Are there risk factors for back pain? And, if there are, what can I do to keep myself healthy and well? Your chiropractor can help answer these questions and more.

One primary risk factor relates to exercise. Everyone has heard, "if you don't use it, you lose it". If you're not exercising regularly, your back muscles are deconditioned and much more susceptible to injury - the strains and sprains we're accustomed to calling "back pain".

Muscles get stronger when they're required to do work. Also exercise helps "train" the soft tissues around a joint - the ligaments and tendons - these supporting structures "learn" how to withstand mechanical stresses and loads without becoming injured. Basically, when you exercise - when you do any kind of exercise - your body gets "smarter" and you're less likely to get those annoying back problems.¹

A related risk factor is weak abdominal muscles. When you were a kid, at some point one of your gym teachers probably told you to "suck in your stomach". Actually, it turns out that was pretty good advice. Your abdominal muscles support the muscles of your lower back. If your abdominals are weak or if you're not using them - letting them hang out and droop instead of keeping them activated - your body weight has to be held up by the muscles of your lower back. They're not designed to do that - they're designed to move your spine around. And eventually, these lower back muscles will give way under the excess strain. The result is a very painful lower back injury.

There are many easy-to-do exercises for your abdominal muscles. The key is to actually do them - and do them after you're finished doing the rest of whatever exercises you've scheduled for that day. How often? Three times a week is plenty. Abdominal routines are quick - no more than 10 minutes. And, remember to use your abdominal muscles throughout the day. Imagine your abdominals are being pulled in and lifted up. This is not a "tightening" - your thought should be "activate". Your body will know what to do, once you've started adding consistent abdominal training to your exercise routine.

Risk factors for back pain may also be found in your personal and family medical history.^2,3 During your initial visit your chiropractor will ask you about accidents and surgeries you've experienced, and discuss any important elements in your family history. For example, surgery to remove an inflamed galllbladder or appendix or to repair a hernia may result in weakened abdominal muscles. A motor vehicle accident or a fall from a height may have caused injuries that healed with soft tissue scarring.

Learning about potential risk factors and taking appropriate action will help ensure a stronger, more flexible, and healthier lower back.

¹Jones MA, et al. Recurrent non-specific low-back pain in adolescents: the role of exercise. Ergonomics 50(10):1680-1688, 2007
²Cherniack M, et al. Clinical and psychological correlates of lumbar motion abnormalities in low back disorders. Spine J 1)4):290-298, 2001
³Plouvier S, et al. Biomechanical strains and low back disorders. Occup Environ Med 2007 (in press)

A 30-year-old mom bends over to pick up her four-year-old and feels a sharp stabbing pain in her lower back. A 60-year-old man bends over to pick up his five-year-old grandchild and feels an electrical shooting pain in his lower back. For both, the pain is so severe they need to sit down.

The next day, both the mom and the grandfather notice they now have pain and numbness radiating down one leg, and they are having trouble walking.

What's going on, how did it happen, and what can be done about it?

First of all, a little basic anatomy is useful. Spinal discs are weight-bearing shock absorbers. They contain a gel-like ball-bearing center, which is surrounded by tough fibrous cartilage, arranged in concentric, criss-crossing circles.¹

As a person gets older, the discs naturally lose some of their water content, and cracks and fissures naturally develop in the fibrous cartilage. If a weight-bearing stress is unusual and unexpected, the gel-like material in the center of the disc can push through one of the fissures and possibly irritate a spinal nerve.

If enough of this material pushes through, the nerve can become inflamed and cause symptoms such as radiating pain and/or numbness, and possibly weakness, in one leg.

Typically, such pain and/or numbness radiates down the leg, traveling below the knee and possibly into the foot.

Such symptoms, with or without back pain, are highly suggestive of an inflamed spinal nerve. In fact, the person will usually say the leg symptoms are much worse and of greater concern than any back pain that may be present.

If the MRI confirms the disc herniation and suggests an inflamed nerve, the diagnosis is complete. What's next?

In the best scenario, conservative treatment may be sufficient and the nerve inflammation improves with time.^2,3 Anti-inflammatory medication may be helpful. Chiropractic conservative therapy may include physical therapeutic modalities and gentle trigger point therapy to relieve associated muscle spasms.

A spinal surgeon should be consulted to provide an additional opinion and input. If pain is severe and there is neurologic loss, surgery may be the best option.

Of course, the best management, as always, is prevention. Pay attention to safe lifting procedures. Exercise regularly and get sufficient rest. Your chiropractor will be able to provide guidance and recommend effective protocols to help you achieve and maintain good health and wellness.

¹Postacchini F: Lumbar Disc Herniation. Springer, 2004, Chapter 2.
²Rothoerl RD, et al: When should conservative treatment for lumbar disc herniation be ceased and surgery considered? Neurosurg Rev 25(3):162-165, 2002.
³Lumbar Disc Herniation. New Engl J Med 347(21):1728-1729, 2002.

Backpacks are the tote of choice for most school-aged children with two books per class to lug around. In fact, it is reported that between 92% and 94% of schoolchildren carry backpacks. And it appears these contraptions are evolving somewhat with sturdier-looking designs, heavily padded straps and about a thousand small pockets for pencils, house keys and other knick-knacks. But even though the sturdiest backpacks can withstand the pressure, how are the kids taking it?

On average, children load their backpacks to between 10% and 22% of their own body weight. During a study conducted in 2005, researchers set out to quantify the pressure and pain incurred when backpacks are loaded so heavily. For the study, 10 children wore backpacks loaded to 0%, 10%, 20% or 30% of their body weight for 30 seconds to determine the amount of pressure under the backpack's shoulder straps. While wearing the backpacks, the children were also asked to report whether they felt any pain and, if so, the severity of that pain.

According to the results, pressure beneath the shoulder straps was "significantly increased" when the backpack was loaded at only 10% of the child's body weight - on the low end of the reported average. Increased pressure also was associated with an increase in pain, and interestingly the pressure was always greater on the right shoulder than the left shoulder. Over the long term, the researchers noted that uneven backpack loads could alter the curvature of a child's spine and produce back pain.
The authors of this study compiled their results and offered a few suggestions for parents of school-aged children and their parents:

1. Backpacks should be positioned high on the back.
2. Backpack straps should be worn over both shoulders.
3. Weight in the backpacks should be minimized.
4. Backpacks should have wide shoulder straps.

It is important to remember that 3 out of every 100 people have some degree of scoliosis - an abnormal curvature of the spine - that begins in childhood and has the potential to worsen over time. Having your child evaluated by a chiropractor is the best way to determine whether he or she has some degree of scoliosis. Chiropractic care can manage any problems related to scoliosis, and a lightened load on their back can have long-term benefits as well!

We've all seen the TV ads ─ nice-looking woman in her fifties, sitting on a nice sofa in a nice living room, rubbing her hands, in obvious pain. Of course, she's not Lady Macbeth, trying to rub off the imagined blood of her murdered husband. She's a woman with arthritis.

According to the Center for Disease Control, arthritis is the leading cause of disability in the United States.¹ Approximately 47 million people have doctor-diagnosed arthritis and 17 million have arthritis-attributable activity limitations.

Osteoarthritis, the most common form, is a degenerative condition affecting the joints and the soft tissues around the joints ─ the associated cartilage, ligaments, and tendons. The most commonly affected areas are the spine, the hands, and the shoulders, hips, and knees. The pain of arthritis, the reduced mobility, and the lifestyle accommodations needed for pain avoidance are discouraging and may even lead to depression.

Many anti-inflammatory drugs are available for the treatment of arthritis, and in recent years many of these have been found to cause severe side effects. Vioxx is the most notorious of these ─ cardiovascular complications caused a worldwide recall of the drug. Celebrex, another well-known arthritis medication, was also found to increase the risk of heart attack and stroke at high doses.

The very good news is there are several wellness-based treatment alternatives to long-term medication. These include exercise, diet, and in many cases, chiropractic treatment.

Exercise is critical in restoring mobility and, over time, in reducing pain.^2,3 Persons with osteoarthritis often experience a vicious cycle of deteriorating symptoms. Pain causes reduced mobility (pain avoidance), which (paradoxically) actually causes more pain, which causes further reductions of mobility . . . . Activities of daily living ─ getting out of a chair, opening a jar, bending and lifting ─ become a real challenge as the person struggles to avoid further pain.

So, restoring mobility is key. Exercise ─ very gently at first ─ is the answer. Range-of-motion activities to get the joints moving again are very beneficial, including
• Arm circles
• Wrist circles
• Shoulder shrugs
• Side-to-side bending for the lower back
• Gentle knee bends
• Ankle circles
• Flexing and pointing the feet

Walking is a perfect exercise for treatment of arthritis. Begin by walking one block, then two, then around the block. Walk five minutes daily for a week, then increase by a minute or two each day. Get up to 15 minutes of gentle walking, then begin to gradually increase your pace. The increased mobility will not only reduce pain, but also provide a cardiovascular benefit and improve one's ability to perform activities of daily living.

Chiropractic treatment, in combination with an exercise program, may assist in restoring joint mobility and reducing pain. Gentle chiropractic manipulative therapy is designed to improve mobility of spinal joints. As spinal joint motion improves, pain lessens, and a positive cycle of return-to-function begins.

¹"Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation." CDC Morbidity and Mortality Weekly Report 55(40);1089-1092, 2006.
²Huang MH, et al: A comparison of various therapeutic exercises on the functional status of patients with knee osteoarthritis. Semin Arthritis Rheum 32(6):398-406, 2003.
³Suomi R, Collier, D: Effects of arthritis exercise programs on functional fitness and perceived activities of daily living measures in older adults with arthritis. Arch Phys Med Rehabil 84(11):1589-94, 2003.

Poets throughout the centuries have helped us see that being young is a state of mind. That special state of mind impels us to take actions on our own behalf, actions that have specific consequences for our health and well-being.

But so many people believe in the power of the dollar. They spend vast sums every year on anti-aging, beauty, and cosmetic products in the false hope of being able to purchase remedies that will restore their fading youth.

Others hasten the loss of their youthful glow. Cigarettes, alcohol, and negative mental constructs such as resentment, jealousy, and anger all work to rapidly break down our health and vigor. Negative emotions are especially insidious. Even if a person is healthy in other respects - eating a healthy diet and exercising regularly - stress, fear, anguish, and ill-will relentlessly add invisible workloads to the day, sapping our strength and aging us prematurely.

People who look and feel ten years younger than the age revealed on their birth certificates have learned how to create a positive mental attitude. It's amazing how much bounce you can add to your step when you intentionally set about having a great day. Of course, this is not merely smoke and mirrors. Those who are intending to be young inside and outside take the necessary steps. They don't eat doughnuts (except on their free food days). They rarely consume fast food. They do eat lots of fresh fruits and vegetables. They do exercise regularly, some even doing some form of vigorous physical activity five or six times each week.

These young-at-heart people get sufficient rest. They are willing to give up the attitudes, positions, and annoyances that do not serve their well-being. And many of them have discovered a natural healing method and philosophy that helps them to be well and stay well - chiropractic care.

Chiropractic is a smart, efficient form of health care. Chiropractic care helps remove physiologic obstacles to good health and helps your body learn how to maintain high levels of functioning. After beginning chiropractic care many people comment that they feel as if they've let go of a big weight they didn't know they'd been carrying around. People say they feel lighter and they have more energy. They sleep better. They even feel as if they're taller.

Others comment that they've become more effective at work and in their personal lives. As a result of chiropractic care their bodies are expending much less energy in wasteful and unnecessary physiologic activities. The result is more available resources to do - efficiently and well - what is necessary each day out in the world.

One wonderful outcome is the ongoing recovery of the youthful appearance and outlook we always want to maintain.

¹Egger GJ, et al: The emergence of "lifestyle medicine" as a structured approach for management of chronic disease. Med J Aust 190(3):143-145, 2009
²Reinehr T, Roth CL: A new link between skeleton, obesity and insulin resistance: relationships between osteocalcin, leptin and insulin resistance in obese children before and after weight loss. Int J Obes (Lond) Epub Jan 12, 2010
³Cohen DL, et al: Cerebral blood flow effects of yoga training: preliminary evaluation of 4 cases. J Altern Complement Med 15(1):9-14, 2009

"60 is the New 40" is more than a marketing slogan. The phrase is also a metaphor for optimism, as well as a metaphor for good health.

How can 60 really be the new 40? First, there are the demographics. Forty years ago, when today's 40-year-olds were just being born, 40 was a fairly substantial age. In the early 1970s, every 40-year-old had lived through World War II. For the Americans, many of the men fought in the Korean War and some may even have fought in the Vietnam War. In the early 1970s, most women had had their first child by age 25. Today, child-rearing years for adults frequently begin in their 30s and even late into their 40s. Life expectancy in 1970 was approximately to age 71. Today, average life expectancy is to age 79 or 80. Putting everything together, it can reasonably be stated that our "senior years" keep getting pushed further and further back.

"60 is the new 40" means there is plenty of productive life ahead. The phrase implies that, if one is ready, able, and motivated, whole new aspects of living can be explored. Whereas in 1970, 40-year-olds were often beginning to be established in middle-management roles in their white-collar companies, or were becoming shop stewards and supervisors in their factories, today men and women in their 60s are becoming entrepreneurs and launching their own businesses. Backed by a lifetime of experience, people in their 60s are going back to school to get the undergraduate or graduate degree of their dreams, or they're setting up shop for themselves as artists, artisans, or consultants. Regardless of the particular individual choice, the point is that people in their 60s are manifesting the spirit and vision that was previously thought to be the special province of those much younger, specifically, men and women in their 20s and 30s. But it would be a stretch to say that "60 is the new 30", so we'll stick with "60 is the new 40".

But these new activities and endeavors require physical resources and energy.¹ If one is not healthy, 60 may in fact not be the new 40. If one is not enjoying good health, then one's focus is usually primarily directed toward getting well. For 60 to really be the new 40, that is, for one to be fully engaged with family, friends, and work, for one to be focusing on the present and maintaining a positive, expectant attitude toward the future, an optimum state of health is required. Such an optimum varies from person to person. What is needed is for us to be functioning at our optimum. Such maximal functioning is based upon numerous factors, including a healthy, nutritious diet,^2,3 regular vigorous exercise, and consistent, sufficient rest. Putting these lifestyle choices into place and making these elements of healthy living habitual will go far toward helping all of us make our chronological age irrelevant.

¹Caprara M, et al: Active aging promotion: results from the vital aging program. Curr Gerontol Geriatr Res 2013;2013:817813. doi: 10.1155/2013/817813. Epub 2013 Feb 7
²Dickinson JM, et al: Exercise and nutrition to target protein synthesis impairments in aging skeletal muscle. Exerc Sport Sci Rev 2013 Jul 18 [Epub ahead of print]
³Levis S, Lagari VS: The role of diet in osteoporosis prevention and management. Curr Osteoporos Rep 10(4):296-302, 2012

Many people experience increasing musculoskeletal joint stiffness as they get older. Shoulders, knees, and ankles don't seem to be as flexible as they once were. It seems more difficult to bend over and pick up a dropped object. It may be uncomfortable to turn your head around to see the car in the next lane that's right in the center of your driver's blind spot. The bad news is that, left unattended, your joints do get stiffer as you get older. Left on their own, your joints will likely lose full mobility. The good news is there's plenty you can do about it. You can regain and retain much of your youthful flexibility if you are willing to be proactive.

First, some basic physiology. Joints such as the shoulder, knee, and ankle are lubricated by synovial fluid. Synovial fluid keeps joints moist, provides oxygen and nutrition, and washes away toxic end-products of normal metabolic processes. The joints in your spine are also lubricated and maintained in this way. But aging reduces the amount of available synovial fluid. Also, normal aging processes increase the viscosity of the remaining synovial fluid. You have less available lubricant and the lubricant that you do have is thicker. The result is stiffer joints, pretty much from top to bottom.

The specific countermeasure to such physiologic aging is to keep active. This is a pretty challenging prescription in a world in which most of our time is spent seated. Our bodies were designed for hard, physical work. But as we've transformed from an agrarian to an industrial society, and more recently from an industrial to a service-based society, the nature of our work has changed dramatically. The vast majority of our work is now done seated at a desk. When we're not typing on a computer keyboard or reading a spreadsheet, we're at home watching TV, playing games on our computing devices, or very rarely, reading. None of these activities involves active motion. If we want to take care of our bodies, we're going to have to be proactive about creating the time to do so.

We're going to be creating time for exercise. Almost any type of exercise causes synovial fluid to be more available, pumping synovial fluid into joint spaces and helping to lubricate joints.^1,2 Exercise increases your internal core temperature, which in turn decreases the viscosity of synovial fluid. The overall result is increased joint flexibility. This benefit is often experienced immediately. The benefit will be long-lasting provided that you continue to exercise regularly.

Thirty minutes of exercise per day, 5 days per week, will assist most of us in maintaining as much joint flexibility as possible. Alternating a cardiovascular exercise day with a strength training day is an optimal program.³ Yoga provides a total body workout which incorporates cardiovascular exercise, strength training, and flexibility. Ultimately, the types of exercise you do are less important than the long-term consistency. Regular, vigorous exercise, done over months and years, will provide great benefit, not only in terms of improved joint flexibility, but also in terms of overall health and well-being.

¹Seco J, et al: A long-term physical activity training program increases strength and flexibility, and improves balance in older adults. Rehabil Nurs 38(1):37-47, 2013
²Garber CE, et al: American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc 43(7):1334-1359, 2011
³Micheo W, et al: Basic principles regarding strength, flexibility, and stability exercises. PM R 4(11):805-811, 2012

The Macintosh operating system contains a subprogram called "Time Machine" that allows you to reset your status to any previously saved state. Provided that you have designated a location for backups, you can literally go back in time and recover documents, directories, and applications you may have overwritten, deleted, or otherwise lost. "Time Machine" is a marvelous productivity tool that permits us to recover from our mistakes. Wouldn't it be wonderful if we had a similar "Time Machine" that would enable us to recover our lost good health? The very good news is that we do.

In fact, you don't have to be a real-life character in an H.G. Well's fantasy tale to be able to achieve a certain degree of metaphorical time travel. You may recall the slogan, "50 is the new 30," which spread quickly through worldwide media outlets about 10 years ago. The notion that "60 is the new 40" soon followed. Surprisingly, unlike most sound bites that propagate effortlessly along social media pipelines, these hopeful phrases actually contained meaningful content. Age 50 and age 60 could, in numerous respects, really be the new 30 and 40.

But not everyone is willing to do what it takes to either slow down time's relentless ticking or to turn back the clock. Real time, that is, your personal time, and real effort are required to achieve the goal of prolonged good health. People age 50, 60, 70, and more-than-80 can enjoy the physical capabilities (mostly), the mental sharpness, and the appearance (within reason) that we used to think belonged only to persons 20 or more years younger. The price of admission to such a process is continuously engaging in the inner workings of the time machine that is available to each of us. We activate and maintain the operation of this "relativistic" system by eating a healthy diet, doing vigorous exercise for at least 30 minutes five times a week,^1,2 and getting sufficient rest on a regular basis, which for most of us means 7 or more hours of sleep per night.

Upon being told of these requirements for good health,³ many people will push back. "I don't have the time" is the primary reply. Of course, one is free not to eat right. One is free not to exercise. But the results of not following-through on these action steps are profound. Heart disease, diabetes, and obesity are the primary outcomes of not engaging in health-promoting behaviors. Interestingly, many people are aware that failing to participate in healthy activities will lead to cardiovascular disease and related disorders. Obviously, mere awareness is not sufficient. What is required is an active choice. If we desire to gain the benefits of our personal time machine we must be willing to pay the price of time.

¹Phillips C, et al: Neuroprotective effects of physical activity on the brain: a closer look at trophic factor signaling. Front Cell Neurosci 8:170, 2014
²Lee JS, et al: Effects of 8-week combined training on body composition, isokinetic strength, and cardiovascular disease risk factors in older women. Aging Clin Exp Res 2014 Jul 6. [Epub ahead of print]
³Erickson KI, et al: Physical activity, fitness, and gray matter volume. Neurobiol Aging 35S2:S20-S28, 2014