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

It's football time...

It's football time alright, but what does this mean for you or your child?

Hopefully it doesn't mean injuries, but chances are you or your child could experience some type of injury. Most injuries in football are minor but with a quick response you can help that injury quickly dissipate. Most injuries like bumps or bruises can be treated on the sideline or at home by icing the injury. I recommend that ice be placed over the injury with a thin paper towel as a barrier to reduce to possibility of creating ice blisters or freezing the skin. I recommend that the ice be left on for approximately 20 minutes and checking the skin every 5 minutes. Young children should ice for about 10-15 minutes.

Football gear is obviously the most important part of the game. My experience of coaching and being a team physician is that equipment isn't checked often enough. Some helmets have an air bladder that should be checked daily for proper inflation. The helmet shouldn't be able to slide around the head! Chin straps should be checked as well. New chin straps will stretch during the breaking in process, so I suggest having your child place their mouth piece in and tighten the chin strap.

Head injuries have become a hot-topic in my profession and I can tell you that most physicians and coaches have little knowledge about handling these injuries. I attended the Los Angeles Summit on Sports Concussion this year and received the newest approach to concussive injuries. The Los Angeles Summit was attended by the whos who in head injuries. The information that has come out is now being enforced in the NFL, NCAA as being slowly addressed in high school football.

In the past when an athlete got a concussion, we would hold the player for a week after all the symptoms vanished. New studies suggest that the brain injury can still be present long after the symptoms have gone away. The important thing for a player or parent to understand is that there are new ways to discover if your athlete is safe to return to contact. You family physician or neurologist may not even know about the new details of these findings and its up to you to ask questions. I would suggest that you visit the impact website if you would like to do some research on your own at.
http://impacttest.com/about/background

If your child has had their "bell rung",

A. Common signs and symptoms of sports-related concussion

1. Signs (observed by others):

• Athlete appears dazed or stunned
• Confusion (about assignment, plays, etc.)
• Forgets plays
• Unsure about game, score, opponent
• Moves clumsily (altered coordination)
• Balance problems
• Personality change
• Responds slowly to questions
• Forgets events prior to hit
• Forgets events after the hit
• Loss of consciousness (any duration)

2. Symptoms (reported by athlete):

• Headache
• Fatigue
• Nausea or vomiting
• Double vision, blurry vision
• Sensitive to light or noise
• Feels sluggish
• Feels “foggy”
• Problems concentrating
• Problems remembering

3. These signs and symptoms are indicative of probable concussion.

There are some simple questions that you need to ask your child. If he or she misses any of these questions, please contact your doctor.

Orientation
Ask the athlete the following questions.

What stadium is this? What month is it?
What city is this? What day is it?
Who is the opposing team?

Anterograde amnesia
Ask the athlete to repeat the following words.
Girl, dog, green

Retrograde amnesia
Ask the athlete the following questions.
What happened in the prior quarter/period?
What do you remember just prior to the hit?
What was the score of the game prior to the hit?
Do you remember the hit?

Concentration
Ask the athlete to do the following.
Repeat the days of the week backward (starting with today).
Repeat these numbers backward:
63 (36 is correct) 419 (914 is correct)

Word list memory
Ask the athlete to repeat the three words from earlier.
(Girl, dog, green)
Any failure should be considered abnormal

If you think your child has suffered a head injury, please feel free to contact me at my office and will gladly help you.

Good Luck to Grace, Simi & Royal High School teams as well as the Viking & Patriot leagues.

Sincerely,

David A. Sommer, DC, CSCS, RSMT, CSMT

New Study: The Effect of Backpacks on the Lumbar Spine in Children

With all the questions and doubts that we have had about backpacks and how they affects our childrens backs, here is a recent study that has proven this topic to be true.

Neuschwander, Timothy B. MD; Cutrone, John MD; Macias, Brandon R. BA; Cutrone, Samantha; Murthy, Gita PhD; Chambers, Henry MD; Hargens, Alan R. MD

Abstract

Study Design. This study is a repeated measures design to measure the lumbar spine response to typical school backpack loads in healthy children. The lumbar spine in this setting was measured for the first time by an upright magnetic resonance imaging (MRI) scanner.

Objective. The purpose of this study is to measure the lumbar spine response to typical school backpack loads in healthy children. We hypothesize that backpack loads significantly increase disc compression and lumbar curvature.

Summary of Background Data. Children commonly carry school backpacks of 10% to 22% bodyweight. Despite growing concern among parents about safety, there are no imaging studies which describe the effect of backpack loads on the spine in children.

Conclusion. Backpack loads are responsible for a significant amount of back pain in children, which in part, may be due to changes in lumbar disc height or curvature. This is the first upright MRI study to document reduced disc height and greater lumbar asymmetry for common backpack loads in children.

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