Injured in an Auto Accident? Chiropractic Care is an Important Part of your Recovery.

Auto accidents can cause a wide variety of injuries, and one of the most common types of injuries seen in these cases is whiplash. Whiplash is a neck injury that occurs when the head is suddenly and forcefully jerked forward and then backward, similar to the cracking of a whip. This type of injury can be caused by the sudden impact of a car accident, and it can cause a range of symptoms including neck pain, headaches, dizziness, and even tingling or numbness in the arms.

Another common injury seen in auto accidents is low back pain. The sudden impact of a car accident can cause the spine to be compressed, leading to strain and sprain of the muscles, ligaments, and even the bones of the lower back. This can cause a range of symptoms including pain, stiffness, and difficulty moving.

Chiropractic care can be an effective treatment option for both of these types of injuries. Chiropractors are trained to diagnose and treat a wide variety of musculoskeletal conditions, and they use a range of techniques to help alleviate pain and improve function.

When it comes to treating whiplash, chiropractors will often use manual techniques such as spinal manipulation or mobilization to help restore proper alignment to the spine and reduce pain and stiffness in the neck. They may also use other therapies such as deep tissue massage, ultrasound, or electrical stimulation to help relieve pain and inflammation. Chiropractors will also usually make recommendations for exercises and stretches that can help improve range of motion, reduce pain, and promote healing.

In the case of low back pain, chiropractors will also use manual techniques such as spinal manipulation or mobilization to help restore proper alignment to the spine and reduce pain and stiffness. They may also use other therapies such as deep tissue massage, ultrasound, or electrical stimulation to help relieve pain and inflammation. Chiropractors may also make recommendations for exercises and stretches that can help improve range of motion, reduce pain, and promote healing.

It's important to note that Chiropractors can also be helpful for the patient's rehabilitation process after a car accident by providing a proper diagnosis and treatment of their symptoms, as well as soft tissue therapies to help with any muscle spasms, strains or sprains.

Additionally, Chiropractors may also collaborate with other healthcare providers such as primary care physicians, physical therapists, or specialists, if necessary. They may refer patients to these providers for additional testing or treatment, or they may work with these providers as part of a multidisciplinary team to provide the best possible care for the patient.

In conclusion, chiropractic care can be an effective treatment option for both whiplash and low back pain caused by auto accidents. Chiropractors use a variety of techniques to alleviate pain and improve function, and they can also play an important role in the rehabilitation process after a car accident. Additionally, working with other healthcare providers as needed, making chiropractic care a very valuable asset in the healing process after an auto accident

How Chiropractic Care Can Alleviate Sciatica

Millions of Americans suffer from sciatica every year; sometimes, the pain is minimal, and other times it’s intense. In either case, finding the right chiropractic treatment will ensure you get optimized care that delivers results. 

Chiropractic care is proven to help end pain by finding what’s causing it. Our comprehensive approach will dictate a rehabilitation plan that reestablishes and restores your full function, taking pressure off affected areas, including those found within the sciatic nerve.

In this article, we’re answering: 

• What is sciatica?

• What are the symptoms of sciatica?

• Who gets sciatica and why?

• Can a chiropractor cure sciatica?

• And more

If you think you have sciatica and want to know what you can do about it, this post is for you- read on…

What is Sciatica?

The sciatic nerve is the largest in the human body, running from the lower back down each buttock and into each leg. Sciatica is the result when undue pressure is put upon the nerve, often because of imbalances in other soft tissues. 

Sciatica Symptoms

Sciatica discomfort comes in an array of forms and severities and can affect many kinds of people from differing lifestyles and with various abilities. Sciatica usually only affects one side of the body, but the whole body can pay the price if it goes untreated.

Common symptoms of sciatica include: 

• Pain in the back, low back, hip, buttocks, or back of the thighs

• Radiating pain from the low back into the buttock or back of the thigh

• Burning sensations in the affected area

• Sharp, intense pain

• Dull, aching pain

• Weakness and motion or flexibility loss

Because we rely on the function of our sciatic nerve for several lower body movements, getting efficient, beneficial care is important to your daily activities. 

How Did I Get Sciatica? 

Sciatica may occur due to anything from a sports accident to poor posture to arthritis. Finding out the cause of your condition is an essential step to ensure you get the proper treatment. 

Common reasons and conditions that lead to sciatica include:

• Herniated disc

• Degenerative disc disease

• Poor ergonomics

• Improper workstation setup

• Pregnancy or weight gain

• Habitual poor movement patterns

• A traumatic event, like a car accident

• Slip and fall
  
  
  

Masking your pain should not be an option; chiropractic methods offer targeted solutions that fix the root cause of your discomfort, so you find symmetry and comfort. 

Chiropractic Care to End Sciatica

Chiropractic care has been used by many to help find relief and recovery without the use of pain medication or aggressive treatments. 

These non-invasive services heal the sciatic nerve and restore proper function, alignment, and movement patterns quickly and effectively. 

Some common chiropractic techniques to correct sciatic nerve imbalances and injuries include: 

• Chiropractic care and adjustments- therapies that manipulate joints and soft tissues that are restricted or compromised, allowing correct movement patterns and flexibility, decreasing pressure in affected areas

• Functional dry needling- tiny needles placed in the skin above injured and painful tissues, improving circulation and healing

• Sports injury and rehab- directional guidance through exercises and stretching techniques that enhance recovery and performance

• Kinesio taping- taping that allows the soft tissues around an injured muscle to move with the body while the injury receives support 

We believe in a full-body treatment plan because we understand how the connectivity between nerves, ligaments, tendons, muscles, and joints must work in unison. In many cases, several chiropractic solutions will be implemented to garner the fastest, safest recovery.

At-home exercises and proactive care education also play an essential role in getting stronger and maintaining good health. 

Visit Revive Sport & Spine for Your Sciatica Treatment 

Our Midvale chiropractic clinic has solutions that end sciatica and all of the symptoms arising from it. We value the importance of your healthy lifestyle and know that living in comfort is your priority. 

Let our team find the unique wellness plan for your needs and get you back out there, doing everything you love. 

Book with us today, and take the first step in stopping your sciatica pain.

Spinal Manipulation - Who Benefits Best From This Effective Treatment Option

Spinal manipulation, the hallmark of Chiropractic Medicine….

First -> Let’s address the elephant in the room! Spinal Manipulation has been touted to help or heal everything from low back pain to the common earache and yearly influenza epidemic. While many practitioners, and patients alike, claim that a chiropractic ‘adjustment’ cured all their ills, current research does not support those claims. We are not here to call those cases out as some people honestly did find an improvement to their conditions through spinal manipulation, we just can not provide consistent results to a large number of subject to clearly understand the mechanism.

However; Low Back Pain, Neck Pain, Muscle and Joint Injuries, Strain/Sprain Injuries…we have mounds of data to support the effectiveness of manipulation and manual therapy in these cases. So much, that we can now predict who will benefit best from this type of care.

What Does Spinal Manipulation Look Like?

Before we jump into what we call ‘Clinical Prediction Rules’ regarding joint manipulation, please realize that each person is an individual, and each condition is as unique as the person who presents with it. Utilizing these rules is not the end all be all; there will be outliers. Some people have tried joint manipulation, or exercise, or dry needling, or a myriad of other therapies with little to no results. Sometimes their condition is passed this type of intervention and needs to bypass conservative care for more invasive options. Moreover, many of these patients either receive ONLY ONE therapy or had the wrong ‘concoction’ of care for their condition, or the phase of healing they were in when the therapy was used was incorrect causing poor timing to be the culprit of poor outcomes. So…if you have tried a few of these, don’t give up and completely write them off. Get a second or third option, look at it with a set of fresh eyes and try a new direction, a new order of care and see how your condition improves.

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Now, back to the predictions. Below are what we consider to be the characteristics of patients who research predicts will have the best and fastest outcomes from spinal manipulation.

1. The Number Of Days With Your Current Low Back Complaint is LESS THAN 16 Days.

2. Pain & Radiation Of Symptoms (Pain, Numbness, Tingling) Does Not Go Farther Than The Knee.

3. Fear Avoidance Behavior Assessment. You Do Not Fear That Your Back Pain Will Last Forever and Will Not Keep You From Enjoying Life In The Future.

4. Through Examination, Movement Assessment, and Provider Palpation, At Least 1 Spinal Segment of the Lumbar Spine is Restricted/Hypomobile.

5. At Lease 1 Hip Has More Than 35 Degrees of Internal Rotation.

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So What Does This Mean?

If you present to an office like ours with ACUTE LOW BACK PAIN that is RADIATING PAIN TO THE GLUTES, RESTRICTED LUMBAR SPINE ROM, and ONE HIP HAS RESTRICTED INTERNAL ROTATION ROM…

YOU ARE A GOOD CANDIDATE FOR SPINAL MANIPULATION

&

WE SHOULD ANTICIPATE GREAT RESULTS.

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Two studies on spinal manipulation, utilizing these Clinical Prediction Rules found:

• Patients who presented with less than 4 of the 5 above rules, had a 45% likelihood for a positive response from spinal manipulation.

• Positive Response means that after 2-3 treatments with spinal manipulation, patients saw a 50% reduction in symptoms and pain.

• A patient who presented WITH at least 4 of the 5 rules, increased their likelihood of a positive outcome to 95%.

• Another study, utilizing a side-lying lumbar manipulation technique along with ROM exercises, found a 50% reduction in symptoms in 11 of 12 participants. The one participant who did not respond still found a reduction in symptoms, but did not reach the 50% reduction mark the study considered as a ‘positive outcome.’

In summary, Spinal Manipulation is an effective and safe tool for low back pain. But it is just that, a tool! Care that relies on only one treatment modality will only be somewhat useful to a specific, and small, population. Care that focuses on the patients' individual presentation and goals, and adapts a variety of therapies for that particular condition will typically yield the best results. If you have tried manipulation, PT, massage, dry needling, or any other therapy as a stand-alone treatment option, I invite you to give us a call to see how we can develop a better treatment plan around your personal goals.

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Resources:

Cleland, JA et al. The Use of a Lumbar Spine Manipulation Technique by Physical Therapists in Patients Who Satisfy a Clinical Prediction Rule: A Case Series. JOSPT 2006.

Flynn, T et al. A Clinical Prediction Rule For Classifying Patients With Low Back Pain Who Demonstrate Short-Term Improvement With Spinal Manipulation. Spine 2002.

Childs, JD et al. A Clinical Prediction Rule To Identify Patients With Low Back Pain Most Likely To Benefit From Spinal Manipulation: A Validation Study. Annals of Internal Medicine 2004.

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Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Cottonwood Heights Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.

Sciatica Pain Relief Part 3: Self-Care & Everyday Actions That Make Sciatic Pain Worse

If you are tracking along with us on this journey of everything Sciatica, your patience and dedication is about to be rewarded. In Part 1 of our Sciatica Pain Relief series, we discussed what Sciatic Nerve pain is and the associated anatomy (always my favorite part). In Part 2 we went a little deeper with the 5 most common causes of Sciatica and touch on a few of the red flags we want to rule out as soon as possible. Having made it through those two very information-heavy articles, it is time to look at what YOU can do to improve your situation as well as some of the most common everyday actions that may be the primary cause for your Low Back and Sciatic Nerve pain.

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EVERYDAY ACTIONS CONTRIBUTING TO SCIATICA PAIN

SITTING:

To some, sitting may seem like a crazy thing to make sciatica worse. However, for those who experience this daily, it is a very real thing. To put this simply, sitting compresses the muscles of the posterior hip, possibly putting pressure on the sciatic nerve. Also, the position of sitting puts tension on the entire posterior chain (back, hip, glutes, hamstrings) potentially irritating the sciatic nerve at the spine, hip, or back of the thigh. Many people with sciatica report finding relief by standing and walking around.

TRAVELING:

Traveling is similar to sitting in that you take the nature of sitting and compressing the sciatic nerve, and add in the cramped, tight situation of traveling on a plane or car. In addition to this, a hotel bed, or worse, your second cousins blow up mattress in their spare bedroom is not making the situation any better.

EXERCISE ROUTINE:

Many patients will relate that exercises such as squatting, deadlifting, and rowing can cause their sciatic nerve pain to worsen. The end range of these exercises, tension on the sciatic nerve, and the repetitive nature of exercise all create the perfect storm to irritate a long-standing sciatic nerve issue.

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HOME CARE OPTIONS FOR SCIATICA PAIN RELIEF

While many sciatica cases require some formal care, all can benefit from frequent attention through home and office-based stretches and exercises. Below are some of our favorite ‘moves’ to help relieve sciatica pain. The truth here is that sciatica relief and recovery takes time, effort, and focus. Do a stretch one or two times is not enough. You may need to perform one of these every hour. You may have to modify your workspace. Guidance here is one aspect of care in our office but the responsibility to complete these is on the patient. Simply put, the more you focus on care outside of our office, the faster your issue typically resolves.

*NOTE: If any of these stretches increase your symptoms, stop and seek professional care. These exercises are not intended to diagnose any condition. Understanding of these exercises and the prescription of these should be performed by a trained provider.

Seated Sciatica Relief - 2 Best Chair Stretches

Best Sciatica Stretch - Utah Sports Chiropractor

Sciatica Self Release - Foam Roller & LaX Ball

Flexion & Extension For Low Back & Sciatica Relief

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RISKS & CONSIDERATION WHEN DEALING WITH SCIATICA

RED FLAGS:

We discussed these in Part 2 of our Sciatica discussion. They are worth reviewing, and if you are experiencing any abnormal or rapid increase in symptoms, professional care and imaging are most likely needed.

STRETCHING:

Something as simple as a hamstring stretch can light up your sciatica like Christmas. As we work through rehabilitative exercises and stretches, gradual progression is a must. Just like any other injury that involves peripheral nerves, more stretching is not always better. Stretching into the pain, or the discomfort zone, when dealing with a nerve issue will likely exacerbate the condition. Start with the above demonstrated exercises, and take it easy!

OCCUPATIONAL & LIFESTYLE MODIFICATION:

Imagine your workspace. Without going through an extensive ergonomics evaluation, what can you change to help your sciatica? Are you able to stand up and work? Do you have a water cooler to frequent? Can you set an alarm on your phone to remind you to stand up and stretch every hour? It is this type of lifestyle modification that is the long game portion of real sciatica relief.

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Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Cottonwood Heights Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.

Sciatica Pain Relief Part 2: Common Causes of Sciatica

In part 1 of our Sciatica Pain Relief series, we covered the basics of sciatica, sciatic nerve pain, and the general anatomy involved. While this may not interest everyone, it is useful in understanding the sharp, burning, and often debilitating pain that radiates down the leg that some people experience with low back pain. Our goal in this series is to inform, empower action, and give our fellow Salt Lake City, Utah friends the information and tools to help yourself through this condition as well as the understanding of when to seek care and a trusted source to do so if needed. In part 2, we are going to briefly discuss some of the most common causes of sciatica but before going forward, check out part 1 by clicking the button below.

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TOP 5 COMMON CAUSES OF SCIATICA

1) Disc Buldge - Intervertebral Disc Compression

Credit: Allan Ropper, M.D., Ross Zafonte, D.O. Sciatica Review Article. New England Journal of Medicine

Starting with the most common cause makes sense as this is what most literature supports and what most people fear when they have some incident or trauma that leaves them with sciatic nerve pain shooting down their leg. A disc bulge is just that, an outpouching, or bulge, of the disc (compressive and supportive tissue between each vertebrae that acts as a shock absorber and allows for movement of the spine) which then presses up against the spinal cord or a nerve as it exits the spinal column. Compression here can be mild to severe, bringing with it anything from pain, numbness, and tingling, to complete weakness of the muscles and limb supplied by the nerve being compressed.

Note: If you are experiencing the latter of those, please seek help immediately as progressive weakness is a red flag and often requires immediate imaging and intervention.

Now, the debate is out on this as disc, and other lumbar spine pathologies are considered somewhat normal. Chances are, before the injury or event that left you feeling this way, the disc bulge was ALREADY PRESENT! This event just aggravated it enough to cause pain.

For Review: Check out the chart in this article we did on spinal imagining and what the best, most current research supports. You will find that most people are walking around with ‘back issues’ with absolutely no pain or quality of life disruption.

THREE THINGS TO KNOW ABOUT SCIATICA & DISC ISSUES

1. You are not your image. Chances are, your MRI will show things that were already present and may not be the primary source of your sciatic nerve pain.

2. A true disc injury and resulting sciatica take time to heal. The body will do most of the work. Chiropractors and therapists are here to help with symptoms, function, and assuring you are in the best position to heal. There is NO magic pill for this, TIME heals.

3. If you are experiencing sudden weakness or progressive numbness that does not let up, seek care immediately as intervention is most likely needed to assure permanent damage is not experienced.

2) Lumbar Spine Stenosis - Canal & IVF Narrowing

Similar to a disc bulge, Sciatica related to Spinal Stenosis is a physical compression of the nerve roots that make up the sciatic nerve. However, this is more of a slow growing, progressive problem. In most cases, these do not wake up in severe pain overnight, these patients report constant discomfort, on-again-off-again radiation of pain, slow loss of range of motion, and typically do not have a time or event to relate a start of the pain.

As we age, the spine and discs degenerate. In the disc, this happens by a loss of height, dehydration, and loss of flexibility of the tissue. In the spine, and other high-stress bone and joint areas, degeneration happens by bone growth, bone spurs, and rigidity of the joints. This degeneration can cause enough of a response that bone will grow around areas where nerves pass from the spinal cord to the rest of the body (Intervertebral foramen or IFV) taking an already small space and slowly closing it down.

3) Piriformis Syndrome - Posterior Hip Tightness

We hit on this at length in the first part of our sciatica series. The relationship between the sciatic nerve and the piriformis muscle is well established. Most people have a sciatic nerve the tracks superficially (toward the surface) over the top of the piriformis muscle or just inferior to it. However, there is an appreciable percentage of the population where the sciatic nerve or a branch from it, pierces the middle of the piriformis muscle. It is believed to be the main culprit of 2-12% of sciatica pain with research on both sides stating over and under-diagnosis. Either way, anatomical and occupational variants are common causes of sciatic nerve pain as well as low back pain.

Credit: Allan Ropper, M.D., Ross Zafonte, D.O. Sciatica Review Article. New England Journal of Medicine

4) Double Crush Syndrome

Double Crush Syndrome, many of the cases we see fall into this category. Let me explain.

A patient presents after a fall, accident, or just a bad nights sleep with a chief complaint of sciatica with low back pain. An exam reveals a limited range of motion in the lumbar spine, tightness of the muscle in the posterior hip, namely the piriformis muscle, and numbness and tingling down the leg. Let's say that an MRI was ordered and it revealed a mild to moderate disc bulge.

Crush One - The disc bulge, assumed to be caused or irritated by the incident, it mildly compressing the nerve. Crust Two - In response to this injury, the body goes into defense mode and muscles begin to tighten, namely those of the posterior hip.

The initial compression at the spinal level causes a 3/10 pain, when you add in the tightness and compression at the hip, the patient is now up to a 7/10 pain with shocks of pain during specific movements. This is a Double Crush.

As with most, the disc issue is hard to affect with treatment directly, but focus can be directed toward the hip muscles, proper movement of the area and exercises to help with mobility and pain are prescribed, bringing the person back down to a 4/10 pain and allowing them to maintain most daily activities while the disc heals…remember, TIME heals discs.

5) Pregnancy

While this is not a diagnosable cause of Sciatica, sciatica is a very common complaint from expecting mothers. The cause here can be as elusive as any other, but pregnancy, the position of the baby, and the mothers specific size, anatomy, and lifestyle habits and experience with sciatica pain before the pregnancy. While there are many unknowns here, sciatica pain typically affects mothers-to-be in the latter half of the pregnancy, and most will respond to conservative care.

RED FLAGS

Sciatica is a very well described condition. The direct cause can be challenging to uncover, but there are a few things to be aware of if you are suffering from sciatic nerve pain. If you are experiencing any of the below items, we suggest you seek care immediately to assure the condition does not cause long term issues and to direct you to the right healthcare provider. Most cases can be managed conservatively (Chiropractic, Physical Therapy, or At Home) while others require medical intervention (injections, imaging, or surgery).

• Progressive neurological symptoms. If you are experiencing numbness, tingling, or weakness that is worsening, please seek help from a trained provider.

• If your injury is the result of a fall, auto accident, or home/work accident, consulting with a healthcare provider will help rule out any significant issues and speed our recovery.

• As with other serious low back injuries, if you experience any loss of bowel or bladder control, this is an immediate ER referral.

• If you have have been dealing with sciatica for more than 1 week without any relief, it is time to get help. Most self-resolving injuries and pain will let up after a couple days.

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Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Cottonwood Heights Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.

Sciatica Pain Relief - Part 1: Anatomy & Definition

WHAT IS SCIATICA?

Sciatica is the term used to describe pain that generates from the sciatic nerve. Many of us have felt this pain in the past, are currently experiencing it, or know someone close to us who constantly battles this sometimes debilitation and always frustrating condition.

Sciatic nerve pain is best known as the pain that seems to start at the low back and shoots down the leg, sometimes all the way to the foot. It can range from dull and ache, like a sore muscle, to a very distinct sharp, shooting sensation that can debilitate and stop a person in their tracks immediately. As the condition progresses, numbness, tingling can be present, and in urgent cases, weakness of the let. With that, low back pain with sciatica doesn’t just affect one area; it can radiate pain to the glues, hip, groin, hamstring, knee, calf, and foot…sometime all of them!

Now that we have a common, agreed upon definition, our purpose with this part of our Sciatica Pain Relief Series is to understand the anatomy involved, which we will review now.

BASIC ANATOMY OF SCIATICA

Ideally, sciatica would have one cause, but with everything else, it just can’t be that easy. While some believe that sciatic nerve pain comes from the back (it can and does), some tend to think it is from muscle and nerve ‘interaction’ somewhere along the course of the nerve as it exits the spine (it can and does that too). But with our hectic lives; the sedentary weeks to weekend warrior type lifestyle, sciatica is typically a combination of the two in what we typically refer to as a double crush injury. We will talk more on this in part two, but for now, let’s look at the anatomy of the lumbar spine and follow the sciatic nerve as it courses down the leg.

The Sciatic Nerve begins in the lower lumbar spine and is made up of nerves from multiple levels of the lower spine in what is called the sacral plexus. Having this many levels of nerves associated with one big nerve gives room for many areas for disruption. As the spinal cord courses through the spinal column, it can be compressed by a damaged intervertebral disc, bulging or herniated, if occurring at the lower levels (L4/L5/S1). From here, the nerve exit the spine through what is called an intervertebral foramen (or a hole in between the vertebrae), where discs, degeneration, and other pathology which we will discuss in part 2. As the nerves begin to come together, the sciatic nerve (now as big around as your thumb) courses through the posterior hip and down the leg.

When we work with patients dealing with sciatica, we give attention to the posterior hip because of the piriformis muscle and its relation to the sciatic nerve. Everyone and their grandmother have been diagnosed with ‘piriformis syndrome’, while an easy diagnosis to give, it is rarely the only reason for the pain we are experiencing. The reason for all the attention though is that sciatic nerve either courses over, pops out underneath, or in 12-17% of the population, pierces right through the piriformis muscle. From here it travels down the posterior compartment of the thigh to the knee where it splits into the tibial and common peroneal nerve, both of which have their challenges.

While this may be overkill for some, it is prudent to know that the likelyhood of your sciatica ONLY being a spine issue is dubious.

Enjoy this brief and basic anatomy lesson, let us know if you have any questions. We will tackle some of the most common causes and daily actions that make sciatica pain worse in part two of our Sciatica Pain Relief Series.

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Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Cottonwood Heights Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.

Resolve Low Back Issues Part 7: What Happens When You Need To Seek Care?

Care & Rehab For Low Back Pain

Supporting The Greater Salt Lake Valley. Helping You Get Back To The Activities You Enjoy.

Our intention with this series on Low Back Pain has been to inform and empower you, or your loved ones, to take action and realize that movement can help, as well as, prevent low back pain. That your low back pain is not a life sentence.

While all of this information is useful and should be utilized before, during, and after a Back Pain episode, the reality is that some people will need to seek care.

You have had a front-row seat to one pillar of our care, the education and exercise component. When seeking care for low back pain, putting your faith solely in one person, and relying on them for everything is not advised and will severely hinder your progress.

YOU (YES, YOU) HAVE TO PUT IN THE WORK, TIME, & EFFORT!

As a Sports Chiropractor that treats low back pain every single day…we see it time and again in our patients… If home care is not adhered to and a person does not take their situation seriously and put in the effort, back pain will take forever (or it seems that way) to resolve.

Today we are going to give you another up-close look at our care process, this time what we actually do here in the office. Our goals are to (1) Determine the cause of your pain/injury (2) Provide care in the office that helps you toward your goal of running, golfing, sleeping, moving again…pain-free, and (3) Give you the tools and education to help yourself.

We structure our care around 3 pillars: Soft Tissue, Joint Motion, Exercise. We have exhausted our opinion and writing on exercise, please refer to parts 1-6 for direction. Now, lets briefly take a look at what care looks like inside the office.

SOFT TISSUE CARE

JOINT MANIPULATION

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Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Cottonwood Heights Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.

Resolve Low Back Issues Part 6: Self-Care - What You Can Do For Low Back Pain

Low Back Pain Self-Care

Over the last 5 weeks, we have discussed everything from what low back pain is, most common causes, some of the most common myths associated with low back pain, and when to consider imaging studies (x-ray, MRI, CT) due to red flags that lead us to something more severe being the cause. We even covered a few tips to help when you find yourself traveling for work or vacation.

We have been building up toward the actual care of low back pain but wanted to fully educate on how common low back pain is, what we know about low back pain at this time, and help you focus on life outside of back pain.

Today, we are going to do just that.

When we look to decrease disability from low back pain and encourage and support patients back to an active lifestyle, this is done in two ways. EDUCATION & EXERCISE. We have already discussed the education component. Now it is time for exercise. Below are 5 ways to help manage and prevent your low back pain with exercise and stretching routines that can be done at home, the gym, or even at the office.

Side Bar -> If anyone gives you a hard time, or tosses a laugh in your way for stretching at the office, I will leave it up to you to either invite them to join (because they need to do this too), or, wait until they start having an issue with low back pain and then pass them our card! Seriously though, invite your co-works to join in, make it an office party, it will be fun.

Fix Your Low Back With These 5 Easy Exercises & Stretches You Can Do At Home or Work.

STEP 1: Get Out Of Bed With Our Morning Routine.

After a good night’s sleep, it is common for our muscles to want to remain in bed. Because of this, early morning activities can challenge our bodies more than they are ready to handle, resulting in a nice low back strain injury. If you are already dealing with low back pain, you know that morning stiffness can prevent you from even rolling over, not to mention actually get up out of said bed.

STEP 2: Desk Sitters - Get Up & Move

While things are improving, the seats we subject ourselves too in our cars, on the train, and at the office are just comfortable enough to keep you seated for an extensive period of time, but provide little support to keep you from tightening up in the process. Start this NOW -> Set an alarm on your phone that goes off every 1-2 hours. Walk around the office, hand-deliver a message, and then take 30 seconds and perform these stretches.

STEP 3: Pre-Workout Hip Mobility

We are going to assume you have a daily routine of some exercise? If you do not, reset, and start adding some exercise to your life, no other method is as impactful on helping your low back issues. Once you get to the gym, or home if you prefer, go through a GOOD HIP MOBILITY routine. We know that the more we improve the mobility of our hips, the less our low back has to work…overwork.

STEP 4: Post-Workout Core Strength

The same goes for core strength as hip mobility. The stronger our core, the less our low backs have to work. Now…I don’t mean getting down on the floor and performing a half-hearted set or some sorry excuse for crunch/sit-up type exercise. We are talking functional here. Planks, Side Planks, Plank Rolls, Heavy Farmer and Suitcase Walks, as well as The Big 3.

STEP 5: Strength For Life

Most people who have dealt with low back pain have since, and forever will, shy away from true strength movements. But let me just plug that as humans, you should be able to squat as well as pick something heavy off the ground without fear of hurting yourself. As you work on hip mobility and core strength, you have to start working in squats and dead-lifts. Start with these modifications and work on control and endurance.

Exercise is considered the best medicine for low back pain. While this is true and I strongly support this. Our actual goal with care is to get our patients back to these activities. But often, patients present in enough pain that they are unable to run, ski, bike, weight lift, etc. With that said, most can start with basic stretching and mobility until the pain is relieved. From there, exercise can prevent flair-ups, or at least decrease their intensity and length of the episode. Either way, low back pain has to have a component that includes YOU doing some, if not most, of the work.

Next week we will look at some of the traditional, as well as, new developments in conservative care low back pain. Until then, and if you are craving more reading, check out our ‘12 Ways..’ Tips guide to further help your low back pain.

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Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Cottonwood Heights Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.

Resolve Low Back Issues Part 5: You Are Not Your Image. (Red Flags & Imaging Considerations)

Low Back Pain Imaging

Best Practices & The Truth

In part 4 of our Fix Your Low Back series, we discussed some of the most common myths and misunderstandings around low back pain, care of low back pain, as well as updating some of the old-fashioned thoughts. Today, we are going to discuss imaging and red flags as it pertains to low back pain and a couple of VERY IMPORTANT things you need to know.

Imaging is an excellent diagnostic tool, when appropriate, to help ASSURE PROPER care.

Not-so-long ago, a patient would walk into a chiropractic office and get a standard set of x-rays; or they would schedule an appointment with an orthopedic physician and would be required to obtain an MRI before they can be seen.

This standard practice has fortunately been labeled as inappropriate, and national organizations such as the American Chiropractic Association and American College of Physicians have recently taken a strong stance against these practices.

CURRENT BEST PRACTICES

1. Do not obtain spinal imaging for patients with acute low-back pain during the initial 6 weeks after onset in the absence of red flags.

2. Imaging should not be utilized to monitor a patient’s progress.
   

WHAT WE KNOW ABOUT IMAGING NOW

There are two extremely important things to know concerning imaging…

1. Imaging can be harmful. Radiation aside. Unnecessary x-rays and MRIs can bring to light ‘normal variances’ that are NOT the generator of pain but are easy to blame. This causes what is being referred to as the ‘medicalization’ of low back pain.

   Example: Someone presents with low back pain, an image is immediately ordered, it shows a bulging disc or some other skeletal irregularity, and the blame for the complaint is placed on this without further discussion. This patient goes on to think that they are doomed to low back pain forever, that their ‘bad back’ will keep them from enjoying their normal activities, and unfortunately, they end up with a regular dose of over-the-counter and prescription drugs.

   Now, this is not always the case, but once or twice each month, a patient with low back pain presents to our office stating that they had a bulging disc in their low back over 10 years ago and have been in constant pain ever since. These cases have more to them than just pain, the overutilization and misuse of imaging lead to fear avoidance and catastrophizing. Both are always present in chronic low back pain!

2. Through recent studies, we know that to a certain degree, lower spine degeneration and pathology are normal, AND NON-PAIN GENERATING, at almost all ages.

Credit: Brinjikji et al. 2015. Journal of Neuroradiology. No Copyright Infringement Intended.

What is so important about this chart? Well….

These numbers represent the percent of specific age groups that had degeneration and disc pathology of the lower back in patients who had NO SYMPTOMS OR COMPLAINTS whatsoever.

Also, this was no small review….this study included over 3100 people!

In review, If we took a pain-free 40 y/o person with NO history of low back pain…

Almost 70% would demonstrate degeneration on x-ray.

50% would show a bulging disc on MRI.

Our take-a-way here… YOU ARE NOT YOUR IMAGE! They can play tricks on your thinking and make your back pain much worse just by you believing that what your image is showing is the end all be all of your pain.

With that aside, we do need imaging. WHEN INDICATED THROUGH A PROPER EXAM! Imaging is great for ruling out serious pathology.

RED FLAGS

Red flags are indicators that let physicians know there might be something more serious going on. This can come from a simple history and exam and they demand attention and should be considered before care of any kind is provided. With that said, here is a small list of ‘Red Flags’ common with low back pain complaints.

• History of Cancer.

• Night Pain.

• Progressive Neurological Symptoms & Weakness.

• Pain Following Trauma (Fall, Auto Accident, etc.)

• Sudden Loss of Bowel or Bladder Function.

• Recent Weight Loss.

• New Back Pain With Fever.

• Failure of 4-6 Weeks of Conservative Care.

• History of Recent Fracture of Suspected Fracture.

• Family History & Signs of Osteopenia & Osteoporosis.

In summary, and I hate to keep harping on this, but your imaging results may not be as important as they are made out to be in regards to uncomplicated, and even chronic, low back pain.

• Spinal degeneration, disc bulge, and other pathologies are often normal findings as we age and have not been proven to be pain generators.

• Imaging early in the care process in the absence of red flags is NOT in line with current ‘best practice’ suggestions and guidelines.

• Studies have shown that a thorough history and exam with your provider can provide information to determine the actual cause of your low back pain.

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Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Cottonwood Heights Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.

Resolve Low Back Issues Part 4: Most Common Myths Of Low Back Pain

Low Back Pain Myths

Few musculoskeletal conditions have a cult-like following of myths as Low Back Pain, many of which have been said by various healthcare providers across all specialties. To help clear the air, let's take a look at the 5 most common misunderstandings and myths that we encounter in our chiropractic clinic that could actually make your low back pain worse.

Before we get started…

These myths and misunderstandings are not aimed at making low back pain seem 'made-up,’ it is a very real and challenging condition. These myths are just folklore passed down from old, unsubstantiated in the research, ways of thinking. Our truth is that, if you believe one thing and that makes you feel that your low back is wrecked for life, a long road of pain is what you are in store for. We call this fear-avoidance and catastrophizing, the medicalization of a condition. We will touch more on this when we cover imaging next week. But a big part of recovering from low back pain is believing that you can get better. It may sound silly, but no more ridiculous than believing these myths below!

NUMBER 1: Your back pain is from a misalignment, bone out of place, or a ‘subluxation.’

We don’t practice this way any longer, stop using explanations from this era.

These are common descriptions patients and doctors alike will give when describing their back pain.  The most common being...you threw your back out, and it is now misaligned...commonly spoken by chiropractors of a generation ago or current doctors, chiropractors, and physical therapists that have not caught up with current research.  The truth to this is that your spine is a dynamic structure designed to move, what we ACTUALLY find is that the pain you are feeling is often associated with immobility, or areas of the spine that should be moving, but due to tight muscles and previous injury, may not be moving well or correctly anymore.  Spinal manipulation or an ‘adjustment’ is designed to restore normal motion to these restricted areas.

A bone did not shift out of place and therefore needs to be put back in! That’s not how it works.

NUMBER 2: Arthritis is the root of all evil!

Arthritis is like wrinkles on your face…lets just keep it nice and say they are signs of wisdom. Truthfully, if you live and play hard and long enough, we will all experience some degree of degeneration.  However, and please understand this, it is a natural process and does not necessarily equate to pain! When conditions present that are more challenging, using arthritis as the ‘fall guy’ is the easy way out for a provider and an often acceptable answer for the patient.

NUMBER 3: “But…I have scoliosis and a short leg” that is the cause of my back pain.

Just like arthritis, scoliosis and an actual short leg (1cm or shorter than the other) are comfortable areas to place blame when someone presents with back pain.  Both can absolutely lead to dysfunction, and if unaddressed, pain and discomfort. To a certain degree, uneven leg lengths and spinal rotation/curvature are normal variants, meaning most people have these at a mild level and are unlikely to be a pain generator. For most (not all) look to place the blame elsewhere.

NUMBER 4: Rest is what I need to recover, right?

The days of ‘take 2 of these, rest, and call me in the morning’ are long gone. You likely have a relative who spent a good amount of their life with back pain that limited some or all of their activity. When you see a case like this or someone who is much too young to be experiencing recurrent back pain, it may seem like the right thing to do is rest up for a while. Fortunately, we now have stacks of research that supports the fact that bed rest is the worst (top 3 at least) idea when it comes to low back pain. The new adage is ‘Movement is Medicine.’ When someone presents to our office, we are not only just trying to relieve pain, but to relieve pain SO THEY CAN GET OUT AND MOVE. Even walking, WALKING, has been shown to reduce low back discomfort and be a great tool to prevent future occurrences.

NUMBER 5: Slap a brace on it & it will be fine.

Brace low back pain long term & you should join the circus with that thinking.

This is excellent advice if you are looking to weaken your core muscles completely. Did you know that powerlifters use the belt to their advantage to complete amazing feats of strength not to brace their low back, but to give their stomach something to press in to, creating intraabdominal pressure (think bracing your stomach if someone was to punch you) that stabilizes the spine from the inside? Our bodies are amazing, it has its own ‘weight belt’ built-in. Using straps, belts, or any other contraption like this for extended periods of time tells your body that you do not need it to do its job anymore. This core weakness and inability to naturally brace yourself through muscle control —> LEADS TO CHRONIC LOW BACK PAIN.

In summary, things change. Our treatment methods and your outlook on your condition must change. Every single one of these five myths is still spouted today in an office somewhere near you. Knowing the validity of that is often more important than the care you receive. While in certain circumstances, these can be valid reasons for low back pain. For most, especially those who come through our Cottonwood Heights, Utah Chiropractic and Rehabilitation clinic, we want a better answer. One that helps address and correct the dysfunction. One that promotes confidence and encourages the patient to try harder, that they can feel better and live a life they enjoy.

Next week, in part 5 of our Fix Your Low Back Series, we are going to discuss red flags, when you need imagining, and why you shouldn’t always rest your diagnosis and pain on those images.

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Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Cottonwood Heights Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.