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Chronic Back Pain

Back Clinic Chronic Back Pain Team. Chronic back pain has a far-reaching effect on many physiological processes. Dr. Jimenez reveals topics and issues affecting his patients. Understanding the pain is critical to its treatment. So here we begin the process for our patients in the journey of recovery.

Just about everyone feels pain from time to time. When you cut your finger or pull a muscle, pain is your body’s way of telling you something is wrong. Once the injury heals, you stop hurting.

Chronic pain is different. Your body keeps hurting weeks, months, or even years after the injury. Doctors often define chronic pain as any pain that lasts for 3 to 6 months or more.

Chronic back pain can have real effects on your day-to-day life and your mental health. But you and your doctor can work together to treat it.

Do call upon us to help you. We do understand the problem that should never be taken lightly.


When Chronic Back Pain Is Actually A Medical Condition

When Chronic Back Pain Is Actually A Medical Condition

Back pain usually comes from lifting an object the wrong way or awkwardly moving the body, injuring the spinal structures or muscles. However, sometimes it could be signs/symptoms of a more serious medical condition. The back pain could be caused by:

How to know when the root cause of back pain is from something else in the body? There are two types of pain that pain specialists look at. These are visceral pain and somatic pain. Visceral pain comes from damage or injury to the organs or organ tissues. This internal pain can radiate to the spine from conditions like:

  • Pancreatitis
  • Ulcerative colitis
  • Crohn’s disease
  • Gall stones
  • Cancers
  • Kidney pain
  • Urinary tract infections

Somatic pain is injury or damage to the muscles, skin, and soft tissues. It can be caused by:

  • Regular wear and tear
  • Aging
  • Injury
  • Sedentary lifestyle

However, visceral pain can cause somatic/bodily pain to flare up. The stress the body is going through because of the medical condition can cause inflammation.

When Chronic Back Pain Is Actually A Medical Condition

Kidney Infections and Stones

The kidneys are located in the rear of the body toward the middle of the back. The kidneys:

  • Filter waste products from the body
  • Regulate bodily fluids
  • Perform other vital functions.

Kidney infections and kidney stones can easily mimic a sprain or strain in the back. Infections or stones can also present with other symptoms like:

  • Fever
  • Nausea
  • Malaise
  • Burning sensation when urinating.
  • The pain feels like it’s higher and deeper in the back compared to musculoskeletal low back pain.
  • Side and groin pain could accompany the back pain.
  • The pain does not go away after shifting positions or lying down.

Urinary Tract Infection UTI

Upper urinary tract infections in the kidneys or ureters can cause back pain. Upper UTIs happen when a lower UTI in the bladder or urethra goes unnoticed or does not respond to antibiotic treatment. Infections can occur at any age, with women and older men being more susceptible. The pain usually presents in the lower back and groin area. Other possible symptoms include:

  • Pain in the back, sides of the lower abdomen between the lower ribs and hips.
  • Fever
  • Vomiting
  • Frequent urination in small amounts
  • Burning during urination
  • Strong urge to urinate
  • Foul-smelling urine
  • Cloudy urine
  • Fatigue.

The pain can feel like:

  • Cramping pain
  • Pressure
  • Soreness

Pancreatitis

Pancreatitis is inflammation of the pancreas, the long flat organ located in the upper abdomen behind the stomach. It assists digestion and sugar management. The American Pancreatic Association reports acute pancreatitis can make individuals feel sick with moderate to severe abdominal pain that can radiate to the back and often worsens after eating. The pain is felt in the upper to middle back. Other possible symptoms include:

  • Abdominal pain that radiates to the back
  • Abdominal pain after eating
  • Fever
  • Nausea
  • Vomiting
  • Tenderness in the abdomen

The pain can feel like ​a pulled muscle or joint pain that increases and decreases at first and then strengthens after eating or lying down.

Inflammatory Bowel Diseases IBD

Ulcerative colitis and Crohn’s disease are inflammatory bowel diseases not to be confused with irritable bowel syndrome.

  • Ulcerative colitis affects the colon.
  • Inflamed intestinal areas characterize Crohn’s disease.
  • Both can cause spreading back pain.

A study found 25% of individuals with IBD have chronic back pain. Other possible symptoms include:

The pain can feel mild or severe, like a cramp in the lower abdomen around the low back. It can present in cycles as a flare-up, then goes away. It’s essential to read the body’s warning signs and not push through the pain or ignore it. If any back pain goes on for more than a week, consult a doctor or chiropractor for a thorough examination. A pain specialist could be recommended if there is chronic back pain from a severe medical condition. A primary doctor or specialist helps keep the medical condition in check, while a pain specialist and/or chiropractor can alleviate chronic musculoskeletal pain from inflammation, irritation, and overstimulated nerves.


Body Composition


Personalized Lifestyle Medicine

Personalized lifestyle medicine develops customized treatment/health plans to fit the individual. It includes:

  • Research on how the body works as an integrated system.
  • Combines new technology approaches in medicine.
  • The relationship between nutrients and gene expression.
  • Life and behavioral sciences.

Nutrigenomics testing helps individuals understand the influence of dietary components on their genes, which can help prevent the development of certain chronic diseases.

References

American Pancreatic Association (Pancreapedia). (2015). Pathogenesis and Treatment of Pain in Chronic Pancreatitis. https://pancreapedia.org/reviews/pathogenesis-and-treatment-of-pain-in-chronic-pancreatitis

American College of Rheumatology. (2019). The U.S. Prevalence of Inflammatory Bowel Disease and Associated Axial Pain: Data from the National Health & Nutrition Examination Survey (NHANES). https://acrabstracts.org/abstract/the-us-prevalence-of-inflammatory-bowel-disease-and-associated-axial-pain-data-from-the-national-health-nutrition-examination-survey-nhanes/

Back Pain: Inflammatory or Mechanical and Chiropractic Care

Back Pain: Inflammatory or Mechanical and Chiropractic Care

It is estimated that every adult will experience some form of back pain at least once in their lives. There’s a difference between mechanical and inflammatory back pain. With inflammatory back pain, movement tends to help it, while resting worsens the pain. For some individuals, relief from inflammatory back pain is something they could have to manage for some time. Fortunately, there are effective management and relief options available.

Back Pain: Inflammatory or Mechanical and Chiropractic Care

Inflammatory vs. Mechanical Pain

Chronic back pain has two major causes. These are Mechanical and Inflammatory. They have slightly different characteristics when presenting. Chiropractors know what to look for to tell the difference between the two. Then a decision can be made on how to proceed with treatment or management.

Inflammatory

Pain caused by inflammation can be described as:

  • Not having a known definite cause.
  • Characterized by stiffness, especially after waking up.
  • Pain reduces with movement, activity, stretching, exercise.
  • Is worst during the early hours of the morning.
  • Is often accompanied by pain in the buttocks/sciatica symptoms.

Mechanical

Mechanical pain can be described as:

  • Pain that becomes worse with activity, stretching, or exercise.
  • Pain reduces with rest.
  • There is no stiffness after sleeping.
  • This pain is not constant but can become intense/severe for short periods.
  • Pain in the buttocks/sciatica symptoms do not present.

Inflammatory and Non-Inflammatory

Non-inflammatory is the same as mechanical pain. Mechanical/non-inflammatory back pain has causation related to the mechanics of the back and can result from injury or trauma. The cause of non-inflammatory pain does not necessarily present right away. For example, poor posture that leads to back pain is a mechanical/non-inflammatory cause. However, non-inflammatory back pain can be accompanied by inflammation as a natural reaction to injury. But this inflammation is not the cause of the pain. Non-inflammatory back pain can be treated effectively with conservative treatments. This includes:

  • Chiropractic adjusting
  • Physical therapy
  • Spinal decompression

Contributing Autoimmune Diseases

When inflammation is the cause of pain, it is considered inflammatory pain. Autoimmune disease/s can cause the body to attack different areas of the body mistakenly. Chronic pain can be caused by autoimmune diseases that include:

  • Rheumatoid Arthritis

Arthritis causes the immune system to attack the joints throughout the body.

  • Ankylosing Spondylitis

This is a rare type of arthritis that affects the spine. It is found more in men and usually begins in early adulthood.

  • Multiple Sclerosis

This is a disease where the immune system attacks nerve fibers and can lead to back pain.

  • Psoriatic Arthritis

This type of arthritis is characterized by patches of psoriasis along with joint pain and inflammation.

Inflammatory Pain Treatment

Individuals that think they might have inflammatory back pain should consult a doctor, spine specialist, and/or chiropractor. A general practitioner can misdiagnose inflammatory back pain as mechanical back pain. Many find relief from taking non-steroidal anti-inflammatory drugs or NSAIDs and following an exercise/physical activity regimen. However, sometimes this is not enough. This is where chiropractic treatment and physical therapy comes in.

Chiropractic and Physical Therapy

These medical professions complement each other well and can be beneficial as a part of an overall treatment plan. A chiropractor, with the help of a physical therapist, can bring significant relief. Management techniques involve:

  • Chiropractic adjustments
  • Flexion-distraction
  • Posture correction
  • Personalized exercises

Inflammation Night Pain

Inflammatory back pain tends to worsen at night. What happens is the inflammatory markers settle down when the body is not moving. A few simple practices can help you get better sleep.

  • Stretch Before Bed and When Waking

Performing stretches before going to bed and after waking up helps keep the body limber.

  • Inspect Pillows and Mattress

Sleeping with the spine out of alignment could exacerbate the problem. Using a too-soft mattress or a too-large pillow could be contributing to the pain. Sleeping on the side is recommended to use a pillow between the legs to keep the low back straight.

Exercises

Some exercises should be discussed with your doctor. Individuals have found that exercise and stretching are essential for relief.

Cardio

These exercises increase heart rate, boost mood, and release natural pain killers. Low-impact cardio exercises:

  • Swimming
  • Walking
  • Cycling

Strength-Building

Strengthening the core muscles will help maintain posture and spine support. Some of these include yoga poses:


Body Composition


Mediterranean Lifestyle

Sustainable and easy to follow three basic elements: following the diet, physical activity, and high levels of socializing. For individuals that want to change their diet and lifestyle to the Mediterranean, try the following:

  • Add more vegetables to meals. This can be salads, stews, and pizzas. Kidney beans, lentils, and peas are common Mediterranean staples.
  • Switch to whole grains as well as products made from whole grain flour. The high fiber content can improve heart health and can help lower blood pressure. Minimize refined carbohydrates like white bread and breakfast cereals.
  • Balance rich desserts with fresh fruits like oranges and bananas that can include antioxidant fruits like blueberries and pomegranates.
  • Treat meat as a side dish instead of the main course. Adding strips of chicken or beef into a vegetable saute/soup.
  • Balance meat dishes with fish and seafood. This includes sardines, salmon, clams, and oysters.
  • Go vegetarian for one day a week.
  • Cut out processed meats with high levels of preservatives.
  • Add healthy fats like avocados, sunflower seeds, nuts, and peanuts to meals.
  • Add dairy like cheese and Greek or plain yogurt.
  • Increase physical activity into a routine.
  • Talk to friends and family.
References

Cornelson, Stacey M et al. “Chiropractic Care in the Management of Inactive Ankylosing Spondylitis: A Case Series.” Journal of chiropractic medicine vol. 16,4 (2017): 300-307. doi:10.1016/j.jcm.2017.10.002

Dahlhamer, James et al. “Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults – the United States, 2016.” MMWR. Morbidity and mortality weekly report vol. 67,36 1001-1006. 14 Sep. 2018, doi:10.15585/mmwr.mm6736a2

Riksman, Janine S et al. “Delineating inflammatory and mechanical sub-types of low back pain: a pilot survey of fifty low back pain patients in a chiropractic setting.” Chiropractic & manual therapies vol. 19,1 5. 7 Feb. 2011, doi:10.1186/2045-709X-19-5

Santilli, Valter et al. “Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized, double-blind clinical trial of active and simulated spinal manipulations.” The spine journal: official journal of the North American Spine Society vol. 6,2 (2006): 131-7. doi:10.1016/j.spinee.2005.08.001

Teodorczyk-Injeyan, Julita A et al. “Nonspecific Low Back Pain: Inflammatory Profiles of Patients With Acute and Chronic Pain.” The Clinical journal of pain vol. 35,10 (2019): 818-825. doi:10.1097/AJP.0000000000000745

Drinking Tea For Inflammation and Back Pain

Drinking Tea For Inflammation and Back Pain

Individuals and doctors have praised the anti-inflammatory, pain-relieving properties of drinking tea. Inflammation is the body’s natural immune response when injury and infection present. This is good. However, it’s meant to be a temporary response that deactivates when there is no longer any danger. When the body is exposed to various irritants like industrial chemicals, inflammatory foods like sugar, refined carbohydrates, and autoimmune disorders can cause the immune system to go into overdrive. Chronic inflammation can develop, circulating powerful hormones and chemicals through the body, causing damage to the cells. One consequence of chronic inflammation is back pain. Besides standard backaches, some chronic conditions are directly tied to inflammation. These include forms of arthritis:

  • Ankylosing spondylitis
  • Rheumatoid arthritis
  • Transverse myelitis
  • Multiple sclerosis
  • These conditions involve inflammation of the central nervous system.
  • Drinking tea can help with back pain and pain in general.

 

Drinking Tea For Inflammation and Back Pain

Teas With Anti-Inflammatory Properties

Certain teas contain anti-inflammatory compounds. These compounds are called polyphenols and work to decrease the chemicals in the body responsible for pain and inflammation. There are varieties of teas that contain anti-inflammatory properties.

Certain Teas Reduce Inflammation

Drinking specific teas with more polyphenols can better decrease inflammation. For example, green tea is higher in polyphenols than black tea. Recent studies centered on individuals with rheumatoid arthritis over six months found significant improvement in symptoms in those who drank green tea. Green tea works best when part of an anti-inflammatory and nutritional lifestyle adjustment. This supports combating inflammation. Other teas that are believed to reduce inflammation include:

  • Turmeric
  • Holy basil
  • Ginger

Three Cups a Day

The amount of tea depends on the quality of the tea and how it is prepared. Doctors recommend around three cups a day for individuals with rheumatoid arthritis. However, these could contain caffeine. If this is an issue, there are decaffeinated versions with the same anti-inflammatory properties.

Drinking Tea Works Best When Combined with Other Treatments

If experiencing back pain or looking to combat a specific condition, it’s recommended to utilize various treatment approaches combined with drinking tea. This includes:

  • Chiropractic care
  • Physical therapy
  • Acupuncture
  • Mindfulness meditation
  • Yoga
  • Dietary supplements
  • Anti-inflammatory diet

Tea Is Not For All Types Of Pain

Certain back conditions benefit from drinking tea regularly; however, spine structural issues or fractures will not benefit from tea’s mild anti-inflammatory properties. It is vital for individuals with back pain that a spine specialist or chiropractor perform a proper and thorough examination, especially for Individuals that take medication that could directly interact with anti-inflammatory teas.

Drinking Tea for Back Pain

For most individuals, drinking tea is safe to help treat back pain conditions and added health benefits. For example, studies have found that green tea has mild anti-cancer, anti-diabetic properties and can help in maintaining a healthy weight. If tea helps reduce pain, it’s worth trying. Remember, pain is the body’s way to alert the individual that something is wrong.


Body Composition


Alcohol and Heart Health

According to the Mayo Clinic, consuming more than three alcoholic drinks in one sitting causes a temporary blood pressure elevation. Foods often served with alcohol are usually high in salt, which can also raise blood pressure. A few alcoholic beverages on a night out is fine, but heavy or binge drinking can lead to short-term spikes in blood pressure that could cause cardiac health problems. These are the short-term effects of alcohol on blood pressure. Heavy alcohol consumption can lead to long term health risks like:

  • Hypertension
  • Heart disease
  • Digestive issues
  • Liver disease
  • Stroke

It’s recommended that individuals incorporate regular exercise/physical activity and healthy diet changes and watch alcohol intake to improve heart health.

References

The Clinical Journal of Pain. (October 2019) “Nonspecific Low Back Pain:

Inflammatory Profiles of Patients With Acute and Chronic Pain” https://journals.lww.com/clinicalpain/fulltext/2019/10000/nonspecific_low_back_pain__inflammatory_profiles.2.aspx

Certain Teas Bring Down Inflammation More Than Others: Journal of Physical Therapy Science. (October 2016) “Green tea and exercise interventions as nondrug remedies in geriatric patients with rheumatoid arthritis” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5088134/

The Bottom Line: Proceeding of the Japan Academy, Series B Physical and Biological Sciences. (March 2012) “Health-promoting effects of green tea” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3365247/

Cardio Exercise Equipment That Won’t Worsen Back Pain

Cardio Exercise Equipment That Won’t Worsen Back Pain

At home or a gym, working out with cardio exercise equipment can be a highly beneficial treatment for back discomfort, soreness, and pain. However, when checking out all the cardio machines it is recommended to use those that will help with back pain and not worsen or cause further injury. The same goes for purchasing cardio equipment to use at home. Research has found that exercise training could be highly effective in the treatment of back pain. A study on pain found that the endorphins generated from aerobic exercise help to lessen low back pain. The North American Spine Society announced evidence-based recommendations for the treatment of back pain, and one of the top recommendations was aerobic exercise. Individuals can always go outside to:

  • Walk
  • Hike
  • Run
  • Bike ride

But mixing it up with cardio equipment can have its own benefits for different reasons. It could be too hot, raining, sometimes individuals prefer a set workout program to reach calorie or distance goals, and it could be easier on the spine. Working out at home or at a gym, cardiovascular machines can help bring relief for back pain.11860 Vista Del Sol, Ste. 128 Cardio Exercise Equipment That Won't Cause Back Pain

Cardiovascular Exercise Back Pain Treatment

Cardiovascular exercise is highly recommended for everyone. For individuals dealing with back pain, exercise combined with conservative therapy is usually part of a treatment plan. This  includes:

  • Physical therapy
  • Chiropractic care
  • Health coaching
  • Diet
  • Aerobic exercise regimen

With an exercise program, experts recommend starting with moderate-intensity aerobic exercise. Moderate intensity workouts are meant to get an individual’s heart and blood pumping, sweating a little, and slightly deep breathing. These types of exercise include:

  • Power walking outside
  • Power walking on a treadmill
  • Stationary biking

As long as the physical activity gets the heart rate up, these exercises have been shown to decrease back pain, relieve stress, and elevate mood. 20 minutes of moderate-intensity exercise three to five times a week for six weeks is what is recommended. This will help the back become healthier, feel better, and is recommended by the American Heart Association.

Exercise Not For All Spine Conditions

However, not all spinal conditions benefit from regular exercising. Getting an evaluation from a doctor, spine specialist, or chiropractor is recommended for injuries, severe and/or persistent back pain before starting a cardiovascular exercise program. This could be a spinal fracture, or spinal condition that requires bracing, or intense physical therapy/rehabilitation. Individuals that do not exercise regularly or have a medical or heart condition/s definitely need to get a doctor’s clearance before beginning a cardiovascular workout regimen.

Top Cardiovascular Exercises and Equipment

Once a doctor clears the individual for aerobic exercise there is no cardio equipment that is off-limits. Elliptical machines and stationary bikes are the most well-tolerated by individuals with back problems/conditions. Because they are low impact. However, if it is tolerable using a jogging treadmill is beneficial as well. Listen to the body. If a workout on a treadmill causes back pain that is not just workout soreness,  stop with that machine and try different cardiovascular equipment that is more low impact. Do not ignore back pain. If pain is continuous and exercising is not helping, stop and see a doctor, or chiropractor to evaluate and analyze the situation. Then they can adjust the exercise part of the treatment plan according to the presenting symptoms.


Body Composition


Concurrent Training

Concurrent training is the combination of aerobic and resistance exercises during the same workout session. Aerobic and resistance exercise impacts the body in different ways. The type of aerobic training determines how it interacts with resistance exercise. The order of the types of exercises like aerobic and resistance workouts can make a difference. Having an understanding of a few specifics about concurrent training will help to make decisions about an exercise program.

  • Aerobic/interval and resistance training does not seem to interfere with the others’ adaptations
  • However, gaining strength could be lowered by adding running to a resistance program
  • Whereas bicycling does not have the same effect.

Cycling and the ergonomics that go with it are similar to traditional lower-body resistance exercises. The muscle contractions that come with running result in muscle damage, while the contractions in cycling also cause muscle damage, it is not to the same extent. Pairing the exercise programs correctly is key, such as a running program in combination with an upper-body lifting exercise can be beneficial. While running and doing leg presses every day could interfere with each other and could cause injuries. Or if doing both aerobic and resistance exercises in the same session, or on the same day, consider the order of the exercises, depending on what the goal is.

Disclaimer

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, CTG*
email: coach@elpasofunctionalmedicine.com
phone: 915-850-0900
Licensed in Texas & New Mexico

References

British Journal of Sports Medicine. (November 2020) “Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis” https://bjsm.bmj.com/content/54/21/1279

Pain. (December 2020) “Are endogenous opioid mechanisms involved in the effects of aerobic exercise training on chronic low back pain? A randomized controlled trial” https://journals.lww.com/pain/Citation/2020/12000/Are_endogenous_opioid_mechanisms_involved_in_the.23.aspx

North American Spine Society. (2020) “Evidence-Based Clinical Guidelines for Multidisciplinary Spine Care” https://www.spine.org/Portals/0/assets/downloads/ResearchClinicalCare/Guidelines/LowBackPain.pdf

Diabetic Back Pain: Ways To Bring Relief

Diabetic Back Pain: Ways To Bring Relief

The diabetic disease processes can be a contributor to chronic back pain. Diabetes can damage the human body from the eyes to the feet if left untreated, and the spine/back is a prime target. Data from 11 studies consisted of individuals over 18 years of age diagnosed with type 1 or type 2 diabetes. The results showed individuals with diabetes had a 35% increased risk of experiencing lower back pain. According to the Centers for Disease Control and Prevention, around 34 million people were found to have diabetes in 2021. Diabetes primarily impacts blood sugar/glucose levels. However, the disease can affect several of the body’s systems. It is a state of chronic inflammation.

Diabetic Back Pain Connection

The connection between diabetes and back pain include:

Neuropathy

Diabetic neuropathy happens when constant high glucose levels damage/injure the nerves. The result is symptoms like pain, tingling, and numbness. It affects up to 50% of individuals with diabetes and can lead to severe chronic back pain. High sugar levels damage various organ systems including the nervous system that results in neuropathy that causes pain/discomfort.

Bone Health

A complication that diabetes can cause is compromised bone health. High glucose levels can damage the collagen that makes up bone. This creates an increased risk of vertebral and other types of fractures. The high-risk compounds fractures that do not heal properly or correctly. Diabetics have an increased risk of fracture because of the accumulation increase of advanced glycation products. This substance forms when proteins or lipids combine with sugar. With time these products can cause damage to various tissues that include bone.

11860 Vista Del Sol, Ste. 128 Diabetic Back Pain: Ways To Bring Relief

Obesity

Obesity contributes to the development of type 2 diabetes and is also a complication that results from incorrect glucose level management. Regardless of which came first, the added weight is a major contributor to back pain because of the added pressure/load on the spine. Excess weight and physical inactivity can result in serious issues of the musculoskeletal system.

Additional Factors

Poorly controlled diabetes also reduces muscle blood flow and increases cartilage inflammation. Other types of tissue damage can occur like degeneration of intervertebral discs and spinal canal stenosis. Disc degeneration and spinal stenosis are common causes of back and neck pain. Diabetics are prone to infection/s. This can cause back pain if it is in the bone known as osteomyelitis.

Diabetic Back Pain Management

There are steps that can help ease pain and discomfort.

Getting Involved In Physical Activity

Exercising/physical activity is a must. The body needs to move to get all the systems flowing improving diabetes and back pain. A sedentary lifestyle can take back pain to new levels with time. Even though when pain presents the first instinct is to stop and rest. Simple ways to get moving include:

  • Walks
  • Stretches
  • Gentle laps in a pool
  • All can help with:
  • Improved blood flow
  • Aids in weight loss
  • Recommended for both conditions
  • Exercising releases endorphins, which are the pain relief chemicals that the body produces naturally.

Reducing Stress

Reducing stress will help manage back pain. A few ways to decompress and reduce stress include:

11860 Vista Del Sol, Ste. 128 Diabetic Back Pain: Ways To Bring Relief

Quitting Bad Habits

Smokers have a significantly higher risk for low back pain compared to non-smokers. Nicotine can alleviate pain short term, but over time the nerves become more sensitive and can increase the pain. Alcohol use can help numb the pain short term, but it can cause muscle spasms and dehydration intensifying the pain. Complications can arise if taking pain medication. The most important thing is managing diabetes effectively. Injury Medical Chiropractic and Functional Medicine Clinic will help the individual feel better, move better, and keep back pain away.

Body Composition

Vitamin D and Healthy Blood Sugar Levels

Vitamin D benefits muscle health, muscle mass, and blood sugar. Insulin is the hormone that lets blood sugar into the muscles. Individuals with adequate blood vitamin D levels significantly lower the risk of hyperglycemia than those with below-recommended levels. Research shows daily vitamin D supplements used in combination with calcium decelerate the gradual rise in blood sugar in those with prediabetes. Adequate vitamin D levels can prevent the progression of hyperglycemia. Supplementation is beneficial for individuals going through a deficiency. Adults should aim for a dietary intake of 600 – 800 IU per day. However, supplements are never a substitute for a healthy and diverse diet.

Disclaimer

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP, CIFM, CTG*
email: coach@elpasofunctionalmedicine.com
phone: 915-850-0900
Licensed in Texas & New Mexico

References

Pozzobon, Daniel, et al. “Is There an Association between Diabetes and Neck and Back Pain? A Systematic Review with Meta-Analyses.” PLOS ONE, vol. 14, no. 2, 2019, doi:10.1371/journal.pone .0212030.

“Diabetic Neuropathy.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 3 Mar. 2020, www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/symptoms-causes/syc-20371580 .

Murray, Cliodhna E, and Cynthia M Coleman. “Impact of Diabetes Mellitus on Bone Health.” International Journal of Molecular Sciences, MDPI, 30 Sept. 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6801685/

Groen BBL, Hamer HM, Snijders T, van Kranenburg J, Frijns D, Vink H, et al. Skeletal muscle capillary density and microvascular function are compromised with aging and type 2 diabetes. Journal of Applied Physiology. 2014;116(8):998–1005. pmid:24577061

Eivazi M, Abadi L. Low Back Pain in Diabetes Mellitus and Importance of Preventive Approach. Health Promotion Perspectives. 2012;2(1):80–8. pmid:24688921

Chiropractic Manipulation Under Anesthesia

Chiropractic Manipulation Under Anesthesia

Chiropractic manipulation under anesthesia, also known as M.U.A is a non-invasive stretching and musculoskeletal manipulation technique. This type of chiropractic treatment can offer relief from chronic and constant back pain and other types of pain that have not responded well or at all to conservative non-surgical care. Chiropractic manipulation under anesthesia breaks up adhesions/internal scar tissue that could result from an injury or previous surgery, helping restore the normal range of motion and reduce pain. This technique is utilized to treat:

Adhesions can grow around:

  • Spinal joints
  • Nerve roots
  • Inside the surrounding muscles

This can result in restricted:

  • Movement
  • Limited flexibility
  • Pain
 

Undergoing chiropractic manipulation under anesthesia while sedated means the body is in a highly relaxed state. This sedation allows the chiropractor to adjust the bones, joints into proper alignment and stretch the muscles without the individual�s voluntary/reflexive resistance. And the sedation allows the chiropractor to use less force, making the procedure painless.  

Manipulation Under Anesthesia Specialists

This type of manipulation is a specialty procedure. Trained and certified physicians only perform it in the fields of:

  • Chiropractic medicine
  • Orthopedics
  • Physical therapy and rehabilitation
  • Osteopathy

 

Advantages to MUA treatment

There are individuals with pain that respond well to regular chiropractic manipulation, physical therapy, or exercise. However, depending on their condition, relief might only last for a few days or weeks. This is where manipulation under anesthesia could improve the range of motion and relieve pain. Manipulation under anesthesia has been performed for more than sixty years. It can be cost-effective and safer than invasive treatment like spine surgery. It is recognized and covered by most insurance and workers’� compensation plans.  

11860 Vista Del Sol, Ste. 128 Chiropractic Manipulation Under Anesthesia
 

Determining if MUA is right for the individual and their condition

Manipulation under anesthesia is not for all individuals with back pain. MUA is only recommended for patients that meet the procedure’s criteria. Like any other type of recommended treatment, a doctor will carefully consider the individual’s medical history, symptoms, previous treatments, and effectiveness. A doctor will also perform a physical and neurological examination with an individual’s complete medical history. Test results will confirm the patient�s diagnosis and determine if anesthetic manipulation can help relieve pain and other symptoms. Tests can include:

  • X-ray
  • MRI
  • CT scan
  • A musculoskeletal sonogram uses sound waves to produce images of muscles, tendons, ligaments, and joints.
  • EKG – electrocardiogram is a test that checks for problems with the heart�s electrical activity
  • Nerve conduction velocity test sees how fast electrical signals move through the nerve/s
  • Pregnancy test

 

Consideration for individuals with:

  • Pinched or entrapped nerve
  • Chronic/Persistent neck or back pain
  • Painful, restricted range of motion
  • Failed back surgery syndrome
  • Chronic sprains and strains
  • Acute muscle spasms
  • Fibromyalgia
  • Chronic spinal disc conditions
  • Fibrous adhesion/s
 

Not an appropriate treatment for individuals with:

  • Uncontrolled diabetic neuropathy
  • Spinal cord compression
  • Morbid obesity
  • Any cancer
  • Acute or healing bone fracture/s
  • Osteomyelitis vertebral bone infection
  • Acute inflammatory arthritis
  • Metastatic bone disease
  • Severe osteoporosis
  • Acute inflammatory gout
  • Tuberculosis of the bone
  • Co-existing medical problems could mean an individual may not be able to undergo any procedure that requires sedation.
  • Another reason why a patient’s complete medical history is vital

 

Procedure

This procedure is usually performed in an ambulatory surgery center that is a modern healthcare facility focused on providing same-day surgical care for diagnostic and preventive procedures or at a hospital. An anesthesiologist administers the medicine/s. The patient could be sedated but not unconscious or general anesthesia meaning complete unconsciousness. The choice of sedation depends on various factors, like the patient’s diagnosis and how severe the condition is. The anesthesiologist can recommend a specific type of medicine or a cocktail of medications for the patient’s comfort during and after.

Once sedated, the chiropractor utilizes specialized techniques to stretch, adjust and mobilize the affected areas of the spine and body. The manipulations free up fibrous adhesions or scar tissue in one or more areas of the spine and surrounding tissues. The procedure usually takes 15 to 30 minutes. The individual will be awakened and then is carefully monitored in a recovery area. Many report an immediate reduction in pain and a broader range of motion after the procedure. There is usually temporary muscle soreness, similar to the soreness after an intense workout.  

11860 Vista Del Sol, Ste. 128 Chiropractic Manipulation Under Anesthesia
 

Before being discharged, the patient is provided instructions about aftercare therapy. Instructions may include:

  • At-home warm-up movements
  • Physical therapy rehabilitation
  • Passive stretching
  • Electrical stimulation
  • Cryotherapy or cold therapy to reduce inflammation and pain

Physical therapy, exercise, and stretching

Three to six weeks after the procedure, individuals continue with physical therapy to help prevent back pain from returning and any fibrous adhesions/scar tissue broken up from reforming. Exercise and stretching will help strengthen and stabilize the abdominal and spinal muscles and prevent pain from returning.


InBody

 

Malnutrition

Malnutrition is defined as a lack of uptake or intake of nutrition that can negatively affect body composition. An important nutrient that elderly individuals might not get enough of is protein. Trouble chewing, food cost, and trouble cooking are all factors that limit elderly individuals’ access to protein, which can lead to sarcopenia. These complications can affect how the body responds to diet and exercise.

That is because protein requirements for the elderly are usually higher than for younger individuals. This comes from age-related changes in the metabolism that includes a decreased response to protein intake. This means that an older individual needs to consume more protein to achieve the same anabolic effect. Micronutrient deficiency is a lack of nutrients like minerals and vitamins. These support important bodily processes like cell regeneration, immune system function, and vision. A common example is iron and calcium deficiencies. This type of deficiency has the greatest impact on normal physiological functions in conjunction with protein-energy deficiency, as most micronutrients are acquired from food.  

Dr. Alex Jimenezs Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that directly or indirectly support our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*  

References

https://pubmed.ncbi.nlm.nih.gov/24490957/

Spinal Misalignments Pain And Discomfort Root

Spinal Misalignments Pain And Discomfort Root

When spinal misalignments happen the body experiences soreness, inability to rotate the neck, or after sitting/standing in one position for too long hip and leg discomfort/pain. This is why spinal alignment is so crucial to healthy living. These examples help to illustrate the delicate balance required in the spine to maintain optimal health, stay pain-free, prevent injury, and the ability to conduct everyday chores/responsibilities without the fear and anxiety of setting off pain symptoms.
11860 Vista Del Sol, Ste. 128 Spinal Misalignments The Root Of Pain And Discomfort

Understanding how pain is processed

Pain is a complex sensation. Neural pain receptors, also known as nociceptors detect harmful stimulation/s in the form of:
  • Body Temperature changes
  • Mechanical forces and pressure on the body
  • Chemical changes in the body brought on by inflammation or cell damage
How the signal transmits from the stimulated nerve and how it is perceived depends on the upper levels of neural activity in the body. Specifically, the spinal cord, brainstem, and the brain. Examples of pain perceptions:
  • Beliefs
  • Mood levels
  • Stress levels
  • General health
  • Other sensations the body could be experiencing
  • Previous pain generating experiences – auto accident, work injury, etc.

Spinal Misalignments and Balance

Pain is essential for alerting the body when engaged in activities, and body positions that can cause damage to the tissues like poor postures, work/sports/personal injuries, inflammatory foods, etc. The nerves’ pain pathways can experience overstimulation when the system is overloaded.
Excessive stimulation can be brought on by chronic inflammation, mood disorders, and poor health. One overlooked issue with the perception of pain is the health/effectiveness of the actual neural pathways. The nerve’s energy is affected by spinal misalignments. Proper nerve health and circulation are crucial for the body to transmit proper pain signals. Spinal misalignments can be brought on by:
  • Chronic poor posture
  • Injury
  • Other imbalances in the body
  • Can lead to major dysfunction of the nerves pathways
The longer the pain and discomfort go on the more intense/severe the issues can become. This is when pain and discomfort become chronic leaving individuals feeling hopeless, frustrated.

Symptoms

The spine does more than provide stability. Any type of spinal misalignments will affect the rest of the body as well. Possible symptoms that the spine is out of alignment includes:
  • Chronic headaches
  • Frequent illnesses
  • Fatigue
  • Lower back pain
  • Neck pain
  • Hip pain
  • Knee pain
  • Numbness/tingling in the hands or feet
  • Walking gait abnormalities causing one shoe to wear out quicker than the other
11860 Vista Del Sol, Ste. 128 Spinal Misalignments The Root Of Pain And Discomfort

Chiropractic Management

Many treatments focus on masking the pain rather than addressing the underlying root cause. This can lead to a chronic pain cycle and dependence on pain medications and invasive treatment. Chiropractic is a science-based approach that focuses on getting to the root issue. Chiropractic utilizes gentle and effective techniques like:
  • Manipulation
  • Exercise regimen
  • Stretching regimen
  • Body mechanics training
  • Health nutritional education
When the body is aligned and the spinal nerves are healthy, an individual’s pain perception will be changed for optimal functionality.

InBody Composition


Body composition goals

The first step is to reduce caloric intake by changing/adjusting dietary nutritional habits. Individuals can experiment with various types of diets and regular exercise regimens, and getting into the habit of getting the proper amount of sleep. Depending on an individual’s existing muscle mass, gaining Lean Body Mass first could be an option. An individual may be able to lose fat and gain muscle because:
  • Increased muscle mass will increase the Basal Metabolic Rate/metabolism, and if no extra calories are added body fat can be shed while building muscle.
  • Lifting weights can increase Total Daily Energy Expenditure, causing the body to burn more calories.
Circuit training is one option for improving changes in body composition while not affecting changes in overall body weight. This means muscle gain and fat loss is happening at the same time.

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
References
Dubinsky RM, Miyasaki J.Assessment: Efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review). Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.�Neurology. 2010;74:173-176. Shrier I. Does stretching help prevent injuries?�Evidence-based Sports Medicine. Williston, VT: BMJ Books; 2002.
Texas Supreme Court’s Decision in “Texas Board of Chiropractic Examiners et al v. Texas Medical Association” Case

Texas Supreme Court’s Decision in “Texas Board of Chiropractic Examiners et al v. Texas Medical Association” Case

After all of these years, I am happy to announce that the Texas Supreme Court has finally made a decision regarding the Texas Board of Chiropractic Examiners et al v. Texas Medical Association case on January 29th, 2021. With great honor and gratitude, I’d like to continue to extend sincere thanks to everyone who worked hard on this case and whose tremendous efforts resulted in the decision. Thanks to the Supreme Court’s decision, chiropractors in Texas can now carry on their jobs accordingly. Below, I have provided a letter from Board President, Mark R. Bronson, D.C., F.I.A.N.M. on behalf of the Texas Board of Chiropractic Examiners stating the Texas Supreme Court’s decision in the Texas Board of Chiropractic Examiners et al v. Texas Medical Association case on January 29th, 2021. – Dr. Alex Jimenez D.C., C.C.S.T.

 


 

February 1, 2021

 

On behalf of the Texas Board of Chiropractic Examiners, I extend our sincere thanks and appreciation to everyone whose efforts resulted in the Texas Supreme Court’s decision in Texas Board of Chiropractic Examiners et al v. Texas Medical Association on January 29, 2021. Special thanks are due to all the attorneys at the Office of the Attorney General who worked on this case over these years.

 

The decision properly affirmed the validity of the Board’s scope of practice rule, which the court clearly said does not exceed our statutory scope of chiropractic practice. The court unequivocally held that the Board�s rules do not violate Occupations Code Chapter 201 or run counter to the chapter’s objectives set by the Texas Legislature, and in fact, carefully observe the statutory boundary between the medical and chiropractic professions. This decision, which recognizes the common sense and long-standing inclusion of associated nerves in chiropractic diagnosis and treatment, preserves and strengthens the essence of chiropractic.

 

Thanks to the court’s decision, our licensees can now fulfill their duties as vital portal-of-entry healthcare providers in Texas without fear. The court’s decision reaffirms the principles of economic freedom that have made Texas the best state in the nation to be a chiropractor.

 

Sincerely,

 

Mark R. Bronson, D.C., F.I.A.N.M. Board President
Texas Board of Chiropractic Examiners

 

Supreme-Court-Decision

 


 

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

 

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas & New Mexico*

 

Easiest Exercises on The Spine and Back Muscles

Easiest Exercises on The Spine and Back Muscles

When lower back pain presents many want to retreat to the couch, bed and just lay down, but doctors, chiropractors, physical therapists, and spine specialists do not recommend this course of action. What they do recommend, other than treatment, is to engage in the easiest forms of exercise on the spine and back muscles. �

11860 Vista Del Sol, Ste. 128 Easiest Exercises on The Spine and Back Muscles

Staying sedentary is one of the worst things an individual can do to their back. When the back is aching exercise can usually help. This is because the muscles, ligaments, tendons are being stretched and not just staying still, which lets inflammation build up and swell. Moving keeps the blood flowing, allowing for broader healing and recovery.

However, back pain relief can be a challenge. Various treatment options exist because there are a variety of causes. The key is figuring out which type is best for each individual and their specific condition. An individual needs to know the cause of their type of back pain, as this determines which exercises should or should not be doing. The Pain and Therapy journal evaluated some of the best exercises for lower back pain. �

Physical Therapy Exercises

The McKenzie method can be very effective for acute disc herniation pain and sciatica. This type of exercise is to figure out if there is a specific position that helps the pain become centralized, correct any motion restrictions, and take the pressure off the region that is compressed or inflamed. Physical therapists incorporate McKenzie exercises as part of regular treatment. The strength-building moves are designed to help support the spine and consist of range-of-movement work and sustained positions.

11860 Vista Del Sol, Ste. 128 Easiest Exercises on The Spine and Back Muscles

Home and Studio Workouts

Pilates is one of the easiest exercises for individuals with chronic low-back pain. Like McKenzie exercises, it utilizes sustained positions that strengthen the trunk/core muscles. The muscles are strengthened using small movements. Using the machine called a reformer, has built-in support for the spine. This is considered a low-key, muscle-toning workout that can ease chronic back pain. �

Water Exercise

Water exercises lessen the body’s weight, taking pressure/stress off the spine. Deep-water running with the water at shoulder-height can significantly improve low-back pain. In a study, a group of overweight/obese women worked out twice a week for an hour-long exercise session. After 12 weeks, improvements in pain intensity, personal care, sitting, standing, and sleeping were reported. �

Easiest Office Exercise

One of the easiest exercises is walking. It is great for the body. But the key is to walk more than usual around the office, or wherever work is. This is not about getting the heart rate up. It is about not staying in the same position for too long. When sitting and focused, an individual can stay in an uncomfortable position for some time and just push through it in an attempt to finish up the work.

Using a timer or an application that alerts every hour to get up and stretch is highly beneficial. Walk correctly to the bathroom, or just get up and walk around for a bit gets the blood pumping through the body and the muscles in motion stretching and contracting. �

Stabilization Exercise

Strengthening workouts can be done at home.

  • Stretch while standing against the wall bringing the arms up and down.
  • Pull the elbows down into the back, which stops the hyperactive trapezius from tensing up.
  • Knee to the chest motion while lying on the back
  • Abdominal crunches while balance on an exercise ball
  • Push the head back into the headrest while driving. This helps avoid the forward head posture.

Contact a doctor, chiropractor, or physical therapist that can recommend the best stabilization exercises for the specific pain/condition. �

11860 Vista Del Sol, Ste. 128 Easiest Exercises on The Spine and Back Muscles

Tai Chi and Qigong

Tai Chi and Qigong are gentle exercises where an individual performs slow, controlled movements emphasizing balance and focus. Both can reduce pain, disability, and other symptoms associated with lower back pain. �


Body Composition Testimonial


 

Exercise After Childbirth

Physical activity for pregnant and post-birth, the American Congress of Obstetricians and Gynecologists recommends the following. The easiest exercise routines can be resumed gradually after pregnancy, once a doctor confirms it is medically safe, depending on the delivery, and the presence or absence of medical complications.

  • Pelvic floor exercises could be initiated in the immediate postpartum period.
  • Regular aerobic exercise in lactating women has been shown to improve cardiovascular fitness without affecting milk production, composition, or infant growth.
  • Nursing women should consider feeding their infants before exercising in order to avoid exercise discomfort.
  • Nursing women also should ensure proper hydration before engaging in physical activity.
  • Take it slow.

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

References

Pain and Therapy. (2020) �Rehabilitation for Low Back Pain: A Narrative Review for Managing Pain and Improving Function in Acute and Chronic Conditions.��https://link.springer.com/article/10.1007/s40122-020-00149-5

Spine.�(2016) �Pilates for Low Back Pain: Complete Republication of a Cochrane Review.��https://pubmed.ncbi.nlm.nih.gov/26679894/

Sarcopenia Muscle Mass Loss With Chronic Back Pain

Sarcopenia Muscle Mass Loss With Chronic Back Pain

Sarcopenia means the loss of muscle tissue/mass from the natural aging process. Something that all of us are going through. However, when chronic back pain is involved it can speed up the natural process, which can lead to various health issues. Keeping the body fit and the spine healthy is the objective with approaches that can be utilized and employed to help maintain muscle mass. By the time an individual turns 30, the muscles are large and strong. But going into the 30s, individuals begin to lose muscle mass and function. Individuals that are physically inactive can lose up to 5% of muscle mass every ten years after 30. Even those who are regularly active, still lose some muscle. Sarcopenia typically kicks-in around age 75-80. However, it could speed up as early as 65. It becomes a factor in bone frailty and increases the risk of falls and fractures in older adults.  
11860 Vista Del Sol, Ste. 128 Sarcopenia Muscle Mass Loss With Chronic Back Pain
 

Muscle Tissue Changes and Back Pain

Loss of muscle mass causes individuals to have a lesser degree of strength and function. As the decline continues, mobility lessens, and disability increases. With less muscle strength individuals become perfect candidates for falls/injury/s and become more prone to weight pain. Body composition shifts can play a major role in issues like spinal stenosis and degenerative disc disease. Bone density also decreases with age increasing the risk of mobility issues. This means less activity which can make back pain worse and keeps the degenerative cycle going. The back pain intensifies, physical function is very limited, and low bone mineral density brings down an individual’s quality of life.

Symptoms and Causes

Symptoms include:
  • Weakness
  • Loss of stamina
With reduced activity muscle mass becomes further shrunk. Sarcopenia is seen more often in individuals that are inactive. However, it is also seen in individuals that are physically active on a regular basis. This suggests that there are other factors involved. Researchers think these could be:
  • The ability to turn protein into energy is decreased
  • There are not enough calories/protein per day to maintain muscle mass
  • A reduction in the nerve cells that are responsible for sending signals from the brain to the muscles when moving, contracting, extending, etc
  • Low concentration of certain hormones, including:
  1. Growth hormone
  2. Testosterone
  3. Insulin-like growth factor

Prevention

Because it can affect younger individuals as well, specifically those who are leading sedentary lifestyles and are overweight, prevention is the key. It is a domino effect that:
  • Starts with reduced activity
  • That leads to weight gain
  • Causing even less activity
When the body’s muscles are not being used they begin to atrophy. Fortunately, the loss can be reversible to a certain degree. Helping to build the muscle mass back up and help prevent sarcopenia is the goal.

 
11860 Vista Del Sol, Ste. 128 Sarcopenia Muscle Mass Loss With Chronic Back Pain
 

Strength training

Muscles need a degree of stress to grow, which is then followed by recovery. Low-impact training programs/exercises performed at least two to three days per week can help keep the muscles healthy and in top form.

General physical activity

Exercise does not have to only be a regimented training form. Being active means keeping the body moving and mobile on a regular basis. This can be gardening, vacuuming, taking a walk around the neighborhood, parking far away when shopping to walk more, taking the stairs instead of the elevator. Anything that involves moving the body regularly and keeps the muscles active will help in the prevention process.

Protein

There is a wasting syndrome known as Cachexia. There is a connection between protein consumption and muscle mass. Older adults are at risk of low protein intake because they do not synthesize amino acids as effectively as they used to. Whey protein is recommended specifically because it creates and maintains high concentrations of amino acids in the blood. Other protein choices include:
  • Greek yogurt
  • Peanut butter
  • Eggs
  • Nuts
  • Seeds
  • Beans
  • Lean animal proteins

Resistance Training

Sarcopenia prevention will promote better back/general health for every age group. However, it is crucial for those who are experiencing accelerated muscle loss like individuals over 50 and especially after 60. Resistance/strength training or some form of physical activity done on a regular basis can significantly slow the decline. But heavy-weights are not necessary. Older individuals might believe weight training means they have to lift heavy with fewer reps and more weight. It is actually the opposite, with more reps and lighter weight. An example could be doing 20 reps with a 5-pound weight instead of 5 reps with a 20-pound weight. The total amount of weight being lifted is the same in both cases. This approach benefits the individual because of the less load/strain on the bones and joints. It also allows older individuals to do more sessions per week, keeping the active overall. Those experiencing sarcopenia, and with lumbar stenosis, to do exercises that challenge the muscles without adding additional pressure on the joints. This could be:
  • Walking in a swimming pool
  • Cycling
  • Pilates
  • Yoga
Bodyweight/calisthenic exercises like pushups, squats, and wall slides can also be beneficial. The focus should be on regular activity that can progress slowly, and promotes tone without risk of injury. Muscle tone is maintained by activity and is essential for everyone. Get a routine, keep moving and the body will benefit greatly.
 

Sports Injury Chiropractic Treatment


 

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
A Few Ways to Manage Chronic Back Pain During Summer

A Few Ways to Manage Chronic Back Pain During Summer

Chronic back pain does not have to ruin the summer season. The best approach is planning ahead remembering a few self-care warm/hot weather tips. The hot weather can worsen pain symptoms. With all the family activities going on, maintaining back pain wellness can be difficult. This is where the planning/preparing for chronic pain comes in.

Individuals should begin thinking around April what they will be doing once the hot months arrive and plan accordingly. However, self-care should be implemented for all seasons.

 

11860 Vista Del Sol, Ste. 128 A Few Ways to Manage Chronic Back Pain During Summer

Water Therapy

Depending on the condition, water can be a friendly sanctuary from the pain with the ability to do some spine exercises. Light stretching can bring relief and keeps the muscles and ligaments stretched. Outside of the pool, a misting fan can create a relaxing atmosphere along with ice packs during summer pain flares. �

11860 Vista Del Sol, Ste. 128

Avoid high heat

Sunburn or prolonged heat exposure can cause burning nerve pain. The changes in temperature and barometric pressure can trigger joint pain. Plan on doing activities in the morning or after the sun has set. Keep a hand-held fan close-by whenever going out. Wear loose light sun friendly clothing, comfortable shoes, possibly a hat to shield the face and keep an ice-cold water bottle with you. �

11860 Vista Del Sol, Ste. 128 A Few Ways to Manage Chronic Back Pain During Summer

Proper seating

Summer activities typically include uncomfortable seating, like small chairs, bleachers, and activities where everyone sits on the ground. Plan ahead for these situations and store a comfortable possibly therapeutic folding or travel chair that fits in an automobile. Add a lumbar cushion to support the lower back. �

prevent migraine headaches chiropractic el paso tx.

Immune system health

Fruits and vegetables can boost the body’s vitamin and mineral bank. Better quality food will make you feel so much better. Whatever you can get at the market, get it and turn it into a cold healthy smoothie. The USDA found that cherries contain pain-fighting and inflammation-reducing compounds that can help reduce pain, specifically arthritis. �

nutritional epigenetics el paso tx.

Air quality

Pay attention to the air quality rating during the summer. Studies have shown that air pollution can increase inflammation, specifically for individuals with:

Before heading outside, check the Air Quality Index or the AQI just as a precaution. �

11860 Vista Del Sol, Ste. 128

Don�t delay healthcare

Don�t let summer vacation or road trips get in the way of your chiropractic treatment plan. Check-in before you go and ask for help to navigate the adventure with as little pain as possible. Self-sufficiency can be achieved by planning ahead. Reduce stress and increase your independence.


Why Chiropractic Works


 

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

What is Degenerative Disc Disease (DDD)?: An Overview

What is Degenerative Disc Disease (DDD)?: An Overview

Degenerative Disc Disease is a general term for a condition in which the damaged intervertebral disc causes chronic pain, which could be either low back pain in the lumbar spine or neck pain in the cervical spine. It is not a �disease� per se, but actually a breakdown of an intervertebral disc of the spine. The intervertebral disc is a structure that has a lot of attention being focused on recently, due to its clinical implications. The pathological changes that can occur in disc degeneration include fibrosis, narrowing, and disc desiccation. Various anatomical defects can also occur in the intervertebral disc such as sclerosis of the endplates, fissuring and mucinous degeneration of the annulus, and the formation of osteophytes.

 

Low back pain and neck pain are major epidemiological problems, which are thought to be related to degenerative changes in the disk. Back pain is the second leading cause of the visit to the clinician in the USA. It is estimated that about 80% of US adults suffer from low back pain at least once during their lifetime. (Modic, Michael T., and Jeffrey S. Ross) Therefore, a thorough understanding of degenerative disc disease is needed for managing this common condition.

 

Anatomy of Related Structures

 

Anatomy of the Spine

 

The spine is the main structure, which maintains the posture and gives rise to various problems with disease processes. The spine is composed of seven cervical vertebrae, twelve thoracic vertebrae, five lumbar vertebrae, and fused sacral and coccygeal vertebrae. The stability of the spine is maintained by three columns.

 

The anterior column is formed by anterior longitudinal ligament and the anterior part of the vertebral body. The middle column is formed by the posterior part of the vertebral body and the posterior longitudinal ligament. The posterior column consists of a posterior body arch that has transverse processes, laminae, facets, and spinous processes. (�Degenerative Disk Disease: Background, Anatomy, Pathophysiology�)

 

Anatomy of the Intervertebral Disc

 

Intervertebral disc lies between two adjacent vertebral bodies in the vertebral column. About one-quarter of the total length of the spinal column is formed by intervertebral discs. This disc forms a fibrocartilaginous joint, also called a symphysis joint. It allows a slight movement in the vertebrae and holds the vertebrae together. Intervertebral disc is characterized by its tension resisting and compression resisting qualities. An intervertebral disc is composed of mainly three parts; inner gelatinous nucleus pulposus, outer annulus fibrosus, and cartilage endplates that are located superiorly and inferiorly at the junction of vertebral bodies.

 

Nucleus pulposus is the inner part that is gelatinous. It consists of proteoglycan and water gel held together by type II Collagen and elastin fibers arranged loosely and irregularly. Aggrecan is the major proteoglycan found in the nucleus pulposus. It comprises approximately 70% of the nucleus pulposus and nearly 25% of the annulus fibrosus. It can retain water and provides the osmotic properties, which are needed to resist compression and act as a shock absorber. This high amount of aggrecan in a normal disc allows the tissue to support compressions without collapsing and the loads are distributed equally to annulus fibrosus and vertebral body during movements of the spine. (Wheater, Paul R, et al.)

 

The outer part is called annulus fibrosus, which has abundant type I collagen fibers arranged as a circular layer. The collagen fibers run in an oblique fashion between lamellae of the annulus in alternating directions giving it the ability to resist tensile strength. Circumferential ligaments reinforce the annulus fibrosus peripherally. On the anterior aspect, a thick ligament further reinforces annulus fibrosus and a thinner ligament reinforces the posterior side. (Choi, Yong-Soo)

 

Usually, there is one disc between every pair of vertebrae except between atlas and axis, which are first and second cervical vertebrae in the body. These discs can move about 6? in all the axes of movement and rotation around each axis. But this freedom of movement varies between different parts of the vertebral column. The cervical vertebrae have the greatest range of movement because the intervertebral discs are larger and there is a wide concave lower and convex upper vertebral body surfaces. They also have transversely aligned facet joints. Thoracic vertebrae have the minimum range of movement in flexion, extension, and rotation, but have free lateral flexion as they are attached to the rib cage. The lumbar vertebrae have good flexion and extension, again, because their intervertebral discs are large and spinous processes are posteriorly located. However, lateral lumbar rotation is limited because the facet joints are located sagittally. (�Degenerative Disk Disease: Background, Anatomy, Pathophysiology�)

 

Blood Supply

 

The intervertebral disc is one of the largest avascular structures in the body with capillaries terminating at the endplates. The tissues derive nutrients from vessels in the subchondral bone which lie adjacent to the hyaline cartilage at the endplate. These nutrients such as oxygen and glucose are carried to the intervertebral disc through simple diffusion. (�Intervertebral Disc � Spine � Orthobullets.Com�)

 

Nerve Supply

 

Sensory innervation of intervertebral discs is complex and varies according to the location in the spinal column. Sensory transmission is thought to be mediated by substance P, calcitonin, VIP, and CPON. Sinu vertebral nerve, which arises from the dorsal root ganglion, innervates the superficial fibers of the annulus. Nerve fibers don�t extend beyond the superficial fibers.

 

Lumbar intervertebral discs are additionally supplied on the posterolateral aspect with branches from ventral primary rami and from the grey rami communicantes near their junction with the ventral primary rami. The lateral aspects of the discs are supplied by branches from rami communicantes. Some of the rami communicantes may cross the intervertebral discs and become embedded in the connective tissue, which lies deep to the origin of the psoas. (Palmgren, Tove, et al.)

 

The cervical intervertebral discs are additionally supplied on the lateral aspect by branches of the vertebral nerve. The cervical sinu vertebral nerves were also found to be having an upward course in the vertebral canal supplying the disc at their point of entry and the one above. (BOGDUK, NIKOLAI, et al.)

 

Pathophysiology of Degenerative Disc Disease

 

Approximately 25% of people before the age of 40 years show disc degenerative changes at some level. Over 40 years of age, MRI evidence shows changes in more than 60% of people. (Suthar, Pokhraj) Therefore, it is important to study the degenerative process of the intervertebral discs as it has been found to degenerate faster than any other connective tissue in the body, leading to back and neck pain. The changes in three intervertebral discs are associated with changes in the vertebral body and joints suggesting a progressive and dynamic process.

 

Degeneration Phase

 

The degenerative process of the intervertebral discs has been divided into three stages, according to Kirkaldy-Willis and Bernard, called ��degenerative cascade��. These stages can overlap and can occur over the course of decades. However, identifying these stages clinically is not possible due to the overlap of symptoms and signs.

 

Stage 1 (Degeneration Phase)

 

This stage is characterized by degeneration. There are histological changes, which show circumferential tears and fissures in the annulus fibrosus. These circumferential tears may turn into radial tears and because the annulus pulposus is well innervated, these tears can cause back pain or neck pain, which is localized and with painful movements. Due to repeated trauma in the discs, endplates can separate leading to disruption of the blood supply to the disc and therefore, depriving it of its nutrient supply and removal of waste. The annulus may contain micro-fractures in the collagen fibrils, which can be seen on electron microscopy and an MRI scan may reveal desiccation, bulging of the disc, and a high-intensity zone in the annulus. Facet joints may show a synovial reaction and it may cause severe pain with associated synovitis and inability to move the joint in the zygapophyseal joints. These changes may not necessarily occur in every person. (Gupta, Vijay Kumar, et al.)

 

The nucleus pulposus is also involved in this process as its water imbibing capacity is reduced due to the accumulation of biochemically changed proteoglycans. These changes are brought on mainly by two enzymes called matrix metalloproteinase-3 (MMP-3) and tissue inhibitor of metalloproteinase-1 (TIMP-1). (Bhatnagar, Sushma, and Maynak Gupta) Their imbalance leads to the destruction of proteoglycans. The reduced capacity to absorb water leads to a reduction of hydrostatic pressure in the nucleus pulposus and causes the annular lamellae to buckle. This can increase the mobility of that segment resulting in shear stress to the annular wall. All these changes can lead to a process called annular delamination and fissuring in the annulus fibrosus. These are two separate pathological processes and both can lead to pain, local tenderness, hypomobility, contracted muscles, painful joint movements. However, the neurological examination at this stage is usually normal.

 

Stage 2 (Phase of Instability)

 

The stage of dysfunction is followed by a stage of instability, which may result from the progressive deterioration of the mechanical integrity of the joint complex. There may be several changes encountered at this stage, including disc disruption and resorption, which can lead to a loss of disc space height. Multiple annular tears may also occur at this stage with concurrent changes in the zagopophyseal joints. They may include degeneration of the cartilage and facet capsular laxity leading to subluxation. These biomechanical changes result in instability of the affected segment.

 

The symptoms seen in this phase are similar to those seen in the dysfunction phase such as �giving way� of the back, pain when standing for prolonged periods, and a �catch� in the back with movements. They are accompanied by signs such as abnormal movements in the joints during palpation and observing that the spine sways or shifts to a side after standing erect for sometime after flexion. (Gupta, Vijay Kumar et al.)

 

Stage 3 (Re-Stabilization Phase)

 

In this third and final stage, the progressive degeneration leads to disc space narrowing with fibrosis and osteophyte formation and transdiscal bridging. The pain arising from these changes is severe compared to the previous two stages, but these can vary between individuals. This disc space narrowing can have several implications on the spine. This can cause the intervertebral canal to narrow in the superior-inferior direction with the approximation of the adjacent pedicles. Longitudinal ligaments, which support the vertebral column, may also become deficient in some areas leading to laxity and spinal instability. The spinal movements can cause the ligamentum flavum to bulge and can cause superior aricular process subluxation. This ultimately leads to a reduction of diameter in the anteroposterior direction of the intervertebral space and stenosis of upper nerve root canals.

 

Formation of osteophytes and hypertrophy of facets can occur due to the alteration in axial load on the spine and vertebral bodies. These can form on both superior and inferior articular processes and osteophytes can protrude to the intervertebral canal while the hypertrophied facets can protrude to the central canal. Osteophytes are thought to be made from the proliferation of articular cartilage at the periosteum after which they undergo endochondral calcification and ossification. The osteophytes are also formed due to the changes in oxygen tension and due to changes in fluid pressure in addition to load distribution defects. The osteophytes and periarticular fibrosis can result in stiff joints. The articular processes may also orient in an oblique direction causing retrospondylolisthesis leading to the narrowing of the intervertebral canal, nerve root canal, and the spinal canal. (KIRKALDY-WILLIS, W H et al.)

 

All of these changes lead to low back pain, which decreases with severity. Other symptoms like reduced movement, muscle tenderness, stiffness, and scoliosis can occur. The synovial stem cells and macrophages are involved in this process by releasing growth factors and extracellular matrix molecules, which act as mediators. The release of cytokines has been found to be associated with every stage and may have therapeutic implications in future treatment development.

 

Etiology of the Risk Factors of Degenerative Disc Disease

 

Aging and Degeneration

 

It is difficult to differentiate aging from degenerative changes. Pearce et al have suggested that aging and degeneration is representing successive stages within a single process that occur in all individuals but at different rates. Disc degeneration, however, occurs most often at a faster rate than aging. Therefore, it is encountered even in patients of working age.

 

There appears to be a relationship between aging and degeneration, but no distinct cause has yet been established. Many studies have been conducted regarding nutrition, cell death, and accumulation of degraded matrix products and the failure of the nucleus. The water content of the intervertebral disc decreases with the increasing age. Nucleus pulposus can get fissures that can extend into the annulus fibrosus. The start of this process is termed chondrosis inter vertebralis, which can mark the beginning of the degenerative destruction of the intervertebral disc, the endplates, and the vertebral bodies. This process causes complex changes in the molecular composition of the disc and has biomechanical and clinical sequelae that can often result in substantial impairment in the affected individual.

 

The cell concentration in the annulus decreases with increasing age. This is mainly because the cells in the disc are subjected to senescence and they lose the ability to proliferate. Other related causes of age-specific degeneration of intervertebral discs include cell loss, reduced nutrition, post-translational modification of matrix proteins, accumulation of products of degraded matrix molecules, and fatigue failure of the matrix. Decreasing nutrition to the central disc, which allows the accumulation of cell waste products and degraded matrix molecules seems to be the most important change out of all these changes. This impairs nutrition and causes a fall in the pH level, which can further compromise cell function and may lead to cell death. Increased catabolism and decreased anabolism of senescent cells may promote degeneration. (Buckwalter, Joseph A.) According to one study, there were more senescence cells in the nucleus pulposus compared to annulus fibrosus and herniated discs had a higher chance of cell senescence.� (Roberts, S. et al.)

 

When the aging process goes on for some time, the concentrations of chondroitin 4 sulfate and chondroitin 5 sulfate, which is strongly hydrophilic, gets decreased while the keratin sulfate to chondroitin sulfate ratio gets increased. Keratan sulfate is mildly hydrophilic and it also has a minor tendency to form stable aggregates with hyaluronic acid. As aggrecan is fragmented, and its molecular weight and numbers are decreased, the viscosity and hydrophilicity of the nucleus pulposus decrease. Degenerative changes to the intervertebral discs are accelerated by the reduced hydrostatic pressure of the nucleus pulposus and the decreased supply of nutrients by diffusion. When the water content of the extracellular matrix is decreased, intervertebral disc height will also be decreased. The resistance of the disc to an axial load will also be reduced. Because the axial load is then transferred directly to the annulus fibrosus, annulus clefts can get torn easily.

 

All these mechanisms lead to structural changes seen in degenerative disc disease. Due to the reduced water content in the annulus fibrosus and associated loss of compliance, the axial load can get redistributed to the posterior aspect of facets instead of the normal anterior and middle part of facets. This can cause facet arthritis, hypertrophy of the adjacent vertebral bodies, and bony spurs or bony overgrowths, known as osteophytes, as a result of degenerative discs. (Choi, Yong-Soo)

 

Genetics and Degeneration

 

The genetic component has been found to be a dominant factor in degenerative disc disease. Twin studies, and studies involving mice, have shown that genes play a role in disc degeneration. (Boyd, Lawrence M., et al.) Genes that code for collagen I, IX, and XI, interleukin 1, aggrecan, vitamin D receptor, matrix metalloproteinase 3 (MMP � 3), and other proteins are among the genes that are suggested to be involved in degenerative disc disease. Polymorphisms in 5 A and 6 A alleles occurring in the promoter region of genes that regulate MMP 3 production are found to be a major factor for the increased lumbar disc degeneration in the elderly population. Interactions among these various genes contribute significantly to intervertebral disc degeneration disease as a whole.

 

Nutrition and Degeneration

 

Disc degeneration is also believed to occur due to the failure of nutritional supply to the intervertebral disc cells. Apart from the normal aging process, the nutritional deficiency of the disc cells is adversely affected by endplate calcification, smoking, and the overall nutritional status. Nutritional deficiency can lead to the formation of lactic acid together with the associated low oxygen pressure. The resulting low pH can affect the ability of disc cells to form and maintain the extracellular matrix of the discs and causes intervertebral disc degeneration. The degenerated discs lack the ability to respond normally to the external force and may lead to disruptions even from the slightest back strain. (Taher, Fadi, et al.)

 

Growth factors stimulate the chondrocytes and fibroblasts to produce more amount of extracellular matrix. It also inhibits the synthesis of matrix metalloproteinases. Example of these growth factors includes transforming growth factor, insulin-like growth factor, and basic fibroblast growth factor. The degraded matrix is repaired by an increased level of transforming growth factor and basic fibroblast growth factor.

 

Environment and Degeneration

 

Even though all the discs are of the same age, discs found in the lower lumbar segments are more vulnerable to degenerative changes than the discs found in the upper segment. This suggests that not only aging but, also mechanical loading, is a causative factor. The association between degenerative disc disease and environmental factors has been defined in a comprehensive manner by Williams and Sambrook in 2011. (Williams, F.M.K., and P.N. Sambrook) The heavy physical loading associated with your occupation is a risk factor that has some contribution to disc degenerative disease. There is also a possibility of chemicals causing disc degeneration, such as smoking, according to some studies. (Batti�, Michele C.) Nicotine has been implicated in twin studies to cause impaired blood flow to the intervertebral disc, leading to disc degeneration. (BATTI�, MICHELE C., et al.) Moreover, an association has been found among atherosclerotic lesions in the aorta and the low back pain citing a link between atherosclerosis and degenerative disc disease. (Kauppila, L.I.) The disc degeneration severity was implicated in overweight, obesity, metabolic syndrome, and increased body mass index in some studies. (�A Population-Based Study Of Juvenile Disc Degeneration And Its Association With Overweight And Obesity, Low Back Pain, And Diminished Functional Status. Samartzis D, Karppinen J, Mok F, Fong DY, Luk KD, Cheung KM. J Bone Joint Surg Am 2011;93(7):662�70�)

 

Pain in Disc Degeneration (Discogenic Pain)

 

Discogenic pain, which is a type of nociceptive pain, arises from the nociceptors in the annulus fibrosus when the nervous system is affected by the degenerative disc disease. Annulus fibrosus contains immune reactive nerve fibers in the outer layer of the disc with other chemicals such as a vasoactive intestinal polypeptide, calcitonin gene-related peptide, and substance P. (KONTTINEN, YRJ� T., et al.) When degenerative changes in the intervertebral discs occur, normal structure and mechanical load are changed leading to abnormal movements. These disc nociceptors can get abnormally sensitized to mechanical stimuli. The pain can also be provoked by the low pH environment caused by the presence of lactic acid, causing increased production of pain mediators.

 

Pain from degenerative disc disease may arise from multiple origins. It may occur due to the structural damage, pressure, and irritation on the nerves in the spine. The disc itself contains only a few nerve fibers, but any injury can sensitize these nerves, or those in the posterior longitudinal ligament, to cause pain. Micro movements in the vertebrae can occur, which may cause painful reflex muscle spasms because the disc is damaged and worn down with the loss of tension and height. The painful movements arise because the nerves supplying the area are compressed or irritated by the facet joints and ligaments in the foramen leading to leg and back pain. This pain may be aggravated by the release of inflammatory proteins that act on nerves in the foramen or descending nerves in the spinal canal.

 

Pathological specimens of the degenerative discs, when observed under the microscope, reveals that there are vascularized granulation tissue and extensive innervations found in the fissures of the outer layer of the annulus fibrosus extending into the nucleus pulposus. The granulation tissue area is infiltrated by abundant mast cells and they invariably contribute to the pathological processes that ultimately lead to discogenic pain. These include neovascularisation, intervertebral disc degeneration, disc tissue inflammation, and the formation of fibrosis. Mast cells also release substances, such as tumor necrosis factor and interleukins, which might signal for the activation of some pathways which play a role in causing back pain. Other substances that can trigger these pathways include phospholipase A2, which is produced from the arachidonic acid cascade. It is found in increased concentrations in the outer third of the annulus of the degenerative disc and is thought to stimulate the nociceptors located there to release inflammatory substances to trigger pain. These substances bring about axonal injury, intraneural edema, and demyelination. (Brisby, Helena)

 

The back pain is thought to arise from the intervertebral disc itself. Hence why the pain will decrease gradually over time when the degenerating disc stops inflicting pain. However, the pain actually arises from the disc itself only in 11% of patients according to endoscopy studies. The actual cause of back pain seems to be due to the stimulation of the medial border of the nerve and referred pain along the arm or leg seems to arise due to the stimulation of the core of the nerve. The treatment for disc degeneration should mainly focus on pain relief to reduce the suffering of the patient because it is the most disabling symptom that disrupts a patient�s lives. Therefore, it is important to establish the mechanism of pain because it occurs not only due to the structural changes in the intervertebral discs but also due to other factors such as the release of chemicals and understanding these mechanisms can lead to effective pain relief. (Choi, Yong-Soo)

 

Clinical Presentation of Degenerative Disc Disease

 

Patients with degenerative disc disease face a myriad of symptoms depending on the site of the disease. Those who have lumbar disc degeneration get low back pain, radicular symptoms, and weakness. Those who have cervical disc degeneration have neck pain and shoulder pain.

 

Low back pain can get exacerbated by the movements and the position. Usually, the symptoms are worsened by the flexion, while the extension often relieves them. Minor twisting injuries, even from swinging a golf club, can trigger the symptoms. The pain is usually observed to be less when walking or running, when changing the position frequently and when lying down. However, the pain is usually subjective and in many cases, it varies considerably from person to person and most people will suffer from a low level of chronic pain of the lower back region continuously while occasionally suffering from the groin, hip, and leg pain. The intensity of the pain will increase from time to time and will last for a few days and then subside gradually. This �flare-up� is an acute episode and needs to be treated with potent analgesics. Worse pain is experienced in the seated position and is exacerbated while bending, lifting, and twisting movements frequently. The severity of the pain can vary considerably with some having occasional nagging pain to others having severe and disabling pain intermittently.� (Jason M. Highsmith, MD)

 

The localized pain and tenderness in the axial spine usually arises from the nociceptors found within the intervertebral discs, facet joints, sacroiliac joints, dura mater of the nerve roots, and the myofascial structures found within the axial spine. As mentioned in the previous sections, the degenerative anatomical changes may result in a narrowing of the spinal canal called spinal stenosis, overgrowth of spinal processes called osteophytes, hypertrophy of the inferior and superior articular processes, spondylolisthesis, bulging of the ligamentum flavum and disc herniation. These changes result in a collection of symptoms that is known as neurogenic claudication. There may be symptoms such as low back pain and leg pain together with numbness or tingling in the legs, muscle weakness, and foot drop. Loss of bowel or bladder control may suggest spinal cord impingement and prompt medical attention is needed to prevent permanent disabilities. These symptoms can vary in severity and may present to varying extents in different individuals.

 

The pain can also radiate to other parts of the body due to the fact that the spinal cord gives off several branches to two different sites of the body. Therefore, when the degenerated disc presses on a spinal nerve root, the pain can also be experienced in the leg to which the nerve ultimately innervates. This phenomenon, called radiculopathy, can occur from many sources arising, due to the process of degeneration. The bulging disc, if protrudes centrally, can affect descending rootlets of the cauda equina, if it bulges posterolaterally, it might affect the nerve roots exiting at the next lower intervertebral canal and the spinal nerve within its ventral ramus can get affected when the disc protrudes laterally. Similarly, the osteophytes protruding along the upper and lower margins of the posterior aspect of vertebral bodies can impinge on the same nervous tissues causing the same symptoms. Superior articular process hypertrophy may also impinge upon nerve roots depending on their projection. The nerves may include nerve roots prior to exiting from the next lower intervertebral canal and nerve roots within the upper nerve root canal and dural sac. These symptoms, due to the nerve impingement, have been proven by cadaver studies. Neural compromise is thought to occur when the neuro foraminal diameter is critically occluded with a 70% reduction. Furthermore, neural compromise can be produced when the posterior disc is compressed less than 4 millimeters in height, or when the foraminal height is reduced to less than 15 millimeters leading to foraminal stenosis and nerve impingement. (Taher, Fadi, et al.)

 

Diagnostic Approach

 

Patients are initially evaluated with an accurate history and thorough physical examination and appropriate investigations and provocative testing. However, history is often vague due to the chronic pain which cannot be localized properly and the difficulty in determining the exact anatomical location during provocative testing due to the influence of the neighboring anatomical structures.

 

Through the patient�s history, the cause of low back pain can be identified as arising from the nociceptors in the intervertebral discs. Patients may also give a history of the chronic nature of the symptoms and associated gluteal region numbness, tingling as well as stiffness in the spine which usually worsens with activity. Tenderness may be elicited by palpating over the spine. Due to the nature of the disease being chronic and painful, most patients may be suffering from mood and anxiety disorders. Depression is thought to be contributing negatively to the disease burden. However, no clear relationship between disease severity and mood or anxiety disorders. It is good to be vigilant about these mental health conditions as well. In order to exclude other serious pathologies, questions must be asked regarding fatigue, weight loss, fever, and chills, which might indicate some other diseases. (Jason M. Highsmith, MD)

 

Another etiology for the low back pain has to be excluded when examining the patient for degenerative disc disease. Abdominal pathologies, which can give rise to back pain such as aortic aneurysm, renal calculi, and pancreatic disease, have to be excluded.

 

Degenerative disc disease has several differential diagnoses to be considered when a patient presents with back pain. These include; idiopathic low back pain, zygapophyseal joint degeneration, myelopathy, lumbar stenosis, spondylosis, osteoarthritis, and lumbar radiculopathy. (�Degenerative Disc Disease � Physiopedia�)

 

Investigations

 

Investigations are used to confirm the diagnosis of degenerative disc disease. These can be divided into laboratory studies, imaging studies, nerve conduction tests, and diagnostic procedures.

 

Imaging Studies

 

The imaging in degenerative disc disease is mainly used to describe anatomical relations and morphological features of the affected discs, which has a great therapeutic value in future decision making for treatment options. Any imaging method, like plain radiography, CT, or MRI, can provide useful information. However, an underlying cause can only be found in 15% of the patients as no clear radiological changes are visible in degenerative disc disease in the absence of disc herniation and neurological deficit. Moreover, there is no correlation between the anatomical changes seen on imaging and the severity of the symptoms, although there are correlations between the number of osteophytes and the severity of back pain. Degenerative changes in radiography can also be seen in asymptomatic people leading to difficulty in conforming clinical relevance and when to start treatment. (�Degenerative Disc Disease � Physiopedia�)

 

Plain Radiography

 

This inexpensive and widely available plain cervical radiography can give important information on deformities, alignment, and degenerative bony changes. In order to determine the presence of spinal instability and sagittal balance, dynamic flexion, or extension studies have to be performed.

 

Magnetic Resonance Imaging (MRI)

 

MRI is the most commonly used method to diagnose degenerative changes in the intervertebral disc accurately, reliably, and most comprehensively. It is used in the initial evaluation of patients with neck pain after plain radiography. It can provide non-invasive images in multiple plains and gives excellent quality images of the disc. MRI can show disc hydration and morphology-based on the proton density, chemical environment, and the water content. Clinical picture and history of the patient have to be considered when interpreting MRI reports as it has been shown that as much as 25% of radiologists change their report when the clinical data are available. Fonar produced the first open MRI scanner with the ability of the patient to be scanned in different positions such as standing, sitting, and bending. Because of these unique features, this open MRI scanner can be used for scanning patients in weight-bearing postures and stand up postures to detect underlying pathological changes which are usually overlooked in conventional MRI scan such as lumbar degenerative disc disease with herniation. This machine is also good for claustrophobic patients, as they get to watch a large television screen during the scanning process. (�Degenerative Disk Disease: Background, Anatomy, Pathophysiology.�)

 

Nucleus pulposus and annulus fibrosus of the disc can usually be identified on MRI, leading to the detection of disc herniation as contained and non contained. As MRI can also show annular tears and the posterior longitudinal ligament, it can be used to classify herniation. This can be simple annular bulging to free fragment disc herniations. This information can describe the pathologic discs such as extruded disc, protruded discs, and migrated discs.

 

There are several grading systems based on MRI signal intensity, disc height, the distinction between nucleus and annulus, and the disc structure. The method, by Pfirrmann et al, has been widely applied and clinically accepted. According to the modified system, there are 8 grades for lumbar disc degenerative disease. Grade 1 represents normal intervertebral disc and grade 8 corresponds to the end stage of degeneration, depicting the progression of the disc disease. There are corresponding images to aid the diagnosis. As they provide good tissue differentiation and detailed description of the disc structure, sagittal T2 weighted images are used for the classification purpose. (Pfirrmann, Christian W. A., et al.)

 

Modic has described the changes occurring in the vertebral bodies adjacent to the degenerating discs as Type 1 and Type 2 changes. In Modic 1 changes, there is decreased intensity of T1 weighted images and increased intensity T2 weighted images. This is thought to occur because the end plates have undergone sclerosis and the adjacent bone marrow is showing inflammatory response as the diffusion coefficient increases. This increase of diffusion coefficient and the ultimate resistance to diffusion is brought about by the chemical substances released through an autoimmune mechanism. Modic type 2 changes include the destruction of the bone marrow of adjacent vertebral endplates due to an inflammatory response and the infiltration of fat in the marrow. These changes may lead to increased signal density on T1 weighted images. (Modic, M T et al.)

 

Computed Tomography (CT)

 

When MRI is not available, Computed tomography is considered a diagnostic test that can detect disc herniation because it has a better contrast between posterolateral margins of the adjacent bony vertebrae, perineal fat, and the herniated disc material. Even so, when diagnosing lateral herniations, MRI remains the imaging modality of choice.

 

CT scan has several advantages over MRI such as it has a less claustrophobic environment, low cost, and better detection of bonny changes that are subtle and may be missed on other modalities. CT can detect early degenerative changes of the facet joints and spondylosis with more accuracy. Bony integrity after fusion is also best assessed by CT.

 

Disc herniation and associated nerve impingement can be diagnosed by using the criteria developed by Gundry and Heithoff. It is important for the disc protrusion to lie directly over the nerve roots traversing the disc and to be focal and asymmetrical with a dorsolateral position. There should be demonstrable nerve root compression or displacement. Lastly, the nerve distal to the impingement (site of herniation) often enlarges and bulges with resulting edema, prominence of adjacent epidural veins, and inflammatory exudates resulting in blurring the margin.

 

Lumbar Discography

 

This procedure is controversial and, whether knowing the site of the pain has any value regarding surgery or not, has not been proven. False positives can occur due to central hyperalgesia in patients with chronic pain (neurophysiologic finding) and due to psychosocial factors. It is questionable to establish exactly when discogenic pain becomes clinically significant. Those who support this investigation advocates strict criteria for selection of the patients and when interpreting results and believe this is the only test that can diagnose discogenic pain. Lumbar discography can be used in several situations, although it is not scientifically established. These include; diagnosis of lateral herniation, diagnosing a symptomatic disc among multiple abnormalities, assessing similar abnormalities seen on CT or MRI, evaluation of the spine after surgery, selection of fusion level, and the suggestive features of discogenic pain existence.

 

The discography is more concerned about eliciting pathophysiology rather than determining the anatomy of the disc. Therefore, discogenic pain evaluation is the aim of discography. MRI may reveal an abnormally looking disc with no pain, while severe pain may be seen on discography where MRI findings are few. During the injection of normal saline or the contrast material, a spongy endpoint can occur with abnormal discs accepting more amounts of contrast. The contrast material can extend into the nucleus pulposus through tears and fissures in the annulus fibrosus in the abnormal discs. The pressure of this contrast material can provoke pain due to the innervations by recurrent meningeal nerve, mixed spinal nerve, anterior primary rami, and gray rami communicantes supplying the outer annulus fibrosus. Radicular pain can be provoked when the contrast material reaches the site of nerve root impingement by the abnormal disc. However, this discography test has several complications such as nerve root injury, chemical or bacterial diskitis, contrast allergy, and the exacerbation of pain. (Bartynski, Walter S., and A. Orlando Ortiz)

 

Imaging Modality Combination

 

In order to evaluate the nerve root compression and cervical stenosis adequately, a combination of imaging methods may be needed.

 

CT Discography

 

After performing initial discography, CT discography is performed within 4 hours. It can be used in determining the status of the disc such as herniated, protruded, extruded, contained or sequestered. It can also be used in the spine to differentiate the mass effects of scar tissue or disc material after spinal surgery.

 

CT Myelography

 

This test is considered the best method for evaluating nerve root compression. When CT is performed in combination or after myelography, details about bony anatomy different planes can be obtained with relative ease.

 

Diagnostic Procedures

 

Transforaminal Selective Nerve Root Blocks (SNRBs)

 

When multilevel degenerative disc disease is suspected on an MRI scan, this test can be used to determine the specific nerve root that has been affected. SNRB is both a diagnostic and therapeutic test that can be used for lumbar spinal stenosis. The test creates a demotomal level area of hypoesthesia by injecting an anesthetic and a contrast material under fluoroscopic guidance to the interested nerve root level. There is a correlation between multilevel cervical degenerative disc disease clinical symptoms and findings on MRI and findings of SNRB according to Anderberg et al. There is a 28% correlation with SNRB results and with dermatomal radicular pain and areas of neurologic deficit. Most severe cases of degeneration on MRI are found to be correlated with 60%. Although not used routinely, SNRB is a useful test in evaluating patients before surgery in multilevel degenerative disc disease especially on the spine together with clinical features and findings on MRI. (Narouze, Samer, and Amaresh Vydyanathan)

 

Electro Myographic Studies

 

Distal motor and sensory nerve conduction tests, called electromyographic studies, that are normal with abnormal needle exam may reveal nerve compression symptoms that are elicited in the clinical history. Irritated nerve roots can be localized by using injections to anesthetize the affected nerves or pain receptors in the disc space, sacroiliac joint, or the facet joints by discography. (�Journal Of Electromyography & Kinesiology Calendar�)

 

Laboratory Studies

 

Laboratory tests are usually done to exclude other differential diagnoses.

 

As seronegative spondyloarthropathies, such as ankylosing spondylitis, are common causes of back pain, HLA B27 immuno-histocompatibility has to be tested. Estimated 350,000 persons in the US and 600,000 in Europe have been affected by this inflammatory disease of unknown etiology. But HLA B27 is extremely rarely found in African Americans. Other seronegative spondyloarthropathies that can be tested using this gene include psoriatic arthritis, inflammatory bowel disease, and reactive arthritis or Reiter syndrome. Serum immunoglobulin A (IgA) can be increased in some patients.

 

Tests like the erythrocyte sedimentation rate (ESR) and C- reactive protein (CRP) level test for the acute phase reactants seen in inflammatory causes of lower back pain such as osteoarthritis and malignancy. The full blood count is also required, including differential counts to ascertain the disease etiology. Autoimmune diseases are suspected when Rheumatoid factor (RF) and anti-nuclear antibody (ANA) tests become positive. Serum uric acid and synovial fluid analysis for crystals may be needed in rare cases to exclude gout and pyrophosphate dihydrate deposition.

 

Treatment

 

There is no definitive treatment method agreed by all physicians regarding the treatment of degenerative disc disease because the cause of the pain can differ in different individuals and so is the severity of pain and the wide variations in clinical presentation. The treatment options can be discussed broadly under; conservative treatment, medical treatment, and surgical treatment.

 

Conservative Treatment

 

This treatment method includes exercise therapy with behavioral interventions, physical modalities, injections, back education, and back school methods.

 

Exercise-Based Therapy with Behavioral Interventions

 

Depending on the diagnosis of the patient, different types of exercises can be prescribed. It is considered one of the main methods of conservative management to treat chronic low back pain. The exercises can be modified to include stretching exercises, aerobic exercises, and muscle strengthening exercises. One of the major challenges of this therapy includes its inability to assess the efficacy among patients due to wide variations in the exercise regimens, frequency, and intensity. According to studies, most effectiveness for sub-acute low back pain with varying duration of symptoms was obtained by performing graded exercise programs within the occupational setting of the patient. Significant improvements were observed among patients suffering from chronic symptoms with this therapy with regard to functional improvement and pain reduction. Individual therapies designed for each patient under close supervision and compliance of the patient also seems to be the most effective in chronic back pain sufferers. Other conservative approaches can be used in combination to improve this approach. (Hayden, Jill A., et al.)

 

Aerobic exercises, if performed regularly, can improve endurance. For relieving muscle tension, relaxation methods can be used. Swimming is also considered an exercise for back pain. Floor exercises can include extension exercises, hamstring stretches, low back stretches, double knee to chin stretches, seat lifts, modified sit-ups, abdominal bracing, and mountain and sag exercises.

 

Physical Modalities

 

This method includes the use of electrical nerve stimulation, relaxation, ice packs, biofeedback, heating pads, phonophoresis, and iontophoresis.

 

Transcutaneous Electrical Nerve Stimulation (TENS)

 

In this non-invasive method, electrical stimulation is delivered to the skin in order to stimulate the peripheral nerves in the area to relieve the pain to some extent. This method relieves pain immediately following application but its long term effectiveness is doubtful. With some studies, it has been found that there is no significant improvement in pain and functional status when compared with placebo. The devices performing these TENS can be easily accessible from the outpatient department. The only side effect seems to be a mild skin irritation experienced in a third of patients. (Johnson, Mark I)

 

Back School

 

This method was introduced with the aim of reducing the pain symptoms and their recurrences. It was first introduced in Sweden and takes into account the posture, ergonomics, appropriate back exercises, and the anatomy of the lumbar region. Patients are taught the correct posture to sit, stand, lift weights, sleep, wash face, and brush teeth avoiding pain. When compared with other treatment modalities, back school therapy has been proven to be effective in both immediate and intermediate periods for improving back pain and functional status.

 

Patient Education

 

In this method, the provider instructs the patient on how to manage their back pain symptoms. Normal spinal anatomy and biomechanics involving mechanisms of injury is taught at first. Next, using the spinal models, the degenerative disc disease diagnosis is explained to the patient. For the individual patient, the balanced position is determined and then asked to maintain that position to avoid getting symptoms.

 

Bio-Psychosocial Approach to Multidisciplinary Back Therapy

 

Chronic back pain can cause a lot of distress to the patient, leading to psychological disturbances and low mood. This can adversely affect the therapeutic outcomes rendering most treatment strategies futile. Therefore, patients must be educated on learned cognitive strategies called �behavioral� and �bio-psychosocial� strategies to get relief from pain. In addition to treating the biological causes of pain, psychological, and social causes should also be addressed in this method. In order to reduce the patient�s perception of pain and disability, methods like modified expectations, relaxation techniques, control of physiological responses by learned behavior, and reinforcement are used.

 

Massage Therapy

 

For chronic low back pain, this therapy seems to be beneficial. Over a 1 year period, massage therapy has been found to be moderately effective for some patients when compared to acupuncture and other relaxation methods. However, it is less efficacious than TENS and exercise therapy although individual patients may prefer one over the other. (Furlan, Andrea D., et al.)

 

Spinal Manipulation

 

This therapy involves the manipulation of a joint beyond its normal range of movement, but not exceeding that of the normal anatomical range. This is a manual therapy that involves long lever manipulation with a low velocity. It is thought to improve low back pain through several mechanisms like the release of entrapped nerves, destruction of articular and peri-articular adhesions, and through manipulating segments of the spine that had undergone displacement. It can also reduce the bulging of the disc, relax the hypertonic muscles, stimulate the nociceptive fibers via changing the neurophysiological function and reposition the menisci on the articular surface.

 

Spinal manipulation is thought to be superior in efficacy when compared to most methods such as TENS, exercise therapy, NSAID drugs, and back school therapy. The currently available research is positive regarding its effectiveness in both the long and short term. It is also very safe to administer under-trained therapists with cases of disc herniation and cauda equina being reported only in lower than 1 in 3.7 million people. (Bronfort, Gert, et al.)

 

Lumbar Supports

 

Patients suffering from chronic low back pain due to degenerative processes at multiple levels with several causes may benefit from lumbar support. There is conflicting evidence with regards to its effectiveness with some studies claiming moderate improvement in immediate and long term relief while others suggesting no such improvement when compared to other treatment methods. Lumbar supports can stabilize, correct deformity, reduce mechanical forces, and limit the movements of the spine. It may also act as a placebo and reduce the pain by massaging the affected areas and applying heat.

 

Lumbar Traction

 

This method uses a harness attached to the iliac crest and lower rib cage and applies a longitudinal force along the axial spine to relieve chronic low back pain. The level and duration of the force are adjusted according to the patient and it can be measured by using devices both while walking and lying down. Lumbar traction acts by opening the intervertebral disc spaces and by reducing the lumbar lordosis. The symptoms of degenerative disc disease are reduced through this method due to temporary spine realignment and its associated benefits. It relieves nerve compression and mechanical stress, disrupts the adhesions in the facet and annulus, and also nociceptive pain signals. However, there is not much evidence with regard to its effectiveness in reducing back pain or improving daily function. Furthermore, the risks associated with lumbar traction are still under research and some case reports are available where it has caused a nerve impingement, respiratory difficulties, and blood pressure changes due to heavy force and incorrect placement of the harness. (Harte, A et al.)

 

Medical Treatment

 

Medical therapy involves drug treatment with muscle relaxants, steroid injections, NSAIDs, opioids, and other analgesics. This is needed, in addition to conservative treatment, in most patients with degenerative disc disease. Pharmacotherapy is aimed to control disability, reduce pain and swelling while improving the quality of life. It is catered according to the individual patient as there is no consensus regarding the treatment.

 

Muscle Relaxants

 

Degenerative disc disease may benefit from muscle relaxants by reducing the spasm of muscles and thereby relieving pain. The efficacy of muscle relaxants in improving pain and functional status has been established through several types of research. Benzodiazepine is the most common muscle relaxant currently in use.

 

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

 

These drugs are commonly used as the first step in disc degenerative disease providing analgesia, as well as anti-inflammatory effects. There is strong evidence that it reduces chronic low back pain. However, its use is limited by gastrointestinal disturbances, like acute gastritis. Selective COX2 inhibitors, like celecoxib, can overcome this problem by only targeting COX2 receptors. Their use is not widely accepted due to its potential side effects in increasing cardiovascular disease with prolonged use.

 

Opioid Medications

 

This is a step higher up in the WHO pain ladder. It is reserved for patients suffering from severe pain not responding to NSAIDs and those with unbearable GI disturbances with NSAID therapy. However, the prescription of narcotics for treating back pain varies considerably between clinicians. According to literature, 3 to 66% of patients may be taking some form of the opioid to relieve their back pain. Even though the short term reduction in symptoms is marked, there is a risk of long term narcotic abuse, a high rate of tolerance, and respiratory distress in the older population. Nausea and vomiting are some of the short term side effects encountered. (�Systematic Review: Opioid Treatment For Chronic Back Pain: Prevalence, Efficacy, And Association With Addiction�)

 

Anti-Depressants

 

Anti-depressants, in low doses, have analgesic value and may be beneficial in chronic low back pain patients who may present with associated depression symptoms. The pain and suffering may be disrupting the sleep of the patient and reducing the pain threshold. These can be addressed by using anti-depressants in low doses even though there is no evidence that it improves the function.

 

Injection Therapy

 

Epidural Steroid Injections

 

Epidural steroid injections are the most widely used injection type for the treatment of chronic degenerative disc disease and associated radiculopathy. There is a variation between the type of steroid used and its dose. 8- 10 mL of a mixture of methylprednisolone and normal saline is considered an effective and safe dose. The injections can be given through interlaminar, caudal, or trans foramina routes. A needle can be inserted under the guidance of fluoroscopy. First contrast, then local anesthesia and lastly, the steroid is injected into the epidural space at the affected level via this method. The pain relief is achieved due to the combination of effects from both local anesthesia and the steroid. Immediate pain relief can be achieved through the local anesthetic by blocking the pain signal transmission and while also confirming the diagnosis. Inflammation is also reduced due to the action of steroids in blocking pro-inflammatory cascade.

 

During the recent decade, the use of epidural steroid injection has increased by 121%. However, there is controversy regarding its use due to the variation in response levels and potentially serious adverse effects. Usually, these injections are believed to cause only short term relief of symptoms. Some clinicians may inject 2 to 3 injections within a one-week duration, although the long term results are the same for that of a patient given only a single injection. For a one year period, more than 4 injections shouldn�t be given. For more immediate and effective pain relief, preservative-free morphine can also be added to the injection. Even local anesthetics, like lidocaine and bupivacaine, are added for this purpose. Evidence for long term pain relief is limited. (�A Placebo-Controlled Trial To Evaluate Effectivity Of Pain Relief Using Ketamine With Epidural Steroids For Chronic Low Back Pain�)

 

There are potential side effects due to this therapy, in addition to its high cost and efficacy concerns. Needles can get misplaced if fluoroscopy is not used in as much as 25% of cases, even with the presence of experienced staff. The epidural placement can be identified by pruritus reliably. Respiratory depression or urinary retention can occur following injection with morphine and so the patient needs to be monitored for 24 hours following the injection.

 

Facet Injections

 

These injections are given to facet joints, also called zygapophysial joints, which are situated between two adjacent vertebrae. Anesthesia can be directly injected to the joint space or to the associated medial branch of the dorsal rami, which innervates it. There is evidence that this method improves the functional ability, quality of life, and relieves pain. They are thought to provide both short and long term benefits, although studies have shown both facet injections and epidural steroid injections are similar in efficacy. (Wynne, Kelly A)

 

SI Joint Injections

 

This is a diarthrodial synovial joint with nerve supply from both myelinated and non-myelin nerve axons. The injection can effectively treat degenerative disc disease involving sacroiliac joint leading to both long and short term relief from symptoms such as low back pain and referred pain at legs, thigh, and buttocks. The injections can be repeated every 2 to 3 months but should be performed only if clinically necessary. (MAUGARS, Y. et al.)

 

Intradiscal Non-Operative Therapies for Discogenic Pain

 

As described under the investigations, discography can be used both as a diagnostic and therapeutic method. After the diseased disc is identified, several minimally invasive methods can be tried before embarking on surgery. Electrical current and its heat can be used to coagulate the posterior annulus thereby strengthening the collagen fibers, denaturing and destroying inflammatory mediators and nociceptors, and sealing figures. The methods used in this are called intradiscal electrothermal therapy (IDET) or radiofrequency posterior annuloplasty (RPA), in which an electrode is passed to the disc. IDET has moderate evidence in relief of symptoms for disc degenerative disease patients, while RPA has limited support regarding its short term and long term efficacy. Both these procedures can lead to complications such as nerve root injury, catheter malfunction, infection, and post-procedure disc herniation.

 

Surgical Treatment

 

Surgical treatment is reserved for patients with failed conservative therapy taking into account the disease severity, age, other comorbidities, socio-economic condition, and the level of outcome expected. It is estimated that around 5% of patients with degenerative disc disease undergo surgery, either for their lumbar disease or cervical disease. (Rydevik, Bj�rn L.)

 

Lumbar Spine Procedures

 

Lumbar surgery is indicated in patients with severe pain, with a duration of 6 to 12 months of ineffective drug therapy, who have critical spinal stenosis. The surgery is usually an elective procedure except in the case of cauda equina syndrome. There are two procedure types that aim to involve spinal fusion or decompression or both. (�Degenerative Disk Disease: Background, Anatomy, Pathophysiology.�)

 

Spinal fusion involves stopping movements at a painful vertebral segment in order to reduce the pain by fusing several vertebrae together by using a bone graft. It is considered effective in the long term for patients with degenerative disc disease having spinal malalignment or excessive movement. There are several approaches to fusion surgery. (Gupta, Vijay Kumar, et al)

 

  • Lumbar spinal posterolateral guttur fusion

 

This method involves placing a bone graft in the posterolateral part of the spine. A bone graft can be harvested from the posterior iliac crest. The bones are stripped off from its periosteum for successful grafting. A back brace is needed in the post-operative period and patients may need to stay in the hospital for about 5 to 10 days. Limited motion and cessation of smoking are needed for successful fusion. However, several risks such as non-union, infection, bleeding, and solid union with back pain may occur.

 

  • Posterior lumbar interbody fusion

 

In this method, decompression or diskectomy methods can also be performed via the same approach. The bone grafts are directly applied to the disc space and ligamentum flavum is excised completely. For the degenerative disc disease, interlaminar space is widened additionally by performing a partial medial facetectomy. Back braces are optional with this method. It has several disadvantages when compared to anterior approach such as only small grafts can be inserted, the reduced surface area available for fusion, and difficulty when performing surgery on spinal deformity patients. The major risk involved is non-union.

 

  • Anterior lumbar interbody fusion

 

This procedure is similar to the posterior one except that it is approached through the abdomen instead of the back. It has the advantage of not disrupting the back muscles and the nerve supply. It is contraindicated in patients with osteoporosis and has the risk of bleeding, retrograde ejaculation in men, non-union, and infection.

 

  • Transforaminal lumbar interbody fusion

 

This is a modified version of the posterior approach which is becoming popular. It offers low risk with good exposure and it is shown to have an excellent outcome with a few complications such as CSF leak, transient neurological impairment, and wound infection.

 

Total Disc Arthroplasty

 

This is an alternative to disc fusion and it has been used to treat lumbar degenerative disc disease using an artificial disc to replace the affected disc. Total prosthesis or nuclear prosthesis can be used depending on the clinical situation.

 

Decompression involves removing part of the disc of the vertebral body, which is impinging on a nerve to release that and provide room for its recovery via procedures called diskectomy and laminectomy. The efficacy of the procedure is questionable although it is a commonly performed surgery. Complications are very few with a low chance of recurrence of symptoms with higher patient satisfaction. (Gupta, Vijay Kumar, et al)

 

  • Lumbar discectomy

 

The surgery is performed through a posterior midline approach by dividing the ligamentum flavum. The nerve root that is affected is identified and bulging annulus is cut to release it. Full neurological examination should be performed afterward and patients are usually fit to go home 1 � 5 days later. Low back exercises should be started soon followed by light work and then heavy work at 2 and 12 weeks respectively.

 

  • Lumbar laminectomy

 

This procedure can be performed thorough one level, as well as through multiple levels. Laminectomy should be as short as possible to avoid spinal instability. Patients have marked relief of symptoms and reduction in radiculopathy following the procedure. The risks may include bowel and bladder incontinence, CSF leakage, nerve root damage, and infection.

 

Cervical Spine Procedures

 

Cervical degenerative disc disease is indicated for surgery when there is unbearable pain associated with progressive motor and sensory deficits. Surgery has a more than 90% favorable outcome when there is radiographic evidence of nerve root compression. There are several options including anterior cervical diskectomy (ACD), ACD, and fusion (ACDF), ACDF with internal fixation, and posterior foraminotomy. (�Degenerative Disk Disease: Background, Anatomy, Pathophysiology.�)

 

Cell-Based Therapy

 

Stem cell transplantation has emerged as a novel therapy for degenerative disc disease with promising results. The introduction of autologous chondrocytes has been found to reduce discogenic pain over a 2 year period. These therapies are currently undergoing human trials. (Jeong, Je Hoon, et al.)

 

Gene Therapy

 

Gene transduction in order to halt the disc degenerative process and even inducing disc regeneration is currently under research. For this, beneficial genes have to be identified while demoting the activity of degeneration promoting genes. These novel treatment options give hope for future treatment to be directed at regenerating intervertebral discs. (Nishida, Kotaro, et al.)

 

 

Degenerative disc disease is a health issue characterized by chronic back pain due to a damaged intervertebral disc, such as low back pain in the lumbar spine or neck pain in the cervical spine. It is a breakdown of an intervertebral disc of the spine. Several pathological changes can occur in disc degeneration. Various anatomical defects can also occur in the intervertebral disc. Low back pain and neck pain are major epidemiological problems, which are thought to be related to degenerative disc disease. Back pain is the second leading cause of doctor office visits in the United States. It is estimated that about 80% of US adults suffer from low back pain at least once during their lifetime. Therefore, a thorough understanding of degenerative disc disease is needed for managing this common condition. – Dr. Alex Jimenez D.C., C.C.S.T. Insight

 

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas*& New Mexico*�

 

Curated by Dr. Alex Jimenez D.C., C.C.S.T.

 

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  42. Nishida, Kotaro et al. �Gene Therapy Approach For Disc Degeneration And Associated Spinal Disorders.� European Spine Journal, vol 17, no. S4, 2008, pp. 459-466. Springer Nature, doi:10.1007/s00586-008-0751-5.

 

Spinal Injection or Nerve Block For Neck and Back Pain

Spinal Injection or Nerve Block For Neck and Back Pain

Spinal injections are exactly what the name says. They are administered direct injections of medicine/s in a specific location of the spine. These are used to treat various conditions affecting the spine when non-invasive treatment/s are not working.

This could be an area along the upper cervical/neck spine all the way down to the sacrum. Injections are also utilized in helping to diagnose neck or back pain that radiates or spreads into an individual�s arms and legs. These are known as:

  • Cervical radiculopathy
  • Lumbar radiculopathy

Spinal injection/s for diagnostic or treatment purposes could be a part of an overall treatment plan along with chiropractic/physical therapy and possible medication.

11860 Vista Del Sol, Ste. 128 Spinal Injection or Nerve Block For Neck and Back Pain

The medicine in the injection

The medicine could be comprised of a local anesthetic on its own, steroid on its own, or a combination of the two. Steroids are short for corticosteroid, which is a strong anti-inflammatory medication. A contrast dye like an x-ray dye could be added to the injection mix. This dye acts as a guide for precise placement of the needle using image guidance.

Spinal disorders that could benefit

Proceeding with an injection treatment plan is based on an individual’s unique factors that apply to their condition/state. This decision will be made after consultation, and diagnosis with your doctor, spine specialist, or chiropractor.

Healthcare providers recommend conservative treatment first. A treatment plan typically runs around 4-6 weeks. If there is no change or improvement in the individual’s condition from the conservative therapy then injection treatment/s could be recommended. Conditions, where injection/s are used, include:

  • Disc herniation
  • Facet joint pain
  • Failed back syndrome
  • Sacroiliac joint pain
  • Sciatica
  • Spinal stenosis

Spinal injection and nerve block difference

Spinal injections are a general term that could mean any type of injection involving the spine. Nerve blocks are a precise type of injection that targets a specific nerve. As the medicine is injected into the target nerve/s, it blocks or creates a blockade of the pain signals being sent from the area (ex. neck, low back, etc.) that is generating the pain.

Injection types

Epidural

An epidural means an injection on the dura. The dura is the outermost layer that encloses the spinal cord. �

11860 Vista Del Sol, Ste. 128 Spinal Injection or Nerve Block For Neck and Back Pain

3 types of epidurals. They are named according to the direction and angle the needle takes to get to the dura.

  • Caudal epidural:

The spinal canal ends at an opening at the end of the sacrum called the spinal hiatus. The medicine is injected into the epidural space through the sacral hiatus. This is the method that is used to provide anesthesia to pregnant women when they’re in labor. �

StructureoftheSacrumDiagram ElPasoChiropractor
  • Transforaminal epidural:

There are nerve roots that come out of the spinal canal at each level through a bony opening called the intervertebral foramen or neuroforamen. The medicine is injected into the epidural space in these areas.

  • Interlaminar epidural:

The lamina is a section that forms the arch of each level and forms the spinal canal. The lamina at each level lays on top of the lamina right below. The needle is inserted between the lamina for delivery of the medicine into the epidural space. �

third and fourth lumbar vertebrae lumbar vertebra lumbar spine vertebral bone

Selective Nerve Root Block – SNRB

These involve the injection of a local anesthetic onto a targeted nerve. They are typically used for diagnostic purposes. For individuals with multi-spinal compression/s, these combined with:

  • Medical history
  • Physical exam
  • MRI

These can help identify the pain generator such as spinal stenosis.

Medial Branch Block – MBB

The facet joints are bony projections that connect a vertebral level to the levels above and below. These can become arthritic and is responsible for different forms of back pain.

This type of spinal injection is local anesthetic injected on the medial branch nerves. These are the nerves that send pain signals from the facet joint/s. They are useful in determining if the facet joint is the pain generator. �

Facet Joint

These are injections directly into the facet joint itself. Much like injecting anti-inflammatory and pain meds into a knee with arthritis.

Sacroiliac Joint

The two sacroiliac joints help connect either side of the sacrum to the hip joint. Like other joints, these can get inflamed and cause painful symptoms. This is an injection directly into one or both of the sacroiliac joints.

Administration of the spinal injection or nerve block

Injections are only to be performed by doctors trained specifically in spinal injections. Injections are usually performed by an:

  • Anesthesiologist
  • Neurologist
  • Neurosurgeon
  • Orthopedic surgeon
  • Physiatrist
  • Radiologist

Role of these procedures

Reasons why an injection could be used:

  • Help as a diagnostic to identify the pain generator
  • Therapeutically to provide pain relief
  • As a prognostic pain predictor of the relief, an individual could expect from a more invasive procedure like nerve ablation.

How often

A maximum of 6 injections for one year is the recommended treatment protocol. Each injection should be based on the effect/s of the previous injection.

Potential benefits

The main benefit is to bring pain relief and the ability to function.

Potential risks

Spinal injections are considered safe with a low rate of complications. The most common include:

  • Bleeding
  • Headache
  • Facial flushing

Major complications include:

  • Puncture of the dura
  • Infection
  • Nerve damage

Major complications happen in less than one percent of those undergoing the treatment. Individuals with diabetes could see a temporary elevation of their blood sugar.

Lasting effects

How long the medicine lasts is different for everyone and comes with variables like:

  • Type of injection
  • Type of pathology
  • Diagnosis
  • Cause
  • How long the symptoms last

Most can expect to have one and a half to three months of relief. However, with some, they may only provide minimal relief, while others may see improvements for up to a year.


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Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at�915-850-0900. The provider(s) Licensed in Texas& New Mexico*

Spinal Stimulation and Chronic Back Pain

Spinal Stimulation and Chronic Back Pain

Spinal stimulation is a treatment option that could help bring relief from pain and improve the quality of life for individuals dealing with chronic pain, like low back, and leg pain. Spinal stimulation can help reduce and manage chronic pain that does not alleviate or reduce with physical therapy, pain medications, injections, and other non-surgical treatments/therapies. �

11860 Vista Del Sol, Ste. 128 Spinal Stimulation and Chronic Back Pain

 

It is a form of neuromodulation that works by blocking pain signals that the nerves send out from reaching the brain. A spinal stimulator is a tiny device that is implanted underneath the skin. The device delivers a very low electrical impulse that masks/changes pain signals before they reach the brain.

A Spinal Stimulation System

Neurostimulator:

This is the entire device that is implanted and sends out electrical impulses through a lead wire to the nerves in the spine.

Lead:

The thin wire that delivers the electrical impulses from the neurostimulator.

Remote control:

This turns on/off the stimulator and increases or decreases the amount of stimulation.

Charger:

Stimulators are rechargeable and normally require recharging about one hour every two weeks.

Spinal Stimulator Types:

Traditional stimulators

These produce a gentle ringing/tingling sensation that masks the pain.

Burst stimulators

These send out random interval bursts of electrical impulses designed to copy the way the body sends out nerve impulses.

High-frequency stimulators

These reduce pain without generating tingling sensations. �

Types of Pain Spinal Stimulation Treats

Spinal stimulation is approved by the U.S. FDA to treat chronic back and leg pain, including pain that doesn’t go away after back surgery known as failed back surgery syndrome. Chronic neuropathic back and leg pain are the most common types that stimulation treats. This means back or leg pain caused by nerve damage from:

  • Auto accident
  • Injury – personal, sports, work
  • Disease

Acute pain is like stepping on a sharp piece of glass, where the pain serves as protection letting you know something is wrong and not to continue. Whereas chronic neuropathic pain lasts for 3 months or more and does not help protect the body. �

11860 Vista Del Sol, Ste. 128 Spinal Stimulation and Chronic Back Pain

Spinal stimulation is also used to treat complex regional pain syndrome or CRPS. This is a rare condition that affects the arms/hands or legs/feet and is believed to be caused by damage or malfunction of the nervous system. It is also used in treating peripheral neuropathic pain. This is damage to the nerves outside of the spinal cord often in the hands/feet that is caused by an:

  • Infection
  • Trauma
  • Surgery
  • Diabetes
  • Other unknown causes

Appropriate Treatment

Spinal cord stimulation should not be used in patients that are pregnant, unable to operate the stimulation system, went through a failed trial of spinal stimulation, and are at risk for surgical complications. The decision to use spinal stimulation is based on an individual’s needs and risks. Talk to a doctor, spine specialist, chiropractor to see if spinal stimulation could be an option.

Benefits and Risks

The effects of stimulation are different for everyone. Therefore, it is important to understand that spinal stimulation can help reduce pain, but not completely eliminate it. �

The Benefits of Spinal Cord Stimulation

In addition to reducing pain, other benefits of spinal stimulation include:

  • Better sleep
  • Improved body function
  • Increased activity
  • Improved mobility
  • Reduced opioid medication/s use
  • Less need for other types of pain meds
  • Reduced dependence on braces/bracing

Risks

During the implantation, there is a risk for:

  • Bleeding
  • Infection
  • Pain at the site of incision
  • Nerve damage
  • Rarely paralysis

� For some individuals, scar tissue can build up over the electrode, which can block the stimulator’s electrical impulse. The lead wire could move or shift out of position. This could lead to impulses being sent to the wrong location. The device itself could shift under the skin causing pain, making it hard to re-charge or communicate with the remote.

There is a risk that the lead wire could detach or break off causing a malfunction and require a replacement. Also, individuals could respond well to the stimulation at first, but later on, they develop a tolerance, and so the therapy no longer has the same impact and the pain could get worse because the nerves stop responding.

Take Precautions

Discuss with a doctor, spine specialist, or chiropractor what you can and can’t do after the stimulator is implanted and activated. Here are a few precautions:

  • Do not drive or operate heavy equipment when the stimulator is active.
  • Stimulation systems could set off metal detectors, which could require manual screening.

MRIs, electrocautery, diathermy, defibrillators, and cardiac pacemakers could have a negative interaction with certain types of stimulators. This could result in injury or damage to the spinal stimulator. Talk to your doctor to determine if a spinal stimulator is a treatment option that will work for you.


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Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at�915-850-0900. The provider(s) Licensed in Texas& New Mexico

A Hot Bath to Relax Back Tension, and Pain

A Hot Bath to Relax Back Tension, and Pain

Chiropractor, Dr. Alex Jimenez shares some how-to advice on taking hot baths for back tension and pain. A bath can be a wonderful and fulfilling experience in self-care for back pain. There are medical benefits from taking a hot bath, as well. A hot bath can be extremely helpful when it comes to back pain.

Dr. Jimenez helps his patients with spinal ailments and conditions that range from arthritis, degenerative disc disease to nerve compression, sciatica, auto accident injuries, sports injuries, etc. In addition to chiropractic, physical therapy, diet, and exercise, he has also seen the power of home remedies, like a hot bath.

There are scientific studies that have shown how hydrotherapy can relieve back pain. Dr. Jimenez describes a hot bath as a muscle-relaxing stimulus. It opens up the muscles, which allows more blood to flow through, which in turn helps to heal injury/s, tightness, and soreness. It helps to clean out lactic acid, which is known to cause muscle pain, fatigue, and muscle cramps.

 

11860 Vista Del Sol, Ste. 128 Hot Bath to Relax Back Tension, Soreness, and Pain

 

Here is what usually happens to the spine when soreness, tightness, aching, and pain present. A spinal structure like a nerve, disc, vertebral bone, or other tissue is injured or on the verge of injury, and the muscles around it contract closely in to prevent more damage.

This is called muscle spasm. Don’t worry the body is supposed to respond this way, as it means the damaged tissue is less likely to sustain further injury. However, muscle spasms can be painful. Much like a Charley horse, a back spasm can have the same effect.

For example, someone standing or working for an extended period places the muscle/s under constant tension, which means they have a higher chance of having a spasm and developing painful symptoms. A hot bath relaxes the muscle/s and reduces/removes the aching soreness and pain. Here are some tips to help relax the back muscles.

Try Epsom Salt

Taking a bath with Epsom salt or minerals that dissolve in water can be helpful, but are not necessary. Many are fantastic skin relaxants, but if you have a hot bath with or without the salt, it�s not going to make a huge difference. What makes the bath work is the heat and the floatation. This what creates the benefits.

Soak 15-20 Minutes

It is really up to the individual, as to how long they want to stay in the tub. One question to ask is how long can you take sitting in hot water? Hot tubs are normally heated to about 102 to 103 degrees. With these types of tubs, individuals can sit for a half-hour or more. However, most of us do not have a jacuzzi, so remember that a regular bath will be warmer possibly 105 or 106 degrees. It all depends on how long you can take the heat. �

Remember not to scald yourself with a bath that is way too hot to soak in, please. It�s ok to get the water running hot, but as it fills turn the heat down and let it cool slightly before stepping in. Most individuals don�t need more than 15 to 20 minutes of soaking time maximum.

As for how often one should take a hot bath, Dr. Jimenez explains that it depends on the severity of the back pain and what type of work and activities the individual does. For most three times a week offers a balanced therapy. If an individual has a strenuous physical job like construction work, manual lifting, standing work, or doing highly repetitive work then they�ll need to do more than 3 times a week.

Strengthen the Body’s Core

A strong core can support and protect the spine, along with the rest of the body. Squeezing and contracting the back, side, and front muscles make the core strong and robust. It behaves like a steel beam supporting the spine when added protection is needed.

11860 Vista Del Sol, Ste. 128 Hot Bath to Relax Back Tension, Soreness, and Pain

Stretch Out

After a hot bath is a perfect time to stretch. Toe touches can loosen tight hamstrings that can strain the lower back. Also, try out yoga’s upward-facing dog pose. Sun salutations can help the spine go through a wide range of motion. Therefore do them slowly and hold each pose for a few breaths. A long salutation or two can feel tremendous when the spine is nice and relaxed.

11860 Vista Del Sol, Ste. 128 Hot Bath to Relax Back Tension, Soreness, and Pain

Take Care When Getting Out

Hot baths might not be a good idea or the right option for certain people. If there is instability in your spine and the vertebra move around more than they are supposed to then a hot bath might not be the best option. Instead, a hot shower with a massage setting could be equivalent to taking a hot bath.

However, if a hot bath is not helping with back pain it could be a sign of something more than muscle tightness or a muscle spasm. A spine specialist or chiropractor can give you a proper diagnosis.

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