Intelligent Design of the Human Back

Our spines and low backs were very intelligently designed. The functional anatomical design of your spine is truly a marvel of nature. Our spines are meant to be incredibly strong, and highly bendable in all directions. That being said, the stresses of daily living exert incredible forces on the human frame. Unforeseen accidents, poor ergonomics, carrying groceries, putting kids in car seat, recreational activities and working in chairs rather than in the field, are all factors that subject our back to destructive forces capable of damaging our neck and back.

What are the most common causes of back pain?

• Working in a seated position, especially when exhibiting a slumping posture over many years
• Imbalance between the flexors and extensors of the torso (we do everything in a flexed or sitting position, but do very little extension of our spine during our normal routine).
• Lifting with tight hamstring muscles
• Weakness and inflexibility of the core muscles of the torso (abdominals, gluteal, hamstrings, hip flexors, TFL, rectus femoris). This requires abdominal compression back braces with mechanical advantage until strength to the core muscles is restored.
• Old soft tissue injuries or sprains/strains that have led to immobility and/or generative arthritis
• "Weekend Warrior Syndrome"

What are the 4 regions of the spine?

The first 3 segments are made up of 24 moveable vertebrae as follows:

1. Cervical Spine (neck) - consisting of 7 vertebral segments, with the majority of rotation occurring in the upper two segments known as C1 and C2 while flexion/extension is most prevalent in the lower five known as C3-C7. 
2. Thoracic Spine (upper/mid-back/rib cage) - consisting of twelve vertebral segments and more limited motion due to the organ protection and support of the rib cage.  Interestingly enough, more folks suffer pain in between their shoulders or in the thoracic area than anywhere else in the spine.  One reason for such is because ribs fasten to the spinal vertebrae via a synovial joint and these joints become easily inflamed through postural stress, emotional tension or fast rotational movements of the spine (e.g. pushing a vacuum, swinging a golf club or tennis racket). Pain in this region is more often misdiagnosed than in other spinal regions and although maybe not as debilitating, the pain can be quite nagging, sharp and bothersome.
3. Lumbar Spine (lower back) - consists of five vertebral segments that run from the lower thoracic spine to the sacrum. The majority of pain is sourced from the discs at the L4 and L5  because they are angled and form a major pivot or stress point with the less mobile spinal base. Fifty percent of forward bending (flexion) occurs in our hip joints while the rest occurs in the lumbar spine. The majority of motion is focused at the bottom two segments (L4/L5), and that is another reason the discs wear out more here than anywhere else.
4. Sacral Region (base of spine) - this region consists of 5 fused or semi-fused vertebral segments that form a heart-shaped spinal base that is wedged between and forms a synovial joint with the pelvic bones. These are known as the "S/I Joints" and are the source of a great majority of lower back pain. The bottom of the sacral region (sacrum) joins with your coccyx or tail bone.

The 24 moveable vertebral bodies are stacked upon one another with a disc between each pair. The main bodies of these vertebrae function to support the human frame and the discs act as hydraulic shock absorbers. Did you know that only half of your body weight is supported by your muscles and the other half is supported by the stacked vertebral bodies? Another note of interest is the fact that 80% of energy we expend every day is simply just to maintain posture against the forces of gravity. That is why ergonomics and good posture is so important -- it conserves energy and prevents us from getting fatigued.

Common Areas of Spinal Failure

• Spinal Discs -- our spinal discs function as shock absorbers and space occupiers to allow room for spinal nerves. They are composed of (1) a tough outer material, and (2) a soft, gelatinous (jelly-filled) inner core. This is very similar to the design of a hydraulic shock absorber for your car.
  
  Our hydraulic discs are made up of 75% water. Often, the discs may dehydrate, leading to dessication or degeneration; becoming inflexible or stiff. This, in itself can become what some describe as their typical morning stiffness. A logical progression of this degenerative process can lead to breaks in the outer tough fibers and actual leakage of the soft inner core. This is often referred to as a slipped or herniated disc because this herniated portion can apply pressure to sensitive nerve roots.
  
  Sometimes a twisting injury damages the disc and can subsequently cause degenerative spondylosis (this is a special name given to arthritis when it involves the spinal disc) in this area. Much of the pain in these cases is the subsequent swelling that compresses the nerve root. Over much time, the body's amazing ability to heal lessens the amount of inflammatory proteins in the area, especially after age 60. Therefore swelling goes down and many of these low back conditions that had been chronic can sometimes subside on their own. This is nature's normal course, but assumes a lifestyle consisting of: a healthy weight, consumption of lots of water,  a nutritionally sound diet and performance of a sound, regular exercise routine.
  
  
• Muscles, Tendons, Ligaments and how they affect your back:
  Injuries to back muscles and soft tissues can cause spasm, immobility and pain.
  
  If the pain lasts for more than two weeks, and proper treatment methods are not instituted,  muscle weakness and tightness may occur; leading to chronic, recurring bouts of back pain.
  
  HAMSTRING MUSCLE TIGHTNESS: I want draw particular attention to this most common instigator of low back injury. Not only do low back pain suffers often develop tight hamstrings leading to a chronic backache, but those folks with tight hamstrings will almost always eventually develop lower back pain. This is even true of young athletes who do not properly obtain and maintain good flexibility of these muscles. Remember, I said earlier that 50% of our flexing forward occurs at the hip joints. This CANNOT happen if the hamstrings are tight because they must release their hold on the pelvis, allowing it to rotate forward at the hip joints. If this motion is limited, then the slack is taken up at the L4-L5 vertebral levels, often discs and/or ligaments at that level.

Is Your Pillow Causing You Pain?

Buying Neck Pillows

Many folks scratch their heads, wondering why they wake up with so much neck pain, and yet they don't know how to solve the problem. It could be as simple as their choice of pillow. Here are solutions to the five pillow mistakes you may not know you're making:

Long Lifespan

If you can fold your pillow in half and it doesn't rebound within 10 seconds, it's time to say farewell and throw that old thing out. Dead skin flakes, dust and sweat fill pillows with extra weight and bacteria. Aim to replace your pillow every 12 to 18 months to best maintain firmness and support for a restful sleep. See this Interesting Pillow Choice Article for some thought provoking suggestions. I often recommend the Nimblepedic Pillow brand (contoured version) as one of the best all-around support pillows for the neck.

What's the Use?

If sleep quality is the only benefit you are receiving from your current pillow, you may be missing out on other benefits and therapeutic value over that eight hour period. Specialty pillows keep your face from wrinkling, acids from refluxing and snores from waking up the whole house. If you have sinus congestion, make sure your pillow is hypo-allergenic. Make sure your head is propped up so your nose is higher than your heart. If you fear wrinkles, find a memory foam pillow like Nimblepedic, so wrinkling pressure on your skin is reduced.

Neck Pillows Should Be Versatile

If you have a conventional, fairly thick, non-contoured pillow for side-sleeping; yet you spend a portion of time on your stomach or back, you may be doing yourself a disservice. To not cause neck or back pain you need a contoured pillow that adapts to all your positions, or you will need to change pillows for each sleeping position. Michael Breus, PhD, told WebMD that sleepers must find the right pillow to fit their specific needs.

Side sleepers should use a pillow that is firm enough to sufficiently accommodate the distance from the ear to the shoulder, so that your head rests parallel to the mattress. Back sleepers need neck-contour-orthopedic pillows. This ensures that their heads aren't pushed up too high or sunk down too low in relation to their shoulders and that they have support for the natural neck curvature (lordosis).

Sleeping prone (aka: face down) is for the most part not recommended. Such stomach sleeping notoriously wrecks havoc with the ligaments and spinal disks of the neck, leading to loss of normal curvature and arthritis over time. If you still choose to sleep on your stomach, use a thin pillow, and try to place a portion of it under your shoulder and chest on the pillow portion opposite the way you turn your chin. Ultimately, the proper pillow aligns the neck and spine, according to the Los Angeles Times.

Filling Material Matters

Pillows should provide comfort and support the same way a mattress should. It’s great if you think a down pillow is super comfortable, but if you are having constant neck pain it could be because you aren't getting enough neck support when you sleep. A  good orthopedic neck pillow can solve this problem, and so can occasionally switching your sleeping position. When you experience neck or back pain, choose a high-density foam or firm cotton pillow that offers more support. Feather pillows are pretty much a non-viable alternative unless you purely sleep on your back and don't really have neck problems.

Money Isn't Everything

Just because a pillow is expensive doesn't mean its less expensive counterpart won't work. ConsumerReports.org sent 71 people home with expensive and inexpensive pillows and instructed them to sleep on each pillow for five consecutive nights. What were the results? Pillow quality relied mainly on each sleeper's personal preferences about pillow firmness, fluffiness, flatness and size, according to the site. When buying, don't just go for best price. Find the right pillow for you by testing its comfort and seeing if it offers you the right neck support.

Back Be Nimble Introduces HealthTap

PRESS RELEASE  -- HEALTHTAP LAUNCHING APRIL 15TH, 2013

HealthTap brings the Full Spectrum of Doctors’ Knowledge to Mobile Health
Leading mobile health platform unveils results of nationwide Top Doctor Competition, and announces new ways to interact with winning doctors and their insights. 

HealthTap is an Interactive Health Information company, backed by some of the top investors in the Silicon Valley. The unveiling of HealthTap will change the face of health information online and redefine how people connect with physicians.  On HealthTap:

• Users can: find real answers to their questions from leading physicians, quickly discover what information other doctors agree with, and find the best physicians in their area
• Users can also find ratings for doctors nationwide

HealthTap puts the relationship between people and doctors first. They offer mobile and internet access to relevant, reliable and trusted health knowledge that is kept current through daily contributions  from top physicians. Web and mobile apps connect  a vast Medical Expert Network of  U.S.-licensed doctors with people seeking answers to their health-related questions.

•  Concise doctor updates on the latest health findings
•  Daily health tips created by doctors in more than 100 topics
•  Quick, personalized doctor answers to health questions
•  Deep Health posts where doctor share their opinions and insights
•  Transparent doctor-doctor consults and dialogues

“HealthTap is putting care and trust back into healthcare by placing the doctor and patient relationship back at the center of the healthcare experience,” says HealthTap Founder and CEO Ron Gutman. “By giving top doctors a simple way to share their knowledge and opinions and get recognized by their colleagues for their expertise, and by users for their bedside manner and care, we’re creating a healthy competition that motivates the best doctors to stand out and help millions everywhere. In a world where we expect to get immediate, reliable and deep insights on movies and restaurants on our mobile devices anytime anywhere, it’s high time we have an easy way to get the same when it comes to our health and well being. With the new HealthTap Spectrum we’re leading the way to comprehensive, caring, trustworthy and high quality mobile health.”

About HealthTap
HealthTap is the best way to connect with trusted health information and doctors. With top-rated web and mobile apps, HealthTap offers immediate and free access to personalized, reliable, and trusted health answers and tips from a network of over 36,000 U.S.-licensed doctors. Sign up today and download HealthTap’s free app for iPhone, iPad or Android at www.healthtap.com.

Physical Therapy Yoga For Pain Managment

Low-back pain is one of the most common physical ailments with over 80 percent of people in the United States suffering some degree of back pain. According to one my colleagues, Dr. Grey Gardner of Van Chiropractic Clinic, chronic lower-back pain can be debilitating—limiting sufferers from performing daily activities, causing sleep deprivation, negatively affecting intimacy and triggering weight gain.

Although chiropractic treatment is often an effective solutions for eliminating lower back pain, practicing yoga serves as complimentary, natural-pain management. The practice of Physical-therapy Yoga and Pain-management Yoga focuses on many advanced and innovative therapeutic techniques to heal injuries and eradicate back pain (as mentioned by physical therapist Reach Krentzman in his interview with LAYogaMagazine.com). Not only can therapeutic yoga target the source of the physical pain, it is thought to deepen spiritual connection, cleanse the soul and foster vitality. This offers a more comprehensive approach to wellness. The practice of yoga helps to alleviate stress and pain while enriching the mind and enhancing awareness.

Pain Management

Yoga followers can encourage healing of mental, emotional and physical pain by engaging in postures. Senior Pastor Ed Young is dedicated to helping people live optimally and healthily. On his official Ed Young Facebook page, he posts a quote by C.S. Lewis: "pain is God's megaphone to rouse a deaf world." Suffering from lower-back pain can be an indirect result of mental and emotional pain. Suppressed emotional pain, stress and the self-internalized pressure of over-achieving can manifest as physical pain in either the torso or lower back.

Healing Yoga Postures

Whether you're resorting to holistic healing methods or experimenting with therapeutic yoga to compliment your therapy, you can practice various yoga exercises at home.
Release tension or help heal nagging pain and stress in the neck, upper back and shoulders with the following sample of therapeutic yoga practices:

• Postural Awareness & Breathing: Target and relieve neck tension by breathing deeply into the abdomen using your diaphragm. In a seated upright position, plant feet on the floor and lower knees below below the hips. Relax while taking 10 deep breaths with exaggerated inhalation (through the nose) and exhalation (through pursed lips). Push the vertex of your skull skyward to maintain proper posture during the exercise. NOTE: if you place the tip of your tongue on the roof of your mouth while inhaling, it will facilitate diaphragmatic/abdominal breathing vs. chest expansion.
• "The Clock:" Standing with your right torso next to a wall, place your right hand at 12 o'clock on the wall and slowly move it clockwise until you are at 3 o'clock. Watch here: The Clock Yoga Exercise Video. Put your left hand on the right rib cage. Inhale deeply and rotate your right torso forward while exhaling. While holding for six deep breaths, you'll stretch your right shoulder down and forward away from your hand.
• Overhead Arms With a Strap: Stretch a fitness strap over your shoulders with your arms apart. Palms should face outward. Place arms on the strap so that you can keep elbows straight. Dropping your chin into your chest will relax the neck. Inhale and hold for six deep breaths. Repeat twice.
• Wall Downward Dog: Put your hands against the wall in a downward dog pose such that your torso is bent forward at 90 degrees with your arms in line with your torso. Legs are underneath hips creating a tabletop. Lift sitting bones into the air while "opening the chest and lengthening the spine." For a demo picture visit "PracticeYoga.net"

Reduce the Hurt of Low Back Pain When You Sit

Reduce Back Pain When Sitting

How many people do you know that say: "I have back pain when I sit". This was a prevalent complaint among many of my patients before I retired from chiropractic practice. Fortunately, there are a few simple things you can do that will go a long way in helping you manage your back or neck condition on a daily basis. One of the most important is to have proper support and posture while you're sitting at your desk.

People who sit at a desk for long periods of time are definitely at risk for developing back pain, as sitting (especially slouching) can add a lot of pressure to the back muscles and spinal discs.

Sitting with your back properly supported without slouching helps to minimize the strain on your back. Supporting the natural inward curve of your lower back (lordosis) is very important if you're sitting for a long time.

Here are a few guidelines for good posture, support for your lower back while sitting at a desk:

• Adjust your chair to make sure your knees are slightly lower than your hips and the weight of your thighs is held more by your feet than by the seat of the chair.
• Sit as close to your desk as possible.
• Make sure your computer screen is about at eye level.
• It's good to have armrests on your chair to support your elbows at a 90-degree angle when your shoulders are relaxed.
• The backrest of your chair should support with some pressure in your lower back. If you can, get a new chair that provides this support, or place an orthopedic support in your chair.
• It sometimes helps stabilize your back to put something under your feet to elevate them slightly. There are good adjustable foot rests made for this purpose.
• If you spend lots of time on the phone, consider using a headset or speakerphone to take the strain off your neck.

Support your back while driving:

Driving for long periods of time, or during a stressful daily commute, can place a lot of strain on your back. When you're driving, remember to:

• Make sure your car seat provides enough support for your lower back. If it doesn't, try using a good back support like the Skwoosh Gel Cradle Lumbar  or Thermarest BackRest by Cascade Designs. 
• On a budget? Try rolling up a small towel and placing it between your lower back and the seat.
• Slightly recline the seat back and move the seat closer to the steering wheel to compensate.
• Sit so that you don't have to stretch to reach the steering wheel, as reaching increases the pressure on the spine and can stress your neck and shoulders.

Move about throughout the day:

Even if you're sitting with correct posture, holding the same position for a long period of time can build up stress and cause discomfort, so it's important to move about during the day. Try to take frequent breaks to stretch and walk around. Whenever possible, take the stairs instead of the escalator and walk/bike, rather than drive.

High tech help for lower back pain while sitting:

• Eradicate pain with the latest medical advancements in pain control with
  WiTouch Wearable | Wireless TENS Unit
• For real stiffness when sitting in the car try unobtrusive "continuous passive motion" or CPM -
  BackCycler Lumbar Support

We hope that these suggestions for simple changes you can make to your sitting posture will help you reduce the hurt of lower back pain. Be Well !

Best Results With Cervical Neck Traction

WHAT IS THERAPEUTIC CERVICAL TRACTION?

Cervical traction is a physio-therapeutic modality (treatment) whereby a linear stretching force is applied to the head in an effort to reduce compression of the spinal structures by increasing space between vertebrae of the spine. These methods becomes therapeutic when any of the following desired results are achieved. Traction can be applied (1) in the supine or “lying face up” position or (2) from a sitting up position utilizing an over-the-door traction type of device. Although some users experience relief from the simple over-the-door units, the associated traction harness tends to place undo stress on the jaw and can cause problems like TMJ. Additionally, only 20 lbs. of traction can be applied by the over-the-door method. Supine cervical traction devices like Comfortrac Cervical Neck Traction or the Saunders Cervical Traction units are the units preferred by most doctors.

DESIRED RESULTS FOR CERVICAL TRACTION

• to reduce nerve pressure
• to overcome muscle spasm
• to reverse the forces of gravity
• to break the cycle of pain/spasm/pain/spasm
• to facilitate disk hydration and healing

CERVICAL TRACTION FOR DISC HERNIATIONS, BULGES AND ARM PAIN

One important functional benefit of traction is that such application of tensile force to the interwoven fibers of the spinal disks, literally creates a vacuum effect that may pull back to center a bulging or herniated nucleus pulposus (center material of disk). Such herniations are often responsible for the pain that radiates to the shoulder, arm and hand. When utilized in a safe, proper manner; traction can offer effective therapy for:

• reduction of disc herniation and associated symptoms
• improvement of joint mobility
• relief of nerve and disc compression
• improvement of posture
• relief of pain

The disc spaces Before Traction and During Traction applied by a Comfortrac Supine Cervical Traction Device
BEFORE TRACTION	INCREASED DISK SPACE

ANATOMY OF CERVICAL TRACTION To better understand the therapeutic value of traction it is important to have at least a basic understanding of anatomy and structures of the cervical spine (neck). As a matter of fact, Medicare and Medicaid authorities define a cervical traction device as one that applies traction to the cervical “anatomy”. Why this is true may be explained by anatomical facts like the following: There is a ligament or band of strong binding material that runs the length of the back side of the cervical spinal vertebrae, actually tying them together. It is interesting to note that when traction is applied to this band, also known as the “posterior longitudinal ligament”, the resulting pull on fibers of the spinal disk causes movement of fluid that creates and draws a vacuum, literally sucking a herniation or bulge back toward the center of the involved disc.

 THE FACTS:

• VERTEBRAE OR BONES OF THE NECK - The cervical neck vertebrae are the smallest of all the spinal vertebrae. The purpose of the cervical spine is to house and protect the spinal cord, support the skull, and enable versatile head movements like rotation, flexing forward, and extending backward. The cervical spine is composed of 7 vertebrae with shock-absorbing, space-occupying disks in between the vertebral bodies of each vertebrae. Behind the vertebral bodies and in front of the weight bearing joints of the vertebrae is the spinal cord. Nerves come off the spinal cord and exit through holes formed at joining portions of each pair of vertebrae. These nerves sense pain and control muscles and organs.
• POSTURE AND CURVE OF THE NECK - the neck has a special curvature called a cervical lordosis that transfers the weight of head to supportive joints rather than the placing pressure on the disks. Spinal disks would wear out quickly if they were forced to carry the weight of our head. This natural curve helps protect our spinal disks.
• SHOCK ABSORBING DISKS - spinal disks are sort of like the inside of a golf ball. They have a gel-like center (nucleus) that is contained by woven rubber-band like structures known as fibro-cartilage. The gel being contained within these fibers acts like a hydraulic shock absorber similar to what is on your car. The disks are also 75% water, functioning to bring nutrients to the live fibro-cartilage cells. Loss of such water decreases nutrient supply and shock absorption, leading to weakness in the fibers that hold the gel nucleus. Weakness can lead to a bulge known as a herniation and can place pressure on the nerves as they exit the spine. Understanding the anatomy helps us understand the physiology of developing symptoms and helps us develop a comprehensive therapeutic approach including sensible lifestyle modifications and good nutrition for the healing spinal disks. With this understanding it is often possible to resolve associated nerve irritation and symptoms without surgical intervention.

CONDITIONS THAT RESPOND TO CERVICAL TRACTION

• Lack of mobility (hypomobility)
• Spinal misalignment
• Disc bulging or herniation
• Cervical spinal nerve impingement
• Cervical spondylosis, osteoarthritis or degenerative disks
• Muscle spasm and general tightness in the neck and shoulders
• Shoulder, arm and wrist pain or numbness
• Cervical neuralgia or radiculo-neuropathy

MAKING CERVICAL NECK TRACTION SAFE FOR HOME USE

Good News - when traction is applied to the spine it tenses the fibrous outer portion of the discs. This tension will open channels for the influx of nutrients and water (hydration) to the cartilage cells, helping restore normalcy to injured disks.
Bad News - however, if application of traction is prolonged beyond a certain threshold, the fluid entering the disk can create excessive osmotic pressure and predispose a disk to rupture. Understanding things like this creates awareness of the need for professional guidance prior to embarking on self treatment with traction.

PLEASE READ THE FOLLOWING CAUTIONARY ADVICE:
First and foremost, never utilize traction without first consulting an attending physician for proper protocol.

Furthermore, let me begin by saying that the use of any mechanical traction should always be preceded by the use of manual traction (i.e. done by hand) performed by your chosen practitioner, whether a skilled chiropractor, physical therapist or orthopedic doctor. This is most safely applied with one hand under the occiput of the skull and the opposing hand on the forehead of the patient. Pressure applied to the jaw puts excessive pressure on the TMJ joint and is not recommended by this writer or most experienced neuro-musculo-skeletal practitioners.

This consult should be concluded with a suggested and monitored course of therapeutic traction. Supine home traction devices can be extremely beneficial if this protocol is followed. Conversely, without proper direction, one could cause more harm than benefit.

WHAT IS THE BEST CERVICAL TRACTION DEVICE?

It is this writer’s opinion and upon the recommendation of most savvy physicians, supine cervical traction units like Comfortrac Cervical Neck Traction or the Saunders Traction Unit are the most suitable for safe home use. They both use pneumatic pumps that can easily be operated by the user and offer both intermittent or continuous traction. See more details in the 2nd paragraph of this article above.

BEST CERVICAL TRACTION TREATMENT METHODS…

1. Two Traction Protocols: sustained or intermittent traction can be applied in a sustained or intermittent manner. Pneumatic supine traction units can administer sustained or intermittent traction.
2. Sustained traction is recommended when treating degenerative disc disease, muscle spasm and nerve root impingement. Care must be taken not to apply sustained traction whereby the amount of time exceeds that recommended by an attending physician.
3. Intermittent traction is recommended for treating facet joints and disc protrusion.
4. When applying intermittent traction, the “rest ” period involves a reduction of traction force (about 50%), not the complete removal of force. Some authorities recommend to reduce the force by 1/3 during the rest phase.
5. Cervical Traction Application to Open Up Space: a minimum of 15 degrees of flexion is necessary to open the cervical posterior facets. To maximally separate the cervical posterior facet articulations, open the intervertebral space, widen the intervertebral foramen and stretch the posterior tissues, 25-30 degrees of flexion is recommended. This position also straightens the normal cervical lordosis.
6. Applying Force to Upper or Lower Neck: traction in the neutral cervical spine position causes the greatest separation in the upper cervical spine; 30 degrees of flexion directs the forces more to the lower cervical spine.
7. Supine Cervical Traction Best: cervical traction should be applied in a supine position for optimal benefit.

CONTRAINDICATIONS, TRACTION CONCERNS AND TMJ PROBLEMS

• Traction contraindicated for cervical distraction injuries at any level (this includes acute and/or unstable, severe sprain/strain injuries of the cervical spine as might occur in a whiplash).
• Traction contraindicated for certain fractures like Type IIA hangman's fractures
• Traction contraindicated for joint hyper-mobility
• Caution must be exercised when performing traction on anyone with TMJ problems. As suggested above, supine cervical traction whereby forces are not exerted on the jaw is not only better traction protocol, but safer for those who already suffer with a TMJ condition.

WHAT SHOULD I FEEL AFTER CERVICAL TRACTION?
 IS THE RELIEF IMMEDIATE? DOES TRACTION HURT?

Although cervical traction can be uncomfortable, it is not suppose to be painful when properly applied. Some folks will complain that they feel soreness of a different kind after application of the therapy. This is quite normal. As a matter of fact, the majority of traction users do not feel better immediately after the traction. It is more common to feel better the next day. On the contrary there are those that experience immediate relief and absolutely enjoy the entire therapeutic experience. This writer is one of those persons. I feel completely relaxed during my traction sessions and feel like the weight has been removed from my shoulders.

Now, this being said, please understand that I’m referring to traction being performed in the supine or “lying face up” position. As discussed earlier, other sitting up methods like over-the-door units present their own set of problems and they make it really hard for the user to relax.

If, after reading this article you feel you are a good candidate for cervical traction you should discuss the possibility with your health care provider. Often, they will prescribe a home cervical traction unit. Ask your doctor if he or she agrees that a supine cervical traction unit like Comfortrac Cervical Neck Traction might be better than the over-the-door type. With a prescription, you may seek reimbursement from your insurance company even though you will often have to make the purchase on your own.

Piriformis Syndrome - self diagnosis - best treatment

I received an interesting email from a lady with the following described signs/symptoms:

Hope you can send me in the right direction. For about 6 weeks I have suffered pain in my right buttock with tingling and pain down my right leg and into the calf of my leg. After reading all the posts that have been sent to you I can understand that my symptoms are likely related to the sciatic nerve. I did not have a fall but simply overdid fast walking which I think is the cause (the music in my headphones was quite lively!). Have been to the physical therapist which made it really hurt, been to the doctor who prescribed a lot of ibuprofin and a muscle relaxer. This is painful when I have to stand still but not when walking. It is painful when sitting for a long period of time. I can bend in any direction and the spine works fine with no pain. After reading online I thought perhaps it might be piriformis syndrome. I see that others recommend Stretching for that. However, you often tell people to avoid stretching because it makes sciatica worse. What to do? Are there certain diseases that can cause this (I had a bladder infection about two weeks after the pain started and took the medication for that and that is gone.) Thanks for your help.

THOUGHTS ABOUT DIAGNOSING AND TREATING PIRIFORMIS SYNDROME
Your self-diagnostic train of thought is remarkably intuitive. It would seem logical that you do not have a lumbar disk problem causing the sciatica, although there are rare cases of such that present with absolutely no back pain. I think you're very likely to have a "Piriformis Syndrome".  Stretching is indeed an important aspect of treatment for such in the long run. However, it is often very much contra-indicated in the initial treatment phase because it could very well have been the long strides (during your fast walking exercise) that over-stretched the Piriformis, causing the initial and likely current spasm. You will almost certainly benefit from appropriate physiotherapy modalities like electrical muscle stimulation over the belly of the muscle and perhaps some deep-pressure massage to relieve the spasm. Sleeping, especially on the side could be irritating the condition and it might be advisable to place a large, fluffy, pressure-reducing foam pillow between your knees to relieve the stretching on the piriformis muscle. The side that is is up, is the side that will get stretched. I personally use and recommend the Nimblepedic Comfort Touch Memory Foam Pillow for this purpose.

Anti-inflammatory meds and muscle relaxors I find to be pretty useless in these cases. Stretching will often irritate until the initial spasm is overcome. This is because stretching the tight muscle often forces it into contact with an already inflamed sciatic nerve. In the long run you might need to have your gait evaluated to note whether there is a problem with shoes or bio-mechanical dysfunction of the foot and ankle that might have led to the onset. For example, pronation, a functionally short leg, or toeing out while walking can all be related. Shoes and/or orthotics can often be a sensible solution. I suspect that the reason walking is not seeming to exacerbate the pain is because you are not being as overzealous with your stride as you were before. However, this does throw up a red flag that makes us want to make sure that your lower abdominal or pelvic organs are not referring pain down your leg. You should have a good evaluation from you internist as well.

When it comes to conditions affecting nerves from the lumbo-sacral area, the nervous system regulation of organs in that region can be affected, leading to a weaker organ that is more prone to infection. Although it may have indeed been coincidental, either condition could have impacted the other.

I think this case is an interesting one that a lot of folks might relate to, so I decided to make a post of my advice to her.

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• IN SUMMARY, you eliminate extra calories and unhealthy chemicals from your diet, while increasing your metabolism, energy level, productivity and longevity.

Key Ingredient	Healthy Benefits for Various Conditions
Green Tea (EGCG)	Anti-oxidant that Improves overall wellness, increases metabolism, promotes weight loss, increases energy, lowers blood pressure, reduces risk of various cancers, dilates coronary and peripheral arteries, helps reduce mouth bacteria and gingivitis. It should also be noted that green tea reduces "platelet clumping" and therefore the risk of stroke or heart attack. It also helps diabetics utilize insulin and reduces hemoglobin A1C.
Noni	General well-being, vitality, potent anti-histamine and anti-inflammatory and anti-allergy benefits
Pomegranate	Potent anti-oxidant that is an endothelial dilator by increasing nitric oxide, reverses arteriosclerosis and vessel disease, hypertension, shrinks enlarged prostates, reduces symptoms of menopause and lessens the risk of breast cancer
Acai	High ORAC value anti-oxidant that reduces cholesterol, fights infection, anti-tumor properties, a stress reducer
L-Theanine	An amino acid that is relaxing and stress reducing
Resveratrol	Retards aging, cardio-vascular benefits
Sea-sourced Trace Minerals	Promotes a multitude of necessary bodily functions, including the regulation of heart beat, the contraction of muscle, and the facilitation of enzymes and anti-oxidants.

GET READY TO BE COMPLEMENTED -- Everyone is going to notice the new you!

BackCycler - Passive Motion Healing Your Back

BackBeNimble.com announces the re-launching of the BackCycler®, their most popular back pain product ever. BackCycler® was previously awarded the Good HouseKeeping Seal of Approval for the best back pain product they tested.

This amazing product uses computerized continuous passive motion to exercise your back while you drive or sit.

The BackCycler improves posture and keeps the spinal disks hydrated while you sit. Sitting is inherently hard on the spine and the continuous passive exercise provided by BackCycler prevents stiffness and fatigue often occurring with long drives or prolonged sitting.

At a modest price of $79.95 BackCycler® is a must for back pain sufferers.

Cervical Kyphosis - Loss or Reversal of Neck Curvature

Most commonly known as a “military neck” a straight or forward curve of the neck is abnormal and may cause an unkind progression of symptoms leading ultimately to cervical disk degeneration.

A healthy neck manifests a normal lordotic curvature as portrayed in the picture to the right. The pathology leading to a neck curve reversal (cervical kyphosis shown below right) may be inspired by a multitude of conditions as follows:

• Post whiplash
• Post head injury
• Stomach sleeping
  
• Poor sitting/working postures
  
• Congenital spinal curvatures
• Osteoporosis
• Degenerative cervical discs (a form of osteoarthritis that can either be the cause of or the result of a cervical kyphosis)
• Compression fracture of vertebral body
• Infection of the cervical spine

ANATOMY: STRAIGHT VS. CURVED

“I’ve always heard that it was good to stand up straight.”

“Stand upright, stick your chest out and hold your shoulders back! Otherwise you’re going get widows hump.”

Are these expressions as familiar to you as they are to me? One might think that having a curved neck goes against what we heard from parents and teachers as we were growing up, but the reality is that there is a little bit a truth in both. Maintaining good posture throughout our lives is crucial to both the health of our spine and vital organs. On the contrary, a special type of curve called a “lordosis” is a good thing, both in the neck and lower back.

When we look at a person from the back their spine should be truly straight, so that the left and right sides of one’s body is symmetrical. However, when we view a person from the side, the front and back of their body is different and this is reflected in a coinciding curvature of the spine. Both the lower back and neck are hollowed out (concave) and the mid or “thoracic” spine is protrudes (convex). Thus there is an alternation of curves functioning to provide stability, shock absorption and aid in propulsion. A straight spine would be very stiff and not flexible. Imagine the plight of a pole vaulter with an inflexible pole.

Nature’s design of our spine and rib cage facilitates breathing and offers protective and supportive framework for vital organs. Spinal disks are shock absorbers and because they are in the front of the spine, lordotic curvatures keep them from having to bear weight. Kyphosis or loss of such curvatures bears weight upon the disks, leading to their ultimate degeneration. This process of deterioration is a form of osteoarthritis and in the spine is known as degenerative spondylosis.

DIAGNOSIS
Although most chiropractors or conservative orthopedists can recognize a cervical curve reversal upon viewing the patient’s posture, a definitive diagnosis may be obtained via a standing lateral (side view) X-ray of the neck. Cause can often be determined by corroborating a comprehensive history, a thorough examination, X-rays and questions about sleep, work and lifestyle.

In my professional career as a chiropractic physician, I found that the majority of young adults presenting with cervical kyphosis either had a whiplash or were stomach sleepers from an early age. For desk jockeys 40-60 years of age, many hours of sitting with their head flexed forward almost dictates the fate of developing kyphosis. In prior years I considered cervical kyphosis a job hazard for the careers of accountants, attorneys and often teachers because of years spent with their head in a book or paperwork. However, the digital age offers some relief in that respect. A well-planned, ergonomically-friendly office can do wonders for protecting the spine in the sedentary worker.

TREATMENT FOR CERVICAL CURVE REVERSAL (KYPHOSIS)
During my chiropractic practice I had the opportunity to note a good percentage of correction toward a more normal lordosis (noted on X-ray) for 70% of patients under my care. This was almost always consistent with those patients that followed all recommendations and were model participants in their own care. Here is the recommended treat plan:

1. Spinal manipulation of stiff and fixated spinal segments by a qualified physician
2. Flexibility exercises for flexion and extension of cervical spine
3. Resistance exercises for flexors and extensors of the neck
4. Learn the Alexander Technique for maintaining good posture (HINT: the basic philosophy is to sit and stand like you were hanging by a string from the vertex of your skull. Liken it to a puppet on a string).
5. Elimination of stomach sleeping
6. Avoid standing on your head, although some yoga postures may be beneficial
7. Use of orthopedic neck pillow while sleeping
8. Establish and ergonomic friendly work environment while working at your desk
• top of computer monitor should be at eyebrow level
• ergonomic chair should remain in a slightly forward tilted position to facilitate an upright posture. If you do not have such a chair, try a wedge cushion with a built in forward tilt.
• prudent use of an ergonomic footrest to balance the forward tilt of an ergonomic chair
• elbows must be at your side during mousing, track pad or keyboard entry. DO NOT reach for these items

DR. OZ – The Wellness Messiah

As a retired chiropractic physician and quasi wellness expert I have long espoused the true philosophy of wellness. I’m what Doctor Oz would call a “wellness warrior”. I can really relate to the philosophy administered by Dr. Oz and the Dr. Oz show team. It pleases me to note that a well-respected medical doctor like Mehmet Oz is reaching a vast audience with a common sense approach for care of the human frame. As a nation we have lived in an environment whereby doctors have hastily recommended surgery or loaded patients up with powerful medicines. We must turn our focus to health and away from simply treating diseases as they arise. I’ll take this moment to commend Dr. Oz for his valiant efforts and designate him the “Wellness Messiah”.

Personally, I have lived true to the wellness warrior lifestyle and strongly advocated such to my friends and family members. During my journey as a health care provider I often experienced the need to overcome negative rhetoric surrounding the chiropractic profession from both patients and allopathic (conventional medicine) colleagues. I found it interesting that patients dosed with multiple medications from their medical doctor(s) were often those that suffered from the greatest ill-health. I have jousted with patient apprehension for alternative therapies, yet have been joyful when the acceptance of such produced a welcomed result.

I believe chiropractors were the first modern day wellness professionals although ancient medicine had its origins in what we now consider alternative therapies. The foundation of the wellness warrior is a strong belief in the innate recuperative powers of the human body. An active, harmonious lifestyle combined with a balanced, colorful, and sustainable diet is the way of the warrior. Key components exclude processed grains and sugars, but require proper breathing, movement (exercise), dependence on vital plants/herbs and judicious use of all Mother Earth’s bounties.

“Let me take this opportunity to join Dr. Oz in welcoming new Wellness Warriors to a vital and long life.”

MBT Shoes - The New Best Running, Training and Recovery Shoes

INTRODUCTION

After a detailed bio-mechanical and practical evaluation of the MBT shoe for both training and recovery I’m really a fan of this so-called “anti-shoe”. It is the contention of this researcher that MBTs will be validated as the new best running shoe for those suffering or recovering from back pain, hip injuries, arthritis, knee problems and conditions of the foot and ankle.

However, unlike the info most prevalently available about MBT shoes creating instability, I believe MBT shoes actually enhance overall stability because of their unique self-righting sole and its ability to act in symphony with the postural muscles. This improves stability as the user's foot interfaces with hard surfaces. The only portion of the gait whereby there is instability in MBT footwear is at heel strike. This functions to absorb the shape of the terrain and lessen pressure on the heel.

MBT functionality could be likened to that of the old Joe Palooka Bob Bag of the 1950's. This was a self-righting punching toy with a counter-weighted bottom. No matter what one did to it, it righted itself in a perfectly vertical format.

WHAT ARE MBT SHOES?

Quite simply they are rocker-bottom soled footwear that enhance a user’s ability to maintain natural and proper postural balance. They are super comfortable and nature’s answer to many sports’ injuries and orthopedic complaints of the back and low

er extremity.

“MBT” is an acronym for Masai Barefoot Technology and the shoes were engineered as a result of studying the Masai Tribe in Kenya. These people have a significant lack of knee, foot and ankle problems.

Most running shoes are designed to lessen the n

eed for a good set of balanced muscles. However, MBT design facilitates muscle activity and the recruitment of muscles maintain the balance of the user. This is similar to the benefits to be gained by running barefoot in semi-soft sand.

Although orthotics can be worn inside MBT Shoes, we find they are often unnecessary. That’s right, MBT shoes are a better substitute for most foot orthotics that were prescribed to either relieve heel pain or improve the biomechanics of the foot.

DESIGN OF THE MBT SHOE

The above diagram showing how MBT design aids the walking/running gait.

The diagram above demonstrates lateral stability and balance fore and aft with MBT footwear.

The unique features of the MBT design are (1) the soft Masai Sensor Cushion and (2) the Self-righting Rocker Bottom Mid-sole.

The sensor cushion is located under the heel, but is longer, less dense and has a different shape than most cushions in the heel of a shoe. On one hand its properties simulate uneven ground, subconsciously soliciting a proprioceptive response from the stabilizing muscles. This compensatory response facilitates adaptation to the terrain.

The balancing action of the mid-sole, with its integrated self-righting/rocker bottom technology, actively exercises the muscles and precisely guides the mid-stance through toe-off motion in a very controlled manner.

All parts of the shoe, work in harmony with the wearer, exercising the entire lower torso and lower extremities while virtually eliminating the stress to joints and ligaments.

MY PERSONAL EXPERIENCE

This researcher is now an avid MBT wearer. After a stay in the hospital as a result of cardiopathy, I noted that my right knee and right heel were in peril giving me trouble walking. Apparently, the lack of oxygen and immobility resulting from a hospital stay had caused a previously minor condition to rapidly deteriorate. Upon examination by a competent physiatrist (doctor of physical medicine), MRI showed a ruptured Baker’s Cyst combined with severe degeneration of my medial cartilage. I was also suffering from a heel spur and plantar fasciitis. I was determined to walk to rehabilitate my heart condition, so I went shoe shopping and purchased a $120 pair of Salomon XT Wings GTX Trail Runners. These shoes are really top of the line and I rather enjoyed them. My condition was slightly alleviated by them, but not to my satisfaction. After 2 months I purchased a pair of ASCIS Gel Kayanos which although nice and light and comfy, made absolutely no improvement. I’ve always been a fan of New Balance, so I looked for their best trail running shoes and purchased those; again to no avail. I then tried Pearl Izumi’s SynchroSync III, which is a wonderful shoe and the best running shoe I have ever tested by far. This made it possible for me to walk with less pain and even run a little bit. However, after 2 months of wearing those, I was still in pain and not complacent with the results. Only out of curiosity and with lots of skepticism did I try MBTs. I had already decided that Pearl Izumi made the best shoe on the market and since MBT is the “anti-shoe” I suppose that is still true. I was accompanying my sister on a quest for a good walking shoe and this led to my first MBT experience. Wow, I was sold the first time I put them on. The pain in my knee and heel were present, but tolerable. I bought a pair and within 3 day of wearing them I was able to run with minimal heel or knee pain. I’ve saw continual improvement over the next 3 months and today, I’m virtually free of the pain.

Sleeping with Hip Pain and Bursitis

Do you suffer with lots of pain in the hip after prolonged sleeping in a side posture? You’re certainly not alone. The cause may be bursitis and this can occur either with the hip/leg on top, or the one that is pressured against the mattress. Hip bursitis can either be acute or chronic hip bursitis.

WHAT IS BURSITIS?
Bursitis is dysfunction in the fluid-filled sac (bursa) that normally provides buffering and lubrication for tendons gliding over a joint. It is often caused by new or old injuries or can be a result of lack of important nutrients to the joint. Acute Bursitis is inflammation of the sac and perhaps over-production of fluid (swelling). Chronic bursitis actually presents with dryness, lack of fluid and poor lubrication for movement of tendons.

HIP PAIN ON THE DOWNSIDE
Although there are many facets of treatment and self-care for bursitis of the hip joint, a pressure point relieving, supportive foam mattress is one very important aspect of treating it. REASONING: (1) It is important to not have pressure on the inflammed bursa while lying on that side. (2) Additional to excessive pressure, poor mattresses lack support and often sag or hammock. That places an undesirable stretch on the muscles associated with the hip on the downside, thus irritating the bursa and impeding healing. One might wake up with pain, clicking, stiffness and limited mobility which may lessen after being up and about for awhile.

HIP PAIN ON THE UPSIDE
Alternatively, your pain may occur in the hip that faces upward. I know this seems sort of odd, but it is actually quite common. REASONING: (1) In most people, their hips are wider apart than their knees. This is especially true in women. This anatomical truth can create tension on hip muscles as the knees come together and stretch such muscles. (2) Or perhaps, one stretches their leg out in front of them twisting the spine and pulling on hip muscles. In those with bursitis, this can wreck havoc with the sensitive bursa. (3) Of course, a supportive, pressure relieving mattress is advisable to prevent excessive hip rotation.(4) However, in this case it is often advisable to also utilize a nice space occupying pillow between the knees. The pillow should be soft enough to not impede circulation but substantial enough to maintain a distance between the knees perhaps equal to the width of the hips. Please note that hip bursitis often is complicated by a component of hip tendonitis which may also be alleviated with the advice of this article. Please also note that this is not the panacea of care for hip bursitis. Functional care involving nutrition, stretching, strengthening and physical medicine are advisable but beyond the scope of this article.

HELPFUL SLEEP SOLUTIONS FOR HIP BURSITIS

Mattresses to consider:

• Nimblepedic Memory Foam Mattress
• Pincore Latex Foam Mattress
• Or, if your mattress is extremely firm, it likely causes pressure points and will actually bend the spine. In such cases, instead of a new mattress, one may consider a memory foam mattress overlay for firm mattresses.

Pillows to consider:

• Between the knees/legs pillow

Adjustable Beds: Enhancing the Sleep Experience

The current evolution of sleep technology suggests considering an adjustable bed for improving sleep quality at any age. Although hospital beds are a form of adjustable bed and have been around for years, the thought of placing one in the home was previously only considered for the elderly and debilitated. Why has the adjustable bed captured almost 40 per cent of premium beds sales in the 21^st Century? First let us understand the importance of a sound sleep.

UNDERSTANDING WHAT SLEEP REALLY IS

Sleep has all of the following characteristics:

• a lack of or decrease in awareness of environmental stimuli
• the maintenance of core body temperature (in homeotherms or mammals like us)
• is easily reversible (to wakefulness)
• has distinct EEG patterns in mammals (different from a state of wakefulness)
• has spontaneous occurrences with inherent repetition (independent of other bodily needs and environmental cues)
• sleep offers the benefit of conserving energy while focusing on repair of the body

WHY DOES ONE NEED A SOUND SLEEP?

Humans spend one third of their lives in a somnolent state. This is one reason your bed is so important. Here are some others:

Sleep deprivation impairs thinking and suppresses the immune system.

Neural activity inducing sleep is synonymous with such that regulates temperature. Much evidence exists that indicates the origin of the sleep process was simply a method of body and mind maintenance. This included both temperature control and the enhancement of memory recorded by neural activity during REM sleep. More specifically, sleep is a period of time whereby the brain and body can learn and mend without the interference of outside sensory stimuli or sleep-disruptive motor activity. In simple terms, we recuperate, learn and commit new information to memory when we sleep. How important might this be for a student?

Thus, sound sleep is a state required for learning new neural patterns. In other words, in order for the nervous system to grow and change, there must be down time from active behavior. Creatures as primitive as worms require adequate sleep. Don’t you think humans deserve at least as much?

EVOLUTIONAL HISTORY OF BEDS AND MATTRESSES

• First Beds - The first beds of ancient man likely consisted of soft grasses and leaves on rock palettes or open ground.
  
• Fancy Ancient Beds - Thousands of years before Christ, in ancient Egypt, royalty slept on the first feather bed mattresses supported by bed frames made of gold, bronze and ebony. Sometimes hay, wool or grasses were substituted for the feathers. Wool and feathers were great for maintaining body temperature and we’ve just touched upon the importance of such.
• Renaissance Materials - The Renaissance Era brought great improvement in mattress plushness. Feathers, straw and/or the shucks of legumes were covered with fine silky or velvety fabrics.
• 16^th Century - In the sixteenth century, foundations created by a web of ropes were developed to create flexible support for mattresses. This is thought to be the origin of the phrase: “sleep tight” because by tightening the network of ropes, more support was provided.
• 18^th Century - During the 18^th century, cotton was utilized for mattress stuffing which was a deterrent for bed bugs that had become accepted as commonplace.
• Early 20^th Century - In the 1930’s America introduced the innerspring mattress.
• 1950’s - Latex foam rubber mattresses were introduced by Goodyear in the 1950’s and marketed by Sears and Roebuck.
• 1980’s - Airbeds hit the market in the 80’s.
• 1990’s – Memory foam mattresses by Tempurpedic® ^® hit the USA.

ADJUSTABLE BEDS IMPROVE THE SLEEP EXPERIENCE

The advent of high quality foam mattresses in the 1990’s brought about innovation. In 1994, it is this author’s belief that, Back Be Nimble was the first company to expound on this by partnering a memory foam mattresses with an adjustable bed from Electropedic. BackBeNimble.com started a nationwide marketing campaign offering a combination of the now famous Tempurpedic® memory foam mattress with this high quality adjustable bed and groomed it for residential environs.

Labeled the European Adjustable Sleep System by Back Be Nimble in 1995 and offering a Tempurpedic® Mattress / Electropedic Adjustable Bed combination, it was brought to the attention of Dave Fogg, the then current CEO of Tempurpedic®, Inc. Mr. Fogg did not feel that the adjustable bed market could be expanded beyond the geriatric market and that Tempurpedic®’s target customers would not likely have interest in such. Additionally, he expressed that beds in this price range would also not sell through online catalogs.

Following this conversation, BackBeNimble.com proceeded to market the European Adjustable Sleep System via both brick and mortar and online media. After three years, almost 50 per cent of Back Be Nimble bed sales were adjustable beds vs. the conventional flat bed.

Needless to say, the bed and mattress industry took notice, nonetheless Tempurpedic®, Inc. It is this author’s contention that 50% of Tempurpedic®’s sales from 2004-2005 combined their Tempurpedic® mattress with one of their Leggett and Platt adjustable bed frames. The rest is history.

IS AN ADJUSTABLE BED RIGHT FOR YOU? Let’s investigate!

• Restful & rejuvenating
• Reduces tossing and turning
• Increases the period of REM sleep
• Comfortable & adjustable
• Pain free & relaxing
• No heartburn, no snoring
• Zero pressure-point adjustable bed mattresses
• 1000 positions for you and your partner with independent controls for each (with dual-adjustable beds)
• Wake up rested and refreshed
• Hmm… Maybe this is “Zzzz” sleep you’ve imagined

Gravity and Zero-gravity Effects of Adjustable Beds

While the beneficial floating or weightless effects of zero-gravity on the spine are experienced on an adjustable bed, these beds also use gravity to benefit your health.

Indigestion: By elevating the torso, normal digestion is enhanced. The stomach acids actually flow down hill, helping to alleviate the discomfort of reflux, GERD and acid indigestion. Breathing is enhanced for more complete oxygenation of the tissues.

Low Back Pain & Sciatica: By elevating the legs while bending the knees, your adjustable bed uses gravity to aid circulation while relieving lower back pain and tension on the sciatic nerve.

FINAL THOUGHTS

Still think adjustable beds are only for the elderly? We don’t either. Sleep was meant to be good at all ages and people of all ages have insomnia or less than adequate sleep. A pressure-reducing mattress on an adjustable bed platform is the current best practice for achieving a restful, rejuvenating sleep.

TEMPURPEDIC^® is a registered trademark of TempurPedic^®, Inc. and use of such does not imply endorsement of this blog by Tempurpedic^®,Inc.

Sciatica: A Real Pain in the Butt

THE MANY FACES AND CAUSES OF SCIATICA
Sciatica merely describes a path of pain and is not a specific diagnosis. The use of the term "sciatica" does not specify a cause.

Defined, "sciatica" is a description of a particular path of pain following the sciatic nerve as it traverses the buttock (hip) and/or continues down the back of the thigh, outside of the leg and perhaps the foot. As our article title denotes, sciatica can be a real pain in the buttocks.

Generally, the worse the condition, the further down the leg the pain travels and may even affect the foot. However, there are certain cases that although severe, only affect the hip area or buttock. It suffices to say that the symptom picture can be quite varied from one individual to another. Although most commonly associated with nerve compression from a low back disc condition, there are many causes of sciatica, some of which are not back related. Interestingly enough even those cases originating from a low back condition may not exhibit any back pain.

Some authorities would argue that if the origin of pain is not compression of a nerve root in the lower back, the result is not a "true sciatica", but a pseudo-sciatica. Synonyms for sciatica would be sciatic neuralgia or sciatic neuritis.

ANATOMY OF THE SCIATIC NERVE

The sciatic nerve is about 1/2 inch in diameter and is known to be the longest and largest nerve in the human body. The nerve originates in the lower spine as nerve roots exit the spinal cord (between the vertebrae in the spine), and combine to extend all the way down the back of the leg to the toes.

It is thus composed from a combination of 5 nerve roots exiting holes known as foraminal openings between vertebrae in the lower lumbar and sacral region. These include the following nerve roots: L4, L5, S1, S2, and S3. Nerve roots in the lumbo-sacral area of the spine are named by the vertebrae above. Thus if the nerve root exits between L5 and S1 it would be considered the L5 nerve root. By understanding this one can correlate the area of symptoms with a specific spinal level.

The five nerves combine anterior to (in front of) the piriformis muscle to become the sciatic nerve. This nerve then travels down the back of each leg, branching out to innervate specific regions of the leg and foot. It should be mentioned here that a spasm of this piriformis muscle where the nerve crosses the sciatic notch can cause sciatic neuralgia and often mimic symptoms of a herniated lumbar disc.
Just above the back of the knee, the sciatic nerve divides into two nerves, known as the peroneal and tibial nerves, going to various parts of the lower leg:

• The peroneal nerve innervates the shin and outer aspect of the leg down to the upper foot.
  
• The tibial nerves innervates the posterior portion of the leg and traverses all the way to the feet to innervate both the heel and sole of the foot.
  

The sciatic nerve supplies both motor input (eliciting muscle movement and reflexes) as well as sensory innervation.

SYMPTOM PICTURE OF SCIATICA

Pain: searing , stabbing, usually intermittent pain is generally the overwhelming symptom. The pain can be felt in the low back, buttock, posterior and outer side of the thigh or leg and possibly all the way to the toes. The pain is most often felt in certain positions, while walking or while straightening the leg. It may occur on both sides (bilaterally), but it is more often one-sided (unilateral). Pain is sometimes exacerbated by sneezing, coughing, laughing or pushing during a bowel movement (Valsalva's Maneuver).

Numbness/tingling: sometimes the pain is either accompanied by or replaced by numbness and tingling known as paresthesia or radiculopathy.

Weakness: in the most severe cases of sciatica there is actually impairment of the motor nerve functions causing weakness in the leg and/or foot. The most common sign of such would be foot drop or the inability to pull the big toe up toward your knee (aka: lack of dorsiflexion).


CATEGORIES OF CAUSES

Mechanical Spinal Nerve Compression: most often from a herniated, ruptured or extruded disc but can be from severe misalignment or vertebral subluxation.
Compression by Muscle Spasm: most commonly known as a "Piriformis Syndrome" whereby the muscle underlying the gluteus maximus (buttock) is spasmed applying pressure to the sciatic nerve underneath. This is known to clued physicians as an "entrapment neuropathy" and is often misdiagnosed as a low back disk herniation because it mimics many of the symptoms of such. This can prudently be differentially diagnosed from a disc herniation by either MRI studies, CT scan or just a good old fashion history and exam including questions regarding pain during coughing, sneezing and bowel movements.
Trauma to the Sciatic Nerve: bruising, puncture wounds, or over-stretching injuries to the nerve itself can produce the symptoms of sciatica.
Spondylolisthesis: this is a slippage of one vertebral body on top of another and may be a result of fracture or a genetic defect in the pars interarticularis. If in the L4 to S1 region, sciatic neuritis symptoms can occur. Although many authors seem to describe a compression of nerve roots resulting from a spondylo-listhesis, it has been my experience both clinically and in my review of the literature that the most accepted authorities believe the nerve root irritation to be a result of traction or stretch of the nerves vs. an actual compression.
Spinal Tumors: space occupying lesions, of the spinal vertebrae, spinal cord, cauda equina, or surrounding muscles or sciatic nerve itself can cause sciatic symptoms.
Sacro-iliac Joint Sprain or Subluxation: this is actually one of the least understood or recognized conditions causing sciatica, but in this clinician's experience is one of the most common causes of sciatica not resulting in pain extending below the knee. Coughing and sneezing does not increase the symptoms in this case and often Kemp's sign will NOT be positive. Subluxation or sprain of the sacro-iliac joint leads to a referred sciatica in this case. This is generally best treated by a chiropractic physician.
Chemical Irritation: although not even known or considered by most practicing physicians, chemical radiculalgia is one of the physical results of back dysfunction and can be the primary cause of sciatica. This is an actual irritation to nerve roots caused by the swelling pressure of inflammation against the nerve. It is a major factor in what is called the "cycle of pain". It may be interesting to note that it has been this practitioner's experience that this is often the factor that is most concerning when dealing with the sequela of a disc herniation or injury. It is the overwhelming reason that Lumbar Epidural Steroid Injections have been so effective in relieving the symptoms of herniated or ruptured disc conditions. It leads some researchers to believe that inflammation may play an even greater roll in symptomatology than the mechanical pressure of displaced disc material.
Viscerally Referred Pain: although not as common as some of the other causes of sciatic symptoms, paresthesias, pain and odd sensations may be felt along the sciatic nerve distribution as a result of problems with internal organs. For example, problems with the prostate gland or female organs can refer sensations along the sciatic nerve. This can easily be ruled out by a thorough examination.

TREATMENT OF SCIATICA

Certainly the best treatment practices for sciatica would include addressing the cause in addition to alleviating the symptoms. Thus the approach may be different dependent on the cause. Sitting, driving and arising from the sitting position is usually a problem for all sciatica sufferers and thus one of the most recommended items would be a pressure relieving seat cushion. One type is known as a memory foam seat wedge. The 2nd type is a gel seat cushion that is wedged for ultra comfort.  Make sure that the cushion you select has a cut-out for the coccyx or tailbone and that it is solid, fairly dense memory foam or a solid type of gel. Ice is nice in the case of sciatica and heat should generally be avoided in acute cases.

Other treatment protocol is more causal specific and usually requires a battery of prescribed and self-care. Some of these are listed below:

DON'TS
Avoid irritation and stretching of the nerve during the healing process. This would eliminate toe touching with the leg straight.

Avoid running, fast walking or other physical activities that increase pain.

Avoid heavy lifting, stooping, squats or prolonged bending.

Avoid sitting on soft overstuffed chairs or couches or desk chairs that fall away when leaned against.

Avoid fast movements.

Avoid arising out of bed w/o first turning on your side

Avoid stomach sleeping or sleeping on your back with both legs straight out.

Avoid straightening the involved leg when sitting.

DO'SDo see a physician or chiropractor for a proper diagnosis and treatment. Depending on findings your doctor of choice may suggest: spinal adjustments or manipulation, deep tissue massage of the buttocks, core muscle strengthening and stretching, repair of a disc herniation, oral anti-inflammatories, lumbar corset or lumbar epidural cortisone injections. Lumbar traction and/or gravity inversion may be advisable in some cases. For less common causes like tumors or referred pain from internal organs, your doctor will likely refer you to a specialist for further investigation.
When sleeping on your back, keep at least the involved leg slightly bent with an orthopedic bed wedge or soft fluffy pillow.

When side sleeping, place a soft pillow between your legs starting at the knee and positioned downward from there.

Do utilize a memory foam seat wedge to keep good posture and remove pressure from the sciatic nerve when seated or driving. For chronic sciatica seated workers should consider the purchase of a nimble ergonomic chair like the Bodybilt task chair.