Chiropractic

Updated low back pain treatment guidelines

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One of the top medical journals – The Annals of Internal Medicine, has published a paper updating the guidelines for the treatment of low back pain. The paper is titled ‘Non invasive treatments for acute, subacute and chronic low back pain: A clinical practice guideline from the American College of Physicians” February 2017. The authors of the guidelines looked at studies of non-invasive (IE not surgical) interventions for treating acute, subacute and chronic low back pain.

It should be noted that acute pain lasts less than 4 weeks, subacute lasting between 4-12 weeks and chronic being pain lasting longer than 12 weeks.

The authors concluded that the following can help as a first line treatment (before taking medications) for acute/subacute low back pain:

  •  Heat
  •  Spinal manipulation
  •  Massage
  •  Acupuncture

Medication should only be considered if there has been no improvement. Patients should discuss the possibility of taking ibuprofen or muscle relaxants with their health care professional.

For chronic low back pain (lasting more than 12 weeks), the authors concluded that the following can help as a first line treatment:

  •  Exercise
  •  Rehabilitation
  •  Spinal manipulation
  •  Acupuncture
  •  Mindfulness based stress reduction – meditation

At Mona Vale Chiropractic Centre, we can use the above recommended techniques to assist and help relieve low back pain. Also, if you are not keen on having spinal manipulation, there are many other techniques that we can use to get the results you are after.

Click on the link to read the full article: http://annals.org/aim/article/2603228/noninvasive-treatments-acute-subacute-chronic-low-back-pain-clinical-practice

Mitchell Roberts – Chiropractor 

Sciatica

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Sciatica is a common presentation to the chiropractor. We often hear a patient saying they have a ‘pinched nerve’, but sciatica is normally not that simple as there are a number of factors that can cause it.

We will start of with some simple anatomy – The sciatic nerve arises from several segments in the lower back, in the lumbar and sacral spine, joining together to form one big nerve which travels through the hip, buttock and all the way down to the toes, branching out as it goes.

sciatic-nerve

Symptoms are often varied, although the main one is pain down the leg, with the ‘classic’ sciatica causing pain in the calf and foot. Other symptoms can include pins and needles, numbness and weakness of the muscles. Very rarely, losing function of the bowel and bladder can occur, which requires urgent medical intervention.

Causes: There are a number of causes for sciatica, here are the most common ones:

  • Disc – A herniation or rupture to a disc can cause leakage of disc contents into the spinal canal and thus place pressure on the nerve. Furthermore, inflammation associated with the injury can also irritate the nerve.
  • Bony growths – These can narrow the canal of where the nerve exits the vertebral column, reudcing the amount of space for the nerve to exit
  • Piriformis syndrome – In a small percentage of individuals, the sciatic nerve passes through the middle of the piriformis muscle (gluteal region). When it is tight it can compress the nerve
  • Joint strain – Inflammation from a joint sprain can irritate the nerve
  • Spondylolistesis – A forward slippage of the vertebra which can compress the spinal cord or exiting nerves

Sciatica causes

Diagnosis – Here at Mona Vale Chiropractic Centre we will perform a thorough history and examination involving orthopaedic and neurological testing to come to a diagnosis. If we believe you require imaging such as x-ray or MRI this can be arranged and we will refer accordingly. Communication with your GP will also occur and if we feel chiropractic treatment is not appropriate for your condition, a referral to the appropriate healthcare professional will be done.

Treatment – There are a number of different treatment options, some of the ones we use include: Adjustments and mobilisations, muscle releases, dry needling, stretching and rehabilitation exercises. The treatment will be aimed to address the cause of the sciatica through improving movement, decreasing inflammation and strengthening surrounding muscles.

What can be done in the meantime for sciatica? Keep moving is the simple answer! Avoid aggravating movements such as bending,twisting and prolonged sitting. Moving encourages blood flow through the joints and muscles to reduce the chances of the lower back from tightening up. Heat is recommended if the injury has been longer than 24 hours.

Mitchell Roberts – Chiropractor

Lumbar Supports

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Lumbar supports are a great idea for the office, car or airplane for that time when you know you will be sitting for an extended period. The good thing about lumbar supports is that you can use something simple – an inflatable lumbar cushion, a small pillow or even a rolled up jacket or towel.
The best position to place the support in is not the same for each individual, as it varies due to the curvature of your spine.The aim is to lengthen the muscles/tissues of the lumbar spine and try to feel that your spine is in a neutral position. Placing it directly onto your lower back may cause too much extension through the lumbar spine, so therefore start off by trying these 2 places:

  • At the bottom of your rib cage
  • Place it just below the belt line

Play around with the position of the support and vary it throughout the day. Also don’t forget to try it on the lounge at home for when you are watching television or reading!

Mitchell Roberts – Chiropractor 

 

Our sedentary lifestyle

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When we think about it, we do sit a lot. From watching TV, driving to work, to using the computer in the workplace and then using our computer at home – we sit for a very long time each day. It is estimated we sit for around 10-15 hours per day.

seats

So, just how bad is all this sitting? It has often been termed that ‘Sitting is the new smoking’. Dr James Levine from the Mayo clinic in the USA suggests that there are over 34 chronic diseases that are associated with excess sitting. These include type 2 diabetes, heart disease and even cancer.

What happens to our body during prolonged sitting? Our metabolism slows due to our cells not needing as much energy, our blood sugar levels and blood pressure both increase. When we are not moving, our muscles are not contracting. When muscles contract, it forces the sugar in our blood to be forced into the muscles to provide a fuel source for contraction. This is the reason type II diabetes occurs – our muscles are not using up the sugar in our blood stream.

How to minimise our seating:

Keep moving at work:

  • Get up and move for 10 minutes of every hour
  • Stretch your back and legs often
  • Walk over to your colleagues instead of emailing or calling
  • Use the stairs
  • Use a standing desk
  • Conduct walking meetings

Reduce the number of hours we watch TV, use tablets/laptops!

Making frequent posture changes is very important. Prolonged sitting does encourage more rounded shoulders, an increase in thoracic kyphosis (ie, hunchback) and a forward head carriage posture (head positioned in front of the shoulders). Breaks as short as 1 minute can even help with posture, you just need to change your static position!

A quick postural exercise:

Brugger’s postural exercise – Start by sitting on the edge of your chair with your arms hanging by your side, palms facing forward. Now rolls your thumbs out and back. As you do this, try and get your shoulder blades to touch each other in the middle of your spine. Add in a chin tuck, by tucking the chin straight back.

bruggers-postural-relief

 

Hold this position for roughly 10 seconds and perform 2-3 times. You can perform this exercise as many times as you want throughout the day. Also don’t forget to include this into your routine of getting up out of the chair and moving!

Mitchell Roberts – Chiropractor