Exercises to Avoid If You Have a Bad Back

You can’t get well if you are continuing to re-irritate your disc. Sometimes the exercises that you STOP doing, are the most important change. If you suspect or know that you have a funky lumbar disc, if it hurts to bend forward, here are the exercises to avoid.You’ll notice I am talking as if to the doctor, but it easily applied just as well to YOU, the patient.Bad-For-The-Back Exercises That Can Prevent HealingThe questions "Who gets well? Who doesn't? Why?" prompted the following observations based on my close to 40 years of chiropractic practice. These observations are limited to a subset of patients who represent probably 40-50 percent of lower back patients with a discogenic or flexion-intolerant lower back. These patients may have sciatica. More often, they just have lower back (and possibly buttock) pain.For you, the doctor, the first step is to know how to identify these patients. Is this condition on your radar? Do you know how to assess for this problem? If this is unfamiliar to you, read my 2014 article on this topic as a starting point.1 Stu McGill, Craig Liebenson and Phillip Snell have all written and taught extensively on this topic."Addition by Subtraction"For this [...]

By |December 20th, 2018|Categories: Exercises|Comments Off on Exercises to Avoid If You Have a Bad Back

Neck Pain: Activation Exercises

My latest Dynamic Chiropractic article, Neck Pain; Activation Exercises, includes links to videos of the exercises. Tight muscles are often best addressed by activating the muscles. Especially when soft tissue work or stretching only gives temporary relief. In observing patients and studying rehab, I have learned that tight muscles are weak muscles and that stretching is sometimes less effective than muscular activation. There is a delicate balance between joints that move too little and joints that are hypermobile.

By |November 7th, 2018|Categories: Exercises|Comments Off on Neck Pain: Activation Exercises

Beating the Winter Blues

Do you tend to get the winter blues? Are you sluggish, have no energy, or sink into a funk? You may gain a few pounds. Your immune system seems to have gone on strike, and you catch every little bug. If you get the flu, it’s even worse, and can take weeks and weeks to get over it. Here are three strategies to beat the winter blues. One is the sunlight vitamin, vitamin D. The second is light, using a bright indoor light. The third is movement, get outside or get to the gym. SUNLIGHT When sunlight strikes our skin, the body produces vitamin D. Even if you get out in the winter, we are too far north to get enough sunlight-generated vitamin D. Vitamin D is really a hormone, not just for your bones. If you ache more in the winter, it could be a sign that your vitamin D levels are too low. Your immune system depends on adequate vitamin D; if you are getting every bug, think about adding vitamin D. Who is prone to vitamin D deficiency? Adults over 50; overweight people; folks with intestinal issues who can’t properly absorb Vitamin D. Additionally, if you [...]

By |January 31st, 2018|Categories: Uncategorized|Comments Off on Beating the Winter Blues

Avoid Being a Crash Test Dummy!

Matt Terreri DC, CCSP Plenty of us have been there, and more of us will go there. Sitting there in your vehicle minding your own business until WHAM! you get hit from behind or perhaps from the front, or maybe even worse. This article will hopefully give you a little insight and advice if you are ever involved in a motor vehicle collision. FIRST THINGS FIRST - Protect Yourself There are some things you can do to help protect yourself before you are involved in a collision. Here is a short list. Check with your insurance company to find out what your coverage is. Many people’s policies are defaulted to the minimum coverage, and with just a little more money per month one can greatly increase coverage which further insures you should anything happen. Raise that “headrest”! I put headrest in parenthesis because that’s what most people call it. In fact, it’s not actually a headrest, but a head restraint. Its purpose is not for you to relax your head against, but rather to keep your head from snapping backward in a collision. In order for this to work, the top of the [...]

By |January 20th, 2016|Categories: FB, Uncategorized|Comments Off on Avoid Being a Crash Test Dummy!

How to Become a Wizard in a World Run by Muggles Combining Evidence: Experience & Expertise = Clinical Excellence

Marc Heller, DC Let’s honor and appreciate the evidence. And, let’s know, that unlike microbial diagnosis, our work does not lend itself to a black-and-white, evidence-based, rigid system. Become the grounded, common-sense wizard. Use both your left brain and your right brain. Learn to listen and observe.

By |November 26th, 2015|Categories: Uncategorized|Comments Off on How to Become a Wizard in a World Run by Muggles Combining Evidence: Experience & Expertise = Clinical Excellence

Adjusting the Occiput on the Atlas

Marc’s article published in Dynamic Chiropractic magazine starts by reminding doctors why low force non thrust techniques are useful. He then go over specific assessment methods for the occiput, and muscle energy mobilization for this joint. He also utilizes the Upper Cervical Side Bend exercise.

Flexion-intolerant lower back pain (Pt.3): Mobilization and soft-tissue treatment

Marc positioning for posterior torsion correction This is the last of our three-part series on the flexion-intolerant lower back. In this article, we explore in depth, hands-on therapy with mobilization and soft tissue that can help the disc patient. We emphasize the area above and below the disc that can be fixated, including the hips and the thoracolumbar junction. We talk about a specific sacral problem, sacral posterior torsion, that tends to coexist with flexion-intolerant lower backs.

By |May 10th, 2014|Categories: Body mechanics, Chiropractic, Lower Back Pain, Musculo-Skeletal Care, Soft-Tissue Work|Tags: , , , , , |Comments Off on Flexion-intolerant lower back pain (Pt.3): Mobilization and soft-tissue treatment

Flexion-Intolerant Lower Back Pain (Part2): Exercise Rehab

Waiter's bow exercise Marc’s article is the second of a series on flexion-intolerant lower back pain.  We emphasize the basic things the patient has to learn or re-learn in their own movement patterns, in order to heal a disc or flexion-intolerant lower back. I had a patient, who had moved away, and then came back for a short visit a few months ago. He had herniated a disc when he was my patient, and we thought we had helped him rehab from it.  When he returned, he had re-herniated his discs two more times, and had two more surgeries.  As I watched him move I realized that he had never understood the hip hinge: that he, over and over, was bending forward the wrong way.  He continued, years later, to irritate and inflame his lower lumbar discs, which made me sad. This principle is so simple and basic, and yet sometimes hard to master.

By |March 25th, 2014|Categories: Chiropractic, Exercises, Lower Back Pain|Tags: , , , , , |Comments Off on Flexion-Intolerant Lower Back Pain (Part2): Exercise Rehab

Back Pain and Invasive Treatment Procedures

Marc Heller, DC Yesterday, one of my patients, who has similar challenges to the ones I face with my back, asked me to write a blog about my own back pain issues.  I thought, really. I obsessed about my friend who recently died 5 years after a failed back surgery. One of my back surgeon friends has said, “The only thing worse than a bad back is a bad back after a botched surgery.” I don’t think my friend who died really had a botched surgery. I do think that he and his surgeon had not explored all of the non invasive and less invasive options, and that he happened to have an unusually severe inflammatory reaction to his surgery, which led him into a vicious cycle leading to 5 years of severe nerve pain. He had a whole series of health problems further complicated by severe chronic pain that led to an early death. I know this is a bit dark but it does have an underlying purpose. Maybe someone who reads this will put off the magic bullet of surgery, and commit him or herself to attempting to get well the hard way. In our [...]

By |March 18th, 2014|Categories: Chiropractic, Cortisone injections, Exercises, Lower Back Pain, Musculo-Skeletal Care|Tags: , , , , , , |Comments Off on Back Pain and Invasive Treatment Procedures

Diagnosing Flexion-Intolerant Lower Back Pain (Part 1)

Waiter's bow exercise I have written several articles on this topic, but I keep learning more about this kind of back pain. This series, with help from Phillip Snell, DC, ( represent our current thinking on discogenic and/or flexion intolerant pain. We emphasize that you cannot recover from this without learning and using proper back mechanics in your everyday life.

By |January 20th, 2014|Categories: Body mechanics, Chiropractic, Exercises, Lower Back Pain|Comments Off on Diagnosing Flexion-Intolerant Lower Back Pain (Part 1)

Effective rehabilitation includes manipulation and soft tissue therapies

This detailed article began as a presentation to our monthly study group by Dr. Craig Thorsen, DC of Grants Pass OR. Exercise rehabilitation is often more effective, if combined with manipulation and soft tissue therapies. We've focused on the lower back with our examples. Marc

By |January 20th, 2014|Categories: Chiropractic, Lower Back Pain, Professional Tips and Resources, Soft-Tissue Work|Comments Off on Effective rehabilitation includes manipulation and soft tissue therapies

Upper trapezius and its effects on shoulder/neck pain

This is Marc’s insightful article dealing with the effect of a weak upper trapezius on the shoulder and neck. This particular muscular issue is among the most missed on a diagnosis, as everyone believes the upper trapezius is hypertonic. If the symptomatic side has a dropped shoulder, look for this problem. Marc

By |November 21st, 2013|Categories: Chiropractic, Neck Pain, Shoulder Pain|Comments Off on Upper trapezius and its effects on shoulder/neck pain

Sciatica and Gluteal Pain Causes

Here is the first of  a 2 part article on sciatica and gluteal pain. Part 2 will be listed at the bottom of this blog. I want to thank many of my patients, who have helped me puzzle through all of the challenges associated with an ongoing “pain in the butt.” So many sufferers get labeled with Pirformis Syndrome, and then get the wrong treatment. The article outlines a series of problems that can contribute to buttock pain.  Here is part 2 of the article. Marc

By |September 3rd, 2013|Categories: Chiropractic, Lower Back Pain|Tags: , , , , , , , , , , |Comments Off on Sciatica and Gluteal Pain Causes

A Clinical View of Discogenic Pain

This abbreviated extract article from National Center for Biotechnology Information of a clinical study done in China is simple and fascinating. The goal of the study was to determine the natural path of proven discogenic pain, which in these patients was determined by discograms. This process is no longer routinely done in the US because of the risk of worsening the degenerative changes in the disc. Unfortunately, the natural history of patients with this condition is not particularly good. 80% of the study group are either unchanged or worse over 4 years.

By |February 4th, 2013|Categories: Chiropractic, Clinical Study Results, Lower Back Pain|Comments Off on A Clinical View of Discogenic Pain

Cortisone Injections May Not Be the Answer

This is a very important article about cortisone injections and I don't know why it took me two years to find it. What it says is that cortisone shots are overused, and they often slow healing. Yes, the cortisone can give quick relief, but over several months, the patient who get the cortisone injections, especially if they get more than one, tends to heal less completely and more slowly. Why? The suspicion is that most of these tendon and joint injuries are not a true tendonitis, not truly inflamed. They are mostly tendonosis, a wear and tear gradual injury. The best therapies for a tendonosis include the exact right amount and form of exercise; build it, don't hurt or harm it. This is easy to say, but hard to do. We are very focused on guiding you in effective rehab, if you are willing to do the work. An additional therapy is Graston technique. We use Graston to stimulate healing of injured tendons that have stopped healing on their own. We usually know within two to three sessions whether this is working for your particular problem. If not, it’s back to the drawing board, figuring out what is the [...]

By |January 24th, 2013|Categories: Chiropractic, Cortisone injections, Musculo-Skeletal Care, Professional Tips and Resources|Comments Off on Cortisone Injections May Not Be the Answer

Discography viability discussion

Marc Heller, DC This article from Orthopaedic Today Europe, Issue 5  is a discussion of the viability of discography.The missing piece of the discussion, in my view, is factoring in the research that shows that discography damages discs. Unfortunately, we still do not have a definitive non-invasive way to test for discogenic pain.I prefer looking at the sum of the evidence, and weighting a more sophisticated physical exam and history which is a more clinical approach.It is good for the individual patient, but hard to prove in a large study.Marc Heller, DC

By |October 26th, 2012|Categories: Chiropractic, Musculo-Skeletal Care, Professional Tips and Resources|Comments Off on Discography viability discussion

The Truth About Salt

Big Brother (meaning the federal nutritional authorities) would like you to eat less salt, but the evidence is quite contradictory. I have always felt that salt intake is better done by taste than by some arbitrary rules. Generally, you would eat fewer prepared and junk foods, which are the sources of “stupid” salt as well as excessive sugar. This well-written, well-referenced NY Times article reviews the evidence that says we don’t really know.

By |June 11th, 2012|Categories: Diet and Nutrition|Tags: , , , |Comments Off on The Truth About Salt

Another Source of Lower Back Pain

Another hidden source of lower back pain is irritation of the superior cluneal nerve, coming from dysfunction at the thoraco-lumbar junction. I have been working with the Maigne syndrome concept for at least 3 months, as of December 2011. It has made me see the integration of the thoraco-lumbar and the lower back and pelvis more clearly. If this concept is new to you, read my article first. Since writing the article, I have been observing my patients. Here are some thoughts. First, it is so wonderful to have a clear indicator. In this case, the clear indicator- Maigne’s gluteal point- is the hot spot, the knot, about 7-8 cm lateral to the midline, just below the iliac crest. If you don’t get rid of this knot, you have not succeeded.

By |March 8th, 2012|Categories: Chiropractic, Lower Back Pain, Soft-Tissue Work|Tags: , , , , , , , , , |Comments Off on Another Source of Lower Back Pain

Lower Back Pain: A Somewhat Unusual Case

A sixty-something-year-old male comes in with thoracic stiffness and lower back pain. The lower back pain would occur on various motions. He had previously been quite active, living on 3 acres and taking care of his property. He had been involved in a vehicle accident, rear ended, several months previous. His previous chiropractic care and massage had seemed to make him worse rather than better, he would spasm the day after the treatments. The key findings on exam included stiff hips, he couldn’t internally rotate beyond 10 degrees on both sides. He was very rigid throughout the thoracic spine. It was hard to elicit tenderness in the thoracic spine, as his muscles were so tight. His lumbar motion was fairly normal, with some pain at the extremes of motion.

By |March 8th, 2012|Categories: Chiropractic, Lower Back Pain, Professional Tips and Resources|Tags: , , , , , , , , , , |Comments Off on Lower Back Pain: A Somewhat Unusual Case

How to Optimize Musculoskeletal Care

We could do better. We meaning all of the therapists trying to help all of our patients. The world of hands on care is very subjective, and we are the seven blind men looking at the elephant. We tend to see and touch through our own limited training, and our current passions. I would like to see us have a bigger view, and see the patterns more clearly. I would like us to engage our patients, and teach each of them what they can do to help themselves.

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