Two Predisposing Causes of Back Pain Everyone Needs to Know About

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This is probably the most important article I have ever written. I know most of you won’t read it because of its length. If you do read it, you will know more about the cause and prevention of back pain than most health professionals who treat this problem. If you or someone close to you has ever had their back “go out” or developed a chronic, recurring backache, this article explains why. I will also share with you the best thing you can start doing right now that has helped me and thousands of my patients overcome back pain. 

I have been treating spine problems for over 20 years and I have observed that back pain presents itself in one of three scenarios…

Scenario 1: You are getting yourself ready to go about your day, you bend forward to put on your socks or pick something up and all of a sudden your back “goes out” and you feel a sharp, stabbing pain. You have difficulty understanding how this could possibly happen. It wasn’t anything strenuous. “All I did was bend over!”

Scenario 2: You bend forward to lift something heavy and when you go to lift, again your back “goes out” and you feel a sharp, stabbing pain. This one you can understand. It was fairly strenuous. “Maybe I lifted the wrong way?”

Scenario 3: The muscles in your back begin to tighten up and you develop a deep dull ache. It may have been from some activity you did from the previous day or it started for no apparent reason. There was no immediate “incident” that set it off. It does get better, but always seems to come back from time to time.

I discuss more on why these scenarios happen later in the article.

If any of you have been lucky enough to experience all three scenarios like I have, you know how bad back pain can be, especially when it is so difficult and painful to get out of a chair, lift a leg up, or turn over in bed. There comes a time when your back becomes such a nuisance you need professional help.

You likely go one of two routes…

The Medical Route. You have a not so thorough exam, an x-ray or maybe an MRI and they don’t see any problems…no fracture, no bulging or herniated disc, no spinal degeneration (arthritis). They are unable to explain why you are in pain when they don’t see any problems on your x-ray or MRI.

MRI showing bulging and herniated discs

Or they do see a bulging, herniated, or degenerated disc and this is what they tell you. They are unable to explain why you have this “damage” in your spine. They commonly tell patients that the problem is due to “aging” or “normal wear and tear.” These are the lamest reasons I have ever heard since my time working in this field. Most patients buy into this line of thinking because it makes intuitive sense, but in reality it doesn’t. If this was true, we would find that EVERYONE has an equal amount of disc and joint wear in EVERY JOINT IN THEIR BODY AS THEY GET OLDER. We simply DO NOT SEE THIS! What we do see is wear and tear in selective joints in selective people. It is occurs in the joints that are least stable and have the worst movement mechanics, not aging and “normal” wear and tear.

The bottom line is signs of spinal degeneration and disc pathologies indicate a long-term “wear and tear” process…not a good thing. Spinal pathologies are mostly what conventional medical professionals are screening for and they aren’t too concerned about the predisposing causes I am going to talk about. In either case, they may recommend a course of anti-inflammatory drugs, a cortisone injection, surgery, or they send you off to physical therapy.

Or you decide to go the…

The Chiropractic Route. You have a bit more thorough exam and you may or may not have an x-ray, depending on the chiropractor’s philosophy and approach. The chiropractor may rub your back, put you on therapy machines and then “cracks” your spine in a few places. Not to say these don’t have some short-term, pain relieving benefits, but these do nothing to address the predisposing causes I am about to talk about.

The 3 Questions Most Spine Specialists DON’T Ask Themselves

Most medical professionals, physical therapists, and even chiropractors don’t ask themselves these questions about the patients they are treating:

  1. “Why did this patient develop a “damaged” disc?”
  2. “What is wrong with this patient’s posture and movement habits that has caused this to happen?”
  3. “What is the best treatment, exercises and movement habits I can teach this patient for the best recovery AND reduce the chances of this happening again?”

If these “specialists” do not ask themselves these questions, it will be very difficult for them to find the long-term solutions for their patient’s problems. Been there, done that! These are the questions that burn in my brain every day!

The Two Predisposing Causes of Back Pain

There are two predisposing causes of back pain that most people don’t know about, including many health professionals that treat back pain! The first one has to do with…

Ideal Static Alignment of the Spine and Posture

Alignment
When I am talking about alignment, I am referring to the alignment of the spinal column and posture. I am also referring to both “static” alignment, such as when sitting or standing still, as well as “dynamic”’ alignment, when our body is in motion.

Ideal alignment of our spine and body as a whole (posture) is vital for not only the long term health of our musculoskeletal system, but it is also a factor for our overall health as well.

Abnormal Static Alignment of the Spine and Posture

Many of us lose proper “static” alignment of our spine and posture due to the injuries we acquire throughout life. Sudden, traumatic injuries, such as a fall, sports injury, or car accident often cause the spine to shift out of place. Working, sitting, or sleeping in a bad posture for extended periods of time can do the same.

Many of us lose proper “dynamic” alignment because we have simply lost the ability to move correctly. We all learned to move and move flawlessly in our first few years of life when we went through the developmental milestones. After years of injuries, compensating for those injuries, and the impact a more sedentary, industrialized lifestyle has had on our bodies, we have paid the price by developing poor movement habits. The best example of this is when people lose the ability to move in their hip joints when they bend, squat, or twist their body. They compensate by bending and twisting more in their lower back. What happens over the long haul? You guessed it, back pain. Many people are in pain because they simply don’t move right!

Centrated Joint
Shoulder joint demonstrating proper dynamic alignment (centrated) when the arm is lifted overhead.
Decentrated Joint
Shoulder joint demonstrating poor dynamic alignment (decentrated) when the arm is lifted overhead.

 

 

 

 

 

 

 

 

 

 

 

Intra-abdominal pressure (IAP)

If we lose proper alignment statically or dynamically, there will be excessive loads (compression, tension, torsion, shear) on spinal tissues weakening them over time. This leads to scenario 1, 2, or 3.

The second predisposing cause of back pain has to do with…

Intra-Abdominal Pressure (IAP)
IAP is the mechanism that stabilizes our spine. It is essentially our “built in” back brace. This is the most important new discovery in the last decade and it is a game-changer for the difficult patients with back pain who don’t get completely better with chiropractic treatment, physical therapy, or their back pain always comes back from time to time.

IAP should be an automatic, subconscious activation of your core before and during every movement you make. The problem is, the vast majority of people who suffer with back problems have lost this automatic ability to create IAP when they bend and move. When IAP is insufficient, spinal tissues begin to pay the price.

Two Common Reasons Why People Lose The Ability to Create IAP

Pain, Trauma, and Injuries. Our bodies have unique ways of creating compensations for physical and emotional trauma. Unfortunately, one of them is an alteration in how we stabilize our core. The automatic ability of creating IAP becomes absent, delayed, or lost during movement. 

Poor Core Stabilization Strategy. Pulling the abdomen in and lifting the chest does not increase IAP and makes the spine unstable and more prone to injury.

Cosmetic, Cultural or Learned Behavior. Some people “suck in” their stomach in an attempt to look thinner. Other people are taught to “suck in” or “pull in” their stomach as an exercise to activate their core. Even though some abdominal muscles are contracting when they pull their belly button towards their spine, they are contracting their muscles in the exact opposite direction that is needed to create IAP and increase spine stability. If this “pulling in” strategy becomes habit, it will have a destabilizing effect on the spine which will eventually lead to pain and wear and tear on spinal tissues.

How Problems With Alignment and IAP Lead to Back Pain: The 3 Scenarios

Problems with alignment and IAP create the perfect storm for the eventual development of back pain and the often associated “wear and tear” spinal pathologies (disc annular tears, bulging, herniations, protrusions, degeneration, arthritis, stenosis, ligament hypertrophy, etc.)

Alignment problems will predispose people to back pain because spinal tissues will be pre-stressed most of the time. Poor static alignment will expose certain discs, muscles, ligaments, nerves, etc. to higher loads compared to ideal alignment. Tissues under greater stress and strain will be more prone to injury, wear and tear and pain generation over time. The bottom line is poor static alignment will increase the likelihood of developing back pain in any of the three scenarios mentioned at the beginning of this article.

X-ray of a misaligned spine in one of my patients with multiple herniated discs and sciatica (leg pain)

IAP problems will predispose people to back pain because the spine is not stabilized properly during movement. Another way of saying it is, IAP takes stress off the spine. If you do not create and maintain IAP during movement, more stress is transferred to spinal tissues. This ends up creating thousands of micro “insults” (small injuries) to the spine every time you move, bend, lift, etc. You don’t feel them until your spinal tissues have become so weak and damaged to the extent that it only takes one more bend of your back to set it off…The straw that broke the human’s back! This is exactly what happens in Scenarios 1 and 2.

The Lumbar Extension Stabilization Strategy

Scenario 3 is like 1 and 2 in that it is usually a combination of an alignment and an IAP problem. Poor alignment stresses spinal tissues over time and eventually you feel tight muscles in your back or a deep, dull ache in your joints or discs. Lack of IAP also stresses spinal tissues. If you can’t create adequate IAP, you have an option to compensate for this by adopting a lumbar extension stabilization strategy. That is, you tighten up your lower back muscles causing it to arch too much to create some semblance of core and spine stability. Unfortunately, this is not an effective long-term solution to the IAP problem. If this strategy persists for too long, back muscles become chronically tight, overused and painful, spinal discs become injured because they are highly compressed, and low back pain eventually develops. This is an epidemic problem I see every day!

Alignment and Intra-abdominal Pressure:
The Keys to a Healthy Back

Now that you know alignment and IAP are the two predisposing causes of back pain, what can you do to fix these problems?

How to Fix Your Alignment
When the spine shifts out of place and becomes misaligned, it usually can’t go back into place on its own. This is where chiropractic comes in. And not just any chiropractor. It needs to be a “corrective” chiropractor. There are many types of chiropractors with varying philosophies and approaches. Corrective chiropractors are trained in the best methods to correct the alignment of the spine. There are several different corrective chiropractic techniques, but the one that stands above all others is Chiropractic Biophysics Technique (CBP). It is the most effective, scientific and researched method of all chiropractic techniques with nearly 200 studies validating its approach. For these reasons, I highly recommend a chiropractor trained and certified in CBP technique.

X-ray of one of my patients BEFORE CBP corrective care. He had multiple herniated discs, back pain, sciatica, and a failed back surgery.
X-ray AFTER a program of CBP corrective care. Back pain and sciatica resolved.

 

 

 

 

 

 

 

 

 

 

 

 

Locate a CBP chiropractor near you

So if your spine is out of place and misaligned (x-rays and posture assessment will verify this), there is not much you can do about this on your own without the help of a corrective chiropractor. They need to determine from your x-rays and posture what spinal adjustments, exercises, or other treatment you might need to correct your spinal alignment to as near normal as possible.

How to Fix IAP
What you can work on and usually improve on your own (if you do it and implement it correctly) is your ability to create IAP when you bend, move, lift, etc.

Place your hands around your waist and cough or make a hard “CHA” sound. You should be able to feel how your abdominal muscles tighten up and pressure builds inside your abdomen. This is IAP! Two things have to happen to create good IAP. The diaphragm, which most people know as the primary breathing muscle, contracts and pushes down into the abdomen and at the same time the abdominal and pelvic floor muscles tighten up. This builds up pressure inside the abdomen which stabilizes and keeps the spine from bending when it shouldn’t bend. It also stabilizes the spine when the spine does need to bend. In both instances, it is this pressure that protects the spine from injury.

How to Assess Your Ability to Create IAP
Place your hands around your waist. Suspend your breath (no breathing), push out into your hands, and tighten up/flex your abdominal muscles at the same time. Think about tightening up your abdominals as if someone is going to punch you in the stomach. If you do it correctly, you should feel pressure build inside your abdomen (IAP) and all parts of your abdominal wall move outward and tighten up. If you are unsure, cough a few times and that is the feel you are looking for. You should feel symmetrical outward excursion and tightening of your entire abdominal wall, especially in your back where your thumbs are located, in the front where your fingertips are, and in the lowest part of your abdomen below your belt line just above your groin. If you find an area that is not pushing out or tightening up very well, these are the areas that you need to work on. You can make this an exercise by placing your hands in your weakest areas and pushing out and tightening up. Hold for a second, release, and repeat 10-20 times or until fatigue. You can do this multiple times a day, every day. It is important to practice this in all position…lying on your back, stomach, each side, sitting, and standing. 

As a side note, you should also be able to breathe into your abdomen (diaphragmatic breathing) at the same time you have created IAP. Here’s the test: Create IAP by pushing out and tightening up no more half way (less than 50% effort). Now breathe into your abdomen while you keep the pressure constant, especially on the exhale. This is very difficult for most people to do and is a further predisposing risk factor for back pain. The breathing component is beyond the scope of this article. I have written another article on this if you want to check it out…

Bad Back? It Might Be The Way You Breathe

If you practice creating IAP enough, you should be able to feel the pressure and tightening without your hands around your waist. Now it is time to use IAP when you move. For this new pattern to get automatically programmed into your nervous system, you need to consciously think about creating IAP right before every movement you make. And not only creating it, but MAINTAINING IT THROUGHOUT THE ENTIRE MOVEMENT! 

These are the most important times you want to do this:

Any time you have to bend or lean forward, such as getting in and out of a chair or your car, leaning forward to pick something up from a table or the floor (whether it is light or heavy), getting things in and out of the refrigerator, lifting up your legs to put on pants, socks, or shoes, during strength/weight training exercises, etc. If you have to hold your breath when you do it, that’s okay.

The goal is to have the awareness to recognize when you remember to do this and when you don’t. There will be times when you catch yourself “in the act” and realize that you forgot to do it. This will happen in the beginning. The important thing is you recognized it and you will remember next time. If you make a habit of doing this long enough, it will become an automatic, subconscious activity like it once was before. Now, each time you move you will be protecting your spine and not injuring your spine.

Many people have trouble knowing for sure if they are creating IAP and maintaining it properly. The best professionals to consult if you need help with this is a chiropractor or physical therapist who is trained in Dynamic Neuromuscular Stabilization (DNS). 

If fixing your bad back is a top priority, your best bet is to find a corrective (CBP) chiropractor who also uses DNS treatment and exercises. 

Research has verified what I have talked about in this article…that improper alignment and lack of proper IAP regulation are predisposing causes of back pain. I hope this article has given you a better understanding why most of us eventually suffer from back pain and why it is such an epidemic problem in our society.

If you like this post, share it. Comment on it. Email me if you have questions about it. Thanks for reading…
Dr. Ryan Hamm
drhamm@drryanhamm.com

On April 29th, I am teaching a special class that will thoroughly cover IAP and diaghragmatic breathing assessment and exercises to help people with back problems. Here are the details on this class…

Exercise Strategies for Better Movement, Core Stabilization, Athletic Performance and Back Pain Prevention

Dr. Ryan Hamm


Dr. Ryan Hamm is a chiropractor in Arlington Heights and has been treating disorders of the spine and extremities for over 20 years. He specializes in posture and movement rehabilitation to resolve painful conditions of the musculoskeletal system. Dr. Hamm has been studying the most critical components people need for ideal posture and movement to minimize joint wear and tear. He has an Advanced Certification in Chiropractic Biophysics (CBP) Technique and he is nearing completion of becoming a  Dynamic Neuromuscular Stabilization (DNS) certified practitioner.

References
Troyanovich SJ, Harrison DD, Harrison DE. Low back pain and the lumbar intervertebral disc: Clinical considerations for the doctor of chiropractic. J Manipulative Physiol Ther 1999; 22(2): 96-104.

Troyanovich SJ, Harrison DE, Harrison DD. Review of the Scientific Literature Relevant to Structural Rehabilitation of the Spine and Posture: Rationale for Treatment Beyond the Resolution of Symptoms. J Manipulative Physiol Ther 1998;21(1):37-50.

Harrison DE, Colloca CJ, Keller TS, Harrison DD, Janik TJ. Anterior thoracic posture increases thoracolumbar disc loading. Eur Spine J 2005:14:234-242.

Harrison DE, Cailliet R, Harrison DD, Troyanovich SJ, Harrison SO. A Review of Biomechanics of the Central Nervous System. PART I: Spinal Canal Deformations Due to Changes in Posture. J Manipulative Physiol Ther 1999; 22(4):227-234.

Harrison DE, Cailliet R, Harrison DD, Troyanovich SJ, Harrison SO. A Review of Biomechanics of the Central Nervous System. PART II: Strains in the Spinal Cord from Postural Loads. J Manipulative Physiol Ther 1999; 22(5):322-332.

Harrison DE, Cailliet R, Harrison DD, Troyanovich SJ, Harrison SO. A Review of Biomechanics of the Central Nervous System. PART III: Spinal Cord Stresses from Postural Loads and Their Neurologic Effects. J Manipulative Physiol Ther 1999; 22(6):399-410.

Harrison DE, Betz J, Ferrantelli JF. Sagittal spinal curves and health. JVSR 2009 July 31, pp 1-8.

Keller TS, Colloca CJ, Harrison DE, Harrison DD, Janik TJ. Influence of spine morphology on intervertebral disc loads and stresses in asymptomatic adults: Implications for the Ideal Spine. Spine Journal 2005; 5:297-305.

Harrison DD, Harrison DE, Janik TJ, Cailliet R, Haas JW, Ferrantelli J, Holland B. Modeling of the Sagittal Cervical Spine as a Method to Discriminate Hypo-Lordosis: Results of Elliptical and Circular Modeling in 72 Asymptomatic Subjects, 52 Acute Neck Pain Subjects, and 70 Chronic Neck Pain Subjects. Spine 2004; 29:2485-2492.

Harrison DD, Cailliet R, Janik TJ, Troyanovich SJ, Harrison DE, Holland B. Elliptical Modeling of the Sagittal Lumbar Lordosis and Segmental Rotation Angles as a Method to Discriminate Between Normal and Low Back Pain Subjects. J Spinal Disord 1998; 11(5): 430-439.

Kolar P, Sulc J, Kyncl M, Sanda J, Cakrt O, Andel R, Kumagai K, Kobesova A. Postural Function of the Diaphragm in Persons With and Without Chronic Low Back Pain. , J Orthop Sports Phys Ther, 2012;42:352-362,

Hodges PW, Cresswell AG, Daggfeldt K, Thorstensson A. In vivo measurement of the effect of intra-abdominal pressure on the human spine. J Biomech. 2001;34:347-353.

Hodges PW, Cresswell AG, Daggfeldt K, Thorstensson A. Three dimensional preparatory trunk motion precedes asymmetrical upper limb movement. Gait Posture. 2000;11:92-101.

Hodges PW, Eriksson AE, Shirley D, Gande-via SC. Intra-abdominal pressure increases sti ness of the lumbar spine. J Biomech. 2005;38:1873-1880. http://dx.doi.org/10.1016/j. jbiomech.2004.08.016

Hodges PW, Gandevia SC. Activation of the human diaphragm during a repetitive postural task. J Physiol. 2000;522 pt 1:165-175.

Hodges PW, Gandevia SC. Changes in intra-abdominal pressure during postural and respiratory activation of the human diaphragm. J Appl Physiol. 2000;89:967-976.

Hodges PW, Richardson CA. Altered trunk muscle recruitment in people with low back pain with upper limb movement at different speeds. Arch Phys Med Rehabil. 1999;80:1005-1012.

Kolar P, Sulc J, Kyncl M, et al. Stabilizing function of the diaphragm: dynamic MRI and synchronized spirometric assessment. J Appl Physiol. 2010;109:1064-1071. http://dx.doi. org/10.1152/japplphysiol.01216.2009

Exercise Strategies for Better Movement, Core Stabilization, Athletic Performance and Back Pain Prevention

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In this exercise workshop, you will learn how to move better, stabilize better, perform better, overcome back pain, and prevent injury. The information you will learn is inspired by the principles of DNS (Dynamic Neuromuscular Stabilization), one of the newest and most exciting approaches to exercise and rehabilitation on the planet.

Class Objectives

  • Introduce the concepts of diaphragmatic breathing, intra-abdominal pressure, dynamic joint alignment (centration), and core stabilization
  • Learn why the developmental “milestones” are the blueprints for ideal movement patterns in adults
  • Learn how the deterioration of flawless movement patterns in infants/toddlers lead to the development of musculoskeletal pain in adults
  • Evaluate and identify any faults in your ability to perform diaphragmatic breathing and intra-abdominal pressure separately and simultaneously
  • Evaluate and identify any faulty movement patterns/compensations you have acquired from pain, past injuries or bad coaching
  • Learn corrective exercises to improve your ability to use diaphragmatic breathing and intra-abdominal pressure with movement to train better movement habits
  • Learn exercises in developmental “milestone” positions to create a better movement platform for higher level exercises, recreational activities, and sports
  • Learn a daily exercise routine you can perform to move better, stabilize better, feel better, and perform better

When:  Sunday, April 29th   9:00-11:00am

Where: First Health Associates
2010 S.Arlington Heights Rd #42 (Lower Level)

Fee:     $39

This class is limited to 12 participants
Registration is required to sign up for this class

This is a floor-based exercise class.
Exercise/yoga mats will be provided.
You can bring your own yoga mat if you desire.
Please wear comfortable workout attire

Questions?  Email drhamm@drryanhamm.com

 

About the Instructor
Dr. Ryan Hamm is a chiropractor in Arlington Heights and has been in practice for 24 years. He specializes in posture and movement rehabilitation to resolve painful conditions of the musculoskeletal system. For several years, he has been studying the most critical components people need for ideal posture and movement to minimize joint wear and tear. He is nearing completion of becoming a  Dynamic Neuromuscular Stabilization (DNS) certified practitioner.

5 Steps For Safe Lifting To Avoid Back Pain

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Do you want to know why some people’s backs “go out” when bending and lifting something up? They bend and lift with bad form and do not activate their core properly.

Here are five important steps you need to take when lifting to avoid a severe episode of back pain:

  1. Position your body’s COM (center of mass) directly above the object you are lifting.
  2. Get equal pressure on the heels and balls of both feet.
  3. Keep your knees centered above your feet.
  4. Make your spine long and straight with no bending or arching.
  5. Create and maintain IAP (intra-abdominal pressure) before and throughout the entire squat and lift. Create IAP by tightening up your abdominals as if someone is going to punch you in the stomach. No sucking in your abs! Your entire abdominal wall should push out and firm up.

Creating and maintaining IAP is one of the most critical parts! Many people do not create IAP or lose it somewhere during the movement. When this happens, stress suddenly occurs in the spine and this is the reason why many backs “go out.”

How to Test Your Diaphragm for Breathing and IAP

Most people who end up in my office with back pain bend and lift with bad form. This is what causes tight muscles, discs to herniate, degenerate and spines to “wear out” over time.

We have a unique and different approach because we look for poor posture and movement patterns that are causing the pain. We then teach patients exercises that retrain their brain to move with better form to avoid future episodes of back pain.

If you or someone close to you is suffering with ongoing back problems, contact us to see if we can help.

 

8 Natural Alternatives to Flu Shots

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Many people are looking for more effective, natural alternatives to flu shots. This comes in the wake of their questionable effectiveness and their potentially harmful side effects.

Is the flu shot worth the risk and how much protection does it offer?

If you follow these eight steps, you can make your immune system stronger to stave off colds and the flu this winter and year round.

Take Vitamin D.  Vitamin D3 (cholecalciferol) supplements are 8 times more effective than flu shots!  Take 1,000-5,000IU/day (children), 5,000IU/day (teenagers), 5,000-10,000IU/day (adults).  Have blood levels tested to achieve 50-80ng.

Eat Less Sugar, Grain and Processed Foods and Eat More Fruits and Vegetables.  Sugar, grains and processed foods cause systemic inflammation and impair immune response making it much easier to get the cold and flu.

Drink Green Tea Instead of Soda.  The polyphenols in green tea are antibacterial, antifungal and antiviral.  They have been shown to block viruses from spreading to other cells.

Get Your Chiropractic Adjustments!  Several studies have shown spinal adjustments stimulate the immune system into action to fight foreign viruses and bacteria.

Get Regular, Good Quality Sleep.  Try to get 6-8 hours a night and go to bed and get up at the same time every day. 

Reduce Stress and Have Effective Tools to Manage Stress. When stress builds up it wears on your immune system making you more susceptible. Make an effort to find solutions when stress builds up before it breaks you down.

Exercise on a Consistent Basis.  Exercise helps boost your immune system, increases circulation of immune cells, and is a great stress reliever.

Be Aware of Sick People Around You and Wash Your Hands. When you are around coughing sick people, avoid breathing in their germs. Also, wash your hands to reduce the chance of spreading viruses to your nose and mouth. Avoid anti-bacterial soaps as they are no more effective than regular soap and they contribute to antibiotic resistance.

 

Sources:

  1. American Journal of Clinical Nutrition, March 10, 2010.
  2. Brennan PC, et al. Enhanced phagocytic cell respiratory burst induced by spinal manipulation: potential role of substance P. JMPT, 1991;14:399-408.
  3. Brennan PC, et al. Enhanced neurtophil respiratory burst as a biological marker for manipulation forces: duration of the effect and association with substance P and tumor necrosis factor. JMPT,1992;15:83-9.
  4. Selano JL. The effects of specific upper cervical adjustments on the CD4 counts of HIV positive patients. Chiro Res J, 1994;3:32-9.
  5. Teodorczyk-Injeyan JA, Injeyan HS, McGregor M, et al. Enhancement of in vitro interleukin-2 production in normal subjects following a single spinal manipulative treatment. Chiropr Osteopat, 2008;16:5.
  6. Teodorczyk-Injeyan JA, et al. Interleukin-2 regulated in vitro antibody production following a single spinal manipulative treatment in normal subjects. Chiropr Osteopat, 2010;18:26.

 

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The Diaphragm’s Role For a Healthy Spine and Body

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The diaphragm is a breathing AND a core stabilizing muscle. It must be able to switch roles and be able to perform both roles at the same time. If you are lying down, the diaphragm is dedicated solely to breathing (far left side of graph in blue). There is no external load applied to your body so the stabilizing role is absent. If you are attempting to lift a 200lb object off the floor, the diaphragm is dedicated solely to stabilizing your core and you will hold your breath throughout the movement (far right of graph in red). The breathing role is absent.Prior to any movement, the diaphragm contracts and pushes down towards the abdomen. At the same time, the abdominal wall and muscles of the pelvic floor expand and “tighten up.” This compresses the abdomen which creates intra-abdominal pressure (IAP). IT IS IAP THAT GIVES US STRENGTH, STABILIZES OUR CORE AND PROTECTS OUR SPINE FROM INJURY.

The majority of the time, the diaphragm is used for breathing and creating IAP at the same time (overlapping roles on graph). This occurs during most movements and activities, such as walking, running, repetitive tasks, etc. This is very difficult for most people to do.

How To Test Your Diaphragm

Normal Inhalation: Diaphragm pulls down, abdomen expands 360 degrees

“Flex, “tighten,” or “brace” your abdominal wall to create IAP and then breathe into your abdomen while maintaining IAP for several breaths. Your chest and shoulders should not lift up during the inhale. Your abdomen should expand and feel like it is filling with air. You should be able to keep your abdominals “flexed”/maintain IAP on the exhale. This is the hard part! If you are unable to inhale and exhale with a braced abdomen, you have a dysfunctional diaphragm.

This is the cause of many spine conditions, such as neck and back pain. This problem also has a “trickle effect” into hips and shoulders that can extend out to hands and feet. If you can’t breathe and create IAP properly, you will not only be UNABLE to correctly stabilize your core, but you will be UNABLE to correctly stabilize your hips, shoulders, etc. as well.

Testing the diaphragm is an important part of my examination process with patients. If it is not working properly, we implement treatment and exercises to rehabilitate this very important yet most neglected muscle in the body. I have helped many patients with this approach no matter what type of pain or musculoskeletal problem they have.

I help people every day with problems caused by a dysfunctional diaphragm. If you or someone you know is having ongoing spine or extremity problems, contact me to see if I can help.

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The Most Important Yet Most Neglected Muscle of The Body Part 2: Diaphragmatic (Core) Stabilization

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Have you ever wondered what it means when a trainer, therapist, or instructor asks you to “brace,” “flex” or “tighten up” your core? More importantly, are you doing it right and are you doing it “automatically” prior to and during normal movements and exercise?

This cue is given to help you create a stable core. The key to a strong, stable core and body is the ability to create pressure within the abdomen, or intra-abdominal pressure (IAP). IAP is a fundamental mechanism for you to initiate, control or even prevent movement. The amount of IAP you create is dependent on what you are doing at any given time. If you are sitting in your car on your way to work, IAP will be minimal. If you are lifting a 100 pound object off the floor, IAP will be greatly elevated. The amount of IAP is constantly regulated to match whatever movement or lifting task that you are performing.

Intra-abdominal pressure (IAP)

Want to feel IAP? Cough or make a “CH” sound. Can you feel the pressure build inside your abdomen? This is what needs to occur automatically to keep your core and spine stable to give you strength and prevent spinal injury.

How Do We Generate IAP?

The core is like a cylinder of muscles. At the top is the diaphragm, the surrounding wall consists of the abdominals and multifidus (along the spine). The bottom consists of the muscles of the pelvic floor. PRIOR TO ANY MOVEMENT, the diaphragm contracts and pushes downward towards the abdomen. At the same time, the entire abdominal wall and muscles of the pelvic floor expand, eccentrically contract and “tighten up.” This compresses all of the contents of the abdomen which creates IAP. IT IS IAP THAT GIVES US STRENGTH, STABILIZES OUR CORE AND PROTECTS OUR SPINE FROM INJURY.

What Happens If We Can’t Generate and Maintain IAP?

Lumbar Extension Stabilization Strategy

Many of us lose the ability to generate and maintain IAP because of past physical or emotional trauma, pain, injuries, etc. The diaphragm is often one of the first muscles to become dysfunctional. Portions of the muscle become “shut down” and it does not push down like it did before. The diaphragm, abdominal and pelvic floor muscles get out of sync, uncoordinated and IAP is diminished. Our only option is to compensate by adopting a lumbar extension stabilization strategy. We tighten up our low back muscles causing it to arch too much to create some semblance of core and spine stability. Unfortunately, this is not an effective long-term solution to the IAP problem. If this problem persists for too long, back muscles become tight, overused and painful, spinal discs can become injured and lower back pain eventually develops. Hip and shoulder joints also become secondary areas of abuse and wear and tear.

MUSCLE TIGHTNESS IN THE BACK IS A COMPENSATION TO THE INABILITY TO GENERATE AND MAINTAIN IAP!

Testing the diaphragm is an important part of my examination process with patients. If it is not working properly, we implement treatment and exercises to rehabilitate this very important yet most neglected muscle in the body. I have helped many patients with this approach no matter what type of pain or musculoskeletal problem they have.

I help people every day with problems caused by a dysfunctional diaphragm. If you or someone you know is having ongoing spine or extremity problems, contact me to see if I can help.

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The Most Important Yet Most Neglected Muscle of The Body Part 1: Diaphragmatic Breathing

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Right now, as you start reading this article, pay attention to your breathing. Are you breathing more in your abdomen or more in your chest? If you are unsure, place one hand on your stomach and the other hand on your chest. Which hand is moving more? If you are breathing more in your chest, your diaphragm muscle is not working properly.

Normal Inhalation: Diaphragm pulls down, abdomen expands 360 degrees

Functions of The Diaphragm

The diaphragm has two functions. One is breathing and the other is core stabilization, which we will discuss in Part 2. The diaphragm is a dome-shaped, paper thin muscle that separates the chest from the abdomen. It attaches to the bottom of the lungs and its outer edges attach to the lowest ribs and spine. When we inhale, the muscle contracts and pulls downward toward the abdomen causing it to expand outward. This creates a negative vacuum in the lungs and they fill with air. When we exhale, the diaphragm relaxes, it moves back up and we let air out.

Under normal conditions, the entire diaphragm muscle is involved in respiration and the entire abdomen expands 360 degrees like a balloon filling with air. Our bodies are getting sufficient oxygen and all is well.

Abnormal Inhalation
Chest and Diaphragm Lift up, Abdomen Pulls In

Consequences of a Dysfunctional Diaphragm

It is very common for the diaphragm to become dysfunctional and not work properly. This can be due to physical or emotional trauma, pain, etc. Portions of the muscle become “shut down” and it does not pull down like it did before. The body compensates by using other muscles to lift the chest up in order to get oxygen. Neck and shoulder muscles such as the trapezius, scalenes, sternocleidomastoid, pectorals and others become overused, tight and painful. Chest breathing can have some painful consequences, including neck and shoulder pain, headaches, and back pain.

Testing the diaphragm is an important part of my examination process with patients. If it is not working properly, we implement treatment and exercises to rehabilitate this very important yet most neglected muscle in the body. I have helped many patients with this approach no matter what type of pain or musculoskeletal problem they have.

I help people every day with problems caused by a dysfunctional diaphragm. If you or someone you know is having ongoing spine or extremity problems, contact me to see if I can help.

 

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Why You Should Not Let Your Vitamin D Go Low

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Vitamin D season is now officially over in the midwest. From September to April the sun is so low in the sky that the UVB rays (the ones that make vitamin D in our skin) simply bounce off the earth’s atmosphere. Blood vitamin D levels drop substantially if you do not take a D3 supplement throughout the winter. This can even happen in summer if you do not get enough sun exposure a few days a week. This will increase the probability of your chances of developing some of the most prevalent diseases that plague us.
Vitamin D Chart
Most labs and physicians say if your blood vitamin D levels are above 30, you’re good. But vitamin D research shows higher is better (see chart). If it is 30, it will help prevent heart disease, but not cancer. You need to get your D levels above 50 or even 60. I recommend taking 5,000-10,000 of D3 daily for adults. Ask you doctor to test your vitamin D and take the right amount to get in the 50-80 range. Take your “D” and stay healthy, everyone!

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