The Healthy Spine Atlanta Georgia

Dr. Roberto Vargas

1375 Peachtree Street, Suite A9 Atlanta, GA 30309 phone: (404) 575-1300
Wednesday, April 22, 2009

Why are humans so prone to back pain?

                                       

Over 80% of people will experience back pain sometime in their life. The spine is also one of the most susceptible areas for arthritis. Why?  Back pain is one of the most common conditions known to human kind and the cost to treat these conditions is an unbelievable $50 billion a year.  Again, why is the human spine so fragile and susceptible to injury?  There are many theories regarding the origins of spinal pain.  In this article we will discuss two theories that I subscribe too.  There is one rationalization that is based on evolution and the other uses the world of neuroscience to illuminate our understanding of the prevalence of back pain. 

The evolution of modern man can be traced back to mammals and other hominids using all four extremities to walk.  Homo erectus was the first human ancestor to walk upright, make complex tools and had a larger brain than that of the previous species of hominids.  Homo erectus was the first time a quadruped frame was forced to walk on two legs.  This new balancing act by our late ancestor added new stresses and proposed new challenges for the hominid frame.   For the first time Homo erectus had to deal with gravitational forces in an original way.  It takes a lot more computing power to balance a two legged frame as opposed to a four legged skeleton. It can also be argued that this is one of the reasons for the increase in brain mass.  This new obstacle of bipedalism still taxes our primitive frame.  Our skeletal design is a disservice to the new challenges of a bipedal world and our spine pays the consequences.  While our brain and nervous systems have evolved greatly, there has been little design changes to our skeleton.  Furthermore, the sedentary lifestyle of modern man further ads to spinal stresses for sitting creates a great amount of pressure on the lumbar spine, even more so than standing. 

Now we will consult the world of neuroscience for an explanation.  First it must be understood that the neuron (nerve cell) is the basic unit of the nervous system.  The neuron requires three things to survive:

1.     Oxygen

2.     Glucose (Food)

3.     Activation (Stimulation)

All neurons even those that transmit pain must have activation or they die.  That’s right your pain receptors are always turned on.  That being said; why don’t we feel pain all the time?  Our brain inhibits pain.  The brain is broken up into lobes and every lobe is design to deal with certain jobs.  The parietal lobe is responsible for the interpretation of touch, pressure and other sensory integration.  When you feel pain in your arm the parietal lobe is responsible for realizing; hey something is wrong with my arm.  The surface of this parietal lobe can be broken down into areas of the body. This is called somatotopic representation.    Some regions of the body have a larger area of representation in the brain.  For example; the hands, head and lips have a lot of representation in the parietal lobe while the lower back has very little.  This map of the body’s surface is called the homunculus or “little man” and is located behind the central sulcus; for further clarification Google, the homunculus of man.  The more representation any given body region has within the brain the better job the cerebrum can do in inhibiting pain from that area.  Hence, pain syndromes involving the lips and hands are rare, while spinal problems are common. This is due to the backs little somatotopic representation.  Our spines can’t get a break.  Thank god for chiropractors.                          

Monday, March 23, 2009

 

The first question that must be asked when discussing any disease process is its etiology.  What are the conditions and mechanisms that allow disease to thrive and cause dysfunction leading to pain?  Today we will be discussing osteoarthritis due to its prevalence in society.  It is said that currently, one in every five Americans has osteoarthritis (OA) and 90% of the population will get OA sometime in the course of their lifetime.  One of the most common places for OA is the spine and it is something that I as a Chiropractor see every day in practice.  When arthritis affects the spine it is called spondylosis.  OA can also be labeled degenerative arthritis or degenerative joint disease.  Many names same disease.  OA is a severe cause of pain and disability for many.   Let’s start with some physiology behind joint health.  Joints in the human body have very poor blood circulation and relay heavily on motion to provide proper nutrition and biochemical exchange.  Decreased motion or hypo-mobility is at the heart of a majority of osteoarthritic patients pain.  Many individuals suffering with arthritis must realize that articular health is maximized through motion and the best environment for arthritis to thrive is in misaligned, hypo-mobile and subluxated joints.   As a chiropractor we are trained in detecting and correcting these misaligned joints called subluxations.  The chiropractor must also be aware that arthritic joints also cause their corresponding muscles to shrink.  Therefore, stretching and exercise should be an integral part of the treatment in order to obtain optimal therapeutic value.   There have been many promising studies done on spinal manipulation and its ability to reduce spinal DJD and disability.  Spinal joints which are adjusted and free from fixation can move optimally through their full ranges of motion thus providing free biochemical exchange and impeding degenerative changes.  All this being said there must be the proper biochemical’s in the body for the exchange to occur.  The building blocks of joint health must be present to prevent premature degeneration and decrease any inflammation that is present.  By addressing arthritis with these conservative methods one will address degeneration and improve function hence decreasing pain.

 

1.     Glucosamine hydrochloride

2.     Chondroitin Sulfates (look for purified sources)

3.     Antioxidants

4.     MSM

5.     Proteases (such as Bromelain and Papain)

6.     Omega 3-Fatty Acids

7.     Herbs with Anti-Inflammatory Properties (Arnica, Boswellia, Feverfew, Green Tea,Turmeric and Willow Bark to name a few)

Tuesday, March 10, 2009

 Many headaches can be treated naturally through different methods with impressive results.  Trigger point therapy (massage) and chiropractic (manipulation) are all very good methods of treating headaches with minimal, if any, side-effects.  Today we will touch on these different modalities but I will focus primarily on the unique relationship of chiropractic and trigger point therapy.  The mechanism on how manual therapies including chiropractic adjustments improve headaches is well documented, studied and understood.  However, do to prejudice towards chiropractic and other alternative forms of healthcare this information is not readily given to the lay person and most of the medical community.  Thankfully, there is a growing body of today’s medical physicians interested in the neurophysiology of spinal adjustments and their effect on the human condition.  For the individual who believes that there is no real prejudice towards chiropractors one must look no further than the case of Wilk vs. AMA.  In this lawsuit (filed in 1977) the AMA was found guilty by the Supreme Court (in 1987) to deliberately put down the chiropractic profession and start a campaign to eradicate chiropractic by various means of propaganda.  It is with great joy that I state that science once again prevailed and human short sightedness failed.  Several years ago in the Toronto Star, a major newspaper in Canada, published an article titled “A Pain in the Neck.  Chiropractors were right. Many headaches are caused by damaged structures in the neck –and scientific evidences proves it.”  The cervicogenic headache model proves that underlying issues in neck structures could be the reason for chronic sometimes debilitating headaches.  Disc disease, postural misalignment, fatigue, arthritis, other articular dysfunction and referred pain zones via trigger points can all cause severe headaches.  The reality of most patients is that these factors often co-exist.  Joint dysfunction can be a powerful perpetuator of muscular trigger points leading to ruthless headaches when found in the structures of the neck.

Peter Rothbart, MD, FRCPC an anesthesiologist and contributor to the article states “We couldn’t believe it at first.  We’ve been able to put together a scientific explanation of how neck structures cause headaches-not all headaches, but a significant number of them.” The concept that one’s headaches could stem from joint dysfunction in the cervical spine (neck) has been around for a long time in the chiropractic profession. It is finally coming around to not only medical doctors but the general public that most headaches are caused by structural sources in the cervical spine.  Thousands of chiropractic patients have benefited from cervical adjustments who otherwise would have needlessly suffered from headaches.  These patients sought to address the origin of their pain and not mask their complaint with drugs.  Reminder, when the opportunity of addressing a biological condition can be handled without the risks of drugs and their side-effects one should embrace such an option.   Structural reasons are at the root of many headaches and wisely individuals are choosing a structural solution, chiropractic adjustments.  Dr. Rothbart also stated “Some brilliant people have put their hearts, souls and minds to this (headache) problem and haven’t come up with anything.  All we’ve been able to do is treat people with an array of medicines, one after the other, and hope the side effects won’t be too bad.” 

Headaches in the forehead, around/behind the eyes and temporal areas are primarily due to trigger points in the splenius capitus, sternocleidomastoid (SCM), sub occipital triangle and upper trapezius muscles respectively.  This neurological observation is well documented and these tender points in the muscles named above are found in the same areas in everyone suffering from headaches.  These headaches can be severe enough to cause nausea, sensitivity to light and intense stabbing/throbbing pain.   Although, migraine variant headaches make up only 8% of all headaches they are often blamed for all severe headaches.  Cervicogenic headaches can be easily confused with a migraine due to their often brutal intensity.   There is an interesting relationship between these two types of headaches.  According to medical texts a great number of migraine episodes are also initiated by trigger points, yet a surprising number of clinicians overlook this common phenomenon.  Treating trigger points may be the only way to offer relief to those who suffer with migraines and cervicocgenic headaches, while a cervical adjustment will increase joint function and ROM decreasing the probability of the trigger points returning.  When it comes to treating the musculoskeletal system one must do just that treat both the muscles and joints.

The neurological phenomenon of trigger points was discovered by Dr. Raymond L. Nimmo a Chiropractor and later developer of trigger point therapy.  It is only natural that chiropractic and Nimmo’s technique be used in conjunction for quick/effective healing.  Dr. Nimmo went on to discover that the formation of trigger points often relates to some form of damage to muscles, either from gross trauma such as a strain injury or from micro-trauma such as a muscular repetitive stress injury. That being said healthy muscles don’t have trigger points.  Prolonged tonicity or contraction of muscles from stress, postural influences, tight/inflexible muscles and neurological influences such as nerve compression will also cause trigger points.  If these points happen to be in the cervical spine or shoulders the individual will develop headaches.  Systemic factors could also cause trigger points such as nutritional deficiencies.  For example, Magnesium deficiency will increase the incidence and severity of muscle cramps and muscular tonicity.  The typical American diet provides about 120mg per day of magnesium while the normal recommended daily allowance for magnesium is 400mg.  In addition, 78% of Americans state that they are stressed with their everyday life including family and work.  Unfortunately, severe stress is another mechanism by which magnesium deficiency occurs.  This one two punch has the typical American at a disadvantage when it comes to magnesium deficiencies and sets the stage for increased muscular tonicity along with the development of trigger points.  Hence, eat plenty of your green leafy vegetables for they are rich in magnesium and help those stressed, taught and tired muscles recover.

Stress seems to be the silent killer in America and is an aggravating factor for all forms of disease including headaches.  Take some time out for yourself.  Participate in exercise, yoga, meditation, massage, breathing exercises and other activities that help you relax.  When dealing with chronic headaches take a multi faceted approach.  Deal with stress, each right, see your chiropractor and avoid chemicals that you may be sensitive to.  Many artificial sweeteners and additives are also excitotoxins.   Excitotoxins are chemicals that literally stimulate neurons to death.   Aspartame, Nutra-sweet, MSG just to name a few will all cause headaches and should be avoided.  For more info on excitotoxins read Excitotoxins: The taste that kills.  Headaches can be treated naturally and effectively.  First try all your conservative measures for you will be surprised how many people they help and they even may help you.  If all else fails then try medication.  There is a place for everything in this world drugs and surgery should be last.         

Friday, March 06, 2009
  • Maintain a healthy diet and weight. Supplementation with Omega 3-Fatty Acids, MSM, and Glucosamine Chodroitin are good ways to keep all your joints with the necessary nutritional building blocks to protect them from injury.
  • Remain active—under the supervision of your doctor of chiropractic.
  • Avoid prolonged inactivity or bed rest. Again, stay active.
  • Warm up or stretch before exercising or other physical activities, such as gardening. A flexibility protocol should be practice such as yoga, GYROTONIC Method or Pilates in order to avoid injury to spinal tissues. It is well known that the more flexible you are the less likely you are to injure yourself.
  • Maintain proper posture.
  • Wear comfortable, low-heeled shoes.
  • Sleep on a mattress of medium firmness to minimize any curve in your spine. The Sleep Number bed from Select Comfort has clinical studies showing improvement with pain for those who suffer from back complaints. The doctor recommends the Sleep Number bed for those who are in the market for a mattress for its customizing firmness.
  • Lift with your knees, keep the object close to your body, and do not twist when lifting. This is the mechanism how individuals hurt the disc's in the spine.
  • Quit smoking. Smoking impairs blood flow, resulting in nutrient and oxygen deprivation (hypoxia) to spinal tissues, decreasing the body's natural healing ability.
  • Work with your doctor of chiropractic to ensure that your workstation is ergonomically correct.
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