Low Back Health Exam

Over 80% of the population will be affected by low back pain at some point in their life.  25% have suffered low back pain in the last 3 months alone!  Low back pain is one of the leading causes of disability and lost production in this country.  Solutions to the problem aren’t often easy and far too many people are left looking for answers for why their back always hurts.  Low back pain is a REALLY BIG DEAL!  Keeping your low back HEALTHY should be a PRIORITY!

If you struggle with low back pain, wouldn’t it be nice to know WHY your back always hurts?  Or maybe, if you’re one of the lucky ones not currently in pain, wouldn’t it be nice to know your low back pain risk and what you need to do to prevent it?

Now you can by taking the test and trying these 5 tests at home!  Why these 5 tests?  These 5 tests are the most basic, functional movements of the low back.  Every healthy person should be able to perform these tests!

So here’s how it goes.  Perform each test below – some may need the help of a partner.  Rate yourself by the grading chart for each test.  Add the scores together at the end to get your score.  Follow the directions to fix your low back!

Let’s get started!

TEST #1:  Straight Leg Raiser

You will need a partner for this.  Download a “bubble level” app on your phone.  Make sure the app measures angle as well.  There are a ton of free ones out there that work well for this.  I recommend “Clinometer” for Android and “iHandy Level Free” for iPhones.

Lie on your back with feet extended out in front.  Place the phone with the bubble app open in the middle of the shin.  One leg at a time, have your partner lift the leg with the knee straight.  Move the leg until it can no longer stretch or the hip or opposing leg starts to lift off the ground.  Record the degree.

20160706_182837

85-90 Degrees = 2 Points          75-84 Degrees = 1 Point          Less Than 74 degrees = 0 Points

 

TEST #2:  Knee-To-Chest

While still laying on your back, one leg at a time, pull your knee to your chest.  The front of the leg should touch the bottom of your rib cage without any pinch in the anterior hip.  If you cannot get the front of your leg to touch your chest, measure how far away by placing fingers between your chest and leg.  Record the distance.

20160706_183142_001

3 Finger Restricted Knee-To-Chest
3 Finger Restricted Knee-To-Chest

Leg Flat On Chest W/ No Anterior Hip Pinch = 0 Points        Leg 1-3 Fingers From Chest = 1 Point          Leg  More Than 4 Fingers From Chest = 0 Points

TEST #3: “Cat Stretch”

You will need a partner and a pencil.

With hands and knees on the floor arch your low back as much as possible by trying to bring your hips to your chest.  Have your partner place a pencil on your lower back.  What does it look like?

Healthy "Cat Stretch" Test
Healthy “Cat Stretch” Test

                                            Pencil Ends Off Back = 2 Points                                              

Flat Pencil Test
Flat Pencil Test

Pencil Flat = 1 Point

Severely Restricted "Cat Stretch" Test
Severely Restricted “Cat Stretch” Test

Pencil Ends Touching, Middle Not = 0 Points

 

TEST #4: Lunge

Standing up, take a large step forward and drop the back knee to the ground.  Keep your body upright.  Place a ruler under your back leg.  Measure how far the front of the hip extends out from the ruler.

Lunge Test
Lunge Test
Overhead View of Healthy Lunge Test Of The Ruler
Overhead View of Healthy Lunge Test Of The Ruler

More Than 12” = 2 Points          9-11.5” = 1 Point          Less Than 9” = 0 Points   

 

TEST #5: Toe Touch

Standing upright bend forward and try to touch the floor in front of your toes.  Use a ruler to measure how far away the tip of your finger is away from the floor.

Healthy Toe Touch Test
Healthy Toe Touch Test

Finger Touching Floor or Palming Floor = 2 Points

Fingers Less Than 2” From Floor = 1 Point

Limited Toe Touch Test
Limited Toe Touch Test

Fingers More Than 2” From The Floor = 0 Points

 

Now that you have gone through all of the tests, add the score of each test together.  What did you get?

9-10 Points = 90-100% Low Back Function = Congratulations!  You have a VERY healthy back!

7-8 Points = 70-80% Low Back Function = Chances are you may not have low back pain now, but you should try to improve the tests that are lagging with some simple daily mobility, stretching, and exercise.  In pain currently?  See below.

Less Than 6 Points = Less Than 60% Low Back Function = Your back is in trouble!  Most of these tests are limited or restricted.  You have less than 60% function of your low back!  That’s a failing grade in school!  Just like in school when you failed a test and you looked for some help to get better grades, you should seek the help of a local musculoskeletal expert for solutions to fix these movements and solve your low back pain!

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It is important to note these 5 tests above are assessments used in the Integrative Diagnosis system.  The most common cause of limited range of motion and pain for these tests are due to muscle adhesion.  Integrative Diagnosis is the most advanced diagnosis and treatment system for solving musculoskeletal problems.

At Thrive Spine and Sport, we are currently the only full body Integrative Diagnosis providers in the State of Iowa. Our treatment fixes adhesion!  If you have been looking for answers to your low back pain, click the appointment request here, or call us at 319-423-0925.

Affected By Low Back Pain?

Staring at your computer screen, you realize you need to take a break.

Deciding to get a drink of water, you stand up from your desk and head to the water cooler. While getting up from your desk, the phone that previously sat on your lap drops to the floor.

You bend down to pick it up, when … bang!

Pain in your low back has frozen you in position and you fight to stand back up. You find yourself hunched forward and to the side. Your low back is in spasm and barely lets you do even the tiniest of movements.

After work, you go home, take a shower, and try to relax and get ready for bed. You can’t get comfortable and you sleep terrible. The next morning is even worse. Pain killers and muscle relaxers aren’t touching it. You go to work and move around a little more and things begin to finally loosen up. A week later you are almost back to normal with only a little bit of pain in the mornings that gets better with a little movement.

You dodged a bullet. Phew.

A couple months go by and things are going great. You go to hunch over a fellow co-workers computer screen and all of a sudden, low back pain strikes again. Same pain — maybe worse this time. You go through the same process and just over a week later things are almost back to normal. But now you’re worried. What is going on? Is it a sprain or is it a disc herniation?

While many people are familiar with low back pain and disc herniation, disc herniation or disc bulges account for only one to three percent of all low back pain cases. According to research, half of the patients similar to the one above will be diagnosed as having a sprain/strain – this is wrong!

Internal Disc Derangement, or IDD, is probably something you have never heard from your doctor. Shockingly, this accounts for almost 40 percent of all low back pain sufferers.  Far too many times this is misdiagnosed, and mistreated!

Symptoms of IDD include:

  • antalgia (forward, hunched posture) with severe pain
  • guarded movement with muscle spasm
  • worse pain in the morning or with rest
  • worsening, multiple previous episodes and relief from symptoms within one to two weeks.

Odds are if you have ever hurt your low back and continue to struggle with pain, even on the rare occasion, this is you.  It is important to note that the muscle spasm and guarding is a protective mechanism of the disc to try to prevent further damage to the disc.

If left untreated the right way, IDD can develop into bigger problems, like disc herniation.  The muscle spasm and pain is NOT a sprain, and your hips are NOT out of alignment!  These are two of the biggest misconceptions with this problem that I see.

So what can you do?  With any pain and injury like this, it is best to get evaluated by a doctor that specializes in treating musculoskeletal conditions sooner rather than later.  With Internal Disc Derangement, the disc is injured – nothing can reverse time and fix that.  Usually, with each incident of pain, symptoms will get worse!

Whether you have been suffering from this condition weeks or months, you will have soft tissue dysfunction, like adhesion, in structures that alter joint mechanics and ncreases stress on the disc. If you are unfamiliar with adhesion, click here for our most recent article discussing it.  Adhesion is one of the most common and misdiagnosed conditions in the body that restricts motion and causes pain.

Overuse Cycle

 

If you have IDD, you must get the surrounding soft tissues fixed to unload the disc to hopefully prevent and reduce future incidences of pain and progressing disc injury! In other words, adhesion must be corrected in order to reduce the likelihood of this problem from returning.

Not fixing this issue will only lead to more problems down the road.  As always when symptoms are present, you have two options — ignore it or fix it.

At Thrive Spine and Sport, we are the only full body certified Integrative Diagnosis clinic in the state of Iowa.  The Integrative Diagnosis system is a diagnosis and treatment system to gain a clear picture and full diagnosis of what is causing your low back pain.  By obtaining a full diagnosis, then applying the correct treatment, resolution for your pain is possible!

Simply fill out the appointment request on this page or call our office at 319-423-0925 to get to the bottom of your pain today!  Any questions can be sent to Dr. Cody at dr.cody@thrivespineandsport.com.

 Thanks for reading!

3 Easy Tests To Help Figure Out Low Back Pain

According to the National Institute of Health (NIH) lower back pain will affect 8 out of every 10 people at some point in their life.  On top of being the leading cause of disability worldwide, lower back pain will cost Americans $50 billion dollars this year!  While some cases of low back pain will go away after a couple days on its own, a majority of cases will become chronic in nature!  So why do some cases go away, while others become chronic? Let take a look!

If you do any kind of research online, you will likely find the same recommendations for pain relief repeated – rest, ice, stretch, warm up better prior to activity, NSAIDs, maintain good posture, get better shoes, etc.  While this may sound like sound advice, none of it really works, otherwise we wouldn’t find so many of us in pain.

Since most people start treatment of low back pain by visiting their PCP, or Primary Care Provider, they are often recommended rest and NSAIDS.  After a couple weeks of inactivity, these same people often find themselves right back where they started once they get back to their daily routine.  Sound familiar? So what went wrong?

The problem is that the rest and NSAIDs temporarily raised your symptom threshold, but did nothing to address the real issue. Stretching may provide temporary relief but no long term benefits. The shoes may have taken some stress off your feet, but didn’t touch the low back pain.  None of the above recommendations address long term fixes!

The problem with all of this, and why your pain has become chronic, is that there was not a single, specific diagnosis made to identify the real problem initially!  In my experience, most people with low back pain have some limiting range or motion in their low back, hips, or both. This limited range places extra stress on the low back, causing weakness and pain!

So how do you know if this limited range affects you and your low back pain?  Fortunately, there are some at-home tests that you can do right now to find out where you’re limited and options to finally get your low back pain under control!

The first test is the Standing Toe Touch.  While this may seem simple, most people with low back pain are unable to bend at the waist and touch the toes to the floor without pain or tension in the back of the knees and calves.  The test should be effortless and without pain.

SLPF
Full Standing Toe Touch

 

Knee-to-chest is the easiest way to test hip flexion.  Lie flat on the floor with both legs extended out in front of you.  Bring one knee up to your chest until the front of the thigh is flat with the chest.  If the opposing leg raises up, pinching is felt in the front of the hip, groin, or outer leg, or the thigh falls short of the chest, the test is limited and a possible cause of low back pain.

Hip Flexion Test
Hip Flexion Test

Hip Extension is vital to the stability of your spine.  To test, start in a lunge position, leaning as far forward onto one hip.  Place a ruler in line with the rear leg just in front of the knee.  Drop a plumb line from the front of your hip to the ruler below.  Normal range should fall between 10-12 inches.  Decreased range or pain with this test is a positive finding for this test.

Kneeling Hip Extension
Kneeling Hip Extension

If you or someone you know suffers from low back pain and cannot perform these very simple tests, there is a good chance they can find relief in our office.  At Thrive Spine and Sport, these tests, and a few others from the Integrative Diagnosis system, are used to gain a clear picture and full diagnosis of what causing your low back pain.  By obtaining a full diagnosis and applying the correct treatment, resolution for your pain is possible!

Simply fill out the appointment request on this page or call our office at 319-423-0925 to get to the bottom of your pain today!  Any questions can be sent to Dr. Cody at dr.cody@thrivespineandsport.com.

Thanks for reading!

 

 

***Special thanks to Ally Thompson of Heat Yoga and Dr. Carl Nottoli of Functional Spine and Sport for the photos****

Chiropractic, PT, or an Educational Booklet: Which Is Better Treatment For Low Back Pain in Cedar Rapids?

Would you believe me if I told you that an educational pamphlet is just as effective as chiropractic care or physical therapy in relieving low back pain?

In 1998, a study published in the New England Journal of Medicine looked to compare the effectiveness of chiropractic, physical therapy, or an educational pamphlet for low back pain.  The conclusion of the study fueled a lively debate.  What the study found was that there was little difference in outcomes between low back pain patients treated with standard chiropractic manipulation, McKenzie exercises, or the educational booklet!  Not surprising, chiropractors and physical therapists alike were outraged from the findings.

While many previous studies done prior have shown chiropractic and physical therapy to be effective for helping with low back pain, why did this study show an educational pamphlet was just as effective?

To start, let’s look at the study design.  The patients were diagnosed with a regional diagnosis, low back pain, after pathology had been ruled out (herniation, cancer, etc.).  This would be no different than saying someone has shoulder pain.  Patients were randomly assigned to either chiropractic, physical therapy, or the educational readings.  This is where things got interesting.

Patients sent to a chiropractor were diagnosed with a sprain/strain 50% of the time, and another 30% of the chiropractic group was diagnosed with facet syndrome, or misalignments of the spine.  The same group of low back pain patients sent to the physical therapist were diagnosed with disc derangement 92% of the time.  This should raise some alarm!  The same group of randomly assigned patients sent to two different providers had significantly different diagnoses!

While it is entirely possible that the provider’s diagnoses were correct, it is highly unlikely that the difference was that dramatic.  It has often been demonstrated that nearly 70 percent of low back pain arises from 3 different sources; disc (39%), facet (15%), and Sacroiliac (SI) joint (13%).  This is where the study inherently failed.

While the study was not specific enough to sub classify low back pain patients into their respective groups, the providers themselves seemed to have classified patients based on what they can fix, not what the patient necessarily had.  McKenzie exercises have been shown to be effective in treatment of pain arising from the disc.  Likewise, chiropractic manipulation would be most effective in treating those struggling with facet and SI joint complications.

While this was not the intent of the study, this ultimately showed where modern day health care has gone wrong!  Too often, providers of any profession try to categorize patient’s problems into what they can fix, and not what the patient actually has.  It comes without saying that patient outcomes would be much higher if patients were given the treatment they need, and not the treatment the provider is certified to practice.   When providers try to fix patients by classifying them into what they can fix and not what the patient actually has, an educational pamphlet has just as much value as chiropractic and physical therapy.

Reference:

Excerpt modified from [Original DC article] by William Brady, DC. Used with permission. www.integrativediagnosis.com