What Makes Low Back Pain So Common?
Clear Lake Doctor Comments: Low back pain (LBP) is one of the most common types of pain involving the musculoskeletal system. LBP sufferers may sometimes miss work or be unable participate in desired activities, social outings, and the like. It can be so disabling that out of desperation, they visit the ER.
There are many causes of LBP. Some of the obvious include over lifting/carrying, performing a task for too long or with too many repetitions, and sitting or standing in one position for too long. However, frequently LBP seems to occur for no apparent reason, or at least none that can be clearly identified. One of the most basic causes of LBP is simply standing on two, rather than four legs. When comparing a 4-legged to a 2-legged subject, arthritis of the spine and disc degeneration occurs much earlier in those of us with two legs. This is due partially because 2/3rds of our weight is supported by the low back and pelvis. In addition, vertical loading occurs in the 2-legged subject whereas the load is distributed between four legs in a horizontal fashion in the 4-legged species. Other less obvious causes of LBP include physical characteristics such as flat feet (fallen arches), a short leg resulting in a tipped pelvis, carrying too much weight, being out of shape/weak muscles, as well as hereditary factors. Non-physical characteristics include diet, exercise participation, lifestyle, stress and other psychological conditions such as depression, anxiety, bipolar disorders, and others. Hence, treatment must address the entire person, not just the low back since often, several of the characteristics mentioned here are present and often participating in the cause for LBP.
Because many of these characteristics are not properly attended to, LBP tends to be recurrent, where multiple episodes come and go over time. In years past, health care providers would focus the majority of their attention on the physical characteristics of LBP and when treatment results was ineffective, the blame was placed on the psychological aspects for which little, if any, treatment was offered. However, over the last 20 years, the shift towards treating the whole person or, adopting the biopsychosocial model (bio- = physical, psycho- = mental, and social = how LBP is perceived and affects daily social interaction) has been emphasized as the appropriate approach when managing patients with low back pain. No longer should the psychological aspect be ignored but rather, identified and treated so that this significant barrier to recovery can be properly managed.
Regarding treatment, unless someone presents with a “red-flag” which, for LBP sufferers include cancer, fracture (especially unstable fractures), cauda equine syndrome (spinal cord pinching resulting in bowel / bladder control loss), or infection, immediate/emergent care is not required. A careful health history followed by appropriate tests can usually identify these “red flags.” Otherwise, surgery for LBP is not recommended until at least 4-6 weeks of treatment with non-surgical approaches are first utilized and, an identifiable “lesion” can be identified that clearly is causing the presenting complaints and clinical findings. Chiropractic has an obvious advantage over specialty care when considering non-surgical treatment of LBP. Both physical and emotional issues are identified and a “team” approach with other health care providers when required is ordered. Moreover, all the international guidelines published for treating LBP recommend spinal manipulation BEFORE most of the other non-surgical approaches are tried due to medication side-effects and, the successes reported in many studies where spinal manipulation is performed.
Dr. Ward Beecher practices at Beecher Chiropractic Clinic at 1001 Pineloch, Ste 700 Houston, TX 77062. You can schedule an appointment with your Houston chiropractor or by calling (281) 286-1300. If you have any questions regarding this blog, please comment below!
Whiplash – The Cause of Pain
To download a copy of this newsletter, please click here.
Houston Chiropractor Comments: Many patients ask the question: “…why do I hurt so much now, and hardly hurt at all right after the accident?” Another common question is: “…why neck pain after a minor car collision can last so long?”
A study that investigated chronic pain and dysfunction in whiplash cases reported a soft tissue origin for injuries associated with low-speed collisions. This means the pain comes from the muscles, ligaments, joint capsules, the disk, but not from a pinched nerve that would send pain down the arm and/or create hand numbness or grip weakness. The study also reported the point at which the neck buckles would only take one fifth to one-fourth of the weight of the person’s head (approximately 2.5 to 3 pounds) if one were to remove all of the supporting muscles, ligaments, and joint capsules. With the muscles and soft tissues intact, there is a very complex buckling pattern that occurs in the neck during most rear-end collisions where the lower half of the neck bends opposite to that of the upper half creating an S-shaped curve (when looking at the neck from the side). When this occurs, the vertebrae in the lower half of the cervical spine extend backwards while the upper half flex forwards, stretching the ligaments beyond the maximum elastic point and tissue tearing occurs. When ligaments stretch or strain, microscopic tearing starts at only 3-5% of tissue strain and when the strain reaches 7-8%, the ligament begins to lose its load carrying capacity and more significant tearing occurs. Unfortunately, none of this can be seen on a standard x-ray and usually goes undiagnosed.
Many variables exist that make assessing the amount of tissue damage difficult to predict or understand. One of these variables is the strength and amount of elasticity of a ligament prior to tearing. Also, the age, gender, and phenotype – that is, skinny, normal, or over weight – makes a difference. Generally, due to a reduced muscle mass in a female compared to most males, women are at greater risk of injury. The position of the person in the car, whether a seatbelt was used or not, if the head was turned before impact, if the collision was anticipated prior to impact, the speed at which one person compared to another can voluntarily contract a muscle are all additional factors affecting the degree of injury and corresponding pain. Another factor is the size of the spinal canal (the place where the spinal cord runs from the brain to the low back) as some people are born with narrow canals, making them more susceptible to injury. Other neurological variables include the degree of the excitability of the nervous system as the more excitable, the lower the pain threshold and pain is perceived more quickly. The type of pain from the deep tissues (ligaments, joint capsules, etc) is different than pain arising from superficial tissues as the former lasts longer and doesn’t follow known neurological pathways into an arm. Also, over time, if pain becomes chronic (pain lasting >3 months), a significantly lower pain threshold is found in these cases vs. normal control subjects.
Hence, when discussing your case with our office, it is important that you share your history of the accident, the time it took after the impact for symptoms to be initially noted, whether it is gradually worsening over time, and any other symptom that is unique to your situation that may not have been discussed here.
Dr. Ward Beecher practices at Beecher Chiropractic Clinic at 1001 Pineloch, Ste 700 Houston, TX 77062. You can schedule an appointment with the best chiropractor in Houston or by calling (281) 286-1300. If you have any questions regarding this blog, please comment below!
Oh, My Aching…Leg?
NASA Area Chiropractor Comments: Certain low back conditions give rise to more than just low back pain. For example, leg pain can be more intense than low back pain, even though the cause of the leg pain is coming from the low back. When this happens, many patients complain that they have “sciatica,” which refers to radiating pain that starts in the low back and extends down into the leg. When the intensity of leg pain is worse than the low back, it can make patients wonder, “…where is my problem really coming from?”
To understand this better, a short “anatomy lesson” is appropriate. The spine can be divided into two halves, front and back. The structures in the front half include the larger, heavier bones called vertebral bodies and the shock absorbing cushions that lie between the vertebral bodies called the intervertebral disks. The disk is like a jelly donut where the center is liquid-like and the outer portion is a tough, criss-cross pattern cartilage arranged like the rings on a tree stump. There are also ligaments that hold the vertebrae and disks tightly together. The back half of the spine includes the spinal cord, nerve roots, as well as the small joints of the back called facet joints. Every movable joint has a joint capsule that helps lubricate the joint and limits the amount of movement, along with surrounding ligaments. The larger, heavier vertebral bodies and shock absorbing disks carry the majority of the weight (approximately 80%) while the smaller facet joints carry much less weight (only 20%) but are more responsible for guiding the movements of our back.
When leg pain is present, it can be caused by either a pinched nerve, or, an inflamed facet joint.
When a nerve is pinched, the cause is usually from the intervertebral disk where the jelly-like center leaks out and presses on the nerve that goes down the leg, commonly referred to as a “herniated disk with sciatica.” This type of pain is quite specific, easy to describe and often extends below the knee to the ankle or foot. It can include muscle weakness, numbness in certain areas of the leg, and bending forward increases low back and leg pain while bending backwards reduces the leg pain (and sometimes the LBP).
When a facet joint capsule tears (technically, called a “sprain”), the pain is “referred” down the leg in a generalized, non-specific manner, usually described as a “deep ache,” often hard to describe and usually does not go below the level of the knee. Here, it feels better to bend forward and worse to bend backwards, of which neither movement changes or affects the leg in a specific way. Disk related leg pain carries a potential for surgery if all non-surgical approaches fail, while facet joint referred leg pain rarely requires invasive treatments or surgery.
The good news is that both of these sources of low back and leg pain are very treatable with chiropractic care! The important point to remember is that obtaining prompt treatment, when symptoms first appear is best – as waiting and hoping it will subside on its own often results in a longer treatment course and is less satisfying for all concerned.
Dr. Ward Beecher practices at Beecher Chiropractic Clinic at 1001 Pineloch, Ste 700 Houston, TX 77062. You can schedule an appointment at BeecherChiropractic.com or by calling (281) 286-1300. If you have any questions regarding this blog, please comment below!
Headaches and Posture
To download a copy of this week’s newsletter, please click here.
Houston Area Chiropractor Comments: Have you ever glanced at your reflection in a storefront window or mirror as you walked by and noticed your posture? Scary, isn’t it? We all know that we should stand up straight but we soon forget when we get busy and stop thinking about it.
Poor posture is often due to years of standing slouched and this bad “habit” usually starts at a young age. Just look around when you’re in an airport or shopping mall and notice the many people 
have poor posture. In fact, people’s posture may reflect their attitude – if they’re happy, sad or depressed. Poor posture may be related to self-consciousness, especially during adolescence. It is also genetic as we frequently see a “trait” throughout family members with similar postural tendencies.
The most common postural fault associated with headaches is the forward based head and shoulders. From the side, it appears that the head is significantly forward relative to the shoulders, the upper back is rounded forward and the shoulders are rolled forwards and rotated inward. One exercise that helps reduce this postural bad habit is tucking in the chin and pretending a book is balancing on top of the head. The objective is to not allow the book to slide forward off your head and land on your toes!
It takes approximately 3 months of CONSTANT self-reminding before the new “good habit” posture becomes automatic, so be patient. Soon you’ll “catch yourself doing it right” without thinking about it.
Frequently, posture is faulty lower down the “kinetic chain.” The first link of the chain is the feet and the last link is the head. Since we stand on two feet, any change in that first link or the feet, can alter the rest of the chain, especially areas furthest away – the head, resulting in headaches. For example, if one leg is short, the pelvis drops, the spine shifts (scoliosis), the shoulder drops and the head shifts trying to keep the eyes level. A short leg usually needs to be managed with a heel lift, an arch support or combination of both to properly treat the headache patient.
Most health care providers EXCEPT Chiropractic Physicians typically ignore these issues. Chiropractic Doctors are specifically trained to analyze posture and correct it. You can depend on our clinic for up-to-date treatment approaches such as these.
Dr. Ward Beecher practices at Beecher Chiropractic Clinic at 1001 Pineloch, Ste 700 Houston, TX 77062. You can schedule an appointment at BeecherChiropractic.com or by calling (281) 286-1300. If you have any questions regarding this blog, please comment below!
Headaches and Different Management Options
To download a copy of this newsletter, please click here.
Houston Chiropractor Comments: Headaches are one of the more common conditions that enter the offices of primary care physicians, including chiropractors. The standard medical treatment revolves around the use of medications and/or injections. The standard chiropractic treatment approach includes manual therapies that may include spinal manipulation or adjustments, manual or mechanical cervical traction, mobilization techniques, trigger point therapy, physical agents or modalities such as electrical stimulation, ultrasound, etc., and nutritional counseling. While both approaches have their pros and cons, there are far less side effects associated with the chiropractic treatment option.
Headaches can generally be classified as primary or secondary. Primary Headaches include Migraine, Tension, and Cluster. Secondary headaches occur because another condition or injury is present such as after a car accident or slip and fall injury, due an infection, a sinus, jaw, and/or dental condition, a vascular injury such as stroke, a medication side effect, psychiatric disorder and others.
Treatment for patients with headaches is dependent on the cause. Choosing a type of health care service for the treatment of headache can be a difficult choice. When considering the use of complementary and alternative medical approaches available to patients with chronic tension-type headaches, a recent report revealed that 40% of 110 patients surveyed utilized some form of an alternative/complementary medical approach. The most frequently utilized was chiropractic (21.9%), followed by acupuncture (17.8%), and massage therapy (17.8%).
If you find yourself frequently utilizing over-the-counter medications such as an anti-inflammatory drugs (ibuprofen: Advil, Nuprin; Naprosyn such as Aleve) or Tylenol, it is probable that the chiropractic management approach will benefit your headache condition.
Frequently, in patients with headaches, the vertebrae in the upper neck lose their normal range of motion and the muscles in that region that attach to the base of the skull become overly tight and squeeze or compress the nerves that feed into the head. This results in radiating pain over the top or around the head, sometimes into the eyes. Chiropractic care can make it easier for you to move your head and neck forwards, back, rotate or twist, and side bend. This, in turn reduces the muscle tension and nerve pinching, which reduces headache pain.
Dr. Ward Beecher practices at Beecher Chiropractic Clinic at 1001 Pineloch, Ste 700 Houston, TX 77062. You can schedule an appointment at BeecherChiropractic.com or by calling (281) 286-1300. If you have any questions regarding this blog, please comment below!
Best Sexual Positions for Back Pain
Clear Lake Chiropractor Comments: Back pain isn’t just one of the most common reasons for people to miss work; it can also affect your sex life. But new guidelines based on how the spine moves during intercourse could help. A frequently asked question is “How can I have sex without causing further damage or pain to myself or my partner?” People are sometimes embarrassed to ask the question, but it is information that they need.
First, people need to understand that there is an emotional aspect to back pain. Back pain can cause stress. The partner who does not have back pain can have a lack of understanding and perceive the stress and reluctance to have sex as a personal rejection and/or resentment. Research has shown to taking it slow and being patient is beneficial. Start off with a light massage, shower or even just gently rubbing in a soothing pain lotion to help loosen the muscles.
Back pain affects 8 out of 10 people at some point in their lives, and low back pain is the main reason for disability. Regarding sex, doctors used to recommend the spooning position for people with back pain, despite a lack of scientific evidence to support it. Also, a sex position that’s appropriate for one type of pain, might not work for another type of pain.
For men who have an increase in pain while bending forward or after sitting for a period of time, the best positions will be a modified “doggy-style” position while their partner supports their weight on either their hands or elbows. If pain is increased by flexion and motion, then a modified “missionary” position is suggested where the man supports his weight on his hands and his partner flexes their hips and knees. If extension causes back pain, it is suggested that this position is modified so that his weight is supported on his elbows. Another position that is suggested for men with extension related pain is the side position or “spooning”. This will help to minimize the pain from extension and minimize the weight bearing.
For women who have an increase in pain when they sit too long or flex forward to touch their toes the best position are ones that minimize spinal flexion like spooning or “doggy-style” with their weight supported on their hands or elbows. If the pain is increased with extension or arching their back then the best position is a modified “missionary” position with their hips and knees flexed.
The good news is that healthy sexual relations will help to minimize stress which ultimately helps to reduce back pain.
Dr. Ward Beecher practices at Beecher Chiropractic Clinic at 1001 Pineloch, Ste 700 Houston, TX 77062. You can schedule an appointment at BeecherChiropractic.com or by calling (281) 286-1300. If you have any questions regarding this blog, please comment below!
Did You Know This About Low Back Pain?
To download a copy of this newsletter, please click here.
Clear Lake Chiropractor Comments: If you have low back pain (LBP), you are certainly not alone. Almost everyone at some point has back pain that interferes with work, daily activities, and/or recreation. Americans spend at least $50 billion each year on LBP. It is the most common cause of job-related disability and a leading contributor to lost work time. Back pain is second to headaches as the most common neurological condition in the United States. Fortunately, most occurrences of LBP go away within a few days. Others take much longer to resolve or lead to more serious conditions (1).
There are two types of low back pain – acute and chronic. Most episodes of acute LBP last from a few days to weeks, are not neurological and usually do not carry a high level of surgical risk. The 
cause of LBP can be difficult to isolate because often, while the cause is cumulative where multiple events over time, the last activity the patient recalls is “bending over for a pencil.” This, by itself is not likely to cause an acute onset of LBP. Low back pain can be caused by trauma such as sports injuries, work around the house such as garden work, car accidents, and others. Chronic low back pain, by definition, is LBP that lasts more than 3 months and the cause can be more difficult to identify and is often cumulative and superimposed on a prior condition such as degenerative disk or joint disease. A real problem is the rate of recurrence or, chronic, recurrent low back pain where pain may subside but returns at various rates of frequency and duration. This category affects a high percentage of the population and represents the true challenge in spine care management.
As people age, their bone strength and muscle stretch, strength and tone usually decreases due to lack of activity. When the disks begin to lose fluid and flexibility, their ability to cushion the vertebrae and function as “shock absorbers” also decreases. Disks can tear, bulge, and/or herniate which results in localized LBP and/or radiating pain that follows the course one or more of the 31 pairs of nerve roots (eg., “sciatica” down the back of the leg). Soft tissues such as joint capsules and ligaments lose their capacity to stretch and can tear more easily, resulting in a sprain or strain (muscle/tendon injury). Other conditions that either cause or contribute to LBP include arthritis, obesity, smoking, pregnancy, stress, poor posture and/or physical health, and can lead to unsatisfied patients if these co-contributors are not properly identified and discussed. Less commonly, LBP can be caused by a more serious condition such as cancer, fracture, infection, spinal cord compression, and various internal conditions (3). Emergency care may be indicated in these circumstances.
At Beecher Chiropractic, we will perform a complete examination, consider other contributing causes, and will treat the problem(s) causing the LBP condition. If needed, working with other allied health care providers will be arranged. Exercise, dietary recommendations, ergonomic or work modifications, spinal manipulation, and modalities will all be considered to help eliminate or control of the LBP. Methods of self-managing the LBP will be emphasized.
Dr. Ward Beecher practices at Beecher Chiropractic Clinic at 1001 Pineloch, Ste 700 Houston, TX 77062. You can schedule an appointment at BeecherChiropractic.com or by calling (281) 286-1300. If you have any questions regarding this blog, please comment below!
Carpal Tunnel Syndrome and Some of Its Causes
Clear Lake Chiropractor Comments: Research has shown certain work practices and risk factors, such as being overweight, can elevate your risk for developing carpal tunnel symptoms.
As a chiropractor, I often look to the spine when my patients have nerve pain. Many people with carpal tunnel syndrome have a history of a whiplash injury or other neck trauma. But how can a neck injury make me susceptible to carpal tunnel? Simple. When you sprain the ligaments in your neck, this can cause damage and inflammation, which can irritate a nerve where it exits the spinal cord and courses between tiny bones to eventually reach your hand. If the nerve is irritated at the neck region, then this makes it more vulnerable to compression as it passes through the wrist tunnel. Signs that your carpal tunnel pain is a neck problem include shoulder and neck pain and/or a history of a neck trauma.
How can this possibly be fixed “chiropractically”? The first step is to diagnose if you have a primary wrist or neck problem, or a problem with both areas. A thorough examination of the neck, 
which may include x-rays, is important. The carpal bones of the wrist can be out of alignment or the vertebrae in the neck can be out of normal position. A specific adjustment can help to correct the abnormal posture and restore mobility.
You may also need to do strengthening exercises, especially if the condition is long-standing or you’ve worn a brace. The muscles of the lower arm are integral to providing wrist support and optimum function
Contractures can develop over time as well, fixating the nerves and not allowing them to glide normally with movements. Deep tissue therapy such as “pin and stretch” and deep massage and break up knots and tight tissues or scarring.
With most patients, alignment is an issue, as is flexibility and strength. I consider the cause of most carpal tunnel symptoms to be multifactorial. Not one exercise, or one pill, or even one adjustment, is right for everyone. However, it’s important to consider conservative options first before deciding on invasive surgery. Even rest and taking pain pills is not really exploring all of the potentially conservative options available.
Dr. Ward Beecher practices at Beecher Chiropractic Clinic at 1001 Pineloch, Ste 700 Houston, TX 77062. You can schedule an appointment at BeecherChiropractic.com or by calling (281) 286-1300. If you have any questions regarding this blog, please comment below!
Minimizing Your Whiplash Risk
Houston Area Chiropractor Comments: While it is hard to prevent someone from crashing their car into your car, there are some things you can do to minimize whiplash injuries.
The first preventive measure is making sure your seat is upright and the head rest touches the top of your head. If there is a lot of distance between your head and the rest, it will do little to help in the event of a collision. Also, if the headrest is too low, in can act as fulcrum, leveraging your neck into a worse position, and increasing injury risk.
Another thing we can do minimize injury risk is being in the best possible shape prior to the trauma. Research has shown people with good aerobic fitness seem to be more resilient after whiplash accidents.
If you are aware you are about to be hit, it is probably best to remain in a neutral position with eyes facing forward. People with their head turned prior to impact seem to have worse ligament injuries.
If you can afford it, a larger car will lessen the momentum of your vehicle after a collision. There are now vehicles with whiplash-protection seats (e.g. Saab) that dampen the effects of rear end-accidents. Frontal collisions tend to be less severe to the neck if the speeds are equal because the chin can hit the chest preventing forward motion of the neck. Rear-end and side-impact collisions do not have this benefit.
Unfortunately, there are many simply unavoidable risk factors. Women and children seem to be more vulnerable, possibly because of the increased head to neck size ratio. Also if you’ve ever had a head or neck trauma before and or have a degenerated disk in the neck, these factors elevate your risk for a more pronounced injury. Other factors that can slow your recovery include wearing a neck brace/collar, taking to bed rest, or getting vertical traction treatments. Inhibiting movements can feel good initially but is not good in the long term because of decreased muscle function and strength. Getting diagnosed as soon as possible can determine the best course of action for getting you to back to a speedy recovery. Just letting things go is rarely a good solution.
Dr. Ward Beecher practices at Beecher Chiropractic Clinic at 1001 Pineloch, Ste 700 Houston, TX 77062. You can schedule an appointment at BeecherChiropractic.com or by calling (281) 286-1300. If you have any questions regarding this blog, please comment below!
Chiropractic Alternative to Back Surgery?
To download a copy of this week’s newsletter, please click here.
Clear Lake City Chiropractor Comments: A large-scale study from Great Britain has shown results that’ll make you wonder whether back surgery is always necessary (Bhattacharyya M. Does the risks and benefits of spinal manipulation in patients with low back pain as a nonsurgical approach translate into better outcomes in routine clinical care: a prospective observational cohort study. J Bone Joint Surg 2008;90B:Suppl.492.). One hundred two patients were followed while they waited to see a spinal surgeon. The patients had disc herniations confirmed by MRI and had sciatic/leg pain. They had also previously tried 4 weeks of medications (non steroidal anti-inflammatory drugs), which had provided no benefit.
While they waited to see the spinal surgeon, they were referred for manipulations provided by experienced chiropractors. The adjustments were given five days per week. 
A few patients had some transient increase in pain and there were three treatment failures (out of 102). Overall the results were very encouraging with patients moved off of the surgery wait-list.
But how is this possible? The disks are the hard cartilage separating each vertebra in your lower back. When this ligament sprains it can bulge onto a nearby nerve, causing back pain or pain down your leg. Precise adjustments use the bones as levers to affect the alignment of these vertebrae and the movement of the joints in the lumbar spine. If alignment is improved, then there is better posture and distribution of loads. When the mobility is more symmetrical, this also may prevent unequal loading of the soft tissues. Helping these mechanical aspects to heal can be enough to lessen your pain and help you to regain your quality of life. In some cases, it seems it may even keep you from a potentially unnecessary back operation.
Based on the results of the study, anyone without need of emergency surgery should try chiropractic care before having an elective operation for a disk or sciatica/leg pain disorder. Emergency problems would be symptoms like bowel and bladder dysfunction and numbness over the tailbone or hips. Most patients do not fit into the emergency-surgery camp.
Dr. Ward Beecher practices at Beecher Chiropractic Clinic at 1001 Pineloch, Ste 700 Houston, TX 77062. You can schedule an appointment at BeecherChiropractic.com or by calling (281) 286-1300. If you have any questions regarding this blog, please comment below!
