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Updated: Jan 4, 2022

A quick read for the busy computer worker.



You may have been told by a friend or family member or read an article warning you that “sitting is the new smoking.”


How did you feel when you heard this? Possibly anxious? Confused? Concerned for the future? Afraid that your body is going to fall apart?


Or maybe someone told you that you deserve your back pain because you sit all day?


These are all real life experiences that I commonly get asked about and you (the reader) deserve to have access to quality information that despells harmful opinions.


Sitting at your desk is NOT slowly killing you, but overall inactivity may be. When you look at it this way, sitting is no different than standing or lying on your back or on your stomach. They all involve static positions and lack of movement.


So, can you sit all day and still be healthy!? Absolutely!


I remember in Chiropractic school one of our professors telling us that if you sat for more than six hours in a day, there is nothing you can do to counteract or undo this amount of sitting.


What a bunch of BS!


There’s no cut off point where a certain amount of inactivity makes it impossible for you to counteract with physical activity. Unless, of course, you are inactive all day, every day. But I think we can all recognize that that is not healthy behavior.


And that brings us to our next question…


How much physical activity do I need?


The current Physical Activity Guidelines for Americans are as follows:




Individuals meeting both the aerobic and resistance training components of these guidelines have better health outcomes across a range of conditions, including obesity, high blood pressure, diabetes, and a number of other conditions. Bennie 2020


Ya, ya…That’s all great, but...


why do my shoulders, hips, back, and neck kill me after sitting at my desk all day?


Joints and muscles LOVE movement, so any period of prolonged inactivity may increase the chances of your body feeling stiff, tight, or painful. Rather than looking at these aches and pains as an indicator of damage, look at them as a sign that it is time to get up and do a bit of movement.


The spine and extremities also love variation. So if you’re locked into four hours of nonstop computer work, it may be a good idea to frequently change positions. Purchasing a standing desk or a desk that goes from high to low, may be a great option.


Certain stretches and repetitive movements can also be tremendously helpful for desk workers.


recommended movements for the

desk worker



In the remainder of this article, you will find just one of the movement prescriptions from our MVMT program MOVE. This program is an educational guide full of in-depth videos and movement prescriptions aimed at the desk worker's common ailments.



MOVE

Low Back & Hip

**Adjustable playback speed.



Modifications/Progressions/Extra Notes:

Prone Press Up Modifications –

a. Yoga strap/band assisted: The strap in particular adds some nice downward pressure for you to use as a fulcrum to extend over. A dog leash may also do the trick.

b. Kneeling hip dips: A great alternative to the prone press ups that is less fatiguing on the arms. Note that the finishing position is identical to the prone press ups. Dip your belt buckle into the floor, exhale, and hold for a two count. Repeat for 10-15 repetitions.

TIP: Similar to the repetitive neck movements, some discomfort is often felt at the finishing position. It is encouraged to repeat for up to 3-4 sets, as oftentimes the discomfort begins to ease, and this movement becomes quite relieving. If you are experiencing significant low back achiness, it may be very helpful to perform one set of one of the above variations every 1-2 hours that you are awake, for 7-10 days, then adjust the reps and sets accordingly. It is also important to emphasize that there is a strong correlation with low back pain and lack of physical activity. Increasing your daily/weekly physical activity may be more helpful than performing prone press ups.

Kneeling Lunge Progressions –

a. Kneeling lunge with speed: adding overpressure and speed often improves the feel-good effect of this movement. Place one hand on the back of your hip and aggressively press the hip forward to finish the lunging movement.

b. Kneeling lunge with reach: another alternative is to lunge forward, reach overhead, and lean away. You may feel a nice stretch on the side of your torso.

c. Kneeling lunge with rear foot elevated (not in video): an additional alternative is to place your rear foot on a stool or your desk chair and go through the same lunging movement. This will place a greater challenge on the front of the thigh.

90/90 Shin Box –

Regression:

- 90/90 Shin box with support: use a pillow, rolled up towel or mat and place it beneath your hips. Typically, the rear hip is the limiting factor in this position so if you’d like to challenge the front hip more, place a book or pillow beneath the front ankle.


TIP: Stay tall, keep your chest proud and oriented forward. Most of the motion should be at the hips. Rotate the top of your back pocket towards the floor and hold for 5 seconds. You will feel a stretch deep inside your hip. Return to the starting position, then hinge forward over the front leg keeping your chest proud. You will feel a stretch in your lateral hip. Hold for 5 seconds and repeat for 5 sets front and back.


In our full program, MOVE, we cover more for the Neck, Shoulders and Mid-Back.


 

If you found this article helpful, please share with your friends and followers. Let us empower and educate each other, so we can all build our confidence in our ability to move.


Leave a comment for discussion or as always, feel free to contact us with questions.


Are you interested in Chiropractic Care, or are you still unsure of who you should see to treat your painful condition? Book a free virtual discovery visit here. We can discuss your current situation and have an honest conversation.





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Updated: Jan 13, 2022

When Should I See a Chiropractor?

We need to start by defining what a Chiropractor is. Chiropractic is often thought of as a type of treatment, rather than a profession. And that is understandable considering there are many Chiropractors who only perform spinal adjustments and then send you on your way.


A Chiropractor can be viewed as a non-surgical neuromusculoskeletal clinician that possesses the scope to diagnose and treat a vast number of conditions. We undergo 3.5 years of rigorous post-graduate training designed to help us also recognize pathology that is out of our scope and warrants referral to another provider.


Chiropractors are uniquely positioned to play an integral role in lifestyle interventions. This often involves a holistic approach to health, including nutritional and exercise advice, stress management, sleep hygiene, and potentially co-management with medical doctors, nurse practitioners, physical therapists, and/or mental health professionals.


In private practice, Chiropractors have the ability to book out longer patient visits. This affords us the time often necessary to fully listen to a patient’s story. This valuable time spent together can be instrumental in forming a strong therapeutic alliance, where the patient and clinician both play an integral part in shared-decision making.


So, when should you see a Chiropractor?


This really comes down to if you have a Chiropractor that you feel you can trust. A masterful Chiropractor should have the tools to directly help you with a multitude of conditions but, as stated before, also be able to recognize issues that are out of their scope and refer you along to another healthcare provider.


What can a chiropractor help you with?

These are some of the common reasons you might see a chiropractor.

  • Low Back Pain

  • Neck Pain

  • Mid-Back Pain

  • Shoulder Pain

  • Groin Pain

  • Hip and Hip Flexor Pain

  • Knee Pain

  • Ankle Pain

  • TMJ Pain

  • Sciatica

  • Disc Herniation

  • Pinched Nerve

  • Stenosis

  • Rotator Cuff Tears

  • Biceps Tendinitis/Tendinopathy

  • Shoulder Impingement

  • Carpal Tunnel Syndrome

  • Thoracic Outlet Syndrome

  • Piriformis Syndrome

  • IT Band Syndrome

  • Patellofemoral Pain Syndrome

  • Femoral Acetabular Impingement

  • Hip Bursitis/Gluteal Tendinopathy

  • Osteoarthritis

  • Plantar Fasciitis

  • Achilles Tendinitis/Tendinopathy

  • Jumper’s Knee (Patellar Tendinitis/Tendinopathy)

  • Golfer’s Elbow

  • Tennis Elbow

  • Hamstring Injuries

Don't see your issue? Contact Us


5 Red Flags to look for when visiting a Chiropractor

There are also red flags to consider when choosing a Chiropractic clinic. The website, Choosing Wisely, is a great resource to help the lay person identify what to look for and what to stay away from when choosing a Chiropractor. In general, here are some things to look out for:


  1. Initial visit X-Rays: Unless your Chiropractor has reasonable suspicion of fracture, infection, cancer, or some other sinister pathology, initial visit X-Rays should NOT be taken.

  2. Using previous or current X-Rays/MRIs to sell you on a treatment plan. There is no QUALITY evidence to suggest that multiple visits to a Chiropractor per week is necessary in order to change anything on your imaging.

  3. Using your X-Ray to validate “spinal misalignments” and the need to correct them with specific Chiropractic adjustments. Also, never been validated. We all have minor asymmetries and outside of severe scoliosis, they are nothing you need to be concerned with.

  4. Spinal decompression packages: While spinal decompression can help some people some of the time, it is not a strongly supported intervention for back pain and should be used sparingly. Spinal decompression packages are often thousands of dollars up front. More cost effective measures should be tried first.

  5. Complete reliance on passive interventions such as: electric stimulation, ultrasound, ice, heat, massage, and even chiropractic adjustments without discussion or implementation of self-management strategies the patient can perform at home.


Are you interested in Chiropractic Care, or are you still unsure of who you should see to treat your painful condition? Book a free virtual discovery visit here. We can discuss your current situation and have an honest conversation.





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Low back pain - What is it and what are the risk factors?


Low back pain is complex. If we had a simple solution, it wouldn't be the leading cause of disability worldwide.


So, what is low back pain?

 

Low back pain is defined by the location of pain, typically between the lower rib margins and the buttocks creases. It can be accompanied by pain in one or both legs and some people with low back pain have associated neurological symptoms in the lower limbs. Low back pain is a complex condition with multiple contributors to both the pain and associated disability, including psychological factors, social factors, biophysical factors, comorbidities, and pain-processing mechanisms (Lancet, 2018).

Low back pain is extremely common. It’s estimated that 85% of adults will experience it at some point in their lives and 7.3% (540 million people) currently have low back pain (Lancet 2020). Of these cases, 85-90% are considered non-specific low back pain.


This poses the question, what is non-specific low back pain (NSLBP)? Due to the complexity of low back pain, a pathoanatomical cause of low back pain usually can not be determined. NSLBP is a term of diagnostic honesty acknowledging our inability to find a specific source of pain.


The diagnosis of NSLBP is not meant to minimize the patient’s experience, but rather indicate that specific causes such as spinal fracture, infection, cancer, axial spondyloarthropathy, or radiculopathy have been ruled out, and reassure the patient that nothing serious or sinister is causing their pain. In fact, NSLBP should be viewed as a fairly benign part of daily life.



Disc Herniation


If you’ve sought medical advice for your low back pain there is a high likelihood you’ve been told you have a disc herniation, bulge, or extrusion. In only a small percentage of low back pain cases can we determine if disc pathology is likely the culprit. These are cases of radicular pain or radiculopathy. Radicular refers to nerve root involvement where there is also a presence of concurrent leg pain (oftentimes worse than the low back pain) and/or clear neurological symptoms. Radicular pain is most commonly caused by disc pathology and is estimated to be the source of low back pain in roughly 10% of cases (Ferreira 2019). The graph below from Ferreira & colleagues shows the discharge diagnosis given to 14,024 patients who visited the emergency room for low back pain between January 2016 and June 2018 at three different hospitals in Sydney, Australia.



Note that of those given a lumbar spine diagnosis as the primary source of their low back pain, 85.4% were NSLBP, 10.1% were radicular pain, and 4.5% were found to have serious spinal pathology.


In cases of NSLBP, is it not possible to accurately determine if disc pathology is the cause of someone’s pain. For example, (Brinjikji 2015) found that 50-70% of pain free individuals, aged 40-49, had findings of a disc bulge or disc protrusion on MRI. Another study by (Brinjikji 2015) found that nearly 20% of asymptomatic patients 50 years of age or younger had disc protrusion compared with nearly 40% in the symptomatic group. This study demonstrates that there may very well be a correlation between disc pathology and NSLBP, but this should not be interpreted as causation. More importantly, diagnosing these findings on MRI is unlikely to change management.



Degenerative Changes


Degenerative joint disease (DJD) and degenerative disc disease (DDD) are commonly given diagnosis. These age-related adaptations are present in an overwhelming number of the asymptomatic population. The chart below from (Brinjikji 2015) a systematic review demonstrates age-specific prevalence estimates of spine imaging findings in asymptomatic patients. Disc degeneration is present in 40% of asymptomatic twenty-year-olds, 80% of asymptomatic fifty-year-olds, and 96% of asymptomatic eighty-year-olds, which I would argue is likely 100% of those eighty years or greater.


MRI is highly sensitive in detecting degenerative changes; however, this study and previous studies demonstrate that it may not be possible to distinguish between age-related degenerative changes and pathologic, pain-generating degenerative changes.



Labelling these anatomical changes as “degenerative” also suggests that there is something wrong with the structure it refers to. The chance of finding these changes on MRI or X-Ray increases as we age, but again, the prevalence of these findings do not correlate strongly with the patient’s reported level of pain or disability. So instead of degenerative changes, we should be using the term normal age related changes.


Take skin wrinkles for example. Your doctor wouldn’t tell you that you have degenerative skin disease. Wrinkles are normal, age-related changes that occur over time.



Who’s At Risk?

 

It should be clear by now, in most cases, there is no singular cause of back pain. Back pain is caused by a combination of biological, psychological, and social factors. This is known as the biopsychosocial model.



Biological Factors


From a biological standpoint there is often a mismatch between what the person asks their body to do and what they are prepared to do or tolerate. This may show up in occupational work, weightlifting, military fitness testing, or frequently seen with weekend warriors. These are issues related to workload management.


How can we reduce the risk of these occurring? Well, in simple terms, begin at a level of activity that is well tolerated and then build slowly from there to increase the likelihood that you are ready to handle a given task.


It should be noted that just because a certain tissue is sensitive, it does not mean that it is damaged or that you will cause harm if the activity is continued. Pain does not equal harm, in most cases, but rather an alarm system that is in place to drive behavioral change. The behavioral change most appropriate with low back pain is to remain physically active within your individual tolerance and then slowly build up from there, giving your body a chance to adapt to the new demands.


Psychological & Social Factors


Psychosocial factors have become increasingly recognized as important contributors to the pain experience (Kraljevic 2011). These factors include depression, anxiety, catastrophizing (ie, an irrational belief that something is far worse than it really is), low self efficacy (ie, belief in one's ability to influence events affecting one’s life), and fear avoidance (ie, fear of pain leading to avoidance of activity). The presence of these factors in individuals presenting with low back pain is associated with increased risk of developing disability (Lancet, 2018).


Many of our beliefs about low back pain are learned threats from close friends, family members, and oftentimes medical providers. This process of learned behavior begins in childhood. Children learn pain-related beliefs and behaviors by observing their parents’ pain behaviors and in turn, adopt similar behaviors in response to their own pain (Stone 2016).


This likely does not come as a surprise, as many of us have a friend or family member who grew up with one of their parents having a “bad back” or “bad knees” and then ended up developing a similar chronic condition themselves. These narratives about pain are harmful and pervasive, and oftentimes lead to fear avoidant behavior. Activity avoidance in response to pain may perpetuate symptoms and lead to long term disability.


Occupational influences also seep into our unconscious thoughts about pain and injury. Brochures and flyers showing “proper lifting technique”. “Don’t lift with your back, that’s dangerous! Lift with your legs.”


The same can be said for social media. “Social influencers” claiming to be experts, warning their followers to not round their back! “Be careful. You only get one spine!”


These narratives are harmful, and this isn’t even the worst of it!


One survey in 2017 asked 130 individuals with persistent back pain, “What is your understanding of why your low back pain is persistent or recurring?” Four clear patterns of thinking were found:

  1. Broken Machine - the body can break and sometimes be repaired. Low back pain persists because something is physically defective.

  2. Low back pain as permanent/immutable - Low back pain is conceptualized as a static or fixed entity that once ‘broken’ it cannot be ‘fixed’. Low back pain is permanent.

  3. Low back pain is complex - multiple factors can contribute to persistence of Low back pain, including biomechanical, psychosocial, and cultural factors.

  4. Very Negative - Low back pain is abnormal, catastrophic, and has a large effect on life.


The most alarming finding from this survey was that 89% of participants indicated that they learned these beliefs from healthcare professionals (Setchell 2017). So not only are we being inundated with harmful information from social media, the workplace, and our loved ones, but we are also receiving unsubstantiated information from medical professionals. This is a huge problem in healthcare and one that needs to be corrected if we wish to reduce the global burden of low back pain.

Lifestyle factors, such as smoking, obesity, and low levels of physical activity, that relate to poorer general health, are also associated with occurrence of low back pain episodes (Lancet, 2018). Unfortunately, roughly 80% of Americans do not fulfill the U.S current weekly Physical Activity Guidelines (Piercy 2018). Part two of this series will discuss what steps you can take to reduce the risk of developing disabling low back pain, possible treatment options, and how you can play an active part in reducing the global burden of low back pain.



Take-Home Points


  1. The majority of individuals will experience low back pain at some point in their life.

  2. 90% of low back pain is considered to be Non Specific Low Back Pain. NSLBP is a diagnosis that accurately represents the complex nature of most low back cases and excludes more emergent causes such as spinal fracture, infection, or cancer.

  3. Imaging such as X-Ray and MRI does not accurately and reliably demonstrate the source of someone’s low back pain, in most cases.

  4. Social media, Dr. Google, occupational safety information, and friends and family are not reliable sources of information for low back pain. Unfortunately, many healthcare providers are not much better. More work needs to be done to improve the narratives around low back pain.

  5. An emphasis needs to be placed on remaining active and continuing participation in meaningful activities, reducing time away from work, and improving overall health in order to reduce the risk of low back pain becoming disabling.


If you found this article useful, please share with a friend, family member, or colleague to help spread evidence-based information. My goal is to play a small part in reducing the global health burden of persistent pain.


- Credit to the Barbell Medicine team, Dr. Greg Lehman, and Dr. Jonathan Hodges for helping to formulate many of the ideas presented in this article.

- Edited by Dr. Lacey Venanzi & Geronimo Bejarano


References:

  1. Brinjikji, W., Diehn, F., Jarvik, J., Carr, C., Kallmes, D., Murad, M., & Luetmer, P. (2015). MRI Findings of Disc Degeneration are More Prevalent in Adults with Low Back Pain than in Asymptomatic Controls: A Systematic Review and Meta-Analysis. American Journal of Neuroradiology, 36(12), 2394–2399. https://doi.org/10.3174/ajnr.a4498

  2. Brinjikji, W., Luetmer, P., Comstock, B., Bresnahan, B., Chen, L., Deyo, R., Halabi, S., Turner, J., Avins, A., James, K., Wald, J., Kallmes, D., & Jarvik, J. (2014). Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. American Journal of Neuroradiology, 36(4), 811–816. https://doi.org/10.3174/ajnr.a4173

  3. Buchbinder, R., van Tulder, M., ÖBerg, B., Costa, L. M., Woolf, A., Schoene, M., Croft, P., Buchbinder, R., Hartvigsen, J., Cherkin, D., Foster, N. E., Maher, C. G., Underwood, M., van Tulder, M., Anema, J. R., Chou, R., Cohen, S. P., Menezes Costa, L., Croft, P., . . . Woolf, A. (2018). Low back pain: a call for action. The Lancet, 391(10137), 2384–2388. https://doi.org/10.1016/s0140-6736(18)30488-4

  4. Ferreira, G. E., Machado, G. C., Abdel Shaheed, C., Lin, C. W. C., Needs, C., Edwards, J., Facer, R., Rogan, E., Richards, B., & Maher, C. G. (2019). Management of low back pain in Australian emergency departments. BMJ Quality & Safety, 28(10), 826–834. https://doi.org/10.1136/bmjqs-2019-009383

  5. Hartvigsen, J., Hancock, M. J., Kongsted, A., Louw, Q., Ferreira, M. L., Genevay, S., Hoy, D., Karppinen, J., Pransky, G., Sieper, J., Smeets, R. J., Underwood, M., Buchbinder, R., Hartvigsen, J., Cherkin, D., Foster, N. E., Maher, C. G., Underwood, M., van Tulder, M., . . . Woolf, A. (2018). What low back pain is and why we need to pay attention. The Lancet, 391(10137), 2356–2367. https://doi.org/10.1016/s0140-6736(18)30480-x

  6. Piercy, K. L., Troiano, R. P., Ballard, R. M., Carlson, S. A., Fulton, J. E., Galuska, D. A., George, S. M., & Olson, R. D. (2018). The Physical Activity Guidelines for Americans. JAMA, 320(19), 2020. https://doi.org/10.1001/jama.2018.14854

  7. Kraljevic, S., Banozic, A., Maric, A., Cosic, A., Sapunar, D., & Puljak, L. (2011). Parents’ Pain Catastrophizing is Related to Pain Catastrophizing of Their Adult Children. International Journal of Behavioral Medicine, 19(1), 115–119. https://doi.org/10.1007/s12529-011-9151-z

  8. Stone, A. L., & Walker, M. S. L. S. (2016). Adolescents’ Observations of Parent Pain Behaviors: Preliminary Measure Validation and Test of Social Learning Theory in Pediatric Chronic Pain. Journal of Pediatric Psychology, 42(1), 65–74. https://doi.org/10.1093/jpepsy/jsw038

  9. Verhagen, A. P. (2016, July 4). Red flags presented in current low back pain guidelines: a review. European Spine Journal. https://link.springer.com/article/10.1007/s00586-016-4684-0

  10. Vos et al. (2020). Global Burden of 369 Diseases and Injuries in 204 Countries and Territories: A Systematic Analysis for the Global Burden of found that 50-70% of pain free individuals, aged 40-49, had findings of a disc bulge or disc protrusion on MRI. Another study adone by

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