Can knowing the characteristics of each stage of healing help expedite recovery for individuals who are healing after neck and back injuries?
Back or Neck Injury Healing Stages
At each stage, different things happen at the injury site. This means recommended exercises and activity levels will vary depending on how long it’s been since the injury. The stages to know about when healing from a neck or back injury. (Brumitt J., and Cuddeford T. 2015)
Inflammation or Acute Stage
Also known as the inflammatory stage, the acute stage occurs during the injury and can continue for 72 hours. The body releases repair chemicals in response to tissue damage, causing inflammation and pain. Symptoms of inflammation, including redness, swelling, pain at rest, and diminished function, are expected. Inflammation and pain during the inflammation stage are caused by the body’s repair chemicals released in response to tissue damage. (Wu, Y. S. and Chen S. N. 2014) The biological reaction decreases mobility so the injured area can rest and heal, but the substances that promote healing also cause pain and swelling. (Shah A. and Amini-Nik S. 2017) Scar tissue also begins to form during the inflammatory stage. (Wilgus T. A. 2020) Initial treatment focuses on reducing pain, swelling, and muscle spasms. Individuals are encouraged to use ice packs, compression, and over-the-counter anti-inflammatory medications like ibuprofen or naproxen. (Duchesne E., Dufresne S. S., and Dumont N. A. 2017)
Subacute Stage
Inflammation decreases, and new connective tissue and capillaries grow to help repair damaged structures. The subacute phase generates new connective tissue and capillary growth and reduced inflammation. (Brumitt J., and Cuddeford T. 2015) Scar tissue continues to grow during this time, as well. The tissues are still fragile at this stage, stressing the injured area should be limited to when the therapist or doctor is examining or working with the patient. Most physical therapists recommend beginning with gentle movement during the subacute phase and gradually building up the intensity of exercise. Mild isometric and low-intensity exercises are often used. Because activity is restricted, the muscles may seem weak. Depending on the severity of the injury and the type of tissue that was injured (i.e., tendons have less blood circulation and tend to heal more slowly, it can take a few days to several weeks. (Brumitt J., and Cuddeford T. 2015)
The Chronic Stage or Maturation
The inflammation disappears entirely during the chronic or maturation stage of neck or back injury healing. The new collagen fibers build strength, and the wound shrinks. (Brumitt J., and Cuddeford T. 2015) During this stage, pain associated with the injury tends to be limited to the end joint’s range of motion. The first ten weeks of the chronic stage are essential for engaging in exercises that enhance healing and help remodel the fibers so they will function as close as possible to the way they did before the injury. (Azevedo P. S. et al., 2016) Exercises during the ten weeks are important because otherwise, individuals can permanently lose some of their ability to move and function.
After around ten weeks, the scar tissue can permanently change, so re-acquiring strength and flexibility may necessitate surgery or manual release treatment from a physical therapist or chiropractor. During this time, the scar tissue can be remodeled with exercise, meaning that the activities and motions performed on the injured area will affect the formation of new tissue fibers. The chronic stage of healing begins after 21 days and doesn’t end after the 10-week prime time (Brumitt J., and Cuddeford T. 2015). It can continue for quite some time.
Treatment
Treatment focuses on engaging the injured muscles in light isometric contractions to help align new collagen fibers. Physical therapy helps rebuild mobility, strength, balance, and flexibility and can also help learn about injury and how to recover. A treatment that may also help during these phases is massage therapy. Extended bed rest or immobility can prolong symptoms and delay recovery. Tips to manage pain and recovery:
When sitting for long periods, get up and move around frequently.
Wear comfortable shoes.
When driving long distances, stop frequently to stand up and walk around.
Sleep on the side with a small pillow between the knees.
Limit how much weight is carried.
Add exercises gradually.
Most symptoms of back strain or sprain improve in about two weeks. Individuals may need additional treatment if symptoms continue for longer than two weeks. Maintaining exercises will continue to make the body stronger, more flexible, more functional, and pain-free.
Chiropractic Care for Healing After Trauma
References
Brumitt, J., & Cuddeford, T. (2015). CURRENT CONCEPTS OF MUSCLE AND TENDON ADAPTATION TO STRENGTH AND CONDITIONING. International journal of sports physical therapy, 10(6), 748–759.
Wu, Y. S., & Chen, S. N. (2014). Apoptotic cell: linkage of inflammation and wound healing. Frontiers in pharmacology, 5, 1. doi.org/10.3389/fphar.2014.00001
Shah, A., & Amini-Nik, S. (2017). The Role of Phytochemicals in the Inflammatory Phase of Wound Healing. International journal of molecular sciences, 18(5), 1068. doi.org/10.3390/ijms18051068
Wilgus T. A. (2020). Inflammation as an orchestrator of cutaneous scar formation: a review of the literature. Plastic and aesthetic research, 7, 54. doi.org/10.20517/2347-9264.2020.150
Duchesne, E., Dufresne, S. S., & Dumont, N. A. (2017). Impact of Inflammation and Anti-inflammatory Modalities on Skeletal Muscle Healing: From Fundamental Research to the Clinic. Physical therapy, 97(8), 807–817. doi.org/10.1093/ptj/pzx056
Azevedo, P. S., Polegato, B. F., Minicucci, M. F., Paiva, S. A., & Zornoff, L. A. (2016). Cardiac Remodeling: Concepts, Clinical Impact, Pathophysiological Mechanisms and Pharmacologic Treatment. Arquivos brasileiros de cardiologia, 106(1), 62–69. doi.org/10.5935/abc.20160005
Can the Oswestry Low Back Pain Disability Questionnaire help assess how low back pain impacts individuals’ ability to perform everyday tasks and activities and help physical therapists incorporate the outcome measure into an effective treatment plan?
Oswestry Disability Questionnaire
The Oswestry Disability Questionnaire, also known as the Oswestry Disability Index, provides objective data about an individual’s lower back pain. It determines the severity of the pain and how much it limits their daily activities. The questionnaire is a validated measure backed by research that can be used to justify the need for medical treatment. It includes questions regarding the symptoms and severity of low back pain and how these symptoms interfere with regular activities. Lower back pain can result from various causes (National Institute of Neurological Disorders and Stroke, 2020)
Arthritis, including inflammatory types of arthritis like psoriatic arthritis and ankylosing spondylitis.
Lumbar vertebrae compression fractures – usually from trauma or osteoporosis.
Low back surgery – including spinal fusions, discectomies, and laminectomies.
Spinal stenosis
Spondylolisthesis
Scoliosis
How The Questionnaire Works
The Oswestry Disability Questionnaire consists of 10 questions about the impact of lower back pain on daily life. The questions are divided into the following categories: (American Academy of Orthopedic Surgeons, N.D.)
Pain Intensity
How intense is the pain?
If painkillers are used, how much symptom relief do they provide?
Personal Care
Can the patient perform self-care activities like bathing and dressing when experiencing significant pain or limitations?
Whether physical assistance from another person is needed?
Lifting
Can the patient lift objects like weights with or without pain?
Can lifting be performed from the floor or a higher surface like a table if the objects are light, moderate, or heavy?
Walking
If and to what extent does the pain limit the patient’s walking distance and independence?
If an assistive device like a cane or crutches are needed?
Sitting
If so, how much pain limits the patient’s sitting tolerance?
Standing
If so, how much pain limits the patient’s standing tolerance?
Sleeping
If so, how much pain limits a patient’s sleeping duration?
Whether pain medication is needed to help the patient sleep comfortably?
Social Life
If and to what extent a patient’s social activities are limited because of pain symptoms?
Traveling
If so, to what extent does pain limit a patient’s ability to travel?
Employment and/or Homemaking Duties
Does pain limit a patient’s ability to perform job-related and/or household activities, including physically demanding and light duties?
Patients self-report the information and complete it on their own based on their understanding of the extent of their lower back pain and disability.
Each question can be scored between 0 and 5, with 0 indicating no limitations and 5 indicating complete disability.
The scores from all the questions are added together for a cumulative total score of 50 points.
Scores
The Oswestry Disability Questionnaire assesses how much a patient’s lower back pain limits daily activities. This information is used in clinical documentation for medical services. A higher score indicates a greater level of disability, according to the following scoring criteria:
0–4: No disability
5–14: Mild disability
15–24: Moderate disability
25–34: Severe disability
35–50: Completely disabled
Physical therapists must create individualized goals for each patient to develop a treatment plan and receive authorization from insurance companies. One of the most important aspects of a physical therapy goal is that it must be measurable. The Oswestry Disability Questionnaire provides a numerical score to track functional limitations and monitor the range of motion and strength testing. A baseline measurement is taken at the beginning of treatment, and progress is tracked in follow-up visits. A new score is used as a treatment goal. According to a study, the minimal clinically important difference (MCID) for the Oswestry Disability Questionnaire is 12.88. The MCID is the minimum score healthcare providers need to confirm a patient’s progress in function due to treatment. (Johnsen, L. G. et al., 2013)
By tracking changes in the total score before, during, and after treatment, healthcare providers can better assess whether treatment improves symptoms. A decrease in total score by 13 points or more would indicate that treatment is helping to improve a patient’s lower back pain and level of disability. Along with physical examination results, the patient’s score and the severity of symptoms can help healthcare providers determine an appropriate treatment plan.
No Disability
Treatment is unnecessary other than providing advice for lifting mechanics and general physical activity to maintain health.
Mild Disability
Conservative measures, such as physical therapy, exercise, hot or cold therapy, pain medication, and rest, are needed to help alleviate symptoms.
Moderate Disability
More aggressive intervention is needed, which can include extensive physical therapy services and pain management.
Severe Disability
Significant medical intervention is needed, including surgery, pain management, equipment like wheelchairs, and help from a caretaker.
Completely Disabled
Patients are either bedbound or have worsening symptoms, and a caretaker is needed to complete daily activities and self-care tasks.
Injury Medical Chiropractic and Functional Medicine Clinic
Improvements in range of motion, strength, and quality of movement and a decrease in total score can help show the treatment’s positive impact in managing lower back pain. A thorough medical exam and diagnostic tests, such as X-ray, MRI, or EMG, can help determine the underlying causes, discover the cause of the problem, and develop an effective treatment plan. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized treatment programs. Using an integrated approach to treating injuries and chronic pain syndromes to improve flexibility, mobility, and agility and help individuals return to normal activities. Our providers use Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers.
Johnsen, L. G., Hellum, C., Nygaard, O. P., Storheim, K., Brox, J. I., Rossvoll, I., Leivseth, G., & Grotle, M. (2013). Comparison of the SF6D, the EQ5D, and the oswestry disability index in patients with chronic low back pain and degenerative disc disease. BMC musculoskeletal disorders, 14, 148. doi.org/10.1186/1471-2474-14-148
Back pain is one of the most common reasons for seeking health care. Individuals dealing with back pain but don’t know the cause may have some inflammatory joint disease or autoimmune condition. Can seeing a rheumatologist help?
Rheumatologist
Depending on what’s causing the back pain, individuals may need to see their primary doctor for a referral. Individuals are recommended to see a rheumatologist if they have back pain that doesn’t come from an injury that doesn’t go away after a few weeks, pain that comes back after treatment, or symptoms that suggest a rheumatic condition. Rheumatologists treat severe or persistent back pain and are experts in autoimmune diseases, including lupus, Sjogren’s syndrome, rheumatoid arthritis, ankylosing spondylitis, axial spondylitis, Psoriatic arthritis, and other forms of inflammatory or autoimmune arthritis.
What Do They Do?
A rheumatologist is an internist or pediatrician who has completed special training in treating conditions that are:
Inflammatory
Autoimmune
Related to painful joint disease
The doctors diagnose, treat, and manage these conditions long-term. Depending on diagnosis and care needs, they may also lead or be part of a team that includes other healthcare providers.
Symptoms
When muscles ache, pain presents, or joints hurt, and especially if there are signs of inflammation that don’t go away, seeing a healthcare provider is recommended. Symptoms of inflammation include:
Redness
Swelling
Pain
Stiffness
Loss of joint function
Usually, to see a rheumatologist, individuals need a referral from their primary care provider and may be referred when:
There is no evidence of a back injury.
At-home therapies like heat application, prescription medications, or physical therapy are unsuccessful.
There is uncertainty about what’s causing the back pain, but I suspect it’s rheumatological.
Blood tests for inflammatory markers or certain antibodies yield abnormal results.
There is a diagnosis of a rheumatic condition and recommend a specialist to manage it.
There is a family history of a rheumatic or autoimmune condition that may cause back pain.
Some types of arthritis can cause permanent, progressive joint damage.
Conditions
Conditions that can affect the spine and cause back pain and are treated by a rheumatologist include: (Johns Hopkins Medicine, 2024)
Rheumatoid arthritis (RA)
This often starts in smaller joints of the hands and feet and later moves to the neck and/or back.
It can also affect different body organs and have systemic symptoms.
Ankylosing Spondylitis (AS)
Primarily a disease of the spine, it may also impact the shoulders, hips, knees, and ankles.
Systemic symptoms, including fever and fatigue, can manifest.
Axial Spondylitis
This primarily affects the spine, chest, and pelvis.
It may also cause problems with the connective tissue, eyes, bowel, and skin.
Psoriatic Arthritis (PsA)
Pain in the lower back is common, especially in severe cases.
It can affect other joints and cause psoriasis.
Reactive Arthritis
This is a reaction to infection.
It is more common in the limbs, hands, and feet joints but can involve the spine.
Enteropathic Arthritis
This mainly affects the spine but can include other joints.
It is associated with inflammatory bowel disease.
Autoimmune diseases that don’t specifically target the spine but can also cause back pain include:
Lupus
Sjögren’s syndrome
Hashimoto’s thyroiditis
Finding a Doctor
Individuals may be fine with their primary healthcare provider’s choice regarding which rheumatologist to see. However, they may want to research other options to ensure the right rheumatologist is chosen. Things to look at include:
Search online medical directories.
Visit the websites of the doctors being considered to learn more about their training, approach, and specialties.
Check online reviews.
Check on health insurance coverage.
Ask members of the healthcare team, friends, and family for recommendations.
Contact rheumatologists’ offices to see if they are accepting new patients.
Once decided, pass along the information to the primary care doctor so they can make the referral.
Preparing For The Initial Visit
Before seeing a new rheumatologist, take a few minutes to prepare so you can make the most of the appointment. Individuals will want to have:
A list of back-related symptoms, including frequency and severity.
A list of what makes symptoms better or worse.
A copy of recent test results and records from other doctors.
Individuals can ask their provider/s to send their medical information to the rheumatologist’s office in advance.
A list of treatments that have been tried and how well they worked.
A list of all medications, over-the-counter and prescription, supplements, and herbal products taken.
A list of medication allergies.
Complete medical history and family history of potentially related diseases.
A list of any questions regarding conditions, treatment, etc.
If possible, fill out any paperwork for the new office beforehand to save time on the appointment day.
Injury Medical Chiropractic and Functional Medicine Clinic
Talking with a healthcare provider is important. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized treatment programs. Using an integrated approach to treating injuries and chronic pain syndromes to improve flexibility, mobility, and agility and help individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers.
Individuals who sit in an office chair for a long period naturally tend to slouch over or slouch down into the chair. This posture can overstretch the spinal ligaments, strain the discs and surrounding structures in the spine, and contribute to or worsen back pain. Can the right office chair settings help relieve and prevent future injuries?
Work Office Chair
Sitting in an office chair for prolonged periods can cause lower back pain or worsen an existing back problem. The main reason behind this is that sitting is a static posture that increases stress in the back, shoulders, arms, and legs, putting pressure on the back muscles and spinal discs. Over time, incorrect sitting posture can damage the spinal structures. Most office chair customers base their decisions on availability, color, style, and price. However, it’s recommended that individuals learn about fitting seating equipment to their height, frame, or any condition, such as back or hip pain. The controls on or under the armrests and at the bottom of the chair seat, including the levers, paddles, and knobs, are there for a reason. Here are some recommendations for adjusting their work office chair to decrease back and hip pain.
Height Adjustment
The chair’s height affects the quadriceps, psoas, and hamstring muscles, which are important in posture-related back pain. Height adjustment is the primary way to change the angle of the hip joint while sitting. This angle affects the position of the pelvis and the degree of curve in the lower back, which can alter the spine’s normal alignment. (De Carvalho D. et al., 2017) Adjusting the chair’s height can provide a reference for other chair and workstation adjustments.
Back Angle
The hip angle is how close (increased hip flexion) or how far away (less hip flexion) the trunk is to the top of the thigh when sitting. Adjusting chair height can control the angle of the hip joint. When adjusting the height, adjust the degree of flexion at the hip joint to ensure ideal alignment for the individual body frame. A recent study measured the load that sitting has on simulated spinal discs. Researchers concluded that pressure on the spine can be relieved with a more open angle between the trunk and the thigh, that is, the hip joint angle. (Rohlmann A. et al., 2011) The backrest, seat tilt, and lumbar support features help maintain a pain-free back and relieve pressure and tension in the lower back and should be utilized.
Seat Depth
A kitchen chair, for example, may have no back supports or armrests to assist with posture and angle. (Holzgreve F. et al., 2022) When sitting, the individual’s back should be against the back of the work office chair for the best support and a healthy posture. Individuals will want to check and see how concave the seat surface is. If there is a prominent curve, this will cause the back to be rounded when sitting, which can become uncomfortable and lead to back pain. A chair with built-in support or a pillow can help adjust the depth. This means that chair size matters, as different people will need seats of varying depths to match their musculoskeletal structure.
Seat Height
Another way to understand the hip joint angle is to compare the height of the knees to the height of the hips. This is usually the easiest way to assess whether the chair height is right while adjusting. When the seat is right, the feet will be flat on the floor. The feet should reach the floor without causing pressure on the back of the thighs. Individuals with dangling feet, which may be because of their height, should place a footrest or thick book under them. The knees should be approximately level with or lower than the hips. In this case, the level is a 90-degree angle between the hip and trunk, which is stress-free on the hips and back.
Risks
Chair Too High
For individuals who can’t reach their feet to the floor, the chair is probably too high. The Occupational Safety and Health Administration (OSHA) says this is potentially hazardous because it can lead to scooting forward and forgoing the backrest’s support (United States Department of Labor, N.D.) Sitting like this is considered an awkward posture and a risk factor for work-related musculoskeletal disorders (MSD). Musculoskeletal disorders and symptoms caused by awkward sitting posture include muscle fatigue, swelling, pain, numbness, or decreased circulation. (Ng, P. K., Jee, K. S. and Lim, S. Y. 2016)
Chair Too Low
If the knees are higher than the hips, the chair is probably too low, causing extreme flexion in the hip joints. Most individuals’ backs can’t handle this well because their hip muscles are not flexible enough. If sitting with knees higher than hips, the position can cause lower back pain.
Taking Breaks
No matter how comfortable a work office chair is, prolonged static posture is unhealthy for the spine and is a common contributor to back problems and muscle strain. Remember to stand, stretch, and walk for at least a minute or two every half hour to prevent the back from staying in one position for a long period. A quick stretch or minimal movement, like a quick walk, will help. A longer walk will help even more, promoting blood circulation to supply nutrients to all the spinal structures.
Moving and stretching regularly throughout the day will help keep the joints, ligaments, muscles, and tendons loose and promote comfort, relaxation, and the ability to focus productively.
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop personalized treatment programs. An integrated approach to treating injuries and chronic pain syndromes improves flexibility, mobility, and agility, relieving pain and helping individuals return to normal activities. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers.
Low Back Pain: Impact and Chiropractic Solutions
References
De Carvalho, D., Grondin, D., & Callaghan, J. (2017). The impact of office chair features on lumbar lordosis, intervertebral joint and sacral tilt angles: a radiographic assessment. Ergonomics, 60(10), 1393–1404. doi.org/10.1080/00140139.2016.1265670
Rohlmann, A., Zander, T., Graichen, F., Dreischarf, M., & Bergmann, G. (2011). Measured loads on a vertebral body replacement during sitting. The spine journal : official journal of the North American Spine Society, 11(9), 870–875. doi.org/10.1016/j.spinee.2011.06.017
Holzgreve, F., Maurer-Grubinger, C., Fraeulin, L., Bausch, J., Groneberg, D. A., & Ohlendorf, D. (2022). Home office versus ergonomic workstation – is the ergonomic risk increased when working at the dining table? An inertial motion capture based pilot study. BMC musculoskeletal disorders, 23(1), 745. doi.org/10.1186/s12891-022-05704-z
Ng, P. K., Jee, K. S. & Lim, S. Y. (2016). Development of Ergonomics Guidelines for Improved Sitting Postures in the Classroom among Malaysian University Students. American Journal of Applied Sciences, 13(8), 907-912. doi.org/10.3844/ajassp.2016.907.912
For individuals dealing with stress, back and neck pain, and wanting to improve overall health, can trying a Hatha yoga class help?
Hatha Yoga Class
A yoga class is great for moms, athletes, or anyone interested in low-impact exercise. Today, many practice yoga for its mind and body, health and wellness benefits. Research shows that hatha yoga helps to reduce stress, relieve back and arthritis pain, support healthy habits, and improve emotional health. (National Center for Complementary and Integrative Health, 2023) Hatha classes stretch, unwind, and release tension, providing a healthy outlet for hectic lifestyles.
What Is It?
In Sanskrit, Hatha translates to force. Hatha yoga focuses on posture and breathing techniques to channel energy. Classes last 45 to 90 minutes and consist of breathing, poses, and meditation.
Yoga can help relieve everyday anxiety and depressive symptoms.
However, it may not be effective for clinically diagnosed mental health conditions.
The reviews and published studies on yoga did not find conclusive evidence to support its effectiveness in managing anxiety disorder, depression, or PTSD.
Arthritis and Fibromyalgia
According to the NCCIH, there is limited evidence to support yoga’s benefits for osteoarthritis, rheumatoid arthritis, and fibromyalgia.
Back Pain
The American College of Physicians recommends yoga as a non-pharmacological back pain treatment. (Qaseem A. et al., 2017)
A review of studies found that yoga improves low-back pain and function with both short-term and intermediate-term benefits, and its effects are similar to those of other types of exercise. (Skelly A. C. et al., 2020)
Balance
According to 11 out of 15 reviewed studies, yoga helps to improve balance in generally healthy individuals.
Emotional Health
Yoga has a positive impact on mental health. Ten out of 14 studies reviewed showed benefits in improving resilience or general mental well-being.
Menopause
Yoga can relieve physical and psychological symptoms of menopause, including hot flashes, according to the review of 1,300 study participants.
Mindfulness
In a survey of 1,820 young adults, participants attributed increased mindfulness, motivation to participate in other forms of activity, and eating healthier. (Watts A. W. et al., 2018)
Multiple Sclerosis
The NCCIH reports showed that yoga had short-term benefits on mood and fatigue in individuals with multiple sclerosis.
However, it did not affect muscle function, cognitive function, or quality of life.
Neck Pain
A 2019 meta-analysis, including ten studies and a total of 686 subjects, found that yoga can reduce neck pain intensity and disability pain while also improving the range of motion. (Li Y. et al., 2019)
Sleep
Several studies have found yoga can improve sleep quality and duration.
Populations found to experience sleep benefits include cancer patients, older adults, individuals with arthritis, pregnant women, and women experiencing menopause symptoms.
Stress Management
Yoga improved physical or psychological stress-related measures in 12 of 17 studies reviewed.
What to Expect
There are several different styles of yoga to choose from. Classes labeled yoga are likely the Hatha variety. Hatha is a gentle style that focuses on static poses and is great for beginners. However, it can still be physically and mentally challenging. Practitioners should wear athletic clothes and sports bras for maximum comfort and ease of movement. Each class varies depending on the instructor, but most last between 45 and 90 minutes.
Class Breakdown
Classes typically start with a gentle warm-up, advance to more physical poses, and end with a short meditation.
Breathing
Most Hatha classes start with a period of focus on breathing.
As you perform the poses, the instructor will continue to remind everyone to focus on breathing and may suggest different breathing exercises.
Poses
Yoga poses, also called postures or asanas, are a series of movements that help improve balance, flexibility, and strength.
Poses range in difficulty from laying flat on the floor to physically challenging positions.
If, during a class, a pose is too difficult, the instructor can provide a modified posture.
Meditation
Most classes end with a short period of meditation.
If you go into a Hatha class and it feels too slow or inactive, there are faster-paced, more athletic yoga classes, including flow, vinyasa, or power yoga classes. See if it’s more your speed.
Injury Medical Chiropractic Clinic
At Injury Medical Chiropractic and Functional Medicine Clinic, we focus on what works for you and strive to create fitness and better the body through research methods and total wellness programs. These programs use the body’s ability to achieve health and fitness goals, and athletes can condition themselves to excel in their sport through proper fitness and nutrition. Our providers use an integrated approach to create personalized programs, often including Functional Medicine, Acupuncture, Electro-Acupuncture, and Sports Medicine principles.
Qaseem, A., Wilt, T. J., McLean, R. M., Forciea, M. A., Clinical Guidelines Committee of the American College of Physicians, Denberg, T. D., Barry, M. J., Boyd, C., Chow, R. D., Fitterman, N., Harris, R. P., Humphrey, L. L., & Vijan, S. (2017). Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of internal medicine, 166(7), 514–530. doi.org/10.7326/M16-2367
Skelly, A. C., Chou, R., Dettori, J. R., Turner, J. A., Friedly, J. L., Rundell, S. D., Fu, R., Brodt, E. D., Wasson, N., Kantner, S., & Ferguson, A. J. R. (2020). Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update. Agency for Healthcare Research and Quality (US).
Watts, A. W., Rydell, S. A., Eisenberg, M. E., Laska, M. N., & Neumark-Sztainer, D. (2018). Yoga’s potential for promoting healthy eating and physical activity behaviors among young adults: a mixed-methods study. The international journal of behavioral nutrition and physical activity, 15(1), 42. doi.org/10.1186/s12966-018-0674-4
Li, Y., Li, S., Jiang, J., & Yuan, S. (2019). Effects of yoga on patients with chronic nonspecific neck pain: A PRISMA systematic review and meta-analysis. Medicine, 98(8), e14649. doi.org/10.1097/MD.0000000000014649
Can chiropractic treatment alleviate pain and correct swayback posture, a postural deformity that can cause lower back pain and mobility issues, for individuals experiencing it?
Swayback Posture
Swayback posture is a common dysfunction involving the pelvis and hip joints tilted forward in front. This causes the pelvis to shift forward, which exaggerates the curves in the lower and upper back, known as lordosis and kyphosis. The pelvis may tilt backward relative to the upper half, causing the buttocks to tuck under. The pelvis coordinates the movements of the head, shoulders, and trunk with those of the feet, legs, and thighs. A neutral pelvis, the ideal position, generally supports a mild curve/normal lordosis in the lower back. The small arch helps the body balance the skeletal parts as they work together to support and move the body’s weight. When a postural deformity occurs, one or more bones may shift from their ideal position to compensate for any pain or loss of balance caused by the original deviation. This deviation can lead to muscle strain, ligament sprain, and/or pain. (Czaprowski, D. et al., 2018)
Postural Deviations
Swayback posture causes the thoracic spine to move backward and round over into kyphosis. At the same time, the pelvis is tilted forward, resulting in an exaggeration of the normal lumbar lordosis. (Czaprowski, D. et al., 2018)
Healthcare providers, chiropractors, and physical therapists use exact measurements to define and treat postural deformities.
A neutral pelvis is a position of balance the entire body uses to help it stay upright, move, and be pain-free.
The ideal or neutral pelvic tilt is a 30-degree angle between the vertical and the plane that passes through the top of the sacrum and the axis of the hip joint socket in the front.
Swayback posture causes the pelvis to tilt forward another 10 degrees.
As a result, the spine compensates, exaggerating the curves in the lower back/lordotic curve and in the mid and upper back/kyphotic curve.
When viewed from the side, individuals can see a backward movement of the thoracic spine.
In front, the chest tends to sink in.
Muscle Group Imbalances
Healthcare providers look at different contributors or causes of postural deviations. Swayback can sometimes be associated with strength imbalances between muscle groups that move the hips, spine, and pelvis and hold the body upright. This includes:
Weakened hip flexors and overly strong or tense hip extensors/the hamstrings.
Tight upper abdominals, weak lower abdominals, and weak mid-back muscles may also contribute.
A corrective exercise program after seeing a physical therapist will help address some or all underlying muscle imbalances.
Risk Factors
Because weight in the abdominal region pulls the pelvis forward, pregnant women and obese individuals can have an increased risk of developing a swayback posture. (Vismara, L. et al., 2010)
Symptoms
The symptoms of swayback posture often include:
Severe lower back pain
Difficulty sitting or standing for long periods
Difficulty performing certain physical activities.
Tightness in the hamstrings and hip flexors
Tightness in the upper back muscles
Headaches or migraines
Chiropractic Treatment
Chiropractic adjustments are a common treatment used to correct swayback posture and can be corrected through various treatments. These include:
Spinal adjustments: The doctor applies pressure to specific spine areas to realign them and help restore proper spinal function.
Non-surgical decompression
Massage therapies
Muscle Energy Technique, or MET, improves muscle strength, flexibility, and function.
Acupuncture
Exercises to strengthen and stabilize the core muscles
Lifestyle adjustments to help reduce stress on the spine
Posture exercises
Biomechanics training
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop a personalized care plan for each patient through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility programs to relieve pain and help individuals return to optimal function. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
How I Gained My Mobility Back With Chiropractic Care
References
Czaprowski, D., Stoliński, Ł., Tyrakowski, M., Kozinoga, M., & Kotwicki, T. (2018). Non-structural misalignments of body posture in the sagittal plane. Scoliosis and spinal disorders, 13, 6. doi.org/10.1186/s13013-018-0151-5
Vismara, L., Menegoni, F., Zaina, F., Galli, M., Negrini, S., & Capodaglio, P. (2010). Effect of obesity and low back pain on spinal mobility: a cross sectional study in women. Journal of neuroengineering and rehabilitation, 7, 3. doi.org/10.1186/1743-0003-7-3
For individuals living with chronic pain and various diseases like Parkinson’s, arthritis, and diabetes, can water aerobics be beneficial?
Water Aerobics
Water aerobics are low-impact exercises performed commonly in swimming pools. It is a great way to exercise for a full-body, low-impact workout without overworking the body’s joints and muscles. Other names used include:
Aquafitness
Aqua aerobics
Aquarobics
Many types can be tailored to individual needs, injuries, and/or conditions. The exercises have various health benefits, especially for those who cannot perform higher-impact movements.
Individuals participating in water aerobics will need a bathing suit, towel, goggles, and a swim cap to protect their eyes or hair from chlorinated water. Individuals do not need other special equipment while exercising as the water acts as extra resistance. Foam dumbbells or paddles can be used to increase resistance. Other optional equipment includes: (Plunge San Diego, 2024) (Harvard Health Publishing Harvard Medical School, 2023)
Kickboards
Wrist and ankle weights
Water-jogging belts
Swim bar
Pool Exercises
There are many types of pool exercises to help reach health and fitness goals. They include:
Water Walking
The basic act of walking in water is a great way to get a full-body workout.
Start by standing in waist-deep water with the feet planted on the bottom of the pool.
Lengthen the spine by bringing the shoulders up and back and aligning the shoulders with the hips and knees.
Once in a good starting position, walk through the water, putting pressure on the heel first and then the toes, just like walking out of the water, while swinging the arms back and forth through the water.
This exercise can be done for five to 10 minutes.
The muscles that will get the most attention are the arms, core, and the lower body.
Arm Lifts
Stand up to the shoulders in water.
With the palms facing up, draw the elbows into the torso while lifting the forearms in front of the body up to the water’s surface.
Once at the surface, rotate the palms to face down and slowly move the forearms back down to the sides.
For more resistance, this exercise can also be done using foam dumbbells.
Repeat the action 10–15 times for one to three sets.
The muscles targeted are the core and the arm muscles.
Jumping Jacks
Water resistance makes jumping jacks in the water much more difficult than on land.
To perform, start by standing in chest-level water with your feet together and your arms straight down the sides.
Once in position, begin by simultaneously swinging the legs out to the side and arms over the head before returning to the starting position.
Muscles targeted include the entire body and cardiovascular system.
Add wrist or ankle weights for more resistance and to make the exercise more challenging.
High-Knee-Lift Extensions
High-knee-lift extensions are performed while standing in water that is waist deep.
To do the exercise, engage the core and lift one leg in a bent position until it is level with the water’s surface.
Hold the position for a few seconds, then extend the leg out in front and hold again.
After the hold period, move the leg back down through the water to the starting position while keeping it straight and flexing the foot.
Repeat on both legs for two to three sets of 15 reps per leg.
Use weights on the ankles to increase resistance.
The muscles targeted include the core, glutes, and lower body.
Risks
While exercising in water, individuals may not notice how much they sweat. This can make it seem like the workout is not as hard and can lead to dehydration. Individuals should always hydrate before and after a pool workout. Individuals who cannot swim well should avoid exercises that do not require a flotation device. Sometimes pools are heated, so choosing one 90 degrees F or below is recommended so the body doesn’t get overheated while exercising.
Stop Pool Exercises Immediately
Performing pool exercises can often seem easier than they are, leading to overworking. Stop exercising immediately if you feel:
Pain in any area of the body
Shortness of breath
Nauseated
Faint
Dizzy
Pressure in the upper body or chest
Other Health Conditions That Benefit
Water aerobics is recommended for most individuals, completely healthy or with a chronic disease. Those with chronic disease have been shown to benefit from the low-impact exercise. (Faíl, L. B. et al., 2022) One study looked at individuals with various health conditions, with the results showing that the following conditions saw improvements after 12 weeks of regular water exercise (Faíl, L. B. et al., 2022)
Diabetes
Arthritis
Fibromyalgia
Bone diseases
High blood pressure
Coronary artery disease
Stroke
Multiple sclerosis (MS)
Parkinson’s disease
While the benefits of water aerobics have been studied and proven effective, individuals should be cleared by a medical professional before starting any new exercise regimen. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution through an integrated approach to treating injuries and chronic pain syndromes, improving flexibility, mobility, and agility programs to relieve pain and help individuals return to normal. Our providers create personalized care plans for each patient. If other treatments are needed, Dr. Jimenez has teamed up with top surgeons, clinical specialists, medical researchers, and rehabilitation providers to provide the most effective treatments.
Pereira Neiva, H., Brandão Faíl, L., Izquierdo, M., Marques, M. C., & Marinho, D. A. (2018). The effect of 12 weeks of water-aerobics on health status and physical fitness: An ecological approach. PloS one, 13(5), e0198319. doi.org/10.1371/journal.pone.0198319
Faíl, L. B., Marinho, D. A., Marques, E. A., Costa, M. J., Santos, C. C., Marques, M. C., Izquierdo, M., & Neiva, H. P. (2022). Benefits of aquatic exercise in adults with and without chronic disease-A systematic review with meta-analysis. Scandinavian journal of medicine & science in sports, 32(3), 465–486. doi.org/10.1111/sms.14112
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