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Archive for March 2016

Back Pain And Running – 8 Thing You Should Know

Have you ever noticed every time you go running, you have lower back pain either during or after the run? If so, you may be wondering if you should quit running, find an alternative sport, or simply stop all activity and adopt a sedentary lifestyle. If you love the benefits of running and want to continue, is there anything you can do to make running tolerable? First, NEVER stop doing activity and adopt a sedentary lifestyle – it will start a slow decline with an unhappy ending! So, let’s see if we can make running work for you!

  1. STRETCH: In general, stretching helps “warm up” your muscles and joints and can prevent the low back from hurting during or after your run. In past articles, we’ve reviewed simple stretches, even some that can be done from a sitting position (when you’re in a hurry). Yoga-based exercises are also excellent!
  2. FOOT STRIKE: The “proper” gait or method your feet hit the ground is very important! To avoid low back injuries (not to mention foot, ankle, knee, or hip injuries), run SMOOTHLY so the heel strike is gliding/glancing vs. a hard vertical load. The foot then “ROLLS” from heel to toe, first on the outside of the foot and then shifts to the inside during which time the arch flattens out, getting ready to “spring” you forward. The heel then lifts up and you push off the ball of the foot and big toe.
  3. RUNNING POSTURE: Lean forwards when you run – DON’T run vertically like a Po-Go stick! By doing this, your momentum move you forward – NOT downwards into the pavement (like a “jack hammer”)!
  4. CORE STRENGTHENING: By keeping your “core” (midsection) strong, your back is more supported and less likely to become injured. Core exercises include pelvic tilts, the “dead-bug”, bridges, prone swimmers, lunges, squats, sit-ups, arch-ups, side bridges, 4-point kneeling/opposite arm/leg, and many others. These can be done on the floor and/or with a gym ball. Balance exercises are also very important!
  5. RELAX: Have you ever noticed when some people run, they just look “tight” and uncomfortable. RELAX – don’t shrug your shoulders up to your ears. Let your arms hang down bent at your sides. Don’t clench your teeth or make a fist – RELAX!!!
  6. PADDED INSOLES: There are many brands of padded insoles – try some and see how they work for you.
  7. RUNNING SHOES: The key here is TRY THEM ON and walk around inside the store. There are a lot of good supportive shoes so just find a brand that works for you!
  8. FLAT FEET: This is common and NOT a reason to stop running. Ask your Osteopath about foot orthotics and the function and importance of the arches
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What’s This Tingling in My Leg?

When you think of low back pain, you may visualize a person half-bent over with their hand on the sore spot of their back. Since many of us have experienced low back pain during our lifetime, we can usually relate to a personal experience and recall how limited we were during the acute phase of our last LBP episode. However, when the symptoms associated with LBP are different, such as tingling or a shooting pain down one leg, it can be both confusing and worrisome – hence the content of this month’s article!

Let’s look at the anatomy of the low back to better understand where these symptoms originate. In the front of the spine (or the part more inside of the body), we have the big vertebral bodies and shock absorbing disks that support about 80% of our weight. At the back of each vertebrae you’ll find the spinous and transverse processes that connect to the muscles and ligaments in the back to the spine. Between the vertebral body and these processes are the tiny boney pieces called the pedicles. The length of the pedicle partially determines the size of the holes where the nerves exit the spine.

When the pedicles are short (commonly a genetic cause), the exiting nerves can be compressed due to the narrowed opening. This is called foraminal spinal stenosis. This compression usually occurs later in life when osteoarthritis and/or degenerative disk disease further crowds these “foramen” where the nerves exit the spine. Similarly, short pedicles can narrow the “central canal” where the spinal cord travels up and down the spine from the brain. Later in life, the combined effects of the narrow canal plus disk bulging, osteoarthritic spurs, and/or thickening or calcification of ligaments can add up to “central spinal stenosis.” The symptoms associated with spinal stenosis (whether it’s foraminal or central) include difficulty walking due to a gradual increase in tingling, heavy, crampy, achy and/or sore feeling in one or both legs. The tingling in the legs associated with spinal stenosis is called “neurogenic claudication” and must be differentiated from “vascular claudication”, which feels similar but is
caused from lack of blood flow to the leg(s) as opposed to nerve flow.

At a younger age, tingling in the legs can be caused by either a bulging or herniated lumbar disk or it can be referred pain from a joint – usually a facet or sacroiliac joint. The main difference in symptoms between nerve vs. joint leg tingling symptoms is that nerve pinching from a deranged disk is located in a specific area in the leg such as the inside or outside of the foot. In other words, the tingling can be traced fairly specifically in the leg. Tingling from a joint is often described as a deep, “inside the leg,” generalized achy-tingling that can affect the whole leg and/or foot or it may stop at the knee, but it’s more difficult to describe by the patient as it’s less geographic or specific in its location. Osteopathic management of all these conditions offers a non-invasive, effective form of non-surgical, non-drug care and is the recommended in LBP guidelines as an option when treating these conditions.

Cram Osteopaths

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BACK PAIN – Most Get MRI At Wrong Time

Low back pain is a very common complaint. In fact, it’s the #1 reason for doctor visits in the United States! The economic burden of LBP on the working class is astronomical. Most people can’t afford to be off work for one day, much less a week, month, or more! Because of the popularity of hospital-based TV dramas over the past two decades, many people think getting an MRI of their back can help their doctor fix their lower back problem. Is this a good idea? Let’s take a look!

Patients will often bring in a CD that has an MRI of their lower back to and ask the ultimate question, “….can you fix me?” Or, worse, “…I think I need surgery.” Sure, it’s quite amazing how an MRI can “slice” through the spine and show bone, soft tissues, disks, muscles, nerves, the spinal cord, and more! Since the low back bears approximately 2/3 of our body’s weight, you can frequently find MANY ABNORMALITIES in a person over 40-50 years old. In fact, it would be quite odd NOT to see things like disk degeneration, disk bulges, joint arthritis, spur formation, etc.!

Hence, the “downside” of having ALL this information is the struggle to determine which finding on the MRI has clinical significance. In other words, where is the LBP coming from? Is it that degenerative disk, bulged disk, herniated disk, or the narrowed canal where the nerve travels? Interestingly, in a recent review of more than 3,200 cases of acute low back pain, those who had an MRI scan performed earlier in their care had a WORSE outcome, more surgery, and higher costs compared with those who didn’t succumb to the temptation of requesting an MRI!

This is not to say MRI, CT scans, and x-rays are not important, as they effectively show conditions like subtle fractures and dangerous conditions like cancer. But for LBP, MRI is often misleading. This is because the primary cause of LBP is “functional” NOT “structural,” so it’s EASY to get railroaded into thinking whatever shows up on that MRI has to be the problem.

Here is how we know this, when we take 1,000 people WITHOUT low back pain between ages 30 and 60 (male or female) and perform an MRI on their lower back, we will find up to 53% will have PAINLESS disk bulges in one or more lumbar disks. Moreover, we will find up to 30% will have partial disk herniations, and up to 18% will have an extruded disk (one that has herniated ALL the way out). Yet, these people are PAIN FREE and never knew they had disk “derangement” (since they have no LBP). When combining all of these possible disk problems together, several studies report that between 57% and 64% of the general population has some type of disk problem without ANY BACK PAIN!

Hence, when a patient with a simple sprain/strain and localized LBP presents with an MRI showing a disk problem, it usually ONLY CONFUSES the patient (and frequently the doctor), as that disk problem is usually not the problem causing the pain! So DON’T have an MRI UNLESS a surgical treatment decision depends on its findings. That is weakness, numbness, and non-resolving LBP in spite of 4-6 weeks of non-surgical care or unless there is weakness in bowel or bladder control. Remember, the majority of back pain sufferers DO NOT need surgery!

Cram Osteopaths

This article was provided by Chiro-trust

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Are You In Your Best Decade

You wouldn’t be unusual in assuming that our health and wellbeing tends to deteriorate as we age.  However, according to a recent survey people in their late 60s reported the greatest sense of wellbeing and happiness. This is despite the fact that most people in this decade of their lives live with a chronic health condition such as diabetes or hypertension.

The survey doesn’t outline why this age group comes out top, but plans for future research to identify this are underway.

We’d like to think that keeping active and looking after your health as a priority are key behaviours that help ensure a happy and healthy life at any age.  If you are in your sixties what do you do to keep healthy and happy?  Do you agree with the results of this survey?  Visit our Facebook page and let us know what you think.

Watching your back,

Cram Osteopaths

What did you think of this health story?  Let us know at info@cramosteopaths.co.uk

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March Health Tips

  1. Fitness tracker – Arguably the most effective way to monitor activity levels and calories burned, fitness trackers like the Fit Bit and Microsoft Band are worn around the wrist and comes in many variations, with some even monitoring heart rate and sleep quality. A great way to accurately monitor every single movement you make throughout the day.
  2. Free phone app – Many free apps like Map My Walk and Map My Run use your smart phone to track movements and calculate calories earned. Simply download an app, remember to keep you phone on your person at all times, and watch your steps add up.
  3. Measure your route – If you don’t have a smartphone or would rather not track activity all the time, simply pick your favourite walk / run / cycling route and use Google Maps or one of the Map My Walk / Run sites above to calculate the distance.

 

Watching your back,

 

Cram Osteopaths

 

 

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