Articles in Category: Chiropractic

Case Study: Low Back Disc Complaint

on Wednesday, 06 March 2019. Posted in Newsletters, General Health, Ergonomics, Chiropractic

Case Study: Low Back Disc Complaint

A 39 year old female presented to our clinic complaining of severe low back pain with left leg referral down into the toes. The problem had started ten days previously for no apparent reason; however, it may have been related to a lifting incident. The patient had presented to the hospital for assessment. She was given pain killers and sent her home. She presented two days later to her GP who once again gave her a prescription for pain killers and sent her home.

On presentation at our clinic she was unable to stand on the toes on the left leg. Presentations of leg referral with weakness or loss of ability to stand on the toes or standing on the heels are always a concern to practitioners. “ Hard neuro signs” can indicate significant compression on nerve roots that can create long standing complications if not addressed readily. Further examination revealed a loss of heel reflex and a straight leg raise of 25 degrees on the left hand side. Additionally there was loss of sensation in parts of the foot and lower leg on the left hand side.

The patient was referred for an MRI which showed a significant disc bulge at L5/S1 on the left hand side, compressing the S1 nerve root. Due to the loss of reflexes and muscle weakness, treatment was initiated with the requirement that significant progress needed to be made within a week or otherwise urgent referral for a neurosurgical consultation was required.

Due to lack of progress she was referred to a neurosurgeon who performed a micro discectomy. The patient presented to our clinic 1 week post-operatively for rehabilitation.

We progressed through a range of decompression exercises, re-strengthening and postural re-training exercises to help her return to normal and fortify the system to protect against future injury.

For these types of cases, patients return to work within 4-6 weeks for office work or 6-12 weeks for manual workers. Full resolution is reached within 12 months.

In this instance the patient had a very good outcome and returned to normal work and activities with no long standing disabilities or ramifications.

This type of case highlights the importance of doing affective neurological and orthopaedic testing to identify correctly what is happening. This appropriate imaging and management to ensure that serious problems are not missed and they are cared for in the most appropriate manner.

We have unfortunately seen other cases similar to this that have not been managed well that have ended up with permanent disability as a result of miss-management.

If you have a significant low back and leg referral complaint, it is always advisable to have this analysed affectively by your trusted health care practitioner.

Correct Sleeping Posture

on Thursday, 31 March 2016. Posted in Chiropractic

Correct Sleeping Posture

By Jakob van Vlijmen

M Chiro, DC

 

As people spend almost one third of their life being asleep, it’s not strange that we get a lot of questions regarding sleep in our practice. More and more people realise that correct sleeping posture and the right mattress are vital for feeling refreshed in the morning. And what is more if done incorrectly; sleeping can be a tremendous strain on your neck and back! The following article will tell you what to look out for and should give you the tools to be able to make sure your sleep is as revitalising as possible.

 

The correct sleeping posture allows for the spine's natural curvature to be maintained. To help explain this we have to look at the spine's anatomy. As some of you may know, the spine is built up of 24 vertebras, a sacrum and a coccyx. The spinal column has a typical S shape with a concave cervical and lumbar curve and a convex thoracic and sacral curve.

 

 upper-extrimities-and-spine-injuries-60-638

During the day the spine is under a lot of stress especially when, during our activities, we are unable to maintain the natural curves of our spine. As discussed in previous articles, correct posture during sitting and lifting is very important to prevent excessive loading of our spines. (For more information on how to sit or lift correctly visit our YouTube channel: https://www.youtube.com/user/sportsandspines) More and more people are becoming aware of this, which is great, however they do not seem to realise the same principles apply at night. An incorrect posture can cause incorrect and excessive loading of our joints. The following pictures should help explain what certain sleeping postures do to your spine.

 

Sleeping on your stomach

Sleeping on your stomach is bad for your spine as the neck is stressed by having it fully rotated and the lower back's curvature is increased causing more load on the lower back. (Image 2)

 

sleeping2 

Even without a pillow the amount of cervical rotation necessary for this position can cause or perpetuate neck pain or headaches. Trying to change your sleeping position can be difficult, but there are some tricks we can teach you to help facilitate your change over to a healthier sleeping position. Ask your chiropractor about this if you want to learn more.

 

Sleeping on your back

When you lie on your back the weight is distributed equally over a large area, this is why this position is deemed best for you. It is important however, that when you lie down on your back you are able to maintain the natural S shape of your spine. At times it is possible that the curvature in the lower back is not sufficiently supported, usually this is the case if the matrass is too hard. To prevent injury and maintain the natural curvature, you can put a pillow or towel underneath your lower back to support it. Another way of de-loading the lower back is sleeping with slightly bent knees by placing the pillow underneath your legs as shown in image 3.

 

sleeping3 

 

When you sleep on your back you need a good pillow to support your head and neck. The height of the pillow is dependent on the curvature of your neck. The pillow needs to support the neck in such a way that the concavity is completely filled up otherwise this may cause a deviation from the necks natural curvature (see image 4). When you sleep on your back, a fairly flat pillow will suffice, however when you sleep on your sides you will need a slightly fatter pillow.

 

sleeping4a  sleeping4b  sleeping4c


Image 4a: pillow is to high                Image 4b: pillow is to low                Image 4c: correct pillow height

 

A pillow that is too hard can cause issues as well as it can create too much pressure on the back of the head. A softer pillow can be more supportive of both neck and head and therefore more suitable, ask your chiropractor if the pillow you are currently using is right for you.

 

Sleeping on your side

Sleeping on your side is a very suitable position, provided you are sleeping on the right pillow and mattress. When lying on your side the neck can tilt sideways due to the width of the shoulders. This is why it is important to have a pillow that is the right size so the head and neck are properly supported. Use one pillow that has the correct height (see image 5) and try avoiding folding a thin pillow up or using 2 stacked pillows.


sleeping5a  sleeping5b  sleeping5c

 

Image 5a: pillow is to low                 Image 5b: pillow is to high             Image 5b: pillow is the correct thickness

 

Orthopaedic Pillows

There are different types of pillows and the ones gaining popularity right now are the orthopaedic ones. We also stock these at IOSAS as they are shaped to perfectly fill up the area underneath your neck and head when you sleep on your side. What is very important when you buy a pillow like this is that you buy the correct size as it is intended to fill up that space and support your neck and head in such a way that your spine is able to remain straight.

 

Mattress

Buying the correct mattress is very important, sadly there is no such thing as the perfect mattress as each one has their pros and cons. And some of these considerations are purely personal. A mattress, depending on the quality, should last about 10 years. The weight of the body distributed differently across the mattress, as you are lying on your side there will be different forces acting upon the hips than on the neck or chest. If the mattress is too soft, too much pressure can be exerting on the spine and it can sink through, as a hammock does (see image 6a). This can lead to neck or back injuries. A mattress that is too hard firstly doesn't provide enough comfort but can also cause neck and back injuries (image 6b). The drawback from sleeping on your side is that the bodies’ contours play a big part; the pressure is higher in areas where the body is wider. In places where the body is narrower it needs more support from the mattress. There are mattresses that are able to give varying degrees of support to keep the spine straight.


sleeping6a  sleeping6b  sleeping6c


Image 6a: Mattress too soft              Image 6b: Mattress too hard      Image 6c: Mattress has correct firmness

 

Lying on your side, on a good mattress with the arms besides the pillow and the legs tucked in slightly with a pillow in between the knees is the sleeping position that causes the least load on the spine and neck (see image 7)

 

sleeping7

 

If you are wondering if your pillow or mattress is right for you, ask your chiropractor about it during your next visit. If you can, bring in your pillow for them to have a look at and ask the team at IOSAS about the mattresses and pillows we sell.

Curbing the Low Back Pain while Driving

on Thursday, 24 January 2019. Posted in Newsletters, General Health, Chiropractic

Low Back Pain while Driving

You are not alone if driving, especially for long periods or through heavy traffic make your back, neck and shoulders stiff.

While these days car seats are more “adjustable friendly'' than before, often still they do not have enough lumbar support and the proper seat angles to take the pressure off your spine.

This then encourages poor low back posture, which in a cascade of events then stresses the mid back and neck at the same time.

If your work requires you to drive for long periods, then you are definitely more vulnerable to this problem.

How Do You Fight Against a Flawed Design?

The answer to this is WORK WITH WHAT WE CAN CONTROL.

STEP 1: START FROM SCRATCH

Push your seat as far back as possible. If the steering wheel is adjustable, bring it high and close to the driver.

Drop the seat height and cushion to their lowest and the seat's backrest reclined back to 30 degrees.

STEP 2: SEAT DISTANCE FROM PEDALS

 

Slowly move the seat forward one notch at a time until you find a comfortable position allowing your leg to have good control over the pedals (ideally the knees should not be over bent).

STEP 3: BACKREST AND CUSHION HEIGHT

 

Again, recline the backrest one notch at a time until your back feels supported. Make sure it is not excessively declined because this will interrupt the driver's field of vision.

As for the cushion height, the rule of thumb is “Knees LOWER or at the SAME height as your Hips”.

This can be a bit tricky because most cushions are in an inclined position making the knees sit higher than the hips (which is not what we want). Bring it up to the point where your knees are at the same height as your hips. Then, sit on a cushion or a rolled up towel to help lift the hips up higher than the knees relieving some of the pressure in the lower back.

STEP 4: STEERING WHEEL

 

Move the steering wheel to a distance where your wrist is comfortably resting on it at 10 and 3 o’clock position with a slightly bent elbow.

It should also be adjusted to a height where the controls are clearly viewed and not touching your legs while driving.

STEP 5: GET OUT OF THE CAR

 

This is probably the simplest thing anyone can do if the back is hurting when driving. Yes. Get out of the car and take a short 5-10 minute walk ideally at each hour of driving.

Studies have shown that the likelihood of a back hurting sitting in a car verse an office chair is a lot higher due to the vibration of the vehicle whilst driving as more strain is inflicted on the spine as a whole.

So, do your back a favour and get that car seat set up right!

 

Written By Iris Tan
B.App Sc (Chiropractic)
M.Clin Chiropractic