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Flat Back Syndrome

Flat Back Syndrome

Individuals believe that maintaining a straight/flat back is healthy. However, the back is made up of natural curves that allow flexibility and optimal movement. If there is a lack of these curves, it can lead to spine issues, discomfort, and pain. A common problem to develop from a spine lacking natural curvature is abnormal kyphosis. This is when the natural curve in the thoracic spine – mid-back or lumbar spine – low back disappears, which results in a flat back. Restoring the curvature can be challenging, as flatback syndrome requires chiropractic adjustments to gently shift and realign the spine back into a healthy curve and re-train the spine to maintain the curve.

Flat Back Syndrome

Causes of Flat Back Syndrome

Flatback syndrome is usually a result of muscle tightness in the lower back muscles, specifically in the psoas muscle. Or it could be degenerative disc disease, where the cartilage supporting the spine begins to weaken. Other causes include arthritis and osteoporosis. Practicing unhealthy posture habits can worsen these conditions, speeding up the loss of the spine’s curvature. Loss of spinal curvature does not occur rapidly, as the body will begin to present with symptoms. The following symptoms could be an indication:

  • Fatigue when trying to stand upright
  • Balance problems
  • Restricted mobility
  • Muscle spasms
  • Chronic low back pain
  • Thigh pain
  • Groin pain
  • Disc herniation

Back pain and problems with balance are the earliest warning signs of flatback syndrome.

Symptoms

Flatback symptoms usually get worse as the day progresses, with a sense of fatigue and increasing difficulty to stand upright. Individuals tend to flex or bend their hips and knees to get into an upright position. This can become an exhausting process as the day progresses. Individuals can also have symptoms of sciatica and/or spinal stenosis with leg pain and weakness that gets worse when walking. Neck and upper back pain can begin to present while straining to align themselves. The symptoms become disabling, often requiring pain medications that limit the individual’s ability to perform daily activities.

Realignment Treatment

A chiropractor must determine the severity of the deviation through a thorough assessment and examination. This shows the loss of curvature to help a chiropractor plan a realignment/remodeling adjustment schedule. Restoring a natural kyphosis is done through a combination of adjustments and bracing. Scheduled spinal adjustments will realign and shift the vertebrae back to neutral, while a back brace supports to prevent any deviation. Stretching and exercising relevant muscle groups is also part of a chiropractic treatment plan. An example is core exercises for strengthening the muscles supporting the spine.


Body Composition


Personalized Nutrition

Because the body is so complex and dynamic, there is no perfect fit when it comes to diet, exercise, or a combination. Fad diets typically recommend that individuals adhere to the same eating guidelines, indicating they will reach an expected result like fat loss. These diets work because they focus on a simple reduction in calorie intake, especially processed and fast foods. The problem is that some of these fad diets can restrict critical nutrients that negatively affect an individual’s health. More information about an individual’s body and how it works is an excellent resource in improving body composition and overall health. Personalized nutrition is an innovative and favorable approach to preventing and treating obesity and related conditions. This approach identifies:

  • Genetic markers
  • Dietary patterns
  • Environment
  • Metabolism

Educated recommendations can be made based on these factors.

References

Drabsch, Theresa, and Christina Holzapfel. “A Scientific Perspective of Personalised Gene-Based Dietary Recommendations for Weight Management.” Nutrients vol. 11,3 617. 14 Mar. 2019, doi:10.3390/nu11030617

Farcy, J P, and F J Schwab. “Management of flatback and related kyphotic decompensation syndromes.” Spine vol. 22,20 (1997): 2452-7. doi:10.1097/00007632-199710150-00025

Lee, Chang-Hyun, et al. “‘Lumbar Degenerative Kyphosis’ Is Not Byword for Degenerative Sagittal Imbalance: Time to Replace a Misconception.” Journal of Korean Neurosurgical Society vol. 60,2 (2017): 125-129. doi:10.3340/jkns.2016.0607.001

Lu, Daniel C, and Dean Chou. “Flatback syndrome.” Neurosurgery clinics of North America vol. 18,2 (2007): 289-94. doi:10.1016/j.nec.2007.01.007

Wiggins, Gregory C et al. “Management of iatrogenic flat-back syndrome.” Neurosurgical focus vol. 15,3 E8. 15 Sep. 2003, doi:10.3171/foc.2003.15.3.8

Fibromyalgia Altered Pain Perception Processing

Fibromyalgia Altered Pain Perception Processing

Fibromyalgia is a condition that causes pain throughout the whole body. It causes sleep problems, fatigue, and mental/emotional distress. It affects around four million adults in the United States. Individuals with Fibromyalgia tend to be more sensitive to pain. This is referred to as abnormal/altered pain perception processing. Research currently leans towards a hyperactive nervous system as one of the most plausible causes.

Fibromyalgia Altered Pain Perception Processing

Symptoms and Related Conditions

Individuals with fibromyalgia/fibromyalgia syndrome/FMS may have:

  • Fatigue
  • Sleep issues
  • Headaches
  • Concentration, Memory issues, or Fibro Fog
  • Stiffness
  • Tender points
  • Pain
  • Numbness and tingling in hands, arms, legs, and feet
  • Anxiety
  • Depression
  • Irritable bowel syndrome
  • Urinating issues
  • Abnormal menstrual cramps

Altered Central Pain Processing

Central sensitization means that the central nervous system, made up of the brain and spinal cord, processes pain differently and more sensitively. For example, individuals with Fibromyalgia could interpret physiological stimuli, like heat, coldness, pressure, as pain sensations. Mechanisms that cause altered pain processing include:

  • Pain signal dysfunction
  • Modified opioid receptors
  • Substance P increase
  • Increased activity in the brain where pain signals are interpreted.

Pain Signal Dysfunction

When a painful stimulus is felt, the brain signals the release of endorphins, the body’s natural painkillers that block the transmission of pain signals. Individuals with Fibromyalgia could have a pain-blocking system that is altered and/or not functioning correctly. There is also the inability to block repetitive stimuli. This means that the individual keeps feeling and experiencing the stimuli even as they try to block them out, suggesting a failure in the brain to filter out irrelevant sensory information.

Modified Opioid Receptors

Research has found that individuals with fibromyalgia have a reduced number of opioid receptors in the brain. Opioid receptors are where endorphins bind so the body can use them when necessary. With fewer available receptors, the brain is less sensitive to endorphins, as well as opioid pain medication like:

  • Hydrocodone
  • Acetaminophen
  • Oxycodone
  • Acetaminophen

Substance P Increase

Individuals with fibromyalgia have been found to have elevated levels of substance P in their cerebrospinal fluid. This chemical is released when a painful stimulus is detected by the nerve cells. Substance P is involved with the body’s pain threshold, or the point when a sensation turns into pain. High levels of substance P could explain why the pain threshold is low in individuals with fibromyalgia.

Increased Activity in the Brain

Brain imaging tests, like magnetic resonance imaging or MRI, have shown that fibromyalgia is associated with greater than regular activity in areas of the brain that interpret pain signals. This can suggest that pain signals are overwhelming those areas or that the pain signals are being processed dysfunctionally.

Triggers

Certain factors can trigger a flare-up. These include:

  • Diet
  • Hormones
  • Physical stress
  • Too much exercise
  • Not enough exercise
  • Psychological stress
  • Stressful events
  • Sleep Patterns changed
  • Treatment changes
  • Temperature changes
  • Weather changes
  • Surgery

Chiropractic

Chiropractic focuses on whole-body wellness. 90% of the central nervous system goes through the spinal cord. A misaligned vertebral bone can create interference and irritation on the nerves. Fibromyalgia is a condition related to the hyperactivity of the nerves; therefore, any vertebral subluxations will complicate and aggravate fibromyalgia symptoms. By realigning the misaligned vertebrae releases the stress off of the spinal cord and spinal nerve root. That is why individuals with fibromyalgia are recommended to add a chiropractor to their healthcare team.


Body Composition


Dietary Supplement Quality Guide

References

Clauw, Daniel J et al. “The science of fibromyalgia.” Mayo Clinic proceedings vol. 86,9 (2011): 907-11. doi:10.4065/mcp.2011.0206

Cohen H. Controversies and challenges in fibromyalgia: a review and a proposal. Ther Adv Musculoskelet Dis. 2017 May;9(5):115-27.

Garland, Eric L. “Pain processing in the human nervous system: a selective review of nociceptive and biobehavioral pathways.” Primary care vol. 39,3 (2012): 561-71. doi:10.1016/j.pop.2012.06.013

Goldenberg DL. (2017). Pathogenesis of fibromyalgia. Schur PH, (Ed). UpToDate. Waltham, MA: UpToDate Inc.

Kamping S, Bomba IC, Kanske P, Diesch E, Flor H. Deficient modulation of pain by a positive emotional context in fibromyalgia patients. Pain. 2013 Sep;154(9):1846-55.

Osteoid Osteoma of the Spine: Muscle Spasms, and Pain

Osteoid Osteoma of the Spine: Muscle Spasms, and Pain

Osteoid osteoma refers to a benign tumor/s that can grow on the spine as well as other areas of the body. They are not cancerous, but they can cause pain and abnormal curvature of the spine. It can begin as a small benign spinal tumor that can cause pain, especially at night. They do respond well to over-the-counter pain relievers and can go away on its own. However, if symptoms are unmanageable, other treatments are available.  
11860 Vista Del Sol, Ste. 128 Osteoid Osteoma of the Spine: Muscle Spasms, and Pain
 

Osteoid Osteoma

Osteoid means a type of tissue that eventually turns to bone. Osteoma means a type of tumor unique to bones. They are small typical size is less than one inch across. These growths represent around ten percent of all benign bone tumors, with one percent representing spinal tumors. They can appear and also affect the bones of the arms, hands, fingers, ankles, or feet. They are discovered on the spine around fifteen percent of the time. Osteoid osteomas of the spine affect the posterior, or back area of the vertebrae rather than the anterior, or front region. However, any area of the spine could be affected. But they are most common in the low back.
  • 60% affect the lumbar spine lower back
  • 27% affect the cervical spine or neck region
  • 12% affects the thoracic spine or middle back

Risks

Osteoid osteoma is not cancerous and will not spread out to the various organ systems the way malignant cancer does. It can be discomforting, painful, and could have to be removed. There are some risks associated with osteoid osteomas including:

Scoliosis

It could provoke muscle spasms of the erector spinae. These are the muscles that support the spine and could lead to scoliosis. The spine has a natural curvature. Scoliosis generates an S or C shaped curve to the left, right, or both ways affecting function and mobility. This type is more likely to contribute to the left or right curve of the spine affecting the lower back.  
scoliosis treatment el paso tx.
 

Incorrect diagnosis

Because osteoid osteoma can cause scoliosis, sometimes a doctor will focus on treating the abnormal curve instead of the osteoma.

Nerve root compression

Most individuals do not pose a risk for nerve root compression. But there is a risk if the growth begins to press against the spinal cord, as it can interfere with nerve function. This can lead to spreading/radiating pain and sciatica.
 

Causes

The causes of osteoid osteoma are not completely understood. What is known is that men are three times more likely to be diagnosed than women. Young people also pose a risk at development. It can develop at any age, but around eighty percent are diagnosed in individuals under 30 years of age. The core of an osteoma is a growth called a nidus. Inside are growing tumor cells, blood vessels, along with cells that progress to bone. A bony shell encapsulates the whole thing.

Signs and Symptoms

Osteoid osteomas usually cause a dull ache at the site of the tumor along with muscle spasms. The pain often gets worse at night. It can be relieved with non-steroidal anti-inflammatory medications like ibuprofen and aspirin. The pain can also be sharp, and occur during the day, worsening with activity and sometimes progressing to severe pain over time. In some cases, however, there are no symptoms.  
11860 Vista Del Sol, Ste. 128 Osteoid Osteoma of the Spine: Muscle Spasms, and Pain
 

Diagnosis

Doctors usually notice painful or swollen soft tissue around the tumor during a physical examination. There could be a lump, but this is rare. Imaging tests like an X-ray or a CT scan will be ordered. An x-ray can show the bone thickening, but a CT scan will show the nidus clearly as a dark center surrounded by white cortical bone. Sometimes a CT and MRI imaging scan is used in conjunction to diagnose osteoid osteomas. In some cases, a biopsy could be needed. This is taking a tissue sample and sending it to a lab to be examined under a microscope. However, this is rarely needed.  
 

Treatment

Nonsurgical

Non-steroidal anti-inflammatory medications can be effective relieving symptoms. If it can be controlled with just medication, then this could be the only treatment necessary. Some patients do well trying a different painkiller if the preferred medication no longer works. This needs to be discussed with your doctor, as chronic medication use is associated with issues like ulcers, kidney damage, and concerns about opioid addiction. When this approach is taken, the pain lasts for about three years with the lesion breaking down in five to seven years.

Surgical

If the pain cannot be controlled or the osteoma develops to scoliosis, surgery could be the next step. Most spinal osteomas are surgically removed with open curettage. It is a small incision. The nidus is scooped/scraped out and the cavity walls are removed with a motorized burr. Often a small amount of bone graft material is used to fill in the area. Unfortunately, surgical resection means having to stay at the hospital. Recovery time can be painful.

Radiofrequency ablation

For osteomas that affect the bones other than the spine, radiofrequency ablation. It is a minimally invasive outpatient procedure with a short recovery time. During the procedure, radiofrequency waves generate heat within the nidus around six minutes destroying the tumor. Surgeons use CT scans to precisely target the tumor. The procedure takes one to two hours and afterward, the patient waits in a recovery room for up to four hours. However, radiofrequency ablation is not as commonly used to treat spinal osteomas. This comes from the risk of thermal nerve damage. The needle tip can reach 194 degrees Fahrenheit, which is more than enough to damage the nerves. Candidates for radiofrequency ablation are usually young patients with no history of neurological problems. Osteoid osteoma is not as scary as it sounds, remember the best defense is a knowledgeable doctor and chiropractor. If back pain is presenting, do not wait to get treatment. There is a spine specialist who can help.

Chronic Pain Chiropractic Relief

 

 

Dr. Alex Jimenez�s Blog Post Disclaimer

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

Spinal Tumors

A spinal tumor is an abnormal mass of tissue either inside the spine or outside. It is also called a neoplasm meaning a new abnormal growth. They can develop in the bone, spread to other parts of the spine, or outside the spine, like the lungs and chest. Tumor cells can multiply slowly or very rapidly. Tumors are either cancerous or non-cancerous. They can develop anywhere in the spine:
  • Cervical – neck
  • Thoracic – mid-back
  • Lumbar – low-back
  • Sacral – sacrum
It is not uncommon for spinal tumors to develop out of a tumor from the individual’s breast, lung, kidney, prostate, or another area of the body that has spread out.  
11860 Vista Del Sol, Ste. 128 Spinal Tumors
 

Symptoms

Whether cancerous or not, spinal tumors can cause a variety of symptoms, including:
  • Pain not related to an injury or physical activity.
  • Pain in the back or neck that presents suddenly, quickly worsens, especially at night. This can be an indicator of a spinal tumor.
  • Pain that radiates to other parts of the body, like the arms, hands, legs, and feet.
  • The pain continues even when resting.
  • Muscle weakness or loss of sensation, especially in the legs, arms, or chest.
  • Difficulty walking
  • Abnormal curvature of the spine not from poor posture
  • Paralysis
  • Loss of bladder or bowel control
  • Lowered sensitivity to heat and cold
An individual could have a dominating symptom/s or a combination.

Causes

As previously mentioned these tumors can originally develop in another part of the body and then metastasize to the spine. These types of tumors are secondary tumors. Research scientists are still trying to figure out what exactly causes primary tumors that originate in the spine. One theory believes genetics plays a role.  
 

Early diagnosis

The most common symptom of a spinal tumor is pain. Examinations and diagnostic tests will be conducted both physical and neurological. A doctor or specialist needs to see and evaluate the spine. This is essential in diagnosing a potential tumor. A doctor could also order:
  • CT scan
  • MRI
  • PET scan – Positron Emission Tomography
  • Myelogram if there are symptoms of spinal cord compression
If the imaging reveals a tumor, a biopsy could be performed. A sample of tissue will be examined under a microscope to see if the tumor is cancerous or not. If the tumor is cancerous, the biopsy will show the type of cancer and determine the stage of the disease. Depending on the tumor type and location, other tests/procedures could be recommended.

Treatment

There are many factors that go into creating an optimal treatment plan. This includes whether the tumor is cancerous or not, size, location, and symptoms. Types of treatment:
  • Observe and wait as small non-cancerous tumors that are not growing or impinging/pinching other spinal structures could only need to be monitored for changes.
  • Surgery
  • Radiation treatment
  • Stereotactic radiosurgery works by delivering a high dose of radiation specifically targeted at the tumor
  • Chemotherapy

Chiropractor Personal Injury Attorney Recommended

 
 

Dr. Alex Jimenez�s Blog Post Disclaimer

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