Dr. Tucker has added SCENAR therapy to his treatment. This is the latest advancement in pain relief technology. SCENAR is a therapeutic medical device FDA cleared for acute and chronic pain, especially pain and stiffness in muscles and joints.
Here’s a link to three very specific exercises to help decrease low back and leg pain, as well as increase low back extension. To your health!
Sitting for long periods during the day predisposes people to injuries like low back strains and neck strains. It also can adversely affect your sports performance. Let’s see, you get up in the morning and go sit down to eat, then you get in your car and drive to work where you sit in your chair most of the day. Need I go on… yes! Large chunks of your day are spent sitting hunched over a computer, or slumped on the sofa. Unless you move around enough, you will feel some or all of the following problems:
- tight hip flexor, hamstring and calf muscles
- tightness through the external hip rotator muscles, which can lead to restricted movement at the hip joint
- reduced extension through the lower back, causing stiffness in the mid (thoracic) spine
- tight and hunched shoulders with weak lower shoulder muscles
- tight and weak muscles at the back of the shoulder
- “poked chin” posture and muscle imbalances in the neck and upper shoulders
Prolonged sitting is linked to hamstring strains, lower back stiffness, nerve irritation, and headaches to name a few things.
Scientific Fact 1 – The 2/3 rule If you were to look at a lumbar spine disc from above, it would look like an onion cut in half. You would see a softer jelly like centre and a system of concentric surrounding rings surrounding this jelly centre. The jelly is called the nucleus pulposis, and the rings are called the annular fibres. The interesting thing about the disc is that only the outer 1/3 of the disc has a nerve supply, the inner 2/3 has no nerves. This means that the inner 2/3 can be damaged, you simply just don’t feel it. However when discs fail, the rings progressively tear from the centre outwards. It is only when the fibres from the outer 1/3 start tearing that you will feel sharp back pain.
This explains many patients situation. Some of you have likely been progressively tearing fibres in the disc. Whatever incident that brought you into the office was the proverbial straw that broke the camel’s back. When the disc starts improving, the opposite happens. The outer fibres repair first. Even when you feel 100%, still give yourself 10 days of being careful as it is quite easy to tear back out to the outer 1/3.
Scientific Fact 2 – Pressure changes. In the 1960’s a clever Northern European by the name of Nachemson performed a neat experiment whereby he measured pressure changes in lumbar spine discs as body position changed. What he found out was that when we stand upright, the pressure on the lowest lumbar disc is about 100kg. When we sit straight, it jumps to 150kg. When we sit slumped (as most of us do), the pressure jumps to 200kg. When we stand and bend slightly over at the spine (imagine picking something up of a chair), the pressure is 225kg. Moral of the story is that activities or occupations that are flexion based will create the most disc pressure and have a greater chance of causing disc damage. The flexion based movements can be sudden or sustained. The 2 cohorts of the population most likely to suffer back pain are office workers (too much sitting in flexion) and manual labour workers (too much load in bending and lifting).
Scientific Fact 3 – Morning Pressure - When we lie horizontal at night, the pressure in our disc drops to about 25kg (on our backs) and 75kg (lying on our side). The decrease in pressure compared with standing results in the disc uptaking fluid. They effectively swell in your sleep. When you awake in the morning you are then actually a little taller for this reason. However, you are also more susceptible to either feeling a damaged disc (this explains why those with fresh disc injuries find it hard to get out of bed) or actually damaging a disc if you lift or bend over. Most acute back pain episodes admitted into Casualty wards occur before 9am in the morning. If you are going to hurt a disc, you have more chance of doing it first thing in the morning.
The answer is motor control. When the interaction between the nervous system, muscles and joints are good we have good motor control. A motor control error can result in a temporary reduction in activation to one of the intersegmental muscles. This may allow rotation at just a single joint to the point at which passive or other tissues could become irritated or injured. This explains how injury might occur just by bending over to pick up a pencil or other light loads.
Any motor control error can cause a short and temporary reduction in activation to one, or more, of the intersegmental muscles. Other common causes that lead to low back disc pain include:
* Flexing the spine over & over.
* Full flexion (bending over) with the following situations makes the spine more vulnerable:
1) excessive loads
2) insufficiently warming up the spine
3) bending over early in the morning
4) after prolonged sitting
“Manipulation or Microdisketomy for Sciatica? A Prospective Randomized Clinical Study,” (Journal of Manipulative and Physiological Therapeutics, October 2010, Vol. 33 Iss. 8, p: 576-584), researchers concluded that spinal manipulation was just as effective as microdiskectomy for patients struggling with sciatica secondary to lumbar disk herniation. The patient population studied included people experiencing chronic sciatica (symptoms greater than six months) that had failed traditional, medical management. Overall, 60 percent of patients who received spinal manipulation benefited to the same degree as those who underwent surgery.
According to the study, “Outpatient Lumbar Microdiscectomy: A Prospective Study in 122 Patients”, more than 200,000 microdiskectomies are performed annually in the United States, at a direct cost of $5 billion, or $25,000 per procedure. In this year-long study, consenting participants were chosen randomly to receive either an average of 21 chiropractic sessions over a year or a single microdiskectomy, both with the additional integration of six supervised active rehabilitation sessions and a patient education program. If cost is assumed at $100 per chiropractic visit, there is a direct, total savings of $22,900 per manipulation patient. System-wide, this could save $2.75 billion dollars annually.
“After a year, no significant complications were seen in either treatment group, and the 60 percent patients who benefitted from spinal manipulation improved to the same degree as their surgical counterparts,” says Dr. McMorland, who also points out that, “The 40 percent of patients who were not helped by manipulation did receive subsequent surgical intervention. These patients benefitted to the same degree as those that underwent surgery initially, suggesting there was no detrimental effect caused by delaying their surgical treatment.”
“Our research supports spinal manipulation performed by a doctor of chiropractic is a valuable and safe treatment option for those experiencing symptomatic LDH, failing traditional medical management. These individuals should consider spinal manipulation as a primary treatment, followed by surgery if unsuccessful.”
Personally I train in the morning. KNOW THIS: first thing in the morning we are up to 19mm taller in the seated position compared to the evening. This is due to the fact that during the night the disks between the vertebra in our spines become more hydrated with fluids. You literally are taller in the morning than when you go to bed at night. During the day we lose this liquid from or disks, in fact 90% of it is lost 60-90 minutes after getting out of bed.
Here’s how you can decide – if you perform a flexion movement of the torso (lean forward; touch fingers to the floor) as you get out of bed in the morning you will put up to 300% more pressure/compression on your disks. This can be disastrous for someone suffering from back problems. UNLESS you bend over and maintain a neutral spine.
People suffering from back problems should keep there backs in the “neutral spine” position as much as possible and avoid flexion and flexion with rotation of the torso, especially just after getting out of bed. Wait 60 – 90 minutes if you can’t bend without a neutral spine.
90% of back pain comes from muscle weaknesses and imbalances.
Four-year follow-up of surgical versus non-surgical therapy for chronic low back pain.
Ann Rheum Dis*. 2010;69:1643-1648.
Surgery is not superior to a short, intensive cognitive and exercise intervention among patients with common low back pain. This research suggests that surgical treatment for chronic low back pain may be overused. Nearly 80% of patients continue to experience some pain or disability at 1 year following their initial clinic visit for low back pain. In a more recent study of 973 primary care patients with less than 2 weeks of low back pain, the rates of returning to work were approximately 50% at 14 days and 83% at 3 months. The fact that many patients have lingering symptoms, in combination with the introduction and promotion of new surgical techniques and equipment, has led to an explosive increase in the use of surgery for low back pain.
Surgery did not improve pain or disability compared with usual care on intent-to-treat analysis. Prescribed exercises with chronic low back pain found that outcomes were similar in the surgical and nonsurgical groups.
Clinical Pearls – More than one fourth of Americans have experienced significant back pain in the past 3 months, and the total cost of low back pain exceeds $100 billion per year in the United States alone; – Surgical treatment of low back pain has become more prevalent; – In the current study, an intensive, brief program of cognitive and exercise treatment produced similar outcomes as surgical treatment of chronic low back pain; – The current study is in accord with previous systematic reviews of treatment for low back pain without significant anatomic changes (such as spinal stenosis) or symptoms (such as radiculopathy); and – Further research could highlight how to use elements of the intensive back rehabilitation program in everyday practice.