How To Sleep When You Have Back Pain

How you sleep is probably one of the main contributors to back pain.  During sleep, back muscles relax and rejuvenate.  The discs between the bones of the spine regenerate and refill with fluid.  And, any tissues that were damaged during the day, will repair at night.

None of the above will happen if you sleep in a contorted or unsupported position.

When you were a young child, you could sleep just about any way you wanted.  Your bones weren’t fully developed, your discs were more pliable, and your muscles rejuvenated quicker.

But as you age, tissues that once were soft, start to stiffen up.  You can’t just sleep any old way anymore.   If you do, you will feel it in the morning.

So, here’s what you need to do.

-Avoid Stomach Sleeping-when you sleep on your stomach, you turn your head to the side to breathe.  This puts pressure on the neck and will cause neck pain and headaches.

-Sleep on your side or your back.  When on your back, use a very small pillow or no pillow at all.  When on your side, the pillow height should be high enough that you feel your head is slightly propped up, but not too high that you feel pressure in your neck.  When your pillow height is correct, you won’t need to put a pillow between the knees.

-Always use a firm surface.  Soft mattresses do not support the spine properly and put your body in a contorted position.  There is no need to use any “gadget” mattresses.  A firm mattress with the right pillow height works every time.

If you are having back pain, someone should be working with you on how you are sleeping.  Unfortunately, most medical doctors, chiropractors and therapists do not focus on it and people suffer un-necessarily from pain.

If I ran the world, it would be malpractice to not teach a back pain patient how to sleep.

I once worked with a husband and wife who both had the same back surgery.  No one ever told them that their 20 year old mattress, that was noticeably sagging for the last 5 years, was the cause of their pain.  All the pain suffering and surgery could have been avoided with conservative treatment and a new mattress.

To find out how I treat back pain log on to: www.newbackpainreliefinfo.com

How Long Do I Need To See A Chiropractor?

There are hundreds of chiropractic techniques out there. Some claim to fix serious problems in a single visit. Some chiropractic techniques have treatment programs that take several years…and everything in between. It can be very confusing for the consumer…and that’s an understatement.

I have personally benefited from long term corrective type care, and short term relief care. I have never tried the one visit method…somehow this does not seem possible…but there are patients that swear it has worked for them.

As a chiropractor in Menomonee Falls,Wisconsin…(it’s been 16 years now) I have focused primarily on tailor made treatment programs based on individual needs. Sometimes this is very short term treatment…just a few visits…and sometimes it’s longer term…a few months.

There is no cook book answer…everyone is different.  A patient that was involved in a car accident certainly needs more chiropractic adjustments than a patient that slept funny.

A patient with a herniated disc in the neck will require more adjustments than a patient with a sprain.

At Pain Free Great Posture we consider your age, your over-all level of physical conditioning and health, whether or not there are multiple areas of involvement (eg: neck, mid back, low back), and if the problem is new or chronic.

Managing chiropractic treatment programs can be an art. So, I also learn from experience helping previous patients with similar conditions.

I also modify the treatment as a patient improves. Yes, chiropractic has a fantastic success rate, as well as patient satisfaction rate…but some people do not respond. Together, we have to decide when chiropractic is not working. I refer out at this point for a second opinion.

Anyway…how many visits you need depends on many factors…but in the end, it’s up to you to decide how you wish to use chiropractic. It’s not an all or none treatment. Typically, you will benefit from whatever you do…even if it’s only one or two sessions.

Personally, I use chiropractic adjustments as a component of an over-all health program which includes exercise, good nutrition, plenty of rest, good ergonomics, and lots of water.

The more attention you put on these other components of health, the less you have to lean on chiropractic. But if need be….chiropractic can pull a heavy load for you…naturally!

Dr. Paul Kramer owns Pain Free Great Posture in Menomonee Falls, WI.  To schedule an appointment call 262-251-8306.

Low Back Pain: Where Does The Pain Come From?

“Were does the pain come from?” is probably the most common question chiropractors hear, and frequently, the patient is not told the answer to this simple question.  The problem is, the question is not so simple.  This is because there are many structures in the low back that share a common nerve supply and hence, the pain arising from those structures is located in the same area of the back.  For example, the back portion of the disk, the facet capsule and some of the deep muscles in the spine are all innervated by the same nerve and therefore hurt is a similar location. In all honesty, the only way to try to isolate the pain generator is to inject a local anesthetic to block the pain for a short while.  This is like when you go to the dentist and they “numb” your tooth so you don’t feel the pain when they work on it.  After a few hours, you start to feel some “life” coming back to your mouth and soon it regains its full feeling. Of course, no one would consider “numbing” the back just to figure out exactly where the pain is arising as really, it’s not that important.  This is because the chiropractic treatment approach is similar regardless of the exact tissue that is involved.  However, it DOES matter in cases where a nerve root is shooting pain down the leg caused by a herniated disk vs. a localized pain in the back that doesn’t radiate.  Hence, doctors of chiropractic work hard to differentiate these two distinct types of conditions as the treatment is definitely different.

In 1995, the Quebec Task Force recognized the importance of this distinction and recommended all health care providers concentrate on differentiating the nerve root / herniated disk case from what is called “mechanical low back pain.” As noted in the model below, the arrow and pen point to the two most common structures that cause nerve root pain (the herniated disk) and mechanical low back pain (the facet joint).

The facet joint, when sprained / injured, hurts worse when bending backwards and feels good bending forwards.  This is exactly the opposite for the herniated disk where bending backwards helps reduce pain and often reduces the shooting leg pain as well, while bending over even a little can create a sharp stabling pain in the back that may shoot down the leg. Of course, there are variations of this and, to make matters more complicated, BOTH the disk and the facet can generate pain at the same time, so it’s not always this cut and dry.

YOU MAY BE A CANDIDATE FOR NON-DRUG NON-SURGICAL CARE FOR LOW BACK PAIN!  FOR MORE INFORMATION LOG ON TO: www.newbackpainreliefinfo.com

What Really Causes Whiplash?

Whiplash is a non-medical term for a condition that occurs when the neck and head move rapidly forwards and backwards or, sideways, at a speed so fast our neck muscles are unable to stop the movement from happening.  This sudden force results in the normal range of motion being exceeded and causes injury to the soft tissues (muscles, tendons and ligaments) of the neck. Classically, whiplash is associated with car accidents or, motor vehicle collisions (MVCs) but can also be caused by other injuries such as a fall on the ice and banging the head, sports injuries, as well as being assaulted, including “shaken baby syndrome.”

The History Of Whiplash. The term “Whiplash” was first coined in 1928 when pilots were injured by landing airplanes on air craft carriers in the ocean. Their heads were snapped forwards and back as they came to a sudden stop. There are many synonyms for the term “whiplash” including, but not limited to, cervical hyperextension injury, acceleration-deceleration syndrome, cervical sprain (meaning ligament injury) and cervical strain (meaning muscle / tendon injury). In spite of this, the term “whiplash” has continued to be used usually in reference to MVCs.

Why Whiplash Occurs. As noted previously, we cannot voluntarily stop our head from moving beyond the normal range of motion as it takes only about 500 milliseconds for whiplash to occur during a MVC, and we cannot voluntarily contract our neck muscles in less than 800-1000 msec. The confusing part about whiplash is that it can occur in low speed collisions such as 5-10 mph, sometimes more often than at speeds of 20 mph or more.  The reason for this has to do with the vehicle absorbing the energy of the collision. At lower speeds, there is less crushing of the metal (less damage to the vehicle) and therefore, less of the energy from the collision is absorbed.  The energy from the impact is then transferred to the contents inside the vehicle (that is, you)! This is technically called elastic deformity – when there is less damage to the car, more energy is transferred to the contents inside the car.  When metal crushes, energy is absorbed and less energy affects the vehicle’s contents (technically called plastic deformity).  This is exemplified by race cars.  When they crash, they are made to break apart so the contents (the driver) is less jostled by the force of the collision.  Sometimes, all that is left after the collision is the cage surrounding the driver.

Whiplash Symptoms. Symptoms can occur immediately or within minutes to hours after the initial injury.  Also, less injured areas may be overshadowed initially by more seriously injured areas and may only “surface” after the more serious injured areas improve. The most common symptoms include neck pain, headaches, and limited neck movement (stiffness). Neck pain may radiate into the middle back area and/or down an arm.  If arm pain is present, a pinched nerve is a distinct possibility. Also, mild brain injury can occur even when the head is not bumped or hit. These symptoms include difficulty staying on task, losing your place in the middle of thought or sentences and tireness/fatigue.  These symptoms often resolve within 6 weeks with a 40% chance of still hurting after 3 months, and 18% chance after 2 years.  There is no reliable method to predict the outcome. Studies have shown that early mobilization and manipulation results in a better outcome than waiting for weeks or months to seek chiropractic treatment. The best results are found by obtaining prompt chiropractic care.

We realize that you have a choice in where you go for your health care needs and we truly appreciate your consideration in allowing us to help you through that potentially difficult process.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR WHIPLASH! FOR A FREE NO-OBLIGATION CONSULTATION CALL 262-251-8306

“My Neck Is Killing Me!”

When patients present with neck pain, they always ask, “where is the pain coming from?” Of course, this can only be answered after a careful history and thorough evaluation is completed, which is what we do in this office.  Let’s take a closer look at what this involves.

The History: This includes a careful description of how the injury occurred, if there was an injury.  For example, in a slip and fall injury, it makes a difference if the patient fell forwards, sideways, or backwards; if they landed on their knees, hips, buttocks, back or if they hit their head on the ground.  Also, if there was a dazed feeling or loss of consciousness in the process.  If there was a head strike, were there any signs of concussion: fatigue, mental “fog,” headache, difficulty communicating or forming words or sentences.  When there is no specific injury, we will ask if there were perhaps one or more, “mini-“ or “micro-“ injuries that may have occurred sometime within 2-3 days prior to the onset of the neck pain.  The cumulative effect of several small “micro-injuries” can result in a rather significant onset of symptoms several days later.  The next batch of information gathered includes factors that increase and decrease the pain, the type of pain quality (sharp, dull, throb, burn, itch, etc.), pain location – “…put your finger on where it hurts and “does it radiate into the arms or legs, severity (pain level 0-10), and timing such as, “it’s worse for the 1st 30 min. in the morning and then loosens up.” Information regarding past history, family history, medical history (surgeries, medications), social history, habits (caffeine, tobacco, alcohol, etc.), and a systems review (heart, lungs, stomach, nervous system, etc.).

The Physical Exam: This includes vital signs (blood pressure, etc), observation – the way the head is positioned (forwards, to the side, rotated, etc.); palpation – touch/feel for muscle spasm, trigger points, spinal vertebra position and motion; range of motion, orthopedic and neurological tests. The exam procedure may also include x-ray, depending on each case.

The Diagnosis: This is determined after taking all your information and “…putting the puzzle pieces together” to determine what is causing your pain.

The Treatment: Chiropractic spinal manipulation (often referred to as “adjustments”) is performed by applying energy or force to the misaligned or fixed vertebra structures by one of many methods depending on the patient’s size, pain level, tolerance, and so on.  The use of physical therapy modalities such as ice,  laser therapy, and/or others, again, depending on your specific situation and needs can also be very helpful.  Similarly, exercises to teach you how to hold your proper posture, to improve flexibility or range of motion, and to strengthen the muscles that are weak really help the beneficial effects last longer. A work station/job assessment may also be needed if that appears to be irritating your condition.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR NECK PAIN! FOR A FREE NO-OBLIGATION CONSULTATION CALL 262-251-8306

Fibromyalgia and Sleep

Fibromyalgia (FM) is a condition that has produced more diverse opinions from researchers and physicians than almost any other condition. This has made finding a health care provider who is willing to manage the FM patient very challenging. Similarly, patient perceptions vary widely from those who strive to live a normal life despite their symptoms vs. those who are unable to cope and “give in” to the disorder. FM occurs in about 2% of the population with the majority of sufferers being women.  Common symptoms include muscle aches, joint pain, sleep disturbance and widespread body tender points or areas. The term “fibrositis” was first reported in 1904 to describe patients with these symptoms with many names being used including myositis, myalgia, fibrosis, myofibrositis, psychogenic rheumatism, and probably others!  Not until the mid 1970’s did the term “fibromyalgia” become the accepted term, getting rid of the “-itis” suffix which means “inflammation” and adopting the “-algia” suffix, which means condition or pain. In the 1990s, the American College of Rheumatology published distinct criteria for diagnosing FM requiring 11 of 18 tender points to be identified on examination, but this too has been criticized with new recommendations to accept widespread pain, sleep disturbance, and long-term or chronic symptoms as being appropriate to establish the diagnosis.  Most recently, a central nervous system (CNS) origin rather than a localized inflammatory condition is now the current accepted area of the body that is the focus of cause and treatment.

Sleep or, the inability to get to deep sleep (which takes 3-4 hours of continuous sleep), has been identified as a major symptom of FM. Similarly, many of the symptoms of poor sleep coincide with the symptoms of FM such as fatigue, poor concentration, irritability, and diffuse pain.  While certain medications and herbal remedies have been focused on and discussed, little has been reported on the changes the patient can make to facilitate sleep. The first order of business to help the sleep pattern is to make sure there are no underlying conditions such as sleep apnea or thyroid disease. Second, what is the FM patient’s sleep habit(s) or routine? This includes the time they go to sleep, the time prior to falling asleep once in bed, how many times do they wake up at night and the length of time to fall back asleep, how rested do they feel in the morning and how long does it take “to wake up” and what has to be done – coffee, meds, etc., to feel “awake.” Third, identify other reasons for waking – pets in bed, a snoring partner, babies/kids or elderly care, and/or working swing or night shifts.  The “treatment” of the FM patient for sleep disturbance includes discouraging daytime long naps – short naps are OK limited to 30 minutes max and at least 8 hours before bedtime.  Here’s a summary list of recommendations:

1. Reduce room distractions (no pets, no TV);
2. Comfortable sleeping temperature and noise level – consider a white noise or “sound machine;”
3. Establish a bedtime and awakening time based on the number of hours that it “usually” takes for that person to feel “rested;”
4. Start a “wind-down” 60-90 min. before bedtime – reading, writing – to relax and “let go” of the day’s events;
5. Avoid stimulating books or movies before bedtime;
6. Writing down cares or worries of the day in a journal 45-60 minutes before bedtime;
7. Avoid next day planning during the “wind-down” time period;
8. Perform deep breathing exercises at bedtime;
9. Avoid caffeine, nicotine, and alcohol pre-bedtime;
10. Limit exercise after 3 hrs before bedtime;
11. Avoid longer than 30 min. naps less than 8 hrs pre-bed time;
12. Avoid eating 3 hours before bedtime;
13. Avoid clock watching;
14. If unable to fall asleep within 15-20 minutes, get up and engage in relaxation exercise and return to bed when feeling sleepy;
15. Consider a softer mattress (harder is NOT always better);
16. Some sleep centers advocate at least 40 minutes of strong light exposure after rising in the mornings.

We recognize the importance of including chiropractic in your treatment planning and realize you have a choice of providers. If you, a friend or family member requires care for FM, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR FIBROMYALGIA! FOR MORE INFORMATION LOG ON TO: www.stopyourfibronow.com

Carpal Tunnel Syndrome: Can We Prevent It?

The cause of carpal tunnel syndrome (CTS) is commonly associated with repetitive motions or, working long hours with fast hand movements such as on an assembly line, food packing line, waitress work, or on a computer keyboard and mouse.  However, there are many other possible causes that are less commonly discussed such as pregnancy (caused by generalized water retention), birth control pills (same reason), obesity (same reason), rheumatoid arthritis, hormonal disorders such as diabetes, thyroid disease, and menopause and others.  Of course, if one combines a fast repetitive job with a hormonal disorder, the chances are increased even more for developing CTS. Essentially, any condition that results in an increase in swelling within the carpal tunnel (wrist), will potentially cause CTS so injuries like sprains/strains, fractures, sports injuries, tendonitis and so forth are all potential causes of CTS.  Common symptoms of CTS include: numbness in the 2nd to 4th fingers/hand, pain in the same location, waking up at night needing to shake or “flick” the fingers, driving related numbness, weakness in the grip, difficulty buttoning a shirt, and performing fast repetitive tasks (sewing, crocheting, knitting, cooking) or awkward wrist position tasks (auto mechanic, waitress, musicians, electricians, plumbers, carpenters).

Knowing the cause is important when considering CTS prevention. It is also important to realize the pressure within the carpal tunnel doubles in people without CTS and increases six times in people with CTS when we flex or extend our wrist up or down so sleeping with the wrist straight REALLY HELPS!  This is why patients wear a wrist “cock-up splint” so they don’t accidentally bend their wrist when sleeping.  Night splints like this are also very effective so the swollen tendons and/or other structures in the carpal tunnel can properly “rest.” If a person has a history of CTS that comes and goes, depending on how active they are, wearing a night splint as a prevention approach is appropriate. The use of a wrist splint during the day is often NOT a good idea if it impedes one’s ability to do their normal or needed tasks.  This is because we will irritate the forearm where the splint hits when we flex / extend the wrist and localized bruising can result (sometimes increasing the symptoms of CTS).  Using a splint on long drives can also be helpful as driving frequently irritates CTS.

Here is a list of precautions that may help in reducing the onset, or if present, the frequency/intensity of CTS symptoms:

1. Reduce your force and relax your grip
2. Take frequent breaks
3. Watch your form
4. Improve your posture
5. Keep your hands warm

Though these strategies can help, make sure you properly manage any existing “other problems” listed in the middle of the 1st paragraph.  Also, as discussed in prior Health Updates, chiropractic management offers a great non-surgical solution to the management of CTS and should FIRST be utilized before considering surgery!

YOU MAY BE A CANDIDATE FOR NON-DRUG NON-SURGICAL TREATMENT OF FOR CARPAL TUNNEL SYNDROME!  FOR MORE INFORMATION LOG ON TO; WWW.RELIEFFROMCARPALTUNNEL.COM

Fibromyalgia Facts

Fibromyalgia (FM) is a condition that is characterized by widespread, generalized pain “all over” the body that does not follow any specific anatomical pathway like the course of a nerve, muscle, or blood vessel. It is often diagnosed only after all other conditions have been eliminated by using various testing approaches such as blood tests, x-ray, CT or MRI Scans, and others.  Controversy exists between health care providers (HCP’s) as some believe that FM either doesn’t exist at all or if it does, it’s grossly over diagnosed while others feel most patients have some form or degree of FM.  Because of this common split in beliefs, patients may be treated poorly by those non-believing HCP’s, which often alienates them from seeking further care for FM.

Recent literature suggests FM is disorder of “central pain processing” or, a specific situation where the pain threshold (the point where pain is felt) is reached sooner than what is normal.  Fibromyalgia has been classified into 2 separate groups – primary and secondary FM.  Primary FM is diagnosed when no known cause can be identified while secondary FM is related to a specific cause such as a disease or condition.  Conditions that have been reportedly associated with FM include irritable bowel syndrome (IBS), TMJ (jaw disorders), chronic low back pain, and headaches. There are genetic as well as environmental factors associated with FM.  Researchers have found that there is a strong familial component with 1st degree relatives where an 8 fold greater risk of developing FM compared to the general population exists. These people are also more likely to have one of the other associated conditions previously mentioned (IBS, TMJ, headaches). Environmental factors can lead to FM in 5-10% of the cases. Some of these include physical trauma such as car accidents, following infections such as parvovirus, Epstein-Barr virus, and Lyme disease. Psychological stress, hormonal alterations such as hypothyroid, drug side effects, vaccination reactions and certain catastrophic events such as war are included in the “environmental factors” category. Gender differences include woman being 2-3 times more likely to suffer from FM than men.

So, what are the treatment options for FM? Typically, if you go to a medical doctor, you can expect various forms of drug therapy – possibilities include anti-depressants, anti-anxiety meds, and sleep aids but with these, watch out for grogginess, side effects and some habit forming/dependency problems. Pain killers or analgesics – opioides are NOT appropriate but often prescribed and narcotics can also be habit forming. Tylenol is perhaps the safest but is not very effective.  Anti-inflammatory include aspirin, ibuprofen but watch for stomach irritation and blood thinning problems. Dr. Christopher Morris, MD reports that drug treatments for FM have, “…very limited success in providing significant improvement in most patients.”  He recommends behavior modification for sleep improvement, exercise (walking, water exercises, strength training, yoga, tai chi, Qi Gong), as well as cognitive behavioral therapy, massage therapy, chiropractic, acupuncture, biofeedback, hypnosis, and dietary modification.  Examples of dietary changes include avoiding foods with certain additives including MSG (monosodium glutamate) and aspartame where in one study, “complete resolution” of FM symptoms was reported.

Patients with FM NEED a “quarterback” to guide them in their management of FM and chiropractic is the PERFECT choice as many of these holistic approaches are utilized or can be coordinated through our office.

We recognize the importance of including chiropractic in your treatment planning and realize you have a choice of providers. If you, a friend or family member requires care for FM, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR FIBROMYALGIA! FOR MORE INFORMATION LOG ON TO: WWW.STOPYOURFIBRONOW.COM

Dizziness and Balance Disorders-Is There a Link to Neck Injury?

Dizziness and loss of balance are a common reason people go to see their medical doctor.  It can be caused by a number of different conditions.  Inner ear infections, tumors, allergies and reactions to medications are all common causes.  But are there other causes ?  Maybe something your doctors might not know about ?

An article appearing in a Germen medical journal, confirms that injuries to the neck can sometimes cause dizziness and balance disorders.  It states:

“After cervical sprain, not only pain and neuropsychological disturbances may occur, but also the following sequelae: cervical dystonia, and torticollis, dizziness, hearing loss for low frequencies, dysphonia and globus.”[Globus is a sensation of something stuck or of a lump or tightness in the throat.]

They recommend spinal manipulation as treatment for these problems.  The article goes on to say: “Except for dystonia the symptoms often respond to manipulation of a blocked articulation between occiput and atlas or axis and the third cervical vertebra.”

If you are suffering from dizziness or a balance disorder, and your doctor hasn’t found the cause, you may want to be checked for a neck problem.  A chiropractor is your best source for this type of treatment.  Make sure your doctor has experience in treating these problems and can screen you for these specific neck issues prior to initiating treatment.

For more information on how we treat dizziness and balance disorders log on to: www.stopvertigonow.com

Information for this article was taken from:
Whiplash, Hearing Loss, and Upper Cervical Manipulation [“Little known sequelae of sprains of the cervicalspine”]
Schweiz Rundsch Med Prax.
[This is a German journal, and the article is in German. The abstract is also in English]
December 2, 1999
88(49):2021-4.
Kaeser HE, Ettlin T.

What is Spinal Stenosis?

Spinal Stenosis means narrowing of the spinal canal.  Narrowing of the spinal canal can cause many different symptoms.  These symptoms include, low back pain, neck pain, pain in the arms and legs, numbness in the arms and legs, muscle cramping and weakness.  These symptoms come from a common cause, so it is helpful to understand why they happen.

The spine contains the spinal cord.  The spinal cord is made of soft nerve tissue.  The nerve tissue sends messages from the brain out to the body and from the body to the brain.  When the spinal canal narrows, it can compress the spinal cord.  When the cord is compressed, the messages going back and forth from the brain and body get altered.  This causes pain, weakness and numbness in the affected area.

The next logical question is, “what can be done about it ?”  From a medical standpoint, surgery is recommended to open up the spinal canal.  Usually a piece of a spinal bone or spinal disc is removed in order to create more space for the spinal cord and nerve tissue.  It sounds easy, but these procedures do have serious risks and have a low success rate.

The latest research on spinal surgery is saying that it should only be attempted after six months of conservative (non-surgical) treatment is done.  If the conservative treatment doesn’t help, then surgery can be attempted.

Chiropractic care can be very helpful for spinal stenosis cases.  You see, part of the problem in spinal stenosis patients is that their spinal alignment causes the spinal cord to be stretched. In areas where the canal is narrowed, this creates more pressure on the cord.  Re-aligning the spine takes the stretch off the cord and allows it to move freely in narrowed areas of the spine.  Removing the stretch relieves a lot of the symptoms and can allow the patient to avoid surgery.

For more information on non-surgical, non-grug solutions for spinal stenosis, log on to: www.newbackpainreliefinfo.com