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.
Burning, numbness, tingling, and pain can be felt in the back, lower back, legs, and feet. A lot of times these symptoms spread out/radiate from one part of the body into another area. Sciatica is an example of pain that radiates into an extremity, in this case, the back of the leg. Nerves originate from the spine and are divided/separated into sensory and motor nerves. The sensory nerve/s give the sensation to the skin known as dermatomes. Dermatomal patterns act as a map on the body.
Example: Dermatomes on the torso of the body react to the thoracic spinal nerve roots, the arms react to the cervical spine nerve roots, and the legs react to the lumbar spinal nerve roots.
Dermatome Location – Corresponding Spine Level
Shoulders – C4, C5
Inner/Outer Forearms – C6, and T1
Thumbs and Little Fingers – C6, C7, C8
Front of Thighs – L2
Middle, Sides of Both Calves – L4, L5
Little Toes – S1
A physician might use a piece of cotton, a swab, pin, or paperclip to test the symmetrical feelings in the arms and legs. Abnormal responses could be a sign of a nerve root problem.
Tendon Reflexes
Most individuals have experienced a physician tapping the knees with a rubber hammer. The normal response is a kick. This is a reflex, which is an involuntary muscular response generated by the hammer tapping the tendon. When the reflex responses do not present, this could mean that the spinal cord, nerve root, peripheral nerve, or muscle has been injured/damaged in some way. Absent reflexes are also clues to other conditions/injuries. An abnormal reflex response could also be caused by a disruption of the sensory (feeling) or motor (movement) nerves and sometimes both. Determining where the neural problem might be, a physician will test reflexes in various parts of the body.
Reflex Tested Areas – Corresponding Spine Level
Upper Arm Biceps – C5-C6 Cervical Spine
Forearm Distal Radius – C6-C7
Elbow Triceps – C7
Abdominal – T8, T9, T10, T11, T12, Thoracic
Knees/Thighs Patellar, Quadriceps – L3, L4 Lumbar
Ankles – S1 Sacral
Neurological Exams for Neck/Back Pain
Muscle Strength/Tone
Muscle strength and tone measurements are another way to diagnose nerve deficits. Depending on the symptoms/condition/injury/s there are different ways to evaluate muscle strength:
Stepping on a stool
Standing on the heels
Standing on the toes
Hopping in place
Performing knee bends
Gripping an item in each hand
Muscle strength is graded and recorded in the patient’s chart.
A physician will test the body’s muscle tone by passively flexing and extending the arms and legs. Normal muscle tone will respond with a slight resistance to passive motion. Other movements test for proximal (trunk/torso) and distal (distant) weakness. Muscle symmetry is also taken into account.
Neurological Tests
If necessary a spine specialist might order neurological studies like a Nerve Conduction Study (NCS) or Electromyogram (EMG), to measure nerve performance.
Imaging Studies
MRI and/or CT scans of the spine can be ordered to help the spine specialist/chiropractor make a correct diagnosis, as well as help in creating a plan of treatment.
Conclusion
A neurological exam, along with a mechanical examination consisting of movement of the arms, legs, and torso, can significantly help doctors in making the correct diagnosis. Examination results are then correlated with the patient�s history, illness, and diagnostic studies. Once the diagnosis is made an appropriate treatment plan is discussed. This will begin with non-surgical strategies but if those fail, then surgical intervention could be considered.
Research has found that vertebrogenic chronic low back pain could be caused by a lumbar vertebral endplatechange that involves the basivertebral nerveand is not disc-related. The underlying cause of chronic low back pain can be very difficult to diagnose. The intervertebral discs are a common suspect, but when disc-related treatments don�t ease the pain, the root problem could be something else. Researchers are exploring an overlooked area with the vertebral endplates being the cause of vertebrogenic low back pain.
Research has found that there are more nerves in the vertebral endplates than in the spinal discs. More nerves can mean higher potential/increase in pain. And like the other areas of the spine such as the discs and joints, vertebral endplates can also degenerate, also increasing the risk for pain.
Vertebral Endplates and Basivertebral Nerve
The vertebral endplates line the top and bottom of each vertebral body. These are the round, thick, weight-bearing bones in the spine. The vertebral endplates are made of cancellous or spongy bone and function as the barrier between each disc and the vertebrae.
The low back/lumbar spine takes the most weight. That can be a significant amount of pressure on the structures in the low back. The endplates are situated between a cushioned disc/s and the hard, bony vertebral body making them vulnerable to degeneration and nerve damage contributing to chronic low back pain. The endplates and vertebral bodies consist of a network of intraosseous nerves.
Intraosseous nerves live within the bone.
The basivertebral nerve� BVN is an intraosseous nerve that winds through the vertebral bodies. This nerve feeds into each spinal bone through the back of the vertebral body and then branches out with nerves going towards the top and bottom vertebral endplates. Research has shown that although these nerves are inside the bone they can send pain signals from a damaged vertebral endplate that could result in vertebrogenic low back pain. This is why it has been�recently linked it as a possible cause of chronic low back pain.
Nerve pain in the spine has been linked with discs that have degenerated. A doctor, chiropractor/spine specialist refers to this as discogenic pain. But with new research, an understanding of the function the vertebral endplates and BVN play in the sensation of pain has been realized and this is where the term vertebrogenic pain comes from. If a doctor discovers that the endplates could be the source of your chronic low back pain, they might use this term.
Vertebral Endplate Pain Diagnosis
Like most back pain conditions diagnosing vertebral endplate pain can be just as challenging. This is because diagnostic imaging scans typically don�t pick up mild to moderate endplate damage. A classification scale known as Modic changes helps doctors identify vertebrogenic pain.
Modic changes or MC are areas that show up on an MRI showing bone marrow damage that has been linked to low back pain. The name comes from the doctor that classified them in 1988, Dr. Michael Modic. Modic changes help doctors and spine specialists see and understand the connection between endplate damage and chronic low back pain.
2 types were identified that show a connection between vertebral endplate damage and chronic low back pain:
Type 1
This type shows a�development� in the vessels of the vertebral body, that includes:
Inflammation
Edema, which is a collection of excess fluid
Endplate changes like a split or crack/s in the endplate
Type 2
This type reveals changes in the bone marrow like fatty deposits that have taken the place of bone marrow.
If the lumbar MRI shows Type 1 or Type 2 MC, a doctor could recommend a conservative treatment plan that could include:
These could be utilized in conjunction with spine specialist care in addressing symptoms and pain. However, if the pain does not ease or reduce with conservative treatment, a doctor could suggest an outpatient procedure.
Candidates for this procedure usually qualify meeting the following:
The individual has struggled with chronic low back pain for at least 6 months
The pain has not reduced/eased up with at least 6 months of conservative care
MRI shows Type 1 or Type 2 Modic changes�that correlate symptoms of vertebrogenic low back pain
The procedure uses fluoroscopy or an x-ray video. A thin tube called a cannula is inserted into a vertebral pedicle. A pedicle is a structure that sticks out from the back of the vertebra. The cannula tunnels its way to the basivertebral nerve. The doctor then runs the Intracept Radiofrequency generator into the path of the nerve and ablates destroys/removes any obstructions in the nerve with the help of the frequency generator. Since it�s a minimally invasive procedure, it can be performed in an outpatient clinic, allowing the patient to go home the same day.
The device/tool used in the procedure is not implanted in the spine. It is removed once the procedure is done.
Expectations as to how long the pain relief will last depends on:
The severity of the condition
Post-physical therapy
Type of work
Diet
Exercise
One study showed the benefits to last up to two years.
If�nonsurgical treatment has not worked for at least six months talk to your doctor about basivertebral nerve ablation for vertebrogenic chronic low back pain. There are risks and benefits both of which should be discussed in depth.
Endplate or Disc and the Root Cause
The intervertebral discs are often the more common cause of low back pain. But they might not be the root cause of spine pain. More research is going on with the role the vertebral endplates play in spine health. As more patients are being diagnosed earlier then better long-term outcomes will follow.
Music therapy, combined with standard medical treatment�has been found to reduce the perception of pain in individuals recovering from spinal surgeries, according to a study published in the American Journal of Orthopedics. Spine surgery recovery can take a long time and take a tremendous toll on the individual and family. Research has found that music therapy can help reduce pain post-surgery.
The study has shown solid findings that this therapy, when combined with standard treatment, positively impacts pain. Individuals report an increase in comfort during the recovery time. Utilizing music in a therapeutic setting can benefit a patient’s treatment plan, as it addresses the whole individual, including mind, body, and spirit. This is the same approach that chiropractic uses.
Combining Standard Treatment with Music Therapy
The study took place at the Spine Institute of New York with the music therapy set-up through the hospital�s Louis Armstrong Center for Music and Medicine. There were 60 patients thirty-five females and twenty-five males ranging in age from 40 to 55. They underwent anterior, posterior, or anterior-posterior spinal fusion surgery. The groups were equally split up. The experimental group had music therapy included with their standard medical care, and the control group only received standard medical treatment.
The experimental group would undergo a 30-minute music therapy session over an 8-hour period within 72 hours after the procedure. The music options included:
Patient-preferred music
Singing
Rhythmic drumming that encourages relaxation
The sessions focused on personal treatment, where the individuals were encouraged to express emotions. A pain scale was used before and after the interventions to measure the results. What was found, was that pain levels would go up slightly in the control group, and in the experimental group, the pain dropped.
Spine Surgery Recovery
With standard care medications are typically the first-line treatment post-spine surgery pain. With all of the negative side effects that come with pain meds/opioids, music therapy is worth considering when looking for non-drug therapies. If anything music is an excellent distraction tool. So long as the music is enjoyable to the individual.
For the most part, many individuals that underwent spine surgery already listen to their music pre and post-operation. It helped them to relax before the surgery and allowed them to focus on something else after. Much like athletes that have their headphones/earbuds when they get to the venue to focus and block out everything going on around them. This therapy works the same way. But now we want to encourage anyone undergoing some spinal procedure to go ahead and jam out.
Calcium is vital to bone health, and as long as you are getting enough supplements are not necessary. Calcium is a primary building block for strong, healthy bones, especially the bones of the spine. A diet rich in Cacan help prevent spinal problems/issues/conditions like spinal fractures and osteoporosis.
The best and easiest way to get the proper amount of calcium is by eating plenty of Ca-rich foods. However, calcium supplements could be utilized to ensure the proper amount is taken every day. To determine if you may need a calcium supplement talk with your doctor to make sure it�s the best option for you.
Calcium Supplements
Calcium supplements can help individuals reach the daily recommended amount, but they are not intended to replace real Ca-rich foods. If there is enough Ca in your diet, a supplement won’t be necessary, unless there is an underlying condition that doesn’t allow the individual to eat certain Ca-rich foods. However, if there is only a lack of sufficient calcium intake then supplements could help. Otherwise, if there is a continued lack of Ca it could be detrimental to bones and overall health.
Proper Amount Every Day
Before considering a supplement, it�s essential to know how much calcium you should be getting each day. Daily recommendations vary by age and sex but largely depend on age:
Men and women age 19-50, including pregnant women, require 1,000 mg a day
Men 51-70 require 1,000 mg a day
Women 51-70 require 1,200 mg a day
The elderly 71 and over require 1,200 mg a day
Your Diet
Once you know how much Ca you need, the next step is to evaluate how much to get. The American Bone Health advocacy group recommends using the Calcium Rule of 300 to determine if a supplement is necessary.
The way it works:
Begin with the number of dairy or juices with added calcium and the amount that is consumed daily.
Multiply that number by 300.
Add 300 if a nutritious and balanced diet is being observed
The total is the proper dietary intake of calcium
If the total does not meet the recommended number consult a doctor or health coach about a calcium supplement.
Supplement Tips
If you decide to take a supplement, check out these tips:
Make sure your doctor/pharmacist know all medications and supplements being taken, this includes over-the-counter products. The reason for this is your doctor wants so be sure they will not interfere with each other or have some kind of negative side effect. An example of this is calcium and iron supplements can prevent each other from properly�absorbing into the body when taken together.
Buy supplements that have the USP Verified symbol, which shows that the supplement has been independently evaluated and certified.
Rather than taking one high-dose calcium supplement, which could be more than 500-600 mg. Smaller-doses of supplements can be taken 2-3 times throughout the day.
The body cannot absorb more than 500-600 mg of calcium supplement at once
Don�t take the supplement with a high-fiber meal or laxative. This fiber can prevent the body from fully absorbing the calcium
There are all kinds of nutrients that contribute to the development and maintenance of healthy bones, but calcium is backed by a strong body of evidence that presents a clear connection to bone health. A simple and straight-forward focus on eating foods rich in calcium can help keep the bones of the spine, and entire body for that matter�strong and supportive for life-long healthy movement.
A February 2020 study explored the relationship between low back pain and menopause. Hormones and vitamin D play a role. Vitamin D deficiency is related to increased lower back pain and degenerative disc disease in postmenopausal women. Decreasing estrogen levels can also drop levels of vitamin D, which can be downright painful if left unaddressed.
Menopause:
Hot flashes
Mood swings
Sleep issues
Libido changes
A drop in�estrogen levels can cause these symptoms.
Degenerative Disc Disease
In between the vertebra are fibrous discs that are the shock absorbers for the spine. These discs also support and stabilize the spine, which allows you to move freely pain-free. The health of the spine is a vital part of well-being and provides the ability to bend, lift, twist, and perform normal activities without pain.
With the passage of time, the discs start to dry out and lose their flexibility and elasticity. When the discs dry out, known as desiccation is a natural process that happens as we age and does not always cause pain symptoms. The discs become thinner and less able to absorb shock that can lead to pain and stiff movement. The loss of elasticity and height in the discs is known as degenerative disc disease.
Stenosis/Compression
With degenerative disc disease, sometimes the body tries to compensate for the loss of stability by producing more bone to stabilize the spine.
This causes bone growth/s, called bone spurs or osteophytes. These can crowd the spinal canal, which is a condition called stenosis.
Stenosis places pressure on the nerve roots that branch off the spinal cord.
The symptoms of this compression can present with:
Pins and needles sensations
Muscle spasms
Decreased sensation to touch
Weakness and pain in the back or that radiate down the arms or legs.
Treatments for degenerative disc disease include physical therapies and surgery. Most cases are treatable without surgery by utilizing physical therapy, occupational therapy, strength/flexibility exercises, injections, and supplements. Surgery could be considered to make more room in the spinal canal, relieve nerve compression, and reduce pain.
Vitamin D and Bone Health
Vitamin D has multiple functions in the body. It’s produced by the body when exposed to sunlight and is also found in certain foods and supplements. One function of vitamin D involves bone health support. The body needs vitamin D to absorb calcium and phosphorus, which are essential for bone production. Calcium is stored inside the bones.
When there is a deficiency in calcium, the body breaks down the bone/s and takes/pulls the calcium back into the blood. Inadequate vitamin D means the body is not able to absorb enough calcium and cannot prevent the bones from being broken down. Vitamin D deficiency at an early age can cause low bone density along with diseases like rickets, osteopenia, and osteoporosis. Osteoporosis is a condition where the bone gradually weakens and breaks easily.
It can cause vertebral compression fractures, where the vertebrae crack because the bone tissue is not strong enough to support the body�s weight and resist gravity.
Two causes of osteoporosis are nutritional deficiencies and hormonal imbalances, like low estrogen production after menopause. Proper vitamin D/calcium intake is essential for preventing and reducing bone loss that can lead to these conditions and increased lower back pain.
Estrogen and Bone/Spine Health
Estrogen plays a role in male and female bone health. Cells called osteoblasts help in the production of bone are highly active. Estrogen helps slow the breakdown of bones and promotes bone growth. A drop in estrogen over time compromises the health of bones. Individuals with chronic hormone imbalances and postmenopausal women are frequently affected by bone disease/s and the loss of bone density over time.�Studies reveal the risk of developing osteoporosis is higher in postmenopausal women.
Estrogen helps maintain tissues that contain collagen, which is found in intervertebral discs. Lower estrogen levels following menopause have shown to lead to more severe lumbar disc degeneration and increased lower back pain in women when compared to men. This demonstrates the importance of monitoring changes in lower back pain for women after menopause.
Vitamin D and the Spinal Discs
The relationship between increased low back pain in postmenopausal women and vitamin D deficiency is real. Supplements can help correct these deficiencies, can help reduce low back pain and promote bone health.
Postmenopausal women are especially at risk for vitamin D deficiency. Vitamin D and calcium supplements can be used in combination.The bone/s breakdown is stopped, while the bone tissue is strengthened thus reducing back pain. Low back pain brought on by degenerative disc disease is pretty much present in patients over age 65.
These health concerns can be helped through:
Vitamin supplementation
Exercise
Healthy diet
Slowing down bone loss can be achieved with strategies that range from diet change to prescription medication.
A doctor could recommend alternative treatments, as part of aplan for neck pain like acupuncture, herbal compounds, and yoga. You may want to try them out yourself. Many have reported that these have really helped. Please consult a doctor before trying any alternative therapies. These are safe but should be set-up by a professional to make sure they are done safely. For example, there could be negative interactions between herbs, supplements, and other medications being used.
Acupuncture
This is an eastern approach to healing. Acupuncture focuses on the body’s energy force known as Qi or Chi. When the energy is blocked from flowing this is when physical illnesses develop. Acupuncture restores the healthy energy flow. It isn’t better or worse it is just different.
Herbal Medicine
There are herbal compounds that have proven to be useful for neck pain.
Capsaicin Cream
Capsaicin is a chili pepper extract and can help relieve neck pain. It temporarily reduces pain. Capsaicin cream can help with osteoarthritis and muscle pain, which both cause neck pain.
Devil’s Claw
Devil’s claw comes from southern Africa, where it has been used for centuries to treat fever, arthritis, and gastrointestinal problems. It is used for conditions that cause inflammation and pain, like cervical osteoarthritis.
White Willow Bark
White willow bark is how aspirin in Europe was developed. Synthetic versions like aspirin can irritate the stomach, which is why the natural white willow bark is used instead. It helps with conditions that cause pain and inflammation like osteoarthritis.
Massage
Neck pain can be caused by stress, overuse, and misuse. Misuse means like sitting hunched over a computer for too long every day will take its toll. Massage helps to release tension, relieve muscle inflammation, and pain. Regular massages could help as a preventative measure.
Yoga/Pilates
Yoga and Pilates can increase core strength, improve balance, posture, and reduce stress. These can all help deal with neck pain/ prevent neck pain when done correctly and safely. Neck pain relief can be found with these treatments. Treatments that focus on relieving tension or stress can prove especially helpful if the pain is related to tight muscles and the physical effects of stress.
These alternative treatments could work at their optimal in combination with other therapies. This is to fully address the underlying spinal condition/root cause, along with any other neck-related symptoms.
Companies are doing what they can to keep operations moving and workers employed. Those that are able to work-from-home are doing so. But working from home is new to many and creates new challenges of converting an area in the house, apartment, etc, to become the workspace.
Back pain is common whether at the office or at the house. Everyday activities like the way you sit or lift can cause back pain if you�re not careful. At the house, it can be easy to lose track of time working. However, sitting with the wrong chair, at an improper height is not great for the body and overall health.
Working from Home and Back Pain
You probably thought you�d be comfortable working while lounging in bed or slouching on the sofa. However, after a few hours,�you would have a sore back, neck, or shoulders muscles. Working on a laptop for hours daily�at the kitchen counter or hunched over a coffee table and not sitting at a table or desk with a proper chair can lead to pain.�The best way to reduce and avoid back/neck pain is to make a few changes to the workstation.
Setting Up The Workspace
A comfortable workspace will increase productivity and physically help you feel good.
Working comfortably for hours, maintaining proper posture, it would be wise to invest in practical office appliances that can support physical well-being. Proper office ergonomics include:
The correct chair height
Footrest
Working desk posture that keeps muscles and joints comfortable
Choosing the ergonomic office chair is important, considering you will be using it for back support. Office chairs are not a one size fits all. The choice could be the difference between having continuing back pain or improving comfort, health, and overall productivity.
Ergonomic Back Support
Despite the adjustable ergonomic chair, you might still have back pain while working. Consider the following because it might not be the chair that�s not working.
Keep Moving Around
Step counts could take a dive when working from home. Exercise and stretching at regular intervals are extremely important to protecting the spine throughout the day. Remembering to do this at home can be harder than working in an office environment. Use an automatic reminder on the phone. Our bodies need regular low-impact aerobic activity. It provides the tissues with vital blood flow and helps minimize back pain.
Be Sure To Check Your Posture
The spine is not fixed in abnormal positions. Sitting and slouching forward for a long time will contribute to back pain. The advantages of sitting straight:
Keeps the Joints Aligned
Keeps the Bones Aligned
Supports the Muscles
Supports the Ligaments
Prevents Muscle Fatigue
Sit all the way back in your chair and take full advantage of the lower back support. The knees should be bent at a 90-degree angle with the feet flat on the floor or on a footrest.
Proper Screen Height
The height of the computer screen should not be too high or too low. Your eyes should aim at the center of the screen without having to crane your neck up or down. It should be directly in front to avoid tilting or turning your head. A laptop should be raised anywhere from 5 to 10 inches to provide the proper height.
Speaker Setting
Don’t go for the multitask when it comes to the phone. Having the phone between your neck/shoulder and working at the same time can lead to stressing your back and hurting/injuring the muscles. Turn on the speaker or use a headset to avoid the awkward neck position.
Breathe Deep
Proper breathing keeps the body and the muscles in the mid and lower back nicely relaxed. Improper breathing can make the nervous system react, causing pain or discomfort. Breathing exercises can be a way to target lower back pain/s. No special equipment is needed and can be done anywhere, anytime. Concentration is the key. Inhale and bring the navel towards the spine and then exhale. This exercise will engage the core muscles and will support the upper body.
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