3 Things Everyone

Should know about

back pain
(But you probably don’t)

Sean O. Riley, DC

Tulsa Spine and Rehab 918-743-3737

Back Pain, Page 1
 What to know about back pain

Understanding it

Why does it hurt in the morning?

Causes & treatments of low back pa
in

Pages 3—9

Preventing it

The role of exercise

bility
Importance of flexibility and mo

Pages 10-14

Treating it

What is chiropra
ctic manipulatio
Finding a chirop n?
ractor

Pages 15-20

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Back Pain: Understanding it

Causes and treatments

Low back pain is one of the topmost reasons people visit their
physicians and chiropractors, and studies have shown there are
roughly four or five common predictors of low back pain.

In order to diagnose the actual pain triggers, we perform

examinations, as well as, send patients for MRI’s and X-rays because
a good diagnosis is essential in prescribing a plan for wellness.

These are five of the most common predictors of back pain, and
although physicians have been teaching and pushing patients to take
precautions to control these predictors for years, it is no less
important today. You will benefit greatly from making wiser eating
choices, losing excess weight, continuing to exercise, and of course,
quitting smoking.

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Obesity
Obesity plays a key role in low back pain and unfortunately, it has
become a part of our modern culture to be at least somewhat
overweight. When we put on excess weight, we also become more
forward weight bearing mechanically, which puts pressure on our
lower back. Secondary to obesity are spinal stabilizers which affect
our core. If our core isn’t functioning properly, chronic low back pain
sets in, which is reflected in injuries after bending and lifting. People
become more prone to accidents and injuries when their core is weak.

Aging
Aging plays a very large role in low back pain and just recently I did
MRI’s on two female patients, one being 42 years old and the other
being 65. Both had the same MRI findings, but the 42 year old
manifested with different symptoms. This is commonly due to body
mechanics. As we age, the margin for error decreases and it becomes
more important that we pay attention to our eating habits, our
weight, and our exercise because all of these play a factor in low back
pain.

Smoking
Smoking is also a common predictor of low back pain. Although it’s
common knowledge that smoking is bad for your heart and lungs,
many people don’t realize that smoking is bad for your spine. It can
cause advanced arthritis and disc disease because it speeds up the
dehydration process in a person’s discs. Aging begins this
degenerative process, but smoking hastens this process even more.
Smoking is something we can control and if you smoke a pack or

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more of cigarettes a day, it’s imperative that you slow down or stop
smoking altogether for the health of your back.

Sedentary Lifestyles
Sedentary lifestyles are yet another predictor of chronic low back pain.
I refer to this as cumulative trauma, which means that over time a lack
of exercise and/or a poor diet contributes to poor mechanics in our
bodies. The best thing we can do for ourselves is to keep moving and
keep exercising. Lack of motion on a regular basis breaks down our
body mechanics and when you add the normal progression of aging,
you are setting yourself up for chronic low back problems.

Desk Jobs
Desk jobs are last, although not the least of the predictors of low back
pain. Sitting at a desk, behind a phone or in front of a computer
increases pressure on the lower back which, over time, causes
problems. Maintaining good posture through good ergonomics is
important, especially when you consider the fact that many people
spend 8 to 9 hours at a desk on a daily basis. We talk to patients about
what are called “micro breaks.” Micro breaks encourage movement
every 10 to 15 minutes, and there are timers that you can download
to your computer which will remind you to take these little breaks.

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Back Pain: Understanding it

Why does my back hurt

worse in the morning?

There are a lot of people who have some level of every day lower
back pain. If you wake up in the morning, and your lower back
hurts even worse, there are a few things you should check out.

The first thing that I would always recommend is to evaluate your

mattress. I'm not telling you to go out and spend thousands of dollars
on a new mattress, but there was a study that I read that said 68% of
people, after evaluation thought they needed a new mattress. So,
check to see if your mattress is giving you enough support. A lot of
times you'll travel to a hotel, and think,“Man, I haven't slept that well
in years!” Well, it's obviously the mattress. Sometimes patients tell
me, “I got down on the floor last night!” Well, that floor probably

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provided quite a bit of support. So, I would definitely evaluate your
mattress.

What Kind of Mattress is Best

I like a firm mattress and my wife and I just had an argument about
this. We just purchased a new mattress a couple weeks ago. The sales
person came over and said, “What can I help you guys with?” I said,
“We need a new mattress.” And he says, “What do you guys want?”
And, simultaneously, I say, “Firm,” she says, “Soft.” He says, “This is a
problem you guys need to work out on your own,” and just left us
alone for awhile.

But related to this type of pain, firm is always going to be better. We

want something to provide plenty of support to the back. That's
why I'm starting to tell patients to get away from pillow tops. Those
things break down. Two years into it, there's almost like a crater in
the top of the bed. I actually went with a memory foam, or
Tempurpedic type mattress that we've really, really liked. It's really
helped us out quite a bit. I just tell folks to get out there, do your
research. Talk to your doctor, talk to your chiropractor, your physical
therapist. Some salespeople, are obviously going to try to sell you one
of the most expensive mattresses. But, get on the mattress. Many of
these mattress stores will give you 90 days to take it back. Just figure
out what you're comfortable with because you're going to be the one
sleeping on it. And firm is always going to be a little bit better than
soft when it comes to supporting your back.

Other Causes of Lower Back Pain in The Morning

There are two other big issues that can come into play. I call them
mechanical and chemical.

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By mechanical, I’m talking about the position you sleep in.
Typically, patients are sleeping on their stomach, and it's big no-no.
When you sleep on your stomach, you're going to put your back into
extension, increasing the pressure into your lower back and making
you really uncomfortable. So how should you sleep? Get on your back.
Put a pillow, or something rolled up, underneath your knees. Get your
knees bent to like a 45 degree angle. That will take some of the
pressure off your back. Or, lie on your side. Get your knees bent to a
45 degree angle. And maybe get something, such as a pillow, between
your knees. Just stay off your stomach.

By chemical, I’m referring to some kind of pain generator.

Typically, like a disk problem. The disk is the spongy, jelly thing in
between two of your vertebrae, in your backbone. When we sleep, that
disk actually rehydrates. It's called hydrostatic pressure. And
actually swells a little bit. So, if there is potentially a little bit of a disk
problem we hear about hernia issues and bulges and protrusions, and
the like. If that thing has a tendency to swell or rehydrate when you
sleep, you're going to be fairly symptomatic or a little uncomfortable
first thing in the morning. So I tell patients to just be very, very
careful of what they do first thing in the morning. Your margin for
error is not as large. It's kind of shrunk down on you a little bit. So be
careful getting out of bed; pay attention to the way you're getting out
of bed. Don't sit straight up. Sitting straight up is going to put a lot of
pressure on that low back, which potentially could irritate that disk a
little bit more. Pay attention to how you roll out of the bed. Roll over
on your side and use your side muscles to bring you up, which will
help you.

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And then most importantly, take it easy with bending first thing in
the morning. We’ve all heard people say, “I threw my back out
putting my shoes and socks on!” What happens, is there's increased
pressure with that disk. We simply go down to put our shoes and
socks on and it aggravates it even more. So get down, sit on your butt,
bring your foot up to you to put your shoes and socks on. With
women, I ask them to try not to bend over to shave your legs in the
shower. Maybe get your leg up, and just really work into it. Let the low
back get warmed up first.

So, golden rule first thing in the morning is to just be very, very
careful about bending and going into flexion.

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Back Pain: Preventing it

Importance of
flexibility and mobility

I am a big fan of establishing mobility first and I frequently talk to

patients about the importance of re-establishing motion through
the use of adjustments and manipulation of joints and soft tissues.
After furthering my training, and after much research, my
understanding is much clearer concerning movement patterns
related to mobility.

Specifically, we need to be able to perform some basic motor

patterns or activities in daily life. Once we re-establish how to do an
activity properly, we can work on strengthening, stabilizing and
exercising different body parts to help us avoid future injury.

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Following the Right Steps to Recovery
Many times people go to the gym to work muscle; however, it is better
to train the motion first and then rehab the muscle or soft tissue. The
first step should be assessment; this can be with a chiropractor, a
physical therapist, orthopedist or your family physician.

Learn what your limitations are before proceeding to the next step.
For example, if I were to ask a patient to put their feet together, bend
down and touch their toes, the majority of people cannot perform this
exercise. The automatic assumption would be that they have tight
hamstrings. However, it may be deeper than that and sometimes the
brain can simply forget how to bend properly.

Tulsa Spine and Rehab starts the assessment on the ground then
transitions a patient to different positions involving vectors or
patterns. From there we make a determination of whether it is really
a mobility issue, a motor learning issue or a movement pattern issue.
This assessment helps formulate a plan for what a patient can do on
their own and what they need assistance with.

Here in the clinic we see a lot of athletes and active people with
trauma to muscles and soft tissues. They have had adhesions or scar
tissue caused by postural stress over an extended period of time. The
day to day repetitions are contributing factors to many injuries
and it’s important to note that once we’ve reset some things and
determined what the problem really is, that motion should be
increased, then the back end should also be stabilized and rehabbed
to aid in strengthening tissues in that region in order to avoid future
problems.

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Back Pain: Preventing it

The role of exercise

for people of every age

We are frequently asked questions concerning exercise and how it

applies to both the young and old. There are a lot of variables that
must be determined before answering these questions, such as:

A) Is it a child or a junior?
B) Is it someone who is injured or recovering from surgery?
C) Is it someone looking to lose weight; or
D) Is it someone who is elderly and looking to regain strength?

Exercises for Children

We’ll begin with young children and juniors. Science and research
have demonstrated that kids need to learn to exercise in a specific

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manner as windows open up in a child’s development. For
example, pre-puberty age children should not start lifting weights
since testosterone is lacking at this age. Boys and girls develop at
different ages, but at this age, they can both benefit from basic
neuromuscular or motor pattern type drills which will allow their
brains to learn basic movement patterns. From there, they can begin
working on balance and agility, followed by individual strength,
power, coordination and endurance drills.

Exercises for the Elderly

Those people who are 65+ years of age, who are healthy with no
serious physical complaints, should place their focus on
maintaining mobility and flexibility. These exercises include
thoracic spine or mid-back mobility as well as hip mobility. As I’ve
stated in past blogs, we live in a forward world; we sit down, we get in
our cars, we work at computers, and all of these movements can
cause a bit of C-posturing to develop in our backs. This leads to
slouching or slumping which can be improved with the right exercise.
Simple getting out and walking will improve all of the above
mentioned facets and it’s an easy, inexpensive way to exercise.

Today, great emphasis is placed on weight training; however, I believe

the real focus should be on maintaining mobility first through the use
of aerobic exercises. This can include use of an elliptical, Stair Master,
bicycle, as well as walking, and each of these will have low impact to
joints. As long as you maintain your physical condition through the
use of low impact exercises, the chance of developing inflammation in
your joints should be significantly lessened.

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Warnings Signs to Look Out For
Here at Tulsa Spine and Rehab, we do not believe in the old saying,
“No pain, no gain.” Pain should serve as your indicator, or as a “Check
Engine” light. This can vary greatly from person to person and
children will naturally have more energy with higher aerobic
function. The older we become, the more we will need to concentrate
on making time to exercise. Adults should try to fit in exercise at
least three times a week for about 45 minutes each time. If you
belong to a gym, that’s great, but it isn’t a necessity. Walking and
moving around doesn’t have to be done under a trainer in a gym and
exercising on your own will only serve to keep you from losing
mobility. Don’t let yourself fall into the cycle we see so many of our
patients suffering from; when they begin to hurt, they do less and the
less they do, the more they hurt. Carve out time in your week and
keep moving!

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Back Pain: Treating it

What is chiropractic
manipulation?

Other terms you might hear about are mobilization, manipulation,

chiropractic adjustment, and osteopathic manipulation. And,
essentially manipulation or mobilization is about increasing
mobility in a joint or soft tissue such as fascia, muscles, tendons
and the like.

There are different forms of providers that can provide manipulative

therapy. You also might hear what's referred to as manual therapy.
Obviously as chiropractors, that's what we excel at. We are trained to
mobilize joints and soft tissues.

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Osteopathic doctors, (Dos) are another form of providers that provide
those services as do Physical Therapists and even massage therapists
are going into more soft tissue or muscle therapy.

The goal of manipulation is reducing restriction

My own explanation of manipulation is that I want to reduce
restrictions of movement. I approach the problem by trying to find a
restriction of movement, whether it’s in the joint or soft tissue. The
goal then becomes reducing the restriction by increasing the
mobility and the function. Simply put, we want to reduce the pain.

So, we want to find something that’s stuck and get it moving to

increase the function and reduce the discomfort. When things stop
moving, they stop functioning as they should.

Manipulation isn't indicative for all conditions. It's very appropriate

for some conditions like acute low back injuries and neck problems.
But if you had advanced degenerative disc disease or cancer or some
other serious disc issues, we'd want to avoid using that type of
therapy.

Is chiropractic manipulation painful?

With any type of manipulation, skilled professionals do it in a safe,
controlled environment. In our clinic we use low force, high amplitude
or quick techniques…just a little bit of motion in the joints that
doesn’t require a lot of rotation.

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Is stretching the same as manipulation?
Manipulation should happen before stretching. Here’s an analogy
that I use in my office quite often. If you have a rubber band with a
knot in it, and you stretch it, you’re only going to tighten the knot.
Over time, muscles can develop trigger points or adhesions. What we
aim to do with manual soft tissue techniques is break down or reduce
the adhesions…the knots in the rubber bands. From there, we can
teach the patient how to stretch properly, in ways where they are not
going to hurt themselves.

What we’re doing at the fascia level is reducing or breaking up that

adhesion so the muscle functions properly and we can maintain it and
manage it with stretching.

Simply put, manipulation or mobilization is a manual therapy that

chiropractors, physical therapists and different physicians use for
certain indicative conditions. It's important that we're utilizing a
specific modality or treatment for the correct condition. And it not only
applies to joints but soft tissues as well. Manipulation is a safe, effective,
efficient form of treatment and many patients respond well to it.

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Back Pain: Treating it

How to find a chiropractor

That’s a question that I’ve been asked quite frequently over the
years. I always tell people that it’s important to use your available
resources, and in this day and age, that means getting online and
using the web.

Check for reviews

You want to see what other patients are saying about the clinic, the
doctor and the staff. Just like buying a book on Amazon, reviews are
readily available, and can give you an idea of just what others have
been experiencing from a chiropractic office. You should try to gather
as much information about the clinic or the doctor as you can.

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Do you really need a chiropractor?
As you do your research, look for an office that uses phrases like
self-empowerment, self-management strategies and activity
modification. Your goal should be to reduce office visits by reducing
re-occurrence of your injury. Patient education is important. If you
learn how to help yourself, you won’t be relying on repeated visits to
the chiropractor just to get through your week!

What about X-Rays?

Many people associate chiropractors as a bit x-ray crazy. They
assume that they’ll get a lot of x-rays before they even see the
chiropractor. We got rid of our x-ray machine years ago because I
believe that it’s pertinent to use them only when we suspect
something quite serious, such as a fracture or some type of disc
injury or cancer or other pathology. If that’s the case, we’ll send them
out for an MRI.

Be wary of chiropractic offices that are shooting x-rays on every

patient that walks in the door. The x-ray is a great diagnostic tool,
but it’s wildly over-used in the chiropractic profession, in my opinion.

How involved should I be in diagnosis and treatment plan?

It's important to know what your problem is. The experience you
don’t want is to go to a chiropractor, or physical therapist or a
physician and leave and you're still unsure what the problem is. You
need someone who will make it a priority to sit down and come to a
good understanding and a good report of what the issue is and how
we're going to fix it. How long is it going to take?

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It's important to have a really solid diagnosis. And if the professional
is unsure, it's appropriate to make that referral at that time to
someone else that might be more prepared to treat that condition.

A treatment plan with measurable goals

Any good treatment plan must have goals, timelines and specific
metrics to achieve. What you don’t want is to wake up 6 months
from now in a therapeutic “black hole” with no end in sight.

Our approach is typically about 4 to 6 visits…not with everything, but

that’s the most common. All conditions are going to be a little bit
different. We want to see changes within a week or two. I’m not saying
that the situation is going to be resolved, but we want changes. For
example, sitting or standing without pain or pain levels decreasing
steadily…measurable things. We’ll set up a plan for a few weeks and
re-evaluate on a week-to-week basis

Be wary of an office that offers a treatment plan of 3 visits a week for

10 weeks. How do they know that it will take 30 visits to fix your
problem? They don’t.

Look for an office that recommends effective and efficient treatment

plans and re-evaluate as you go to make a better determination of
what you need.

Summary
Not every patient will find relief in 4 to 6 visits, but be wary of those
long, extended treatment plans. Most importantly, look for offices
that are going to empower you with the knowledge of what you can
do as a patient to help yourself!

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 The straight story on
Tulsa Spine and Rehab

I got involved in chiropractic about twelve years ago, I wanted to

help athletic, healthy type people with physical conditions. And,
that's what Tulsa Spine and Rehab is, actually. It’s a rehab facility
where we provide conservative treatment options for different
types of conditions, whether it's spine, knee, shoulder, or neck
pain.

We provide different types of options for people under one roof. Like I
said, I got involved with chiropractic for the purpose of just helping other
people. I like the non-surgical method of what we're doing.

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Treating athletes is our passion
Growing up as an athlete I dealt with many injuries, and physical
therapy, chiropractic and different modalities were able to help me.
So we treat a lot of athletes in our clinic. It set the stage for me on
what I wanted to do moving forward as my profession, as well. That's
the story of Tulsa Spine and Rehab. We got a bunch of like-minded
providers together: physical therapists, clinical massage, yoga,
chiropractic, etc. And our goal is to provide conservative treatment
options for these different conditions under one roof in an
atmosphere where we keep it fun and light.

I started out by myself and through the years I've added different
providers and it's been a really good mix. With these different
services that we're able to offer patients, you can come in, we can
make a better determination if you’ll need chiropractic care or if
physical therapy is going to be an option or both, or maybe massage
or yoga is best for you.

I think there are a lot of different treatments and options patients

have. The problem is, you may have to travel around town and go to
different clinics and different facilities to receive these different types
of treatments. That's one of the advantages at Tulsa Spine and Rehab.
You're able to get multiple options under one roof with like-minded
providers. I think it's really important that all your providers are on
the same playing field related to communication. It's patient based.
We're here to do what's best for the patients.
A part of the team
When an athlete goes away from his own training staff and looks for
some additional help for injuries or even conditioning, many turn to
us. There comes a time when an athlete is going to have to decide

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when and how he wants to move forward. An athletic training staff
can be really advanced and they're there to provide a service and
treat injuries and so forth. But, I feel that, if the athlete or the patient
is not responding, if he thinks it might be something a little more
serious, I think it's important to make the best determination of the
problem. Once we determine what that problem is, we can make
different recommendations on how to treat that problem with
chiropractic, physical therapy, massage and so forth. So initially, first
tier, the athletic trainer is a really important option on the team.
From there, if we're concerned that there might be a more serious
underlying problem, we might want to look at an orthopedist, a sports
medicine physician and go from there.

Keeping Things Light

Now, I said that we like to keep things light at Tulsa Spine and Rehab,
even though this is a serious business. But we like to have some music
playing, get patients interacting with one another, get the staff
interacting with them, and hopefully create an environment where
the patient says, “OK, I gotta go to rehab today, I gotta go see my
chiropractor”, whatever it may be. But they think, “Hey it's kinda fun
and I have a good time over there!” Hopefully it’s an environment
that they enjoy coming to.

If we sound like the kind of place that can help you, call the office at
918-743-3737. Since I’m a direct access provider, patients can call me
directly and schedule an appointment. I always emphasize when I'm
visiting people in the community, “Why don't you come in and visit
with me. Let's go through a consultation, an examination. And this
might be a good fit, it might not be a good fit for you.” And so, let's just
visit, make a good determination.

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 3345 South Harvard, Suite 101
Tulsa, OK 74135

918-743-3737

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