Back Talking!

ACP guidelines? What are those? Dealing with low back or neck pain? There is a good chance that you have visited your medical doctor  to discuss treatment options for your back or neck pain. The American College of Physicians (ACP) is the second largest medical organization in the US behind only the AMA. It is comprised of medical doctors that are internists or internal medicine doctors. Internal medicine doctors are typically your primary care physician that takes care of adults only. And if you have a specialist doctor like a cardiologist or an orthopedist, there is a great chance that their initial training was in internal medicine. Definition of Guideline: a general rule, principle, or piece of advice. Guidelines for physicians are designed to help them with decision making when dealing with a certain condition like headaches or lower back pain. It gives them a synopsis of the latest research and the recommended best way to treat that condition. The ACP released an update to the previous guideline for treating low back pain in February 2017 and it was published in the journal The Annals of Internal Medicine. The update stated the following: What should be tried first are non-drug therapies such as superficial heat, massage, acupuncture, or spinal manipulation. Did they say SM the bread and butter the treatment of choice of chiropractors? Physicians should avoid prescribing unnecessary tests (x-rays for example) and costly and potentially harmful drugs, especially narcotics. The bottom line is if your primary care physician is not recommending or referring you out to a chiropractor, they are doing you a disservice. Gone are the days of just medicating someone with stronger and stronger pain killing medications that treat only symptoms and never fix the cause. Have a listen, and as always, I’d like to hear from you. Reach out to me at todd@backtalkinghelp.com

The year 2017 will be memorable for many reasons. Within the world of spines, lower backs, and necks there were some big advancements to help us move forward into 2018 with great momentum. The majority of patients that show up in my clinics have had previous episodes of lower back and neck pain. For many, the treatments that they had to help with those conditions may have done more harm than good. Their care was mismanaged along the way. Too often, drug therapies were the treatment of choice. Great for killing the pain, but not so good for fixing the cause of the pain. 2017 Back Pain Guidelines Get Updates In 2017, we saw 2 significant organizations either update their guidelines for the treatment of back pain, or create a complete new set of guidelines altogether for the treatment of back pain or pain alone. In January of 2017, the American College of Physicians updated their guidelines stating that non-drug treatments should be the first choice of physicians. Recommending spinal manipulation as the treatment of choice! In June of 2017, the FDA (Food and Drug Administration) in the wake of the ongoing opioid epidemic that is gripping the United States, published a new guideline. This guideline recommends for physicians to avoid the prescribing of narcotic prescription medications and recommended spinal manipulation for those suffering from back or neck pain. A Look Forward to 2018 2017 was the year of talking about the opioid crisis that is having a devastating effect on the United States, 2018 will be the year of taking action. Strong action is being taken in physicians offices across the country to advise physicians to minimize the use of opioid medications, and to make it harder for patients to obtain these medications. We should see more patients flowing into chiropractic offices across the country, as they have the proper tools to help back and neck pain patients. Listen to the episode:

We all have a love affair with our cell phones. But I remember resisting getting one in the first place. I was perfectly content having a phone hanging on the wall at home that had a answering machine attached to it. Why would I want someone to get in touch with me if I wasn’t at home or at work I used to think. Man how times have changed. Now if I forget my phone at home I feel like I have left the house naked. A 2015 survey revealed some rather startling usage rates and the amount of time people spend in front of some type of screen. All age groups spend as much time in front of a PC/laptop/tablet/phone screen as they do asleep in bed Adults 55 and older average 6.64 hours in front of a screen Adults 18-24 spend on average 8.83 hours in front of a screen! 84% admit to suffering from back pain in the past year This group loses more working days to back pain than their parents’ generation (1.5 days more) Their pain is more likely to be experienced in the upper back and neck Text Neck All of this screen usage has created a new modern day malady appropriately named “text neck”. Ideally, the head should sit directly on the neck and shoulders like a golf ball sits on a tee. But when we begin to flex the neck forward, the weight of our head is more like a bowling ball than a golf ball. The head weighs about 12 pounds. If we have our neck flexed at a 15 degree angle, its weight effectively reaches 27 pounds. At a 45 degree angle, that weight becomes 49 pounds, and at 60 degrees – 60 pounds! To put that in perspective – that’s like having an 8 year old child hanging off of our neck! This forward neck posture leads to strain on the discs and increases the potential for disc herniation. It places a tremendous strain on the ligaments in the neck, which may cause them to become lax – or loose, which can lead to joint instability. It places extra strain on the joints and may lead to early degenerative joint disease or arthritis. It causes your neck and upper back muscles to be in a constantly contracted state – which leads to muscle fatigue, tightness and usually an accompanied burning pain. It causes the muscles at the back of our skull called the suboccipital region to have to work overtime. When these muscles tighten they can contribute to tension headaches. For stretches to help with text neck, click here! To listen to the episode, here it is! If you are interested in seeing Dr. Todd Wegerski as a patient, he can be found here.

We are back with our “2 for Tuesday” series on Back Talking! I am hosting weekly Facebook Live sessions every Tuesday at 2 pm, so check us out over on Facebook at The Joint Morrisville page. This was our second show on Facebook Live, and the first question that I answered was submitted by Margarita, a listener here in North Carolina who had a question about wearing waist trainers. The second question that I tackled is a frequently asked question in my office, “what is the popping sound when I crack a joint?” Waist Trainers Well this was a new one for me, I had absolutely no idea what she was talking about with a “waist trainer”. So off to google I go and the first thing that popped up was an image of Kim Kardashian wearing a “waist trainer”. Right away I recognized what they were talking about. It is essentially a corset. Now celebrities are claiming to have gotten back “in shape” quickly after giving birth, wearing a waist trainer. One new celebrity mom touted that it helped reduce water retention and swelling of the uterus, “all the while supporting that unwanted baggy baby skin.” Well what is waist training? It is the practice of wearing a constricting garment – such as a corset or shapewear – to reduce the size of your waistline. This practice goes back hundreds of years, and were popular around a hundred years ago as a fashion statement. Now waist trainers wrap around the lower rib cage and waist area to provide an instantly slimming look, they can reduce your midsection instantly by one to 3 inches. But the result is only temporary – giving a smaller waistline and a overall thinner appearance. If you want to go out and look really thin, I don’t have a problem with you wearing one of these. But, you’ll probably have to put up with some discomfort as well. As far as claims that these can reshape the body or trigger fat loss, there is no evidence. That discomfort I was talking about includes difficulty breathing as it interferes with diaphragm motion, heartburn as it pushes the stomach and its contents back up into the diaphragm and esophagus, it also compresses all of your organs such as the liver, kidneys, intestines and lungs as mentioned before. There is an interesting video out there on Dr Oz’s website, and I’ll put a link to the video in the show notes. He takes a woman volunteer and they perform an MRI on her, with and without the corset on. The results are rather dramatic as we get to peer inside of her and see what is happening to her organs. You see the liver being indented and deformed by the ribs, you see the stomach grossly misshapen and pushed back up to the diaphragm. You see the kidneys squished and actually elongated. Now all this squishing of your organs can decrease their blood flow and their ability to function properly! Also, wearing a waist trainer can actually decrease your core strength, your abdominal muscle tone, and cause atrophy of the muscles that make up you abdominal wall. This is exactly the opposite of what you want if you are looking for that smaller-flatter stomach! These are not a substitute for a consistent exercise program and proper diet and nutrition. If you want tighter abs, core training including curl-ups and planks form the basis for increasingly abdominal muscle strength and endurance. To lose weight, there isn’t a cheat or a quick fix to fitness. You have to do it the old-fashioned way of proper nutrition and hard work in the form of moderate to intense exercise. And to those new moms, that uterus is going to shrink when it feels like shrinking, and you can’t get rid of water weight with a corset...

We are back with our “2 for Tuesday” series on Back Talking! I am hosting weekly Facebook Live sessions every Tuesday at 2 pm, so check us out over on Facebook at The Joint Morrisville page. This week was our first show on Facebook live, so the first question that I answered was an easy one – Who am I, and why you should listen to me. The second question was asked of me in the office last week, someone was surprised to find out that x-rays weren’t necessary. So question 2 is “Are x-rays necessary?” Are X-rays Necessary? There are many tools that doctors have in their toolbox, and imaging studies such as x-ray, CT scans, and MRI allow us to peer into the body like never before. But in my opinion, the most important part of a patient encounter is the history. If the doctor asks the right questions, they have in their mind a working diagnoses before they have even touched the patient. In the answers that the patient is giving the doctor, they are listening to what are termed red flags. These are items that get the doctors attention and require further investigation. In regards to x-rays for back pain, they are only indicated if one or more of the following red flags are present: severe or progressive neurologic deficits such as loss of motor control ( i.e. foot drop or loss of reflex upon exam) loss of bowel or bladder control fever unexplained weight loss previous history of cancer long term use of steroids or immunosuppressants trauma So the answer to the question “are x-rays necessary?” is occasionally. Thank goodness that these red flags are not very common. In my practice maybe less than 5% of first time patients are referred out for some type of imaging. To listen to the podcast, click on the link below.

We continue with the series titled “what is causing your low back pain?” on Blab. We’ve been hosting weekly blab episodes every Friday at 1p, so come check us out over at blab.im. This week we discuss John, he is an elder gentleman who has arthritis, most likely caused by the 30 plus years of working on a police force. Arthritis One of the most common causes of low back pain worldwide. There are actually over 100 different types of arthritis, which is essentially a condition where one or more of your joints is inflamed. The most common form is osteoarthritis. Its typical presentation is that of pain, stiffness, and in some cases swelling. It affects around 1 in 5 Americans, and it is estimated that more than 20 million Americans have severe limitations on a daily basis due to arthritis. It places a tremendous burden onto the US healthcare system and on the economy. It causes more than 1 million hospitalizations and 45 million doctor visits in a given year. We spend more than $100 billion in its treatment. Recent discoveries have found a genetic link to osteoarthritis. But yet we are no closer to having a solution to the problem. In this episode we follow John. He is a retired cop who spent over 30+ years either walking a beat, or behind the wheel of a patrol car. I’ve seen him off and on for over 10 years now, so I know what he diagnosis is when he walks through the door. Typically he will have done something crazy to cause the arthritis in his back to flare up. This time around it was painting a room while sitting in a chair. Take a listen to this episode below!

In this week’s episode of Back Talking! we continue with the series “What is causing your lower back pain?” Lumbar strains represent probably the largest single cause of someone struggling with a lower back pain issue. We decide to clean out the basement,  help a friend move that old couch down into the basement, or spread a truckload of mulch in a weekend, and the next thing you know is that you can’t get up off of the floor! Lumbar Strain There is always confusion regarding the words sprain and strain. People use them interchangeably, but there is a difference in the medical world. A sprain is the tearing or stretching of a ligament, a strain is the tearing or stretching of a muscle. When someone rolls their ankle and sprains it, they have suffered an injury to the ligaments surrounding the ankle joint. When someone overdoes it working in the yard, it’s typically a muscle injury. The good news is that muscle strains recovery fairly quickly. In this case study we follow Jason. He is one of those guys that had a truckload of mulch dumped into his driveway. He then spent the next 2 days spreading that around his yard with a rake and a shovel. If that wasn’t enough, the following weekend he decides to tear a rotting deck off of the back of his house. The days that followed for him were a real struggle, so much that his wife had to help him dress and put on his shoes for him! He’s having a hard time sitting at work as well. We also clarify the age old heat or ice debate that people so frequently ask about. We also discuss the use of topical creams such as Icy-Hot and Ben-Gay. So take a listen and see how Jason recovers from his weekends of work!

Annular tears most commonly occur in discs that are degenerating or breaking down. In this episode we continue our series on blab titled “What is causing your lower back pain?” We discuss Sheila, a 54 year old office worker who has recently been diagnosed with an annular tear. Annular Tear The intervertebral disc is comprised of 2 components, the annulus fibrosus and the nucleus pulposus. The annulus is made of tough cartilage and is arranged in concentric rings around the inner nucleus. Its job is to contain the nucleus and to withstand the high compressive forces of the spine. The inner nucleus pulposus is made up of several substances, most importantly proteoglycans and water. Its job is to help spread those compressive forces of the spine over a greater surface area of the vertebra. A healthy disc absorbs its nutrition from its neighboring vertebra. It needs oxygen, glucose and water to survive. When discs begin to degenerate, they lose their ability to attract oxygen, glucose and water, their cell metabolism begins to slow down and they eventually die. The annular fibers then can no longer withstand the high forces generated in the spine and they can develop tears. The tear can be radially through the layers from the inside out, or concentrically – in between 2 layers. Some tears are symptomatic and produce pain, while others are not painful at all. In this episode we discuss Sheila. She was recently diagnosed with a radial annular tear. She was experiencing lower back pain. She was a very non-compliant patient, as some are, and did not do what she could to help herself get out of pain. The best clinician in the world will not be able to help you unless you remove the source and cause of the pain.

Spondylolytic spondylolisthesis. Wow that is a mouthful! Okay, now for a translation of the words, that should help to make things a little clearer. Scotty Dog! Spondylo means vertebra, lytic means to burst, and listhesis means to slip. So the word translates to a burst and slipped vertebra! Yikes! that doesn’t sound very good! Actually, there are many people walking around with this and have no idea at all. Spondylolisthesis This condition has numerous causes, and in fact has been classified into 6 different categories. What we are going to discuss today is the lytic type that affects the pars interarticularis. The mechanism of injury for this type is thought to be from repetitive cycling of the vertebra between flexion and extension. This cycling motion creates either a stress fracture or a complete break through the posterior arch of the vertebra called the pars interarticularis. To understand this better, think of when you are trying to break a “green” stick. You bend it back and forth, back and forth, until it finally snaps. Well this is essentially the same phenomenon that takes place in the spine. An activity such as gymnastics, with all of the tumbling and flipping,  football lineman in going from a 3 point stance to make contact with the player across the line of scrimmage, and pole vaulters arching up and over the bar, are all considered high risk activities for spondylo’s. In this episode we follow the story of Jessica. She is a 17 year old student at one of the local high schools. She is a volleyball player with scholarships to 3 colleges to play ball for them. She is also on several club teams in the area, so she is on the court 6 days a week. With all of the training, playing in matches, and time spent in the weightroom, she has developed a spondylolytic spondylolisthesis.

Canal stenosis is a common diagnosis for someone suffering from back and/or leg pain. What is stenosis? Canal Stenosis Stenosis is from the Greek and means narrowing. With that it mind, it should make things a little clearer. You can have narrowing in blood vessels (think heart attack), narrowing in your intestines (scarring from Crohn’s disease), and narrowing in your spinal canal. The canal is where the spinal cord and the nerves that exit off of the cord live. Any of the structures that surround the canal can cause it to narrow, or stenose. Bone, discs, and ligaments are the typical culprits. Degenerative changes in the spine, typically seen in the older  populations, is the number one cause of spinal stenosis. The disc may bulge or herniate into the canal. Osteophytes or bone spurs from the vertebrae may also encroach on the canal. The facet joints may start to hypertrophy or enlarge due to wear and tear, and that enlargement can make the canal size smaller. And finally, the ligament that has as it’s function to keep stuff out of the back of the canal, can also hypertrophy and shrink the size of that canal. Lumbar Canal Stenosis As mentioned above, there are numerous ways that the spinal canal can be narrowed. When this occurs it can place pressure on either the spinal cord and its exiting nerves. That pressure can cause pain, and also tingling, weakness, and cramping in the legs. In this podcast, this is a replay of the audio from our video show on Blab. We are running a series titled “What is causing your lower back pain?” You can find the video show under the “video show” tab on the homepage. This weeks episode focused on an older gentleman who was struggling with spinal stenosis. So take a listen.

Have you been struggling with facet issues? Well you are not alone. Facet joint problems are one of the leading causes of lower back pain. Back Talking, the video show,  has moved and is now being hosted on Blab. We are currently running a series titled “What is causing your lower back pain? In this the so called “pilot episode”, we discuss a real life case study of someone diagnosed with facet syndrome.

America is facing the worst addiction crisis ever seen. This story is not about shady drug dealers or back alley deals. It starts with every day people seeking pain relief in their doctors offices. America is awash in opiate pills, there are enough pills prescribed each year to keep every adult American medicated around the clock for a month. Regrettably, almost 1 out of 4 people will become addicted and over 17,000 people a year die from prescription opiate overdoses. People suffering from back pain are at risk of being improperly managed by their physician and prescribed increasingly stronger medications such as opiates. Tweet This

Given the fact that we spend almost 1/3rd of our lives in bed, the position that you sleep in can have a direct impact on your back health. Hard Days Night! In episode 8 of Back Talking, Dr. Todd Wegerski began the discussion on sleep with recommendations for the best type of mattress that you should be sleeping on, and the best type of pillow that you should using. Well you can own the best mattress and pillow in the world, but it isn’t worth much if you twist yourself up in a pretzel while you sleep! Listen below for the 2 best positions that one should be sleeping in to prevent back pain or to help manage your back pain.

Given the fact that we spend close to 1/3 of our day (and lifetime) in bed, the right type of mattress and pillow can make a difference in waking up achy and sore vs refreshed and ready to tackle the day. Back pain is one of the top reasons that we start to lose mobility as we age. It interferes with physical activity, and could begin the downward spiral of weight gain, loss of strength, endurance, and balance. In this episode of Back Talking, we examine the literature to see what is the best recommended mattress and pillow type for you to help prevent or manage back pain.

In this episode of Back Talking! we take a look at the recently updated FDA warning for NSAID medications. Common examples of NSAID medication are Motrin, Advil, and Aleve. The use of NSAID medications in the United States has skyrocketed, total annual sales of the before mentioned drugs alone tops out at over $1 billion. But there is a significant risk of heart attack or stroke related to the use of NSAID medications.  Take a listen.

In this episode of Back Talking, it’s a “2 for Tuesday” version of the show. Our first topic of discussion is pregnancy. Pregnancy and lower back pain go together like peanut butter and jelly.  Is it any surprise with the suggested 25-35 pound weight gain and a protruding abdomen? But surprisingly only 1 out of 3 pregnant women seek care for their lower back pain. The most common treatment sought is massage therapy, then yoga, with chiropractic care down at the bottom with only 6% choosing chiropractic care! The changes taking place to mom and the growing baby inside greatly increases the stress on the lumbar spine and pelvis. Discs, ligaments, and joints can become damaged and pain generators. But chiropractic care can help in all those instances. There are tremendous benefits of receiving chiropractic care during pregnancy:  It is completely safe, and it is drug free! The use of drugs are always a concern during pregnancy Of those pregnant women seeking care, 84% found relief! So it works! Significantly reduces the likely of “back labor” during labor Of first time moms, labor times were cut by 25%, compared to those who did not receive chiropractic care during pregnancy. Of those who had given birth before, labor times were 31% shorter. I think any woman would gladly sign-up for shorter labor times! The second topic is about acetaminophen, or more commonly known as Tylenol. Low back pain and Osteoarthritis guidelines list acetaminophen as the first go-to drug of choice for these conditions. However, an analysis of research showed that the widely used pain killer was ineffective against back pain and offers only minimal benefit to those with hip or knee osteoarthritis. With ongoing and increasing concern about treating musculoskeletal pain with drugs, this highlights the importance of non-drug related treatment options. While the effectiveness of exercise for both spinal pain and OA is established, the findings of these studies emphasize that the time has come to shift our attention away from popping pills as the default option for managing chronic musculoskeletal pain. Non-pharmacologic treatments work, are safe, and have benefits that reach far beyond the musculo-skeletal system.

In this Two for Tuesday episode, we discuss 2 commonly asked topics regarding the lower back. Many people upon arising have some form of exercise or stretching routine. But you may be surprised to find out that you should wait about 30 minutes or so after getting out of bed before you jump into that stretching routine! That stretching may be doing more harm than good, and may be what is preventing your back from recovering from an injury. The second topic deals with back or core strength. It is thought by many that having a strong core or back will prevent your back from potentially being injured. Quite the opposite is true, it takes very little strength (about 10% of your back muscles maximum power) to stabilize the spinal joints. It is endurance that is more protective for backs than strength! That is why I’m always saying to get off your butt and move! Take a listen:

Todd Wegerski hosts “2 for Tuesday” What I do most is answer questions. People ask a lot of questions regarding what is going on with them. I can see the wheels turning so to speak when we are talking. I’ve done this long enough to anticipate what people are going to ask next. I’ve decided to do a “2 for Tuesday” series. There are many questions that need an answer, but don’t warrant a long drawn out response. So here we go! In this first “2 for Tuesday”, the first question is about back belts. You know the ones, you’ve seen them on weightlifters and at your local Home Depot. But is there a benefit to wearing them? Question 2 is a simple strategy that you can use at work to change your posture to minimize stress and strain on your body!  Hint: it’s something you’ve been sitting on for years. To learn more about Todd, come visit us!

In this episode of Back Talking! Dr. Todd Wegerski continues the discussion of what causes back injuries, and expands into tissue healing and what risk factors can potentially cause a back injury. We delve into and answer the following questions: Do tissues heal within 6-12 weeks? Can it take up to 10 years for some low back disorders to form? Lasting changes to which injury leads Do sedentary workers have a higher rate of disc herniation? and many more

Way to go Charlie Brown! In this episode of Back Talking! Dr Todd Wegerski discusses the one reason, yes the one reason that causes back injuries. With 80% of the population having back pain at some point in their life, and with 50% of those having a recurrence every year, we have reached epidemic proportions. Learn how through a skillful provocative examination, such as a movement screen, we can identify what is the true culprit that is causing your back pain. We review how different types of tissue loading causes injury, but we reveal the one thing that can help you avoid back injuries.

In the first episode of Back Talking, Dr. Todd Wegerski discusses the “current state” of back pain in the United States and world today. Did you know that 80% of people will suffer from back pain at some point in their life, and that over half of those people will have a recurrence every year? Did you know that we spend over a $100 billion dollars a year treating back pain in the US, and the problem is only getting worse? The discussion focuses on what has caused us to have the situation that we face today. Problems such as medical mismanagement, the obesity epidemic, lack of exercise, and the modern lifestyle has led us down the path of the back pain epidemic.

Every show starts somewhere! This is the inaugural episode of Back Talking! Dr. Todd Wegerski DC discusses the “Why, Who, and What” of the show. Back Talking will discuss all things related to the spine. Discussions will be centered around what is causing your back pain, conditions that cause back pain, treatments for back pain, and what everyone wants to know – how to keep it from coming back! So join us here as we “talk back.”