So… my back hurts. Now what?

Pretty much all of us will experience back pain now and again. As a matter of fact, many of us will endure crippling, stabbing back pain, even pain or numbness into the butt or legs.

Another fact is that most people pay very little attention to the physical health of their backs or necks until things are really starting to hurt. That’s why so many people have their first visit to a “back doctor” be a visit to the orthopedic surgeon or neurosurgeon. Of all the “back doctors” to see first, those should not be on your list.

pain descriptive words

I’ll be honest, chiropractic is GREAT for treating simple low back pain. Good ol’ regular biomechanical low back pain responds GREAT to chiropractic adjustments. Countless research studies in proper, well-respected medical journals have confirmed this. Some of that research is here, but that’s not the point of this article.

You have a few things you can try first. Like everyone else in the world, your first attempt at fixing something should probably be a relatively inexpensive option that has the smallest likelihood possible for something bad to happen.

You can try any one of these things:

Chiropractor Visits
Course of Physical Therapy Sessions
Acupuncture
Massage Therapy
Ice or Heat
Stretching or Exercise
Painkillers
NSAID’s
Steroid Injections
Nerve Block
Spinal Surgery

Looking at this list, we can tell right off the bat that some of these are easier, safer and less expensive than others.

Stretching or exercising is free. It’s not necessarily easy, especially if you are in pain, but it’s one way to go. Massage and acupuncture are both safe and natural, so they are good places to start if you want to avoid drugs. Physical Therapy, depending on your therapist, is probably going to be mostly or somewhat natural, and besides needing to have you come in three times a week so they can watch you exercise, it’s a great way to recondition your out-of-shape back.

Painkillers and NSAID’s are, well, drugs. So if you are trying to get the back pain monkey off your back without drugs, they aren’t going to be on the list. For what it’s worth, painkillers will probably do something to get rid of the pain. Of course, when they wear off, you will be back in pain. NSAID’s may be able to deal with the injury in your back by reducing the inflammation, and this may get the pain to disappear for a while even after the medicine has left your system. The problem here is that NSAID’s aren’t safe for everyone, and even if they work for you and are safe for you, whatever caused the inflammation (and therefore the pain) in the first place is still probably causing inflammation just like before, and it’s only time before the pain returns (probably worse).

Nerve blocks and surgery are very poor first-lines-of-defense if your back pain is non-emergency and non-traumatic. In other words, if your back hurts because your posture sucks and you never exercise, then a nerve block isn’t the right way to go unless you are into injuring yourself on purpose. And surgery obviously shouldn’t be on your Christmas list, either.

Since a chiropractor is the author of this article, you can bet I saved chiropractic for last because I was saving the best for last. And it is. Chiropractic is great for so much more than back and neck pain, but our bread and butter is helping people get rid of back or neck pain. People (who have never been adjusted before) are almost always surprised at how effective chiropractic is. The reason chiropractic is so effective is because you and me have bodies that are designed to function normally, and a chiropractic adjustment takes a screwy spine and, for lack of a better description, straightens that spine out. Then the spine works better…and then it doesn’t hurt any more. Rather than cover the pain with medicine we adjust the body so that it will work normally, and since normal function is supposed to be pain-free, the client typically feels better. It’s not magic, it’s actually basic physics, a touch of the basics of mechanics, and some rudimentary biology. The body is supposed to work normally, and without pain, so sometimes it just needs to be pushed back in the right direction.

So, if you want to be pushed in that direction, give us a call. Thanks for reading. -Rob

Low Back Pain from Running

Many runners present to our office saying that running has been causing them lower back pain recently. This is not an unusual thing to occur. Due to the anatomy of the lower back, running may greatly increase the burden the bones and joints of the lumbar spine and hip have to carry.

Many people already know that when running the amount of weight, or force, transmitted up the legs from the feet each time the foot hits the ground is a multiple of the person’s actual body weight. If a 200 lb. individual is running, each time one foot hits the ground because of the force of gravity and momentum that single foot will absorb more than 200 lb’s of force, and all that force must travel up the leg (the kinetic chain) and into the lower back and spine as it is dissipated. Running, therefore, puts a lot of force into the feet, ankles, knees, hips, and lower back. This is not necessarily a bad thing, but it may cause pain or health problems if their are imbalances in the body that cause this force to be asymmetrically transmitted, or if the back or legs or already weakened by injury and are unable to dissipate the forces adequately.

Sometimes this pain in the lower back is actually pain from the sacroiliac joints. These joints can be felt as two bony bumps at the bottom of your lower back, and at the top of your butt area. Many people complain of “low pack pain” and then point to these joints. Hip misalignments or imbalances in how force is transmitted upwards can cause pain at these joints. Because they are MAJOR weight-bearing joints and they are the main joints connecting the legs to the rest of the body, they are susceptible to misalignments knows as subluxations, and they often refer pain into the lower back or the buttocks.

Other times the pain is actually located in the low back, either in the muscles or in the joints. Muscular pain will likely be to the side of the spine bones, either on one side or both, and may be relieved with some heat or stretching. The question that must be answered is: what is causing the muscle problem?

  • Is it a lack of proper hydration causing cramping and spasm?
  • Is it a strain from lack of stretching beforehand?
  • Is it a strain due to bony misalignments at the points where the muscle originates or attaches?
  • Is it a muscle spasm caused by nerve irritation?
To properly resolve the muscle problem, the cause must be identified.
Many times, the issue is with the joints of the lower back, such as the discs or the facet joints. If this is a disc issue, you are likely experiencing increased pain with things like:
  • Bending over
  • Bending over with trunk rotation
  • Sitting, and getting up from being seated
  • Each time the foot hits the ground as you run
If it is a suspected disc problem, it is recommended that you consult a chiropractor (like me, hint hint!) and see if you can resolve the disc pain without drugs or surgery. If chiropractic is not sufficient, then consult an orthopedist and see if you are a candidate for surgery. BUT do not go straight to the orthopedist because you should begin with less-invasive options that are reversible, and you should NOT begin with highly-invasive and irreversible options.
The facet joints are often hard to pinpoint as the cause of the lower back pain. They may cause increased discomfort with:
  • Standing tall, or leaning backwards
  • Running downhill
  • Standing tall and rotating your trunk
Facet joints issues are typically simple to treat with chiropractic adjustments. The joints must be mobilized to ensure that there is no pressure on the adjacent spinal nerves. Postural advice or exercises would likely be beneficial.
If you think you may be experiencing some of these problems, call out office today at (301) 378-0334 and you can come in for a free, no-pressure consultation. The doctor will take a look at your issue, ask some questions, do some good listening, and let you know if we can help. Until then, run safely and drink plenty of water to make sure it isn’t an issue of dehydration causing muscle strain.

Cornhole, Coffee and Brewery Tours at Park Bench Chiropractic

Rob and Logan went to the craft beer mecca of Frederick – Flying Dog Brewery – to get some BREWERY TOUR PASSES…15 of them in fact. We will be giving away Flying Dog Brewery Tour passes to bike swappers, cornhole players, and anyone lucky enough to get one on Sunday October 2nd. Get your coffee buzz on with Dublin Roasters and win a pass to get your beer buzz on with Flying Dog.

The chiropractors at Park Bench will be playing cornhole with anyone interested, and giving out prizes all the while.

Check out the Flying Dog Brewery website to learn about their awesome craft beers, and see the Dublin Roasters Coffee website to learn about the coffee shop hosting the Bike Swap. See the Frederick Bicycle Coalition website for more information on the swap. Be there Sunday, October 2nd to take part in the fun.

Baby, you were born to run, barefoot?

Lately there has been a lot of interest in barefoot running, or running with minimalist footwear on. I think it would be really great to provide some quality general information about this for those considering the idea of running either barefoot or in something minimalist like Vibram Five Fingers.

In general I am a big fan of the concept that getting “back to the basics” is usually the healthy thing to do. I prefer my food unprocessed and whole. I like my exercise to be simple and functional. The idea of running barefoot has a certain appeal to it – after all, our ancestors managed to flee from man-eating predators without the benefit of $100 running shoes. But, does running without shoes on (or with minimal footwear) actually do us any good, or is it a dangerous fad that leads to injuries?

Before I delve into the topic at hand – running without traditional running shoes – I will quickly discuss the options available. You can either drop the footwear entirely and go barefoot, or you can go with a minimalist option like Vibram footwear. The minimalist choice will provide some protection to the soles of your feet, but will rob your body of the biggest form of feedback as you run – the feedback from the soles of your feet. Being barefoot will give your body and nervous system more input and more control, which is great for mastering something new like ditching the running shoes. So there is a trade-off you must make between the protection that minimalist footwear provides and the neural feedback and increased neuromuscular control that being barefoot provides. Also, being barefoot allows your feet to breathe and sweat more freely, and develop more strength and control in the small intrinsic muscles of your feet.

Some proponents of barefoot running claim that running barefoot as our ancestors did is healthier for our feet. One reason is that when running without shoes the outside front of the foot takes a lot of the impact, while running with shoes on leads to high-impact heel strikes, with the person placing all their weight on the heel and then pushing off from the forefoot. Without shoes on the runner will not land on their heel with such force, as this would be painful to do without shoes, and will instead use the front of the foot to provide most of the immediate shock absorbing and ground contact.

One way in which the foot is marvelously designed is the ability of it to absorb impact from running with minimal force being transferred to the knees, hips, or low back. This process of shock absorption built into our bodies was built in when we were evolving and when there was no such thing as modern footwear with thick cushioning. Now that we tightly encase our feet and provide padding underneath, we are able to land on our heels and run like we do currently. Unfortunately, this heel-striking that shod running promotes bypasses the natural shock-absorbing that occurs between the toes and heel, and transfers increased force up the legs to our knees. Being barefoot involves the entire foot to a greater degree than wearing shoes does, and allows our feet to work as designed and dissipate forces right there at the level of the foot. Put simply, being barefoot allows the body to function as designed with regard to shock-absorption.

Now, while words are great they are certainly no substitute for real world experience. So, if you are interested in the topic of barefoot running then you should stand up and go outside and run a hundred feet or so with shoes on. Really focus on how your feet are meeting the ground. You will notice that your heel is what hits the ground first, and then you push off with the front of your foot. Now, take your shoes off and find somewhere without too many rocks (or any dog poo or broken glass) and run a hundred feet barefoot. You might notice that landing on your heel hurts when you’re barefoot, and your feet might be more comfortable with you landing on the front of your foot and not even having your heel touch the ground at all.

This is a completely different biomechanical situation. Running with shoes means your heel strikes and then your foot flattens briefly as you transition weight onto the forefoot, and then you push off the front. Without shoes the heel strike shouldn’t occur to such a degree, and the force with which your foot strikes the ground will feel less forceful. It will seem a bit like “tip-toeing” as you run.

When your foot hits the ground, heel first, this causes all the muscles, bones, and joints in your leg and hips to react in a specific fashion to maintain stability and provide speed and strength. Running without shoes changes that biomechanical process so that there are different forces and stresses on your entire body, from your toes all the way to the top of your spine. As in any change in life, it is important to take it slowly and safely.

This is an important concept to focus on for a moment. Think of the force that is transmitted up your legs and into your spine as you run with a high-impact heel strike, and then think of the force transmitted up your body with the lower-impact forefoot strike that running barefoot promotes. Decreased mechanical forces putting load on our spines is a good thing. The benefit of diminished force being places on our skeleton and our joints is something that, as a runner, you will need to weigh carefully against the ability of your body to adapt to running without shoes and the different biomechanical forces that your feet and legs will be exposed to. If you can run without shoes on and gradually decrease shoe-usage in order to prevent injury, then it is certainly a good possibility that ditching the shoes and letting the feet breathe will be good for your body.

You don’t need to go from shoes to no shoes, though. There is a middle ground. Different shoe companies are all introducing minimalist footwear. One major brand is the Vibram Five Fingers. They provide barely anything in the way of support for your ankle and foot, but they do have a decent amount of padding on the bottom to protect you from sharp rocks or glass without providing so much padding that it’s like wearing shoes.

If you are going to try out barefoot running, or running with minimal footwear, then it is important that you do it correctly to avoid injury. Some tips include:

  • It might be a good idea to just go barefoot at home, or as you do your day-to-day activities, to accustom your body to the lack of protection and support.
  • Start slowly – if you normally go 3 miles each time you run, do only the last ½ mile barefoot.
  • Slowly (and I do mean slowly) add distance or time to your routine, so that you do not shock the body and cause an injury. Taking a month or more to transition to barefoot is a minimum, in my opinion.
  • Stop at the first sign of pain!
  • When running barefoot pay special attention to lifting your feet off the ground as opposed to throwing your feet into the ground in front of you. Run “lightly” without plodding or slamming the foot down.
  • You might notice yourself taking shorter strides – this is normal.
  • Be aware of how your entire body feels after running barefoot – that mans the soles of your feet, your ankles, your knees, your hips and low back, and anything else that feels different.

If you don’t get into barefoot running slowly, you may very well get sidelined by an injury that will make running – with or without shoes – painful and difficult. Some possible injuries include:

  • Pain in the calf or Achilles tendon – because shoes raise the heel off the ground a bit this chronically shortens the calf muscles, and when running barefoot this can overstretch this muscle before it learns to become more stretched naturally. Achilles and calf problems can then lead to…
  • Plantar fasciitis – pain at the sole of the foot that is worse when stretched, or worse n the morning when you first step out of bed.
  • Soreness on the topside of the foot – likely from shifting conditions of muscles, bones and joints in the feet as you get used to running without shoes.
  • Bruising or other injuries from pebbles or other things you may step on.
  • Sprained ankles – keeping your ankles surrounded by padding is good for preventing sprains, but is bad for developing neuromuscular control of the ankle, so transitioning too quickly to non-traditional footwear may lead to sprains if you aren’t careful.
  • Stress fractures – some people have reported getting stress fractures in their foot bones from jumping into barefoot running without proper preparation.

So, to summarize, running barefoot can be a great way to strengthen your feet and legs and to develop the small muscles of your feet. This can benefit your entire body by providing a more stable base and by decreasing wear and tear on your knees and other joints. It also carries risk, though, because you must ease into this new style of running slowly and deliberately, being mindful of pain and always listening to your body as it adapts to the world of barefoot running.

At Park Bench Chiropractic we adjust the spine first and foremost, but we also pay attention to the joints of your arms and legs – including ankles, knees, hips, shoulders, elbows, and wrists. Before you transition to less footwear, or throughout that transition, we encourage you to come in and have either Dr. Matt or Dr. Rob evaluate your lower extremity for joint imbalances that could make it more difficult for you to make the change, or to see if the change is even something that is right for you.

Feel free to call or stop by Park Bench Chiropractic if you want to talk about this with one of the doctors.

Beating Chronic Pain with Routine Exercise

Routine exercise is the first on the list because it is the lowest cost and it helps the greatest variety of health problems.

All you really need is about 20-30 minutes each day, and at a high enough activity level that you get your heart pumping and your body moving. Preferably, you should be doing something you enjoy doing – walking, jogging, swimming, riding a bike, hiking in the woods, running with your dog, anything will do. The more body parts you can get moving, the better.

“The single thing that comes close to a magic bullet, in terms of its strong and universal benefits, is exercise.”
Frank Hu, epidemiologist at the Harvard School of Public Health.

?Perhaps the most immediate benefits are reaped by people with joint and neuromuscular disorders. Without exercise, those at risk of osteoarthritis become crippled by stiff, deteriorated joints. But exercise that increases strength and aerobic capacity can reduce pain, depression and anxiety and improve function, balance and quality of life.

“The less they do, the worse things get. The more their joints move, the better.”
Dr. Moffat, professor of Physical Therapy at New York University.

Routine exercise really is the cure-all for a wide variety of painful conditions. You name it, exercise can help it.

Even when it comes to mental health, exercise can help. Endorphins released during exercise improve mood and decrease pain. They just make your feel better, and this lets you work through your health problem with a positive attitude.

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Dr. Romano is a board certified and licensed chiropractor in Maryland. He practices in Frederick, Md at 1780 North Market Street. He has an interest in the science of pain and it’s relationship to chiropractic. He has a Bachelor’s Degree in Psychology and a Doctorate in Chiropractic. Dr. Romano and Dr. Schooley are available to speak to groups about pain, the importance of a healthy nervous system, and other health topics.