No one really wants to be a worrier. We certainly don't want to visit our chiropractor or family doctor for every ache and pain. But eventually we all experience physical problems and it may be difficult to know what to do about them. Some problems are immediate and serious. If you suddenly experience crushing chest pain and radiating pain down your left arm, possibly with nausea, profuse perspiration, and a feeling of impending doom, you know you have to call "911" immediately, if you can. If you awaken in the middle of the night with an intense, deep, sharp pain in your lower right abdomen, accompanied by vomiting and a fever, you know you need to go to the Emergency Room right away. In these exceptional cases, however, most people know which steps to take. What should you do when your pain is not clear-cut and dramatic, as it is in a heart attack or acute appendicitis? General guidelines are available which may be applicable in many situations.
Overall, pain is a warning signal. But many problems that cause pain take care of themselves. For example, you may twist an ankle on your daily walk. It may hurt to put weight on that ankle and there may even be a bit of swelling, but within two days your ankle is much better. There was initial pain owing to soft tissue injury, possibly involving muscles, tendons, and/or ligaments. However, the injury wasn't so severe that your body's ability to self-heal couldn't manage the situation. In the case of a greater degree of initial pain and more swelling, or if improvement wasn't being obtained within 48 hours, a visit to your chiropractor would be appropriate. In borderline situations involving musculoskeletal pain, whether you choose to seek professional advice depends on your intuition and level of pain tolerance. If you think something is "wrong", regardless of the nature of the injury or the intensity of your pain, you should seek professional assistance.
With some categories of physical problems, making the time to visit your chiropractor is the best course of action.1,2 A single occurrence of low back pain or neck pain could be ignored, especially if the problem goes away in a few days. But repetitive episodes of spinal pain should always be evaluated by your chiropractor. A severe headache should probably lead to a chiropractic examination, especially if you've never before had the type of pain and the intensity of pain that you're currently experiencing. Persistent radiating pain into an arm or leg, accompanied by numbness and tingling, should be evaluated by your chiropractor. Again, if discomfort persists and you can't clearly explain to yourself why you're having the pain that you're having, the best thing to do is to make an appointment to see your doctor, that is, your chiropractor or your family physician. You want to obtain expert information and advice, and you want to receive treatment if needed and instructions on how to care for yourself in the days, weeks, and months ahead.3
Comfort level is a valuable criterion with respect to your overall health and well-being. After considering the general guidelines, people should take the appropriate action that they believe will best serve their welfare.
1Smart KM: Mechanisms-based classifications of musculoskeletal pain. Part 1. Symptoms and signs of central sensitisation in patients with low back (plus/minus leg) pain. Man Ther 17(4):336-344, 2012
2Thornton GM, Hart DA: The interface of mechanical loading and biological variables as they pertain to the development of tendinosis. J Musculoskelet Neuronal Interact 11(2):94-105, 2011
3McCarberg BH, et al: Diagnosis and treatment of low-back pain because of paraspinous muscle spasm: a physician roundtable. Pain Med 12(Suppl 4):S119-S127, 2011
Herniated discs in the lumbar spine are fairly common and having one doesn’t sentence you to a lifetime of back problems. In fact, at least one-third of people over age 30 are found to have one or more herniated discs in the lower back when a magnetic resonance imaging study (MRI) is done for reasons other than back pain. What this means is that lumbar disc herniations represent routine wear-and-tear on the body. Lumbar disc herniations are not a problem in and of themselves.1
Problems of interpretation arise when a person with back pain is found to have a lumbar herniated disc on MRI. The main questions are whether the herniated disc is causing the back pain, whether it’s related to the back pain, or whether it’s an incidental finding (something discovered on examination but which has nothing to do with the present problem).
Your chiropractor is aware that these possibilities exist and will not jump to the conclusion that the disc herniation is the source of the pain. The majority of cases of lower back pain are not clearcut, but one set of circumstances is fairly straightforward. If a patient experiences sudden, severe lower back pain and also has leg pain and/or numbness and tingling that radiates down one leg to below the knee, then a lumbar disc herniation pressing on a spinal nerve is a very likely scenario. In such a case, if an MRI confirms that a lumbar disc has herniated and is actually pressing on a spinal nerve, then your chiropractor will probably reasonably conclude that the disc injury is the cause of both the back pain and leg pain.
But this is an uncommon scenario. Most people with lower back pain do not also have such radiating symptoms. If a person’s back pain is not getting better within a reasonable period of time, then an MRI might be done. If lumbar disc herniations are found, it is very difficult to determine conclusively whether they are related to the back pain. Lower back pain can result from numerous causes, including injuries to the muscles that bend, rotate, and flex and extend the spine. Injuries to tendons that connect these muscles to the bones of the lower back are possible. And injuries to ligaments that hold the lumbar vertebras together can be very painful. Thus, a herniated disc may or may not be contributing to the overall pattern of compromised muscles, tendons, and ligaments.
The bottom line in the majority of cases is being able to treat the person effectively with conservative care. Chiropractic care, combined with appropriate rest and followed, when the time is right, with rehabilitative exercise, is usually all that is required for even acutely severe back pain.2,3 Each aspect of such conservative care - chiropractic care, rest, and rehabilitative exercise - is key to the person’s recovery. A small proportion of cases, in which a herniated disc is actually pressing on a spinal nerve and causing back pain and radiating pain below the knee, may require more than conservative care. Regardless, chiropractic care is the right way to begin care for almost all cases of lower back pain.
1Maus T: Imaging the back pain patient. Phys Med Rehabil Clin North Am 21(4):725-766, 2010
2van Middelkoop M, et al: Exercise therapy for chronic nonspecific low-back pain. Best Pract Res Clin Rheumatol 24(2):193-204, 2010
3Standaert CJ, et al: Comparative effectiveness of exercise, acupuncture, and spinal manipulation for low back pain. Spine 36(21 Suppl):S120-S130, 2011
Not all back problems are created equal. One person may have been working on a home improvement project and injured her back while simultaneously bending and twisting. Another person may have developed back pain as a result of a vehicular collision. Another person may be experiencing back pain as a result of osteoporosis. Yet another person may have a serious illness which causes back pain as a related problem.
Back pain is a problem common to many types of injuries and illnesses. How can you tell the difference - in other words, how can you tell when back pain requires you to take action, such as seeing your chiropractor? A reasonable approach is to use a 48-hour guideline. Your body usually has a powerful ability to heal itself. If your back pain hasn't gone away on its own within 48 hours, then seeking professional assistance is a very good plan.
However, some situations require immediate attention. For example, if you've had an accident, seeing your chiropractor right away is probably the right thing to do. In another scenario, if you begin to experience severe pain without an obvious cause, then seeing your chiropractor right away makes a great deal of sense. Like many things in life, having physical pain requires us to use good judgment. The 48-hour rule-of-thumb applies to most situations, but if you've had an accident or are having an unusual problem, see your chiropractor as soon as possible, today if necessary.
When a person has back pain, it's very important to make sure there are no related problems. Most of the time there aren't, but no one wants to be the exception and it's always better to be safe than sorry. Making your own diagnosis is never a good idea. "Oh, that's been bothering me for months," some people will say. "It's just back pain." Of course, such an approach to one's health violates the 48-hour rule. If the problem really wasn't anything much, it would have gone away within a few days. Something else is going on, and usually the longer a physical problem is left untreated the more difficult it is to deal with. The old expression, "an ounce of prevention is worth a pound of cure" is as true today as it was 100 years ago.
Your chiropractor is an expert in back pain. They know that physical pain happens for a reason.1,2 Their job is to discover that reason, using the tools of history taking, physical examination, biomechanical analysis, and special tests, if necessary, such as x-rays and other imaging methods. Most of the time, the underlying problem is mechanical in nature, involving the spinal joints and associated soft tissues, including the ligaments, muscles, and tendons. Such mechanical problems cause the vast majority of cases of back pain, and are directly addressed by chiropractic care.3 In unusual circumstances, your chiropractor will refer you to another specialist. The important approach in all situations is to seek appropriate care. Your chiropractor's office is the right place to start.
1Bakker EW, et al: Spinal mechanical load as a risk factor for low back pain: a systematic review of prospective cohort studies. Spine 34(8):E281-E293, 2009
2Shambrook J, et al: Clinical presentation of low back pain and association with risk factors according to findings on magnetic resonance imaging. Pain 157(7):1659-1665, 2011
3Wilder DG, et al: Effect of spinal manipulation on sensorimotor functions in back pain patients: study protocol for a randomised controlled trial. Trials 12:161, 2011
Out of the blue, your back starts to hurt. At first, it's just an annoyance. You can live with it. You've had lower back pain before and it went away on its own.
Now it's a few weeks later. You've got a low-grade pain that's not getting any better. You're actually worse, in fact, because your back hurts most of the time.
What to do?
You don't want to run to a doctor. After all, it's just back pain. Everybody has back pain. So you begin to solicit advice from your friends. And, of course, your friends have plenty of advice. "Do these exercises my doctor gave me." "Do these stretches - they worked for me." "Go to yoga class." "I know a great Pilates instructor. She'll get you in shape and your back will stop hurting." "Take vitamins and drink more water." "Meditate."
Your friends mean well and it's all very good advice. But none of it seems to work. Another month goes by and now the pain is increasing. It's even affecting your sleep.
It's time to see a doctor. But which one? For the most part, medical physicians are not experts on back pain. Typical recommendations include rest, moist heat, and anti-inflammatory medication.1,2 But, really, you've done all that. You need more specific advice.
Choices might include doctors of chiropractic, orthopedic surgeons, and physical therapists.
Many orthopedic surgeons are spinal specialists, but what they do is surgery. This would be a last resort, typically, after other treatment options have failed.
Physical therapists are highly skilled practitioners who focus on exercise, rehabilitation, and re-training. They are not primary care providers, and typically patients are referred to physical therapists by family physicians, chiropractors, and orthopedic surgeons.
Doctors of chiropractic are spinal specialists, too, and what chiropractors have to offer is expert conservative therapy.3 Chiropractors treat back-related problems all day, every day, and are the right doctor to see first.
As spinal specialists, chiropractors receive extensive training in evaluating patients with back pain. Chiropractors consider all aspects of the problem, and develop sound treatment plans based on the facts. If a person does not respond as anticipated, their chiropractor has a "Plan B" in place for further evaluation and possible referral.
When choosing a doctor, you're allowed to ask questions and participate in the process. The strategy for follow-up is critically important.
First, if you're improving and doing well, how will can you help keep the problem from recurring? Will your chiropractor prescribe stretches, exercises, and other self-care action steps to help you keep yourself well?
And, what steps will be taken if your problem and pain are not improving? Where might you be referred for further tests and evaluation? Chiropractic treatment is a powerful tool in most cases of back pain. Symptoms should begin to improve quickly. Have your chiropractor outline the "Plan B" if you are, in fact, not getting better.
Your doctor of chiropractic will be able to answer these questions.
1Zuhosky JP, et al: Industrial medicine and acute musculoskeletal rehabilitation. Arch Phys Med Rehabil 88(3 Suppl 1):S34-39, 2007. 2Cayea D, et al: Chronic low back pain in older adults. What physicians know, what they think they know, and what they should be taught. J Am Geriatr Soc 54(11):1772-1777, 2006. 3DeVocht JW: History and overview of theories and methods of chiropractic. Clin Orthop Relat Res 444:243-249, 2006.
It seems that as they get older, many people expect their knees to give out. Osteoarthritis of the knee is, in fact, common in those over age 50 and knee arthroscopy is one of the most frequently done orthopedic surgeries.1 Also, increasing numbers of people are undergoing total knee replacements. The rate has been recently described as "soaring".2
What's going on? Is this mechanical failure people seem to be experiencing in their joints a new phenomenon? Or are more diagnoses being made now owing to the ready availability of CAT scans and MRI units? Are more surgeries being done owing to the abundance (at least in urban areas) of surgeons wanting to perform these procedures?
Regardless, deeper questions point to lifestyle patterns that may predispose a person to developing knee osteoarthritis. A comparison with earlier times may be useful in this context. For example, it's not well-known that people in the Middle Ages - the 11th and 12th centuries - lived into their 80s. They managed to get along without ibuprofen, without arthroscopy, and without major surgical procedures. But we live in the 21st century. What is our problem?
The major difference between the average person living 900 years ago (or even 100 years ago) and us is that most of those people did a variety of physical activities all day long. People plowed fields and chopped down trees. They built fences and did housework. They walked to the market and carried their purchases back home. They were active, frequently intensely active throughout the day, often working 6 days a week. We're just as active and work just as hard. But most of our work and activities involve a seated position. In contrast to our forebears, we sit all day. Compounding the problem, more than 2/3 of adults (in the United States, at least) do no regular exercise.
The result is that joints which were designed to perform heavy physical work are now effectively doing none. Our hips, knee, and ankles were built to support a labor-intensive lifestyle which initially involved hunting and gathering and then (for the majority of Homo sapiens) focused on agriculture. Now these large joints are inactive for most of the day. Everyone knows that a machine left untended will begin to malfunction. Dust and rust accumulate and the machine will break down, usually sooner than later. Our bodies are no different.
Thus for many of us, the short answer is that our knees hurt because we don't use them properly. Of course, some persons have medical conditions such as rheumatoid arthritis that often involve chronic knee pain. But the vast majority of knee problems are due to lack of use. What there is to do is to get active. The good news is that restoring regular vigorous exercise is easy. Walking at a modest pace for thirty minutes, five times a week, is all that it takes. You can do more, but that's a personal choice. Exercise is not a magic solution, but restoring needed activity levels is an important part of the solution to chronic knee pain.3
1Potts A, et al: Practice patterns for arthroscopy of osteoarthritis of the knee in the United States. Am J Sports Med 40(6):1247-1251, 2012
2Leskinen J, et al: The incidence of knee arthroplasty for primary osteoarthritis grows rapidly among baby boomers: A population-based study in Finland. Arthritis Rheum 64(2): 423-428, 2012
3Smith TO, et al: The effectiveness of proprioceptive-based exercise for osteoarthritis of the knee: a systematic review and meta-analysis. Rheumatol Int 2012 Jul 22 [Epub ahead of print]
Mindfulness techniques can assist a person substantially in achieving improved levels of health and well-being. These methods, including meditation and guided imagery, are gaining prominence as more traditional medicine group practices, hospitals, and teaching institutions 1,2 are embracing an integrated approach.
Learning the basics of mindfulness methods is easy and straightforward. Success in applying these techniques requires attention and discipline, and one's capabilities in these areas increase with time and practice.
Guided imagery involves picturing a peaceful, relaxing setting and may incorporate persons, animals, and other living beings in the imagined environment. The purpose of the exercise is to focus and immerse yourself in the quiet and soothing surround. The benefit derives from profoundly shifting one's habitual focus on stress and stressful circumstances onto positive images that help support health and healing.3
To begin, you seat yourself comfortably in a location where you won't be disturbed or distracted by others. You close your eyes, take a few relaxing breaths, and affirm to yourself that you're going to have a positive experience. You start the self-guided imagery session by picturing a favorite place, one that is enriching and uplifting, such as a beach, nature trail, or mountain habitat. The environment does not have to be one with which you have actual experience. The power of self-guided imagery is that your imagination is, in fact, your open-ended guide.
For example, if you're on a beach, you could first focus on the sensation of the warmth of the sun on your skin. Feel how it feels. Really focus on the aliveness that the sun's rays generate throughout your entire being. Picture yourself in your comfortable beach chair and experience the textures and tactile sensations of your casual, colorful beach attire.
After a while, you may choose to walk down to the shoreline. Feel the warmth of the sand on the soles of your feet. Experience the contours of the sand and how your balance has to adjust with each step to match the miniature hills and valleys of the sandy shore. Hear the deep rumble of the ocean and the gentle susurration of the waves. Focus on a sequence of waves. See them rise, crest, and crash on the shore. Experience the ebb and flow of your own heartbeat and your own breath, your personal internal rhythms that align with the rhythms of the ocean shore.
Your self-guided imagery sessions may last for five or ten minutes. You could do these sessions daily or one or two times a week. Essentially, you're telling yourself a wonderful story that you experience in your mind's eye. Your self-guided imagery sessions are filled with beautiful images, sounds, and even music that provide an experience of peace, fulfillment, and happiness. Over time, the results include reduced stress, greater awareness, a heightened sense of presence and being-in-the-world, and improved health.
Regular Chiropractic Care and Mindfulness Techniques
Whether you're engaged in meditation, guided imagery, awareness practice, or breathing exercises, musculoskeletal aches, pains, soreness, and tension can interfere with what you're attempting to accomplish. Unless you're an advanced mindfulness student, these physical ailments can easily become the focus of attention and drain energy from your healing process.
Regular chiropractic care can provide effective solutions to these daily musculoskeletal stresses and strains. By detecting and correcting sources of nerve interference and spinal biomechanical dysfunction, regular chiropractic care restores optimal functioning and structural integrity to your body's skeletal and muscular framework. As a result, you're able to breathe more easily and fully, get more oxygen into your system, and deliver more healing nutrients to the regions of your body that need them the most. In this way, by helping to resolve and heal stumbling blocks to your concentration, focus, and attention, regular chiropractic care provides great benefit to every mindfulness practice.
Zech N, et al: Efficacy, acceptability and safety of guided imagery/hypnosis in fibromyalgia - A systematic review and meta-analysis of randomized controlled trials. Eur J Pain 21(2):217-227, 2017
Nooner AK, et al: Using Relaxation and Guided Imagery to Address Pain, Fatigue, and Sleep Disturbances: A Pilot Study. Clin J Oncol Nurs 20(5):547-552, 2016
Charalambous A, et al: Guided Imagery And Progressive Muscle Relaxation as a Cluster of Symptoms Management Intervention in Patients Receiving Chemotherapy: A Randomized Control Trial. PLoS One 2016 Jun 24;11(6):e0156911. doi: 10.1371/journal.pone.0156911. eCollection 2016
Relaxed breathing, also called diaphragmatic breathing, can help you relieve stress.
Have you ever noticed how you breathe when you're stressed? Stress typically causes rapid, shallow breathing. This kind of breathing sustains other aspects of the stress response, such as rapid heart rate and perspiration. If you can get control of your breathing, the spiraling effects of acute stress will automatically become less intense. Relaxed breathing, also called diaphragmatic breathing, can help you relieve stress.
Practice this basic technique twice daily, and whenever you feel tense. Follow these steps:
Inhale. With your mouth closed and your shoulders relaxed, inhale as slowly and deeply as you can to the count of six. As you do that, push your stomach out. Allow the air to fill your diaphragm.
Hold. Keep the air in your lungs as you slowly count to four.
Exhale. Release the air through your mouth as you slowly count to six.
Repeat. Complete the inhale-hold-exhale cycle three to five times.
To find your mantra you can go to a peaceful place, sit in a comfortable position, and focus on a word or phrase that you find relaxing.
Autogenic means something that comes from within you. During this type of relaxation, you repeat words or suggestions in your mind to help you relax and reduce the tension in your muscles. Find a peaceful place where you'll be free of interruptions. Then follow these steps:
• Choose a focus word, phrase, or image you find relaxing. Examples of words or phrases include "peace," or "I am peaceful." This is called a mantra.
• Sit quietly in a comfortable position.
• Close your eyes.
• Relax your muscles, starting at your head, working down your body to your feet.
• Breathe slowly and naturally, focusing on your word, phrase, or image.
• Continue for 10 to 20 minutes. If your mind wanders, that's okay. Gently return your focus to your breathing and the word, phrase, or image you selected.
• After time is up, sit quietly for a few minutes with your eyes closed. Open your eyes and sit in silence for a few more minutes.
Relationships are important for good emotional health. Numerous studies have shown that people who have close friends and intimate relationships are healthier, happier, and live longer. In fact, the simple act of petting a dog, holding a child, or seeing someone you love causes a decrease in stress hormones in the blood, decreases blood pressure, and calms the mind. So, if you want to be healthy, stay connected to others.
As the author Dr. Tedd Koren says "Emotional health is also dependent on being connected - to yourself and others. The more connected you are to yourself the more you can connect with others and the more fulfilling your connections (relationships). The more relationships in your life the more happiness, joy, hope, optimism and vitality you will have; the healthier and longer you will live and the quicker you will recover from physical and emotional traumas and illness."
To rest your mind and take a visual journey to a peaceful place, consider listening to soothing sounds.
If you have about ten minutes and a quiet room, you can take a mental vacation almost anytime with soothing sounds. Consider music such as relaxation CDs or internet radio stations to help you unwind. To rest your mind and take a visual journey to a peaceful place, consider the following:
Spoken word. These CDs use spoken suggestions to guide your meditation, educate you on stress reduction or take you on an imaginary visual journey to a peaceful place.
Soothing music or nature sounds. Music has the power to affect your thoughts and feelings. Soft, soothing music can help you relax and lower your stress level.
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