Back Clinic Chiropractic. This is a form of alternative treatment that focuses on the diagnosis and treatment of various musculoskeletal injuries and conditions, especially those associated with the spine. Dr. Alex Jimenez discusses how spinal adjustments and manual manipulations regularly can greatly help both improve and eliminate many symptoms that could be causing discomfort to the individual. Chiropractors believe among the main reasons for pain and disease are the vertebrae’s misalignment in the spinal column (this is known as a chiropractic subluxation).
Through the usage of manual detection (or palpation), carefully applied pressure, massage, and manual manipulation of the vertebrae and joints (called adjustments), chiropractors can alleviate pressure and irritation on the nerves, restore joint mobility, and help return the body’s homeostasis. From subluxations, or spinal misalignments, to sciatica, a set of symptoms along the sciatic nerve caused by nerve impingement, chiropractic care can gradually restore the individual’s natural state of being. Dr. Jimenez compiles a group of concepts on chiropractic to best educate individuals on the variety of injuries and conditions affecting the human body.
Minimally invasive spine surgery known as M.I.S.S is an option to traditional open surgical procedures, as well as an alternative when non-surgical approaches are working but the pain or condition is becoming worse, regardless. These are performed to treat a variety of spinal disorders like:
Bone spurs
Degenerative disc disease
Herniated disc
Scoliosis
Spinal instability
Spinal stenosis
Spinal tumors
Minimally invasive surgery can offer potential benefits. These include
A small/tiny incision/s
Minimal cutting through soft tissues like ligaments, and muscles
Outpatient option/s
Reduced post-operative pain
Quicker recovery
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The Focus of Spine Surgery
There are two main goals when it comes to spine surgery or rather the goal/focus of the surgery. These are decompressing and stabilizing the spine.
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Decompression of the spine
Spinal decompression involves removing any tissue/s that are compressing/pinching the nerve structures like a spinal nerve root or the spinal cord itself. Bone spurs and fragments from a herniated disc are the types of tissue/s that can cause neural compression.
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Stabilization of the spine
An abnormal movement of one or more levels/segments of the spinal cord can cause back pain, neck pain, or both. Surgeries that are meant to stabilize and stop these abnormal movements utilize spine instrumentation combined with fusion.
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Spine Surgery Techniques
Minimally invasive spine surgery techniques include:
Rather than cutting through soft tissues, a tubular retraction instrument generates a tunnel that expands and passes between the muscle/s to access the spine’s column. Then an endoscope or a tiny video camera goes in and around the area, projecting a visualization of what’s happening on a monitor during the procedure.
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This is the surgeon’s/team’s eyes as they work to repair the damage. The surgery is run through the tubular retraction system along with any specially designed instruments that are needed. Types of surgical procedures performed with minimally invasive surgery include:
Discectomy
Microdiscectomy
Foraminotomy
Microforaminotomy
Microlaminectomy
Microlaminotomy
The micro means that the surgery is done using a special microscopic camera to view the disc/s and nerve/s. Imaging scans, systems, and image-guidance technologies, like fluoroscopy, which is a real-time x-ray are utilized during the surgery pinpointing the key aspects of the patient�s spinal anatomy. The surgical imaging shows 2D and 3D views, which guides the placement of any instrumentation, like pedicle screws.
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Disorders Treated with Minimally Invasive Surgery
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Degenerative disc disease
Degenerative disc disease is known as DDD often develops progressively in older adults and affects the intervertebral discs. The normal wear and tear of cellular age-related changes in the body can cause the spine’s discs to:
Stiffen
Lose Flexibility
Loss of Strength
Loss of Height
Lose shape, along with the ability to absorb/distribute the forces associated with moving
These structural changes increase the risk of disc herniation and subluxations.
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Herniated discs
A herniated disc also called a slipped, bulging, and ruptured disc. This happens when the soft gel cushion of a disc breaks through the protective outer layer. Other than the damaged disc, the loose interior gel can also irritate and inflame the nerves causing back pain. �
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Scoliosis
Scoliosis is an abnormal sideways curve of the spine that can cause progressive spinal deformity. A scoliotic curve can look like an �S� or �C.� Most cases have no known cause, and while the condition is more commonly associated with children, adults can develop scoliosis, as well.
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Spinal stenosis
Spinal stenosis happens when the spinal nerve roots and the spinal cord become compressed/pinched. These nerves branch off the spinal cord and exit the spinal canal through passageways called neuroforamen. Nerve and spinal cord compression can cause symptoms like:
Pain
Weakness
Tingling sensations
Numbness
Sometimes, pain can travel into the arms or legs
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Spine Surgery Risks
With any spine surgery there are potential risks and complications that can occur. Here are some possible complications that can happen during and after surgery, with both open and minimally invasive procedures.
Minimally invasive spine surgery does offer many benefits:
Tiny incision
Less pain
Reduced risk
Faster recovery
Let’s not forget that M.I.S.S is still surgery. Less than 5% of people with back or neck pain need spine surgery and, surgery is the last resort for treating pain and symptoms caused by a spinal condition/disorder.
It is only when non-surgical treatments like chiropractic, acupuncture, physical therapy, medication, or spinal injections do not reduce symptoms in 3 to 6 months. This is when you qualify to be a candidate for spine surgery. There are certain types of spinal disorders that require urgent or immediate surgical intervention.
Talk with your doctor, chiropractor, or spine specialist about the pain, the symptoms, and compare the results of the different therapies/treatments and go from there. With any type of surgery there are many considerations to discuss before making a decision to treat back or neck pain and if minimally invasive surgery could be an option.
Staying at home means it can be tough to see a doctor, chiropractor, spine specialist, or neurosurgeon to handle back pain, especially when it tends to flare up at the most inconvenient times. There are still options, here�s what to do. What options are available when you want to see a doctor about back pain, but getting to the clinic can be a challenge.
Fortunately, there are a variety of tools to handle back pain that can provide some relief.
Over-the-counter pain medications like Motrin are one of the best medicines for non-traumatic back pain inflammation.
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Heat Packs/Heat Therapy
Heat therapy promotes vasodilation and draws nutrient-rich blood into the targeted tissues. Increased blood flow delivers oxygen and nutrients and cell waste is removed. The warmth decreases muscle spasms, relaxes tense muscles, relieves pain, and increases range of motion.
Superficial heat is available in different forms, which include:
Hot and moist compresses
Dry or moist heating pads
Hydrotherapy
Commercial chemical/gel packs
Remember heat packs in any form should be wrapped in a towel to prevent burns, as a punctured heat pack should be discarded, as the chemical agent/gel can burn skin. �
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Cold Packs/Cold Therapy
Cold therapy produces vasoconstriction. This slows blood circulation, which reduces inflammation, muscle spasms, and pain. Superficial cold is also available in different forms, which include:
Commercial cold packs
Ice cubes
Iced towels/compresses
Hydrotherapy.
The application of cold therapy is usually less than 15 minutes, as the effects of cold are known to last longer than heat. Cold packs or ice should never be applied directly to the skin.
A towel, should be placed between the cold object and the skin surface to prevent any skin and nerve damage. A punctured cold pack should be discarded, as the chemical agent/gel will also burn the skin.
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Telemedicine
It might be hard to believe that a virtual video visit can work to handle back pain. On a video call, a chiropractor is unable to physically palpate the sore areas and measure the range of motion and strength. However, this should not discourage you from scheduling a virtual appointment.
Telemedicine, without a physical examination, can be highly beneficial. A chiropractor can start the process of ordering tests, like MRI, X-ray, etc. Even if the pain is tolerable, meaning the kind that doesn�t need medicine or imaging tests, this should not be an excuse to skip an orthopedic visit.
With telemedicine, a chiropractor can still give advice, show back stretches, exercises, order back pain supplements, and talk about the risks and benefits of treatments available to try on your own. �
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Physical Therapy
With chronic low back pain, chances are your chiropractor suggested physical therapy or PT. Now is the time to bring back those PT exercises, especially with a back-pain flare-up.
Low-back pain or any back pain for that matter with no neurological issues, could mean that a stretching and exercise program is all that is needed. Find out if your chiropractor or a physical therapist offers other options:
Patient portal communication or e-visits.
Uploads of illustrated handouts describing how to do various stretches and exercises.
Remote evaluation. The individual submits pictures or a video of their movements for personalized feedback, which the chiropractor or physical therapist evaluates and provides.
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Get Active
Evidence shows that being active is better than resting. Moving increases the blood flow to the muscles, which helps with muscle spasms, trigger points, tense muscles/ligaments, and other issues.
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Pilates
Pilates focuses on controlled movement, breathing, and stretching. A review found Pilates can be a highly effective and beneficial approach to handle back pain and related discomfort. Check out beginner Pilates videos. Be sure to avoid any move/s that cause pain, worsens the existing pain, or generate new pain.
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Yoga
A review found that yoga can help improve mobility and decrease pain. If this is a new practice, start with gentle yoga or restorative yoga.
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Walking
Going for a walk is easy, accessible, and is beneficial for the spine. Walking can be as effective as non-drug interventions in decreasing pain and discomfort in chronic low-back pain. Simple movements along with rollers and massagers can handle back pain as well. These include:
Self-massage with a tennis ball
Foam rolling
Hand-held massager
Stretching
McKenzie Method, comprised of gentle stretching exercises
These strategies and approaches can become the methods and techniques for the relief of existing back-pain in the absence of a doctor, chiropractor, or physical therapist.
Back spasms can be compared to a Charley horse in the back. These are a common complaint in doctors’ clinics throughout the country. Spasms can accompany back pain and neck pain, they can be the result of a traumatic event, like a slip and fall accident or an automobile accident. Here is why they occur and what to do about them. �
Back Spasms
A back spasm is an involuntary and sustained contraction of one or more muscles of the spine. Spasms can occur without pain when the muscle/s shift, and pulse. But it’s when pain accompanies the spasm that it can become an issue that can lead to a chronic condition.
Example: Runners get the feeling of having a Charley horse in the calf muscle. Having a back spasm is the same. Spinal muscle spasms could be an indication of something serious, like a micro tear around a spinal disc that can generate inflammation to cause the muscles to tense up.
However, with most cases, a back muscle spasm is a symptom of a mild muscle injury, like a sprain. It can be hard to diagnose the pathology of a muscle spasm. One theory is that if there is a noxious stimulus coursing through the body, specifically the back, it can disrupt/disturb the muscles. When this happens the muscles brace/bunch up together to protect the spine. Here’s are five muscle spasm types that can cause back and neck pain.
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Cervical Spine
If there is a spasm in the neck, it’s more than likely a contraction of the trapezius muscle. This is the muscle group that runs down the neck into the middle or thoracic spine/back.
Back spasms in the cervical spine could indicate a contraction of the sternocleidomastoid. This is located at the base of the skull on both sides of the head. When these muscles spasm, the pain is usually localized or in one area that leads to muscle irritation. However, if the spasm is a symptom of underlying inflammation or nerve irritation, then the pain could radiate and spread down.
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Thoracic Spine
The trapezius starts at the neck to the last vertebra of the thoracic spine or the middle-back. Therefore, a back spasm can affect the neck as well as the middle of the back as well. Spasms in the midback can also result from a contraction of the rhomboid muscle. These connect the shoulder blades to the rib cage and spine.
Because there is less movement in the middle-back, the muscles in this area are less likely to spasm, compared to the cervical/neck area and the lumbar/low area.
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Lumbar Spine
Spasms in the lower back occur from a contraction of the erector spinae muscles. These are the large group of stabilizing muscles that are on either side of the spine or the latissimus dorsi. These muscles are commonly referred to as lats. They are one of the largest muscle groups in the body and cover the middle and lower back.
Relieving Spasms
Treatment for muscle spasms depends on how the injury originated. A full medical history is crucial for a doctor, spine specialist, or chiropractor to be able to look at all the angles in determining and diagnosing the root cause.
It could be from just leaning over and picking up a box to sleeping in an improper/uncomfortable position. This type of pain is less concerning as it is more than likely a sprain or strain, and can be treated rather quickly.
However, if the spasms started after being involved in an automobile accident or falling pretty hard, then there could be serious damage to the area. Back spasms that occur after these types of situations require an immediate full neurologic and muscular examination. This along with advanced imaging, like an MRI.
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Specialists
A spine specialist or chiropractor wants to make sure they’re not missing any underlying injuries or instabilities of the spine that would require extensive and possible invasive treatment. Red flag situations include osteoporosis, which is the loss of bone mass or ankylosing spondylitis, which is a form of arthritis that mainly affects the spine.
Osteoporosis can cause an underlying compression fracture.
Ankylosing spondylitis can cause parts of the spine to fuse together.
Both underlying conditions can cause muscle spasms. However, conservative treatment for most cases is all that is usually needed to relieve muscle spasms of the spine. These include:
Anti-inflammation medications and creams
Chiropractic manipulation to improve spinal muscles range of motion
Heat and ice application
Light activities/exercises like walking that don’t include any bending, twisting, and lifting
If results do not improve within four to six weeks of conservative treatment, then an MRI or other type of scan of the area will be needed.
All that said preventing back spasms is the way to go. We’ve all heard the phrase to be heart-healthy, which concerns cardiovascular health. Now it’s about being spine healthy. Keeping the abdominal muscles, lumbar extensors, and the erector spinae muscles fit is the key. This can be accomplished with regular stretching and core exercises. Also doing yoga and Pilates will go a long way in minimizing muscle spasms and preventing injuries.
Sit-stand desks are coming around, especially with so many of us working from home. Sitting is not a bad thing, it is just that we do it too much. Whether at home or work, too much-sitting causes health problems, and musculoskeletal problems, which can lead to a chronic back pain condition.
Too much sitting has been compared to smoking, and sitting in front of a computer for hours and hours has led to 85% of workers reporting discomfort/pain/ health issues at work. Fortunately, there is hope for the modern-day office known as the sit-stand desk or a standing office desk. Individuals are rapidly discovering the benefits of this ergonomic tool. �
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� Sit-stand desks encourage workers not to sit as much and stand for a while. This generates a spectrum of spine health benefits that range from reducing pressure on the back to burning a few extra calories just from changing positions. Thinking of investing in an adjustable desk, here are some key things to consider.
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Get a new sit-stand desk or a unit that sits on top of my desk
This depends on the amount of space that is available. If there is plenty of space, specifically, to spread things out over a large desk area, then it can make sense to invest in a stand-alone sit-stand desk. If the current desk is right for you, then a sit-stand desk put on top of the current desk may be the better option.
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Height Adjustment
It�s important that the height of the desk can be adjusted. This has to do with different heights for different work tasks. For example, an individual could prefer one height for writing and another height when working/keyboarding on the computer.
If the desk is going to be used by others, then it�s essential that the height can be adjusted to meet the needs of those with different heights and work preferences. The Business and Institutional Furniture Manufacturers Association recommends that the height range be 22.6? to 48.7?. Ultimately the range depends on those using the desk. �
Depth of the desk
Depth is the front-to-back tabletop distance when facing the desk. A good choice is a desk that has a minimum depth of 30?. This allows those who prefer more desk space the ability to spread out the work. However, smaller depths are available.
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Weight capacity
Sit-stand desks are built to handle the weight of the usual desktop items:
Computer
Monitor/s
Keyboard
Mouse
Speakers
Phone
With heavy items, it’s best to review the weight restrictions of the desk you will be using. Weight restrictions vary, but there are all kinds of desk models to fit your needs. �
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Desk budget
This depends on your budget, work purposes, and quality. Sit-stand desks can be found in a wide range of prices. Opting for the cheapest desk is not the wisest thing to do. Remember these desks are an investment in the spine and overall health. Consider the quality of the desk and how long it will last along with a warranty to protect you if the desk malfunctions.
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What to look for
Sit-stand desks come with all kinds of options, in terms of quality and convenience.
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Noise level:
If a quiet work environment is important, then look into desks that offer a quiet action/transition when switching from sitting to standing and vice versa.
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Speed:
Some desks can take a long time to switch. Be careful with these because the use of the full functionality can diminish because of the length of time it takes. Look for the quick adjustment type.
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Manual vs. electrical:
There are some desk models that operate using hand cranks, locking switches, etc. while others use electric/pneumatic lifts to raise and lower the desk with a power button. The method of movement chosen will have a distinct impact on the ease of use, speed, and noise level.
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Programmable:
Some desks can be programmed with height preferences so they can be set to the desired position and saved.
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Customization:
If the desk needs to be able to function around privacy screens or specialized office equipment, a one-size-fits-all desk may not be the best option. This is something to consider if the desk needs to fit perfectly in an established environment. �
Keeping the desk in the standing position
Some individuals may feel better standing all day. However, standing for long periods does as much damage to the spine as sitting all day. The best approach is to vary postures over a workday.
After sitting for an hour, get up and move around.
If you�ve been standing for a while, take a break and sit.
That is what sit-stand desks are made for. They are made to promote changing positions throughout the day, which is the best thing for the spine. Be prepared for a transition period. Standing at work can bring some unexpected fatigue if you’re used to sitting all day.
Getting into the flow of working while sitting then standing, then going back can be a bit daunting. The goal is to slowly build up the amount of time standing, switching to a sitting position, and getting comfortable doing it. Things that can help with the transition are to wear supportive shoes or get custom foot orthotics and use an ergonomic foot mat to make the transition more comfortable.
It will be a short-term adjustment period, but the long-term benefits are well worth it. Employers and employees along with their spines will be very thankful.
Pregnancy back pain is very common. At least 50 percent of pregnant women and up to 80 percent will experience back pain at some point during their pregnancy. This is completely natural from the added weight of the baby. However, combined with all the other issues that arise during pregnancy ranging from:
Mood swings
Morning sickness
Fatigue
Urinary issues
Lower back pain
This can cause uncomfortable symptoms and take a serious toll on the body. Severe back pain during pregnancy is rare. We’ll look at why you could develop pregnancy back pain, along with steps and proven ways to feel better.
Back Pain Causes
Pain can occur at any trimester, but it usually arises in the later months as the baby and belly grow. Pain can be mild to severe and usually happens in the lower back. There does not have to be pre-existing back problems.
Pregnancy itself changes the body in ways that can lead to back pain.Example: As the uterus gets heavier, there is the added strain placed on the back muscles. This can alter proper posture and cause discomfort/pain. Pregnancy changes the center of gravity and accentuates the spine’s curve in the lower back. When the abdominal muscles and core are weak and not strong enough, the changes of the curvature worsen since it is these muscles that stabilize the back.
When pregnant, the body releases a hormone called relaxin that loosens ligaments, which is the tissue that connects the bones to each other inside the pelvis. The ligament loosening can affect back support and be a cause for pain. Other reasons women experience pregnancy back pain include:
Stress
Poor posture
Standing for too long
Injury
Trauma
Tips for Relief
There are ways to ease pregnancy back pain without medical intervention. Here’s how:
Pay Attention to Posture
When standing up, make sure to stand straight with the shoulders held back. If you must remain standing for a long time, elevate one foot on a box, chair, or stool to relieve the pressure on the spine. Try to avoid standing for long periods. Remember to take regular breaks and get off your feet. Maintain proper posture when sitting, as well.
Utilize an Ergonomic Chair
Both at home and at work that offers plenty of support for the back. Also, a small cushion or pillow placed behind the lower back, along with a stool or footrest for elevating the feet can be highly beneficial.
Proper Lifting
Of course, do not lift heavy objects, and avoid bending at the waist to pick up items off the floor. Instead squat, bend the knees, and lift with the legs, not with the back.
Exercise
The best time to start an exercise regiment is before conception. Regular physical activity/exercise can help prevent and ease back pain, along with all of the other benefits.
Doing simple exercises before getting pregnant can improve core strength, which can go a long way. Try to get as close as possible to a healthy weight before getting pregnant. This has the added benefit of reducing pregnancy risks and cesarean delivery.
Once pregnant, mild or moderate exercise can help get a handle on back pain and prep the body for childbirth. Gentle workouts are the way to go. These will strengthen the back, core, and leg muscles. Recommended for pregnant women are:
Walking
Swimming
Prenatal yoga
Stretches
Ask your provider which exercises, stretches are best for you. Remember movement is far better than resting too much. Also, working with a physical therapist or chiropractor in back strength will help immensely.
Exercise Clothes
Wear comfortable, spine supportive shoes. High heels should be removed altogether and take caution with flats, as these can and do often lack arch support. Shoe inserts/orthotics can help.
Maternity support belts for back pain relief can also be an added tool. Currently, there is not a great deal of scientific proof that they work. But many women swear by them when they were pregnant.
Sleep Adjustments
Try sleeping on one side with the knees bent, along with a pillow between the knees or under the abdomen. Another possibility is using a firmer mattress. This can support the back better than a soft sinking mattress. If a firm mattress is not possible, consider placing a stiff board under the mattress for added firmness.
Take naps, making sure to get the proper sleep that the body needs. This is especially true as the later weeks of pregnancy approach. This is easier said than done, but a warm bath can help the body relax before bed.
Complementary practices
Some women have found alternative medical approaches like acupuncture and prenatal massage to be quite helpful in easing pregnancy back pain. Before trying it out talk to your OB/GYN. Once discussed, you can decide if it’s a healthy choice. Make sure the masseuse or alternative practitioner has experience working with pregnant women.
Pain Meds
Pregnancy back pain is a leading cause of opioid prescriptions. When it comes to medication, a critical issue is a potential for opioid abuse. There are some over-the-counter meds that can help ease back pain.
However, Non-steroidal anti-inflammatory drugs or NSAIDs have been linked to pregnancy complications, and most doctors recommend not using them. Instead, try acetaminophen, which is just as effective and safe during pregnancy. Using hot and cold compresses and pain relief creams/ointments can also help. Pregnant women should always speak with a healthcare provider before starting any medication.
Medical Help for Pregnancy Back Pain
During pregnancy, some back pain is normal. When there is severe pain, sudden pain, or pain that lasts longer than two weeks this could be a sign of a more serious condition. It could be an indication of preterm labor, a urinary tract infection, or kidney stones.
Call a doctor if you experience any of the following:
Accompanied back pain with vaginal bleeding, fever, urinary burning or changein vaginal discharge
Suddenly unable to walk due to pain or weakness
Lose feeling in the back, legs, buttocks, and pelvis
Numbness could be the sign of a compressed nerve
Conclusion
Pregnancy back pain usually fades away once the baby is born, these steps can be taken in the meantime to ease any discomfort. Don’t forget to ask your OB/GYN for recommendations.
PODCAST: Ryan Welage and Alexander Jimenez, both medical students at the National University of Health Sciences, discuss the several new approaches that they developed in order to help people continue to engage and participate in exercise from the comfort of their own homes. Using their advanced understanding of functional medicine, biomechanics, and nutrition, they undertake explaining simple methods and techniques for complex movement protocols. Moreover, Alexander Jimenez and Ryan Welage discuss how diet can be an essential element in overall health and wellness. Dr. Alex Jimenez offers additional guidelines with the Functional Fitness Fellas, among further advice. – Podcast Insight
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Thank You & God Bless.
Dr. Alex Jimenez RN, DC, MSACP, CCST
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