Question
Dear Shawn

Thank you for your detailed answer to my question and advice.  Could I take up more of your time on a couple more specific questions.

Every few years I would suffer a prolonged period of back pain.  Some years the pain is chronic, but this year it was relatively manageable.  My back popped during mobilization in the physiotherapy sessions and my physiotherapist was surprised of this in the first few sessions.

My physiotherapist has been teaching me core muscles strengthening exercises which I do regularly, and also to use my core muscles and mind my posture in all my daily activities.

After 3 months of physiotherapy, I am getting myself back to the gym.  I stretch before and after exercising, and throughout the day.  But when I tried to walk faster on the treadmill, say at 8km per hour, I have been experiencing two problems.  

Firstly, my right knee has become painful and I have to reduce the speed.  And it would stay painful for days and once for over 2 weeks.

Secondly, my lower back would become achy afterwards.  And the flexion stretches (which my physiotherapist advised to be better for me) felt painful after doing them, and my back would become tense and painful later with restricted movements.  When this happens and if I stretch my back with the sideway turn types of stretches, if "something pops" in the joints, as if something gets "unlocked" in the spine, it gives relief to my back pain and the back becomes more loose and I feel better.  I do not stretch trying to get it to pop, it just happens sometimes, and when it does my back becomes more free.

What I find most disturbing is the feeling of the movement in the joint before the sound is heard.  Not only has the cracking noise become more frequent and louder, the feel of the movements also has become more pronounced.  

As to the supplements.  I take the brand Vitabiotics, I think they are a good make. I take one tablet containing omega-3, glucosamine, with vitamins C, D3, E, B12, folate; and another tablet for the calcium, magnesium and zinc.

Again, I would be grateful for any comments and advice you might be able to give me regarding this.

Thank you.
Katherine


Answer
Dear Katherine,

Well, the fact that you back continues to 'pop' but the pain comes back after awhile indicates that you have continual fixations in the spine which are not being releases.  Rather the adjacent joint spaces are likely hypermobile and are the ones making the noise.  I would recommend that you find a good local chiropractic physician to properly adjust the spine at the fixated segments so the hypermobile areas can relax and reduce their motion.

I would further suggest that you ask the physiotherapist about extension types of exercises for lumbar spine stability and strengthening.  These are sometimes referred to as McKenzie exercises, and your physiotherapist should know them well.  In addition, there is a specific exercise called the birddog that works for balance, and stability of the spinal core muscles...specifically the multifidus muscle.  This is a great exercise and one you should learn to perform with good form.  Again, ask your therapist to demonstrate, or you can find it illustrated on the Internet.

To address the knee, this is difficult to ascertain without further information.  Such as where is the pain located, how does it feel, what positions make it worse, do you only have pain with the increased speed or do you have it will increased stride length as well.  There are various orthopedic tests that would be helpful as well.  if you have any further information on it, write me back.

Concerning the Vitabiotics, I am not familiar with the brand.  However, if you are taking only two tablets, I can tell you that you are only getting a fraction of what you really need.  To get enough Omega III fatty acids, I take 4 pills/day of a concentrated formula, and they are pretty big for a supplement.  Additionally, to get enough glucosamine, you will need to take approximately 3 capsules of almost any brand on the market.  Bottom line here is that I sincerely doubt that you are getting an adequate amount of nutritional support from what you are currently taking.  Especially if there are other nutrients to be included in the product.  Just as an example, I consume 15 capsules per day in 3 divided dosages for my basic nutritional regime.  If I happen to be sick I add specific immune support to that.

Allright Katherine, hope this helps.  Let me know if you have any further comments or questions, or if you want any further help with the nutritional testing and support.

Respectfully,
Dr. J. Shawn Leatherman
Director of Clinical Rehabilitation
www.suncoasthealthcare.net