Back pain comes in many forms and behaves quite differently from person to person. Treatments can vary from manual therapy to psychological. As a Denver chiropractor, my job is to figure out why a person is having back pain and figure out the best approach for that particular person. Each problem with the spine may require a unique approach, depending on the cause, which in some cases may be due to a vitamin D deficiency.
When treating a particular person, I believe a holistic approach is best suited for the most favorable outcomes. This approach must take into account all health related factors, including dietary and supplementation. Spinal related pain can come from a multitude of issues, further necessitating a holistic approach, these can include; long term muscles imbalances, degenerative joints, scoliosis, trauma, excessive regular postural stress, genetic factors, poor movement patterns, excessive phone and computer use, dietary choices, and as it shows in the literature, is related to Vitamin D deficiency (1,2,3,4)
Back pain is currently an epidemic, and the treatment of it is not so simple and straight forward. Attacking back pain from my perspective should encompass the possibility of a Vitamin D deficiency. The “sunshine” vitamin is lacking in most people, and in part is determined by your ethnic origin and lifestyle. Most people are stuck indoors during the prime hours of sun exposure needed to make Vitamin D. Another large factor is that when people are outside that they cover themselves in sunscreen, thus preventing the bodies manufacture of Vitamin D. Estimates (5) range from 41.6 % to 82.1% of people are deficient in Vitamin D, and some studies have much higher numbers of people being deficient or insufficient.
The best way to determine if your Vitamin D serum levels are low is to have a blood test. This is an inexpensive test and can help determine how much supplementation is needed. Supplementation has been shown to decrease and in some cases completely alleviate back pain (6).
1. Spine (Phila Pa 1976). 2003 Jan 15;28(2):177-9.
2. Scand J Prim Health Care. 2011 Mar; 29(1): 4–5.
3. BMJ. 2005 Jul 9; 331(7508): 109.
4. Curr Rheumatol Rev. 2013;9(1):63-7.
5. Nutr Res. 2011 Jan;31(1):48-54. doi: 10.1016/j.nutres.2010.12.001.
6. June 2008 issue of the journal Pain and Treatment Topics.
Trent Artichoker MS, DC
Doctor of Chiropractic
Denver Chiropractic, LLC
3890 Federal Blvd Unit 1
Denver, CO 80211
I suppose if this were true, chiropractors, physical therapists, orthopedists, and other professionals that deal with the back wouldn’t have many patients to treat. I’ve heard highly respected doctors repeat this myth that back will go away on its own in six weeks, but the reality of the situation is the exact opposite. Most back pain will not go away on its own. In fact, most likely it will not go away on its own, and if it does, it’s going to come back, possibly worse.
This perspective of back pain going away in six weeks was started from a study in the 1990’s that surveyed medical doctors and how long it took their patients to get over acute back pain. The problem was the design in the study, and therefore inaccurate data, which led to flawed conclusions. Back pain is very prevalent, with lifetime prevalence in a community estimated to be between 50 – 85% (1).
If back pain went away in 6 weeks, then why is it the second most frequent cause of worker absenteeism, and the most costly ailment of working age adults in the United States? It is also the 3rd most commonly reported symptom. Don’t make the mistake that back pain will go away on its own. It perhaps might, but most likely it will come back, as the best predictor of future back pain is past back pain. The next episode may be worse, and will probably last longer.
As a Denver chiropractor, who treats back pain every day, it is much more difficult to fix a person’s back when they have had the problem for a long time. Back pain could be the sign of something much more serious, so getting it evaluated is the best and smartest action you could take. Suni (2) found that recurrence rates are high, ranging from 60-86% in the first year. Early intervention is key to help prevent chronic low back pain.
A study by Hestbaek (3), reviewed 36 longitudinal studies and found no evidence to support the claim that 80-90% of low back pain patients would be pain free in a month.
There are studies after studies that are recent that show that low back pain just does not go away in 4-6 weeks. I have seen first hand that most cases of back pain are recurrent, and most likely to come back much worse. If you are having back pain in Denver, I would love to help make you feel better. Please call for a consult or appointment.
Dr. Trent Artichoker MS, DC
Denver Chiropractic, LLC
3890 Federal Blvd Unit 1
Denver, CO 80211
- Papageorgiou AC, Croft PR, Ferry S, et al. Estimating the prevalence of low back pain in the general population: Evidence from theSouth Manchesterback pain survey. Spine 1995;20:1889-1884.
- Suni J, PT, PhD, Rinne M, PT, MSci, Natri A, MD, DScik et al. Control of the lumbar neutral zone decreases low back pain and improves self-evaluated work ability: a 12 month randomized controlled study. Spine 2006;31:E611-20.
- Hestbaek L. et al. Low Back Pain: What is the long term course? A review of studies of general population. Euro Spine Journal, 2003; 12: 149-65.
Author: Dr. Trent Artichoker
The spine has over 100 joints that allow it to move and function freely. The high mobility that the spine gives us, can also mean that problems arise because of the extreme complexity of the structure and function of spine. I am one of the chiropractors in Denver that concentrate on spine and pelvis problems.
Chiropractors in Denver provide thorough exams for the spine and pelvis
It is paramount that you see a spine specialist, such as a Denver chiropractor to examine your spine. Chiropractors are specialists when it comes to the spine. The chiropractic specialist will conduct a very thorough examination of your spinal related pain complaint.
A typical examination will look something like this:
1. Paperwork – Documenting main complaint and symptoms, with pain diagram and consent forms, and office policies signed.
2. Paperwork – Family history, past medical history, current medications, past experience with chiropractors.
3. Consult – More thorough discussion of location of pain, what the pain feels like, what makes it worse, what makes it better, how it was injured, date it was injured, prior injuries to the area, prior imaging done, getting worse or getting better, how severe the pain is at different times, associated symptoms, neurological complaints, and other info such as medications, recent illnesses or fevers, sleep patterns, current exercise, alcohol or tobacco use, and present diet.
4. Examination – Possible imaging or referral may need to be done. Observation of posture, standing active range of motion, deep tendon reflexes, motor/muscle testing, orthopedic testing (big category), pulses, blood pressure, neurological exams, possible heart/lung/abdomen exams.
5. Discussion of exam findings – discuss options, treatment recommendation, possible side effects from therapy
Possible Diagnosis from Examinations
This can be a very big category, as one condition is usually present with other conditions. There are thousands of diagnosis’s that doctors use, and they are based on the International Classification of Diseases. Here is a short list of possible problems that can show with an examination by chiropractors in Denver.
- Sacroiliac Syndrome
- Lumbar Strain/Sprain
- Lumbar Facet Syndrome
- Lumbar Instability
- Lumbar Disc Herniation
- Lumbar Stenosis
- Cauda Equina Syndrome
- Lumbar DJD
- Leg Length Inequality
- Vertebral Epipysitis
- Costosternal Syndrome
- Postural Syndrome
- Thoracic Outlet Syndrome
Author: Dr. Trent Artichoker
From Dr.Shaw’s Newsletter?
Every doctor has been challenged by patients that have spinal degenerative changes. These “normal” age related findings are usually discovered when a patient presents to the physicians office with complaints of spine pain and radiographs are ordered. The results come back with the diagnosis of spondylosis, arthropathy, degenerative disc disease, degenerative joint disease, etc and immediately the uninformed doctor assumes that the underlying cause for the pain is the degenerative process…a process which can take years to develop and has never been directly associated with spine pain as the primary causative factor. The March 2010 issue of the prestigious journal SPINE contained a study addressing exactly this issue and helps us to better understand that which most of us already know in the orthopedic and spine related professions.
This study looked at a subset of 187 participants that were chosen from the 3,529 participants enrolled in the Framingham Heart Study who underwent CT scan to assess aortic calcification. The study was designed to look at the prevalence of back pain in the population and then at the relationship between lower back pain and spinal degenerative changes. They looked for degenerative spinal changes in the population and related it to the existence of lower back pain. 104 men and 83 women, with a mean age of 52.6 years, participated in the study. There was a high prevalence of intervertebral disc narrowing (degenerative disc disease) (63.9%), facet joint osteoarthritis (facet arthropathy) (64.5%), and spondylolysis (degenerative joint disease) (11.5%) in the studied sample. Only spinal stenosis showed statistically significant association with LBP. All other degenerative processes were no more prevalent with back pain than people with otherwise healthy spines.
The authors concluded that “Degenerative features of the lumbar spine were extremely prevalent in this community-based sample. The only degenerative feature associated with self-reported LBP was spinal stenosis. Other degenerative features appear to be unassociated with LBP”.
While this is not the first study to report this finding it is the most recent and because it comes from a very well respected journal it should carry some weight. Some will argue that the study only looked at the lumbar spine for lower back pain and therefore did not address the cervical spine. While this is true, and the cervical spine is a completely different structure, much of this can be extrapolated to the entire axial spine and even extremity joints. Spinal degeneration alone is generally benign and usually an incidental finding. However, there are some known facts about the degenerative joints that must be considered when discussing causation, severity of injury and prognosis,
Degenerative joints are associated with hypertrophic spur formation. This spur formation is usually the result of some degree of joint laxity. This laxity alters the normal mechanics of the joints. In the spine the laxity commonly originates from loss of disc height and/or over use. It also comes from normal aging, postural stresses, and traumatic insult. The development of arthrosis and spondylosis is a protective measure by the body to stabilize the spine and protect the delicate neurologic structure that the spine protects. The stabilization resulting from the process results in connective tissues and joints that are less elastic and more vulnerable to injury than the healthy tissues that have the normal viscoelastic and biological properties. Although not necessarily pain productive on its own, these stabilizing connective tissues are more vulnerable to injury as a result of their lowered capacity to withstand rapid stretch, shear, compression, traction and rotation. Therefore, a sneeze, a cough, a fall or a motor vehicle collision in a person with a degenerative spine will have a greater probability of sustaining a more serious injury than a healthy person, even if both were asymptomatic beforehand.
Obviously, the greater injury potential and the existence of poor quality connective tissue lead to a longer healing process and offer a less optimistic prognosis. People with pre-existing degenerative changes that are otherwise pain free will require longer period of care and have lesser probability to reach the same level of outcome as a healthy person. In the absence of forces that overcome the supportive spinal tissues these people have no greater likelihood of developing pain in the spine than do people without degeneration (unless they develop degenerative central stenosis).
Professionals working with traumatically injured people need to understand these principles. That means health care professionals as well as the attorneys that represent their legal considerations. Hopefully, the knowledge of these facts will result in better outcomes for their health… and their case.
Author: Dr. Trent Artichoker
BACKGROUND CONTEXT: Evidence-based clinical practice guidelines (CPGs) for the management of patients with acute mechanical low back pain (AM-LBP) have been defined on an international scale. Multicenter clinical trials have demonstrated that most AM-LBP patients do not receive CPG-based treatments. To date, the value of implementing full and exclusively CPG-based treatment remains unclear.
PURPOSE: To determine if full CPGs-based study care (SC) results in greater improvement in functional outcomes than family physician-directed usual care (UC) in the treatment of AM-LBP.
STUDY DESIGN/SETTING: A two-arm, parallel design, prospective, randomized controlled clinical trial using blinded outcome assessment. Treatment was administered in a hospital-based spine program outpatient clinic.
PATIENT SAMPLE: Inclusion criteria included patients aged 19 to 59 years with Quebec Task Force Categories 1 and 2 AM-LBP of 2 to 4 weeks’ duration. Exclusion criteria included “red flag” conditions and comorbidities contraindicating chiropractic spinal manipulative therapy (CSMT).
OUTCOME MEASURES: Primary outcome: improvement from baseline in Roland-Morris Disability Questionnaire (RDQ) scores at 16 weeks. Secondary outcomes: improvements in RDQ scores at 8 and 24 weeks; and in Short Form-36 (SF-36) bodily pain (BP) and physical functioning (PF) scale scores at 8, 16, and 24 weeks.
METHODS: Patients were assessed by a spine physician, then randomized to SC (reassurance and avoidance of passive treatments, acetaminophen, 4 weeks of lumbar CSMT, and return to work within 8 weeks), or family physician-directed UC, the components of which were recorded.
RESULTS: Ninety-two patients were recruited, with 36 SC and 35 UC patients completing all follow-up visits. Baseline prognostic variables were evenly distributed between groups. The primary outcome, the unadjusted mean improvement in RDQ scores, was significantly greater in the SC group than in the UC group (p=.003). Regarding unadjusted mean changes in secondary outcomes, improvements in RDQ scores were also greater in the SC group at other time points, particularly at 24 weeks (p=.004). Similarly, improvements in SF-36 PF scores favored the SC group at all time points; however, these differences were not statistically significant. Improvements in SF-36 BP scores were similar between groups. In repeated-measures analyses, global adjusted mean improvement was significantly greater in the SC group in terms of RDQ (p=.0002), nearly significantly greater in terms of SF-36 PF (p=.08), but similar between groups in terms of SF-36 BP (p=.27).
CONCLUSIONS: This is the first reported randomized controlled trial comparing full CPG-based treatment, including spinal manipulative therapy administered by chiropractors, to family physician-directed UC in the treatment of patients with AM-LBP. Compared to family physician-directed UC, full CPG-based treatment including CSMT is associated with significantly greater improvement in condition-specific functioning.
Objectives: To compare occurrence of repeated disability episodes across types of health care providers who treat claimants with new episodes of work-related low back pain (LBP).
Method: A total of 894 cases followed 1 year using workers’ compensation claims data. Provider types were defined for the initial episode of disability and subsequent episode of health maintenance care.
Results: Controlling for demographics and severity, the hazard ratio [HR] of disability recurrence for patients of physical therapists (HR = 2.0; 95% confidence interval [CI] = 1.0 to 3.9) or physicians (HR = 1.6; 95% CI = 0.9 to 6.2) was higher than that of chiropractor (referent, HR = 1.0), which was similar to that of the patients non-treated after return to work (HR = 1.2; 95% CI = 0.4 to 3.8).
Conclusions: In work-related nonspecific LBP, the use of health maintenance care provided by physical therapist or physician services was associated with a higher disability recurrence than in chiropractic services or no treatment.
Journal of Occupational & Environmental Medicine:
April 2011 – Volume 53 – Issue 4 – p 396–404
I think we like to have internal civil wars between our brains and our bodies. Even though they are intimately connected, I think the brain has a superiority complex. I see this battle when it comes to the desk jockey. This is the person who sits all day, every day, and that is how they make their money, by sitting and doing computer-desk work. I realize that this is unavoidable and can be very taxing on the body, but if I had a choice, I think I would rather be a stunt man and take my injuries one by one vs. slowly becoming a mongoloid like cave dweller chained to one position. Heck, even prisoners have more freedom than desk jockeys.
This internal war starts with the body revolting, sending messages to the brain to move, squirm, readjust, get up, take a break, stretch, and so on. The mind recognizes the bodies check engine signals, but overcomes them with rationalization. The mind tells the body to take it, and keep on sitting. The mind realizes the importance of surviving, but also keeps in minds that whole must keep working to earn that oh so precious dollar.
At one point the mind might give a little and do more exercise outside of the working hours, but sometimes this is not enough. With some minds, there is recognition of the importance of the work space ergonomics. The chair is always recognized as very important. Here comes the problem. Some minds will start to think that sitting on a huge ball will help keep them upright for endless hours that their job demands. They think that the ball will magically strengthen their core to a point that they can sit forever without fatigue, like some sort of superhero. Short periods of large ball sitting are okay, but endless sitting will short circuit the system. This is when they find me, a Denver chiropractor, and the one they seek for help. Their brain has recognized its own inability to protect itself, its civil war has lost, and the body is battered and can no longer cooperate.
Well, I want to help all of the professional sitters sit better, to be able to sit longer, and sit without fatigue. I recently have had more than a normal amount of people come to the clinic and tell me they have neck and back pain, and they want me to fix them. When there are no obvious injuries, I have to play a bit of Sherlock Holmes. I usually suspect with a high degree, the job category, especially if they sit all day. When it comes out that they are using a large ball to sit on, I have to pull my teacher hat out.
Most people like to think they have good ergonomics. This of course is natural for the professional sitter. Let me tell you why sitting on a ball all day is wreaking havoc on your body.
Sitting requires using your muscles to some degree. It you are using the same set of muscles to sit for extended time, that is, more than 30 minutes, your muscles will fatigue. Think of holding a bowling ball like a waiter holds a tray. With the weight directly over the hand and weight, it is not so bad, because it requires a high degree of balancing versus strength. This is the concept that the ball sitters are using, but it is flawed. For a short time this version of sitting will work, but certain muscle groups will fatigue at one point.
The goal of sitting well is to shift the strain on muscles, and not have one group of muscle bearing the burden. This is what happens with ball sitting, one group of muscles are doing all the work while the rest are sitting back and taking a nice vacation.
Shifting the load on muscle groups to different muscle groups is the key to prevent one set muscles from fatiguing, and using a ball to do this is impossible. With a ball, you cannot rest your arms; your arms are endlessly hovering to type and mouse. The muscles that do this are what many people call their shoulders. This is the Upper Trapezious, Levator scapulae, Rhomboids, Splenius Capitus, and many others that share connections with the neck and back. The muscles in your low back share the same burden, they never get to rest, because they are always engaged.
By using these muscles continuously, you will put a tremendous amount of strain on the upper back, low back, and the neck. Using a ball also prevents you from resting your neck. Having a chair where you can tilt back and rest your noggin, and rest your arms while you take or make a call is just what the body wants, a shift in muscle group use.
Prolonged use of any muscle will put the check engine light on. Using over the counter non steroidal, like Ibuneverworkuprofin, or Tyandnotfixanol will never cure your problem. You are just putting tape over the check engine light. After a while of body revolt, your joints will be out of alignment, trigger points and muscle adhesions will develop. This will show as low back pain, upper back pain, shoulder pain, neck pain, and headaches.
If you keep repeating the pattern of using your ball to sit on while you are developing neck and back pain, your problem will become much harder, longer, and much costlier to fix than buying a good ergonomic chair. Do your body a favor and get rid of that six dollar Walmart ball that you are using.
Next time you sit on your ball, become aware of what muscles you are actively using. Next, think of how long those same muscles can keep contracted without fatigue. Listen to your body, it will tell you what it needs, as long […]
Cold Laser Treatment
We are still far away from hover boards, and time machines, but our advances in laser therapy to treat pain and injuries has come a long way. Our chiropractic clinic in Denver has the latest advancement in laser therapy. We utilize the MR4 Super Pulsed Laser.
This one piece of equipment utilizes a combination of 5 different therapies. It includes in one treatment, 1. A super pulsed laser, 2. Pulsed broad band infrared, 3. Pulsed red light, 4. Static Magnetic field, and 5. Electric stimulation. This is a very powerful combination, that is used to treat over 300 different conditions.
One of the coolest advances with cold laser equipment, is that it has TARGET technology. Which stands for Treatment Area Recognition and Guidance Enchanced Technology. We use the device to scan an area, and it recognizes areas of increased impedence. This is the area we treat. We pull the trigger, and therapy starts, once the impedence improves, the device stops therapy.
One of the big advantages of this type of cold laser therapy is how deep the laser can penetrate. The laser is able to reach 5 inches of tissue depth. This is amazing, and unique in that other modalities cannot achieve this reach.
Clinical effects of the 5 therapies include:
1. activation of RNA and DNA synthesis
2. increased cell metabolism in the form of ATP
3. improvement of microcirculation
4. reinforcement of collagen synthesis and reduced fibrous tissue formation
5. anti-inflammatory response
6. edema reduction
7. pain reduction
8. stimulation of T-cell production
9. increased levels of prostaglandin synthesis
10. gentle heating of surface tissue layer
11. acts upon receptors in the skin and reduces pain
12. microcirculation activation
13. stimulates epithelial cell growth and regeneration
14. reinforces laser penetration into target tissues
15. localized pain relief
16. reduction in swelling
Laser therapy can be a perfect adjunct to the visit to the chiropractor. I schedule 15-20 minute appointments that include any combination of services that we provide to ensure the most impact.
Laser therapy has over 4,000 clinical trials world wide to document the effects. It is used in over 3,000 hospitals, and used in over 10,000 private practices. It can be used on just about any part of the body, and it has relatively few contraindications.
Olympic athletes, the special forces, US major league soccer team, NBA & NFL players, National soccer team, and chronic pain sufferers all utilize the MR4 Super Pulsed Laser.
The laser can treat a multitude of conditions such as
1. acute, sub-acute, and chronic pain
2. back pain
3. neck pain
4. carpal tunnel symptoms
5. arthritis pain
7. ligament sprains
9. tennis elbow
10. soft tissue injuries
11. muscle strain
This is just a partial list of conditions that the cold laser treats. It is used to treat over 300 different conditions. Cold laser treatments range from 1 time per week for 5 weeks to 2-3 times per week for 6-15 weeks. The frequency of visits is determined by the magnitude of the condition. Treatment by the laser usually lasts between 5-15 minutes.
Dr. Trent Artichoker MS, DC
Denver Chiropractic, LLC
3890 Federal Blvd Unit 1
Denver, CO 80211