QuestionQUESTION: I am having severe lower back and butt pain, the pain is mostly in the butt area that is mostly at the top of my buttocks that is mostly in the middle and to the left, also have had some lower back pain. I have been working long hours and work in a office where I have been spending at least 10 hours working at a computer, along with a hour drive to and from work. The pain just started a couple of days ago, and is worse when I am at my desk and on the drive home ( basically when sitting for long periods of time). Today the pain in my butt area is very severe. I am not having any leg pain. I did try some deep tissue massage and as soon as the spot on my butt was hit I had some pain that shot up my back. I am also using some heat which does seem to be realiving the pain a little. Do you have any suggestions on what I need to do?
ANSWER: Dear Angela,
Your complaints are common place in a chiropractor's office. Most of the time when you have low back pain that is focused around the low back and buttock, it is because of inflammation in the joints of the low back (facet joints) or pelvis (sacroiliac joints). Many times this is accompanied by sore and achy musculature or actual muscle spasms which can be quite painful especially when pressed on.
Now more serious forms of back pain are from degeneration around the joint space and disk, or an actual disk bulge/herniation which may cause nerve root pressure/inflammation. All of the above has the potential for creating pain into the buttock or down the leg.
Here is the good news, most of these problems can be effectively managed or eliminated with spinal adjustments, improved posture, and rehab exercises to stabilize the core and spine. But first thing is first. you need to find out what is the actual problem, and the best way to do that is with a comprehensive physical examination. I would ask your family, friends and co-workers for a referral to a chiropractic physician they know and trust...this is often the best way to find a good doctor. Call the office and schedule a consult (this should be brief, but free) and you can see if the doctor they have referred is right for you. If so, schedule an exam, which should include a complete medial history, a focused history of the problem, and orthopedic tests, neurological tests, range of motion of the low back, and x-rays. With the above information, the doctor should be able to give you a good answer of what is the problem, (a diagnosis), and outline a program to correct the problem and reduce your pain and suffering while increasing your function. Normally a few weeks of care will have you feeling much better.
In the mean time, please read the below article I have written, and start to employ some of the methods for reducing stress on the spine while at work. Often simple breaks for exercise during the day will alleviate significant amounts of stress on the back. If you have any further comments or questions, please feel free to write me back. Good luck Angela.
Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net
Training for Stability of the Neck and Back匩ot What You Think!
Dr. J. Shawn Leatherman
A brief look around any boardroom, construction site, grocery store etc?will provide any observer an insight into poor posture and de-conditioning syndrome. A deconditioned individual has only one option for lasting pain relief which is increasing their functional capacity. The average teenager and adult have pronounced spinal displacements due to chronic poor ergonomics of basic living, poor posture, and constrained working environments. Back or neck pain is the number one reason for a visit to the chiropractic physician and medical doctor! Shouldn抰 you work to prevent injury and strain? The obvious answer is yes!
The most common reasons for back and neck pains are poor lifting techniques, abnormal posture, and repetitive micro-strain coupled with the lack of stability within the muscular system, and trauma. It is sometimes difficult to avoid trauma, but if you eliminate poor technique, improve the ergonomics of your work station, and train your spine for stability, you significantly reduce your risk of injury. Remember that we live in a gravity controlled environment and all muscular actions are in direct opposition to gravity. We stabilize bridges and buildings so they won抰 buckle or break, you need to do the same for your spine.
That being said, conventional strength training with free weights and isolation machines will give general overall gains in muscular strength if utilized properly, but won抰 necessarily target stability of the core or the spine. Muscles to target are the multifidus, rotatores, intertransversales, transverse abdominis, and the pelvic floor. Moreover, it is important to train for balance and symmetry thereby reducing abnormal weight bearing on all joints of the body.
Lifting technique is important for optimal health and the reduction of injury. To execute a lift properly, the back should be fairly straight while maintaining the normal lordosis (forward arch of the low back). This position will activate the musculature properly for stability while not recruiting the ligaments for support. Squatting is optimal, due to its neutral spinal position and the ability to use the muscles of the legs to accomplish the lift. Stooping should be avoided, especially with repetitive movements. Stooping creates an unstable configuration for the disk with increased tensile pressure on the posterior portion of the disk due to increased compression on the anterior portion of the disk. This can easily result in a rupture of the disk. In addition, objects should not be lifted if they are placed awkwardly which may require twisting and or bending, weights should be held close to the body, and jerky movements are only appropriate for highly trained individuals such as advanced athletes under the supervision of a trainer. The last key is to create contraction of the abdominal musculature before the lift. This provides greater stabilization the spine, and your entire core. You can easily accomplish this by sucking the belly button in toward the spine. This activates the transverse abdominus muscle which is key for all movements.
One of the most deleterious activities people engage in is sitting. Sitting increases disk pressure more than standing and encourages abnormal flexion (forward bending) of the neck and upper back in addition to slumping in the chair. These postures chronically load the disks, ligaments and musculature of the spine creating micro-injury and dysfunctional movement patterns.
Many of us spend the majority of our days at a desk, computer or workstation. We need to consider and modify our workspace carefully. Adding a support for the lumbar spine reduces disk pressures. A seatback angle of 5-15 degrees from vertical will reduce low back muscle activity and disk pressure. Proper desk height is approximately 30 centimeters from the seat of the chair. Arm rests are important in limiting strain on the upper muscular complex of the back and neck to include the trapezius, rhomboids, and levator scapulae. The shoulders should be able to relax with the elbows bent at 90 degrees while the hands rest on the desk surface.
Forward movement of the head on the neck is extremely problematic. For every inch forward the head moves in relation to the neck and shoulders, the compressive forces on the lower neck increase by the entire weight of the head, 10-16 lbs. Think about the difference in holding a bowling ball close to the body, or away from the body. This illustrates the differences in muscular work needed to support the weight and the ligamentous strain. Computer monitors should be elevated so that the center of the screen is at eye level while looking straight ahead. This will reduce eye strain; further reduce muscular tension of the neck while limiting the forward flexion of the head, therefore reducing the abnormal loading of the ligamentous complex. This will also help reduce those 搘ork headaches? Placing the monitor higher to induce a slight extension of the head is permissible.
Now that you have proper technique, and your workstation is optimal, structural and functional training of the musculature on the back of your body and your core is the key. You must have a balanced and relaxed spinal cord for optimal function. That being said, specific training is the way to achieve spinal balance and stability, and you don抰 have to go to the gym to achieve it. If you can appreciate that we spend most of our days in a flexed position, the way to relieve that cumulative stress is to train the small stability muscles in an extended position.
Most people are flexed forward at the hips/pelvis, have rounded shoulders, and a forward head and neck, this is called Global Flexion. Extending the head backwards, opening up the chest by turning the palms of your hands outward and stretching your arms backwards relieves this global flexion. The last step is to stand up and bend backwards at the waist approximately 20 degrees. You have just accomplished the task of Global Extension. If you flex or tighten up all you muscles while in this position it further accentuates the value of the exercise and also promotes increased blood flow and oxygen delivery to the body. This is a relief position that everyone should use frequently throughout the day to abate cumulative postural stresses.
Moving on, posture is the next consideration. Your posture should not be a conscious task, but with the level of deconditioning in the population, conscious postural improvements are necessary. This is mostly common sense, and your mother has telling you to do this since you were a child. Exercise your postural muscles while walking. Stand up straight, hold your head up high and walk with confidence looking ahead of yourself, not at the ground. Pull your shoulders back, breathe deeply, and take confident long strides. This alone will bring more oxygen to your body by fully opening up the lungs, increasing blood flow, and reducing abnormal stress on spinal structures. You can also practice this position on a physio-ball or thera-ball to improve your seated posture and balance. Complex postural issues and stability issues need to be addressed by a professional.
Remember that weight training, aerobic activity, and general fitness types of activities are only good for you if done with proper form, balance, control and stability. If you don抰 have good posture and spinal symmetry, a traditional workout program will only make those problems worse. It is essential to incorporate stability into your spine and your life before starting any exercise program. You should see a medical or chiropractic physician before starting a fitness regime to make sure you are in good health and able to handle the rigors of increased physical activity. If you have any cardiovascular issues, a stress test should be performed. Many subsequent doctor visits are caused by improper fitness activities; it is better to see you doctor before rather than after.
All chiropractic physicians will be able to teach you about postural imbalances and how to improve your own posture, but many chiropractors have additional post-doctoral training in advanced postural biomechanics and structural correction to help you attain improved spinal dynamics. Ask your chiropractic physician to tell you about their training, and provide written documentation about their qualifications. To learn more about postural correction check out http://www.idealspine.com/. In addition, a Certified Pilates instructor, http://www.nypilates.info/, http://www.pilates-trainning.com/ or Certified Personal Trainer http://www.nsca-lift.org/, http://www.ncsf.org/ can have great benefit. Remember to check their qualifications as well.
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QUESTION: I want to thank you so much for your time and your response to my question. I ended up having to go the er today, the pain just got so bad I was in tears most of the night. They did x-rays and said that I had a mucusule sprain in my lower back and my tale bone was bruised. They gave me a pain shot along with a steriod shot, and prescibed some pain medicine along with muscule relaxers. Do you think that seing a chiropractor would still be beneftical now or would I Need to wait until this heels? The dr said that there is quite a bit of sweeling in my lower bag and my butt area. Did this sound like a good treatment that they have me on? And also I am going to have to work this coming up week, do you any suggestions anything I can use in my chair since I have to be behind a computer all day long and also the long ride to and from work?
AnswerDear Angela,
Seeing a chiropractor would still be beneficial. I'm glad you went to the ER, the injections will help, but are only going to help to reduce the active inflammation and kill the pain only. The injections will not change any physical relationship between the joints, therefore spinal manipulation will still be beneficial. However, I would wait one to two days before you get your examination...this will give the medicine some time to work, and time for the inflammation to reduce. Not to mention, the injection sites may be sensitive as well. By the way, make sure that you get the x-rays from the ER to take to the chiropractor you choose...they will need them to look at, and it will save you money from having to get new films taken.
Concerning the chair, if sitting is painful due to pressure, then you should definitely utilize a pillow or cushion to alleviate it. Otherwise, a lumbar support for the low back is a good option as well...this will help to maintain proper posture in the seated position and reduce stress on the low back. Not to mention, make sure to take frequent breaks...get up and stretch or walk for a few minutes, then get back to work. One last option for you: buy a therapy ball to sit on while working at the computer. This will make you sit up more and not slouch. If you are under 5'5", then a 55cm ball is the correct height, under 6', then a 65cm ball is the correct height, over 6', then a 75cm ball is the correct height. These balls are also great for home rehab to improve low back strength and stability.
Good Luck Angela.
Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net
