Low Back Pain - Ask Dr. P - The Pain Doc

Why Skinny Thin People Can Still Have Low Back Pain

by Pain Doc | Aug 13, 2015 | Low Back Pain

It’s probably a safe bet to assume that people with chronic lower back pain are more likely than not to be overweight or obese. Although there are a few exceptions related to genetic disorders and medical conditions–thyroid disease, Cushing’s syndrome, depression– those who are overweight got that way because they are less physically active and do not eat as healthy as those who are not overweight; i.e. they consume more calories on average in their diet. This is attributed to mindset, which is a major contributor to, if not actual origin of most types of chronic disease (heart disease, cancer, diabetes, high blood pressure). With excess weight comes excess pressure to the weight bearing joints of the low back, hips, knees, ankles and feet; hence the association between back pain and overweight individuals.

But what about those folks who are normal weight, or even under weight and have terrible episodes of low back pain?

It seems highly unlikely, but it does happen. After all, how can a skinny person who doesn’t have much fat and muscle to carry around develop low back pain?

If you are thin and have recurring lower back pain, here are some possible explanations:

Bad genes

Ongoing research is finding a connection between certain gene markers and lumbar disc degeneration. If you possess such markers in your genetic profile, you are more vulnerable to developing degenerated discs, which are a common source of lower back pain.

The good news is that such bad gene markers need to be activated in order to do damage. You may be able to delay, or prevent this activation by practicing a healthy lifestyle– eat naturally occurring foods with copious amounts of anti-oxidant and nutrient-rich green, leafy vegetables; regular, moderate exercise, adequate rest/ deep sleep; minimizing toxins (alcohol, sugar, tobacco, pollution, chemicals in cosmetics and food additives); and engaging in socially rewarding activities. The opposite behaviors are the very things that can trigger activation (up-regulating) of bad gene markers, initiating the sequence of events that eventually will manifest the disorder– smoking, drinking, junk food, lack of exercise, pollution and so on.

You are sedentary most of the day

You don’t have to be overweight to be sedentary. If you have a high metabolism or simply don’t gain weight despite eating junk food, big lunches and late night snacks, don’t celebrate– you may be skinny but unhealthy in several health metrics like strength, energy and stamina; cardiovascular endurance and insulin sensitivity.

Sedentary people sit more than they stand in a day and stay relatively motionless (TV, internet jockeys) and don’t exercise or do physically demanding work. A sedentary lifestyle leads to muscle atrophy in the legs, pelvis (hips, buttocks), abdominal muscles and spinal (postural) muscles. Those muscles groups, because they aren’t firing together often, lose coordination with one another. The autonomic part of the brain “forgets” how to make them contract properly, in proper synchronicity, during every day movements such as bending and twisting of the torso; lifting objects from a low position to a higher one and rising off a chair. As a result, the lower back does not get proper support, opening it up to injury.

Sedentary individuals are prone to experience an acute low back injury when trying to move something heavy or suddenly engaging in physically demanding activity; or their low back pain may develop from insufficient support to the lumbar vertebrae, causing weak back muscles to strain and joint surfaces to get overly taxed.

Previous injury or history of cumulative force trauma to your spine

If you played a sport or recreational activity when you were younger that involved jumping and landing, you may have predisposed yourself to disc degeneration with all the repetitive trauma to your spine and weight bearing joints. Sports that fall into this category are gymnastics, basketball, football and volleyball. Motocross, parachuting and martial arts are other activities that can result in cumulative force trauma to the spine. Such forces over time pound the L4/5 and L5/S1 discs and may even damage the vertebral end plates of the vertebrae above and below. When this happens, that area calcifies and nutrient absorption from the tiny capillaries in the end plates into the disc is reduced. As a result, degenerative joint disease accelerates. The disc thins and forms painful tears and/or bulges.

It’s also possible that the cumulative force trauma caused a pars stress fracture, or spondylolysis that is making your L4 or L5 vertebrae unstable, where it shears back and forth during bending of the waist, irritating ligaments and nerves.

If the following signs and symptoms apply to your particular low back pain, there is a good chance you have a pars fracture and/or instability of your L4 or L5 vertebrae:

adolescent athlete
low back pain predominantly on just one side of the lower back
started as mild pain; worsens with running and jumping
feels the worst when arching backward, twisting the waist or straightening your back from bending
gets worse with sports or heavy work, and better with rest

$pars stress fracture xray$

If jumping or contact sports are in your history, get a motion x-ray study (x-ray views taken in lumbar flexion, neutral, and extension in the weight bearing position), or video fluoroscopy study. The x-ray series will reveal if one segment is moving abnormally relative to the ones above and below. If diagnosed, the standard approach to treating spondylolysis is to modify your movements to reduce the shearing effects; strengthen the core muscles so that they offer more stability to the lumbar spine; lumbar bracing and perhaps shoe orthotic inserts.

Unfortunately, pars fractures do not usually heal due to the delay in discovering them, and the difficulty in bracing them. In some cases, the gap is closed by fibrous tissue the body lays down, which offers some stability.

Vegetarian Diet

Your vegetarian diet (if that’s the case) could be contributing to back pain. Vegetarians are more susceptible to having Vitamin B12 deficiency, since Vitamin B12 is only found in animal sources. Vitamin B12 is the “energy” vitamin and plays a big role in a number of important biological pathways. Studies show that low levels are associated with ataxia (shaky movements and unsteady gait), muscle weakness, spastic muscles, incontinence, low blood pressure and vision problems.

Vegetarians may not be getting enough sulfur in their diets. Your body needs sulfur to build strong muscles, bones and cartilage, among other things. Sulfur is also believed to be protective against glycation— the harmful reaction where excess glucose combines with proteins in tissues, effectively denaturing them (rendering them useless). While plants like onions, leeks and asparagus contain sulfur, animal protein is the most complete form.

Lastly, vegetarians may not be getting enough cholesterol in their diets. Cholesterol is needed for healthy cell membranes, proper nerve function and synthesizing cortisol and sex hormones.

A great meal to counter-act all these deficiencies is bone broth soup. Packed with calcium, collagen, elastin, chondroitin, sulfur and more, bone broth soup is great for your skin, hair, nails, connective tissue, nerves bones and muscles. Not too many meals can compare, nutrition-wise to bone broth soup with spinach!

Osteopenia

If you are a female whose mother has osteoporosis, you may be carrying the gene. Osteopenia is the loss of bone mass and occurs when your body does not replace calcium as fast as it resorbs it (releases it from your bones into the blood). It may be related to low Vitamin D levels, thyroid disorders, estrogen deficiency, hysterectomy or other condition which would cause bone to lose calcium.

Osteopenia leads to osteoporosis, where the cancellous or spongy, inner part of a bone has lost much of its density, thereby weakening the bone. Osteoporosis of the spine leads to a humped/ stooped posture as the vertebral segments shrink, and fragile bones highly susceptible to fracture. Spontaneous vertebral body fractures are common in osteoporosis and an often overlooked cause of back pain.

If you suspect osteopenia, I would advise getting your Vitamin D levels checked. Vitamin D is necessary for your body to absorb calcium from you diet, in your intestines. If you are low, make it a point to expose your body to the sun 4 hours a day. The UV rays in sunlight initiate the synthesis of Vitamin D3 from cholesterol present in your skin. Then it is converted to another form in the liver (calcidiol) and finally to the active form (calcitriol) in the kidneys. So your liver and kidneys need to be healthy– avoid alcohol, tobacco, drugs, unnecessary medications.

Also, take high doses of Vitamin D supplements. Based on current research, consuming 1,000–4,000 IU (25–100 mcg) of vitamin D daily should be ideal for most people to reach healthy vitamin D blood levels. This may seem high, but know that much of what you take does not get absorbed; around 30%.

Lastly, did you know that Pulsed Electromagnetic Field Therapy (PEMF) can increase bone density? PEMF is the external application of compatible electromagnetic fields to the body to augment the body’s naturally occurring fields, which helps cells and tissue function more optimally. PEMF is often used to heal non-union fractures, as well as help reduce inflammation and pain.

Bio Balance Pulsed EMF

You can read more about how Pulsed EMF works here.

The bottom line, thin people get back pain, too. If you are normal weight and are experiencing lower back pain, look into these possible causes and take action. All of the above factors can be positively affected by making changes in your lifestyle.

If you were diagnosed with degenerative disc disease, check out the recommended home therapy devices in our Amazon store:

Try using the PosturePump

posturepump elliptical spine trainer

This device decompresses the lumbar discs so that they can rehydrate and heal faster. Simply place it under your low back as you lie on the floor, and pump up the air bladders to your tolerance. Let the PosturePump spread your discs apart in this position for 10-15 minutes, twice a day. Your pain should face as more space is created by thickened discs.

Fight back against hard to avoid sedentary behavior! If you are one of the millions of people who must sit hours and hours behind a desk at work, consider getting a standing desk. Standing relieves some pressure to your low back by transferring some of it to your legs and by encouraging a lordotic (inward curved) low back. Here is a low-cost solution:

Vari-Desk Stand Up Desk

standing_desk

Top Five Low Back Pain Relief Strategies

by Pain Doc | Aug 1, 2015 | Low Back Pain

When your low back hurts, you know the next couple of days aren’t going to be fun. Your low back, or lumbar spine is like the foundation of a house: it bears and balances all the weight above it, so if there are mechanical problems, the whole structure is affected. In fact, some cases of low back pain cause obvious tilting of the upper body to one side when standing, due to the structural imbalance.

There are countless studies on low back pain– how it develops; what causes the pain; who is at most risk for developing low back pain; how long it lasts and so on. For “non-specific” low back pain where there is no injury event, it is unclear which structures are generating the pain. It may be the back muscles, a vertebral ligament; a disc, nerve root, sacroiliac joint; or even referred pain from an organ. This makes treatment, especially invasive treatment (surgery, injections) challenging and often ineffective.

What is known is that if you have low back pain that continues down your buttock, and perhaps down the back of your thigh and leg all the way down to your foot, then it is very likely due to a bulging disc in your low back pressing on a nerve root. If this describes you, don’t give up hope. I’ve seen cases like this resolve with targeted exercises, spinal adjustments and time. But I’ve also seen cases like this turn into back surgery cases, where the surgeon goes in and removes part of the disc that is compressing the nerve, and sometimes the entire disc and fusing the adjacent vertebrae.

Non-radiating back pain can be equally bad. If the back muscles spasm, the pain can be incapacitating. I’ve seen many cases like this where the patient dropped to the floor, wincing in pain and avoided any type of movement. Aside from a cortisone injection, there is not much one can do initially for acute back spasm other than ice and rest until the muscles let go; then attempt things like chiropractic adjustments, PT, stretching and modalities like laser therapy.

Then of course, the rare causes of low back pain — cancer, tumors, bone cysts and other diseases; spinal stenosis, referred pain from kidney stones; fractures, and spondylolisthesis (slippage of vertebrae during movement). These will require diagnostic testing and proper management.

But for the vast majority of low back pain cases, there are things you can do to reduce their effects and reduce their incidence of occurrence. Here are my Top Five low back pain relief strategies:

Lose weight

(if you are overweight). This is just basic, common sense. If you are 30 pounds overweight, it’s like a normal weight person carrying a backpack full of rocks all day. Excess weight centered around the abdomen changes the center of gravity of your body. This bends your spine abnormally when you are standing, sitting, and even sleeping; setting the stage for back pain.

The best and fastest way to lose fat weight is to restrict carbohydrates in your diet, practice intermittent fasting, and exercise 30-60 minutes at least 3x/day. If you have to cut one of these out; I’d say the exercise. Caloric restriction burns fat cells on a much larger scale than exercising does. The reason is that simply by being alive, your body, depending on your mass, burns 1500-3500 calories per day. If you consume less than what you burn, you will lose fat weight. So, try eliminating bread, pasta, bagged and boxed snacks, sugar and fruit juice from your diet. Drink only water. Eat between the hours of 9 am and 4 pm, or 12 pm and 6 pm only. This gives you an 18 hour fast, where your body will start burning its fat stores.

Stand more

When you sit, the natural inclination is to round your lower back. You may try to force yourself to sit erect for a few minutes, but after a while, your low back muscles fatigue and allow your lumbar spine to bow out again. This posture weakens the lumbar spine’s structural integrity because it separates the facet joints (see middle image below), which makes the lumbar spine less sturdy (“unlocks” it). The angle of the vertebral bodies also apply a backwards force to the disc that can encourage posterior disc bulging or herniation.

bad-spine

The bad health effects of prolonged sitting goes way beyond back pain. The amount of time a person sits during the day is associated with a higher risk of heart disease, diabetes, cancer, and death, regardless of regular exercise, according to a review study published in the Annals of Internal Medicine. This is significant, because computers are firmly integrated into the fabric of life– just about every business from farmers to tech giants rely on computers, and as for now, they are mostly used at a desk. Low back pain cases can only go up if more and more people spend their work hours sitting behind a desk.

A low tech solution to this is to use a standing desk, like the height-adjustable Vari Desk. The Vari Desk is actually a large monitor stand that sits on a standard desk and can easily switch from normal height to standing height. This way, you can gradually increase your standing hours, allowing you to build up your tolerance to working while standing. For example, for the first week you can try standing 30 minutes every two hours; then work up to standing 30 minutes every hour, then up to three hours straight. Standing activates the erector spinae spinal muscles (which are inactive when sitting, leading to weakness and atrophy); but best of all standing naturally causes you to form the stronger lordotic curve in your low back. The lordotic curve is the opposite of bowing and is the “strength” position of the lumbar spine as the facet joints in the back interlock, offering stability and protection to the discs.

Do functional exercises

While your back is not hurting, why not strengthen it to keep it that way? This will decrease the incidence (occurrences) of low back pain. Functional exercises include squats, medicine ball exercises, planks, kettle bell swings and “bootcamp” style exercises that focus on strengthening the muscle orchestration of all the muscles in the body at the same time, rather than one type of muscles (for example, biceps curls is not a functional exercise).

Do Back extensions

For most people with back pain, back extensions are helpful. Again, this arcs the low back in the lordotic curve, which can press the disc material back to center. You can do them standing, or prone (yoga cobra position). Do about 10 extension exercises twice a day.

Spinal Adjustments

If you have a history of back pain and/or stiffness; trauma to your body such as prior car accidents or previous involvement in gymnastics, football or basketball; and/or a history of prolonged sitting you are a good candidate for periodic spinal adjustments, or spinal manipulation. Spinal manipulation, the practice of moving segments of the spine using manual (by hand) techniques, can reduce the symptoms of lower back pain. Chiropractors provide most spinal manipulation in the U.S. Some physical therapists and osteopaths do it as well.

Chiropractic adjustments are quick, low amplitude-high velocity manipulations to the spine, which differs from “long lever” movements (joint mobilization, passive stretching). They are done to impart better movement and also to “fire” nerves involved in pain and spinal muscle contraction. This can reduce pain and muscle spasm and restore proper movement to a joint segment. When a lumbar joint segment moves better, it improves hydration to the discs and ligaments. When it is properly aligned, it won’t wear out as fast.

Consistency in approach varies greatly from chiropractor to chiropractor as there are more than one ways to manipulate the spine, and different target goals (pain relief vs. attempting to change curves of the spine, etc.). Then there are “holistic” chiropractors who promote spinal adjustments for general health maintenance. I recommend that you find an experienced chiropractor with a good, local reputation who focuses on short term care to relieve pain and can advise you on home care exercises after your pain has subsided.

Below is a video I made that explains the logic behind lumbar spinal adjustments for low back pain:

Integrate these five practices, and I believe that low back pain will not be a factor in your life for a long time to come.

Back Pain from Pregnancy – New Study Finds Spinal Manipulation Dramatically Reduces Pain

by Pain Doc | Jul 9, 2015 | Low Back Pain

According to a new study published in the July issue of the Journal of the American Osteopathic Association, German researchers found osteopathic manipulative therapy (OMTh) decreased postpartum low back pain by over 70 percent in women who had given birth at least three months before beginning treatment.

On average, women who received osteopathic spinal manipulation reported a 73 percent decrease in pain, compared to only seven percent in the control group. Pain was evaluated by a 10-point Visual Analogue Scale (VAS) and functional disability as measured by the Oswestry Disability Index. The Oswestry Disability Index is a battery of questions that asks the subject to rate on a scale of 1-5 how difficult it is to do common, daily activities (such as getting dressed). It is a popular tool doctors in physical medicine use to measure a person’s improvement to treatment, since pain is very subjective in nature. After all, what matters most is not the level of pain but rather the level of physical functioning the person is capable of, despite the pain.

But what exactly is osteopathy, and how different is it from chiropractic?

This requires a bit of a history lesson. Both disciplines had their start in the mid to late 1800s in the U.S., an era characterized by experimentation in various alternative healing methods. Diseases like syphilis, small pox, polio and other maladies plagued the population and there was very little doctors at the time could do. Vaccines and antibiotics were not discovered yet, and people were desperate to find a cure. This period is also when the term “snake-oil salesman” was coined, as some unscrupulous individuals used the crisis as an opportunity to make money.

Osteopathy has its origin in 1874 when Andrew Taylor Still, a medical doctor was dissatisfied with the limitations of conventional medicine. He theorized that disease originated in bone tissue and could therefore be treated by manipulating bones and tissues. Still developed the discipline of osteopathy and created the first school in Kansas that offered the “D.O.” degree – Doctor of Osteopathy.

Chiropractic has its origin in the 1890s when D.D. Palmer, a magnetic healer theorized that mechanical dysfunction of the spinal joints could influence nerve and blood flow throughout the body, making conditions ideal for disease. He and his son B.J. Palmer developed chiropractic in the early 1900s, emphasizing “adjustments” to the spine using the hands.

As both disciplines grew in popularity, the medical profession took notice. As in big industry today, when such competition arises there is either a buy-out, merger, or attempts to dominate the market (and public opinion) and put the competing entity out of business. Osteopathy eventually got absorbed into the medical (allopathic) model, and today D.O.s are physicians on par with M.D.s. Many D.O.s do not do manual therapies in their practice since drug prescription became the primary treatment methodology among allopathic medical practitioners especially toward the latter half of the 1950s, continuing today.

Chiropractic, on the other hand, blazed its own trail and is an independent specialty outside of the medical umbrella. There used to be significant professional conflict between chiropractors and medical doctors, but these days there is more more cooperation. Physicians are more confident in referring back pain cases to chiropractors, as patients attest to its benefits for helping reduce musculoskeletal pain.

Pregnancy and Back Pain

The Germany study is not surprising. Spinal manipulation, whether osteopathic or chiropractic adjustments, is helpful in restoring alignment and movement in the pelvic structure and lumbar spine following birth. During the last trimester of pregnancy when the mother gains the most weight, the center of gravity of the abdomen moves outwards, placing a greater strain on the lower back. The lumbar spine arcs more acutely, increasing pressure within the facet joints during standing. The weight of the baby can also rotate the pelvis anteriorly over the femur heads which can cause sacral and hip pain, due to it being a weaker stability position..

If after three months of giving birth you still have back pain, consider getting spinal manipulation. The goal is to free up any restrictions that may be present anywhere in the spine, pelvis and hip joints and strengthen surrounding muscles. A good practitioner will show you exercises to do at home to rehabilitate the area.

Below is a video that will give you an idea of what to expect:

One note you should be aware of: Spinal manipulation or “adjustments” is a fine dexterity, complex skill that needs a lot of practice in order for one to become proficient in it. Unlike osteopaths, chiropractors cannot prescribe medications so the bulk of their practice involves delivering spinal manipulation. Chiropractors therefore tend to be more skilled in this area.

Read this article by the American Chiropractic Association on 5 Conditions Chiropractic Care Can Improve During Pregnancy.

For more information on the Germany study that shows the efficacy of spinal manipulation for postpartum low back pain in women.

Golf Injuries and Pain – How to Protect Yourself and Have Fun

by Pain Doc | Jun 27, 2015 | Low Back Pain

If golf is one of your favorite recreational activities, you likely are aware of the unique demands the game places on your body. Perhaps you even sustained an injury or developed pain related to your golf game. Let’s take a closer look at the physical demands of playing 18 holes.

First of all, let me start out by saying that besides being a popular sport, golf is a good opportunity to exercise (especially if you carry your own clubs and don’t use a cart).

Number one, it involves a lot of walking. The best part about walking is that it keeps you away from sitting. It may not sound like a big deal, but it is. Excessive sitting, science is finding, is associated with deleterious health outcomes regardless of physical activity. This means too much sitting is so bad for your health that exercising later cannot recoup the damage it does.

Secondly, you are outdoors exposed to sunshine. Getting adequate sunshine is essential to maintaining normal Vitamin D levels, which promotes strong bones, teeth and supports the body’s immune system. Being outdoors among trees and grass on the weekend is especially beneficial to your health if you have a high-stress office job during the week.

So if you abhor exercising in a gym, perhaps you should investigate the game of golf, if you haven’t already.

Now, back to the topic. Here are the potential problems that can come with playing golf:

Driving. Each hole starts out with a driver, the longer clubs with bigger, heavier heads. These clubs are designed for distance and therefore require a big swing radius (a big wind-up).

Well, that wind-up involves over-rotation of your lumbar spine. That feeling of discomfort when you swing a driver is occurring at the lumbar facet joints, the small joint surfaces behind the vertebral bodies that interlock with adjacent vertebrae above and below.

Most rotation movement of the torso is produced by the thoracic vertebral joints, from the base of the neck down to the beginning of the lumbar (low back) spine. This is because facet joints of thoracic vertebrae are relatively flat and in the same rotational plane, as illustrated below:

Lumbar vertebrae, on the other hand, have deeper, concave facet joint surfaces that act as limiters to rotation. Basically, lumbar vertebrae do not like to twist.

You can feel the pressure in your low back when you have the driver at the top of back swing position and again towards the end of the swing. The rotational (twisting) force is reduced when you lift and turn in your rear foot as you follow through the swing, but if that foot motion is delayed the lumbar spine absorbs more of the rotational force.

Over time, repeated over-twisting of the lumbar spine can cause the lumbar facet joints to degenerate and even develop fractures. This can lead to other problems, like pinched nerve roots from foraminal stenosis (narrowing of nerve passageway due to bone and/or ligament occlusion). Tiger Woods used extreme lumbar rotation in his swing and it caught up to him; he had four low lumbar surgeries over his careerr and now suffers from chronic low back pain.

The lesson here is to make sure you lift your trailing foot at the appropriate time of the swing to avoid excess rotational pressure to your lower back (and be mindful not to over rotate, otherwise risk having back problems in the future).

Another joint that bears a lot of stress during driving is the lead knee. As you follow through with the swing, your pelvis rotates with your spine. Tightly connected to each side of your pelvis are the femoral heads– one half of the hip joint. When you lift your trailing foot, it reduces rotation to your lumbar spine by removing a stabilizer, but at the price of putting a greater rotational burden on the lead knee and ankle. As the pelvis rotates and reaches end-range, it pulls the femur with it. But the femur and tibia remain stationary (golf shoe spikes dug into the turf ensure this; plus more of your weight shifts to the lead leg towards the end of the stroke). This results in a torsional force generated through the lead leg, internally rotating the hip, knee and ankle. This can cause strain to the hip joint, meniscal tears in the knee and sprain to the ankle ligaments.

So the lumbar spine and leading hip, knee and ankle are joints that absorb significant rotational stress during a driving swing.

To a lesser extent, the leading shoulder joint and wrist absorb stress due to their awkward positions; the shoulder with acute internal rotation and the wrist acute radial deviation. This can strain the shoulder rotator cuff and ligaments and tendons of the wrist.

Putting (and driving). It may not seem like a lot of movement is going on during putting, but the putting position is indeed strenuous to the lower lumbar discs. You are bent at a 30 degree angle or so at the waist for an extended time (most people concentrate and take their time before their putt attempt). This is one of the worst positions for your low back as it places tremendous pressure on your L4 and L5 discs. especially if you have a weak core (abdominal and low back muscles).

The hydrostatic pressure builds up in the disc, enough to cause a disc herniation in some people.

In the picture above, the golfer is preparing to hit the ball with a driver. Notice the angle of the torso relative to the legs. The fulcrum is exactly at the L5-S1 joint and the lever is the torso, with the load being the gravity vector of the torso (weight). The force (F) is partially distributed to the back muscles, but the discs still bear significant pressure in this position.

The Solution

If you’re an avid golfer, a little sore back isn’t going to stop you from playing, right? That is usually the case in those who love their sport or hobby.

So my advice to you is:

Always use proper form and good posture. When driving, emphasize generating power from your core muscles– abdominals, especially obiques–then your latissimus (“lats”) muscles. Lift your trailing foot at the precise moment to lessen lumbar rotation during a wide swing.
If you are prone to low back pain, modify your driving swing to protect your back. You may have to use less lumbar rotation and more power from your arms and shoulders. Practice your custom swing and hone it so it becomes natural during game time. For example, if you are getting low back pain, shorten your lumbar rotational arc by 30 degrees and generate more power from your latissimus muscles to compensate.
Minimize rounding (flexion) of your low back during putting and driving. A straighter or even concave low back is stronger than a flexed low back. This is called “hinging.” You keep your lumbar spine and pelvis locked, and hinge at the hip joints to lower your torso to the ground.
Exercise and stretch the swing muscles. The muscles you should target for stretching are the trapezius, latissimus dorsi, rhomboids and triceps.
Strengthen your shoulder joints by lifting light dumbbells in all directions/angles (from 12 o’clock position to 6 o’clock position) with palm facing down. Starting position of arm is down to your side; ending is as high as you can go.
Stretch your shoulder joints using a 5-10 lb dumbbell or kettle bell, letting it hang straight down as you lean over and stabilize with the other hand on a chair or your opposite, bent knee. Make small circles with the weight, increasing in size; then reverse directions.
Strengthen your core: abdominals and low back, using medicine ball exercises.
Seek out an Active Release Technique (A.R.T.) therapist in your area. This is a special form of massage that involves engaging certain muscles while the therapist works them and is great for improving range of motion.

And last but not least, my standard mantra: your body will work better for you if you feed it well and give it enough rest. Make at least 80% of your diet naturally-occurring foods (as opposed to processed and prepared foods) emphasizing colorful vegetables, animal protein (grass fed/ pastured when you can) and healthy fats (olive oil, nuts, seeds, eggs, coconut, avocado, fish). A well-nourished body can heal injuries quicker and more completely, which is especially important if you play any kind of sport.

Also, don’t expect to be sedentary all week and be able to do activities physically demanding on the weekend. Excessive sitting/ lack of exercise de-conditions muscles. It makes them less coordinated, smaller and weaker. This is a recipe for injury (“weekend warrior” injuries).

A simple hack to passively get more exercise if you are a desk jockey is to get a standing desk. It’s better for your back, and your overall health (see below).

Now, go and have fun on the golf course! (with this information in mind).

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Chronic Back Pain – Here Are Your Options

by Pain Doc | Mar 26, 2014 | Low Back Pain

From my casual observation as a clinician, about 80% of people suffering from back pain fit a certain demographic profile:

Male
Age 35-60
10-20+ pounds overweight
Works in manual labor or;
White collar- prolonged sitting
Sedentary or moderate physical activity

Of secondary association, there are these traits:

History of past injury
History of contact sports or sports involving jumping (i.e. gymnastics)
Familial history of back pain
Smoker
Stressed
Insufficient sleep
Unbalanced diet: junk food, excess carbs, insufficient vegetables

Now of course there are people who have back pain who don’t have any of these characteristics, but those individuals are a very small minority.

If half of these factors apply to you, there is a good chance you have back pain in some form.

The problem with “non-specific” chronic back pain that is not associated with a single-event trauma like lifting something heavy is that, by the time you feel the pain, the internal structures that are causing it have degenerated to a point where it is difficult to completely resolve. And, males in general usually defer seeing a doctor or specialist when they feel the first signs of something wrong; they are more likely to ignore it until it gets to a level where it interferes with their activities in some way.

Non-specific low back pain is often difficult to diagnose because there are usually multiple things happening simultaneously:

spondylosis (bony projections indicative of joint degeneration)
stenosis (narrowing of spaces where nerves pass through)
arthritis (inflammation within the joint surfaces)
vertebral slippage (spondylolisthesis; retrolisthesis)
disc degeneration
ligament calcification
sometimes osteopenia (loss of bone mass)
sometimes paraspinal muscle spasms/ hypertonicity
sometimes spontaneous fracture

There is a lot of debate among physical therapists, chiropractors and orthopedic specialists regarding how far can a degenerated disc and associated spondylosis recover, and if it is even possible at all. Is it “once you have it, you have it for life?” or is there still a miraculous chance that your body can repair degenerated areas in the spine if you just give it the right conditions?

The answer has big ramifications; after all, getting diagnosed with chronic pain due to lumbar degenerative disc disease at age 40 can be devastating if it means that you have to live the rest of your life with low back pain. We all want not just to live, but to live with vitality; right? We don’t want to go through life sitting down, watching everybody else have fun; we want to engage life and live it to its fullest.

What we do know is that once you develop osteophytes (spondylosis)– those bony spikes that protrude from the edges of vertebral structures– they do not resorb, no matter what. Thankfully, they are “slow growing,” and it is possible to stem that growth by doing things like losing weight if you’re overweight, eating healthy, exercising and strengthening your back and core muscles to improve support. But once they reach a certain point and obstruct nerve passageways, you’re looking at surgical intervention (spinal decompression surgery), which often works but also often causes new problems, or provides temporary results as the osteophytes resume growing.

But with discs, there is more hope. Discs are mostly water. If you can re-hydrate your discs and get them healthy, they will increase in thickness and in the process create more space between your vertebrae, potentially relieving pressure from pinched nerves and impacted facet joint surfaces. However, some people have passed the point of no return where the disc is functionally “dead” (looks solid black on MRI). In these situations, the vertebrae eventually fuse together which accelerates stenosis, requiring surgical decompression.

So, if you have chronic back pain, your alternatives are to engage in lifestyle modification habits that strengthen the body and promote healing; work with a chiropractor, physiatrist or other rehab specialist to see if improving joint movement and muscle balance are enough to resolve the problem; or consult with an orthopedic MD and see if you are a candidate for surgery.

Stay tuned, as I will soon be coming out with a Healthy Lifestyle Education instructional course designed to help those with chronic pain.

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Study Shows Benefit to Stratified Care for Low Back Pain

by Pain Doc | Mar 19, 2014 | Low Back Pain

A recent study (ImPact Back Study) published in the Annals of Internal Medicine demonstrated that low back pain sufferers had statistically significant improved treatment outcomes, at a lower cost when the case was classified as either low, medium or high “risk” for persistent disability and received a standardized treatment method for that level.

Specifically, low-risk patients received a single session of intervention comprising assessment, education and support for self-management.

Medium-risk patients receive physical therapy interventions that focus on reducing pain and disability, encouraging physical exercise and facilitating early return to work.

Meanwhile, high-risk patients receive “psychologically informed” physical therapy that integrates cognitive behavioral techniques with traditional physical therapy to reduce pain and disability, improve psychological functioning and facilitate self-management.

Other benefits associated with stratified care as compared with usual care included significantly more risk-appropriate referrals to physical therapy, a 39% relative reduction in sickness certifications, a 50% relative reduction in time off work sick, a decrease in use of non-opioid medications and concurrent increase in use of mild opioids.

This study was done in the U.K., so there are likely differences in the protocols for treating low back pain compared to the U.S. It is interesting that common procedures in the U.S. for “high risk” low back pain such as facet injection and decompression surgery were not mentioned. Perhaps it is their experience that such procedures have not demonstrated efficacy in resolving low back pain, and that psychotherapy combined with traditional physical therapy is more effective.

The bottom line is that, if you have low back pain, an accurate diagnosis is obviously very important. Granted, in many cases the origin is difficult to pin down, it is prudent to take into consideration the possible role of the patient’s psychology and use appropriate interventions like CBT. Defaulting to opioid and non-opioid drugs may be counterproductive, as addiction and liver and kidney toxicity is always a risk.