Back Clinic Chiropractic Spine Care Team. The spine is designed with three natural curves; the neck curvature or cervical spine, the upper back curvature or thoracic spine, and the lower back curvature or lumbar spine, all of which come together to form a slight shape when viewed from the side. The spine is an essential structure as it helps support the upright posture of humans, it provides the body with the flexibility to move and it plays the crucial role of protecting the spinal cord. Spinal health is important in order to ensure the body is functioning to its fullest capacity. Dr. Alex Jimenez strongly indicates across his collection of articles on spine care, how to properly support a healthy spine. For more information, please feel free to contact us at (915) 850-0900 or text to call Dr. Jimenez personally at (915) 540-8444.
Spinal Stenosis Walking Issues:Stenosis means a narrowing. Spinal stenosis can happen in any spine region, but the neck and lower back are the most common locations. The spinal canal becomes narrower and can cause the nerves to become compressed, pinched, and irritated and can extend from the lumbar spine through the hips, buttocks, legs, and feet. Individuals with lumbar spinal stenosis may have difficulty walking caused by sensations of discomfort like numbness, electrical shocks, and pain, requiring the need to lean forward to relieve pressure and symptoms. Additionally, symptoms are likely to worsen the longer the walk. Chiropractic treatment can treat spinal stenosis because it corrects and re-aligns the spine, thus reducing pressure on the spinal cord, joints, and nerve roots.
Spinal Stenosis Walking Issues
The spine is made up of interlocking vertebrae. The regions are cervical, thoracic, lumbar, and sacral bones with a foramen opening. These openings form the protective tunnel/spinal canal surrounding the spinal cord. The spinal cord is a group of nerves that run through the tunnel. The narrowing suffocates the nerves supplying the lower extremities that can influence walking activity.
Symptoms
There may be no symptoms with early lumbar spinal stenosis. Most individuals develop symptoms gradually and may begin to notice them while walking or standing. These can include:
Lower back pressure sensations when standing upright or walking.
Leg numbness, tingling, weakness, burning, and/or cramping.
Muscle weakness.
Persistent pain in the back, hips, buttocks, or legs while walking.
Difficulty lifting the top part of the foot – known as drop foot.
Loss of sensation in the feet.
A weak foot that drops/slaps down when walking.
Loss of sexual ability.
In more serious cases, severe numbness, bladder problems, and inability to stand.
Individuals begin to lean forward when symptoms start, bringing relief by reducing the pressure on the nerves. However, constantly leaning forward leads to other posture and health problems.
Diagnosis
A doctor or chiropractor will ask questions about symptoms and medical history and perform a complete physical examination to diagnose lumbar spinal stenosis. During the physical examination, a healthcare provider will look for signs, such as loss of sensation, weakness, and abnormal reflexes.
Tests:
X-rays of the lumbar spine may show bone growths called spurs that push on spinal nerves and/or narrowing of the spinal canal.
Imaging tests – A CT or MRI scan can provide a detailed look at the spinal canal and nerve structures.
Other studies include – bone scans, myelogram, which is a CT scan that uses a color dye, and EMG, which is an electrical test of muscle activity.
Chiropractic Treatment
Chiropractic care combined with physical therapy is a tried-and-true treatment for spinal stenosis. A chiropractic treatment plan can include targeted and passive exercise programs. Targeted exercises involve strengthening the core and back muscles. Passive treatments include hot and cold therapy, massage, decompression, and electrical stimulation. The objective of chiropractic therapy is to:
Strengthen muscles in the core and legs
Correct posture and body mechanics.
Improve mobility.
Maintain ability to perform day-to-day activities.
Recommend stretches.
Educate on how to keep the spine and back muscles safe.
Train on using devices like a back brace, cane, or walker properly.
Advise about shoe inserts and splints.
Suggest work and home environment modifications, such as ergonomics and cushions.
Chiropractic Relief
References
Conway, Justin, et al. “Walking assessment in people with lumbar spinal stenosis: capacity, performance, and self-report measures.” The spine journal: official North American Spine Society journal vol. 11,9 (2011): 816-23. doi:10.1016/j.spinee.2010.10.019
Lurie, Jon, and Christy Tomkins-Lane. “Management of lumbar spinal stenosis.” BMJ (Clinical research ed.) vol. 352 h6234. 4 Jan. 2016, doi:10.1136/bmj.h6234
Macedo, Luciana Gazzi, et al. “Physical therapy interventions for degenerative lumbar spinal stenosis: a systematic review.” Physical therapy vol. 93,12 (2013): 1646-60. doi:10.2522/ptj.20120379
Tomkins-Lane, Christy C et al. “Predictors of walking performance and walking capacity in people with lumbar spinal stenosis, low back pain, and asymptomatic controls.” Archives of physical medicine and rehabilitation vol. 93,4 (2012): 647-53. doi:10.1016/j.apmr.2011.09.023
Prolonged standing can cause the pelvis to push backward, increasing the curve of the lower back/lumbar region. This increased pressure on the soft tissues surrounding the spine causes the lower back muscles to tighten and/or spasm, resulting in discomfort in the joints and nerves. Weakened core muscles and unhealthy posture/postural syndrome are the most common causes, but injury, aging, congenital malformations, or a disease/condition can also contribute to the symptoms. Injury Medical Chiropractic and Functional Medicine Clinic has a top team of professional therapists to evaluate the problem, diagnose the cause/s accurately, and develop a customized treatment and rehabilitation plan.
Prolonged Standing Back Discomfort
Back Structure
The lower back is one of the most used areas of the spine, moving around and bending during a normal day. When the body stands, the spine naturally curves both in and outwards.
The inward curve, called lordosis, curves towards the front of the body at the lower back and neck regions.
The outward curve, called kyphosis, curves towards the back of the body at the chest.
When bending over while standing, the five lumbar vertebrae of the lower back change position and shift from lordosis to kyphosis when bent completely.
When standing up from bending, the lumbar vertebrae change position again and return to the lordosis position.
Causes
The facet joints allow movement between each spine level. The standing spinal curvature can increase contact between the facet joints. As the body ages, the facet joints and discs begin to wear out, which can cause the discs and facet joints to become inflamed. Prolonged standing during normal daily activity combined with inflammation in these joints can aggravate the inflammation and cause symptoms. Regular routines and habits may contribute to low back discomfort during prolonged standing. These include:
Sleeping on a sinking or unsupportive mattress.
Practicing unhealthy postures that cause imbalances with proper weight distribution.
Not wearing proper footwear and/or supportive orthotics forces the lower spine into increased curvature and can compress the facet joints.
Not getting enough physical activity that strengthens the core.
Chiropractors are experts on the musculoskeletal system. They will:
Listen to the patient about symptoms, medical history, and occupation.
A physical examination of muscle tone, strength, and range of motion.
Therapeutic massage, electric muscle stimulation, and ultrasound therapy can help reduce muscle inflammation and increase circulation to injured soft tissues.
Chiropractic adjustments will reset joints, removing pressure from the surrounding muscles and nerves.
Targeted therapeutic strength training is recommended for core and leg muscles to improve hip flexibility.
Non-surgical decompression or traction, either with a machine or suspension, can reverse the pressure in spinal discs.
Standing Lower Back Relief Exercises
References
Hasegawa, Tetsuya, et al. “Association of low back load with low back pain during static standing.” PloS one vol. 13,12 e0208877. 18 Dec. 2018, doi:10.1371/journal.pone.0208877
Jo, Hoon, et al. “Negative Impacts of Prolonged Standing at Work on Musculoskeletal Symptoms and Physical Fatigue: The Fifth Korean Working Conditions Survey.” Yonsei medical journal vol. 62,6 (2021): 510-519. doi:10.3349/ymj.2021.62.6.510
Ognibene GT, Torres W, von Eyben R, Horst KC. Impact of a sit-stand workstation on chronic low back pain: randomized trial results. J Occup Environ Med. 2016;58(3):287-293. Abstract. www.ncbi.nlm.nih.gov/pubmed/26735316. Accessed March 2, 2017.
Parry, Sharon P et al. “Workplace interventions for increasing standing or walking for decreasing musculoskeletal symptoms in sedentary workers.” The Cochrane database of systematic reviews vol. 2019,11 CD012487. November 17, 2019, doi:10.1002/14651858.CD012487.pub2
Rodríguez-Romero, Beatriz, et al. “Thirty Minutes Identified as the Threshold for Development of Pain in Low Back and Feet Regions, and Predictors of Pain Intensity During 1-h Laboratory-Based Standing in Office Workers.” International journal of environmental research and public health vol. 19,4 2221. February 16, 2022, doi:10.3390/ijerph19042221
Smith, Michelle D et al. “The Influence of Using a Footstool during a Prolonged Standing Task on Low Back Pain in Office Workers.” International journal of environmental research and public health vol. 16,8 1405. April 18. 2019, doi:10.3390/ijerph16081405
Neck aches, soreness, and pain symptoms are not always neck-related. Tight thoracic or mid-back muscles can pull on the neck muscles causing various symptoms. Upper back tightness occurs anywhere from the neck’s base to the bottom of the rib cage. The bones in the upper area don’t move or flex as much as the neck and low back. This can lead individuals to believe there is nothing wrong with the mid-back, as there are no pain symptoms or signs of discomfort. However, individuals don’t realize how tight the muscles are, which can go on for years, causing neck issues. Injury Medical Chiropractic and Functional Medicine Clinic can relieve symptoms, release, and relax tight muscles, increase circulation, and restore optimal function.
Mid-Back Muscle Tightness
The upper and middle back is the thoracic spine. The thoracic spine has twelve small bones called vertebrae. Each vertebra on the thoracic spine is connected to a pair of ribs. The ribs wrap around the body and attach to a long, flat sternum bone. This forms the rib cage. The bones in the upper back work with the ribs to stabilize the back and protect vital organs, including the heart and lungs. The tightening and pulling eventually cause neck aches that can come out of nowhere; even when not moving and looking straight ahead, there can be persistent dull achiness or stinging sensations.
Causes
Unhealthy posture, disc problems, injuries, fractures, or other issues or conditions can cause mid-back muscle tightness.
Posture
Constant sitting or standing combined with unhealthy posture and being hunched over can cause the muscles to tighten, limiting mobility.
Holding Onto Stress
Chronic stress can cause muscle tightening, whether it is in the low back, mid-back, neck, or elsewhere.
Hereditary
Individual genetic makeup may make the body more susceptible to muscle tightness.
For example, individuals with a lot of muscle tone vs. individuals with less muscle tone may experience muscle tightness more often.
Adequate Hydration
Being properly hydrated is important for muscle and joint lubrication.
Water provides nutrients to contracting muscles.
This keeps the body loose and ready for movement.
Muscle Imbalance and Underlying Weakness
Individuals that tend to work one side of the body more than the other or have repeatedly been moving in a certain way for years can cause muscle imbalances and trigger points to develop.
If muscle tightness continues, even after stretching, it could be an underlying weakness.
The muscles can sometimes seize up and guard, so they feel tight when they have become chronically weak and not strong enough to meet the physical demands.
Chiropractic Care
Chiropractic care involves various therapies to address the root cause fully and relieve neck aches. These include:
Massage therapies to break up compacted muscle tissue.
Remove trigger points.
Relax the muscles to a pliable state.
Perform chiropractic adjustments to realign the spine.
Stretching and strengthening.
Posture training that includes stretches/exercises.
Nutritional plans to help strengthen muscles.
Thoracic Tension Release
References
Gatt, Adrianna, et al. “Anatomy, Fascia Layers.” StatPearls, StatPearls Publishing, Jul 25, 2022.
Liebsch, Christian, and Hans-Joachim Wilke. “How Does the Rib Cage Affect the Biomechanical Properties of the Thoracic Spine? A Systematic Literature Review.” Frontiers in bioengineering and biotechnology vol. 10 904539. Jun 15, 2022, doi:10.3389/fbioe.2022.904539
Maciejewska-Skrendo, Agnieszka et al. “Genetics of Muscle Stiffness, Muscle Elasticity and Explosive Strength.” Journal of human kinetics vol. 74 143-159. 31 Aug. 2020, doi:10.2478/hukin-2020-0027
Modes RJ, Lafci Fahrioglu S. Anatomy, Back. [Updated 2022 Feb 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK539746/
Page, Phil. “Current concepts in muscle stretching for exercise and rehabilitation.” International journal of sports physical therapy vol. 7,1 (2012): 109-19.
Petrofsky, Jerrold et al. “The Efficacy of Sustained Heat Treatment on Delayed-Onset Muscle Soreness.” Clinical journal of sports medicine: official journal of the Canadian Academy of Sports Medicine vol. 27,4 (2017): 329-337. doi:10.1097/JSM.0000000000000375
Non-radiographic axial spondyloarthritis or nr-axSpA and non-radiographic ankylosing spondylitis/AS are related. However, non-radiographic axial spondyloarthritis can present AS symptoms with active inflammation of the spine and sacroiliac/SI joints, causing back and hip pain but does not reveal joint damage on X-rays or MRIs. Injury Medical Chiropractic and Functional Medicine Clinic can explain what it means to have non-radiographic axial spondyloarthritis, how it can be managed, and what to do to prevent it from turning into ankylosing spondylitis.
Non-Radiographic Axial Spondyloarthritis
Non-radiographic axial spondyloarthritis means there are early AS symptoms but have not developed enough joint inflammation or damage to show up on an X-ray or other form of imaging. Early evidence of joint inflammation includes blurring of the joint edges and localized regions of joint erosion. It can be difficult for physicians to see these subtle changes on an x-ray.
Ankylosing Spondylitis
Ankylosing spondylitis, or AS, is a form of inflammatory arthritis that affects joints in the spine and elsewhere.
It is a chronic, inflammatory, autoimmune disease.
Medical research is still ongoing to determine the exact cause, but a genetic component is believed to be contributing factor.
Around 85% of individuals with ankylosing spondylitis have inherited the HLA-B27 gene, which is associated with multiple autoimmune conditions.
In the early stages, individuals will present lower back pain around the sacroiliac joints or the joints that connect the spine to the pelvis.
Later stages have more obvious X-ray findings, like the fusing of the sacroiliac joints and the lower spine that takes place over time.
Joint inflammation can progress, causing permanent joint damage and spine rigidity.
Most individuals with the condition can manage their symptoms with NSAIDs, chiropractic care, physical and massage therapy, and range of motion exercises.
Stage 1
There is no evidence of spinal inflammation on x-rays.
MRI provides more detailed images of bones and may reveal bone marrow edema or accumulation of fluid in the structures of the spinal bones and joints.
Individuals with non-radiographic axial spondyloarthritis, you are here.
Stage 2
There is visible inflammation of the spinal joints on the x-ray.
The sacroiliac joints between the spine and the pelvis are the most affected.
Stage 3
Chronic inflammation of the joints has caused bone loss and permanent joint damage, resulting in spine rigidity.
Symptoms of Non-Radiographic Axial Spondyloarthritis
There are differences between back pain associated with muscle strain and arthritis. Back pain symptoms include:
Starts to present before age 40.
It has a gradual onset and can go unnoticed for years.
Improves with movement or activity.
Eases up throughout the day.
Starts up in the evening when resting.
Other symptoms include:
Joint stiffness
Swollen fingers
Heel pain
Bilateral buttock discomfort and pain
Slowing Progression
Progression from non-radiographic axial spondyloarthritis to ankylosing spondylitis occurs in 10% – 20% of individuals over a two-year period. Progression factors include genetics, gender, degree of joint damage, and level of inflammatory markers at the time of diagnosis.
Early diagnosis and treatment can slow the progression before significant joint damage with anti-inflammatory therapy, rheumatological therapy, and targeted exercise.
Work with a specialist like an orthopedic spine specialist and rheumatologist that understands the disorder and is up to date on the most recent treatment modalities.
D. J. Pradeep, A. Keat, K. Gaffney, Predicting outcome in ankylosing spondylitis, Rheumatology, Volume 47, Issue 7, July 2008, Pages 942–945, doi.org/10.1093/rheumatology/ken195
Kucybała, Iwona, et al. “Radiologic approach to axial spondyloarthritis: where are we now and where are we heading?.” Rheumatology international vol. 38,10 (2018): 1753-1762. doi:10.1007/s00296-018-4130-1
Michelena, Xabier, López-Medina, Clementina, and Helena Marzo-Ortega. “Non-radiographic versus radiographic axSpA: what’s in a name?”.” National Center for Biotechnology Information. October 14, 2020. doi.org/10.1093/rheumatology/keaa422
Ankylosing spondylitis, or AS, is a type of inflammatory arthritis that usually impacts the spine, causing back stiffness and pain, pain in the hips, and decreased range of motion. Brain fog can also be a symptom of AS and other chronic inflammatory conditions. Brain fog can affect memory, concentration, decision-making, learning, and problem-solving. Injury Medical Chiropractic and Functional Medicine Clinic can educate on the causes of ankylosing spondylitis brain fog and how to reduce its effects.
Brain Fog
Experts do not fully understand how conditions like AS cause brain fog and how it affects the brain and central nervous system. However, they believe brain fog is linked to chronic inflammation and pain associated with the condition, along with certain factors.
Chronic Inflammation
Inflammation occurs when the body’s immune system attacks healthy cells.
This triggers the release of inflammation-causing cytokines.
Cytokines can interfere with normal brain function.
Ankylosing Spondylitis Chronic Pain
Chronic pain can cause fatigue and unhealthy sleep quality.
Fatigue and poor sleep can worsen chronic pain, leading to intense fatigue and extreme sleep issues, becoming a vicious cycle.
Corticosteroids
Doctors typically treat ankylosing spondylitis with corticosteroids.
Individuals with cardiovascular risk factors have an increased risk of brain fog from the medications.
Depression
Individuals with AS can present symptoms of depression, which has been linked to cognitive impairment.
Depression can contribute to the development of brain fog.
Cornelson, Stacey M et al. “Chiropractic Care in the Management of Inactive Ankylosing Spondylitis: A Case Series.” Journal of chiropractic medicine vol. 16,4 (2017): 300-307. doi:10.1016/j.jcm.2017.10.002
Vitturi, Bruno Kusznir et al. “Cognitive Impairment in Patients with Ankylosing Spondylitis.” The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques vol. 47,2 (2020): 219-225. doi:10.1017/cjn.2020.14
Zhang, Jun-Ming, and Jianxiong An. “Cytokines, inflammation, and pain.” International anesthesiology clinics vol. 45,2 (2007): 27-37. doi:10.1097/AIA.0b013e318034194e
After a car accident, you may notice neck pain. It could be a slight soreness you think is nothing but take care of. More than likely, you have whiplash. And that little soreness can turn into a lifetime of chronic neck pain if only treated with pain meds and not treated at the source.
Whiplash trauma, aka neck sprain or neck strain, is an injury to the soft tissues around the neck.
Whiplash can be described as a sudden extension or backward movement of the neck and flexion or forward movement of the neck.
Severe whiplash can also include injury to the following:
Intervertebral joints
Discs
Ligaments
Cervical muscles
Nerve roots
Symptoms of Whiplash
Most people experience neck pain either immediately after the injury or several days later.
Other symptoms of whiplash trauma can include:
Neck stiffness
Injuries to the muscles and ligaments around the neck
Headache and dizziness
Symptoms & possible concussion
Difficulty swallowing and chewing
Hoarseness (possible injury to the esophagus and larynx)
The sensation of burning or prickling
Shoulder pain
Back pain
Diagnosis of Whiplash Trauma
Whiplash trauma usually causes damage to the soft tissues; a doctor will take x-rays of the cervical spine in case of delayed symptoms and rule out other problems or injuries.
Treatment
Fortunately, whiplash is treatable, and most symptoms resolve completely.
Most often, whiplash is treated with a soft cervical collar.
This collar may need to be worn for 2 to 3 weeks.
Other treatments for individuals with whiplash may include the following:
Heat treatment for relaxing muscle tension and pain
Pain meds such as analgesics and non-steroidal anti-inflammatory
Some people will tell you that whiplash is a made-up injury that people use to get more money in a settlement stemming from an accident. They do not believe it is possible in a low-speed rear-end accident and see it as a legitimate injury claim, mainly because there are no visible marks.
Some insurance experts claim that about a third of whiplash cases are fraudulent, leaving two-thirds of the cases legitimate. Much research also supports the claim that low-speed accidents can indeed cause whiplash, which is very real. Some patients suffer from pain and immobility for the rest of their lives.
NCBI Resources
Chiropractors will use different techniques to relieve the pain of whiplash and help with healing.
Chiropractic Adjustment The chiropractor performs spinal manipulation to move the joints into alignment gently. This will help to align the body to relieve pain and encourage healing.
Muscle Stimulation and Relaxation This involves stretching the affected muscles, relieving tension, and helping them relax. Finger pressure techniques may also be combined with trying to alleviate pain.
McKenzie Exercises These exercises help with disc derangement that whiplash causes. They are first performed in the chiropractor’s office, but the patient can be taught how to do them at home. This helps the patient have some degree of control over their healing.
Each whiplash case is different. A chiropractor will evaluate the patient and determine the appropriate treatment case-by-case basis. The chiropractor will determine the best course of treatment that will relieve your pain and restore your mobility and flexibility.
The spine is the body’s central highway, with the spinal canal as the main lane that handles all the traffic. There are entrances and exits, or spinal cavities, that allow the nerves to branch off the spinal cord and run throughout the body. A traffic jam develops during lane closures, accidents, or construction at an entrance or exit. Lateral recess stenosis causes the narrowing of the spine’s lateral recess/Lee’s entrance, which can compress nerves, impede nerve circulation, and cause painful symptoms.
Lateral Recess Stenosis
The spinal column provides a strong and flexible structure for the spinal cord. The nerves travel from the spinal cord through various openings and passageways to the rest of the body. One of the openings is known as the lateral recess. Stenosis means narrowing. When a lateral recess in a vertebra develops stenosis, the nerve in that area can get jammed/pinched with no room to move, causing varying symptoms and sensations.
Symptoms
Depending on where the stenosis is taking place (neck, middle or low back), common symptoms of lateral recess stenosis can include:
Back pain that can spread out to other areas.
Cramping that can spread out to other sites.
Radiating pain that worsens with movement and eases with rest.
Numbness or weakness of the legs or arms.
Electrical tingling sensations down the leg or arm.
Muscle groups around the stenosis area are built up to take the pressure off of the area, alleviating symptoms.
Medications
A doctor or spine specialist may recommend or prescribe medication to ease symptoms. These include:
Tylenol – acetaminophen.
NSAIDS – Advil/ibuprofen or Aleve/naproxen.
Muscle relaxers
Steroid Injections
According to a study, neurogenic claudication is the main reason for disability and loss of independence in the elderly.
Neurogenic claudication describes pain and weakness in the buttocks and legs during physical activity that originates from the nerves, not the vessels.
This can happen from inflammation and swelling around a compressed nerve.
A steroid injection can decrease inflammation for several months.
Surgery
If activity modification, NSAIDs, bracing, and physical therapy don’t work or provide adequate relief, a doctor or specialist could recommend surgery.
Drug Design, Development and Therapy (2014) “Steroid for epidural injection in spinal stenosis: a systematic review and meta-analysis” doi.org/10.2147/DDDT.S78070
Lee, Seung Yeop, et al. “Lumbar Stenosis: A Recent Update by Review of Literature.” Asian spine journal vol. 9,5 (2015): 818-28. doi:10.4184/asj.2015.9.5.818
Liu, Kuan, et al. “Steroid for epidural injection in spinal stenosis: a systematic review and meta-analysis.” Drug design, development, and therapy vol. 9 707-16. Jan 30, 2015, doi:10.2147/DDDT.S78070
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Brain Fog
