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.
Living with chronic back or neck pain can lead to depression, feelings of worry, nervousness, hopelessness, as well as other mental health-associated symptoms. Your pain medicine physician or your back specialist may refer you to a psychologist or psychiatrist. Referring you doesn�t mean your physician believes your pain is all in your mind! Rather, he/she is taking an optimistic step in treating you as a whole individual � by treating both the physical and psychological pain.
Chronic Neck &�Back�Pain Is Complicated
As someone living with chronic pain caused spondylosis, degenerative disc disease, spinal cord injury or some other back problem, you understand pain is a complicated issue, and treatment requires the expertise of a spine�specialist. Perhaps your pain management plan features a blend of treatments � medication for neuropathic pain, a periodic epidural spinal shot, a muscle relaxant, or physical therapy. Treatment of stress, nervousness, and depression (there are various types) needs the same level of expertise but from somebody who focuses on managing mental health problems.
Depression & Chronic Pain
Are you aware that depression and chronic pain often go together? Depression is a critical condition, and nothing to be embarrassed of. It has been reported that as many as 50% of individuals with chronic pain are depressed.1 So, if you are depressed, you’re far from being alone.
The signs and symptoms of depression can manifest themselves differently in each individual, but tiredness, sleep disruption, changes in eating habits, listlessness, and feelings of hopelessness are all quite common. Aches and pains are a very common symptom of depression notably, depression can lead directly to neck and long-term back pain.
Treating Depression & Pain
Two classes of antidepressants often used to treat depression in those that experience chronic pain are selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs). Generally prescribed SSRIs include and fluoxetine (Prozac) and sertraline (Zoloft), whereas usually prescribed SNRIs include duloxetine (Cymbalta) and venlafaxine (Effexor). These drugs have now been demonstrated to be effective and safe for handling depression in the context of continual pain, but like all medicines, they come with some risk of unwanted effects. As always, be sure to go over these drugs in detail together with your physician before beginning any treatment regimen that includes them, and inform your physician of all of the medicines (including over the counter medicines), herbal remedies, and nutritional supplements you’re currently taking so as to avoid any negative drug interactions.
Moreover, or in addition to medications, other types of treatment may include:
Talk therapy, more officially called cognitive behavioral therapy (CBT). The focus of CBT is to help the individual manage their situation and may include learning how to problem solve, thus engaging the individual to alter specific thought patterns to your more positive outlook, and conquering�fears.
Practice relaxation techniques such as meditation or breathing exercises.
Routine exercise might help curb feelings of worry, stress as well as depression. Exercise causes the entire body to release endorphins, which can cause you to feel much better and may reduce pain perception too.
Pain in the upper and/or mid back is not as common than lower back or neck pain. The upper back is called the thoracic spinal column, and it is the most secure part of the spine. The reach of movement in the upper back is limited because of the backbone�s attachments to the ribs (rib cage).
Upper back pain is generally caused by soft tissue injuries, like sprains or strains, muscle tension caused by bad posture, or looking downward for long time spans (eg, texting, mobile phone use).
Pain
Tightness
Stiffness
Muscle spasm
Tenderness to touch
Headache
What causes or leads to upper back pain?
An episode of upper back pain can be actuated by distinct moves and actions, including:
Twisting
Excessive bending
Whiplash or alternative neck injury
Lifting improperly
Poor muscle tone
Persistent movements, overuse
Contact sports
Carrying a load that is heavy
Smoking
Being overweight
Poor posture�working at the computer for�a long time without taking a break to walk around and extend, or in general can promote upper back pain. Both muscle fatigue and muscle pull, which often result from poor posture, can trigger the pain.
So what can I do about it?
Usually, upper back pain is not a cause for worry; however, it can be uncomfortable, painful, and inconvenient. Also, if pain develops suddenly and is serious�such as from an injury (eg, fall)�and, certainly if pain and symptoms (eg, weakness) progressively worsen you should seek medical attention.
Generally, the next home treatments can help relieve back pain that is upper.
Short term rest
Mild�Stretches
Over the counter medicine, for example ibuprofen, (Motrin�), naproxen sodium (Aleve�), or acetaminophen (Tylenol�). Take with food, and don’t take more than the recommended dose.
Use a cold pack that is commercially available or fill a plastic bag with ice and seal it wrap it. Apply to the painful area for 20 minutes every 2-3 hours for the first 2 to 3 days.
Heat (after the very first 72 hours). After using moist heat, gently stretch the muscles to enhance mobility and alleviate stiffness.
Your physician may prescribe drugs, like a muscle relaxant or perform trigger point injections to greatly help break up muscle spasms. He or she may also recommend physical therapy to increase flexibility, mobility and alleviate pain. Other treatments your doctor may suggest include acupuncture and chiropractic care.
Most cases of upper back pain resolve in 1 to 2 weeks without additional treatment. When you’re able to perform them without pain restart your regular activities slowly. Don�t rush matters, however: you could interfere with your healing and risk reinjury.
As always, abrupt or severe pain ought to be dealt with promptly.
Back pain may be common, but it is not normal. It is so common that half of all working Americans admit to having back pain symptoms each year. That means there are potentially 150,000 people who suffer from back pain in the city of St. Louis alone. Low back pain is the single leading cause of disability worldwide per the Global Burden of Disease 2010 and it is also one of the most common reasons for missed work. In fact, back pain is the second most common reason for visits to the doctor�s office, outnumbered only by upper-respiratory infections.
Imaging will show all my back problems
Imaging may not reveal everything. Back pain is often a complex and multi-factorial issue, meaning that a spinal diagnosis isn�t always straightforward. To uncover what�s causing your back pain and what�s necessary for recovery requires a full clinical diagnostic process. This typically requires three steps. First you need a review of your medical history. To get to the root of your back pain, your physician should spend time asking you a series of questions about your symptoms, history, activities, positions, treatments, and more. After that is explored you will need a physical examination. A competent physician should check your spine to determine function, strength, discomfort in certain positions, and more. Lastly, you will go through diagnostic testing. Only after a physician has reviewed your medical history and given you a physical examination is imaging appropriate. Everything from an X-ray to CT scans and MRI scans can be appropriate to assess certain conditions.
Back pain that comes and goes isn�t a problem
Our bodies are incredible at adapting. However, what we know is that in nature nothing stays the same.� When someone tells me that their problem comes and goes it concerns me because it due to something that they are doing or not doing that�s causing them to either notice the problem or not notice the problem. Either way the underlying problem is still there and needs to be corrected. When the pain comes and goes, it�s usually the lead up to your back �going out� without warning. The reality for many individuals is that back pain is a result of a cumulative effect from simple movements.�� There�s always a cause for back pain and seeing a physician is your best chance for appropriate diagnosis and recovery
In fact if you find yourself saying, �back pain runs in my family� or �I just learned to live with it,� those are concerning statements because it means that the current approach you�re taking to correct the problem isn�t working, and you should make a change in order to actually correct the problem.
Drugs and Surgery are the only way to correct your back pain
In 2013 The Journal of the American Medical Association suggested chiropractic care as an option for people suffering from low back pain and noted that surgery is usually not needed and should only be tried if other therapies fail. In fact, after an extensive study of all available care for low back problems, the federal Agency for Health Care Policy and Research recommended that low back pain sufferers choose the most conservative care first. They also recommended spinal manipulation as the only safe and effective, drugless form of initial professional treatment for acute low back problems in adults
�Back pain is a normal part of aging
While we see back pain in older populations we also see it in younger populations as well.� We are seeing more and more people starting to have more back pain and arthritis at younger ages.� There are even times where I hear patients ask if arthritis in their spine is normal at their age. Again this may be common, but it is not normal.� If it were normal it would likely be seen in the entire spine not just in specific segments of the spine.
Tips to Prevent Back Pain
�Maintain a healthy diet and weight.
�Remain active�under the supervision of your doctor of chiropractic.
�Avoid prolonged inactivity or bed rest.
�Warm up or stretch before exercising or physical activities, such as gardening.
�Maintain proper posture.
�Wear comfortable, low-heeled shoes.
�Sleep on a mattress of medium firmness to minimize any curve in your spine.
� Lift with your knees, keep the object close to your body, and do not twist when lifting.
�Quit smoking. Smoking impairs blood flow, resulting in oxygen & nutrient deprivation to spinal tissues.
�Work with your doctor of chiropractic to ensure that your
Dr. Vidan�is�a private practice Chiropractor in St. Louis. He�is very passionate about helping athletes from peewee�s to pro�s get back on the field after an injury and stay on the field. This allows athletes to enjoy the most out of their sporting experience. Dr. Vidan provided chiropractic care for the St. Louis Cardinals players and staff during the 2011 World Championship season, and continues to enjoy the opportunity to help athletes and organizations at the highest levels.
Many of us experience back and neck pain. But when is it the right time to see a chiropractor for a diagnosis or treatment? And can they really help? The answer is yes.
Chiropractors have been around for a hundred years, and are licensed doctors who are required to pass a series of four national board exams and are regulated by state licensing boards. They are medical professionals who diagnose and treat musculoskeletal and nervous system disorders.
A chiropractor can use many different techniques to relieve pain, including applied pressure, massage, and hands-on manipulation (adjustment) of the vertebrae and joints. They may also order X-rays, MRI studies, and lab work. Chiropractors don�t prescribe medications, but they do recommend such things as therapeutic and rehabilitative exercises and nutritional and lifestyle counseling to help the body heal itself.
Chiropractors believe one of the main causes of back or neck pain is subluxation. Subluxation occurs when your vertebrae become misaligned. Treating subluxations can help to alleviate pain associated with a myriad of conditions, including:
headaches
sciatica
trauma, such as whiplash
scoliosis
leg pain
sports injuries
bursitis and tendonitis
fibromyalgia
spinal arthritis (spondylosis)
Sometimes chiropractic care (eg, an adjustment) can cause mild soreness or aching but that usually resolves itself within 12 to 48 hours.
Chiropractic Tests
When you visit your chiropractor for the first time, he/she will probably ask you to perform a series of simple tests to evaluate your posture and range of motion. You may be asked to bend forward,� backward or side-to-side. The chiropractor will also check the way you walk and how your posture looks sitting down and standing up.� Other tests may include:
Piriformis Test: The patient flexes and bends the knee while lying down.
Straight Leg Raise: One leg at a time is raised in a locked-knee position to check the sciatic nerve and flexibility of the hamstring muscle.
Measuring the length of each leg helps determine if there is a discrepancy in leg length or if the pelvis is out of balance.
Hand strength (grip)
Evaluation of reflexes and muscle testing
Sometimes you might hear a pop while the chiropractor is testing or adjusting you, which is perfectly normal. This is caused by small pockets of air or bubbles in the fluid that surrounds your joints. When joint tissues are stretched, those pockets of air �pop,� which creates the cracking sound you hear.
Diagnosis
Once the chiropractor identifies the problem, he/she can recommend treatment options, and explain how many chiropractic visits are necessary to reach an expected outcome (eg, resolution of pain). He/she may also suggest improvements to your diet and lifestyle, such as quitting smoking or increasing/modifying certain activities. A chiropractor may also recommend certain types of exercises in conjunction with chiropractic treatment to stretch and/or strengthen the back and neck.
Adjustment Techniques
A chiropractor is educated in dozens of ways to treat pain. Here is a sampling of the different techniques that may be used.
Toggle Drop � The chiropractor presses down firmly on a particular area of the spine followed by a quick and precise thrust.
Lumbar Roll � With the patient on his/her side, a quick thrust is applied to the misaligned vertebrae.
Release Work � The chiropractor uses gentle pressure with the fingertips to separate the vertebrae.
TENS (Transcutaneous electrical stimulation) � This device sends stimulating pulses across the surface of the skin and nerve strands to block pain signals along the nerves and release endorphins which are natural painkillers.
Cold/Heat Treatment � Chiropractors may alternate between ice and heat therapy to treat back or neck pain. Ice packs are used to reduce inflammation (swelling) for 15 minutes at a time. A heating pad (or other heat source) helps increase circulation and may promote faster healing.
Table Adjustments � The patient lies on a special table with a �drop piece� then a quick thrust is applied when the table drops.
Instrument Adjustments � Instead of hands-on manipulation, the patient lies on the table face down while the chiropractor uses a spring-loaded activator instrument to perform the adjustment.
Manipulation Under Anesthesia � This is performed by chiropractors certified in this technique. The treatment is performed in a hospital outpatient setting.
Keep in mind that chiropractic care is not a cure-all for your back and neck pain! However, it is considered by many to be a safe and effective way to help relieve pain and improve spinal function. Many physicians and surgeons recommend chiropractic care to their patients.
If you want to reduce the number of opioid prescriptions and pills being used, and potentially misused, you need alternative pain management. And chiropractors say that�s what they�ve been providing for decades.
�It gives people options, and that�s probably the most important thing right now is to give people options for treatment,� Dr. Mark Stagnone, president of the New Hampshire Chiropractic Association said.
At its annual meeting, the association is pointing to a trio of recent studies showing that chiropractic care cuts down on the use of opiate pain medicines.
In one of the studies, a former Dartmouth doctor analyzed 33,000 cases of lower back pain in a New Hampshire database.
�His preliminary research is indicating that there�s about a 56-57 percent reduction in opioid use when chiropractic care has been utilized in a patients treatment,� Stagnone said.
James Vara, the governor�s adviser on addiction and behavorial health, said the state needs more alternative pain management.
�It becomes a question of what insurance covers it and how long they cover it for, and that�s certainly something I�ve looked at and will continue to,� said Vara.
The Current Insurance Model Puts Patients On A Path To Prescription Drugs
�The problem that it produces is that the average individual who�s trying to treat a condition is faced with paying a high co-pay to visit a chiropractor or paying a considerably lower one to see a primary care physician,� Stagnone said.
Changing that dynamic will require legislation that has failed in the past. But chiropractors said in this ongoing addiction crisis, it�s time for adjustment.
Chiropractic care is covered under the New Hampshire Health Protection program, or expanded Medicaid. And if the program lapses, so does that coverage.
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Painkillers Sometimes Increase Chronic Pain
We’re facing an opioid addiction crisis in America. Opioid (narcotic) pain medications killed an estimated 14,000 people in the U.S. in 2014 through overdose. A further 14,000 people overdosed on heroin, another opioid that many people turn to when they can’t access prescription painkillers.
This epidemic is why physicians and pharmacists are increasingly raising the bar on who can receive opioid medications, how much, and for how long. It’s not just the addiction risk that calls for caution when using opioids to treat chronic pain though�long-term use of opioids can actually make pain worse.
Becoming addicted to pain medication is a disease. This is because these painkillers (oxycodone, hydrocodone, methadone, fentanyl) cause a change in your brain chemistry that is not under your control.
Most people who take opioids for more than 2 to 4 weeks will develop a tolerance to the medication. Tolerance means your body may need an increased dosage to feel the same effect. Opioid tolerance can cause withdrawal symptoms when the medication is stopped. This is a natural process, and it is not to be confused with addiction.
In his recent blog on the subject, Dr. Ullrich explains: “Pain medication addiction is a more complicated process. It involves manipulative behavior to obtain narcotic medications and a refusal to discontinue a medication even though it is no longer being used for a medical purpose. Some, including those at significant risk of overdosing, will go to multiple doctors to get medications.”
For those who are addicted to opioid medications, a detoxification program is often needed. Painkiller addiction is a chemical, physical disease, one that requires expert medical treatment in a safe, humane environment.
Most people know that painkillers can be addictive, but they don’t know that taking opioids over a long period of time may in fact increase a patient’s sensitivity to pain (hyperalgesia). This happens because long-term use of opiate painkillers causes a decrease in your ability to tolerate pain and an increase in sensitivity to pain. In fact, people taking opioids long term may keep having pain, or may see their pain increase, long after the original cause of pain has healed.
Stopping opioid use can solve this problem�but it may not seem as if the pain is gone at first, because the discomfort of withdrawal can mimic the original pain. Dependency is not easy to deal with, but it shouldn’t be an excuse to stay on the opioid medication and raise the risk for addiction. This is why physicians are encouraged to only prescribe opioids for short durations and be cautious when using them to treat chronic pain.
Since long-term use of opioid painkillers is a risky option for controlling chronic pain, patients are often advised to focus on other safe, proven methods for managing chronic pain, such as:
Exercise to maintain motion and release endorphins
Cognitive therapy to develop coping techniques
Relaxation and meditation techniques to distract the brain from pain
Six Things Every Chiropractor Should Know About Opioids
Men health concept. Portrait of 50s mature Asian man reading the label on bottle medicine, sitting on sofa at home.
An increase in addictions and deaths due to opioids has raised significant concern and media attention. We offer this brief overview on this important public health problem for the practicing chiropractor.
1. What Are Opioids?
Opioid medications are prescribed to reduce pain; however, they are addictive and can be dangerous. Although some suggest there is �no safe dose� for opioids, these drugs may be helpful for people with severe pain, such as those experiencing pain from cancer. However, over the past several decades, more patients have been prescribed opioids for musculoskeletal pain, such as back or neck pain, instead of being provided with nondrug therapies.
As with any drug, opioids have side effects and may �adversely affect respiratory, gastrointestinal, musculoskeletal, cardiovascular, immune, endocrine, and central nervous systems.�1 �As the dose increases, the risks for overdose and health concerns also increase, including �fractures, addiction, intestinal blockages, and sedation.�1 If too high a dose is consumed or if opioids are taken with certain other drugs or alcohol, death may result.
2. Why Is Opioid Use / Overuse Problematic?
Since 1999, prescription opioid sales have increased fourfold, along with a surge in the use of opioids as a first line for pain management, rather than only for severe cancer-related pain. This trend has led to burgeoning opioid prescribing in the U.S.:2
? One in five people with non-cancer pain have been prescribed opioids.
? More than 165,000 prescription opioid-related deaths occurred between 1999 and 2014.
? An estimated 2 million people were addicted to opioids as of 2014.
3. Who Is Addressing This Health Crisis?
Currently, many professions are seeking ways to address this national epidemic. The medical profession has launched various initiatives to help medical doctors (MDs) reduce prescriptions. These include an initiative to remove pain as the 5th�vital sign, and promoting guidelines for when to prescribe and how to better manage patients in pain without the use of opioids.
The Centers for Disease Control and Prevention (CDC) has�released guidelines�to curb opioid prescriptions, with the following categories of recommendations to those who prescribe opioids: 1) determine when to initiate or continue opioids for chronic pain; 2) opioid selection, dosage, duration, follow-up, discontinuation, and assessing risk; and 3) addressing harms of opioid use.
In addition to these efforts, even more focus is needed to assist people who seek help for pain and to provide them with nonpharmacological alternatives.
4. What Can Doctors of Chiropractic Do?
Chiropractic care can be part of the solution. DCs can work with other health care providers and support policy to offer alternatives to opioids for addressing patients in pain, especially chronic non-cancer pain.
Although there are no large trials comparing outcomes of chiropractic care to opioids, we do know opioid use is associated with worse functioning in back pain patients at six-month follow-up3 �and greater disability;4 �and that injured workers whose first health care visit is to a DC have better outcomes.5 �We also know that the per-capita supply of DCs and higher use of manipulative therapy is associated with lower rates of opioid prescriptions among Medicare recipients.6
All this suggests chiropractic care may help reduce the use of and need for opioid prescriptions for back pain sufferers; and may play an important role in reducing the opioid epidemic by helping to prevent patients from ever getting an opioid prescription in the first place.
Important resources DCs should be aware of include:
? Chiropractic: A Safer Strategy Than Opioids:�www.f4cp. com/f4cp_opioid_white_paper.pdf
? Centers for Disease Control and Prevention (CDC): Opioid Overdose:�www.cdc.gov/drugoverdose/ Six Things Every Chiropractor Should Know About Opioids By Claire Johnson, DC, MSEd, PhD, Bart N. Green, DC, MSEd, PhD and Michael Haneline, DC, MPH Reprinted with permission from Dynamic Chiropractic, Sept. 1, 2016, Vol. 34, Issue 15 (www.dynamicchiropractic.com/digital/index.php?i=1220&r=t#19)
5. What Can We Do If a Patient Is Already Taking Opioids?
Most chiropractors take a history and ask patients what medications they are taking. The first step is to recognize that the following are opioid-class drugs: hydrocodone (Vicodin), ultram (Tramadol), oxycodone (OxyContin, Percocet), morphine (Kadian, Avinza) and codeine.7
Once we know a patient is taking opioids, we must first seek to understand the situation before we provide education.
Questions we can ask include:
? For what condition is the patient taking the medication?
? How long has the patient been taking opioids and at what daily dose?
? Who is the provider watching over their prescription? Is more than one provider prescribing opioids?
? When was the last time the patient saw the prescribing physician and when is the next appointment?
? Does the patient have any safety issues? For example, does the patient operate machinery? Is the patient experiencing side effects such as �sedation, dizziness, nausea, vomiting, constipation, physical dependence, tolerance, or respiratory depression�?8
? What is the patient�s level of function? Are there any psychological flags or addictive behaviors?
? Is the patient taking any other substances or drugs that may have deadly interactions, such as alcohol, benzodiazepines and/or other opioids?
As chiropractors, we can discuss treatment goals, such as reasonable functional activity; and pain goals with and without medication. We also can discuss potential adverse events, including the risks for side effects, addiction and death.
We can inform patients of other dangers they may not be aware of, such as the deadly combination of opioids when combined with other drugs that depress CNS activity (e.g., alcohol or drugs for anxiety such as benzodiazepines). We can encourage patients to contact the prescribing provider to discuss reducing and stopping opioid use, and to ask for safer alternatives for pain control, such as chiropractic care, physical therapy, acupuncture and mind-body methods. If a patient is already addicted, we can encourage the patient to seek a specialist provider and addiction care program. (Note that some patients may need to remain on opioids, such as for cancer pain or end-of-life care.)
Most importantly, we can work with the patient and their prescribing provider to offer them nonpharmacological care to help reduce their pain and help them reach their functional goals.
6. How Can We Collaborate More on Solutions?
As DCs, we can work more closely with local MDs and discuss better ways to collaborate concerning patients with pain. Remember that MDs are not the enemy, but are an essential component of the solution to this epidemic. Most MDs are also extremely concerned about the opioid epidemic, and are looking for efficient and cost-effective ways of helping their patients. We should remain professional when speaking about MDs with our patients, as our patients likely have good relations with them.
We can be part of the safety net to help reduce the number of people who become addicted or die from overdose. As we work with other health care professionals and our patients, we can remind them that the first recommendation per the CDC�s�Guideline for Prescribing Opioids for Chronic Pain�is �Nonpharmacologic therapy and nonopioid pharmacologic therapy are preferred for chronic pain.�9 �Thus, through collaboration, the chiropractic profession can be a part of the solution.
The bipedal posture of humans carries many benefits for us, but alternatively, this standing posture also adds pressure on the spine as well as other bones and surrounding muscles of the body. Together with an individual�s improper sitting position and the natural wear and tear degeneration of tissues through age, it�s not uncommon for individual�s to develop symptoms of back pain. In fact, back pain is considered to be the second most common cause people seek medical attention, only next to upper-respiratory infections. According to some experts, as many as 80% of individuals may experience back complications at some point in their lives.
Although back pain and its associated symptoms is common among the population, treating your injury or condition is crucial for individuals to achieve a healthy lifestyle. Chiropractic care focuses on the structure and function of the human body, primarily that of the spine. A chiropractor can diagnose a possible injury or condition causing back complications and determine the most appropriate treatment for each individual using spinal adjustments, manual manipulation and occasionally, recommending exercise and dietary lifestyle changes to improve a person�s wellbeing. Chiropractic adjustments can be an effective treatment for back pain as well as other types of pain.
Additionally, before relying on chiropractic care for diagnosing and treating a back complication, the common injuries or conditions relating to back pain can be prevented in a variety of ways such as,�maintaining a healthy diet and weight are important towards preventing back pain,�avoiding prolonged inactivity or bed rest, staying active, warming up or stretching before exercising or participating in other physical activities to avoid further injuries, maintaining a proper posture, wearing comfortable, low-heeled shoes, and sleeping on a mattress of medium firmness to minimize any curve in the spine.
Many people frequently experience back complications resulting from their everyday life routines. Back injuries can range from a sharp pain to a dull ache, typically associated with symptoms of tingling, numbness, and/or burning sensations.�While a majority of back complications can be considered minor injuries that usually heal rapidly, some complications can often develop into chronic back pain and chiropractic treatment can help. For more information, please feel free to ask Dr. Jimenez or contact us at (915) 850-0900.
Dr. Eric Goodman is the creator of Foundation Training, a highly effective protocol. Foundation Training focuses on body weight exercises that integrate as many muscles as possible to strengthen and elongate your core and posterior chain � which includes all the muscles that connect to your pelvis, whether above or below it � thereby alleviating many chronic pain issues.
The protocol has evolved over the years, and I�ve interviewed Goodman twice before, in 2013 and the most recent two years ago in 2014, covering various updates.
Goodman, who is trained as a chiropractor, is a pioneer in the world of structural biomechanics. His program teaches you to optimize your posture, thereby decreasing bodily pain and your risk of exercise injury.
�The idea is really simple. Our body is made to help itself. As long as we can get the muscles to align it properly, our breathing patterns to align properly, our pelvic muscles to be more stabilized, our posture will involuntarily become stronger,� he explains.
�My education is in chiropractic. I�m licensed in Colorado and California, but I only really see patients if they need an adjustment for some reason that they can�t do the poses.�
Why Foundation Training?
While in chiropractic school, Goodman developed severe low back pain. His doctors suggested surgery, which he wisely rejected. Instead, his own pain set him on the path of discovering a long-term solution, which ultimately resulted in Foundation Training.
�My passive care was good. I was getting chiropractic care. I was being stretched. I was being massaged and worked on. But I wasn�t strengthening my spine myself. That�s the difference that I made,� he explains.
�I don�t think that I will ever negate chiropractic, because I love chiropractic. I love the ability and capacity to align the body, align the nervous system and create a very good environment for different process to occur.
[But] if you�re going to get your neck adjusted, I want your neck to stay long and strong afterwards, because that�s what�s going to stop you from having that same adjustment again a week later.�
While obsessively studying anatomy, alignment and exercise in an effort to resolve his back pain, Goodman began to notice that he, and many other people who were in pain, could not move the way the body was designed to move, and this was causing a degenerative effect � and those who were moving properly were able to regenerate and increase strength, while reducing injury and pain.
�I was in chiropractic school. I really understood the body well. I decided that this is going to become an obsession. I�m going to figure this out. I can�t become a doctor, have patients come to me that are asking for my advice on an injury that I have that I can�t fix. It�s not OK.
So, over the course of about four years, I did that. I became very obsessed. I used my anatomy knowledge. I used my understanding of exercise.
I was a personal trainer actually long before a chiropractor. Foundation Training is what I came up with. It�s what I do for myself every single day, and it�s what I�ve been extraordinarily fortunate to teach to thousands of people at this point.�
The secret to Foundation Training lies in its simplicity: no gyms, no specialized equipment and no complicated stretches. By incorporating a series of powerful movements into your daily routine, you can move better, breathe better and get back to using your body the way nature intended.
Addressing Back Pain
Low back pain is a very common problem, and the most common reason why people seek out Foundation Training. In the video below, Goodman demonstrates a back extension exercise that is particularly helpful for back pain relief.
The premise is simple. By strengthening the muscles in your back, they will keep your spine properly braced through all the movements you do as you go about your day-to-day life.
Overall, about 7 out of 10 people who learn Foundation Training do so to address back pain, 2 out of 10 seek to improve their sports performance and the remaining 10 percent typically seek to address knee pain, neck pain, jaw pain, plantar fasciitis, carpal tunnel and other chronic pain.
How to Get Started With Foundation Training
In addition to their latest book, �True to Form,� Foundation Training offers a variety of ways to get the benefits of their system, including their free videos on their website at www.FoundationTraining.com.
Foundation Training also offers certification for clinicians, practitioners, trainers and instructors who are looking to share this groundbreaking and highly effective protocol with their clients and patients.
�There are probably more people using our free videos to get well than using our DVDs and books,� he says. �That�s awesome. That�s why we have free videos.
Our latest book, �True to Form,� is our illustrative process of bringing Foundation Training into your everyday activities � brushing your teeth, waking up from bed, reaching into the refrigerator, whatever, how to apply very simple movement patterns that make you stronger while you do that.
Then if you want to really get into it, we have DVDs and we have a new streaming website. If you�re really into it � come to our workshop or certification. If you come to our workshop and you decide you want to go through a certification, we take the amount of money you paid on the workshop, 100 percent of it, off the cost of the certification.�
While millions of people have gotten started through the free Foundation Training videos, the optimal way to get the most out of Foundation Training is the comprehensive step-by-step program offered on their website or a certified Foundation Training instructor.
The Importance of Posture for Ease of Movement and Health
As noted by Goodman, �Posture is a beautiful thing, except when it�s messed up.� Indeed, while I see many people walking the beach during my daily walks, poor posture is the norm, with hunching being one of the most prevalent posture problems. Indeed, �standing tall� is so basic yet most have forgotten how to do it. When you stand tall, your muscles actually work more effectively.
�We naturally adapt towards our chosen method of absorbing gravity � �Our muscles absorb force � Whether they�re contracting or expanding, they are absorbing or providing force. If you take the opportunity of gravity � this ever-present weight of your own body � and simply provide 5 percent more energy in absorbing it, 5 percent more conscious effort throughout the day, it�s going to change your life forever. It�s going to have people reacting to you differently. It�s going to have you reacting to things like anxiety differently. You�re going to feel the difference of a closed airway and an open airway.
You�re going to feel the tightness of your jaw from the head traveling to forward, contracting the back of your neck when you�re in a bad posture � You start interacting with people like a confident human being interacts.�
Patience and Practice
Most people have poor posture these days. Besides chronic peering down on your smartphone or tablet and excessive sitting, which encourages poor posture unless you�re paying careful and active attention to your body at all times, we�ve also been taught certain posture strategies that actually worsen posture rather than improve it.
Pulling your shoulders back to straighten your posture is one example. As noted by Goodman, this is a �compartmentalized correction� at a place that�s not actually causing the problem. More than anything else, the places that cause the problems in posture are the upper and lower ends of your spine.
A very basic explanation is that your upper and lower spine should be pulling away from each other, not compressing or falling toward each other. So the back and top of your head needs to be pulling away from your tailbone, straight up and neither forward nor backward.
As for how long it might take to correct your posture, it clearly depends on your individual and specific circumstances: how long you�ve had poor posture, how much time you dedicate to corrective exercises and the extent of your postural problems.
�It may be a matter of weeks to months. I believe for some people it may be a year [to complete] the whole process. [But] they�re going to be feeling better along the way. They�re going to notice incremental changes. They�re going to see that their body is supporting itself better steadily. They�re thinking about it less. They�re feeling less pain. They�re feeling better posture. That�s when the real changes start to happen. But there�s no set timeline.�
Walking 101
Walking is foundational for optimal health, and walking with good posture can really maximize your benefits. Your choice of footwear can have a significant influence here. When walking in sneakers or heels, your heel is raised higher than your toes. This in turn makes your arch tighter, which completely alters your range of motion. So, to start, walk barefoot or find a pair of zero-drop shoes.
The rationale behind walking barefoot has to do with plantar flexion, the shortening of the muscles on the back of your ankle and the lengthening of the muscles at the front of your ankle and shin. When walking barefoot, you alter the way the back of your body absorbs force for the better.
Dorsiflexing is a tremendously important piece of walking. This is where you�re lifting the top of your foot toward your shin. When you�re walking with plantar flexion (due to wearing heels), you rarely dorsiflex, thereby contracting and shortening the muscles of your shin.
�That�s Step 1, making sure that there is good dorsiflexion in every step,� Goodman says. �Literally lift the top toes away from the ground. Lift the balls of the feet away from the ground and try to spread your feet a little bit. That will allow your hips to follow a much more natural range of motion. As your feet dorsiflex, it triggers these muscles of the inside and outside of your legs.
Those muscles have internal rotation capacity and external rotation capacity. Both of which are very important for walking � The ability of the adductors, the medial hamstring, the muscles of the inner part of the thigh, the inner upper part of the thigh, to contract during a walk, to spin that hip a little bit more neutral towards straight ahead �
Long story short, range of motion of the hips is so significant to walking. That range of motion is limited most frequently in people at the feet with plantar flexion, excessive plantar flexion or excessive external rotation.�
Head Posture While Walking
The other piece of the puzzle is the location of your head. Most people walk as if they�re sniffing their way forward, head leading the rest of the body. A more natural posture is to lift your chest upward, which allows your shoulders to lift and your chin to retract more or less automatically. So think: �Chest up, chin back.� Initially, this may feel and even look a bit awkward, but you�ll notice it�s a significantly more powerful way to walk, allowing you to engage more muscles.
�If you simply focus on chin back, chest up, shoulders big, broad, not backing down but out � if you focus on that � you�re going to be walking very different. You�re going to experience this really rhythmic counterbalance in your walk. When the right foot comes forward, the shoulder comes forward on the opposite side.
It�s just these nice little muscular glutes, hamstrings, calves, adductors across the body to the opposite shoulder and pec � So many muscles involved. It�s the SCMs that are very important as well to keep that chin back, chest up function happen.�
Preventing iPhone Neck and Dowager�s Hump
The chest up, chin back posture will not only make you look better, but proper posture may also help prevent osteoporosis and significantly reduce your risk of developing a dowager�s hump, which tends to be quite common among the elderly, and women in particular.
This forward slumped posture tends to be related to chronic improper posturing that worsens over time, eventually leading to the development of rigid intractable calcifications. The beginning of the progression of the dowager�s hump is typically the loss of thoracic extension.
�I think the lack of movement and stagnation in bone leads to calcification and typical degenerative changes. Degenerative changes along with spine make it less mobile � It supports it because the muscles aren�t, the discs aren�t. It puts very rigid support structures in place.
Now, can you imagine 20, 50 years from now, when it�s 60 or 70 years after cellphones and iPads came around, the dowager�s humps, we can start calling them the iPad hump � The younger you are, the more capacity you have to be plastic, to engage your body�s natural tendency to respond to stimulus in such a fashion that will get better and better at doing the thing you�re asking it to do.
If you�re often asking it to look down at your phone, please often ask it to lift your chest up, to pull your chin back and to just stand very firm on the ground. Just look at your phone while keeping your chin back and chest up.�
According to Goodman, even if you�ve already started to develop a slight hump, chances are you�ll be able to significantly improve your alignment provided your spine has not yet calcified. Exceptions might be if you have ankylosing spondylitis (AS) or diffuse idiopathic skeletal hyperostosis (DISH). Naturally, the younger you are, the more room for improvement there is.
One important aspect of Foundation Training is what Goodman refers to as compression breathing. With his breathing protocol, you literally re-educate the muscles surrounding your axial skeleton, the spine of your rib cage, teaching them to be in a state of expansion rather than contraction. You�ll find a demonstration of this technique in the video above, followed by another founder exercise.
�[This breathing technique] is something that�s always going to set our work aside from everything else. Not better. Not worse. Different. It�s an accessory,� Goodman says.
�Decompression breathing, which can be taken and applied to any movement, any exercise, any activity � will do more for your spine, more for your chest and neck, more for your dowager�s hump � than anything else I can possibly teach you. The unique thing about it is our specific protocol of learning how to engage the diaphragm more appropriately by drastically strengthening the muscles that surround the rib cage.�
Here�s a quick summary of the compression breathing exercise demonstrated above:
Position your feet so that the OUTSIDE of your feet are parallel. This will make it appear as though you�re standing slightly pigeon-toed
Pull your chin back and lift your chest
Place your thumbs at the bottom of your rib cage, and your pinkies on your pelvic bone
With each breath, your aim is to increase the distance between your thumb and pinky fingers, as well as increase the width of your upper back. This occurs as you elongate the back of your rib cage. Each inhalation expands your rib cage, and each exhalation will keep the abdomen extended and tight. So each in-breath fills up your rib cage, and each out-breath maintains the height and width of your rib cage
Repeat five to 10 rounds with three to four breaths per round
More Information
You have many options when it comes to learning Foundation Training. You can start by reading through or listening to my previous interviews with Goodman, �How Foundation Training Can Help You Maximize Strength and Freedom of Movement� and �New and Revised Foundation Training Exercises Add Even Greater Health Benefits.�
For free video demonstrations and tutorials, be sure to check out FoundationTraining.com and the free videos they have available at their site. For even more in-depth information, pick up Goodman�s latest book, �True to Form: How to Use Foundation Training for Sustained Pain Relief and Everyday Fitness.� Join Foundation Training Connect or check out their free resources at FoundationTraining.com/free-resources.
Just remember, the key is to actually DO the exercises. Just reading about them or watching a video will do you no good. The good news is, even if you�re wheel-chair bound, you can perform the compression breathing exercises, which will, at bare minimum, help you breathe better.
�I have a friend that is [in a wheelchair] and we do some of those workouts. He�s a very good guy from Oklahoma City, but had a very tragic accident. I really hope I get to spend some more time with that guy and see what we can do just based on breathing,� Goodman says.
Foundation Training is a�program that teaches you to optimize your posture. By getting the muscles, breathing patterns, and pelvic muscles to be aligned properly and more stabilized, our posture will involuntarily become stronger,� decreasing bodily pain and risk of injury.
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Head Posture While Walking
