Spine Health & Spinal Hygiene

(HealthDay News) — Chronic lower back pain affects millions of Americans. Many try steroid injections to ease their discomfort, but researchers now say this remedy provides only short-term relief.

In their study, investigators from France focused on 135 patients with back pain seemingly caused by inflammation between the discs and bones (vertebrae) in the lower spine.
 
The researchers found that a single steroid injection eased pain for one month. After that, however, effectiveness waned. Virtually no difference was seen one year after treatment between patients who did or didn’t get the injection.

“Our results do not support the wide use of an injection of glucocorticoid in alleviating symptoms in the long term in this condition,” said lead researcher Dr. Christelle Nguyen.
The findings are consistent with earlier studies, said Nguyen, an assistant professor of physical medicine and rehabilitation at Paris Descartes University.

Nguyen said she and her colleagues had hoped that targeting local disc inflammation with an anti-inflammatory steroid would help alleviate long-term pain.

To test their theory, they selected patients with chronic lower back pain and signs of disc inflammation on an MRI. On average, participants had suffered from back pain for six years. Half were assigned to a single steroid shot; the other half got no injection.

Patients rated their pain severity before the injection and again one, three, six and 12 months after the treatment.

One month after treatment, 55 percent of those who got the steroid injection experienced less lower back pain, compared with 33 percent of those who weren’t treated.

“However, the groups did not differ for the assessed outcomes 12 months after the injection,” Nguyen said.

For example, patients who did or didn’t received a steroid injection ended up in similar circumstances, with the same incidence of disc inflammation, lower quality of life, more anxiety and depression and continued use of non-narcotic pain pills, she said.

Overall, most patients found the steroid injections tolerable, and would agree to have a second one if necessary, Nguyen said. “We had no specific safety concerns and found no cases of infection, destruction or calcification of the disc 12 months after the injection,” she added.

The results were published March 20 in the Annals of Internal Medicine.

Dr. Byron Schneider, of Vanderbilt University School of Medicine in Nashville, noted there are many different causes of back pain.
In this study, the patients suffered from chronic back pain, he pointed out. “Patients with chronic lower back [pain] probably have more than one cause of their pain, which may be why the good results they found at one month weren’t there a year later,” said Schneider, an assistant professor of physical medicine and rehabilitation.

The study results don’t mean steroid injections should be avoided altogether, he noted.

Patients with a sudden episode of back pain — so-called acute pain — probably don’t need a steroid injection, he said.
 
Chiropractic Care Boosts Surgery Avoidance

“But if they’re not getting better after a month or two the way we would expect them to, at that point it would be reasonable to discuss the pluses and minuses of a steroid injection,” said Schneider, co-author of an accompanying journal editorial.
Chronic (long-term) back pain is a different situation, he said. Treating chronic back pain means treating the pain itself, but also using cognitive behavior therapy and “pain psychology” to help patients cope with pain, he said.

“For chronic pain, physicians need to address the musculoskeletal reasons that cause the hurt, but also other reasons that patients may be experiencing pain,” Schneider said.

According to the editorial, psychological distress, fear of pain and even low educational levels can affect pain levels.

More information
For more on lower back pain, visit the U.S. National Institute of Neurological Disorders and Stroke.

Doctor of Chiropractic, Dr. Alexander Jimenez looks at high heels at what they do to the back.

Ladies, ever wonder why you suffer from regular bouts of lower back pain?  Achy hips?  How about crazy tight leg muscles?  Don’t blame it on your cycling class, or too many squats or, the trainer you only see once or twice a week.  Look down.  Are you wearing high heels?  Bingo!  You’ve heard high heels are bad for you.  But it’s not just because they cause all kinds of pain and trauma to your feet.  High heels are also messing up your physical fitness.  They throw you out of proper postural alignment causing your joints and spine to take on more wear and tear, which means aches and pains.

Is it possible to still look rockin’ and save your joints?  My suggestion is more Athleisure-wear.  I know some fashion hard-liners say, no way will I walk around in yoga pants on a weekday!  But we’ve come a long way since those flare-leg, fold-over yoga pants.

Let’s chat for a moment about the evils of high heels.
First there’s the obvious.  They make your feet hurt.  Blisters, calluses and swelling are par for the course.  And pointy toes, fuhgeddaboutit!  I’m sure they were invented by someone on the Marquis de Sade’s payroll.  Second, they can lead to foot injuries like plantar fasciitis (usually from a bone spur that makes your heels hurt), hammertoes, bunions, and neuromas.   Then there’s the domino effect.

Not only do high heels make your feet hurt, but problems with the feet can travel up the leg and cause injuries in the back, knees and hips.  Your knees take on extra pressure from the weight being pushed forward onto the balls of the feet.  Walking in this position makes your hip flexors and calf muscles short and tight.  And it doesn’t stop there.  Back problems are incredibly common in women who don’t give up their high heels.
 
Back Problems are incredibly common in women who don’t give up their high heels

Here’s why:

1. Postural changes: The S-curve of your spine has cushiony discs in between the vertebrae that act as a shock absorbers to protect them from stress. Like when you’re bending or jumping.  Wearing heels causes the lower back to arch more than normal because the body weight is pushed forward.  To compensate, the upper body has to lean back to maintain balance.  This puts extra stress on the discs.   Spending hours with your body in funky alignment can lead to muscle spasms and back pain.  Tight hamstring muscles, which attach to back of the pelvis and lower back, can also make your back ache.
2. Anatomical changes: Wearing high heels on a daily, or very regular basis, over years, can actually cause anatomical changes to your body.  In addition to the extra strain on your back and knees, the calf muscles can also shorten and the tendons can get tighter and thicker.

And It Can Get Even Nastier If You Get One Of These Spine Injuries:

• Spondylolisthesis: it’s a mouthful, but is a common injury that can happen in the lower back from too much hyperextension (arching the back).  It’s when one vertebra slips forward over another.
• Foraminal stenosis: I have this one congenitally and it sucks. This is a spine and nerve issue that occurs when anatomical abnormalities reduce the spaces the nerves travel through as they exit the spinal column.  The spaces are called foramina, and when they get blocked, the nerves get squeezed.  The pain can radiate through the buttocks and down the legs.  Symptoms are shooting pains, numbness, tingling, muscle weakness, spasms and, or cramping.
• Sciatica:  The sciatic nerve is the longest one in the body.  It runs from the bottom of the lumbar spine all the ways down the legs.  When the sciatic nerve gets compressed it causes radiating pain, tingling, numbness and muscle weakness down the leg and can The pain can travel all the way to the bottom of the foot.

What Can You Do?  My Case for Athleisure-Wear To Combat Back Pain
  
It’s time for stuffy office attire to retire.  Comfy clothes and flat shoes can be very chic.  Have you seen the boards on Pinterest?  Thanks to this hopefully permanent fashion style, my jeans and heels spend more time in my closet than on my body.  Leggings and cute kicks are my go to’s.  Night out?  No prob.  I reach for my sleek workout leggings, a ruched top or off the shoulder top with some high heel sneaks (they’re wedges so not nearly as bad for you).  I also discovered these by Bluprint which I put to the test at 2 huge conventions where I walking and standing for hours on end.  The soles made of memory foam – like those beds!
 
My podiatrist friend, Steven Rosenberg, DPM has been preaching the need for comfy shoes to his female clients for years.  (Fortunately for his practice, not everyone listens!)  Dr. Steve says, wearing shoes designed more for comfort can help you live more pain-free.  “Because comfort shoes are made of soft cushiony materials with soft foam innersoles, those are what you should turn to for shopping, walking or standing for long periods of time to avoid blisters, muscle spasms or arch cramps.”   He also says to check for arch support in your shoes.  If there’s none, you can buy ones to put inside.
 
Even after reading this, you may still not be willing to give up high heels for good.  Me either.  I still get glammed up once in a while.

Here Are Some Tips For When You Must:

• Wear them for as little time as possible.
• Try to opt for heels around 2” high
• Steer clear of pointy toes.
• Buy shoes with leather insoles to so your foot doesn’t slide.
• Buy arch inserts or use orthotics to support your arches.
• Vary your footwear so you’re not wearing high heels every day.
• Gradual or lower slopes are a little better, go for platforms or wedges instead of stilettos
• Thicker heels are better than spiky heels
• Stretch and strengthen the overworked muscles.

Here’s How:

• Stretch your leg muscles and hip flexors before and after wearing heels.  For the calves, stand on a step and let one heel hang down until you feel a stretch.

Try this convenient device, the foot rocker by Vive.  It stretches the calf and the sole of the foot relieving pain from plantar fasciitis.

• Massage and stretch the muscles in the soles of your feet.  Roll your foot on a golf ball before and after wearing heels and, get regular foot massages.
• Strengthen and increase the range of motion in your ankles and feet.  Put a rag on the floor.  Using your foot, write the letters of the alphabet.  Also put a bunch of marbles on the floor.  Pick one or a few of them up using just your foot.  Put them down about 6 inches away without lifting your foot off the floor.  Try that 10 times.  If you don’t have marbles, you can do it with a hand towel.

So next time you’re shopping for shoes, think about your foot fitness first.  Look for fashion that keeps you closer to the ground and that will hopefully keep you farther away from the doctor.

Doctor of Chiropractic, Dr. Alexander Jimenez looks at the cervical spine and low back pain.

Low back pain and leg pain are the most common cause of disability worldwide. As such new research based treatment approaches are needed. This new randomized trial by BCP Non-profit and Cairo University tested the ability of the cervical Denneroll orthotic to improve cervical spine curvature and its consequent effect on low back and leg pain.

Great short term results were found where patients receiving the cervical spine Denneroll improved with low back pain, leg pain, neurological outcomes and disability compared to a PT only interventional group.

Doctor of Chiropractic, Dr. Alexander Jimenez looks into Tai Chi for back pain.

Q&A with Tai Chi Specialist Dr. Paul Lam

While lots of people take a “no pain, no increase” approach to work out, that’s for handling back and neck pain not always safe or effective. That’s where tai chi comes in. This low-impact, slow moving form of exercise delivers results without the sweat and soreness. Though it’s tender and meditative tai chi promotes strength, flexibility, and balance—the trifecta to get a healthier spine.

In case you have back or neck pain—or you’re looking for methods to prevent it in the first place —tai chi may be worth investigating. To help answer common questions and shed light on lesser-known facts relating to this ancient Chinese mind and body practice, we reached out to Dr. Paul Lam, manager of the Tai Chi for Health Institute in Australia.
 

Tai Chi Can Help

Q: During your research, what has become the most insightful finding you’ve found about tai chi as it relates to back pain?

A: The most insightful finding in my research concerning tai chi involved the mental impact and the deep stabilizer muscles to back pain.

Ninety percent of men and women have back pain at some period in their own lives, and more than 60 percent of that is continual. I discovered that nearly all individuals with back pain, no matter what the cause, have poor stabilizer muscles. Research has shown that strong stabilizers will prevent back pain and hasten healing.

Reinforcing the stabilizer muscles that are back is quite similar to tai chi training. The main element is an erect pose, exercising the stabilizers through the pelvic floor along with the transverse abdominus muscles, and using abdominal breathing. This really is among the important reasons why tai chi works so well for back pain.

One other insight I’ve discovered involves your head. Anxiety makes pain worse. Oftentimes with the continuing and persistent back pain, the cause of the pain might have gone, but the pain continues. Like a phantom pain, the thoughts’s ingrained custom proceeds to provide pain signals to the brain. Tai chi trains body and the mind, making both integrated and more powerful. It is but one of the utmost effective tools to greatly help with the mental aspects of back pain.

Q: What’s your best advice for somebody who’s apprehensive about beginning tai chi?

A: The reason why they are apprehensive about beginning tai chi, it depends. I can guarantee them it is safe, simple to understand, and proven effective, if people believe tai chi is a martial art and might be overly hard to learn. Millions of people around the globe have learned and profited from it, although the other consideration is the fact that individuals might believe tai chi is too tough to learn.

Q: How do individuals get the most?

A: I advocate people to practice tai chi for 30–40 minutes daily (it may be performed in separate sittings) most days each week. You will gain significant improvement in your quality of life and relief from back pain.

Q: Do you have some success stories that are personal which you can share regarding the benefits of tai chi for back pain?

A: Thousands! But to pick on only one, I’ve comprised a letter below written by a woman named Amatullah from Saudi Arabia.
“In 2009, I ‘d back pain for quite a while. Nothing worked, although I attempted many types of therapy. My friend said, ‘Try tai chi, it’s a gentle exercise.’ Because my back was sore, I refused at first, but I attempted it. It was really surprising to me how people from 35 to 80 years old could do the movements, when I couldn’t. I found to be able to steadfastly keep up their health, some of them had been practicing for up to 35 years. I understood they were much fitter and much more flexible than my parents, therefore I decided to learn it. I practiced in all weather, in the park every day. My back pain vanished and has never return.”

Q: Are there tai chi resources you can recommend?

A: Yes, the Tai Chi for Health Institute web site has many resources, including a summary of accredited educators around the planet.