown to cause more problems than it solves! Long periods of sitting, standing or lying in bed tend to make pain worse. Most people do a lot better by staying active.

Use appropriate pain relief – many people are reluctant to take pain relief incase it ‘masks damage to the back’ (I.e. they worry they will damage their back if they use analgesia to reduce pain), this is not the case. Pain relief allows people to stay mobile which prevents the back becoming weak and tight. Movement is good for the back (as long as you don’t over do it) pace yourself and do what you can.

Try to settle symptoms – use heat/ ice, gently massage the area, try a few gentle back movements, have a swim, sauna or jacuzzi – see what works for you to settle your symptoms.

Final thoughts; back pain is very common and in the vast majority of cases does not involve serious disease or damage. The back is a strong stable structure, supported by strong ligaments and muscles and is capable of managing day to day activities. Most acute back pain will settle in 6-8 weeks, stay active, pace yourself and keep positive to help with a speedy recovery.

Low Back Pain and Weight Loss

Have you ever been told (or at least heard it said): If you could just drop a few pounds, your low back pain would improve? It’s pretty well accepted that excess weight contributes to low back pain. So, if that’s the case, which dietary approach is “…the best?”

Even though weight loss is very important, it can be very challenging for patients because it takes commitment to achieve long-term success. Sure, we can lose weight with the Adkins Diet, the Mediterranean Diet, the South Beach Diet, or through Weight Watchers and a host of other approaches, including weight loss acupuncture. But, why do we seem to gain it right back once we discontinue the diet plan? There must be a way to take the weight off and then keep it off.

We have a very similar genetic makeup to our Paleolithic (cave man-era) ancestors. Since this is a fact, we can look at the type of food our distant ancestors consumed and logically draw the conclusion that the “Paleo diet” or “caveman diet” would be a great alternative to our current diet. Thankfully, this does not mean that we change our wardrobe and lifestyle to the point that we go back and live in caves and throw spears to hunt and gather!

What it does mean, however, is we consume similar foods: grass fed animal meat (the more lean the better) and food that grows off the land – that is, fruits and vegetables. These foods are easily broken down and assimilated without alerting our body’s defense system (the autoimmune system) that some foreign particle is inside of us resulting in an army of antibodies showing up to ward off these enemy particles. By avoiding this autoimmune response, at the same time, we are reducing or avoiding the inflammatory process all together, which is a common denominator to all illnesses, including musculoskeletal conditions like back pain.

So, what do we eat too much of now that the cave man didn’t eat? The answer is gluten! Most flour-based products (bread, pasta, cookies, cake, etc.) contain gluten and are “pro-inflammatory” or cause systemic inflammation. Over time, this can lead to weight gain, diabetes mellitus, heart disease, stroke, as well as a host of many other conditions. The reason glutens are bad is that our bodies are not genetically able to handle the breakdown of these large “macromolecules.” When glutens are detected, we produce antibodies to attack these particles that are resting on the intestinal wall, which in turn, is damaged in the process, resulting in a “leaky gut” allowing the absorption of these large particles. This results in yet further autoimmune responses as these large (normally not absorbed) macromolecules are detected in our blood stream, thus furthering the inflammatory process. This damage leads to further malabsorption syndromes and a vicious cycle is created. So, what can we do to prevent this from happening and, how can we reduce the inflammation through our diet?

Easy! Just stop eating glutens! Over time, your weight will drop, your energy levels will increase, and when the mental fog lifts, you’ll feel 10 years younger and you’ll be able to enjoy life more completely. Sound too good to be true? Try it – prove us wrong – we dare you! ????

Chicago Back Pain Help

Back Pain is VERY likely to affect all of us at some point in life. The question is, do you control IT or does IT control you? Here are ten “tricks” for staying in control of “IT!”

1) STRETCH: When you’re in one position for a long time (like sitting at your desk), SET your cell phone timer to remind yourself to get moving and stretch every 30-60 minutes! Mornings are a great time to stretch.

2) BE SMART: Do NOT place your computer monitor anywhere other than directly in front of you. Shop carefully for a GOOD supportive office chair that is comfortable and a good fit.

3) POSTURE: For sitting, sit as upright as comfortably possible keeping your chin tucked in so the head stays back over the shoulders.

4) SHOE WEAR: Avoid wearing heels greater than one inch high (2.54 cm). A supportive shoe that can be worn COMFORTABLY for several hours is ideal! Generally, the “skimpier” the shoe, the worse the support, so don’t “skimp” on shoe wear!

5) SMOKING: Carbon monoxide from cigarette smoke competes with oxygen at each cell in the body literally suffocating them, which makes the healing process more difficult.

6) WEIGHT: Your body mass index (BMI) should be between 18.5 and 25. Search the internet for “BMI Calculator” and plug in your height and weight to figure out yours. BMI is a reliable indicator of body fatness and a great way to determine where you are at for goal setting.

7) ANTI-INFLAMMATION: Common over the counter (OTC) medications include ibuprofen and naproxen. However, recent studies show these types of medications (NSAIDS) may delay the healing process. A healthier choice is ginger, turmeric, and bioflavonoids, which are commonly bundled together in a supplement. Eat fresh fruits, veggies, lean meats, and food rich in omega-3 fatty acids. Vitamin D, magnesium, and coenzyme Q10 are also smart choices. AVOID FAST FOOD as they tend to be rich in omega-6 fatty acids, which can promote inflammation.

8) ICE: This could be included in #7 but deserves its own space. Ice reduces swelling while heat promotes it. Try rotations of ice every 15-20 minutes for about an hour three times a day to “pump” out the swelling!

9) STAY ACTIVE: Balance rest with physical activity like exercise or simply going for a walk. The most important thing is to move your body around.

10) STRENGTHEN: Core stabilizing exercises (sit-ups, planks, quadruped) and BALANCE exercises are VERY important!

Active Release Therapy – Chicago

Active release technique, also known as ART, is a combination of movement and massage to treat pain in ligaments, nerves, tendons, muscles, and other connective tissue in the body, according to practitioners. Some people admit it can be painful.

“This is quite different from a massage,” says Jessica Tranchina, an Austin, Texas-based ART-certified therapist. “It’s not relaxing, in fact it hurts.” She is usually works on specific muscles rather than the whole body.

P. Michael Leahy obtained a patent for ART in 1990. Dr. Leahy is the team soft-tissue specialist for the Denver Broncos, and the head of the ART treatment team for the North American Ironman Triathlons. Dr. Leahy and his staff in Colorado Springs, Colo., train and certify ART therapists.

Though professional athletes use the technique, people who sit at a desk and suffer from neck, back and shoulder pain can benefit, says Ms. Tranchina. The idea behind ART is to identify scar tissue on and in between a patient’s muscles. Scar tissue can make muscles shorter and weaker and nerves can become compressed. ART therapists break up the scar tissue by applying pressure with their hands to lengthen the tissue.

Robert Gazso, an ART physiotherapist at Studiomix, a fitness studio in San Francisco, says other types of massage don’t allow for the proper tension on the muscles to break up scar tissue: “We are prying a muscle off of a muscle or a nerve off of a muscle by breaking up the scar tissue with our fingers,” he says.

A. Lynn Millar, a physical-therapy professor at Winston-Salem State University says ART is like deep tissue massage and myofascial release, which treat chronic pain. “It’s the same principle of breaking up scar tissue so that the muscles move more freely,” she says.

Active Release: Chicago In Health Center – More Details

What Can I Do to Prevent Low Back Pain?

Back Pain – Chicago

One important concept in back pain is making the patient an active participant in their rehabilitation. It’s important to change our sedentary lifestyles so that we not only get well, but also do things that prevent problems from occurring in the first place. But first, it is important to understand how back injuries occur. When we bend and twist and pick up things, tremendous forces are placed on the disks and ligaments of the spine. It’s important for muscles to be coordinated and flexible so you have maximum strength to resist.

Hopefully you’ve begun an exercise program. One of the more neglected areas of daily spinal hygiene is stretching. By stretching the muscles that move the bones and joints, we make them more flexible. This can make you more resilient at resisting heavy or awkward loads.

The important thing is to do stretches correctly. In general, you want to be warm when you stretch. If you’re not too warm, then proceed slowly, gradually bringing more circulation to the area. After a long walk is a good time to stretch. You can also do stretches throughout the day, even in your office chair. Simple hand and shoulder stretches can be done at the computer and they can help to release tension in the shoulders and wrists.

It’s helpful to hold the stretch for at least 40 seconds so that the muscles have a chance to respond and elongate, and do not bounce or move in a quick or rapid way.

If you have a back or other joint injury, it’s important that certain stretches are avoided, because they can further increase the stretch on ligaments. For example, you may not be able to touch your toes right now, but there are better ways to gain this flexibility than through toe-touching stretches. This is because bending forward can also aggravate a lower back condition. Instead, try bringing the leg up to stretch the back of the thigh by placing the foot on a chair or table. By keeping the low back in good upright posture, the back of the thigh is stretched while also lowering the stress on the spinal disks.

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