Low Back Pain and Sleep – Part 2

Last month, we discussed the relationship between sleep deprivation and low back pain (LBP) and found that LBP can cause sleep loss AND sleep loss can cause LBP. It’s a 2-way street! This month, we will look at ways to improve your sleep quality, which in return, will reduce your LBP. There are many ways we can improve our sleep quality. Here are some of them:

  1. Turn off the lights: Complete darkness (or as close to it as possible) is best. Even the tiniest bit of light in the room can disrupt your internal clock and your pineal gland’s production of melatonin and serotonin. Cover your windows with blackout shades or drapes.
  2. Stay cool! The bedroom’s temperature should be ≤70 degrees F (21 degrees C). At about four hours after you fall asleep, your body’s internal temperature drops to its lowest level. Scientists report a cooler bedroom mimics your body’s natural temperature drop.
  3. Move the alarm clock. Keeping it out of reach (at least 3 feet) forces you to get out of bed and get moving in the AM. Also, you won’t be inclined to stare at it during the night!
  4. Avoid loud alarm clocks. It is very stressful on your body to be suddenly jolted awake. If you are regularly getting enough sleep, an alarm may even be unnecessary.
  5. Reserve your bed for sleeping. Avoid watching TV or doing work in bed, you may find it harder to relax and drift off to sleep.
  6. Get to bed before 11pm. Your adrenal system does a majority of its recharging between the hours of 11 p.m. and 1 a.m. and adrenal “burn-out” results in fatigue and other problems.
  7. Be consistent about your bed time. Try to go to bed and wake up at the same times each day, including weekends. This will help your body to get into a sleep rhythm and make it easier to fall asleep and get up in the morning.
  8. Establish a bedtime routine. Consider meditation, deep breathing, using aromatherapy, or essential oils, or massage from your partner. Relax and reduce your tension from the day.
  9. Eat a high-protein snack several hours before bed to provide the L-tryptophan needed for your melatonin and serotonin production.

My hips don’t lie…Think you’re fat?…and the 1-Page Health News

Some people object to the idea of squatting. They say it’s bad for you, not something anyone ever does, blah, blah, blah. I can tell you from 15 years of experience that the hips don’t lie: People who can’t drop into a full-range unweighted squat sooner or later will have back problems. It’s that simple.

The picture is me cleaning my grill before my dad arrived last weekend. If I couldn’t get into this squat easily, I’d be standing there stooped over at the waist. When stooping instead of squatting becomes a habit, something bad eventually happens. This is the person who blows out his or her back tying a shoe or picking up an empty dog food bowl.

Next time you’re in ask either myself or Dr. Stripling to check your squat for you. IF you can’t do it, we can probably teach you.

Mental Attitude: Think You Are Fat? Researchers found that normal weight teens who perceive themselves as fat are more likely to grow up to be fat. 59% of girls who felt fat as a teen became overweight in adulthood while 31% of girls who did not consider themselves fat during adolescence were found to be overweight. Normal weight girls were more likely than boys to rate themselves as overweight (22% of girls vs. 9% of the boys). One reason for weight gain in later years may be due to psychosocial stress, which can be associated with gaining weight. Under this scenario, the psychosocial stress related to having (or not having) an ideal body type, along with the perception of oneself as overweight, can result in weight gain. Another explanation may be that young people who see themselves as fat often change their eating habits by skipping meals, which can

lead to obesity. Also, a diet you can’t maintain over time will be counterproductive, as the body tries to maintain the weight you had before you started to diet. Norwegian University of Science and Technology, July 2012

Health Alert: Depression Is A World-Wide Problem. It’s widely believe that depression is a phenomenon of Western culture, but researchers who analyzed studies involving over 480,000 people across 91 countries have found the opposite is true. They estimate the rate of depression in Middle Eastern and some Asian countries (~9%) is twice that found in countries like the United States and Australia (~4%). World Health Organization, 2010

Diet: Bad BBQ News! Barbecue can sabotage your waistline. A 20 ounce T-bone steak can weigh in at 1,540 calories, with

124 grams of fat.  A corn-fed 85% ‘lean’ cheeseburger has 750 calories and 45 grams of fat. Pork or beef ribs come from the fattiest part of the animal. Healthier options include pork tenderloin, skinless chicken breast, and lean ground beef. American Heart Association

Exercise: Good Reasons. Regular exercise maintains or improves joint flexibility, improves your glucose tolerance and reduces workdays missed due to illness. Surgeon General’s Report on Physical Activity and Health, 1996

Chiropractic: Motion and Nutrition. Cartilage is avascular, meaning it does not receive nutrition via blood vessels. Like a sponge, it takes in fluid and releases the fluid when compression is applied. This alternating compression and re-expansion allows it to receive its supply of nutrients and remove metabolic waste. Arthritis & Rheumatism, 1984

Wellness/Prevention: Lose To Gain? People who are overweight or obese could gain ten years worth of health benefits by simply losing 20 pounds. Modest weight loss (average 14 lbs) reduced the risk of individuals developing Type 2 diabetes by

58%. Weight loss of just 10% of a person’s body weight has been shown to have long-term impact on sleep apnea, hypertension, quality of life, and to slow the decline in mobility that occurs as people age. American Psychological Association, July 2012

Quote: “We can’t solve problems by using the same kind of thinking we used when we created them.” ~ Albert Einstein

This past week at Boulder Peak, and the latest edition of Denver Chiropractic Center’s 1-Page Health News

This past week the staff from Denver Chiropractic Centers all over the state. Dr. Hyman was up in Beaver Creek training for Xterra Beaver Creek on July 14. While biking, he ran into a bear under lift 11. There’s a little snippet of video posted on our blog: http://www.denverback.com/?p=861

Dr. Stripling and Keri were up working hard leading the Active Release treatment team at the Boulder Peak Triathlon this weekend. Here’s a picture from the brief window when Dr. Hyman stopped by:

And here’s the 1-Page Health News for You…

Mental Attitude: Immune Against Alzheimer’s? Researchers discovered the best marker associated with memory is a gene called CCR2. This gene showed immune system activity against beta-amyloid, thought to be the main substance that causes Alzheimer’s disease. According to Dr. Lorna Harries, “Identification of a key player in the interface between immune function and cognitive ability may help us to gain a better understanding of the disease processes involved in Alzheimer’s disease and related disorders.” National Institute on Aging, June 2012

Health Alert: Cancer Rates Expected To Increase! Cancer incidence is expected to increase more than 75% by the year 2030 in developed countries, and over 90% in developing nations. Countries must take action to combat the projected increases in cancer rates via primary prevention strategies such as healthier lifestyles, early detection, and effective treatment programs. Lancet Oncology, June 2012

Diet: Snacking On Raisins. Eating raisins as an after-school snack prevents excessive calorie intake and increases the feeling of fullness as compared to other commonly consumed snacks. Grapes, potato chips and cookies resulted in approximately 56%, 70% and 108% higher calorie intake compared to raisins, respectively. The cumulative calorie intake (breakfast + morning snack + lunch + after-school snack) was 10-19% lower in children who ate raisins as an after school snack when compared to children who consumed other snacks. Canadian Nutrition Society, May 2012

Exercise: Exercise and Cancer. Researchers are working toward proving that daily yoga or 20 minutes of walking will likely extend a cancer patient’s survival. In 15 years, doctors have gone from being afraid to recommend exercise to cancer patients to having enough data that shows it is safe and effective, particularly for relief of treatment side effects. American Society of Clinical Oncology Annual Meeting, June 2012

Active Release: A whole lot of nerve? Your nervous system runs and controls every aspect of your body. For example, there are 45 miles of nerves in your skin alone. Nerves throughout your body can become trapped in muscles, causing symptoms from headaches to carpal tunnel to sciatica to tingling in the toes. Active Release can take pressure off of nerves and fix problems. Gray’s Anatomy / Active Release Techniques

Wellness/Prevention: Early Stress? Children who experience intense and lasting stressful events in their lives score lower on tests of the spatial working memory and have more trouble on tests of short-term memory. Journal of Neuroscience, June 2012

Quote: “Remember to perform random acts of kindness.” ~ From the film Pay It Forward, released in 2000

Our 14th Anniversary and This Week’s 1-Page Health News

Those of you who want these weekly 1-Page Health News emails sent directly to your email can go to denverback.com and fill out the little form on the upper left part of the page.

May marks another year for Denver Chiropractic Center. For those of you keeping score, that’s 14 years down, and now in our 15th year.

Last week was the busiest week we’ve ever had. Ever. And we’d like to thank you. Your trust, support and referrals are what make our existence and growth as a business possible. We look forward to being here to help you for a few more decades. Once again, thanks.

We’d also like to wish all the moms out there a Happy Mothers Day.

Here’s this week’s 1-Page Health News:

Mental Attitude: Berry Good News. Men who regularly consume foods rich in flavonoids (such as berries, apples, certain vegetables, tea and red wine) may significantly reduce their risk for developing Parkinson’s disease. Flavonoids are naturally occurring, bioactive compounds present in many plant-based foods and drinks. Neurology, April 2012

Health Alert: Stressed? The risk for coronary heart disease and stroke increases by 30% in a person whose partner has cancer. The cause is probably the negative stress to which the cancer patient’s partner is exposed. Previous studies show that stress can affect the nervous system, blood pressure, and inflammation, increasing the risk of developing coronary heart disease and stroke. Centre for Primary Healthcare Research in Malmö, April 2012

Diet: Pain Relief. The supplement Methylsulfonylmethane gave osteoarthritis patients relief from symptoms of pain and physical dysfunction. Osteoarthritis Cartilage, 2008 Exercise: Being Fit. Improving or maintaining physical fitness appears to help obese and overweight children reach a healthy weight. During a four-year study, obese and overweight girls and boys who achieved fitness were 2.5 to 5 times more likely to reach a healthy weight than those who stayed underfit. Obesity, April 2012

Active Release Techniques: Sciatica. Many people with sciatica are worried that it’s coming from a ruptured disc. While this is sometimes true, in most cases, muscles are pressuring the sciatic nerve and causing symptoms down the back of the leg. The piriformis is a likely suspect, as are the hamstrings. Using Active Release Techniques to relieve the tension in these muscles can take the pressure off of the nerve and fix the problem.

Wellness/Prevention: Obesity and Watching TV. In a study of obesity among European children, Dr. Yannis Manios, Assistant Professor at Harokopio University in Athens, writes, “We found that many countries are lacking clear guidelines on healthy eating and active play. However, there is good evidence linking sedentary behavior (like TV watching) with subsequent obesity. Obesity Reviews, March 2012 (Um, this is not brilliant work.)

Quote: “Simple diet is best; for many dishes bring many diseases; and rich sauces are worse than heaping several meats upon each other.” ~ Pliny

Is it sciatica or Low Back Pain? How can Denver Chiropractic Center help you with Active Release Techniques?

Low back pain (LBP) can be localized and contained to only the low back area or, it can radiate pain down the leg. This distinction is important as LBP is often less complicated and carries a more favorable prognosis for complete recovery. In fact, a large part of our history and examination is focused on this differentiation. This month’s Health Update is going to look at the different types of leg pain that can occur with different LBP conditions.

We’ve all heard of the word “sciatica” and it (usually) is loosely used to describe everything from LBP arising from the joints in the back, the sacroiliac joint, from the muscles of the low back as well as a pinched nerve from a ruptured disk. Strictly speaking, the term “sciatica” should ONLY be used when the sciatic nerve is pinched; causing pain that radiates down the leg.

The sciatic nerve is made up of five smaller nerves (L4, 5, S1, 2, 3) that arise from the spine and join together to form one large nerve (about the size of our pinky) called the sciatic nerve – like five small rivers merging into one BIG river. Sciatica occurs when any one of the small nerves (L4-S3) or, when the sciatic nerve itself, gets compressed or irritated.

This can be, and often is caused from a lumbar disk herniation (the “ruptured disk”).  A term called “pseudosciatica” (a non-disk cause) includes a pinch from the piriformis muscle where the nerve passes through the pelvis (in the “cheek” or, the buttocks), which has been commonly referred to as “wallet sciatica” as sitting on the wallet in the back pocket is often the cause.

When this occurs, the term “peripheral neuropathy” or “ peripheral nerve entrapment” is the most accurate term to use. Direct trauma like a bruise to the buttocks from falling or hitting the nerve during an injection into the buttocks can also trigger “sciatica.”

The symptoms of sciatica include low back pain, buttocks pain, back of the thigh, calf and/or foot pain and/or numbness-tingling. If the nerve is compressed hard enough, muscle weakness can occur making it hard to stand up on the tip toes creating a limp when walking. In the clinic, we will raise the straight leg and if pinched, sharp pain can occur with as little as 20-30° due to the nerve being stretched as the leg is raised.

If pain occurs anywhere between 30 and 70° of elevation of either the same side leg and/or the opposite leg, this constitutes a positive test for sciatica (better termed, “nerve root tension”). When a disk is herniated into the nerve, bending the spine backwards can move the disk away and off the nerve resulting in relief, which is very diagnostic of a herniated disk. Having a patient walk on their toes and then heels and watching for foot drop as well as testing the reflexes, the sensation with a sharp object, and testing the reflexes at the knee and Achilles tendon can give us clues if there is nerve damage.

At our clinic we’ve gone beyond simple traditional chiropractic adjustments to “align the spine.” We use more advanced techniques, like Active Release Techniques to address the pressure that the muscles can exert on the sciatic nerve. We will also use motion-restoring spinal adjustments to restore healthy mobility to the spine. By utilizing these advanced techniques, we are usually able to get excellent results for our patients with low back pain and sciatica in a relatively short period of time.

It all starts with the initial exam. Call us to schedule yours 303.300.0424. We’re here to help you!

Miss Keri’s Bike Crash and This Week’s 1-Page Health News

Our awesome office manager Keri (my kids call her Miss Keri) was run off of the Cherry Creek bike trail and into a concrete half wall this weekend. Another cyclist was going too fast in the other direction, was too far over to his left, and basically forced Keri to choose between colliding with him or scraping the wall.

She chose the wall and this morning is sporting a nasty wound on her right arm. Of course, this guy didn’t bother to stop (maybe he was on his way to do Rocket Surgery). The message- be careful out there. A whole lot of morons are legally loose on our streets.

Of course, Miss Keri is tough as nails and never misses work, so she’s here today- bandaged up & ready to help you.

Here’s this week’s 1-Page Health News.

Mental Attitude: Get Your Sleep! Older adults with poor sleep habits have an altered immune system response to stress that may increase their risk for mental and physical health problems. Stress leads to significantly larger increases in a marker of inflammation in poor sleepers compared to good sleepers; a marker associated with poor health outcomes and death. Poor sleepers report more depressive symptoms, more loneliness and more global perceived stress relative to good sleepers. As people age, a gradual decline in the immune system occurs, along with an increase in inflammation. Heightened inflammation increases the risk for cardiovascular disease, diabetes and other illnesses, as well as psychiatric problems. American Journal of Geriatric Psychiatry, March 2012

Health Alert: Slow Down — You Move Too Fast? People who are considered ambitious, attend the best colleges and universities, have prestigious careers and earn high salaries don’t necessarily lead more successful lives. Ambition has its positive effects (in terms of career success, it certainly does) but ambitious people are only slightly happier than their less- ambitious counterparts and they actually live somewhat shorter lives. Journal of Applied Psychology, March 2012 Diet: Fish Oil. Six weeks of supplementation with fish oil significantly increased lean mass and decreased fat mass in test subjects. International Journal of Sport Nutrition and Exercise Metabolism, October 2010

Exercise: Good Reasons. Exercise helps you maintain proper muscle balance, reduces the rate and severity of medical complications associated with hypertension, helps alleviate menstrual symptoms and lowers your heart rate response to submaximal physical exertion. Surgeon General’s Report on Physical Activity and Health, 1996

Chiropractic: Adjustment or Microdiskectomy for Sciatica? 60% of patients with sciatica (symptoms of unilateral lumbar radiculopathy secondary to lumbar disk herniation at L3-4, L4-5, or L5-S1) who had failed other medical management (patients must have failed at least 3 months of nonoperative management including treatment with analgesics, lifestyle modification, physiotherapy, massage therapy, and/or acupuncture) benefited from spinal manipulation to the same degree as if they underwent surgical intervention. JMPT, October 2010

Wellness/Prevention: Dark Chocolate Good For The Heart. A flavonoid called epicatechin, found in dark chocolate, enhances mitochondria structure in people with advanced heart failure and type 2 diabetes. Mitochondria are cellular structures that provide the energy a cell requires in order to move, divide, and contract. Both heart failure and type 2 diabetes impair these cells, resulting in abnormalities in skeletal muscle. In individuals with diabetes and heart failure, these abnormalities in the heart and skeletal muscle cause decreased functional capacity, resulting in difficulty walking even short distances, shortness of breath, and a lack of energy. Clinical and Translational Science, March 2012

Quote: “Common sense is the collection of prejudices acquired by age eighteen.” ~ Albert Einstein

16 Years of hip pain? Really?

OK, so all of the staffing chaos is behind me. The new
office manager, Amy, is on board and doing a great job.
Massage therapist Erin has been seeing clients and
getting rave reviews. So, on to this week’s question.
Once again, the person is real, and the question is
too:

“I was in a car accident 16 years ago, and I’ve
had hip pain ever since. I’ve had X-rays, and the
bone is fine. I have trouble lifting my leg to
climb in and out of the bathtub. Is this something
that you can help me with?”

The answer:

“Yes, I can probably help you. When muscle gets
injured, whether it’s a car crash, sports injury,
or repetitive motion, the healing process creates
scar tissue. This scar tissue changes the way that
muscle works – it doesn’t contract and relax as
efficiently as it used to. This leads to pain,
tightness, weakness, and other problems.

This condition can linger on for years, even decades.
Since nothing breaks up scar tissue as effectively as
Active Release, patients with long term problems
start to finally get relief. I have actually treated
injuries that were 20 years old and made dramatic
improvements.”

In this case, I treated the lumbar muscles, hip flexors,
glutes, and the piriformis. They were heavily scarred,
and the patient started noticing improvement after
the first visit. I’m still treating her (3 times as
of this wiriting) so I can’t yet claim success, but
I’m confident this patient will feel about 90% better
when we’re done.

A patient’s question about sciatica

Dear Glenn,

Here’s another question from a patient:

Hello Dr. Hyman,

I’ve been experiencing an annoying pain that originates
in my glute and goes down the back of my leg. You treated
a friend of mine for sciatica (I’m assuming that’s what
this is). Can you help me and how?

The answer:

“Sciatica” refers to pain in the sciatic nerve’s
distribution, down the back of the leg. It’s caused
most commonly by one of two problems:

Pressure on the nerve from a bulging disc.
Pressure on the nerve from the muscles in the area.

The muscular cause is way more common.

The first step is to perform a thorough examination
and make sure your problem is not caused by a
herniated disc. If it is, that can be treated,
but treatment is different.

If I determine that the pain comes from the muscles,
I will identify the muscles involved and release them.
I do this by applying gentle tension to the muscle and
combining that with specific movements. This is
known as Active Release Technique®, which I am
certified to provide (I’m also an ART instructor).

If the joints in your low back and pelvis
are stiff and contributing to the problem,
they may be adjusted. Adjustments are a
gentle way to loosen joints. Very little
force is used with adjustments and they
usually feel great.

The first step is to make an appointment and let
me determine what’s causing your sciatica, then
we can determine the correct treatment plan.

On average, 4-8 visits are required.
……….

If anyone that you know is suffering from
sciatica, tell him or her to call us at
303.300.0424. We can help.

Glenn Hyman
http://www.denverback.com