sports medicine

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


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.
 

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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