Chiropractic + Wellness

The sacrum and coccyx are part of the vertebral spinal column and could contribute to low back pain. They are not like the other bones in the spinal column. The sacrum, also known as the sacral vertebra, sacral spine, and S1 is a large, flat triangular-shaped bone that is between the hip bones and below the last lumbar vertebra known as L5. The coccyx, known as the tailbone, is positioned below the sacrum.

The sacrum and coccyx are made up of smaller bones that fuse and grow into a solid bone mass by the age of 30. The sacrum is composed of 5 fused vertebrae known as S1-S5 and 3 to 5 smaller bones that fuse creating the coccyx. Both are weight-bearing bones and are integral to walking, standing, and sitting functions.

Sacrum and the Lumbosacral Spine

The sacrum forms the back of the pelvis. Along with the coccyx and the two sacroiliac joints make up the pelvic girdle. S1 is at the top of the sacrum and connects to the last lumbar vertebrae L5. Together they create the lumbosacral spine. Where they join forms the lumbosacral curves known as lumbar lordosis and lumbar kyphosis.

The curvature works to support the upper body, weight/force distribution maintains spinal balance and flexibility. Lordosis is the inward curve of the spine, but too much can cause swayback that can be associated with spondylolisthesis. Loss of this curve can cause spinal imbalance and can lead to Flatback syndrome.

Kyphosis is the outward curve of the spine. The location of the sacrum at the intersection of the spine and pelvis means it has an important role in the movement of the low back and hips. The sacrum’s joints help to bear weight and help stabilize the spinal column along with the ligaments, tendons, and muscles to help support/stabilize joint movement.

Lumbosacral joint

Joint L5 and S1 connect the lumbar spine to the sacrum. The pressure at this meeting point can be massive as the curve of the spine shifts from the lordotic forward curve to a kyphotic backward curve. The L5-S1 region bears weight, absorbs, and distributes the upper body’s weight when moving and resting. Disc herniation and spondylolisthesis are more common at L5-S1 for this reason.

Sacroiliac joints

The sacroiliac joints connect the sacrum to the left and right sides of the pelvis. The range of movement of the sacroiliac joints is minimal compared to other joints like the knees. However, the joints are essential for walking, standing, and stabilization of the hips. Sacroiliitis and sacroiliac joint dysfunction are two spinal disorders related to the joints. Other spinal disorders related to the sacral spine include:

• Sciatica
• Tarlov cysts
• Spinal chordoma, a common type of spine bone cancer

The Coccyx’s Function

The coccyx commonly known as the tailbone is just below the sacrum. It is smaller than the sacrum and has an important weight-bearing function. It helps supports weight while sitting. An example is leaning back while sitting. This motion and position increase the pressure/weight on the coccyx. An injury in this area can cause tailbone pain. Inflammation of the coccyx’s connective tissue that results in tailbone pain that gets worse when sitting is a common symptom. A traumatic event like a fall or auto accident that causes a tailbone fracture can also cause this pain.

Sacral and Coccygeal Nerves

The spinal cord ends at L1-L2, which branches out into the cauda equina, which is a bundle of nerves that looks like a horse's tail. In the sacrum, there are sacral nerves known as the sacral plexus. Plexus means a network of nerve structures. The sacral and lumbar plexus compose the lumbosacral plexus. This is where the sciatic nerve, which is the largest nerve in the sacral plexus converges into the band. Sciatic nerve compression causes a combination of symptoms known as sciatica. It is very well known for causing low back and leg pain.

The coccygeal nerve serves the tailbone. There are five sacral nerves numbered S1 through S5 and are part of the spinal cord.

• S1 supports groin and hip function
• S2 the back of the thighs
• S3 the middle of the buttock area
• S4 and S5 the anus and vagina

Injury or trauma to the sacral spine can cause mild stress fractures to severe bone fractures. These fractures can cause sacral nerve compression and intense pain. Symptoms include:

• Low back pain
• Leg pain
• Bowel dysfunction
• Bladder dysfunction
• Unusual buttock/s or groin sensations
• Osteoporosis or spinal inflammatory arthritis increases the risk of a sacral fracture.

Sacrum and Coccyx Injury Prevention

A doctor or chiropractor, physical therapist are excellent sources for information to help prevent sacrum and coccyx pain. These medical professionals will utilize a patient's medical history, recommend lifestyle changes and injury prevention guidelines.

• If at risk of developing osteoporosis then a bone mineral density test could be recommended.
• Activities that stress the lower spine should be avoided. Extreme flexing could cause or contribute to low back/leg pain, numbness, and weakness.
• Moderate exercising like walking, jogging, yoga, and strength training all help keep the spine strong, flexible, and healthy.
• The core or abdominal muscles should be strengthened. Proper core muscle strength will stabilize the sacrum.
• Proper posture must be maintained. Avoid slouching as this places added pressure on the lumbosacral spine and the sacroiliac joints.
• Proper body mechanics when engaging in any activity needs to be observed.
• Use leg strength to lift objects.
• Avoid twisting while lifting or holding heavy objects, as this can cause sprain, strain, or serious injury of the lower spine.
• Put on the seat belt. Auto accidents are a major cause of spine trauma. Exercise restraint when driving or riding in any vehicle even a golf cart.

Sciatica Pain Relief

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

An overview of chiropractic treatment for lower lumbar back pain, how it works, how safe it is, and how often treatment is necessary. Along with the principles of chiropractic for the relief of lower/lumbar back pain, whether acute or chronic. Seeing a doctor of chiropractic/DC, a chiropractor or a chiropractic physician can be highly beneficial towards effectively treating low back pain.

Practice 

Chiropractic medicine utilizes a variety of treatments/therapies that are designed to manipulate/adjust the:

• Spine
• Joints
• Tissues

These treatments focus on the entire body to relieve pain and improve functional ability. This is referred to as spinal manipulative therapy or SMT, but there are many other treatment methods and techniques.

Every chiropractor has a personal treatment approach based on the patient's condition/s, medical history, and personalized treatment plan. A chiropractor will begin traditionally starting off with soft, natural, less-invasive treatments. If these do not generate positive results they will move on to more aggressive techniques.

Consent Form

At every stage of the chiropractic process, there is a strict emphasis maintained on proactively discussing with the patient exactly what is taking place and what is going to happen. A chiropractor makes sure that the patient understands everything that occurs during:

• Diagnosis
• Examination
• Procedure/s

This is all done in order to educate the patient and receive direct permission to start the treatment. The emphasis on informed consent is essential. This is because some chiropractic techniques could carry material risk. This means that a certain technique or particular procedure could possibly cause injury.

A chiropractor also informs the patient of the possible risks of not being treated. It is not meant to scare a patient. It is to eliminate any misunderstandings and make sure that the patient has full control over their body, so they can make an informed decision, as to which way they want to go.

Examination

A chiropractor will thoroughly examine a patient before making any sort of diagnosis or treatment plan. The assessment can include:

Medical history

The characteristics of the pain, any red flag symptoms that require further diagnostic testing will be conducted to remove any potentially serious medical issues that can be associated with neck or lower lumbar back pain-like:

• Neurological disorders
• Fractures
• Infections
• Tumors

There can be many reasons as to why low lumbar back pain happens. A chiropractor will investigate and develop a personally customized treatment plan. Next, a physical exam will be performed. This includes an orthopedic and neurological exam. These will test the:

• Reflexes
• Sensory nerves
• Joints
• Muscles
• Other areas of the body

Advanced Diagnostic Testing

Imaging and laboratory tests are not always used for non-specific lower lumbar back pain, but they could be necessary if there are signs/symptoms of an underlying condition.

Severity/Duration of Condition

Chiropractic medicine looks at the symptoms and conditions of an injury or ailment and classifies them on how severe they are, and how long they last. Symptoms can be divided into degrees of severity: They are:

• Mild
• Moderate
• Severe

For the duration period, pain and other symptoms are referred to as:

• Acute pain - lasts for less than 6 weeks
• Subacute - lasts between 6 and 12 weeks
• Chronic - lasts for at least 12 weeks
• Flare-ups - the same symptoms happen irregularly or from an exacerbation of the original injury

Treatment Trial

If an individual is dealing with acute or subacute lower lumbar back pain, then a chiropractic trial could be an option. This could be two to three weekly sessions over the course of two to four weeks adding up to twelve total sessions. This can be a sufficient treatment to completely alleviate the pain. However, when the pain does not go away then additional treatments could be necessary, especially if an individual has other issues/conditions.

Measured Outcomes

Outcome measurements are a valuable tool because they help determine whether or not the treatment is producing significant results. Some outcome measurements of treatments include:

• Numeric Pain Scale for patients to rate the pain
• Pain diagram so patients can describe the location and character of the pain
• Increases and decreases in normal daily practices, like work, exercise, and sleep
• Testing functions
• Lifting ability
• Strength
• Flexibility
• Endurance

For some low lumbar back pain could last and go over the 12-week mark making it a chronic pain condition. A chiropractor will look for signs/symptoms to see if there is a risk of developing chronic pain.

Chiropractic How Often

When the pain is acute lower lumbar back pain, a standard treatment plan can be six to ten sessions over the course of two to four weeks. These treatments emphasize the passive non-exercise approach of manual therapy for relieving pain and improving function.

If the non-exercise method doesn't deliver positive results then a more active exercise-based treatment can be utilized to increase function and return an individual back to normal life.

Back Pain That Doesn't Go Away

Often acute symptoms are resolved within the first 4-weeks. But it is possible that the pain can become chronic, meaning that it lasts longer than 12 weeks. Some individuals can hit a plateau during the recovery process.

This is referred to as MTB or that the patient has met the therapeutic benefits. A chiropractor will want to see if pausing/stopping chiropractic treatment will have a residual effect, exacerbate the pain, or reduce function and activity.

Example: If mild to severe chronic lower lumbar back pain has worsened, a patient could need one to six more visits with each pain episode. And this would be two to three weekly treatments for two to four weeks. However, patients rarely need continuing or ongoing care of one to four visits per month.

Re-Evaluation

Chiropractors will not continue treatment/s if they are not helping the patient. Therefore, every 2 to 4 weeks there is a re-evaluation of the patient to see if the treatment is still having a positive and beneficial effect. Here are some of the criteria for continuing treatment:

• Individual still responds positively to the treatment
• The individual has met the therapeutic benefits and worsens when they are not treated
• Proof shows that self-care alone will not be sufficient to maintain the therapeutic benefits

Continuing Treatment

Living with chronic lower lumbar back pain can be a challenge, but chiropractors want to emphasize to individuals that self-care is an essential component for pain management. This includes physical rehabilitation combined with range-of-motion exercises. A chiropractic physician may encourage a variety of treatment options, like:

• Acupuncture
• Massage therapy
• Crossfit Rehabilitation
• Yoga
• Pilates
• Health coaching
• Psychosocial counseling
• Other beneficial treatment options

Chiropractic treatment and the benefits are different for everybody. This is why it is important to communicate with your chiropractor every step of the way and to be open-minded about the different treatment options they offer.

Why Chiropractic Works

Back and low back pain can strike without warning.

It can come from bending over or lifting something and then you're stuck, unable to move.

However, muscle spasm in the low back is a common occurrence.

Eight out of 10 adults will experience back spasm along with back pain during their lives.

The cause of back pain and spasm can come from:

• Overuse
• Accident
• Sports injury

But a lot of times the root cause of the muscle spasm can come from a tiny injury to one of the structures in or around the lumbar spine.

If there have been one or more episodes of muscle spasm, more than likely it's going to happen again.

The muscles in the low back all work together with the abdominal muscles.

If they weren't there, then extension and lateral movement of the spine would be impossible.

The back muscles provide stability and keep the spine erect and balanced.

The balance can be compromised when spasms present along with an injured lumbar joint or disc.

Muscle spasms

These muscle spasms are involuntary and are contractions that happen spontaneously.

When the spasms occur out of the blue, the triggers are preceded by a series of small strains to the spine which develops over time.

Once the injury is active the inflammation sets in.

Then the nerves become overly-sensitive which causes the muscle/s to contract and spasm.

Disc Disorders & Spasms

Degenerative disc disease or a herniated disc can cause episodes of low back pain.

A herniated or bulging disc can compress a spinal nerve root, which causes irritation and inflammation.

The body tries to control the affected area by tightening the surrounding muscles and that's when the spasms happen.

Muscles can become too tight because of:

• Lack of exercise
• Too much exercise
• Structural imbalances
• Dehydration
• Electrolyte loss
• Combination of all above

Conversely, there can be muscle groups that have become too weak.

Imbalances present themselves and chronic force is transmitted to the spine in a bad way.

Even a single off movement can trigger an injury to a:

• Spinal joint
• Ligament
• Disc

And this results in spasm and back pain.

Muscle spasm in the low back can be very painful and debilitating over a short period.

Treatment

When it starts:

• For the first 48 to 72 hours apply ice for 20 minutes and then every two hours while on your back.
• Always use an ice pack and never apply directly to the skin.
• After 72 hours then apply moist heat, which can be done with a heating pad.

If this does not work, try soaking in the hot tub, with Epsom salt.

Heat increases blood flow to:

• The affected area
• Relaxes tight muscles
• Relaxes irritated nerves

Also elevating the legs takes the pressure off the spine and can help relieve pain.

Over the counter medications like Aspirin or ibuprofen can help reduce inflammation and pain.

Discuss with physician or healthcare provider regarding dosing regimen most suitable.

There can also be a combination of therapies

• Rest
• Ice/heat
• Medication
• Chiropractic
• Massage
• Physical therapy
• Foot Orthotics

A combination of treatments often generates better results than only one therapy.

Prevention

Once the spasm has passed, and the inflammation has subsided focus on prevention:

• Stretch - Incorporate stretching exercises daily, muscles benefit from gentle stretching.
• Pilates or yoga can work wonders and always stretch before physical exercise.
• Get fit - no regular physical activity can lead to serious conditions and possibly chronic pain.
• Exercise benefits all, even some light walking around the neighborhood is enough. Just get moving!
• Playing a sport could be a way to keep active. Remember, in order for any exercise to work is that it is done regularly.
• Strength training is important, just as its name implies strength training builds muscle and reduces muscle imbalances.

It’s never too late to increase strength and flexibility.

Look at activities that you and your friends/family can enjoy and make doing them a regular thing.

A chiropractor is the ideal medical professional to consult with for any unexplained pain in the musculoskeletal system. They are highly qualified professionals that their specialty is treating conditions like lower back pain and they are very affordable. If you or a loved one have pain in the lower back, give us a call. We’re here to help!

Understanding *FOOT PRONATION* & How to Correct it | El Paso, TX (2019)

Understanding how excessive foot pronation can affect a patient's overall health and wellness is essential to follow-up with treatment. Custom foot orthotics can help correct excess foot pronation or supination to help improve foot health issues. Excess foot pronation and/or supination can affect the natural alignment of the spine, ultimately affecting posture and mobility. The following video describes how excessive foot pronation and supination occurs and how it can affect overall health and wellness. Dr. Alex Jimenez, a chiropractor in El Paso, TX, utilizes custom foot orthotics to help correct excessive foot pronation and supination.

Low back and neck pain are common symptoms which can tremendously affect a person's everyday physical activities. Spinal misalignments, or subluxations, can occur due to a variety of health issues, including automobile accidents, sports injuries, slip-and-fall accidents, and work-related injuries, among others. Chiropractic care is a safe and effective, alternative treatment option which can help treat neck and back pain. Patients demonstrate how Dr. Alex Jimenez, chiropractor, and his staff have helped provide them with the necessary pain relief they deserve. Dr. Alex Jimenez is highly recommended as the non-surgical choice for neck and back pain, among other health issues.

Chiropractic Treatment 

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As El Paso’s Chiropractic Rehabilitation Clinic & Integrated Medicine Center, we passionately are focused on treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities.

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Throbbing, dull and achy, sharp and excruciating. All of these words can be used to describe lower back pain.

Unfortunately, lower back pain is a common occurrence in adults. According to the American Chiropractic Association, low back pain is the single leading cause of disability worldwide, with millions of reported cases every year.

What Treatment Should You Seek If You Experience Pain in Your Lower Back? 

The good news is that it often heals on its own. A few days of over-the-counter pain meds, ice, and taking it easy, and you could be back to normal.

However, those who continue to deal with the pain after a few weeks' time may choose to look for other solutions. This is also true for people who experience repeated flare-ups, or chronic lower back pain.

One of the best and most popular options is chiropractic care.

Why? 

First of all, chiropractic care doesn't focus solely on the pain but helps the body heal itself. Chiropractors understand the bones, muscles, discs, and nerves in the back, and are able to figure out the reason for the pain.

From there, they can create a customized treatment plan from compresses to spinal manipulation to exercises that help heal the area and reduces the pain.

Second, It's A Drug-Free Solution.

Because of its healing, restorative approach, chiropractic treatment tends to the source of the pain, instead of simply dulling it. Spine Universe estimates 6 to 12 treatments are typically needed to treat low back pain, but each individual person's requirement may vary.

Throughout these treatments, spinal alignment begins to balance the other parts of a person's back and helps correct the issue causing the pain. Also, spinal manipulation helps improve mobility and function in many cases, whereas drugs alone do not.

Finally, Chiropractic Care for Lower Back Pain Also Helps Minimize Relapses 

Patients who experience lower back pain obviously never want to deal with it again, but it can flare up periodically. According to the National Institute of Neurological Disorders and Stroke, roughly 20% of those who suffer from low back pain will eventually deal with it chronically. This can cause frustration, primarily when it affects mobility.

Before you run screaming in horror to the medicine cabinet, one of the best reasons to participate in chiropractic treatment is that it helps reduce the chance of a recurrence. By working on the total body and getting it in the best shape possible, the patient is stronger and more balanced to handle their workload and other strenuous activities. Chiropractors also impart advice on how to minimize the chances of re-aggravating the lower back.

Millions of people suffer from back pain each year, and some never visit a chiropractor. Those who do choose chiropractic treatment are privy to treatment that reduces their pain, increases healing, shortens their downtime and lessens their chances of a recurrence. If over the counter medication and ice packs haven't worked within a few days, it's time to make an appointment for a consultation with a licensed chiropractor. You will be happy you did.

Lower Back Pain Chiropractic Treatment

If you are pregnant and have back pain, you are not alone. An estimated 50 to 70 percent of women who are pregnant experience back pain, according to the American Pregnancy Association. While pregnancy and childbirth is one of the most incredible experiences a woman can have, it is also very hard on her body. There are many dramatic changes that take place during that 9 to 10 month of gestation so it is understandable that she is going to feel some aches and pains along the way.

There are a number of reasons why a pregnant woman may experience back pain including:

• Natural changes to her body such as softening of ligaments and loosening of joints as her body prepares to give birth
• A shift in her center of gravity as her girth increases.
• Weight gain.
• Position of the baby.
• Her posture.
• Stress, exhaustion, and worry.

Is Chiropractic Care Safe During Pregnancy?

Chiropractic care has long been held as a viable method for relieving back pain in pregnant women. Historically, midwives and other natural or alternative practitioners were the ones advocating its many benefits. This resulted in minimal data from clinical studies existing on the topic.

However, in the last decade or so, researchers have been looking closer at chiropractic and its many benefits. In one study of pregnant women and chiropractic, 94 percent of the participants experienced dramatic improvement in their pain in just 5 days.

Today many doctors and obstetricians are sending their pregnant patients to chiropractors to help them manage their back and joint pain. It is perfectly safe for both mother and baby – and both can benefit from it. 

Benefits Of Chiropractic Care During Pregnancy

While chiropractic care during pregnancy can be used as a safe, non-invasive, and drug free method of pain relief, women may also enjoy other benefits which include:

• A healthier, happier pregnancy.
• Improved mood and less anxiety.
• More mobility.
• Decreased morning sickness and nausea.
• Easier, faster labor and delivery.
• Better flexibility.
• In some cases, prevent cesarean delivery.
• Improved sleep.
• Faster recovery time.
• Relief of pain in the back, joints, and neck.

By keeping the body in proper alignment, chiropractic care can help a woman have a healthier, happier pregnancy. She can enjoy the many benefits and experience less pain so that she can better focus on the joy of pregnancy and the wonder of bringing a new life into the world.

Why You Should Have Chiropractic Care During Pregnancy

Pregnancy brings about many changes in a woman’s body. Hormonal changes as well as physiological ones occur at rapid speeds as her body creates and maintains a perfect environment where her baby will develop and grow. These changes can cause the spine or joints to become misaligned. When this occurs, painful conditions can be created, including:

• Increased curvature of the back.
• Pelvic changes.
• Protruding abdomen that puts pressure on the back.
• Changes in posture.

Keeping the pelvis and lower back well balanced and aligned is integral to preventing lower back pain during pregnancy. What’s more, when the pelvis and spine are not in alignment, it can limit the amount of room the baby has in the womb. This condition is called intrauterine constraint. This can also inhibit the baby’s ability to get in an optimal position for delivery.

Keeping the body, including the spine, in proper alignment is vital to mobility, flexibility, and overall wellness of the body even when it is not pregnant. However, pregnancy puts specific stress on the body, creating certain needs that chiropractic care can meet. It is safe, it is effective, it is fast, and it works.

Chiropractic Clinic Extra: Stress Management Treatment

Women experiencing low back pain will find there are a variety of possible causes. Lower back pain can stem from the reproductive system or the spine itself. Finding the possible cause of low back pain can be difficult to diagnose. As well as, pinpointing the pain can be a very challenging task. Women wonder how it's possible to mistake menstrual cramps for back pain and then it happens to them. There are certain conditions that make the low back and core region a central location of continual pain. And unfortunately, women could be more susceptible.

Most individuals will experience low back pain at some point during their life. However, there is a slight prevalence and is more common in females than males across all ages. Low back pain in women increases with age. A research comparison studying middle-aged individuals reported an increase of low back pain in females versus males post-menopause. Some possible low back pain causes include.

Menopause and Hormone Issues

Chronic lower back pain is one of the most reported musculoskeletal issues women face during menopause. About sixty-seventy percent of perimenopausal women present symptoms associated with estrogen deficiency. And over half in perimenopause report chronic musculoskeletal pain. Many of these studies show increasing menopausal symptoms and the correlation to chronic low back pain symptoms.

Menstruation and Uterine Dysfunction

Dysmenorrhea is a uterine dysfunction that involves frequent and severe cramping during menstruation, which often leads to low back pain. The condition is classified as primary or secondary. Both types include low back pain as a common symptom.

Primary dysmenorrhea starts when a woman begins menstruation and continues throughout their life. Intense contractions can cause continual and severe menstrual cramping. Secondary dysmenorrhea usually starts later and is caused by another condition like endometriosis or pelvic inflammatory disease.

Endometriosis

Endometriosis is a condition that can contribute to back pain in women. Tissue that behaves like endometrial tissue begins to grow outside of the uterus, in the pelvic cavity or other areas. The new tissue responds to the body's hormonal changes and can cause swelling, pain, spotting, and bleeding. Endometriosis growths bleed monthly as well. Without a place for the blood to go, the excess irritates and inflames the surrounding tissue.

The condition can cause heavy periods, chronic pain, and scar tissue build-up. Symptoms can present at any menstrual cycle stage. Pelvic pain that runs down the legs is common. Some women have also reported throbbing, shooting pain that can be mild to severe. Symptoms include:

• Abdominal pain
• Low back pain
• Pain when walking or standing
• Pain during ovulation
• Pain when urinating
• Urinary urgency
• Pelvic inflammation
• Constipation
• Pain during intercourse
• Bowel movement pain
• Rectal pain that radiates
• Pain caused by scar tissue build-up within the bladder, fallopian tubes, bowels, and ovaries
• Chronic fatigue

Endometriosis can be diagnosed by a doctor during an initial pelvic exam. Further imaging tests to assist in the identification could be requested.

Spinal Issues

The reproductive organs can sometimes contribute to back pain. However, women can also be susceptible to degenerative conditions that affect the spine's structure. Low back pain is common with an average patient experiencing one to two episodes a year. Low back pain can start in early adulthood and become a chronic problem that can be triggered by various events or activities. Most back pain issues are resolved within six weeks. This is known as acute low back pain. When the pain doesn't stop for more than 12 weeks it is considered chronic lower back pain.

Postmenopausal Compression Fractures

Around twenty-five percent of women will go through a vertebral compression fracture of the middle or lower spine. The risks increase with age, with around a 40 percent chance at 80 years of age. Small cracks in the vertebrae can cause severe disability and limit function. Osteoporosis is the most common cause of vertebral compression fracture/s. Postmenopausal women are at an increase of developing osteoporosis. This comes from hormonal changes that decrease bone mineral density, leaving the bones open to fracture.

Spondylolisthesis

This is when one vertebral body, or the thick oval bone segment in front of the vertebra, slips against an adjacent body. The result is pain or mechanical symptoms. The pain can spread throughout the spine to the hip, buttocks, into the legs, and possibly the foot. The condition can be congenital, from an unknown cause, or acquired. There is some research on childbirth and hysterectomies putting women at risk for spondylolisthesis.

It is common in the lumbar spine/lower back, but can also present in the cervical spine/neck region. The thoracic/middle spine is extremely rare except in trauma cases. The thoracic spine is the longest region of the spine. It is between the cervical and lumbar regions. One cause of the increased pain is longer times spent sitting in chairs that are not ergonomic. A second is being confined to smaller workspaces. The key is to get up and move around or use a sit-stand desk to alternate sitting and standing. Irregular and localized low back pain is typical for low back spondylolisthesis. The pain usually worsens when the area/region is flexed or directly touched.

Piriformis Syndrome

Back pain sometimes isn’t back pain, but piriformis syndrome. The piriformis muscle is a small muscle that extends from the lower spine to the top of the femur. It can involuntarily contract and compress or irritate the sciatic nerve. The muscle helps rotate and turn the leg and foot outward. Symptoms are consistent with sciatica. It typically presents with buttock pain that shoots, aches, or throbs along the leg’s backside, thigh, calf, and foot. Tingling along the nerve along with numbness is common. Causes include:

• Buttock injury
• Hip injury
• Weight training specifically the gluteal/buttock, hips, and hamstrings
• Sitting for a long time - Examples include truck drivers, desk job workers, etc.
• Damage to the piriformis muscle
• Sciatic nerve wraps around the piriformis muscle

Sacroiliac Joint Dysfunction

Sacroiliac joint dysfunction involves inflammation of the joints, located at the connection of the pelvis and lower spine. It can present as low back or buttock pain that radiates down the leg/s. The pain worsens when climbing stairs or standing for an extended amount of time. Sacroiliac joint dysfunction can be tough to diagnose, as it is often mistaken for other low back pain causes.

SI joint dysfunction causes:

• Pregnancy - the increased weight and altered movement/s can cause additional stress and wear.
• Joint infection - in rare cases, the joints can be subject to infection.
• Arthritis - the joints can develop arthritis from normal wear and tear.
• Traumatic Injury - the joints can be injured from a forceful impact from a fall or auto accident.

Most cases do not end up requiring medication or surgery. It is when the pain lasts more than six weeks that there could be something more taking place like neurologic symptoms or other conditions, spinal or otherwise.

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The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

Q: I'm experiencing back pain more so now. My question is, is this back pain from my baby is it normal or is it something else? I'm a 30-year-old woman in the second trimester with our first child. I would have back pain before I was pregnant but nothing serious, just normal work and a little soreness at the end of the day. There was never back soreness or pain that I thought warranted a visit to the doctor. My doctor says that it is normal from the weight of the baby and there is nothing amiss, but to discuss this with a chiropractor, as there could be some treatment/therapies/exercises to help.

El Paso, TX.

A: Having low back pain before you were pregnant concerns me, as what you are saying sounds like a possible herniated disc bulging or slipped disc. However, I cannot give you an official diagnosis unless I see you as a patient and can't say if it is something else.

But low back pain can be caused by a combination of things. This includes your pregnancy along with:

• Herniated disc
• Disc degeneration
• Age
• Muscle spasm/s
• Daily wear and tear
• Injuries
• Unknown injuries
• Added Weight

These are just a few of the things that could be causing your low back pain. Add pregnancy to this list and low back pain can become unbearable. Your pain can be made worse by a variety of factors.

For example, let's say you were lifting a few pieces of light furniture before you became pregnant, and that slight soreness you felt and thought was nothing could actually be a strain, muscle spasm, or over-stretch that did not cause an injury but is the beginning of an injury waiting to happen.

During pregnancy, a growing belly can put place more pressure on the:

• Intervertebral discs
• Joints
• Muscles
• Ligaments

Hormones that are released during pregnancy can also exacerbate your back pain. The hormone relaxin causes the pelvis and the ligaments of the lower back to gain flexibility. This is in preparation for the delivery and can cause low back pain because of the added flexibility you are more prone to injury, which is why doctors say to take it easy. It could all be a combination of these factors but I would have to examine you, go over your medical history to get a proper diagnosis to create a personalized treatment plan during pregnancy and after if the need is there.

Treatment During Pregnancy

There are several treatment options for back pain. During pregnancy is not the time to experiment with medications or back pain treatments that could cause a negative response or something else to your health. The goal during pregnancy is safety.

Here are four safe therapies for managing back pain while pregnant:

1. Gentle exercise/s like walking and yoga helps alleviate back pain and can also generate an overall feeling of wellness.
2. Physical therapy can decrease your back pain by strengthening the muscles. A physical therapist that has experience working with pregnant women is the best option.
3. Prenatal massage relaxes tense back muscles and reduces stress. Look for a massage therapist that specializes in prenatal massage.
4. Prenatal yoga classes are great for decompressing/destressing during pregnancy.

Discuss all of this with your doctor and all treatment options. It's not a good idea to start a new exercise program when you're pregnant. If there was a regular exercise routine before you were pregnant, you can continue, but you may have to make some adjustments as your body prepares for the delivery. Once the baby is born, you and your doctor can re-evaluate your treatment plan. But regardless of your treatment plan, you should still continue to maintain a proper healthy weight by eating right and exercising regularly to prevent back pain from worsening.

Treatment for Low Back Pain During Pregnancy

Low back pain affects millions of people each year and is the number one cause of disability worldwide. In the US, it is estimated that 31 million people experience pain in their lower back. It is prevalent and can be debilitating. As patients search for relief, they soon find that not all lumbar pain is created equal. There are many causes and treatments vary widely depending on the issue. Radiculopathy is a condition that can contribute to lower back pain, but chiropractic care can help patients better manage it.

What is Lumbar Radiculopathy?

Radiculopathy is associated with some of the most significant causes of chronic or acute low back pain. However, it is important to note that the condition itself does not cause the pain. Instead, elements of radiculopathy, such as disc herniation, nerve root impingement, and facet arthropathy are actually what causes the pain.

Radiculopathy is a condition of the spine that occurs when a nerve is compressed, causing pain, weakness, tingling, or numbness along the nerve’s course. In the lower back, that course is in the leg. While it is most common in the lower back, radiculopathy can occur in the cervical or thoracic regions of the spine as well.

Symptoms of Lumbar Radiculopathy

The symptoms of lumbar radiculopathy include pain, tingling, and numbness in the legs. Some patients experience extreme, painful sensitivity to light touch.

The nerves in the lumbar region of the spine supply sensations to the buttocks and legs as well as control muscles. So, when a nerve is compressed in the lumbar spine, those are the areas that are affected. The condition is often called a “pinched nerve” or sciatica because of the way that the pain radiates through the buttock and into the leg. 

Causes of Radiculopathy

Irritation or compression of certain nerves are what causes radiculopathy, but it is worth looking at the causes of this irritation or compression to see the deeper cause of radiculopathy. These may include mechanical nerve compression due to:

• Bone spur
• Disc herniation from osteoarthritis
• Thickening of surrounding ligaments
• Infection
• Tumor
• Scoliosis

Degeneration or trauma can cause inflammation in the spinal nerves which can lead to pain.

Who is at Risk for Radiculopathy?

Certain people are more prone to radiculopathy based on the activities they engage in and their genetics. Patients who regularly participate in contact sports, heavy labor or any activity that puts a repetitive or excessive load on the back are more likely to have the condition. Patients who have a family history of spine disorders, including radiculopathy, are also more at risk of developing it.

Chiropractic for Lumbar Radiculopathy

A review published in the Journal of Chiropractic Medicine examined 162 patients with radiculopathy who were treated with chiropractic care. Of those patients, more than 85% not only experienced pain relief, but their conditions were resolved. This was done over 9 treatment sessions. Most of the patients saw an improvement of their symptoms within 4 days of their first treatment.

There are a number of treatments for lumbar radiculopathy, including pain medication, epidural steroid injection, and surgery. However, chiropractic care is non-invasive and does not have the unpleasant, sometimes harmful of many pain medications. It is safe and effective, treating the entire body instead of just the part that hurts.

When treating lumbar radiculopathy, the chiropractor may use several techniques such as spinal adjustments as well as stabilization exercise and neuromobilization. They will also work with the patient to determine if there are engaging in any activities that increase their risk factor for the condition. In some cases, the chiropractor may recommend certain lifestyle and dietary changes to increase whole body wellness and a stronger, healthier spine.

Chiropractor Low Back Pain Therapy

The human body is an intricate machine; everything is connected in one way or another. This means that when one part is not functioning as it should, it can throw everything out of balance. The relationship between the feet, back, and hips is significant, so when there is a problem with feet, it can cause pain in those areas. Fallen arches are a foot problem that is a widespread cause of lower back pain. However, many people who have fallen arches don’t even realize that they have an issue.

What are Fallen Arches?

There are more than 100 ligaments and muscles in the foot that stabilize the bones and keep everything in the proper position. Ligaments prevent joints from extending beyond their intended limits. They contain elastin which allows them to act much like a rubber band, stretching with movement or flexion then returning to their regular length when the joint returns to its resting position.

There are a variety of things that can happen that cause those ligaments to stretch, causing them to lose their ability to support the foot as they should. This can lead to pes planus (flat feet), also known as fallen arches.

Most people don’t realize that there are actually three arches in the foot, not just one: lateral, medial, and anterior. They act as shock absorbers for the body. When they don’t function as they should, don’t absorb the shock of movement and activity, it puts added wear and tear on the body. While foot, knee, hip, and back pain is common with fallen arches, it also is a major cause of impaired functioning of the lower extremities. It can also lead to balance problems.

Causes of Fallen Arches

The primary cause of fallen arches is improper footwear. Shoes that do not adequately support your foot and arch can lead to structural problems.

Other causes of fallen arches include:

• Tendons in the foot that are torn or stretched
• Certain health conditions including
  • Rheumatoid arthritis
  • Pregnancy
  • Diabetes
  • Obesity
  • Aging
• Structural abnormalities that are present from birth
• Inflammation, deformity, or damage of the posterior tibial tendon that runs from the middle of the arch to the lower leg, running along the ankle
• Nerve issues
• Bones that are dislocated or broken

Recognizing the symptoms of fallen arches and knowing that you have a problem can help to prevent the pain but can also arrest further damage to the foot.

Do you have Fallen Arches?

While many people with fallen arches experience no symptoms or problems, others do. If you experience any of these symptoms of flat feet, it should prompt a visit to your doctor.

• Pain in the foot, knee, leg, hip, or lower back
• Feet that easily get tired
• Difficulty with balance
• Swelling on the bottom of the foot
• Pain or achiness in the foot, particularly in the heel or arch
• Certain movements. such as standing on tiptoe, are difficult

There is a quick, simple test that you can do at home to see if you have fallen arches:

1. Wet your feet
2. Stand on a flat, hard surface, such as a floor or concrete pad (you need to be able to see your footprint) or walk in soft soil or sand
3. Look at your footprints. If you see a print that shows the heel and ball of your foot with a thin, curved imprint running along the outside, then your foot structure is normal. If you can see the imprint of your entire foot, then you probably have fallen arches.

The problem with fallen arches is that the damage cannot really be reversed once it begins. However, the progression can be stopped with proper treatment.

What are the Treatments for Fallen Arches?

The treatment for fallen arches depends on the cause and severity of the condition. If it isn’t causing pain or other problems, the doctor may elect to do nothing.

However, if there is pain or mobility issues present, treatments may include bracing, prescribing NSAIDs for pain and inflammation, and even surgery in some cases of torn tendons or broken bones. An increasingly popular treatment for fallen arches is chiropractic care. This natural, non-invasive therapy treats the whole body so that it addresses the cause of the condition as well as associated risk factors and helps patients manage the pain, significantly improving their quality of life.

Heel Spur Treatment

David Garcia, maintenance facility worker, and a proud Dad in El Paso, TX at the Region 19 Education Services Center. However, Mr. Garcia's everyday life has become influenced by his chronic lower back pain. After undergoing worsening symptoms for some time, David Garcia was recommended to seek chiropractic care with Dr. Alex Jimenez by his sister, a former patient of Dr. Jimenez. Mr. Garcia has since experienced enormous relief from his lower back pain, and he's grateful to Dr. Alex Jimenez and his staff for supplying him with education regarding his health problems as well as adequately caring for him. David Garcia recommends Dr. Alex Jimenez as the non-invasive surgical selection for lower back pain.

Low Back Pain Relief

Low back pain is not a specific injury or condition but instead a group of symptoms which may be brought on by a wide variety of underlying health issues, all in varying levels of seriousness. The majority of low back pain does not have a definite cause but is believed to be the consequence of including strains or sprains, musculoskeletal issues. Obesity, smoking, weight gain during pregnancy, stress, poor physical condition, poor posture, and poor sleeping positions also have been attributed to developing low back pain. A complete list of potential causes comprises many less common ailments. Physical triggers might include osteoarthritis, degeneration of the disks between the vertebrae or a spinal disc herniation, broken vertebra(e) (like from osteoporosis) or, rarely, an infection or tumor of the spine. But there is relief with chiropractic care and therapy.

We are blessed to present to you El Paso’s Premier Wellness & Injury Care Clinic.

Our services are specialized and focused on injuries and the complete recovery process. Our areas of practice include Wellness & Nutrition, Chronic Pain, Personal Injury, Auto Accident Care, Work Injuries, Back Injury, Low Back Pain, Neck Pain, Migraine Treatment, Sports Injuries, Severe Sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Stress Management, and Complex Injuries.

As El Paso’s Chiropractic Rehabilitation Clinic & Integrated Medicine Center, we passionately are focused on treating patients after frustrating injuries and chronic pain syndromes. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities.

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Truide Torres, office manager, first received chiropractic care with Dr. Alex Jimenez during her pregnancy for her lower back pain. Mrs. Torres experienced aggravating symptoms throughout the progression of her pregnancy, which led her to seek a natural treatment approach for her own health as well as that of her own baby. Once Truide Torres started chiropractic treatment with Dr. Alex Jimenez, she recovered her quality of life and was able to return to her original state of well-being. As an office manager, Truide Torres also receives regular chiropractic care for any lower back pain which may occur as a result of her job. Mrs. Truide expresses how important it is to continue her spinal maintenance and she highly recommends Dr. Alex Jimenez as the non-surgical choice for a variety of health issues.

Lower Back Pain During Pregnancy Treatment 

Low back pain (LBP) is a frequent health issue involving the muscles, nerves, and bones of the spine. Pain may differ from a dull persistent pain to a sudden sharp sensation. Low back pain can be classified by length and severity (pain lasting less than 6 months), sub-chronic (6 to 12 months), or chronic (over 12 months). The status could be further categorized by the underlying cause as both bodily, non-mechanical, or referred pain. The symptoms of low back pain may generally improve in a couple weeks from the time they begin, however, some cases may require additional treatment. In the majority of episodes of lower back pain, a specific underlying cause isn't identified or properly cared for, and healthcare professionals may attribute it to mechanical issues like joint or muscle strain.

INJURY MEDICAL & CHIROPRACTIC CLINIC NEWS EXTRA: MIGRAINE PAIN TREATMENT

Damaris Foreman suffered from migraines for about 23 years. After receiving traditional treatment for her migraine pain without much improvement, she was finally recommended to seek migraine pain treatment with Dr. Alex Jimenez, a chiropractor in El Paso, TX. Damaris greatly benefitted from chiropractic care and she experienced a tremendous sense of relief following her first spinal adjustment and manual manipulation. Damaris Foreman was able to confront many of her misconceptions and she learned very much about her migraine pain. Damaris describes Dr. Alex Jimenez's migraine pain treatment as one of the best treatment she's received and she highly recommends chiropractic care as the best non-surgical choice for improving and managing her migraines.

A migraine can be identified as a primary headache disorder characterized by recurrent headaches characterized from moderate to severe in intensity. Typically, the headaches affect one half of the head, are pulsating in nature, and can last from two to 72 hours. Associated symptoms may include nausea, vomiting, and sensitivity to light, sound, or smell. The pain may be aggravated by physical activity. Up to one-third of people who suffer from migraines experience migraine with aura: typically a brief period of visual disturbance that signals that the headache will soon happen. An aura can occur with little or no headache pain following it.

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Chiropractic Alternative to NSAIDs for Back Pain

Arlington, Va.--People suffering from back pain should consider first trying chiropractic services and other non-drug therapies in light of a new research review that found common over-the-counter and prescription pain medications have limited effectiveness for back pain and raise the risk of side-effects, according to the American Chiropractic Association (ACA).

The review, published this month in Annals of the Rheumatic Diseases, examined 35 randomized, placebo-controlled trials, encompassing 6,000 patients, to determine the effectiveness and safety of non-steroidal anti-inflammatory drugs (NSAIDs) for spinal pain. The authors of the report found that NSAIDs provided “clinically unimportant effects” when compared with patients who received only a placebo. Meanwhile, those who used NSAIDs had a 2.5 times greater risk of experiencing gastrointestinal disorders.
“At present, there are no simple analgesics that provide clinically important effects for spinal pain over placebo,” the authors noted.


The news about NSAIDs follows reports last year that prescription opioids also have limited effectiveness for back pain—one of the most common causes of disability worldwide.


“The American Chiropractic Association urges people to try non-drug approaches to back pain relief first, before resorting to over the counter or prescription medications,” said ACA President David Herd, DC. “In addition to spinal manipulation, chiropractors can offer a range of non-drug therapies for back pain and recommend exercises and important lifestyle changes to help prevent future back pain and injury.”

According to a 2016 Gallup survey, more than 35 million people visit a chiropractor annually.

About the American Chiropractic Association
The American Chiropractic Association (ACA) is the largest professional association in the United States representing doctors of chiropractic. ACA promotes the highest standards of ethics and patient care, contributing to the health and well-being of millions of chiropractic patients. Visit us at www.acatoday.org to find an ACA chiropractor near you.

NSAIDs: Non-Steroidal Anti-Inflammatory Drugs

Every day, an estimated 30 million people worldwide take a non-steroidal anti-inflammatory medication, or NSAID.

These versatile medications, available in over-the-counter and prescription strength, treat both pain and inflammation. Inflammation is a contributing factor in most back pain conditions, so reducing inflammation is important to alleviate the pain.

See Lower Back Pain Symptoms and Causes and Causes of Upper Back Pain

NSAIDs are used to address acute (short term) as well as chronic back, neck, and muscle pain.

See Pain Management for Chronic Back Pain

Painkillers for Back Pain and More:

Common uses for NSAIDs include treatment for:

• Mild or moderate back pain, tenderness, inflammation, and stiffness
• Activity-related pain or discomfort (e.g. pain that follows sports or activities such as housework, shoveling snow, or other exertion)
• Pain related to muscle strain in the low back and elsewhere
• Neck stiffness related to muscle, ligament, or tendon strains or damage
• Osteoarthritis joint pain
• Rheumatoid arthritis
• Ankylosing spondylitis
• A number of other forms of arthritis pain

This article provides information on how non-steroidal anti-inflammatory medications can be helpful against back, neck, and other pain, as well as several potential risks and complications to be considered.

Most Common Types of NSAIDs:

NSAIDs comprise a large class of drugs that act by hampering body substances called prostaglandins, which trigger feelings of pain, giving NSAIDs fever-reducing, pain-relieving, and anti-inflammatory properties. There are many types of non-prescription (over-the-counter) and prescription NSAIDs. The four NSAIDs most often used to treat many types of back and neck pain are:

• Aspirin (brand names include Bayer, Bufferin, and Ecotrin, St. Joseph)
• Ibuprofen (Advil, Motrin)
• Naproxen (Aleve, Anaprox DS, Naprosyn)
• Celecoxib (Celebrex)

Other Forms of NSAIDs:

In addition to the above, NSAIDs come in forms other than those taken by mouth. For example:

• Ketorolac can be given as an intravenous, intramuscular, or intranasal drug, making it useful after surgery or if the patient cannot eat.
• Diclofenac is available topically as a gel (Voltaren), patch (Flector), or solution (Pennsaid). The medication is applied directly to the area of pain. Topical forms reduce gastrointestinal and other potential side effects of NSAIDs.

NSAIDs: Non-Steroidal Anti-Inflammatory Drugs

Common NSAIDs for Back Pain
Potential Risks and Complications of NSAIDs
Types of NSAIDs
Anti-Inflammatory Medications for Back Pain Relief Video

Effective Use of NSAIDs:

Taking NSAIDs continuously, rather than just at the onset of pain, helps build up the body’s anti-inflammatory blood level, resulting in a better healing environment in the affected area. The efficacy is markedly lower if NSAIDs are taken only when experiencing pain.

See Using Medication to Manage Pain and Reduce Sleep Problems


Other Points To Be Aware Of While Taking NSAIDs:

• Checking with the doctor. Because NSAIDs have risks and complications, it is important to keep the doctor informed. People taking NSAIDs for long periods are advised to see the doctor regularly so any side effects can be monitored. In some cases, a change in medication may be required.
• Using as little as possible. The U.S. Food and Drug Administration advises that the lowest effective dose of NSAIDs be used, and then for only as long as necessary.
• Combining with acetaminophen. NSAIDs and the pain relief medication acetaminophen (e.g. brand name Tylenol) work differently, so sometimes doctors recommend taking both medications. This often offers better pain relief than taking one type of pain medication. Some people find it also helps lessen the pain as one dose wears off, alternating between the two—for example, taking a dose of ibuprofen, then 3 hours later taking a dose of acetaminophen.

Any adverse reactions from taking an NSAID, or any other medication, should be reported to the doctor without delay.

When NSAIDs Are Not Advised

People having a lumbar fusion surgery are typically advised not to take NSAIDs for at least 3 months after surgery due to concerns about the impact NSAIDs may have on bone healing.

Many doctors also tell patients to stop using NSAIDs prior to other types of surgery because the medication poses an increased risk of bleeding.

Low Vitamin D Linked to Increased Headache Risk

News Bite: Vitamin D may be a component factor in headache a new study demonstrates.

More research is adding to the literature of a link between vitamin D deficiency and headaches, at least for men living in colder climates.

Data from 2600 middle-aged men from Finland who participated in the Kuopio Ischemic Heart Disease (KIHD) Risk Factor Study showed that those with the lowest levels of serum 25-hydroxyvitamin D (25[OH]D) were more than twice as likely to report having chronic headaches as those who had the highest vitamin D levels. In addition, reports of chronic headache were significantly more frequent in months other than the summer months (June through September).

The investigators note that although past studies have examined the link between vitamin D and headaches, the results have been “inconclusive” because many included small sample populations. When the KIHD study originally started, men in this part of Finland had the highest prevalence of heart disease in the world, and it was looking at risk factors for cardiovascular disease.

During the baseline examinations, questionnaires asked the participants to report headache status during the previous 12 months. “Frequent headache” was defined as a daily or weekly occurrence — and was reported by 9.6% of the full group.

Also at baseline, fasting venous blood samples were collected during morning hours and 25(OH)D concentrations were measured.

Interestingly, the mean concentration of serum 25(OH)D for the study group was 43.4 nmol/L, which is below the 50-nmol/L threshold generally considered to be a marker of vitamin D deficiency. In fact, 67.9% of the group had levels that were less than 50 nmol/L.