Always Learning

I just spent the weekend at a great seminar. After 15 years of practice, I finally made it to a Cox Decompression Seminar and I was not surprised about the amount of information that I learned. Dr. James Cox is without a doubt the biggest reason for the advancement of my profession in these last 3 decades. If you have been in my practice and treated by me then you most likely received a treatment that was founded by Dr. Cox.

His drive to advance the knowledge of our profession is un-paralleled and I appreciate it more everyday. I would also like to give Dr. Cox credit for these past blogs since it is his material. Life is about learning from others and spreading the word.

I hope that in the next few years, I can repay him with some case studies that will further help prove his efforts. I feel that I am at a time in my practice that I can start to explore in education of my colleagues.

If you would like to see more about Dr. James Cox, please follow this link. He has an enormous amount of material on his website.

coxtechnic

Part 4

VERTEBRA & SACROILIAC SUBLUXATION
There are many definitions of what a subluxation is but I will try and make it as simple as possible to understand. A subluxation refers to a joint that has moved from its normal position to a point that it’s stuck and is now affecting normal motion of itself and the joints adjoining it. When a joint becomes subluxated, pain receptors will “excite” and fire impulses which are recognized by the brain. The brain will then go into a protective mode which may cause many reactions like muscle spasms or inflammation. Joints are not meant to rub up against each other (in the case of a subluxation) but rather to glide by each other. Joints contain fluid to assist in movement and reducing friction but when a joint subluxates, the fluid can act as an adherent and keep the joint from moving back to its normal position. As a chiropractor, it’s my goal to locate a subluxated joint and move it back to its normal position. During this process (or what I call an “adjustment”) a “popping” sound may occur. The popping sound is created by separating the joint surfaces during the adjustment. Let me explain further; when two surfaces are pushed up against each other and they have a viscous material (joint fluid) between them, the fluid acts as an adherent. When you pull those surfaces apart it, a vacuum phenomenon is created. Once the vacuum phenomenon is released, a “popping” sound will be heard. I use the example of two wet pieces of glass against each other. If you tried to pull the wet glass apart it would be difficult, but once you broke the suction a popping noise would be heard. Maybe I went a little too far with my description, but many people ask about the popping sound. Some people envision the joint surfaces grinding over each other when it’s completely the opposite.

When a joint is subluxated many other things can be affected. Located around a vertebra are nerves that can become pinched which will often radiate pain to the surrounding areas of the back, the leg or arms (depending on which area of the spine we are talking about). Also, small muscles and tendons can be stretched which are also have pain sensitive nerves. The discs between the vertebrae can also become irritated by a subluxation. The main point is that having one joint subluxated can affect many surrounding areas and can create a great amount of discomfort. It must be pointed out that the longer a subluxation is left in place, the more possible the surrounding structures can be pre-maturely degenerated. So, if you suspect that something may have shifted in your spine, it’s important to get it checked as soon as possible. It’s not worth the possible headache!

Part 3

SCIATICA
Pain in the low back and leg (fig. 12 a,b,c) Is the most common symptom with pain during movement. The inability to bend and twist the low back is very evident. The amount of pain depends upon the severity of the disc protrusion. The pain in the low back and leg may be sharp stabbing pain, extending with seeing agony from the low back to the foot, or it may be of less severity representing a dull ache. The pain may be felt in the back or any area of the lower extremity supplied by the sciatic nerve. Usually, the pain is in one leg. The pain may be described as any of these sensations: burning, numb, pins and needles, worms crawling in the skin, tingling, or a feeling that someone has your leg in a vise and squeezing it. In severe cases, inability to move the leg may be evident.
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LEG PAIN (SCIATICA) DISTRIBUTION WHEN NERVES
ARE COMPRESSED BY A DISC BULGE
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Part 2

DISC INJURIES (Slipped Disc)
Figure 9 shows a normal disc and figure 10 shows a protruding “slipped” disc. The disc is a spongy pad which holds the vertebrae apart. The disc consists of outer rings of fibers which surround and contain a mass of gel-like fluid called the nucleus pulposus. The vertebrae above balances over the mass of fluid and depends upon it to allow the spine to be moveable. Loss of this disc material makes the spine move abnormally and any tearing or ripping of this disc may result in the substance of this nucleus shifting backward and gradually putting pressure against the sciatic nerve roots which results in back pain and, possibly pain down the leg as seen in figure 11.

The pain of a disc may stay in the low back or may radiate down the leg, usually in the back or side of the thigh and calf or front of the leg. Sometimes, one or more of the toes may become numb or tingle. Pain may be noted on the top or bottom of the foot or along the side of it. You will notice marked spasm in the low back. In many cases the patient will lean to either the right or left and find it painful to stand erect. Coughing, sneezing or straining may aggravate the pain.

There is a tear in the rubber band-like disc allowing the inner gel-like material to slip backward to pinch the nerve root.

Depending on the severity of the disc bulge, the pain (sciatica) will travel down the leg.

Happy New Year!

In my first blog report of the 2011 year I would like to begin a series of posts that will help educate my readers. It is often that I have patients come to my clinic after they have failed to get relief from other facilities and it’s my belief that this is usually due to a lack of a proper diagnosis. Since the lower back is the most common problem I will focus on the symptoms and diagnosis of the lumbar spine. Hopefully this information will help you understand all the possible scenarios of the lumbar spine. With this information you will have plenty of material that will help you ask the proper questions to your doctor. The topics that I will cover in the next few weeks will include the following:

1. Normal Anatomy & Disc Degeneration
2. Disc Injuries (Slipped Disc)
3. Sciatica (Leg Pain)
4. Vertebrae & Sacroiliac Subluxation
5. Facet Syndrome
6. Short Leg Syndrome
7. Spondylolithesis
8. Scoliosis
9. Transitional Vertebrae

LOW BACK & LEG PAIN
If you have lower back pain, you are not alone. Lower back pain with or without leg pain, afflicts 1 out of every 3 Americans. The pain in the leg is called sciatica and may occur in the buttock, thigh, leg, ankle or foot and represents irritation of the longest nerve in the body – the sciatic nerve. This nerve starts in the lower back where it is formed from the union of five nerve roots that come from the spinal cord. Most authorities state two basic sources of lower back pain – the intervertebral disc and the facet joints. There are many reasons why these structures create pain and will be covered in this series.

Part 1
NORMAL ANATOMY & DISC DEGENERATION
Figure 1 shows what a normal spine looks like. (A) Notice what a normal disc looks like. (B) Shows the normal facet articulations and (C) shows the opening where the nerve exits the spine.


Figure 2 shows what degeneration looks like. (A) Points to a degenerated disc which reduces the size of the hole where the nerve exits the spine (B)


The nerve that comes from the spine must pass through the narrowed opening then travels down the leg. Therefore, narrowing of the disc with misalignment of the joints causes pressure of the nerves by narrowing this opening. The loss of the disc height is called disc degeneration while misalignment of the joint is called a subluxation. Treatment of the back must be directed toward relieving the disc narrowing and the subluxation. Disc degeneration is sometimes referred to as Arthritis but this is a poor choice of term. Arthritis is not always the cause of pain but can be reaction from the body when disc height is lost and subluxation of the joint is present.
That’s why treatment with pain killers or anti-inflammatories doesn’t get rid of the problem. Your doctor needs to concentrate on reducing the pressure on the nerve.

Tis’ the season for back pain

As we push the clock forward this time of year a reaction of hibernation seems to fall in place. It’s colder, the sun doesn’t show its face very long and we become less active. What happens? We SIT! During the summer months, people are naturally more active. Long hours of sunlight after work gives us warm comfortable hours to recreate or do household activities.

As the sun sets around 4:45pm as compared to the summer sunset of 8:00pm we lose anywhere from 2-3 hours of daily activity. Multiplying that by 7days, gives us 14 to 21 hours of extra inactivity. I believe this is why we seem to have an increased amount of back pain this time of year. I repetitively ask my patients about this topic and they almost unanimously agree that they are more inactive this time of year. They find themselves in front of the television or computer wasting precious hours of activity. Their mind thinks that since its dark, it must be time to relax.

Sitting for long periods of time is a direct facilitator of lower back pain. Sitting creates an increased compressive force upon the fluid filled discs (the body’s shock absorbers) which compress upon the bony structures and sometimes the nerves. This will start a reaction from the muscles surrounding the spine to protect the spine by contracting (spasms). It also creates an inflammatory reaction within the cells which can ultimately create a “snowball” effect which leads to more symptoms in other body parts. If you are older and have degeneration of the spine, your time limit for sitting is decreased. You will most likely have pain much sooner than someone more youthful.

Many people then find themselves reaching for “over the counter” medications or going to their medical doctor only to get a prescription for pain medication and muscle relaxers. If you are given Vicodin (most often prescribed) then you become more tired because of the side effects of the drug (not to mention its addicting status). If you are given muscle relaxers then, well, you can guess how they will make you feel.

Here’s an example of a typical day:
Let’s say that you drive to work every day, then sit at a desk, then drive home only to sit the night away in front of the television or the computer, do you think it’s possible that you will end up with back pain? Most likely, yes…

What to do about back pain:
There are so many treatment possibilities at our disposal to remove back pain, but keeping back pain from coming is the best treatment of all. Daily stretching is a great start for eliminating chronic back pain. Seems simple enough, but you will be surprised about how good you will feel by including the easiest form of exercise (stretching) in to your daily life. You can go one step further by including a core exercise program, swimming or walking around your neighborhood.

In my 15 years of practice I have seen the scenario where people ultimately end up having back surgery because of their lifestyle (or lack thereof). If you find yourself with an increased amount of back pain, then there many treatment options available to you. I practice by the motto of; “Least invasive to most invasive”. What this means is, start with the easiest form of treatment and work your way onward. Going straight to the surgeon isn’t the best option. Be careful of the advice that is given to you by others. What did or didn’t help them isn’t necessarily the same for you. Each and every person’s condition is unique. Find a physician that has a good reputation. Chiropractic is often a great place to seek initial help for back problems. If you trust your medical doctor’s advice, then ask them which chiropractor they trust and use as a referral source.

I feel that our spine was a bad design for the way we use them for. We were born to hunt and gather, not to sit and watch. If you fall into this category and are experiencing back pain, I would suggest repelling against the winter instinct of shutting life down because the sun doesn’t shine. Stay active after dark!

Sincerely-

David Sommer, DC, CSCS, RSMT, CSMT

Injuries in youth sports – Overuse is a common cause

Sports participation for today’s skeletally immature athletes is greater than ever before. The demand of the youth athlete to participate in sports year round is commonplace. Most youth athletes are either in multiple sports with no sign of downtime in sight or they participate in one sport year-round. The injuries that I am seeing today are mostly due to the over training of these kids. The typical bump, bruise, sprain/strain have given way to a mass influx of overuse injuries like meniscal tears and cartilage injuries, osteochondritis dissecans of the knee, Little League elbow and Little League shoulder, stress fractures, patellofemoral pain, shin splints, Osgood-Schlatter disease, and Sever’s disease. The sad part of all this is that they are all preventable but I am finding that the pressure of not being there or falling behind out-weighs listening to their body. Many kids succumb to the pressure of their parents to press on and deal with the injury. Only when the athlete complains enough or they are sidelined, then parents seek treatment for their child, when they should have sought treatment the day the injury announced itself.

Often when these kids visit my clinic they deny my recommendation to cease participation and want enough treatment to keep them in the game (basically get them well enough to continue training or playing). Overuse injuries don’t quickly heal and most of these injuries can require taking an entire season off.

Many of these kids are touted as “elite athletes” or “scholarship” kids. The mindset of the parent or youth is that if they don’t get to train or play, they will fall behind. The fact is, the injury that they have can haunt them forever and may worsen to the point of surgical intervention or that they are no longer the “elite ones”. Training or playing with any injury can affect all the great mechanics that they have work so hard to develop. These injuries can also affect other areas of their body which can create further injury (the snowball effect).

The other scenario that I see is when a child has never been involved in sports and then they are thrust into a training regime that their body hasn’t had time to develop into. These kids show up to practice and are expected to catch up rather than slowly work them into to the sport. Running sports such as track and cross country coupled with soccer are a common scenario that creates lower extremity overuse injuries. When I see these kids for treatment in my clinic the parent is often only interested in getting their child well enough to get them out of pain and back into their sport. They don’t follow the recommendation of slowly working their way back into the training program.

I have pondered long and hard about why some kids get injuries and other don’t. The child’s frame and genetics play a huge part in how they their body will react to what is asked of it. Is your child overweight or do they have and eating disorder? Do they have alignment problems in their feet, knees and hips? Many injuries occur during rapid growth periods that creates muscular tightness (the bones are growing faster than the musculature). Extrinsic risk factors may include intensity and frequency of play, playing surfaces, protective equipment, and coaching.

I have read that Pediatricians emphasize, “A child is not a little adult.” In sports medicine, we must remember that, “A child athlete is not a little adult athlete.” Their bodies are constantly changing and the forces that are placed on their frame during development can create injury or affect the way their body continues to develop.

I suggest that if your child is in youth or high school sports that you be ready for an injury to occur. If you have a child that is involved in ongoing participation in sports then you need to have a plan of action for taking care of those injuries and also a plan about what you are ready to do when they need to take time off. For most injuries, the body heals well if given the opportunity. Time out from sports or at least modified activity is often needed. If I can be of any assistance or if anyone has any questions about their injury please feel free to contact me at my office.

Sportingly,

Dr. David Sommer, DC, CSCS