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Low Back Pain & Scoliosis

Low Back Pain & Adolescent Idiopathic Scoliosis

Scoliosis is a curvature of the spine that is shaped like a “C” or an “S” when looking at the person from behind. I’m sure you’ve noticed when you’re at a beach, at a swimming pool, or walking in an airport, some people have a high shoulder, walk with a bit of a limp if one leg is short, and may have a shoulder blade that sticks out more than the other. Scoliosis often develops for unknown reasons (hence the term, “idiopathic”) during the adolescent age range between 10 or 11 years old and can progress, not change or less often, improve up to age 16 to 18. During these 4-6 years, the time when the adolescent is growing quickly, the curve often worsens without any intervention but few studies have looked at what types of treatment or combinations of treatment work the best, especially non-surgical methods.

A recent study was conducted that looked at the response to non-surgical treatment using conventional medical treatment (MT) vs. conventional MT plus chiropractic, as well as conventional MT and “sham” (fake) chiropractic treatment.  This is a pilot study using a small population of patients in order to determine if a larger scale study would be important to run (which was determined to be the case).

The conventional medical treatment approach included two groups – observation (a “wait and watch” approach) in a braced group verses a non-braced group. The chiropractic treatment group received spinal manipulation using “diversified technique” which is widely used where the patient is treated while lying on their stomach, sides, and back and the type of manipulation used was the thrust type where the “cracking” sound occurs (which is caused by the release of gas from the joint capsules and is technically called cavitation). This was applied to the regions determined by the chiropractor as requiring the treatment by using palpation (touch) methods, postural examination, range of motion, and x-ray and all chiropractors involved had 6-hours of training to assure consistent and similar approaches were used. Treatments were administered (determined by a survey of many chiropractors) at 3x/week for a month, 2x/week for a month, 1x/week for a month, and 2x/month for 3 months or as needed for a total of 6 months. The “sham” or fake chiropractic treatment used the same treatment frequency and similar positioning of the patient but purposely did not obtain a joint cavitation or “crack” but still seemed “real” to the patient.

The primary outcome used to determine “success” was a reduction of the scoliosis curve measured on x-ray at a 6-month point. Using the standard medical model, those with curves of 20-25 degrees require careful observation, curves 26-40 degrees are potential candidates for bracing, those greater than 40 degrees are potential candidates for surgery and, an increase in curve by more than 5 degrees measured twice a year or every 6-months is considered failure.

The results are interesting. Of those receiving only conventional medical treatment, none improved and one failed. The same occurred in the conventional MT plus sham/fake chiropractic. NO ONE failed and one improved in the chiropractic treatment plus MT group making it the only successful non-surgical treatment approach in the study. The preliminary findings from this study are huge! Chiropractic treatment in this group of adolescent children was determined to be THE ONLY non-surgical approach that had the ability to maintain (not allow the curve to progress) or even better, improve the curve!

At Denver Chiropractic Center, we work with many patient who have scoliosis. We combine Active Release Techniques to release tight soft tissues, chiropractic adjustments to increase spinal mobility, and physical therapy exercises to help retrain the nervous system. Call us today to see how we can help. 303.300.0424

We realize you have a choice in where you get your healthcare services.  If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

Low back pain – why patient education is a part of how Denver Chiropractic Center can help you.

Low Back Pain & Patient Education

Patient education is a very important aspect of caring for our patients. In fact, it can be one of the most important aspects of care. For example, when patients present with a brand new injury and pain levels are off the map, it’s quite common for that acute suffering patient to inappropriately think that, “I’m going to die… this hurts so much!” Hence, one of the very first things we do as chiropractors is to determine what structures are generating the pain so we can tell you!

Once you have an understanding of where the pain is coming from and why it hurts so bad, then you can be reassured that it’s not life threatening or dangerous. Also, at this acute point of time, the patient often unknowingly puts heat on the back, often for hours. This is the WORST thing you can do as the area is already swollen and putting heat on a swollen area draws more blood and fluids into the area. It’s literally like throwing gas on a fire. So, receiving proper information from us such as, put ice on the area for 15-20 minutes on and off several times in a row to “PUMP” the swelling out of the area will make complete sense.

Also, did you know that 2/3rds of our body’s weight is above the waist? That means, when a 150# person bends over, they are “lifting” 100#! That’s one of several reasons why bending over can be so dangerous. To “fix” that, squat by bending the knees keeping the back straight and keep objects that you might be lifting close to your body as that weight literally weighs 10x more when your arms are straight and you’re lifting. When you can’t squat and have to bend over, bend the knees, arch your back (literally “stick your butt out”), and bend over at your hip joints – DON’T use your back. You’ll need to practice that one a few times before it’s fully understood.

As your back pain improves, we will review these important self-help approaches and add new “tricks of the trade” like certain stretches, some strengthening and perhaps some balance exercises. Did you know that your thigh muscles shrink just by sleeping overnight? It’s true! When you wake up in the morning, your thigh muscles are smaller than when you went to bed. Well, this same muscle shrinkage (technically called “atrophy”) occurs in the lower back and hips, so strengthening exercises are REALLY IMPORTANT! Just think, if your muscles shrink overnight just from laying in bed, what about when you might have been told to use bed rest for several days or more? There potentially is a lot of muscle shrinkage and weakness that can occur in a relatively short amount of time and therefore, strengthening exercises also need to be taught in order to regain your strength so you can more safely do your activities.

Now what about back pain prevention? What methods to you think will help us NOT get low back pain? That’s right – managing weight! If your BMI (body mass index or, the ratio between your height and weight) is >25, you need to trim down a bit (or more). Go on line and SEARCH BMI, and pick one of many “BMI Calculators” to figure out your BMI. So, what do chiropractors know about weight loss?

Did you know the chiropractic college curriculum includes more nutritional courses than most medical schools? We will help you find a way to lose weight – whether its calorie restriction, a special diet like no/low salt, gluten-free, or a diabetes-specific diet. Another prevention trick for the low back (actually, whole body!) is to STAY FIT! Make aerobic exercise and even a light weight lifting program part or your daily ritual. Other methods help too, so come in and let us guide you in this journey to better health!

We realize you have a choice in where you get you healthcare services. If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

What Denver Chiropractic Center’s doctors do to workout in the winter & This week’s health news for you…

WEEKLY HEALTH UPDATE

Week of: Monday,  October 17, 2011

Courtesy of: Denver Chiropractic Center

Now that everyone on our staff is done with races for the year, it’s time to focus on winter conditioning (despite the fact that it’s 76 degrees out as I write this).

For Dr. Hyman, it’s a mix of P90X and Kettlebells. For Dr. May, it’s Kick boxing. Dr. Stripling is a Cross Fit guy and just got his Kettlebell Certification, so you can bet he’ll be swinging some Russian Iron around this winter. Who knows, you may even see us show up for some snowshoe races (really).

If you have any questions about your off-season or winter-season exercise program, we’d be happy to answer. Dr. Hyman and Dr. May are both Certified Strength and Conditioning Specialists, and as noted above Dr. Stripling is a certified kettlebell expert. So ask away!

Without further delay, here’s this week’s Health News For You…

Mental Attitude: Don’t Worry Be Happy. The more you stay positive and happy in life, the better chance you have of avoiding a stroke. Optimistic people have a healthier immune system, faster wound healing, and a lower risk of heart disease. So don’t worry, be happy. Journal of The American Stroke Association and The Mayo Clinic, Aug 2011

Diet: Prune Power? In the US, 8 million women have osteoporosis because of the sudden cessation of ovarian hormone production at the onset of menopause. In the first 5-7 postmenopausal years, women are at risk of losing bone at a rate of 3-5% per year. In a study, the group of women who consumed dried plums had significantly higher bone mineral density in comparison with the group of women who ate dried apples. This was due, in part, to the ability of dried plums to suppress the rate of bone resorption, or the breakdown of bone, which tends to exceed the rate of new bone growth as people age. British Journal of Nutrition, Aug 2011

Exercise: Good Reasons. Exercise reduces your anxiety level, helps control blood pressure in people with hypertension, and protects against “creeping obesity” (the slow, but steady weight gain that occurs as you age). Surgeon General’s Report on Physical Activity and Health, 1996

Chiropractic: Happy Patients! In this study, the average intake pain rating of patients cared for by Doctors of Chiropractic was 6.2 of 10, and the average discharge score was 1.9 of 10. 95% of the patients rated their care as “excellent.” Journal of Manipulative Physiological Therapeutics, Feb 2011

Wellness/Prevention: Ancient Bugs. When they were developed less than a century ago, scientists were surprised at how fast bacteria developed resistance to antibiotic drugs. Recently, researchers discovered antibiotic resistant genes in bacteria recovered from 30,000-year-old permafrost. This shows antibiotic resistance is a natural phenomenon predating the modern clinical antibiotic use. Nature, Sept 2011

Quote: “Anything that won’t sell, I don’t want to invent. Its sale is proof of utility, and utility is success.”

~ Thomas A. Edison

Active Release Techniques: Pain Between the Shoulder Blades. One of the most common complaint that new patients bring to Denver Chiropractic Center is pain between the shoulder blades. This is almost always caused by poor posture. Chronically tight muscles start to build scar tissue and become painful. Using Active Release, adjusting , and corrective exercises we can break up the scar tissue and help you correct your posture. If you have pain between your shoulder blades, give us a call at 303.300.0424.

Weekly Health News for You 10/10/2011

Dr. Hyman is back in the office after taking a week off. He looks rested and is ready to see you!

4 members of our staff did the Denver Rock n Roll 1/2 Marathon on October 9, here are their times:

Dr. May 1:57

Keri B, Office Manager, 2:04

Dr. Stripling 2:04

Erin Young, LMT, 2:05

Mental Attitude: Money Can Be Depressing? Rates of depression are higher in countries with higher per capita incomes. 121 million people worldwide have depression. Severe depression can lead to suicide and causes 850,000 deaths every year. The United Sates and France had the highest depression rates. Higher incomes can be related to more work hours and a lowered quality of life. 15% of people in high-income countries were likely to become depressed during their lifetime, compared with 11% of those in low or middle-income countries. British Medical Journal, Aug 2011

Health Alert: You Are Getting Very Sleepy. Insomnia affects 23% of US workforce, costing $63.2 billion annually. Insomnia is a condition characterized by difficulty falling asleep and remaining asleep. It includes a wide spectrum of sleep disorders, from not enough sleep to lack of quality sleep. Sleep, Aug 2011

Diet: Bad Habits? People entering the movies were given a bucket of either just-popped, fresh popcorn or stale, week-old popcorn. Moviegoers who didn’t usually eat popcorn at the movies ate much less stale popcorn than fresh popcorn. Moviegoers who typically had popcorn at the movies ate about the same amount — regardless it was fresh or stale. When we’ve repeatedly eaten a food in an environment, our brain comes to associate the food with that environment and we keep eating as long as those environmental cues are present. Personality and Social Psychology Bulletin, 2011

Exercise: Runners Drinking Too Much? 50% of recreational runners may be drinking too much fluid during races. 37% of runners drink according to a preset schedule or to maintain a certain body weight and 9% drink as much as possible. Expert guidelines recommend runners drink only when thirsty. 30% incorrectly believe they need extra salt while running,

British Journal of Sports Medicine, June 2011

Chiropractic: Careful. In work-related nonspecific low back pain, the use of health maintenance care (treatment after initial disability was resolved) provided by Physical Therapist (PT) or Medical Physician (MD) services was associated with a higher disability (injury) recurrence than in the use of Chiropractic (DC) services.

Journal of Occupational and Environmental Medicine, April 2011

Quote: “A question that sometimes drives me hazy: am I or are the others crazy?” ~ Albert Einstein

Active Release Techniques: Sore Knees. The knee joint is a very complex joint. Various layers of muscles tendons and ligaments both move and support the knee. While there may be many causes of knee pain, we’ve found at Denver Chiropractic Center the common cause is tight quads transmitting force to the patellar tendon (the tendon that connects the knee cap to the shin). ART to the both the tendon and quadriceps muscle, along with rehab and stretching, can fix things up in 4-8 visits. If you or someone you know is dealing with knee pain, give us a call. 303.300.0424.

Low Back pain and Spondylolisthesis. How we can help you at Denver Chiropractic Center

Low back pain can arise from many conditions, one of which is a mouthful: spondylolisthesis. The term was coined in 1854 from the Greek words, “spondylo” for vertebrae and “olisthesis” for slip. These “slips” most commonly occur in the low back, 90% at L5 and 9% at L4. According to www.spinehealth.com and others, the most common type of spondylolisthesis is called “isthmic spondylolisthesis,” which is a condition that includes a defect in the back part of the vertebra in an area called the pars interarticularis, which is the part of the vertebra that connects the front half (vertebral body) to the back half (the posterior arch).

This can occur on one, or both sides, with or without a slip or shift forwards, which is then called spondylolysis. In “isthmic spondylolisthesis,” the incidence rate is about 5-7% of the general population favoring men over women 3:1. Debate continues as to whether this occurs as a result genetic predisposition verses environmental or acquired at some point early in life as noted by the increased incidence in populations such as Eskimos (30-50%), where they traditionally carry their young in papooses, vertically loading their lower spine at a very young age. However, isthmic spondylolisthesis can occur at anytime in life if a significant backward bending force occurs resulting in a fracture but reportedly, occurs most frequently between ages 6 and 16 years old.

Often, traumatic isthmic spondylolisthesis occurs during the adolescent years and in fact, is the most common cause of low back pain at this stage of life. Sports most commonly resulting in spondylolisthesis include gymnastics, football (lineman), weightlifting (from squats or dead lifts) and diving (from over arching the back). Excessive backward bending is the force that overloads the back of the vertebra resulting in the fracture sometimes referred to as a stress fracture, which is a fracture that occurs as a result of repetitive overloading over time, usually weeks to months.

If the spondylolisthesis lesions do not heal either by cartilage or by bone replacement, the front half of the vertebra can slip or slide forwards and become unstable. Fortunately, most of these heal and become stable and don’t progress. The diagnosis is a simple x-ray, but to determine the degree of stability, “stress x-rays” or x-rays taken at endpoints of bending over and backwards are needed. Sometimes, a bone scan is needed to determine if it’s a new injury verses an old isthmic spondylolisthesis.

Another very common type is called degenerative spondylolisthesis and occurs in 30% of Caucasian and 60% of African-American woman (3:1 women to men). This usually occurs at L4 and is more prevalent in aging females. It is sometimes referred to as “pseudospondylolisthesis” as it does not include defects in the posterior arch but rather, results from a degeneration of the disk and facet joints. As the disk space narrows, the vertebra slides forwards.

The problem here is that the spinal canal, where the spinal cord travels, gets crimped or distorted by the forward sliding vertebra and causes compression of the spinal nerve root(s), resulting pain and/or numbness in one or both legs. The good news about spondylolisthesis is that non-surgical approaches, like Active Release Techniques, spinal manipulation and core strengthening exercises work very well to manage sondylolisthesis. We use all three at Denver Chiropractic Center.

We realize you have a choice in who you see for your healthcare services.  If you, a friend or family member requires care for low back pain, we are here to help you. Just call us at 303.300.0424 to set up your New Patient Appointment. Or have us call you by filling out the very brief form on our website: http://www.denverback.com/contact.html

How you sit says a lot

I just got the Denver Chiropractic Center Primary Pattern Rehab Protocols back from the printer. After all of these years, I finally put those protocols to paper and you’ll start getting them now at your appointments. Thanks to Otto the Hungarian Typesetter for doing the layout (really, he lives near Budapest).

Did you know that I can pretty much tell if you’re at risk for back problems based on how you sit down into a chair? It’s true. Since the glutes and back extensors, if properly firing and properly patterned, control your descent into a chair, I can tell if yours are working or not. If you tend to put a hand on your knee or an armrest when getting into a chair, you’re in trouble.

Using the arm to ‘build a bridge’ tells me that your glutes are not firing effectively. This means that you’re probably not using your glutes for other tasks, like picking objects up from the floor. Failing to use these muscles is a recipe for future back problems.

A typical patient with a back crisis thinks that it was caused by the bag of dog food he stooped over to grab. Or perhaps that patient was trying to get that squirming child into her car seat.

The reality is, almost all back problems are cumulative. Bad motor habits cause important muscles, like the glutes and spine extensors, to work less and less. If you’re not firing these muscles, you’re using other muscles, probably smaller spinal muscles, to take up the slack. This is what wears out spines and causes big back problems. The dog food and squirming kid are just the straws that break the camel’s back.

A great way to protect yourself is to start working on the squat pattern and getting it right. The Chair Squat Protocol is a Phase 1 Primary Pattern exercise that will help you. Remember of course to check with your doctor first.

Start with a sturdy chair, ideally with its back against a wall (1).

1

With your calves barely touching the chair, maintain a slight arch in your back and move your rear down and backwards into the chair(2).

2

Without shifting all of your weight onto the chair, use your glute muscles (by pushing your heels into the floor) to come back up (3).

3

My arms are extended in the pics as a counter-balance, but you don’t need to do that. Using this little exercise, every time you sit into a chair, you can work on protecting your back over the long run by using your glutes and spinal extensors.
This will help ensure that you continue using these important muscles and supporting your spine functionally. Yes, there are even more aggressive ways to work these muscles (that’s Phase 2 and Phase 3).

If you’re putting up with pain, whether it’s back pain, shoulder pain, headaches, shin splints or anything else, give us a call 303.300.0424. We’re here to help you.

Glenn Hyman

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We are in-network providers for the following plans:

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We process all insurance paperwork for you!

If you don’t see your plan on this list, call us 303.300.0424, and Robyn will help you figure out if you have coverage in our office. Discount packages are available for those without insurance coverage.

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