Spoon, Fork, or Knife – What Treatment Is Better For Low Back Pain?

While treatment options are many, solutions are but few!

31 million Americans experience low back pain at any given time!  Read that again.  10 percent of the population in the United States experiences low back pain every day!  Unfortunately, that number is also on the rise!

Low back pain is already the single leading cause of disability worldwide, and also one of the most common causes of missed work!  Shockingly, low back pain is the second most common reason for a visit to the doctor, just behind upper respiratory infection.

In the past few decades there have been significant improvements in technology and treatments aimed at eliminating low back pain.  So why does the low back pain epidemic continue to rise?  What is the solution moving forward?

A few years back, the New England Journal of Medicine posted an article on a comparison of physical therapy, chiropractic manipulation, and an educational booklet for the treatment of low back pain.  The results fueled a lively debate among providers in regards to effective treatment for low back pain.  Their conclusion found no difference in outcomes between low back pain patients being treated with chiropractic manipulation, physical therapy with McKenzie exercise, or the educational booklet!  Future studies have also found similar conclusions!

These results can be demoralizing to those seeking help from low back pain!

So what are we doing wrong?  It is highly likely we are not being specific enough with our diagnoses and treatment options!  In all these studies, low back pain was being treated as a single entity with only one cause.  In the aforementioned study, chiropractors diagnosed sprain or strain in half of the patients and facet syndrome in another 30 percent.  Physical therapists diagnosed a disc derangement 92 percent of the time.  Furthermore, these diagnoses are inconsistent with the expected percentages of each pathology.

What an incredible error!  While this seems simple, a treatment applied must match the accurate diagnosis for the patient!

Adhesion, disc injuries, stenosis, nerve entrapment, strains/sprains, tears – all of these things cause pain.  All of these items can be found in the low back.  However, each of these items require different treatment options.   All of these problems can be found at a chiropractic, physical therapy, or medical office.

While all of these problems can be found in the any of these clinics, most treatment is predetermined.  Chiropractors are going to adjust, PT’s are going to stretch and strengthen, and MD’s are going to prescribe pills or provide cortisone.  Treatment is applied, in most cases, without regard for the diagnosis.

If I were to ask you which is better – a knife, fork, or spoon – you may want to know what food you are eating.  By analogy, if I were to ask you which treatment is better for low back pain -chiropractic, physical therapy, or an educational booklet – would you answer the question before knowing what is actually wrong with the patient?

In order for the low back pain epidemic to go away, we have to have providers be more specific with their care!

 

At Thrive Spine and Sport, we pride ourselves on finding the right solution for you!  As the most advanced Integrative Diagnosis providers in the state of Iowa, we offer advanced diagnosis and treatment solutions.  Most patients have seen multiple providers before finding their real cause and solution for their pain.  Not everyone is right for our care, but patients leave our office knowing what is wrong and what needs to be done moving forward!

If you have been struggling with low back pain, we invite you to schedule a consult to meet with one of our highly trained doctors over your condition.  Call 319-423-0925 or click below!

The Hip Lift: The Most Underutilized Exercise To Prevent Low Back Pain

The hip lift may be the most underutilized exercise that could effectively prevent your low back back pain from ever coming back!

While the exercise only aims to isolate and strengthen the hamstrings, strong and healthy hamstrings are vital to a healthy low back. How do stronger hamstrings help with low back pain?

The hamstrings are a group of muscles made up of three distinctly different muscles that have the same attachment to the pelvis.  By strengthening this group of muscles, the hamstrings add needed support to the pelvis when standing, walking, and moving.  This in return, reduces the daily strain in the low back and can prevent your low back pain from returning!

While the hip lift may seem easy, do not let it fool you!  When performed properly it is very difficult for even the strongest person!

To perform the movement, you will need a support bench or chair.  Start by laying near the bench, placing your heels just on the support.  Proper bench or chair height will put your shins roughly parallel to the floor.  Next make sure your feet and knees are hip width apart, and your knees are directly over your hips.

The movement will take 5 seconds to perform.  Start the movement by driving the heels through the bench to engage the hamstrings.  Keep your core relaxed through the movement to make sure the work is done completely by the hamstrings.  Slowly raise the hips up for 2 seconds until your back is just over fist high off the ground.

Hold for a second at the top of the movement and slowly return to the floor for another count of 2.  Briefly pause for a second on the ground while maintaining the tension in your hamstrings, before starting another rep.

The hip lift is performed everyday for 2 sets and 15 reps per set.  When starting, most cannot perform that many reps and fall in the 6 to 10 rep category if they are performing the movement correctly.  For a demonstration on the movement please watch the video below.

As mentioned in the video, the hip lift is designed to prevent low back pain, not fix low back!  If you currently suffer from low back pain, it is advised to find the root of the problem before beginning this exercise.  Implementing any exercise without proper instruction, and specific purpose can be dangerous!

————————————————————

If you, or someone you know is currently suffering with low back pain, let the experts at Thrive Spine and Sport help!  We invite you to call our office today at 319-423-0925 or request an appointment on our website by clicking here! If you have any questions over this exercise, or your low back pain please email us at info@thrivespineandsport.com.

At Thrive Spine and Sport, our goal is to educate and help as many people inthe community as possible!  We do hope that you found this article beneficial, please share this with friends or family in need!  

Thanks for reading!

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!

————————————————————————————————————————————————

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.

6 Questions To Solve Your Neck or Back Pain

If you’re reading this, you most likely suffer from some sort of chronic low back or neck pain.  Ask yourself these following questions:

  1. Is your pain worse in the morning?
  2. Does the pain get better after waking up and moving around?
  3. Have you had multiple or previous episodes of moderate to severe pain?
  4. Does the pain usually last 2-10 days before going away?
  5. Trouble sitting or standing prolonged periods of time?
  6. Are movements “guarded/protected” or noticing decreased range of motion?

 

If you answered “yes” to a majority or all of these questions, you most likely are suffering from a disc injury whether you have been diagnosed with it or not.  Internal Disc Derangement (IDD) accounts for upwards of 40% of all low back pain and a majority of neck pain!

Disc injuries are often made worse by the presence of adhesion.  Adhesion is the most common cause of pain and decreased range of motion in the body.  Adhesion acts like glue on muscles to restrict movement.  Restricted motion causes more load on injured discs, leading to more pain and long term problems.

The good news is that a large majority of disc injuries do not require surgery!  Disc injuries respond well to conservative management and treatment.  By fixing and removing adhesion, discs are essentially “decompressed” and unloaded.  You are left in little to no pain and able to return to regular, daily activity.

At Thrive Spine and Sport, we are certified through Integrative Diagnosis for the diagnosis and treatment adhesion.  Our treatment has helped many people looking for answers to their pain.  We have helped patients prevent surgery and those still suffering with pain after surgery.  If you answered “yes” to most or all of the questions above, chances are we can help!  Call our office today at 319-423-0925.

3 Reasons For Tight Hamstrings You Dont Know About

If your hamstrings are always “tight” there is a reason behind it – and it’s not because you’re not stretching.  In fact, if you are stretching, it may be making it worse!  While this may sound like crazy talk, allow me to explain.

The hamstrings are a group of 3 different muscles.  They originate on the pelvis and insert on the lower leg, just below the knee.  They are primarily responsible for extension of the hip and flexing the knee.  The hamstrings play a vital role in most of our daily activities, which include standing, walking, running, and jumping, but they also play a protective role for nerves and joints.

The Hamstrings

While there can be many different reasons for “tight” hamstrings, the 3 most common I see in my office are the following:

Nerve Entrapment.  The sciatic nerve runs from the lower back down into the foot.  This nerve moves and flosses through many different structures on its route.  Often times this nerve will get glued down, and stick to some of the muscles it comes into contact with in the hip and upper thigh – this includes the hamstrings.  When this nerve is prevented from moving properly, and we try to stretch, the body will engage the hamstrings sooner than it would if the nerve wasn’t glued down to protect the nerve from potential harm. This is give off the feeling of “weak and tight.”

Hip Joint Dysfunction.  Place your hand on the outside of your hip. Do you feel the bone there? Now, more than ever with our modern day lifestyles, this joint can become compromised by adhesion and scar tissue.  The femur is held into the hip socket by a group of ligaments.  These ligaments will often form loads of scar tissue after performing repetitive activities or keeping it in place for prolonged periods of time.  This scar tissue will then restrict hip motion.  With this reduction in movement, the joint is more prone to future injury, the hamstrings help to protect this joint by activating earlier than normal and reduces the range of motion.

Hip Capsule

Disc Injury.  Unfortunately, far too many people are walking around with disc injuries, whether they know it or not.  When a disc becomes injured, many simple day to day tasks become more difficult, like trying to stand from a seated position, or bend forward.  Any flexion movement, places more stress on the injured disc.  Part of the job of the hamstrings is to extend the hip and keep you upright.   If we have an injured disc, the hamstrings will try to keep you upright to protect the disc and avoid any unwanted load.

A Few Common Disc Issues

So what can you do?

Often the answer to your problem is simpler than you think.  “Tight” hamstrings are a common problem, but can lead to bigger, chronic issues. Catch all solutions like stretching are rarely ever the answer.  Start by contacting a local expert to get the correct diagnosis for your problem.   Only with the right diagnosis can you finally fix your problem!

If you live in Cedar Rapids or surrounding areas and are constantly struggling with “tight” hamstrings, we invite you to check out our office.  The experts at Thrive Spine and Sport can easily diagnose and provide you with the right plan to fix your problem!  Call our office at 319-423-0925 or fill out an appointment request by clicking here

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****

Will Stretching Help My Pain?

If you have ever been in pain, chances are you were told to stretch.  For some of us it helped, others it didn’t.  Why did it work for some, while others stay in pain and are left thinking they just need to stretch more? Could stretching actually make the pain worse?

To understand this topic, we have to talk about some complicated subjects; anatomy, physiology, and kinesiology.  Please don’t run away, we will make it easy for you to understand.

To start lets agree, that as humans, we all have the same parts, and should, therefore, all move the same and respond similar when exposed to common environments.  Let’s also agree that our modern day lifestyle leaves us in poor postures for most of the day.  Be honest with yourself right now and assess your posture.  Is your head forward into your computer or flexed down to your phone trying to read this?  Is your low back rounded and flexed while at your desk right now or on your drive home?  Chances are it probably is, and you’re like this for most of the day without realizing it. These positions are already lengthened or stretched positions, so why isn’t it helping?

We walk a very fine line everyday balancing between what our body was designed to handle, and what we actually put our body through.  We must understand that when we overload or overwork our body either through training, work, or sitting at a desk all day, the body will have to create compensations to better accommodate the stress being placed on the body.  In the initial phases of compensation, the body will feel “weak and tight.”  This serves as a protective role on the body, and is commonly referred to as “protective tension.”

Protective tension serves a purpose to protect the body from injury by providing stability to an unstable area.  While it may feel good to stretch really all that is happening during this time is that a bunch of stretch receptors are getting fired off and overriding the current symptoms.  This is why you may feel better in the short term but relief never lasts more than a few hours. This is also why it can lead to long term pain, as stretching often leads to more cumulative damage in already lengthened tissue!

If we fail to recognize why the protective tension is occurring and continue with our regular activity without modifications, friction, pressure, and tension, will eventually lead to the development of dysfunction in the body.

Having already agreed that as humans we will mostly have the same parts and respond similar given the same situations, we know that in muscles, or where nerves come into contact with muscles, adhesion will ultimately form in structures with continuous overload from repetitive motions or prolonged positions!  Adhesion is the most common pathology found in muscles, but unfortunately, one of the most misdiagnosed conditions in the human body.  I am going to go out on a limb and guess you haven’t heard this term before.  Fortunately, it can be easily fixed!

Overuse Cycle

Adhesion, or scar tissue, when present, acts like glue on the muscle and nerves.  This further leads into the continuous cycle of feeling “tight” but will also start to cause pain and injury.  If left untreated, this relatively easy problem to fix only gets worse and leads to bigger complications down the road.  Weakness, pain, and even tingling, burning, and numbness, when present along a nerve, can all be caused by adhesion.

Adhesion

Stretching, unfortunately, will not fix adhesion.  In order to fix adhesion, adhesion must be broken down through manual therapy by a certified practitioner that is trained to diagnoses and treat adhesion.  When adhesion is removed, the “need” to stretch is removed.  By removing adhesion, the body can then move better, and function better on a day to day basis without the need to stretch!  Stretching can help to prevent adhesion from coming back in the future, and keep you healthier, but will not fix adhesion in the present.

At Thrive Spine and Sport, we are currently the only full body Integrative Diagnosis provider in the state of Iowa.  Integrative Diagnosis providers are trained to find faulty movement patterns, diagnose, and treat adhesion to fix your pain or movement problem! If you are constantly feeling “tight” or having pain, weakness, or numbness and have failed to find anything that has fixed the problem, I invite you to get to the bottom of your problem! Simply fill out the appointment request on this page or call our office at 319-423-0925 today!

Thanks for reading!

 

 

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