Post spine surgery physical therapy or PT is the next phase after a discectomy, laminectomy, fusion, etc., to gain optimal mobility and ease the transition for a full recovery. A chiropractor and physical therapist team will help with proper muscle training and activation, pain and inflammation relief, postural training, exercises, stretches, and educate the individual on an anti-inflammatory diet. Physical therapy post spine surgery reduces:
Scar tissue
Inflammation
Muscle weakness
Muscle tightness
Joint stiffness
The therapy also identifies and treats any issues that caused or contributed to the spinal damage/injury. A study found physical therapy to improve postoperative ambulation, pain, disability, and decreased surgical complications.
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Post Spine Surgery Physical Therapy Goals
Physical therapy goals are to return the individual to full function before chronic pain or injury. These include:
Decrease pain and stress around the surgical site.
Loosen and stretch the muscles surrounding the surgical site.
Strengthen the back and neck muscles.
Stabilize the back and neck muscles.
Learn to move around safely.
Prepare for everyday physical activities like standing up or sitting down, lifting, and carrying objects.
Improve posture.
The therapy team will develop a customized treatment/rehabilitation plan as well as post-surgical recovery at home to help the individual and family to understand what to expect, including psychological factors like not wanting to perform the exercises or stretches to avoid pain, frustration, anger, depression, and wanting to give up. However, individuals can maximize the benefits to ensure an optimal outcome before surgery by pre-conditioning identifying structural and functional issues contributing to the injury.
Physical Therapy Involves
Therapy can be done at home, in a hospital or rehab setting, or at a chiropractic/physical therapy clinic. Therapists use:
A physical therapy session can last 45 minutes to an hour. It’s essential to discuss hopes and expectations post-surgery and after the therapy has finished. The therapists will explain the healing process, the treatment progression, and any questions a patient may have. Understanding the treatment process will help the individual want to engage in the treatment plan. The therapist team will also interface with the surgeon to prevent adverse outcomes.
Optimal Health
The physical therapy team will help the individual feel better with each session and stay motivated. Having a solid relationship with the therapy team makes it easier to share goals, worries, and challenges that the team can adapt to as progress is made. To gain the most from the therapy:
Try working with a therapist that the surgeon recommends can be helpful as they already have a working relationship.
Keep communication open between the surgeon and team.
Adhere to any precautions and restrictions set by the surgeon and therapy team.
Maintain recommended exercises at home between sessions.
Ease into activity and avoid overexertion.
Post spine surgery physical therapy helps accelerate the healing process and serves to help individuals regain their quality of life.
Body Composition
Power Of Protein
Protein is an essential component of muscle development, bone density, muscle mass, and lean tissue when building a healthy body. Protein is necessary for all the body’s physiological functions.
References
Adogwa, Owoicho et al. “Assessing the effectiveness of routine use of postoperative in-patient physical therapy services.” Journal of spine surgery (Hong Kong) vol. 3,2 (2017): 149-154. doi:10.21037/jss.2017.04.03
Atlas, S J, and R A Deyo. “Evaluating and managing acute low back pain in the primary care setting.” Journal of general internal medicine vol. 16,2 (2001): 120-31. doi:10.1111/j.1525-1497.2001.91141.x
Gellhorn, Alfred Campbell et al. “Management patterns in acute low back pain: the role of physical therapy.” Spine vol. 37,9 (2012): 775-82. doi:10.1097/BRS.0b013e3181d79a09
Jack, Kirsten et al. “Barriers to treatment adherence in physiotherapy outpatient clinics: a systematic review.” Manual therapy vol. 15,3 (2010): 220-8. doi:10.1016/j.math.2009.12.004
Lindbäck, Yvonne et al. “PREPARE: Pre-surgery physiotherapy for patients with degenerative lumbar spine disorder: a randomized controlled trial protocol.” BMC musculoskeletal disorders vol. 17 270. 11 Jul. 2016, doi:10.1186/s12891-016-1126-4
The most common form of pain is the headache. Whether dealing with a mild, dull ache, severe throbbing, or painful tension along the scalp and neck, headaches can disrupt and get in the way of everyday life. Over-the-counter pain medications can offer temporary relief, but they don’t get to the root and solve the cause. Chiropractic is a safe and effective treatment option that will bring head pain relief and treat what is causing the headache/s.
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Triggers
Individuals engage in more sedentary activities, and more hours spent in one fixed position combined with poor posture can increase joint irritation and muscle tension in the neck, upper back, and scalp. Headaches can have a variety of causes or triggers. These can include:
Stress is the most common trigger
Muscle tension
Insomnia
Environmental stimuli – noises, lights, smells
Dehydration
Weather changes
Foods
Blood sugar changes
Excessive exercise
Most Common Types
There are two main categories: primary and secondary headaches.
Primary headaches
Primary headaches are when the headache itself is the main problem and is not a symptom of underlying diseases or conditions. These include:
Headache pain comes from interacting signals in the brain, blood vessels, and nerves. A mechanism activates specific nerves that affect the muscles and blood vessels, sending pain signals back to the brain. If any of the following is occurring it is recommended to contact a doctor, headache specialist, or chiropractor.
Three or more headaches a week.
Headaches that get worse or don’t go away.
Having to take a pain reliever every day or almost every day.
Need more than 2-3 doses of over-the-counter medications a week to relieve symptoms.
Headaches triggered by strenuous activity, hard work/exertion, bending, coughing.
What time of day/night the headache usually occurs?
How long does the headache last?
Where the pain is located?
Type of pain – throbbing, comes and goes, dull aching, one-sided, etc.
Does the headache come on suddenly without warning or slowly progress?
Are there other symptoms like weakness, nausea, sensitivity to light or noise, decreased appetite, changes in attitude or behavior?
Chiropractic
A chiropractor will assess, diagnose, conduct a physical examination to determine the cause and develop a personalized treatment plan to alleviate the pain and help to manage and prevent headaches. Treatment approaches include:
A combination of chiropractic manipulative therapy.
Activate trigger points to release tension and allow for optimal nerve and blood circulation.
Active and passive exercises.
Massage.
Health coaching.
Body Composition
Water
Most of the body is made up of water with the percentage of body composition that is water changing based on individual functional needs. Essential functions of water include:
Help to build/repair almost every cell in the body.
Regulating body temperature through sweating and respiration.
Energy from carbohydrates and proteins is transported by water through the blood.
Assists in the removal of metabolic waste through urination.
Acts as a shock absorber to protect the brain and spinal cord.
Creates saliva/fluids to lubricate the joints.
The amount of water in the body depends on various factors that include:
The most common water comes from lean body mass. This includes blood, organs, and muscle. Major body organs’ water content:
Lungs – 83%
Muscles and kidneys – 79%
Brain and heart – 73%
Skin – 64%
Bones – 31%
References
Bryans, Roland et al. “Evidence-based guidelines for the chiropractic treatment of adults with headache.” Journal of manipulative and physiological therapeutics vol. 34,5 (2011): 274-89. doi:10.1016/j.jmpt.2011.04.008
Tyagi, Alok. “New daily persistent headache.” Annals of Indian Academy of Neurology vol. 15,Suppl 1 (2012): S62-5. doi:10.4103/0972-2327.100011
Improving posture can be challenging. Poor posture is often the source of various musculoskeletal issues like chronic pain throughout the body. Poor posture can be so ingrained in the brain that it becomes an unconscious positioning reflex that feels right but could be worsening spinal, hip, and leg problems. The Alexander Technique could be a treatment option that could help long-term.
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Alexander Technique
The approach focuses on learning mind-body awareness. It is an educational process to teach individuals to become aware of their body positioning and change unhealthy posture/movement habits into healthy ones. The objective is learning to utilize sufficient levels of muscle tension for everyday activities, like sitting, standing up, and walking in a healthy way to maintain optimal health of the musculoskeletal system.
The theory is that less tension minimizes wear and tear on the muscles and structures of the spine vulnerable to compression.
The fundamental goal of the Alexander Technique is to undo all the unhealthy tension habits to decompress the spine and retrain the mind and body to approach movement and body positioning in a new and healthy way.
Teachings
The technique can be done in a class setting or one-on-one teaching because everyone’s postural and movement habits are unique. A teacher helps identify the tension-inducing postures and educates the individual on how to correct them. Human touch is an integral part of the Alexander Technique. Using their hands gently to adjust the individual to a proper upright position, a teacher helps release pressure from the head, neck, shoulders, and upper back. The individual learns to release the tension throughout their body. The Alexander Technique is a type of hands-on therapy; it is not manipulation or massage. It uses a light touch with no risk of injury to the spine, allowing anyone to participate. However, individuals must be willing to participate/engage in the process to get the benefits. Most individuals can tell if it’s right for them during the first lesson.A typical program teaches:
Staying alert to the body’s warning of tension and compression.
Tension Build Up
Individuals usually don’t even realize they’re constantly placing pressure on their spine from unhealthy postural habits, building up muscular tension they never knew they created. For example, unhealthy neck position habits include:
Pushing the head forward
Slumping over
Pinning the shoulders back
These postures generate/build pressure and tension that radiates outward and down to the large muscles of the spine.
Habitual downward pressure can pull and change the spine’s shape, leading to degenerative forms of spinal deformity in severe cases.
When the tension is released, the neck and body begin to stand upright comfortably, without pulling down or pulling back.
Frederick Matthias Alexander
Developed the technique in the 1890s to help his muscle tension problems affecting his acting career. When performing, he would stiffen his neck and pull his head back and up, building tension that caused him to tighten his throat and lose his voice. He did not know he was doing this until he performed in front of a mirror and saw his awkward positioning. He realized this and retrained himself to pose naturally, stay relaxed, and be aware of any tension building in the muscles to release it immediately. Alexander Technique educators/practitioners practice all over the world. The American Society for the Alexander Technique or AmSAT website has a Find A Teacher Tool that connects individuals to AmSAT-approved teachers.
Body Composition
Practicing Mindfulness
Developing a mindfulness practice can help identify triggers of negative behavior or thoughts. Just like diet and exercise, practicing mindfulness is unique to everyone. It is recommended to try different things like:
Journaling is another way to tune into oneself. Grab a pen and paper, a computer, tablet, or phone, and take a few minutes to write every day.
Write one thing that makes you happy.
One thing you want to improve.
One goal you want to accomplish that day or that week.
Mindful music listening can help reduce stress by allowing the individual to focus their attention when their mind is going in all directions.
Instead of turning to the news or email when waking up, grab a cup of coffee or tea and listen to a favorite podcast or music.
Put the phone away and listen to your mind and self.
Try to meditate in the morning when waking up. This helps set the day’s goals/plans. Goal-setting mindfulness has been shown to reduce stress levels and anxiety. However, if the morning is not possible then at night before bed can be used to reflect on the day’s activities, what went well, what didn’t, how to improve something, whatever the case, the point is to make time for yourself to reflect, set goals, and develop a plan to achieve those goals.
References
Becker, Jordan J et al. “Preliminary evidence for feasibility, efficacy, and mechanisms of Alexander technique group classes for chronic neck pain.” Complementary therapies in medicine vol. 39 (2018): 80-86. doi:10.1016/j.ctim.2018.05.012
Cacciatore et al., Improvement in automatic postural coordination following Alexander technique lessons in a person with low back pain. Physical Therapy Journal, 2005; 85:565-578. Accessed January 5, 2011
Chin, Brian et al. “Psychological mechanisms driving stress resilience in mindfulness training: A randomized controlled trial.” Health psychology: official journal of the Division of Health Psychology, American Psychological Association vol. 38,8 (2019): 759-768. doi:10.1037/hea0000763
Little P, Lewith G, Webley F, et al. Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain. The BMJ. 2008;337:a884. doi: doi.org/10.1136/bmj.a884.
Paolucci, Teresa et al. “Chronic low back pain and postural rehabilitation exercise: a literature review.” Journal of pain research vol. 12 95-107. December 20 2018, doi:10.2147/JPR.S171729
Musculoskeletal Nutrition: Musculoskeletal conditions are non-communicable conditions/disorders and are the most common conditions that chiropractors and physiotherapists treat. Unhealthy lifestyle practices like smoking, an unhealthy diet, and little to no exercise or physical activity impact musculoskeletal disorders and remain the most common causes of physical disability and pain. Musculoskeletal conditions include:
Back pain
Carpal Tunnel Syndrome
Tendonitis – inflammation of the fibrous tissues that connect the muscles to the bones.
Rheumatoid Arthritis
Osteoarthritis
Bone Fractures
Fibromyalgia
A lack of proper nutrients increases the risk for bone, muscle, and joint disease. A proper diet combined with strengthening and stretching will help with injury recovery and help prevent disorders, injury, and pain. For example, inadequate consumption of calcium and vitamin D intake can lead to osteoporosis. Both nutrients are necessary for musculoskeletal health. Calcium helps build bone tissue, and vitamin D promotes calcium absorption.
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Musculoskeletal Nutrition
Even physically active and healthy individuals’ can go through inadequate nutrition intake, increasing the risk of injury from its effect/s on rehabilitation and recovery. There are mechanisms to insufficient nutrient intake that can lead to muscle injury.
Intense training causes skeletal muscle breakdown that can worsen from poor dietary protein intake.
Not hydrating the body can compromise blood flow to working muscles, increasing the risk for injury and other health issues.
Hydration influences the amount and composition of joint fluid and helps maintain articular cartilage.
Deficiencies in nutrients like:
Potassium
Iron
Zinc
Magnesium
Chromium
Copper
Vitamins
The lack of micronutrients and their role in bone and muscle metabolism increases the risk for injury and the development of musculoskeletal conditions.
Overall Health
Connective tissue holds the body’s bones and muscles together and is essential for joint integrity. Athletes and individuals with physically demanding jobs and lifestyles need to take care of their connective tissues to prevent degradation, injuries, and joint conditions, like arthritis and tendon injuries. It is recommended to have a diet that is:
Achieving optimal health requires all-around healthy lifestyle choices and musculoskeletal nutrition.
Body Composition
Superfoods
Many nutrient-rich foods can be incorporated into an individual’s diet to improve overall well-being.Superfoods are high in antioxidants and contain vast amounts of vitamins and minerals. A superfood is a food rich in compounds that are beneficial to an individual’s health. These compounds include:
Phytochemicals – include antioxidants like polyphenols that provide anti-inflammatory properties.
Fiber
Omega-3 fatty acids
Superfoods are recognized by national nutrition guidelines as Powerhouse Fruits and Vegetables or PFV. Antioxidants reduce free radicals and prevent and repair damage caused by oxidative stress. Oxidative stress occurs when free radicals accumulate in the body and can lead to chronic and degenerative illnesses like arthritis, cardiovascular disease, and cancer. A diet rich in antioxidants can expedite recovery time from injury, illness, and physical activity/exercise-induced stress.
Anthocyanins are a type of polyphenol that become antioxidants that help reduce the incidence of chronic disease. They are different types of pigments found in plants, giving fruits and vegetables their vibrant colors. These include:
Black beans
Berries
Cherries
Pomegranates
Peaches
Eggplant
Purple sweet potatoes
A diet rich in anthocyanins can reduce oxidative stress and inflammation, help prevent cardiovascular disease, and control and prevent diabetes.
References
Craddock, Joel C, et al. “Vegetarian and Omnivorous Nutrition – Comparing Physical Performance.” International journal of sports nutrition and exercise metabolism vol. 26,3 (2016): 212-20. doi:10.1123/ijsnem.2015-0231
Mendonça, Carolina Rodrigues et al. “Effects of Nutritional Interventions in the Control of Musculoskeletal Pain: An Integrative Review.” Nutrients vol. 12,10 3075. 9 Oct. 2020, doi:10.3390/nu12103075
Sale, Craig, and Kirsty Jayne Elliott-Sale. “Nutrition and Athlete Bone Health.” Sports medicine (Auckland, N.Z.) vol. 49,Suppl 2 (2019): 139-151. doi:10.1007/s40279-019-01161-2
Slavin, Joanne L, and Beate Lloyd. “Health benefits of fruits and vegetables.” Advances in nutrition (Bethesda, Md.) vol. 3,4 506-16. 1 Jul. 2012, doi:10.3945/an.112.002154
Tucker, K L et al. “Potassium, magnesium, and fruit and vegetable intakes are associated with greater bone mineral density in elderly men and women.” The American journal of clinical nutrition vol. 69,4 (1999): 727-36. doi:10.1093/ajcn/69.4.727
Sports chiropractic athletes: A sports chiropractor is a specialist that works with athletes to improve their performance. These doctors specialize in assessing and treating sports injuries. Treatment also prevents future damage/injury by providing a customized rehabilitation, strengthening, flexibility, and mobility program, that includes:
Exercise prescription
Ergonomic recommendations
Health coaching/counseling
Therapeutic sports massage
Sports chiropractic deals with preventing, diagnosing, and treating sports-athletic-based injuries to muscles, tendons, ligaments, and joints. Sports chiropractors have extensive training in evaluating muscular-skeletal problems related to sports participation overuse. Diagnosis is acquired through:
Chiropractors are masters of the human body and trained to use advanced diagnostics tools. A sports chiropractor evaluates individuals from all levels of sports and fitness, including:
Athletes – professional or recreational
Weekend warriors
Military personnel
The objective is to identify musculoskeletal problems related to sporting activity or overuse, alleviate pain, rehabilitate, and strengthen to prevent future injury. They can diagnose and treat sports-related injuries from common overuse injuries like:
Hip pain from frequently running on pavement.
Shoulder pain from damage caused by continued overhead throwing or hitting.
Low back and leg issues from twisting, bending, jumping, and reaching.
Balance
Athletes need a healthy balance of endurance, strength, and structure. Through biomechanics training, sports chiropractic restores the body’s natural balance and proper function. The goal is to get the athlete re-engaged and protected against further injury and play without any problems or limitations. Sports chiropractic athletes can return in a short amount of time from injuries that include:
Torn ACLs
MCL Sprain
Ankle Sprain
Achilles Tendonitis
Rotator cuff tears
Quadriceps Strains
Hamstrings Strains
Shin Splints
Sports Hernia
Neck Pain
Back Pain
Spondylolisthesis
Prevention Regimen
They can recommend prevention programs to prevent potential problems before an athlete gets hurt. A chiropractor will detect developing muscle imbalances before they turn into a chronic condition that can lead to damage to the rest of the body. Additional therapies include:
Massage
Hot/cold treatments
Ultrasound therapy
Low-level laser therapy
Adjustments, stretching, core training, therapeutic sports massage, health coaching, and nutritional counseling will strengthen the body, allowing for performing physical activities and sports at optimum levels.
Body Composition
Sports Performance
Working with sports chiropractic athletes means achieving a balance of lean mass to maintain sports performance and reduce the risk of injury. Athletes, doctors, and trainers monitor gains over time to maximize performance and watch for signs of potential injury. A method of monitoring for potential injury is the ECW/TBW Analysis. When training and engaging in sports, the body is under physical stress. The proper amount of rest and recovery are needed to allow muscles to recover and regrow. Inflammation is reflected in the ECW/TBW by monitoring changes over time. A steady increase can indicate a sign of overtraining or improper recovery. Monitoring this progression can alert doctors and trainers that an athlete needs a less intense workout or longer recovery to reduce the potential for overtraining injury.
References
Corcoran, Kelsey L et al. “Association Between Chiropractic Use and Opioid Receipt Among Patients with Spinal Pain: A Systematic Review and Meta-analysis.” Pain medicine (Malden, Mass.) vol. 21,2 (2020): e139-e145. doi:10.1093/pm/pnz219
Naqvi U, Sherman Al. Muscle Strength Grading. [Updated 2021 Sep 2]. In: StatPearls [Internet]. Treasure Island (F.L.): StatPearls Publishing; 2022 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK436008/
Nelson, Luke et al. “A descriptive study of sports chiropractors with an International Chiropractic Sports Science Practitioner qualification: a cross-sectional survey.” Chiropractic & manual therapies vol. 29,1 51. 13 Dec. 2021, doi:10.1186/s12998-021-00405-1
Williams, Sean et al. “Kinesio taping in treatment and prevention of sports injuries: a meta-analysis of the evidence for its effectiveness.” Sports medicine (Auckland, N.Z.) vol. 42,2 (2012): 153-64. doi:10.2165/11594960-000000000-00000
Sciatica motor vehicle crash. After an automobile crash/accident, symptoms of pain and discomfort can immediately follow the force of impact, indicating an injury. Many injuries and symptoms appear right away, like:
Pain from high-impact trauma and cuts.
Bone fractures.
Dislocations.
Neck whiplash.
Back pain.
The sciatic nerve is the largest in the body, and any damage can cause pain in one or both sides of the body. Pressure and compression on the nerves, ligaments, and muscles accompanied by weakness or numbness in the lower back, legs, or feet could cause delayed sciatica symptoms hours, days, even weeks later. It is critical to meet with a doctor and auto accident chiropractor after any type of accident, large or small, to develop a thorough personalized treatment plan.
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Sciatica Motor Vehicle Crash
Sciatica can be brought on by a pinched nerve, which is often the result of the spine shifting out of place, causing herniation and compression on the sciatic nerve. The trauma from a motor vehicle accident can cause the spinal discs to be knocked out of place, rupture, and leak out, irritating the surrounding tissue and nerve endings. Back injuries are among the most common forms of damage/injury resulting from a motor vehicle accident/crash that can lead to sciatica. Broken and/or fractured vertebral, hip, or pelvis bone fragments can compress the sciatic nerve. Even when the initial result of the impact does not result in sciatica, over time, an untreated back injury could lead to sciatica symptoms.
Symptoms
Motor vehicle crashes often activate or aggravate pre-existing conditions like asymptomatic degenerative disc disease, affecting the sciatic nerve causing discomfort and pain. Common symptoms include:
Mild discomfort or achiness.
Tingling sensations from the lower back and down the back of the leg.
Weakness, numbness, or difficulty moving the leg and foot.
Inability to bend the foot upward at the ankle- known as foot drop.
Constant pain in one side of the buttocks or leg.
Sharp pain that makes it difficult to stand up and walk
Difficulty sitting.
Burning or tingling in one leg can worsen when sitting.
Intense pain.
Sharp burning and/or what feels like shooting electricity pain.
Diagnosis
A spine doctor and chiropractor will use diagnostic imaging tools like X-rays, and CT scans to see the scope of the injured area.
An X-ray will show a detailed image of the spine and affected bones in the area.
A CT scan will include a 3D image that shows the surrounding musculature, tissues, and nerves that could be damaged/injured.
Treatment
The doctor and chiropractor will then develop an appropriate and personalized treatment plan that could utilize various methods and techniques.
Chiropractic is commonly the first treatment to realign the spine and relieve pressure on the nerve.
A pain management specialist or physical therapist will be brought in for rehabilitation/recovery as adjustments progress.
Orthopedists and neurologists may be brought in for less conservative treatment in more severe cases, including surgical options.
Other treatments can include steroid injections or anti-inflammatory medicines to relieve nerve pressure.
Body Composition
Injury Rehabilitation Phase
Current in-clinic methods of measuring the composition of an injured body are indirect, while medically advanced techniques limit the frequency of testing. InBody provides cost-effective, comprehensive, and timely measurements that identify areas of weakness from damage, injury, or recent surgery and develop a customized rehabilitation program to improve functional status.
During the rehabilitation phase, increased sedentary behavior and/or immobilization causes muscle loss in the injured or operated region. By independently evaluating lean mass in each segment of the arms, legs, and torso, a chiropractor or physical therapist gathers baseline information on the body segments with restricted mobility.
InBody can help provide further insight into an individual’s body composition to analyze long-term health risks and develop a personalized exercise intervention to improve overall health and reduce health risks. This provides beneficial information for identifying potential imbalances related to muscle loss post-injury/surgery that can be targeted and improved. Identifying these imbalances allows the therapists to increase functional fitness and mobility, helping the individual reduce the risk of re-injury or new injuries.
References
Defouilloux, B et al. “A propos de trois observations chez des polytraumatisées de la route présentag une fracture du bassin associée à des signes neurologiques” [Apropos of 3 cases of multiple traffic injuries presenting pelvic fractures associated with neurologic signs]. Journal de radiologie, d’electrologie, et de medecine nucleaire vol. 48,8 (1967): 505-6.
Noble, J et al. “Analysis of upper and lower extremity peripheral nerve injuries in a population of patients with multiple injuries.” The Journal of trauma vol. 45,1 (1998): 116-22. doi:10.1097/00005373-199807000-00025
Walsh, K et al. “Risk of low back pain in people admitted to hospital for traffic accidents and falls.” Journal of epidemiology and community health vol. 46,3 (1992): 231-3. doi:10.1136/jech.46.3.231
Sleeping with a bulging disc can be challenging for the body to achieve the proper rest. And sleeping in an awkward position can add stress to the spine, making the bulge worse, which can cause tingling, numbness, pain, and digestive problems. This can disrupt the sleep cycle and prevent proper healing of the spinal injury.
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Sleeping With a Bulging Disc
When sleeping, most back pain occurs in the lumbar or lower back, in one of two places where the spine meets the pelvis. Around 95% of lower back herniations happen in the L4-L5 spinal segment or the L5-S1 Lumbosacral joint. Any back pain can turn into a vicious cycle of:
Sleeping with a bulging disc requires maintaining the ears, shoulders, and hips aligned to keep the spine aligned.
Sleeping on The Back
Back sleeping done correctly is the best way to sleep for the spine’s health. The important thing is to ensure the entire back is supported when sleeping. If there is a gap or space between the mattress and the back, the weight and gravity force the spine to lower in an unnatural way to fill the space. This can cause back muscle soreness, injury, and sciatica. A thin pillow, blanket, or towel can be used to fill the space, giving the spine the support it needs. Back sleepers can also benefit from a pillow or two under the knees to elevate the legs and help maintain the natural curve of the pine.
Sleeping on The Side
Side sleepers can try pulling the legs up toward the chest, and placing a pillow between the knees can provide relief when sleeping with a bulging disc. Pulling the legs up in the fetal position can relieve pressure on the discs. It is recommended to switch sides to keep the spine balanced. This helps maintain hip alignment, which helps keep the spine in a neutral position.
Sleeping On The Stomach
It is recommended to avoid sleeping on the stomach. This pulls the spine down into an unnatural curve that can cause and exacerbate back pain. For individuals that naturally stomach sleep, it is recommended to place a pillow under the hips and lower abdomen to prevent unnatural spinal positioning.
Chiropractic Relief
Utilizing the right sleeping position can provide pain relief and thorough rest. However, sleeping with a herniated disc is far from what is needed to get back to a normal healthy sleeping pattern. This depends on the location of the bulging disc, severity, and cause. A chiropractor can:
Help the individual develop an optimal sleeping routine and positioning.
Body Composition
Sleep and Growth Hormone In Children
Growth, in all ages, is primarily controlled by growth hormone. The hormone is regulated by the hypothalamus and pituitarygland which plays an important role in sleep. Growth hormone has been found:
It peaks during the beginning of deep sleep.
There are multiple smaller peaks during the other stages of sleep.
Those who have a delay at the beginning of deep sleep have delayed rises in growth hormone levels.
For children to grow they need to have proper levels of growth hormone. This means they need to have the proper amount of sleep for proper body composition. Research has found that increased levels of sleep resulted in less overall fat mass and a reduced percentage of body fat allowing their bodies to grow.
References
Al Qaraghli MI, De Jesus O. Lumbar Disc Herniation. [Updated 2021 Aug 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK560878/
Desouzart, Gustavo et al. ‘Effects of Sleeping Position on Back Pain in Physically Active Seniors: A Controlled Pilot Study. 1 Jan. 2016: 235 – 240.
Kose, Gulsah et al. “The Effect of Low Back Pain on Daily Activities and Sleep Quality in Patients With Lumbar Disc Herniation: A Pilot Study.” The Journal of neuroscience nursing: Journal of the American Association of Neuroscience Nurses vol. 51,4 (2019): 184-189. doi:10.1097/JNN.0000000000000446
Sener, Sevgi, and Ozkan Guler. “Self-reported data on sleep quality and psychologic characteristics in patients with myofascial pain and disc displacement versus asymptomatic controls.” The International Journal of prosthodontics vol. 25,4 (2012): 348-52.
Flexibility and range of motion are essential elements for an individual’s overall health, physical fitness, and quality of life. Healthy flexibility helps the body:
Maintain a physically active lifestyle.
Maintain strength.
Improve endurance.
Prevent injury.
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Flexibility and Range of Motion
Joint stiffness and pain can make it challenging to engage in everyday activities and maintain mobile, physical, emotional, and internal health. To keep the body flexible and moving, individuals need to use their entire body and range of movement. Becoming sedentary affects the body’s flexibility, leading to slowed/blocked blood circulation, nerve energy signal disruption, and sickness. To improve flexibility and range of motion, it is recommended to include:
Stretching the body
Regular exercise and physical activity
Yoga
Healthy diet
Healthy weight
Proper sleep
For individuals with stiffened muscles and joints, chiropractic medicine can increase the body’s flexibility, improving the range of motion in the joints. Chiropractic optimizes the function of the joints, improving mobility with less pain. When living with arthritis, chiropractic is an excellent therapy to decrease pain and activate the body’s natural healing abilities. Chiropractic adjustments align the spine and improve nervous system function.
Nerve Pressure
Nerve pressure can cause pain or tingling sensations that can become difficult to manage. A shifted misaligned spine can compress nerve endings, causing pain that presents with or without movement. Getting the body in motion and moving around is essential to treat stiffness and joint pain. The objective of chiropractic is to align the spine and body and relieve pressure on the nerves helping the body gain back its flexibility and range of motion. Once the body is adjusted, the nerve endings are no longer irritated, relieving the pain. Chiropractic uses various techniques to deal with areas of compression, including stretching, percussive massage, low-laser therapy, ultrasound, and strengthening exercises.
Chiropractic adjustments relieve pain and improve mobility.
Strengthening exercises to keep the spine in proper alignment.
Exercising keeps the adjustments in place.
A careful assessment of the condition will determine the cause of stiffness and joint immobility. Chiropractic can treat the joints, bones, and muscles to improve flexibility manage muscle spasms and soft tissue tenderness to alleviate symptoms restoring and improving range of motion. Chiropractic adjustments are combined with therapeutically designed stretches and exercises to perform at home, along with an anti-inflammation diet and supplements.
Body Composition
Zinc
Zinc is an essential nutrient that provides overall immune function. It is a powerful antioxidant that helps prevent and reduce oxidative stress and inflammation responses. Various bodily chemical reactions require Zinc. Zinc is necessary for muscle protein synthesisand hormone regulation. Zinc deficiency is common in older individuals and has been connected with degenerative diseases that include:
Green, S et al. “Physiotherapy interventions for shoulder pain.” The Cochrane database of systematic reviews vol. 2003,2 (2003): CD004258. doi:10.1002/14651858.CD004258
Hartvigsen, Jan et al. “What low back pain is and why we need to pay attention.” Lancet (London, England) vol. 391,10137 (2018): 2356-2367. doi:10.1016/S0140-6736(18)30480-X
Kavuncu, Vural, and Deniz Evcik. “Physiotherapy in rheumatoid arthritis.” MedGenMed: Medscape general medicine vol. 6,2 3. 17 May. 2004
Page, Carolyn J et al. “Physiotherapy management of knee osteoarthritis.” International journal of rheumatic diseases vol. 14,2 (2011): 145-51. doi:10.1111/j.1756-185X.2011.01612.x
Wessels, Inga et al. “Zinc as a Gatekeeper of Immune Function.” Nutrients vol. 9,12 1286. 25 Nov. 2017, doi:10.3390/nu9121286
Today, more than ever, individuals are less physically active and sitting down for more extended periods causing the gluteus muscles to be used less and weaken. Weak, inactive, or tightening glutes can cause instability in the lower spine, the hips, and the pelvis to shift out of alignment. This leads to low back and buttock pain. The pain is constantly dull, aching, pulsating, then when moving, getting up, it throbs and stings. Gluteal strengthening exercises can strengthen the muscles and alleviate the pain.
Contents
Gluteal Strengthening
Every individual has a unique physiology. The body develops asymmetrically as the individual favors one side or area of the body over another. This can cause imbalances in the muscular system, leading to awkward positioning that causes pain. The muscle groups that support the lower back consist of the:
Core muscles
The gluteal muscle group includes:
Gluteus Maximus
Gluteus medius
Gluteus minimus
Pelvis muscles
Hamstrings
Quadriceps
In some cases, the development or lack of level of an individual’s upper back strength can also affect the amount of strain on the lower back.
Gluteal Strengthening Difference
Many joints connect in this area that can have functional problems. The muscles within the lower back need:
Stretching allows the body to enhance the limits of its flexibility and mobility. Most of the stretches are involve the hip joint, as this is one of the most effective ways to loosen the gluteal regions. It’s essential to warm the muscles slightly with a light activity while stretching them to elongate naturally.
Seated Figure 4 Stretch
Sitting in a chair.
Cross the right leg over the left.
With the right ankle resting on the left knee.
It should resemble the number 4.
Bend forward at the hip, placing slight pressure onto the left leg.
Hold this stretch for ten-twenty seconds.
Stretch the other side.
Placing the left foot on the right knee.
Repeat this three times.
Downward Dog
This yoga pose engages all the muscles along the back. With the glutes at the top in this position, it forces them to activate, allowing them to stretch fully.
Hold this pose and focus the attention on the glutes.
Squats naturally engage the glutes. This is a variation on a squat that focuses on developing gluteal strength.
Stand with the back facing the wall.
Place a Swiss stability ball between the wall and the back.
Lean back into the ball for balance.
Lower the torso until the knees reach 90 degrees.
Return to standing.
Repeat for ten reps.
Do three sets.
Body Composition
Analysis An Effective Tool
Opportunities to increase physical activity lead individuals in a positive direction. The most common reason for reducing and stopping healthy changes is a lack of motivation and feedback. Strategies that provide immediate feedback are essential to:
Monitor progress for establishing a baseline.
Set appropriate and attainable goals.
Track changes over time.
Ensure success.
Monitoring changes with a simple weight scale or Body Mass Index calculator provides limited ability to accurately track changes that only highlight weight changes and not track progress in muscle gain or fat loss. In less than 45 seconds, the InBody Test provides doctors, trainers, and physical therapists with easy-to-understand, accurate and objective measurements to evaluate body composition that includes:
Assessing muscle distribution.
Target areas weakened by condition or injury.
Identify muscle and fat imbalances in each area of the body.
Monitor changes to determine the efficacy of the treatment plan, exercise program, and diet plan to ensure long-term success.
References
Akuthota, Venu et al. “Core stability exercise principles.” Current sports medicine reports vol. 7,1 (2008): 39-44. doi:10.1097/01.CSMR.0000308663.13278.69
Distefano, Lindsay J et al. “Gluteal muscle activation during common therapeutic exercises.” The Journal of orthopedic and sports physical therapy vol. 39,7 (2009): 532-40. doi:10.2519/jospt.2009.2796
Glaviano, Neal R et al. “Gluteal muscle inhibition: Consequences of patellofemoral pain?.” Medical hypotheses vol. 126 (2019): 9-14. doi:10.1016/j.mehy.2019.02.046
Jeong, Ui-Cheol et al. “The effects of gluteus muscle strengthening exercise and lumbar stabilization exercise on lumbar muscle strength and balance in chronic low back pain patients.” Journal of physical therapy science vol. 27,12 (2015): 3813-6. doi:10.1589/jpts.27.3813
Macadam, Paul et al. “AN EXAMINATION OF THE GLUTEAL MUSCLE ACTIVITY ASSOCIATED WITH DYNAMIC HIP ABDUCTION AND HIP EXTERNAL ROTATION EXERCISE: A SYSTEMATIC REVIEW.” International Journal of sports physical therapy vol. 10,5 (2015): 573-91.
Sometimes the bones or vertebrae of the spine can crack and collapse under their weight. This is known as a compression fracture, vertebral compression fracture, or VCF. There are almost 1 million compression fractures every year, usually because the bones become weakened and crack under the weight of the vertebrae above them. These fractures can cause spinal weakness affect posture and the ability to stand up straight. They are often the cause for individuals to hunch over, also called kyphosis.
Contents
Compression Fracture
Compression fractures are small breaks or cracks in the vertebrae. The breaks occur in the vertebral body, the thick rounded part on the front of each vertebra. These fractures cause the spine to weaken and collapse. With time, these fractures affect posture as the spine curves forward. The fractures are often found in the middle/thoracic spine in the lower area. They often result from osteoporosis but can also happen after a trauma like an automobile accident, work, sports injury, or a tumor on the spine.
Symptoms
Compression fracture symptoms range from mild to severe or no symptoms. Many individuals can stand or walk without pain. They are often discovered when X-rays are taken for another condition. Symptoms include:
Back pain can come on suddenly and last for a significant time, often diagnosed as chronic back pain.
It usually develops between the shoulders and the lower back.
The pain and discomfort decrease when lying down and worsen when standing or walking.
Decreased mobility or flexibility in the spine. Individuals are unable to twist or bend.
Hunched over appearance, known as dowager’s hump or hunchback.
Loss of height from the vertebrae compression and the spine curving.
Pinched nerves
Nerve damage can cause tingling, numbness, and difficulty walking.
Loss of bladder or bowel control with severe, untreated fractures.
Individuals At Risk
Individuals who have had a compression fracture are more likely to have another one.
Women over 50 have a higher risk due to osteoporosis.
With age, the risk increases for men and women.
Diagnosis
A doctor will perform an examination and ask about symptoms. The exam will include:
Checking spinal alignment.
Posture analysis.
Gently palpates different areas of the back to identify the source of pain.
Examine for signs of nerve damage that include numbness, tingling, or muscle weakness.
A doctor will order imaging studies to examine the backbones, muscles, and soft tissues. Imaging studies include:
CT scan, X-ray, or MRI of the spine.
DEXA scan is a type of X-ray that measures bone loss bone density.
A myelogram is a procedure used along with imaging studies. A contrast dye is injected into the spine before the scan making the images easier to see.
Compression fracture treatment focuses on relieving pain, stabilizing the vertebrae, and ongoing fracture prevention. Treatment depends on the severity of the fracture and the individual’s overall health. Treatment can include:
Pain Medication
A doctor can recommend over-the-counter non-steroidal anti-inflammatory medication.
A doctor may prescribe muscle relaxers or prescription medication.
Follow instructions carefully when taking medications.
Back Brace
A special type of back brace helps to support the vertebrae.
The brace can also relieve pain by reducing how much the spine moves.
Strengthening Meds
Medications known as bisphosphonates can help slow down bone loss, stabilize the bones and prevent fractures.
This minimally invasive procedure relieves pain, stabilizes the bones, and improves mobility.
During vertebroplasty, the doctor inserts a needle in the vertebra and injects bone cement.
During kyphoplasty, the doctor inserts an inflatable device that they fill with cement.
Both are outpatient procedures allowing the individual to go home the same day.
Individuals over 65 or that have osteoporosis or a history of cancer are recommended to see their doctor. Individuals who present with sudden back pain that doesn’t get better after a day or two are advised to see a doctor and evaluate for back pain so the doctor can determine the cause and develop a treatment plan.
Body Composition
Vitamin D To Build Muscle
Skeletal Muscle Mass decreases as the body ages, primarily due to decreased physical activity. Vitamin D has been reported to influence muscle quality. This could be helpful for adults as they age. Muscle loss diminishes functional performance on activities that require strength and coordination. When this loss of muscle mass becomes significant, it becomes a condition known as sarcopenia. Treatments include:
Bischoff-Ferrari, H A et al. “Vitamin D receptor expression in human muscle tissue decreases with age.” Journal of bone and mineral research: the official journal of the American Society for Bone and Mineral Research vol. 19,2 (2004): 265-9. doi:10.1359/jbmr.2004.19.2.265
Donnally III CJ, DiPompeo CM, Varacallo M. Vertebral Compression Fractures. [Updated 2021 Nov 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK448171/
Hassan-Smith, Zaki K et al. “25-hydroxyvitamin D3, and 1,25-dihydroxyvitamin D3 exert distinct effects on human skeletal muscle function and gene expression.” PloS one vol. 12,2 e0170665. 15 Feb. 2017, doi:10.1371/journal.pone.0170665
McCarthy, Jason, and Amy Davis. “Diagnosis and Management of Vertebral Compression Fractures.” American family physician vol. 94,1 (2016): 44-50.
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