Arthritis and Degeneration in the Low Back

by Kyle Bangs D.C., M.S.

“Degenerative disc disease”, “disc bulge”, “osteoarthritis”. These are some of the common diagnoses that many people see all over their MRI or x-ray reports. While these diagnoses might sound scary (and, unfortunately, are often used to sell patients expensive treatment plans), most of the time these signs aren’t the reason that you’re experiencing low back pain. So called “spinal degeneration”, more often than not, is a sign of normal aging and not a sign of disease or a significant marker of pain. It’s so common that up to ½ of healthy adults in their 20’s have these “signs of degeneration, and are not experiencing pain

degenerative-disc-disease.jpg

 

With increasing use of imaging technology, we see the diagnosis of “disc degeneration”, “disc height loss”, “disc bulges”, and “facet degeneration” becoming more common. Research on these imaging results have time and time again shown very poor correlation with pain in the low back. Research conducted on healthy people of all ages with no history of back pain, found that these changes in the spine are very common and are normal signs of aging in the spine. All of the subjects in this experiment had MRIs of their low back and the findings were recorded. Rates of common diagnoses in this group with no back pain are:

 

DDD MRI.jpg

Rates of common diagnoses in this group with no back pain are:

Disc degeneration 37% age 20s, 68% age 40s; 96% age 80s

Disc signal loss - 54% age 40s; 86% age 60s; 97% age 80s

Disc height loss - 24% age 20s; 45% age 40s; 67% age 60; 84% age 80s

Disc bulge - 30% age 20s; 50% age 40s; 69% age 60s; 84% age 80s

Disc protrusion - 29% age 20s; 33% age 40s; 38% age 60s; 43% age 80s

Annular fissures - 19% age 20s; 22% age 40s; 25% age 60s; 29% age 80s

Facet degeneration - 4% age 20s; 18% age 40s; 60% age 60s; 83% age 80s

Spondylolisthesis - 3% age 20s; 8% age 40s; 23% age 60s; 50% age 80s

Remember that all of these people do not have any history of back pain! All of these findings on your imaging are more likely part of the normal aging process rather than the reason your low back is always aching. Low back researcher Stuart McGill remarks that “a degenerative disc disease diagnosis is the equivalent of telling your mother-in-law with wrinkles that she has degenerative face disease!”

A very severe case of degenerative face disease

A very severe case of degenerative face disease

While there are many reasons to get advanced imaging of your spine, you have to take the findings with a grain of salt. There are people in severe pain with no findings on imaging, and there are people with no pain with severe degenerative findings on their imaging. The symptoms need to correlate with findings on your health history and physical examination. If serious signs arise on the examination (known as red flags), advanced imaging such as CT or MRI can be a the proper next step. A proper health history and physical examination from your chiropractor or health care provider is essential.

What does this mean for you? It’s probably good news! Having signs of degeneration on your x-rays or MRIs doesn’t mean that you will not respond to conservative treatments such as chiropractic care. Most likely the treatments offered by your chiropractor such as spinal manipulation and progressive rehab exercises are exactly what you need to get feeling better and get back to doing what you love.

What can you do with spinal degeneration?

  1. You do not have to be afraid of moving and exercising.
  2. You can live a full, active, and healthy life even with signs of spinal degeneration.
  3. Find the right health care provider that will treat how you move and function, not treat your scary imaging results.

We pride ourselves at Function Performance Sport Chiropractic in giving authentic and effective care. We will work with you to find out what your individual goals are and work together to accomplish them!

If you’re having low back pain that is preventing you from living the active life that you want to live, click below to get in contact with a chiropractor in Oregon City today.

References:

Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., … Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811–816. http://doi.org/10.3174/ajnr.A4173

Getting Back Into Lifting - The Deadlift

by Dr. Kyle Bangs

The barbell deadlift is among the best ways to build endurance and strength in the low back and posterior chain. Unfortunately, you’ve probably heard of several people getting injured during this lift. Almost always, there’s a failure in maintaining proper form. If you’re new to deadlifting, or noticing a lot of pain and pressure in your back after deadlifting, make sure to get a qualified coach to watch your form to make sure you’re maintaining proper mechanics in your spine and hips.

It’s normal to feel unsure about lifting after a bout of back pain, but I can assure you that deadlifting is one of the best exercises to maintaining a resilient back. If you’ve hurt yourself deadlifting before and are a little wary, there are other exercises that can help you with the transition back into deadlifting.

Grooming the hip hinge

Make sure to shift your weight into your hips and drive them backwards. Step away from the wall to make it more difficult. The most important part of this is maintaining a rigid torso. If you’re bending in your low back, you aren’t performing this correctly.

 

Performing the deadlift with a kettlebell

The kettlebell is useful to start learning, or re-learning, how to deadlift. Without worrying about getting the bar around your knees, you can focus on safe back positioning and moving through the hips. If you’re having trouble with keeping your back in neutral at the bottom of your deadlift, then try a Romanian deadlift variation with the kettlebell. Think of starting the rep in the top position of the KB deadlift. Now start the rep by moving your hips back and maintaining a rigid torso. The bottom of the rep will be when you FEEL as much tension in your hamstrings as you want to tolerate, NOT when the KB touches the floor. Return to the starting/top position once you get to the maximal amount of tension.

 

Deadlifting from a rack or blocks

If you’re goal is to get back into deadlifting with a barbell, this is a great exercise to perform. If you’re lacking mobility to get into the proper start position while maintaining a safe back position, the blocks or rack will help you with that. Progress by lowering the rack or choosing lower boxes once you can perform the lift with good technique. An additional benefit is that you’ll be able to lift more weight with good form than if you were pulling off the floor. This can have the psychological advantage of making your back feel robust and strong because you’re putting it in a position to be the most successful.

 

Give these exercises a try and let us know what you think!

Are you at a higher risk for ACL injury

By Dr. Ben HOKENSON

 

Anterior Cruciate Ligament tears are common in sports, and may not fully recover. Prevention can possible with awareness of faulty movement, and retraining patterns of weakness.

  • ACL tears are one of the most common knee injuries
  • Most ACL tears are the result of landing from a jump or planting, cutting or pivoting in sports; most commonly without contact.
  • ACL reconstruction is generally necessary if you want to regain knee stability to return to sport since the ACL is crucial for stabilizing the knee when turning or planting.  
  • The anterior cruciate ligament is one of the four main ligaments of the knee, and the ACL provides 85% of the restraining force to anterior tibial displacement at 30 degrees and 90 degrees of knee flexion
ACL.jpg

Do you have any of these 3 Risk factors?

1.  Are you Female? Females are 4-5x more likely to tear and ACL than men.

Reason: Multi-causal, turns out its not a simple answer; anatomical and geometric differences of the knee and hip, as well as hormonal and genetic differences create difference stiffness and strength in the connective tissues.

2.  High BMI (body mass index)                                                                              

Reason: Although BMI is currently thought to be a poor barometer for healthy weight and fitness, in this case, higher body mass can be harder for ligaments to support during intense sporting activities.

3.  Poor neuromuscular control/motor control (coordination of movement)       

Reason: We rely on muscle control to support our joints throughout most of the range of movement.  When muscles don't fire properly, poor movement patterns result and more stress is endured by your joints and ligaments.  We can evaluate this in the office and gym with a couple simple movement tests.

A few signs of poor motor control in the lower extremity

Excessive pronation of the feet; inwardly rotated or pointed knees during standing, squating and/or jumping; poor stability and balance standing on one leg; poor posture

Would you like to test your motor control? 

The Box jump off test is a simple and safe test to perform yet can be complex to fully analyze.  Movement based health professionals may use the "Landing error scoring system"/LESS which requires video analysis of the action to fully analyze. This test may be simplified for general impressions of ones motor control abilities. 

If you would like to read an in depth look at the Landing error scoring system click on the link below.

http://natajournals.org/doi/pdf/10.4085/1062-6050-50.1.10?code=nata-site

Key points: ( not a fully inclusive list)

  • Can the person "stick" the landing?
  • What is the foot position at landing? Heel to toe? Midfoot?
  • Is the entire movement performed under good control?
  • Do the knees track straight without excessive inward deviation?
  • Is there excessive foot rotation, either internal or external?
  • Is there excessive trunk flexion?
  • Is there excessive joint movement overall?
  • Does one foot land before the other?

 

The Y balance test, is another great test to quantify your stability and motor control, and is used as a marker for improvement in performance and injury risk.   This tests compares strength and stability from one side to the other.  

 

How's your motor control?  

 

References:

Padua, D. A., Marshall, S. W., Boling, M. C., Thigpen, C. A., Garrett, W. E.,Jr, & Beutler, A. I. (2009). The landing error scoring system (LESS) is a valid and reliable clinical assessment tool of jump-landing biomechanics: The JUMP-ACL study. The American Journal of Sports Medicine, 37(10), 1996-2002. doi:10.1177/0363546509343200 [doi]

Active Shoulder and Core Workshop Recap

First off, we would like to thank those who were able to come to our Active Shoulder and Core Workshop yesterday! This was part of a monthly series where we go in-depth on a region of the body and how to increase performance and function. In case you missed it or you just want a refresher, here is a quick recap of a few of the things we went over.

Dr. Kyle working cueing movement in the upper spine.

Dr. Kyle working cueing movement in the upper spine.

 

Neck Stability

We started off with a quick lesson in how your neck and upper back posture can greatly affect your shoulder function. After running through some baseline shoulder movements, we went into an exaggerated poor posture. The forward head and shoulder position and the overly rounded upper back immediately limited movement and a lot of the participants found that shoulder movements with exaggerated poor posture caused some familiar stiffness or pain.

The exercise that we used to find out if you could use some work on your neck stabilizer muscles was the head lift with the chin tucked:

A lot of shaking, or the inability to hold that chin-tucked position indicated that some targeted neck exercises would be a great addition to your daily movement habits. Perform 2-3 seconds holds of the chin retractions while lying face up on the ground, and then progress to lifting your head up off the ground while keeping the chin tucked for sets of 4-6 holds.

 

Breathing Dysfunction

We then went demonstrated how proper diaphragmatic breathing was able to help relax some of the muscles in the neck and shoulders. The crocodile breathing exercise focused on feeling the air going down towards your pelvis, and the pressure of the air pushing your abdomen into the ground. We will cover more ways to practice diaphragmatic breathing in future workshops as well. 25 breaths performed 2-3 times a day can go a long way in alleviating tension in your neck and shoulders.

 

Upper Back Mobility

Next, we explored a few exercises to improve the mobility of your upper spine. We demonstrated with the wall angel evaluation how limitations in the upper back movement can affect how well you can control your rib positioning and your arm movements. To get more movement in that upper part of your back, the modified sphinx position can be used. Perform 10-15 repetitions alternating between bringing the spine up towards the ceiling and then bringing your chest down towards the floor with an emphasis on moving just those top few segments in the back.

The side-lying windmill exercises builds on that by adding in some critical rotation to the thoracic spine. Really striving to reach the fingers away from your body, and leading the movement with your eyes are important. Strive to perform a few sets of 8 repetitions throughout the day or prior to a workout.

 

Integrating the Shoulder and Core

We ended with the banded wall walk exercise. This exercise really challenged everyone's ability to integrate proper core positioning with movement of the arms. Things to strive for with this exercise was to maintain the rib position over the pelvis as well as resisting the tendency to dive the head forward or shrug the shoulders up towards the ears.


This was just a quick recap of some of the evaluations and exercises we did at our Active Shoulder and Core Workshop. Keep an eye out in the future for information on our next Active Workshop series focusing on the hip hinge pattern and the posterior chain!

CrossFit... Maybe not so dangerous after all

Rates and risk factors of injury in CrossFit: A prospective cohort study   

 by Dr. Kyle Bangs

Nervous about getting injured during your journey with CrossFit? Well, more research says that the health and performance benefits of CrossFit outweigh the minimal risks.

A study published in early 2017 in The Journal of Sports Medicine and Physical Fitness followed 117 CrossFit participants for 3 months, to determine the injury risk of CrossFit, and identify the pre-existing risk factors among participants. The overall rates of injuries for CrossFit were found to be very low at about 2.1 injuries per 1000 training hours; comparable to many other forms of training including running, triathlons, and weightlifting and much lower than most amateur team sports. When injuries did occur, most involved the low back, knees, and wrists. They usually occurred during weight lifting movements, especially the squat but also deadlifting and overhead pressing exercises. Other studies have found the shoulders are more frequently injured with CrossFit, as well.
 

 

Are you at an increased risk for injury? The study suggests that any one of this factors may put you in greater risk of injury.

  1. Are you a man?

  2. Do you have previous injuries?

  3. Do you have asymmetries with the “Functional Movement Screen” OR “FMS”

 

By the way, did we mention Dr. Kyle is offering Functional Movement Screens at Function Performance.

 

Male athletes in this study (and in previous CrossFit injury studies) were found “very likely” to have an increased risk of injury compared to females regardless of other variables. Previous research has investigated this heightened male risk.  They found that men are less likely to ask a coach for help during lifts, resulting in poor form, or progressing too quickly to higher loads.

Participants with a prior injury (within the last 6 months) was another strong risk factor for increased likelihood of injury. This is no surprise as injuries and pain can alter the way the body moves, even after the injury subsides. Often times the factors that lead one to get injured are not adequately addressed during the healing and rehabilitation phases after an injury. This may have something to do with the next risk factor as well.

                                                                  Don't do this.  

                                                                  Don't do this.

 

The last factor that could lead to an increased risk of injury was found to be the number of asymmetries on the Functional Movement Screen (FMS).  The FMS is a short assessment of your quality of movement and is able to show where your personal movement quality falls short. FMS screening scores have been shown to be associated with injury risk in several sports and activities, especially when athletes demonstrate asymmetry in movement.

Bottom Line? When considering the evidence, CrossFit is considered as safe as most fitness related activities. What can you do to reduce the risk of injury even further?

  • Focus on the quality of your lifts before you start pushing for number (weight/repetition) goals. If you’re unsure about a movement or lift, ask the coach for some 1 on 1 help with it before attempting to load it. If you ever think “I wonder if I’m doing this right,” then it’s time to ask for some feedback.

  • If you’ve had an injury in the past, get it evaluated by a healthcare practitioner that you trust. Pain alters your quality of movement, and those movement changes can persist long past an injury is healed.

  • Have your movement screened. An FMS screen can be a quick way to determine how your body moves and will find the big differences between your right and left sides that could increase your risk of injury. With an FMS screen, you’ll get a few corrective exercises that you can work into a warm-up to start addressing these issues on your own.

 

References

Hak, P. T., Hodzovic, E., & Hickey, B. (2013). The nature and prevalence of injury during CrossFit training. Journal of Strength and Conditioning Research, doi:10.1519/JSC.0000000000000318 [doi]

Klimek, C., Ashbeck, C., Brook, A. J., & Durall, C. (2017). Are injuries more common with CrossFit training than other forms of exercise? Journal of Sport Rehabilitation, , 1-17. doi:10.1123/jsr.2016-0040 [doi]

Moran, S., Booker, H., Staines, J., & Williams, S. (2017). Rates and risk factors of injury in CrossFit: A prospective cohort study. The Journal of Sports Medicine and Physical Fitness, doi:10.23736/S0022-4707.16.06827-4 [doi]

Weisenthal, B. M., Beck, C. A., Maloney, M. D., DeHaven, K. E., & Giordano, B. D. (2014). Injury rate and patterns among CrossFit athletes. Orthopaedic Journal of Sports Medicine, 2(4), 2325967114531177. doi:10.1177/2325967114531177 [doi]

New Doctor and Expanded Hours

If you haven't heard the good news yet, we are now open 6 days per week Monday through Saturday. Dr. Kyle has joined us to offer additional treatment days on Tuesdays, Fridays, and Saturdays. With a Masters in Science in Sports Medicine, Dr. Kyle has extensive training in the management of sports injuries, movement assessments, functional rehabilitation and pain science research.

Our new hours are:

Monday: 8:00-12:30 & 2:00-6:30

Tuesday: 8:00-12:30 & 2:00-6:30

Wednesday: 8:00-12:30 & 2:00-6:30

Thursday: 8:00-12:30 & 2:00-6:30

Friday: 8:00-12:30 & 2:00-5:30

Saturday: 8:00-2:00