Upper and Lower Crossed Syndromes

New Year, New Resolutions, And (Avoiding) New Injuries (Part 1)

“Ok, THIS is the year. I swear. It’s time to be healthy. No more cookies. No more chips. DEFINITELY no more ice cream. AND I’m going to the gym. Everyday. Maybe twice a day. I’m very serious. Have I mentioned that THIS IS THE YEAR?!”

Sound familiar? I’m guessing almost all of you have heard someone resolve to make similar changes since the first of the year. Maybe that someone was you? Personally, I’m a big fan of resolutions and their ability to change the trajectory of our lives when we commit to them. The New Year happens to be a fantastic time to take inventory of our finances, relationships, lifestyle, and health. Obviously, one of the most common commitments for people to make is to workout more. Why do you think gyms love January 1^st? More members, more money! The problem is, when we jump into a new activity that our bodies aren’t used to, it’s a shock to the system. Now originally, this blog was supposed to be about common injuries sustained at the gym when we throw ourselves into our New Year’s resolutions. What I realized, however, is that the potential for injury starts well before we step foot in the gym. Remember the desk that most of you are tethered to 40+ hours/week? We need to address that first; the desk, all of the sitting, and what it does to our bodies by the end of the day. Once we understand that, we can figure out how to counteract the effects of sitting and prepare for exercise. (Coming in Part 2!) This way, we have at least half a shot of getting through a workout injury free!

Take a second to think about how you spend most of your day. Are you imagining yourself not only at your desk, but also in the car and then on the couch after work? Don’t worry. You’re among the majority. (Actually, I need you to worry JUST a little bit because all that sitting is making your body pretty unhappy with you. But again, don’t worry because there are ways to make improvements!) The problem is, when you force your body into one (poor) posture all day long, eventually your body adapts. Trust me when I tell you that these particular adaptations are not in your best interest. And I’m sure you started your day with the best of intentions! You got to the office, sat down in your (hopefully ergonomically sound) desk chair, and situated yourself the way every “Proper Sitting Technique” article ever written has instructed you to. Your posture is perfect…for about the next 12 seconds. Then someone calls, so you shove the phone between your ear and your shoulder in order to continue typing. You get tired and distracted and before you know it you’re hunched over your computer, shoulders are rounded forward, your head and chin are jutting out toward the screen, and you’re cursing at whoever made the chair because obviously they didn’t SIT in the chair before they mass-produced it.  Combine all that with thinking you’re doing yourself a favor by jumping head first into a workout after 8 hours at your desk, and we’ve got a problem.

Your discomfort, and this posture, actually has a few names. They are the Upper and Lower Crossed Syndromes. These syndromes both describe the adaptations that the soft tissues/muscles have made in response to the hunched-over posture you’ve subjected them to while at your desk. They describe the pattern of some muscles contracting, shortening, and tightening all day, while others are stretching, weakening, and underutilized. To get an idea of which muscles are doing what, imagine looking at someone from the side (their profile) and drawing one X right through their upper body, and another through the lower body. Get it now? Upper and Lower CROSSED Syndromes. Pretty creative, right? You can draw a diagonal line through the weak muscles (front of the neck and down through the body to the muscles between the shoulder blades), and another through the tight ones (chest muscles up through the body to the back of the neck), front to back.

In Upper Crossed Syndrome, the muscles in the front of the neck are responsible for neck flexion (chin to chest) and chin retraction (chin straight back to the spine). Go ahead and sit up tall and a place your pointer finger on your chin. Now push your chin straight back to the spine (you should see a nice double chin forming), remove your finger, and hold this position. Do you feel the muscles in the front of the neck activating to keep your head back, ears over shoulders? Now relax and jut your chin forward. Those same muscles go totally slack. This is the exact position you end up in at your desk. Those muscles don’t do any work all day long, and as a result get progressively weak over time. Now the muscles in the back of the neck are there to lift the chin up and extend the head back. When your chin is jutting forward, however, those muscles are back there just holding on for dear life. They’re keeping your head up so that you can see the computer screen, and not just the floor of your office. Expecting these posterior neck muscles to work non-stop during your work day is crazy! They end up tightening and shortening, and causing all sorts of neck tension and headaches.

The chest and back also suffer. With your shoulders rounded over a keyboard all day, your chest muscles shorten and tighten. Opposing this are the muscles of the mid back that are trying to pull your shoulders back and shoulder blades together. Because of your position, they can’t, and just like the anterior neck muscles, when they aren’t used they give up. They get weaker. The problem is that the changes to the muscles that I just described aren’t transient. They don’t just ‘go back to normal’ once we shut down our computers and stand up. Those changes have now affected your posture, and pretty soon you’re just as “hunched over” when you’re up and walking around as you were at your desk.

As I’m sure you can imagine, Lower Crossed Syndrome follows the same pattern in response to habitual sitting. A diagonal line of weakness can be drawn from the abdominal muscles, down through the body to the glutes. Another can be drawn for the tight muscles from the front of the hips up through the low back. Our abdominal muscles aren’t engaged to keep us sitting tall, and thus they weaken. The low back muscles, on the other hand, work all day long to keep you upright as you lean forward toward your desk. Your glutes aren’t activated at all when you sit contributing to their weakness, and sitting in a chair all day with our hips flexed means the anterior hip muscles shorten and tighten over time. When you stand after a long day, muscle adaptations have occurred and you’re walking around with a lot less mobility in the hips and low back, while other muscles aren’t doing their jobs! Bad combo.

The point of all this is to show you how far from normal your bodies are functioning after a long day (or after 20 years) of sitting.  (As a chiropractor who takes care of people all day long who are coming in with desk-related aches and pains, I think it’s kind of my job to do so!) Just as you can imagine it’d be a bad idea to get up from your office chair and start sprinting, our bodies are also not 100% ready to walk into a gym and start with a set of dead lifts. This doesn’t mean that you shouldn’t go to the gym though. In fact, it’s a great idea. We just need to PREPARE for it. Next week we’ll talk about some quick things to do before your workout to attempt to un-do the sitting, and warm up. In the meantime, Dr. Luke wrote a great blog called “Sitting Is The Problem.” (http://copleysquarechiropractic.blogspot.com/2014/03/sitting-is-problem.html) Take a minute to look over some of the other problems that sitting can cause, as well as some great tips for making your 10hr day at a desk more manageable. Check back next week for Part 2, and until then get up out of the chair that you’ve been sitting in to read this blog, and take a lap!

-Dr. Doscher

Shoveling and Low Back Pain

It’s that time of year again here in the Northeast. Temperatures have dropped, snow has started falling in sheets, and it seems like every other day we’re outside bundled up in our winter gear trying to clear that snow out of the driveway and off the front steps. It’s an inevitable part of living in Massachusetts. Injuring yourself while making sure you can get out of your house and off to work, however, doesn’t have to be. As a chiropractor in Boston and a resident of this very cold state, I can tell you it is this time of year that brings more people into the office with household-related injuries than any other season. The ‘simple’ (read: rarely simple, usually exhausting, and hardly ever fun!) act of shoveling snow ends up injuring more people each year than even I can believe!

A recent study published in the American Journal of Emergency Medicine reported an average of 11,500 shovel-related injuries in the ER each year. While fractures, cardiac events, and cuts or bruises were all identified as reasons for seeking medical attention, not surprisingly low back injuries were among the most common. Approximately one third of the injuries reported in the ER were low back in nature! Those low back patients are the very same patients walking through our doors, wondering how they managed to hurt themselves shoveling. Let’s take a look at the most common injuries we’re seeing, and how to prevent them!

How many times have you come in from shoveling and thought, “Wow. I’m going to be sore tomorrow”? No matter how you slice it, shoveling is a form of exercise, and a unique one at that. Like any other form of exercise, if it’s new to you (or perhaps, it’s the first snow of the winter) your muscles are not accustomed to what you’re about to put them through. Let’s start with some general biomechanics:

Each time you bend forward to scoop snow, the muscles of the low back and the hamstrings have to stretch and lengthen to get you closer to the load you’re about to lift. If you continued this forward movement, though, you’d end up face-planting! In order to prevent that, those same muscles have to quickly contract and shorten to stop you after a few inches of forward bending. Now you’ve got snow (ie. weight) loaded on the end of the shovel, a few feet away from your body. Not only do your core muscles have to stabilize you, but those same low back and hamstring muscles have to continue to contract even more forcefully to lift you and the snow upright. Lastly, you’re probably twisting to one side to toss the shoveled snow out of the way. Repeat this stretch, contract, and twist combination another 900 times along the length of a driveway, and you’ve got yourself a workout! (Incidentally, this is probably the WORST way to approach shoveling, but also the most common. We’ll make sure to address good technique shortly J.) This repetition of movement resembles most exercises at the gym, and as a result the muscle fibers of the low back and legs react the same way. Each time the small individual muscle fibers that make up a muscle are stressed during exercise, they are subjected to damage on a microscopic level, aka micro tears. The body recognizes the damage and sends extra blood, nutrients, and waste clean-up to the area to help heal, rebuild the muscle, and make it stronger. A by-product of this is inflammation. Now, inflammation tends to get a bad rap, but (when under control in the right circumstances) it’s actually a very normal and healthy part of healing. Inflammation helps to heal those muscle fibers, but is also perceived by us as tenderness or pain. So, you shovel for the first time this year, or the snow is exceptionally heavy, or you’re out there every hour because it’s falling THAT fast, and you end up sore because it’s new to your muscles in one way or another.

Some muscle soreness is generally not the end of the world, but severe tightness or pain definitely isn’t normal. What you should really be aware of is the potential to cause a true sprain/strain injury of the low back by overdoing it. Remember how we talked about a muscle’s ability to shorten and lengthen? Well, sometimes if we stretch too far or too quickly, the muscle tendons or ligaments of the low back can be over-stretched or torn past the point of the normal micro tearing we just talked about. We end up with a sprain or strain. Both injuries result in lots of muscle spasm, excess inflammation, and pain. Lift more snow than you’re used to, or twist to toss the snow aside before your body stabilizes itself, and the next thing you know you’re really injured!

Another potential injury commonly associated with shoveling is a disc injury. Intervertebral discs are the cushions between each bone (vertebra) of the spine, responsible for shock absorption. Think of a disc as the body’s equivalent of a jelly donut; squishy jelly inside, dense dough outside. The jelly inside the donut has room to move around within the confines of the dough as it’s squeezed (loaded) and pressure changes. When we bend one way, the jelly naturally moves in the other direction to relieve pressure. Sometimes, however, if the pressure pushing the jelly around as we move is great enough, that jelly can start to seep into the dough and get pretty messy. In our bodies, when the gelatinous inner substance of the disc (normally contained by the tougher outer layers) starts to push outward, the disc ends up injured and inflamed as it bulges. Less commonly, it can even push through those outer layers resulting in a herniated disc. Despite the amazing ability of these discs to withstand forces, there are circumstances in which they are more vulnerable. For instance, sitting increases the pressure in the disc far more than standing does. The same is true for forward bending. Bend forward with a load, or bend and twist, and you’ve now put your discs in the most stressful positions possible. Sound familiar? Bending forward with your shovel, loading it with heavy snow, and then lifting it and twisting to toss it aside is the trifecta of movements that put the discs at the greatest risk of injury. Injuring the outer layers of the disc can cause immense pain, inflammation, and spasm in the low back. Herniating a disc, however, means nearby spinal nerves or the spinal cord may be affected. Injury to these structures can result in all of the discomfort we just mentioned, plus pain, numbness, and/or tingling into the legs. It’s a much more severe injury to sustain.

Now that we’ve covered all of the big, bad stuff that COULD happen, let’s try to prevent it! Here are some tips for tackling the snow safely:

·      Avoid Shoveling: If you have a snow blower, you’re one of the lucky ones! Use it! If not, please continue reading…

·      Warm Up: We’ve already established that shoveling is a form of exercise. Just like we get our bodies warm before lifting weights, we should be doing the same before shoveling. Take a couple of laps up and down the driveway to get the muscles warm and prepped for activity.

·      Salt/Sand: Use it to make sure you have good footing and balance, allowing your muscles to activate normally. Slippery surfaces make you unsteady and can catch your muscles off guard, leading to injury.

·      Ergonomic Shovels: They make shovels with curved handles and adjustable lengths for people of all heights so you’re not bending as much. While you’re at it, chose a lightweight shovel. The snow is heavy enough!

·      PUSH the Snow: Pushing the snow out of the way instead of lifting it is a lot easier and requires much less bending and stress on the low back. When you have to lift it, try a little less snow.

·      Technique: Start by squaring your body off to the load, keeping it in front of you. Use one hand closer to the blade and one hand near the handle. Keep the low back as straight as possible. Brace your core (imagine someone is about to punch you in the stomach and tighten your abs for protection), bend at the hips and lift with the legs to minimize the amount of pressure on the low back and in the discs. Keep the load as close to you as possible for more control and less strain on the muscles. Instead of twisting and tossing the snow, pivot to where the snow will be discarded and deposit it. This helps reduce the added pressure on the discs created by forward bending combined with twisting.

·      Pace/Rest: Sometimes taking a break makes all the difference. Give your body a chance to regroup, and head back out. Also, instead of trying to lift 12in of snow at once, take a few off the top each time to make it lighter and more manageable.

·      Remember: Heart issues have been reported in association with shoveling and the cold weather. If you have a history of cardiac issues, check with your doctor for clearance. If you notice any cardiac symptoms while shoveling, seek medical attention immediately.

Now, if somehow you still find yourself injured or uncomfortable, there are ways to heal more quickly. Your chiropractor has the ability to evaluate the severity of your injury and treat appropriately. Muscle spasms can be reduced, mobility can be restored, sprains/strains can be healed, and even minor disc injuries can be addressed with various techniques. More importantly he or she should be able to give you the appropriate strengthening exercises once healed, to prevent further injury. After all, it’s a long winter with plenty more snow on the way, and your driveway isn’t going to shovel itself! Stay safe out there!

-Dr. Doscher

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[i] http://www.ajemjournal.com/article/S0735-6757(09)00371-4/fulltext

 http://ergo.human.cornell.edu/ErgoPROJECTS/97projects/coffiner.htm

Sitting is the Problem!

First blog in almost a year!  I know what you've been thinking... "why did it take so long?"  "wow I've missed these posts" "I will literally cry if they don't post another article soon!" "How can I go on living without a new post??"  I know, I know, and I'm sorry for the delay :) Apparently a ton of people in Boston have needed a chiropractor!  So we've been kinda busy... But we're back!

Currently I'm about 10,000 feet above sea level (that's a guess, I have no clue how high we are, but it sounded like a good number), stuck in a metal tube that's traveling hundreds of miles per hour. For those of you have already figured out that I'm in a plane... congratulations :) Currently I'm somewhere over Chicago on my way to San Francisco (and then vegas) and one thing is becoming very obvious to me... this is a long flight and I'm bored! Wait no that can't be it... that would be an even more boring blog post than normal. Ah yes, I remember now... my back hurts! It's been about 2 hours and I haven't gotten up once. My gluts are starting to tighten up and my lower back is starting to feel stiff, it's not all that painful yet but it's starting to ache. Suddenly I am understanding why the majority of people I see come from the John Hancock tower or the Prudential center. And the reason is that most people who work in Boston sit for a living... and sitting is the #1 cause of back pain.

I wish it wasn't, I really do, I wish sitting had nothing to do with back pain. My job would sound so much cooler if the majority of people I saw were injured BASE jumping or cage fighting... or even falling down the stairs after a drunken debacle. But alas, those hardly ever happen. The majority of people walk into the office and tell us that they really didn't do anything... but their back always hurts. I guess the question is why? So to understand why sitting is so bad for the human body we have to look at the spine itself.

When we're born the spine is a big C shape, cause we've spent 9 months curled up inside the womb. As we start to crawl we actually develop different curves in our spines, and as we begin to walk upright our spinal development is finished with a nice curvy spine. It's basically an S shaped curve(google it for more details). It's similar to a spring... and that's basically what our spines do, they compress, expand, flex and extend like a slinky (for those of you old enough to remember a slinky). Every time we walk or jump our spines compress then expand again, kind of like a slinky would. That's normal spinal motion, and it's actually how our spines stay nice and mobile throughout life. The movements of the spine allow for blood flow and nutrients to travel in and out of our spines which prevent things like disc issues and arthritis from occurring. 

Proper spinal curves also improve the function of the human body. Try to think of the best athletes on the planet. Do you have someone in mind? Now think about their bodies, not in a gross way :) but in a spinal curve way. What you'll notice, if you look closely, is that the best athletes in the world have impeccable posture but also have big butts. That may sound strange but it's quite true. Look again at pictures of sprinters or power lifters or even baseball players, they all have huge glut muscles. And the reason they have huge glut muscles is because they have perfect spinal curves which makes their gluts actually stick out further than the normal person... thus allowing for proper gluteal development and power. Now lets assume that you had perfect spinal curves when you were a kid... which by the way doesn't always happen, some people just don't develop the correct curves and they have a lifetime of back pain... but I digress. So assuming you have great spinal curves and you have a nice lower back arch while standing, lets take a look at what happens when you sit down. 

Immediately upon sitting you lose your lower back arch. You can try this on yourself, sit down and place your hand on the small of your back... is there any space in between your lower back and the seat back? I guarantee there isn't any space and you probably had trouble just fitting your hand behind your back because the small of your back was jammed into the seat back. So right when we sit down we lose the normal curve and that curve becomes a straight line. Well what's the big deal about losing a curve in the low back? The problem is that now we've lost the shock absorbing properties of a spring. Remember before how we were talking about the curves of our spines providing shock absorption? Well now instead of our spines compressing and extending like they should, they become a rod, it's like pushing on both ends of a straw... there's just no give. So now instead of our spines absorbing the shock of gravity or bumps in a car the shock is absorbed by our spinal discs and that's a bad thing.

Discs are kind of like Jelly doughnuts, just tougher, and as the disc get compressed the jelly has a tendency to push out towards the edges. This causes what's called a disc bulge and eventually these disc bulges cause irritation to nerves that run very close to the discs. And since nerves control both sensations of pain and muscle function, bulging discs can cause not just pain but also stiff and tight muscles. So the simple act of sitting, causes the spine to straighten, lose it's normal arch and shock absorbing capabilities, thus putting all the pressure on the discs, which then can cause nerve irritation, which then cause pain and tightness. That's quite a downhill spiral all caused by just sitting!

Not only does sitting cause us to lose our spinal curves but if we were standing we could dissipate all the pressure into our thighs and lower legs and feet... but since we're sitting, now all the pressure goes directly to our low backs. We've stopped using our legs to dissipate the pressure. Plus the act of sitting causes our hips to twist into the sitting position, which causes a constant pull on where the muscles of the butt attach to the bones of the hips and low back. So we've got an orchestra of compression, pulling muscle fibers, irritated nerves and bulging discs! It's the worst thing humans can do for their bodies... and here I am, and you probably are as well... just sitting... minute after minute, hour after hour.

This leads me into a side bar here... have you ever known anyone with "No ass"? Or maybe your significant other makes fun of you for having no ass... and I feel for you if this is you... I've been there :) But I'm sure you know someone who seems to actually have a flat back and butt area... now these people have lots of back pain or eventually will. Cause they have no curves! Just a big rod for a spine, which is horribly irritating for the back. So if you know of people like this please try to get them in to see someone so they can hopefully prevent pain down the line.

As I sit here on my flight, suddenly realizing how far away the west coast actually is, I look around and see people of all ages.  The younger people are fine with all this sitting, most of them are actually asleep, and have curled up into such strange positions it's horrifying for a chiropractor to see! But they are young and can handle it. The spine and muscles of young people respond the way everything else does for young people, with resiliency. But when I look at myself or the 60 year old woman next to me I see a much different story. We're both fidgeting around and trying to stretch out constantly, because our spines have lost our normal squishy curves, from years of sitting and abuse.

The point of this blog is basically that human beings aren't designed to sit... period. And most back pain would go away if people didn't sit... thus making my job obsolete. Wait, no that's not what I wanted to say, scratch that. Sit as much as possible! haha... just kidding! But in actuality I sometimes have this conversation with people in the office. Where I say that the main issue here is the fact that someone sits all day. And of course they say "well I can't stop sitting" and I say "whelp enjoy seeing a chiropractor for the rest of your life." And I giggle... and they don't laugh... crickets :)

But in all seriousness, it's a tough problem to beat. Most people sit for 6-8 hours each and everyday of the work week, and there's nothing they can do about it. But the answer is to stop sitting! It's like going to see someone for eye pain cause you stare at the sun a lot... they would say stop staring at the sun and your eyes would stop hurting! With sitting it's just not that simple cause most people don't have a choice. Luckily we can help most people in the office, but it's not a permanent fix, these people would have to stop sitting to be cured of their pain. And you can't expect to reverse 8 hours of sitting by stretching for 30 seconds... it just doesn't happen! That being said there are a few things that people can do to minimize the damage of sitting.

1.  Get a back huggar for your chair. That's not a spelling error, that's the brand. Get it online, $30 or something like that. Put it in your chair at work. It will keep your low back curve from flattening out. 2.  Spend some time watching TV like a child. Basically get down on the floor on your stomach, put your elbows on the ground in front of you, and prop your head up with your hands. Look at any child for instruction. This position is basically the opposite of sitting. And for most people this kills their backs in the beginning because they've become so used to sitting and curling. But after a few weeks you'll be able to hold that position longer and longer. For those Yogis out there, this is similar to the cobra position.
3.  Get up and every 30 minutes for 10 seconds and then sit right back down. This breaks the compression cycle of sitting and may prevent some pain.
4. Stretch your TFL muscles by using a trigger point ball of some sort... or a lacrosse ball or anything small like that. Just lie on your side and have your TFL muscles, google them to figure out where they are, compress into the ball on the floor. Find a spot that really hurts, making sure you're not on the bone, and just lie on it for 3-5 minutes. Repeat on the other side. This will release the TFL muscles which get abnormally tight the longer you sit.
5.  See a chiropractor (shameless plug!) For some people, the back huggar and the lying on the stomach and getting up and stretching just aren't enough. And those people see chiropractors every month. We relieve the pressure and compression from weeks of sitting in about 15 minutes and then these people go right back to sitting... and we repeat this cycle. But for those people who can't find relief any other way it's a great thing to rely on.

The take home here is that humans weren't designed to sit and cross country flights are boring and painful. So quit your job and travel the country on foot from now on :) Happy sitting everyone!

Is your Chiropractor your Cure?

I've got a friend who wakes up at 5am and swims for 1 hour before work every single day. Which to me sounds absolutely awful... cause I think swimming is one of the hardest exercises to do.  I'm just not a swimmer, if I do a few laps I think I'm gonna die, I mean literally, I may just pass out and sink!  So to me, he's a crazy person, but you know what?  He loves it.  When I ask him why he does it he always responds with "cause it evens me out and I'm just not myself if I miss a day."  Again... crazy person!

So he's an example of a person who has to do something every day or else he doesn't feel good.  But we all have things like this.  For some people it's walking or running, drinking coffee or making a smoothie, meditating or calling best friends.  We've all got things that we have to do in our lives to make us feel good.

Now if we stopped doing these things, we'd be all out of whack.  If my buddy stopped swimming he'd be miserable, and we all know of the woman who if she stopped taking her morning walks to the coffee shop would be a disaster.  My point here is that we all do things to make us feel better and improve our lives but they aren't one time occurrences, they're things we do on a daily or weekly basis, and if we stop doing them we don't feel good.  For some people this thing is seeing their chiropractor.

Some people have to see their chiropractors on a weekly or monthly basis to feel good.  For these people seeing their chiropractors is like swimming, or working out, or drinking coffee or calling best friends.  It's the thing they need to feel normal.  And if they stop seeing their chiropractor they just don't feel well... their pain comes back, headaches come back, stress comes back, whatever it is comes back. For some people, seeing a chiropractor is as much a cure for their pain as working out is a cure for weakness. (I think that's an analogy... or a simile... I can never remember which is which).  Meaning that seeing their chiropractor isn't their cure, it's just the thing they've found that improves their lives.

"For some people, seeing a chiropractor may be as much a cure for pain as working out is a cure for weakness."

And even though we all know this, some people have a really tough time dragging themselves into the chiropractors office on a monthly basis.  If you're old enough to remember the charlie brown cartoons you'll remember how charlie brown would walk when he was upset.  Head down just dragging his body along... just like this arrested development spoof (and I apologize if you don't know what arrested development is and you don't get this reference)  This is how some people arrive in the office!

Now this isn't true for everyone.  The majority of people we see don't have to come back for life and are feeling much much better within 1-3 weeks.  But for a handful of people that's not the case.  Some people just have bad backs and have to see their chiropractor throughout life or else their pain comes back.  I'll share a story with you about what I mean.

A few weeks ago we had a woman come into the office who has mild scoliosis which causes her to be in some sort of pain every single day.  And she had been in pain for over 30 years, tried everything from pain killers and physical therapy to acupuncture and herbal remedies... none of which helped her pain.  So she came to us, as some people do, as a last resort and only because her best friend convinced her to come in.  We examined her, saw the mild scoliosis and the pain it was causing and explained to her that we could help her pain... but we could NOT cure her scoliosis.  She responded by saying "I'll do anything to get out of pain, I can't live like this anymore."  So she began treatment... still not really believing we could help her.

Now a little background here.   With mild scoliosis there is a slight curve to the spine which causes altered mechanics in the spine.  You get too much pressure and too much irritation on one side of the spine.  So the joints of the spine jam together on one side and stop moving correctly which causes a lot of discomfort and achiness for most people who battle scoliosis.  But if the joints of the spine can be loosened then the pressure is released and most people get can get relief.  This is why we see hundreds of people with mild scoliosis... because adjustments are very effective at helping this type of pain.  But of course we don't cure the scoliosis, we just allow some people to live relatively pain free.

So we started treating this woman, and low and behold, after 8 adjustments she was out of pain for the first time in 30 years.  Fantastic you may be saying!  And that's actually what she was saying... how great it was for her to be out of pain.  So we started treating her weekly, then once every two weeks, and then once a month.  A woman who had constant pain every single day now only had to see her chiropractor once a month... how fantastic!  Well not exactly, because as most people do, this woman eventually said this.... "well you've helped me more than I ever thought anyone could, but I really don't want to come every month cause I live on the other side of the city, so what can I do on my own so that I don't have to come in?"

And there it was... the question that I could not answer... because there's no good answer.  People with scoliosis got dealt a bad hand, if you will.  The mechanics of the spine will always be a bit off, and will need some sort of care.  But since she had gotten so much relief she felt that there must be some way of not coming in for care anymore.  Now remember, she had once said "I'll do anything to get out of pain" and was now saying "I really don't want to come once a month"... what a shocking change!  And also remember, she had tried literally everything before coming to see me, and now was asking me what else she could do on her own to prevent her pain... as if I knew some crazy stretch or exercise that nobody knew of... which of course I didn't.  And this doesn't just happen with scoliosis.  It happens with degenerated discs, sciatica, chronic headaches, fibromyalgia, pain from sitting at a desk all day, pain from traveling for a living, and other pain syndromes associated with the ways people live their lives.

Here's another example.  The guy who sits at his desk for 10 hours a day, getting up only once to grab lunch.  Comes into the office complaining of back pain that has gotten so severe that he can't sleep at night.  He's on heavy doses of pain killers and muscle relaxers which just make him tired all day but don't really help his pain.  He now can't focus at work and he's losing business because of it.  So I examine him and find that his constant sitting is compressing the joints of his spine which is causing his pain.  I told him that I could get him out of pain but NOT permanently because his pain is CAUSED by sitting.  To which he responded "I hurt literally all day and I can't live a normal life without sleeping so do whatever you have to do and I'll come as much as I need to."  So after 2 weeks of treatment he started feeling great.  But he couldn't go more than 2 weeks without getting an adjustment or else his pain comes back.  Doesn't sound too bad right?  From constant pain that caused sleepless nights to having to walk 3 blocks to see his chiropractor for 15 minutes every 2 weeks.  But after a month or so of bi-weekly treatments the question came up again "Doc I feel great when I see you every couple weeks but I'm really busy at work and I just can't get here every 2 weeks so what can I do on my own to not have to come here?"  And again, other than telling him to stop sitting, I didn't have a good answer.  So of course I sarcastically told him he could "stop being you" and we laughed a little... but that joke got us nowhere of course.

And the reason I don't have good answers to questions like the ones I heard from these patients is because the pain many people experience is caused by either something incurable like scoliosis or how people live their lives.  Whether it's sitting, travel, scoliosis, or too much stress.  But these aren't things I can cure.  So when people ask me what else they can do, I really don't have an answer.  And when I do hear this question I always think it's sort of funny, because it's kind of like walking to your hair dresser and saying "Listen, I love how you make my hair look but I live 3 blocks away and I really don't have time to come in here, so what can I do on my own so that I don't have to come see you?"  Sounds funny right?

So what's my point here?  Well my point is that some people have to see chiropractors their whole lives, it's just the way it is.  And it's not because their chiropractor is telling them they're gonna die if they don't come in.  It's just that their chiropractor may have been the only person to ever help their pain and there's no permanent cure for them.  There's no real cure for scoliosis or for sitting all day.  Just like some people have to avoid red meat or else they'll get a heart attack, swim in the morning or else they're miserable, or drink coffee in the morning to get through the day.  Some people just need chiropractors... but is that necessarily a bad thing?  Can you imagine if these people were never introduced to their chiropractor?  And along the same lines can my friend imagine if he never found swimming?  Daily life clearly just wouldn't be the same.

So the next time you drag yourself across town, kicking and screaming, to see your chiropractor, for that long 15 minute appointment, just try to remember how much pain you were in before your first visit.  And just think that even though your chiropractor may not be able to "cure" your chronic pain... they may be able to give you a life without pain.... even though it's a huge "pain" to get to their office :)

A Pinched Nerve in my neck!

Raise your hand if you've ever had someone kick you in the neck... anyone?  No?  Well my hand is raised.  My nephew slammed his foot into my neck last friday, not in a malicious way but he jumped on me and his foot happened to land on the side of my neck.  It was really a great feeling.  And yes, he's only 3 years old, and yes I should be "more manly" and just tough it out but come on people... it's a foot to your neck!  So it hurt, and I'm basically writing this whole post for sympathy.  And this may or may not be related but that same night... I threw my neck out for the first time in my life!

"My neck went out", "I pinched a nerve in my neck", "I can't turn my head!"  These are common things we hear in the office and for the vast majority of people we're able to fix the issue within a few visits.  But when it happens to me things aren't as easy!  Cause who's gonna fix me?  You? Who do I call?  Where do I go?  Well when it happened to me, I initially did what everyone else does... I hoped it would just go away.

So I woke up at 3am saturday morning lying almost on my stomach with my head turned to the side, which never happens.  I sleep on my side, never on my stomach, and since this was the first time I've ever slept on my stomach I woke up in some pain.  Plus lets not forget my black belt (not even close) giant (40 pound) 30 year old (3 year old) muscle bound (all bone basically) nephew that kicked me in the neck!  So anyway, I woke up feeling like something was pinched or jammed in my neck.  Every time I tried to turn my head I got a sharp pain deep in my neck.  "So this is what everyone complains about" I said to myself, followed by "this kinda sucks." Hey it was 3am, I couldn't think of anything more eloquent to say to myself!

When I woke up a few hours later I knew that something was wrong and I had to do something.  So of course I started to ice it, well that didn't do anything other than numb my neck up, which was kinda nice, but when that wore off I was still in a good deal of pain.  I knew something was really jammed up.  And at this point I got the idea of writing a blog post about what exactly was "jammed" or "pinched" in my neck, because I understand physiologically what it is, but I don't think most people do.  So here we go.

To understand what gets "jammed" or "pinched" in the neck we have to take a look at spinal anatomy, and I'll try to make it really basic for those of you who hate anatomy.  Whenever 2 bones come together they form a joint, just like where your thigh and shin bones come together you get a joint called your knee joint.  Or where your upper arm and lower arm come together is called your elbow joint.  In the neck we have 7 different bones (vertebrae) stacked on top of one another.  Where each bone contacts the bone above it is called a Facet Joint and there's one on the right side and one on the left side.  This is shown in the picture below where we see 2 of the vertebrae of the neck.  This view would be looking at someone from the side.

In a normal spine these facet joints provide movement.  Just like the knee joint enables the bones of the leg to flex and extend, the facet joints of the spine enable the head to look up, down, left and right.  If we didn't have facet joints we wouldn't be able to move our heads, so they're very important.  As you can see below, the bones actually glide on top of one another at the facet joint, as if you were rubbing your hands together.  This is shown below.

Picture #1

                            
                                 

Picture #2

                           

Now to someone who's never looked at vertebra or facet joints before these 2 pictures may look identical, but look closer at the facet joints.  In the second picture you'll notice that the bones aren't quite as lined up as they were in the first picture.  Below you can see this in detail where I've added red lines on the joint surfaces of the 2 bones that make up a facet joint.  You'll see that the bottom picture shows that the top red line has actually moved upwards, enabling someones head to make a "yes" motion.
       
    Picture #3

    Picture #4

This is how our bodies move, it's how we turn our heads, it's how we twist our torso, and how we bend our lower back.  Every movement depends upon facet joints.  This is one of the main reasons why people see chiropractors.  They make sure that the facet joints are gliding properly.  Each bone should glide on top of the other bone below it, but sometimes these joints can stop moving correctly, they can become "jammed" or "pinched" together, and this is what chiropractors refer to as being "out of alignment." Think about you rubbing your hands together in front of you but pushing them really hard together and then trying to keep rubbing.  It's difficult to do and starts to actually hurt your hands, and the same thing happens in your neck.

Many medical professionals don't quite understand human movement and biomechanics so they like to say that the spine can't really go out of alignment.  So is it truly out of alignment?  Well yeah technically it is, we're talking about 2 vertebrae that come together to form a facet joint and those 2 vertebrae becoming stuck so that when a person tries to move their head the facet joint doesn't move correctly.  That means the 2 bones now aren't gliding in the proper range of motion and by definition that would make this part of the spine "out of alignment."

But if your definition of "out of alignment" is a stack of blocks with some blocks sticking out the side then you won't understand this type of alignment.  We're talking about how the spine is moving, not how the spine looks on a static X-ray picture, it's all about functional movement.  Think about when your car is "out of alignment."  Do you see it?  Or do you feel it?  You feel it right?  The only time you actually see the alignment problem is when the tires wear out or something breaks.  Normally you just feel the car start to shake and veer to the side, but if you look at the car from the outside you don't see anything at all.  But functionally your car is moving incorrectly, it's actually out of alignment.  Same thing goes for the spine, you don't normally see the issue, you feel it, and damage is only seen after months or years of the problem persisting.   But if you're looking at an X-ray and expecting to see the picture below then you're gonna think this "out of alignment" statement is nonsense cause you'll never see this.

We're talking about proper spinal movement being altered and thus effecting alignment. But if you look at an Xray of a human spine you'll never see one of the blocks (vertebra) sticking out to the side. The terminology is what gets many people, and many doctors, confused.  But I digress.

Let's get back to the most important part of this post... my neck!  It was still killing me.  So what actually happened to my neck?  Well what happened was that I slept on my stomach which places the head into extension and that compressed my facet joints and they "pinched" or got "jammed" together.  This causes inflammation and pain.  So every time I tried to turn my head or look up and down my facet joints weren't gliding like they should so it felt like something was jammed or pinched together in my neck.  And that's exactly what was happening.

What happened to my neck is what happens to thousands of people every day, and isn't just caused by sleeping wrong.  It can be caused by a trauma, tight muscles, degeneration in the neck, sitting too long and a plethora of other reasons.  Most people who have neck pain or low back pain have problems in their facet joints.  The pain is easily fixed when the facet joints are returned to normal movement.  When they aren't fixed in a timely manor, or if the facets get jammed very close together, the nerve that comes out right next to the facet joints becomes irritated and then you've got a pinched nerve.  This causes pain typically behind the shoulder blade, on the outside of the shoulder, or down the arm but it all stems from the facet joint irritation in the neck.

Now I know what you're saying as you sit on the edge of your seat... "So what did you do for your neck?"  well first off, thanks for caring!  Second, I toughed the day out because my chiropractor was out of town.  Then I woke up on sunday, even more swollen and more angry at my neck.  So I finally made it out to see my chiropractor and he was able to pinpoint which facet joints were stuck and he adjusted those areas.  I could now move a bit better.  Was my pain gone?  Nope!

Why not?  Well my pain didn't go away instantly because that's not how the body works.  For the previous 2 days my body was swelling from my injury, the muscle tissue had become tight and knotted, and my neck was filled with substance P (a chemical that causes pain).  So did seeing my chiropractor cure  me?  Well not right away, all he did was get my facet joints moving again so that my body could start to heal, whereas before I wasn't able to start the healing process cause things were "stuck" together.  But it takes time for the body to heal itself.  So the remainder of the day I iced and by that night I was starting to feel a whole lot better.  By monday, I was back in the office feeling better and treating patients who were dealing with the same problem I had all weekend.  I followed up on monday night with a second adjustment which seemed to cure the residual "pinch" I was still feeling.  But if I hadn't been able to see my chiropractor I would have  been in pain for many days, if not weeks, from a simple "jammed" facet joint in my neck.

Doctors Note:

1. Facet Joints are where 2 vertebrae come together.  They enable us to turn our heads, and bend our bodies.  Without proper Facet Joint motion we get tight, stiff, and eventually jammed in our spines.

2. Facet joints that aren't moving properly is what chiropractors call "out of alignment" and causes swelling, pain, dysfunction and a feeling of "pinched" or "jammed" in the neck/back or muscles near the neck/back.

3.  The sooner you can get the facet joint moving again the quicker you will heal.  The longer you wait the more it will swell up and the longer it will take to heal.  See your chiropractor the day that you feel the pain.

4.  The adjustment won't cure your pain instantly, it will just enable the body to start to heal.  Once the healing process starts the inflammation will decrease as well as the pain.  It may take 1 adjustment, or it may take 5 or even 10 adjustments, it all depends upon how far "pinched" the spine actually becomes.

High Ankle Sprains

Last night I had the pleasure of sitting in the 2nd row at the Celtics game.  Which, for anyone who's never been that close to a professional athlete, is quite impressive.  The size and speed of these athletes is incredible.  They bounce off the floor with breathtaking speed and agility.  They effortlessly jump higher than most of us could ever think of jumping and seem to not even be trying.  Kicking and twirling all over the place.  And yes, if you hadn't figured it out already, I am talking about the Celtics Cheerleaders! Now this post isn't about me, and most the other guys in the stadium(you know who you are) watching the cheerleaders, well I don't think it is... we'll have to see where this blog ends up :)

But in all seriousness, I was really impressed by what these very small, but very strong, women could do.  Now on the other end of the spectrum are the gigantic basketball players.  These guys also showed some incredible speed, agility, and jumping power.  The human body is remarkable and to see professional athletes perform certainly puts the human body on display.  Now to be clear, this is not about me just going gaga for professional athletes, because I think what professional athletes do should be appreciated, not idolized or deified.  Lets all remember what Charles Barkley had to say about professional athletes (his famous commercial "I am not a role model" for those of you who've forgotten).  

Now I know when I started this blog I had a point... now what was it?  We've really gotten off track here.  Professional athletes, cheerleaders, Charles Barkley... Oh yeah... Ankles!

As I watched the game I noticed the extensive wrapping on many players ankles, clearly to provide more support.  One guy seemed like he was actually playing with pants on because he was so heavily taped.  It seemed nobody had bare ankles.  But why would everyone tape an area of the body that is already so strong and stable?  What happens to the ankle that is so bad?  It turns out that the ankle joint isn't quite as stable as we'd like, especially when pushed to extremes, and some very painful injuries occur when things go wrong.  So the next few posts will be all about the foot and ankle!  Who's excited?  We'll discuss ankle sprains, plantar fasciitis, turf toe, fractures, cuboid syndrome and who knows what else?!!  But today we'll start with what is called a High Ankle Sprain.

Now if you're a football fan then you're probably a fan of America's team the Dallas Cowboys... but if you're not that lucky then you may be a Patriots fan.  And every Patriots fan knows the damage a high ankle sprain can cause.  Both of their tight ends, Gronkowski and Hernandez, have had this injury over the past 2 years.  But why is it so bad?  Isn't it just like any other ankle sprain?  Just higher?  Well not quite.  I'm sure many of you have scoffed at the tv when you saw them unable to run and jump like normal after weeks of not being able to play.  You may even have thought you could recover quicker than these guys... well not so fast.

Every athlete in the world knows what it feels like to sprain an ankle.  You jump up, land wrong and boom, the ankle rolls to the outside and you're out for a few days.  It hurts, it may bruise, but it heals.  The picture below demonstrates this rolling action of what is called an Inversion Ankle sprain.  You get some muscle tissue tearing, maybe some slight ligament tearing, a good deal of swelling, pain and bruising.

This type of sprain is so common because of how the ankle joint is designed.  Right now you could roll your ankle to the outside as you're sitting at your desk with no big problem.  If it went too far, as in a sprain, it would hurt, but normally it's an action the ankle can handle.  But try to roll your ankle to the other side and it's a different story.  Try it.  Roll your ankle from the outside to the inside and it's not as easy.  

An ankle that rolls to the inside is what is called an Eversion Ankle Sprain... which most often causes what is called a High Ankle Sprain.  The image below shows the contrast between inversion and eversion sprains.

As you can see the Eversion sprain causes pain, bruising, tearing, and swelling on the inside of the ankle as opposed to the outside of the ankle.  Seems easy enough right?  Well the issue here is that the inside of the ankle is protected by a huge ligament, called the deltoid ligament, which prevents these types of sprains.  This is why most athletes have never had an Eversion sprain, or a high ankle sprain.  It's as if the body has it's own ankle taping mechanism for the inside of the ankle.  So to get an eversion sprain you have to tear through that taping mechanism which means the amount of force needed is much greater.  So you don't see these in basketball players usually, or dancers for that matter.  You see these injuries in Football players.  Because what you need for these injuries is basically for someone to fall on your leg and twist it outwardly.  The image below shows this injury... now if you're a patriots fan you may want to look away.

As you can see here Gronkowki's ankle is being forced outward, which is normally a very stable area because of that strong deltoid ligament.  As the defenders body weight becomes heavier the deltoid ligament can't prevent the ankle from rolling even further outward.  What happens next is the issue.  That ligament starts to tear and not only that but since there is so much force involved other ligaments start to tear... ligaments that are higher up on the leg called syndesmotic ligaments.  These are ligaments that connect the two bones in the lower leg to one another.  They hold the tibia and fibula together.  The picture below demonstrates this.  

Now not only has the athlete torn a few ligaments in the lower ankle but now they've torn some very important ligaments in the lower leg as well.  These ligaments keep the bones connected so if they're torn the ankle becomes very unstable.  Also, many times the force is so great that part of the lower leg bone(the fibula) actually breaks.  Now for some people the tear, or the break, isn't severe enough to require surgery so they eventually heal.  For others surgery is required, and for many football players surgery is the only option.  These injuries require a 6-week minimum recovery time and in surgical cases it could be months before the player returns.  Which is why Gronkowski had such a hard time moving in last years super bowl, and the fact that he even played is actually very impressive.  The picture below demonstrates all the types of ankle sprains we just discussed.

High ankle sprains are clearly much different than the ankle sprains most of us have experienced, not only are they higher but the mechanism is completely different.  The whole foot rotates outward, not inward, and very important ligaments are torn and bones may be broken.  So the next time you hear that a football player on your favorite team has a high ankle sprain remember that they're probably not weak or just milking the injury.  These injuries are a totally different animal.  

Doctors Note:

1.  There are essentially two types of ankle sprains.  Inversion, where the foot rotates inward.  And Eversion, where the foot rotates outward.  Inversion sprains are common, eversion are not common and usually require someone falling on the ankle to occur.

2.  Inversion ankle sprains can heal usually in 1-4 weeks.

3. Eversion ankles sprains involve much more ligament tearing and damage which requires more time to heal.

4. Eversion sprains usually cause what is called a high ankle sprain where not only are the inside ligaments torn but also the syndesmotic ligaments holding the tibia to the fibula are also torn.  A broken bone may also occur during a high ankle sprain.    

5. Eversion sprains may require surgery and almost always require a recovery time of well over a month.

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IT Band Syndrome

Fall is officially here and the holidays are approaching... what's this mean?  Well it means that we can all stop working out, grow beards, wear flannel shirts, watch football and drink beer all day... fantastic! Just kidding.  Or am I?  No I really am, we can have a football flannel shirt blog some other time.  What it really means is that everyone and their mother is trying to get the most out of the last few weeks of bearable weather by running more. Boston is filled with road races this fall, every weekend, and every holiday until it gets too cold outside to feel feelings anymore!  And like clockwork, every year, our office fills up with runners complaining of IT band pain and/or IT band Syndrome.  Now you may be saying... "what's an IT band?"  Lets find out.

If you look at the pictures above you'll see a long white "band" of fascia (which is kind of like a tougher skin that's underneath the skin... not a muscle and not a tendon).  The IT Band is a tight band that runs from the gluteal muscles up near the hips all the way down to the outside of the knee. The purpose of this band is hip and knee stability, especially during running or standing on one leg. If this area gets too tight or irritated it starts to pull on where it attaches to the knee and can cause pain, in most cases the pain is rather severe.   It's described as a stabbing pain that prevents runners from continuing their run.  But it's not only seen in runners, it can be seen in people who aren't very athletic at all... but we'll talk about runners because it's more prevalent in this demographic.

There are a few causes of IT band syndrome and IT band pain.  The first is simply a tight IT band which happens when we sit too much, don't stretch our gluteal muscles, don't exercise enough, etc.  These cases usually get better by stretching, rest and rolling.  Everyone has seen these people at the gym rolling up and down on a foam roller trying to loosen up their IT band.  It would be great if healing this problem was as simples as rolling up and down on a foam roller.

The second cause is the angle created from the hip, the knee, and the ankle. The picture below explains what we mean.  The example on the left is the problem, where the knees come close to connecting.

 

This natural posture causes abnormal stress on the hips and eventually the IT band.  And since women more often have this type of anatomy we see IT band problems popping up more frequently in woman.    People with this problem have a harder time healing and getting back to running because it's not as easy as rolling on a foam roller.  This problem has to be looked at from many angles. First we look at the feet, to see if flat feet or fallen arches are causing the knees to bend inwards.  If they are, sometimes inserts can help.  Or on the opposite end of the spectrum, bare foot running or minimal shoes may help.  Try the new balance minimus shoes or the vibram 5 finger shoes. These shoes seem to help a lot of people regain their arch stability, so you can also try those for a few months. And if you don't want to look ridiculous all the time I would go with the new balance ones :) Next we look at the hips for tight or spastic TFL muscles or gluteus medius muscles which may be tugging on the femur bone and increasing the angle at the knee.  If inserts, stretching, and/or deep tissue gluteal work doesn't fix the problem then we look at the 3rd cause of IT band syndrome which, believe it or not, is the spine.  

Now at this point you may be saying "oh here we go, of course the chiropractor thinks IT band syndrome is caused by the back... just like every other problem."  And you may even be saying this to yourself in a mocking tone!  Don't worry, I won't take offense :) Just try to stay with me on this one!  The reason some IT band issues are caused by the low back has to do with physics and how the body absorbs shock.  

Every runner understands shock and the transfer of force.  We've all had that run, when we're tired and achy and it feels like every step is painful.  Or you've literally heard someone running by you as their feet slam against the ground in what looks like a very painful running motion.  In an ideal world the force of hitting the pavement would be absorbed by your body.  Try to picture a runner.  Now think of the runner in black and white.  As the foot hits the ground think of an electric shock being formed down near the foot.  Now watch that shock wave travel up the foot, through the ankle, through the knee, through the hip, through the BACK, up the spine, into the head and then back down the body.  This is how force is absorbed by the body.  Anyone who's gotten a headache during running knows what it feels like if force is not properly absorbed.  

If the spine isn't moving correctly this force doesn't travel through it correctly, it basically gets blocked by an immobile spine.  What I mean by this is that the human spine should move like a slinky(I hope everyone remembers what a slinky is).  Each part of the spine should move independent of every other part, just like a slinky moves and glides.  If, due to injury, tightness or prolonged sitting, the spine becomes compressed, it's like the slinky gets a a few kinks in it.  Now instead of having a nice fluid spine where the force can easily be absorbed we've got a spine that is very rigid and unable to absorb force.

Now back to that image of the electricity running up from the foot into the body.  Visualize again that the force has made it up to the low back but now instead of being absorbed by the upper body it's deflected back to the leg.  This causes all the force to be absorbed in the lower body.  This in turn will stress out the muscles of the leg, the IT Band in particular, and eventually cause pain.  These cases of IT band syndrome don't respond well to simple stretches or ultrasound therapy.  

Many IT band issues can be avoided or cured rather quickly once the low back is adjusted and allowed to move like it's supposed to move.  If you're someone who is frustrated with the lack of improvement in your IT band issues you may just need a difference approach.  There's always a cause to the pain, and in turn, there's typically a cure.  Happy running.

Doctors Note:

1. IT Band Syndrome is caused by either tight muscles, fallen arches, poor leg mechanics or low back problems.

2. Most cases don't need months of treatment.  Make sure whoever is taking care of your pain looks at the low back as well.  Every part of the body effects the other, so don't just focus on one part.  Look at the body as a whole.

3. Rolling on a foam roller, ice and rest will help mild cases.  But many other cases need to add in low back work as well.

4. Try the new balance minumus shoes or the vibram 5 finger shoes for 3 months and see if it helps.

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