All Posts tagged Low Back Pain

Chiropractor

Massage vs Laser Relief for Low Back Pain

Chronic low back pain is the most common musculoskeletal condition. The traditional treatments for acute or chronic low back pain have been surgery or narcotics, but the opioids epidemic has many doctors nervous about prescribing drugs like hydrocodone or oxycodone. Surgery hasn’t always worked and has its own risks. Are there other strategies for dealing with chronic low back pain? TheraLase laser is an effective non-invasive approach to helping you become pain free.

Have you ever suffered from back pain? It is estimated that 80% of Americans experience low back pain sometime during their life time. It can be triggered by poor posture or lifting something heavy. It can occur when a bulging disc presses on a nerve in the spine. Hopefully the back pain will go away. It’s one thing to have temporary back pain but another to suffer from a back injury that leaves you in chronic pain. Millions of Americans go through unrelenting and debilitating back pain after an accident or injury.

Chronic pain makes people irritable, touchy, tired, and it even alienates people socially. It can make it difficult to be around other people. They don’t want to see you suffering, anxious, and become depressed or feeling hopeless.

I use Theralase laser as a treatment approach offered to chronic low back sufferers who once felt desperate and helpless. Theralase laser helps to achieve beneficial therapeutic outcomes including the alleviation of pain, inflammation, and promotion of tissue regeneration. Chronic back pain doesn’t mean having surgery until you have tried TheraLase.

Call 310-444-9393 for an appointment

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Thera-band Launches CLX

In January 2015 Thera-Band will launch the CLX.

Dr. Jeffrey Tucker requested that Thera-band make a continuous loop band like the Stretch Strap and in 2014 they gave Dr. Tucker a prototype. He has been beta testing the CLX for a year before the ‘launch’ in his private practice in Los Angeles, CA. He put together routines based on traditional band and bodyweight training.

Dr. Tucker says “I combined my knowledge of anatomy and movement  into progressive CLX training” for my patients”. Dr. Tucker has 30 years of experience teaching patients flexibility and strength training. CLX represents an evolved fusion of the Thera-band Stretch Strap and Dr. Tucker’s fascial knowledge and bodyweight strength methods.

Many techniques are combined using the CLX – fascial stretch, PNF, muscle release techniques, static stretch techniques along with proper form and progressions.

“Those doctors, patients and athletes familiar with CLX will be ahead of the pack.  Come in and visit me to learn bleeding-edge exercises, new approaches, next-gen thinking in band training and therapy.”

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Laser Therapy

By Jeffrey Tucker, DC, DACRB

Therapeutic lasers are used for three primary indications: eliminating pain, reducing inflammation and accelerating tissue healing. There are different types of light forces such as LED’s, low powered lasers and high powered lasers or “super-pulsed” lasers.

I have more than five years of experience using a Class IV laser and, more recently, decided to add the Class IIIB in my practice. My choice to add a Class IIIB laser had to do with the depth of penetration and the ability to use laser without having to move the handle around on the patient’s dermis without fear of it getting too hot and burning the patient.

We are all familiar with going to the market, buying a light bulb, usually anywhere from 25 to 100 Watts. We’ve placed that bulb in the socket and felt the heat it generates. I’m sure your fingers have experienced the burn by that heat. Laser light is a type and source of energy that can generate heat. The light must be absorbed in order for a photo chemical reaction to take place. For my practice, I need a device that can penetrate this light source deep into the hips, shoulders, knees, low back, etc. The Class IIIB is able to penetrate four inches of tissue, whereas other light products with the low powered LED do not have the power in order to penetrate sufficient depth of tissue. If you are dealing with more acute injuries or superficial injuries, these systems would be fine, but if you are dealing with deeper tissues or more chronic conditions, you are going to need more powerful systems.

There are two methodologies used to increase power. One is the Watts. There are lasers that use a “super-pulsed” technology with a very high impulse function of 50 Watts across the laser diode. Remember what a 50 Watt light bulb would feel like on your fingers once it’s in the socket! So, for a fraction of a second there is 50 Watts of power at that tissue surface. This “super-pulsed” function is what allows the practitioner to hold the handle of the laser in one place without a hot burning sensation and for the light to penetrate up to four inches into tissues. We cannot leave 50 Watts of continuous power on the same spot of tissue because it would burn a hole through the patient. The “super-pulsed” delivery method provides an average power of 100 mWatts. The maximum permissible tissue exposure is 500 mW depending on the wavelength.

The second important method to increase power is getting light of the right color. Photochemists typically work in only a few sections of the electromagnetic spectrum. Some of the most widely used sections, and their wavelengths, are the following: Ultraviolet: 100–400nm; Visible Light: 400–700nm; Near infrared: 700–2500nm.

The class IV laser companies try to increase the power because they feel that more power is better. They are right up to a certain extent, once they go above 500 mWatt (half of watt), they now exceed the maximum tissue exposure and the Class IV lasers will deliver heat to tissues which is why they have to defocus the beams or use the roller tract ball at the end of the laser handle. The advantage of a roller ball or tract ball is that you can perform fascial release during the laser treatment. Again, the disadvantage to the class IV laser is that the practitioner has to keep the light moving otherwise if they hold it in one place it will burn the patient. The important thing about how lasers work is to get the right light wavelength down into the tissues.

All lasers (class I, class III, class IV), are tools that emit light and work on the ATP pathway. It is the emitted light from the laser that produces photochemistry and therefore photobiology. For the basic functions of the body (metabolism), we need food and we have to have oxygen, water and glucose. The glucose or the sugar molecule goes into the cell and gets transported into the mitochondria. Between the inner and outer membrane of the cell, the glucose molecule is transformed through a process called phosphorylation, which is known as Adenosine tri-phosphate which gets converted to the basic energy source of cells called ATP. The last source of the Krebs cycle or the citric acid cycle forms ADP to ATP and involves a Cytochrome which is a light sensitive protein. Our eyes see from 400 to 700 nanometers of light. At four hundred nanometers (400nm), we see violet, then blue, green, orange and yellow. Red is the widest bandwidth, the peak is at 660nm.

Lasers also use two other pathways to help the healing process. One is the nitric oxide pathway. Nitric oxide is a very powerful molecule but it has a very short term life. It causes endothelial cells to relax or become flaccid which causes temporary vasodilation in capillaries. Vasodilation causes more blood, more oxygen and more fuel molecules to the tissues and kicks off the lymphatic system to drain off more interstitial fluids. Some molecules are too big to go through the circulatory system and need to go through the lymphatic system. The nitric oxide causes the lymphatic system to become more leaky and allow more absorption of interstitial fluids. You can take a person with osteoarthritic knees or an inflamed knee and measure the circumference of the knee with a cloth tape measure. After you laser them for 10 to 15 minutes, including the lateral and medial joint lines, you will see a reduction in the measurement of the knee circumference. The lymphatic system is a very important system for the body. It drains fluid, swelling and facilitates the natural fluid flow in order to be healthy. By activating both the cardiovascular system and the lymphatic system you can affect healing at a much faster rate.

The most common reason patients seek our professional help is because of pain. No matter how hard I try to create a practice with patients coming in for diet, nutrition and exercise therapy, I am still known for helping people get out of pain, especially chronic pain. I have a lot of first hand experience using laser to help many people go on their happy way after seeking help and not getting full satisfaction from acupuncture, physical therapy, drug therapy,and surgery. Pain is a biochemical process and laser helps relieve pain.

A nerve cell receives a stimulus of pain, trauma, heat, cold or whatever type. The receptors force sodium outside of the cell wall and create a potential difference of 80 milli-Volt. When the sodium is outside, its very hard for it reintegrate back into the nerve cells. It has to go through a sodium- potassium pump. The peak absorption of lipids is 900 nanometers, so if you look at the lipid membrane of a cell it’s a bi-lipid membrane. By using 905nm light with the “super-pulse” technology we can make the lipid membrane more porous and allow faster integration into nearby channels. This promotes removal of noxious pain chemicals when patients are treated. After a laser treatment the patient will say my injury “feels different,” “my pain is less,” “it dropped from an 8 to a 4 out of 10,” “it feels like I have greater range of motion.” Why? Because we have rebalanced the sodium potassium, we produce a lot of nitric oxide and we took away the inflammation and accelerated the tissue healing by ATP.

I have been impressed with the many conditions that laser can affect: TMJ, traumatic brain injuries, neck pain, shoulder pain, low back pain, knee osteoarthritis, rheumatoid arthritis, epicondylitis, iliotibial band, chondromalacia patella, plantar fasciitis, achilles tendinitis and muscle stiffness. There are hundreds if not thousands of conditions to treat but only a few contraindications of laser light.

Because laser light is so powerful, on a square inch basis, it is 100 times more powerful than the sun. This light would be damaging to the eyes. We make sure we wear special glasses and don’t point laser into the eyes. If the light goes into the optical path, the cornea of the lens focuses 30,000 times onto the retina and you would cause permanent damage to the retina if it was a sustained dose. Luckily, we have a blink reflex, but having laser into the eye is one of the main contraindications. If you are working around the periphery of the face, you have to wear glasses. If they are face down on a table and I am working on the back, I ask them to close there eyes, and in this case they don’t need to have laser glasses. Another contraindication is cancer. We do not treat somebody who has cancer if they have not been clear for five years. We are also cautious not to treat the abdomen of a pregnant woman.

Laser is effective for nerve action growth, wound healing, damage to nerves either through surgery or trauma, diabetic ulcers, diabetic polyneuropathy, venous stasis, improving oxygenation and myofascial pain. Laser is noninvasive, has little known side-effects and is safe. In conjunction with exercise therapy, nutrition and our hands-on skills, it is a highly effective treatment. Compared to drugs like NSAIDs and Cox 2 inhibitors, there are no contraindications.

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Low Back Pain!

From personal experience I understand back pain. I’ve dealt with an unstable lower lumbar region and the consequence…on/off back pain, for the past twenty years. I have come to understand exactly what happens when we feel pain in the spine. I’ve learned through managing my own condition and treating thousands of sufferers in my Chiropractic Rehab practice – for nearly three decades – that when it comes to low back pain and treatment “One size does not fit all”.
 
Once you have had one bad episode of low back pain, having another episode is the nightmare every patient wants to avoid. Some people even have spent countless hours rehabilitating there low back, doing different modalities, core exercises, lumbar stabilization exercises, Pilates, etc, strengthening there back and hoping to avoid another episode. Then in the middle of a meeting, you just try to get up out of a chair, or get out of bed in the morning, or lift something heavy, and suddenly you feel low back spasm – with pains coursing up and down your back. You can’t move without increasing the intensity of the pain. It’s an awful feeling! 
 
Back pain – whether sudden or chronic, constant or intermittent – is debilitating for all active people. And without seeking effective treatment, it won’t go away. 
 
Don’t get discouraged. The low back can become balanced and enhanced naturally. Let’s start with the basics:
1. Overall nutritional support is essential, and I recommend the ‘low inflammation’ or Paleo diet, a good multivitamin and fish oils (about 2-4 grams of omega 3 per day).
2. Begin a walking program. Research has shown that walking briskly each day is as effective as Prozac for depression (which often accompanies back pain). Build up to 30 minutes 5 days a week. After three weeks of a half hour walking program you are ready for more vigorous cardio exercises. 
3. Get more sunshine – maybe while you are walking. Inadequate sunlight is a common cause of pain and depression. Take vitamin D3 daily.
4. Get eight hours of sleep every night.
5. Begin a foam roll program.
6. Ask your Chiropractor to give you floor exercises, body weight exercises, and help you to progress to strengthening exercises.
   
Prevention is ALWAYS better than the cure.  Protect your body by seeing a Chiropractor.

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Facts About the Spinal Discs

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.

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What Causes Low Back Pain?

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

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Karel Lewit, MD, said…

“The first treatment is to teach the patient to avoid what harms him.”

When you come in to see me I will perform an evaluation. My job is to help you manage your painful episode, but to also target & contain the risk factors. The number one risk factor for musculoskeletal injury is a previous injury. That means if you have had one painful low back episode you are more likely to have a second episode. My job is to help you lower that risk. The way I help my clients is by teaching them corrective exercises.

Even very small structural changes, if they occur over time, alter the muscles and joints ability to perform properly. Corrective exercise focuses on fixing the cause of pain, instead of just addressing symptoms, it works where many other remedies fall short.

Weakness and tightness are often attacked with isolated and focused strengthening and stretching protocols that don’t work. The majority of musculoskeletal pain syndromes, both acute and chronic, are the result of cumulative microtrauma from stress induced by repeated movements in a specific direction or from sustained misalignments. We need to teach the body how to develop proper movement so you can get out of pain.

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Should I workout first thing in the morning or at night?

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.

Conclusion:

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.

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Back Pain – Avoiding It

Here is some of the advice that I hear myself sharing with patient’s who suffer from low back pain.

Tip 1 – Don’t perform repeated bending over or heavy lift in the morning.

Don’t get right out of bed and start bending over to lift objects at home or for work. The lumbar disc pressure is greatest in the morning due to the uptake of fluid into the disc overnight. If the disc is pre-swollen and thus already has higher intradiscal pressure, then it makes sense to avoid any flexion (bending over, rounding your back) based movements early in the morning.

I love working out first thing in the morning. So I have to be especially careful when I bend over that I bend from the hips and not the lumbar spine. I make sure that I’m warmed up properly, and I do bodyweight squats before adding any loads to my deep squats or deadlifts. If you work in a manual labour based occupation, then if possible avoid the lifting jobs until a little later in the morning.

Tip 2 – Sit at work or the car  with a lumbar support

Avoid sitting in a slumped position. Sustained sitting postures tend to be a big factor in people who suffer flexion based back pain. If you have to sit for long periods, use a lumbar roll. Buy a McKenzie roll at Relax The Back Store, Acology on Wilshire Blvd., or use a rolled up towel to put in the small of your back.

Tip 3 – Regarding chairs at work & home

The biggest factor in back pain and back muscle fatigue is sustained poor posture – again, avoid slumping. The best chair in the world is useless if you don’t frequently change position. By this I mean getting up every 20 minutes. Stand up, reach both arms up to the ceiling as if you are pushing the ceiling upwards. Hold it for 20-30 seconds. If you have an ergonomic chair, change the elements of the chair such as height, pitch of the seat and angle of the back support often. While at work or driving long periods, every 1/2 hour change 1 element of the chair to share the load and fatigue around the spine-pelvis. If you have a poor chair, get a new one!

Tip 4 – Mattresses.

We move around a lot more in our sleep than you think – about 40 times per night. It may be a slight change in arm position, or flipping from one side onto the back. I’m not big on spending a ton of  money on a mattress. If your mattress is more than 10 years, you probably need a new one. If you wake up stiff in the morning, try another bed for a couple of nights. If you wake up feeling better, it’s your bed. Get a good quality mattress, usually medium firm is the right one. 

Tip 5 – Bending over

If you have to bend over to pick something up, then bend at your hips not at your back. A Romanian deadlift is an exercise/movement that involves bending over by pivoting the hips into flexion whilst keeping the spine in a neutral position. This is far more effective for protecting the lumbar spine from high disc pressure than bending from the spine or even deep squatting. When you deep squat to lift, most of us don’t have the flexibility in the hips to maintain a neutral pelvis position. What invariably happens is the pelvis posteriorly tilts (tilts backwards) and flattens out the lumbar spine. This is akin to flexing the spine and thus leads to higher disc pressures.

If the object you need to pick up is light and small, then use a golfers lift. This is performed by bending from the hips on one leg whilst the other leg extends straight out the back. Use one hand to support the balance on a table or chair.

Tip 6 – If you have pain, the sooner we talk the faster we can try home remedies and therapy 

If you happen to suffer an acute back pain episode, call me right away. 

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