Sitting is Bad for Your Health

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coupleWalkingSM

A new meta-analysis shows that sitting too much increases your risk of early death from any cause.  The other important finding is that this increases your risk even if you exercise.  Further, the study showed that the less active you were, the more likely you were to die prematurely.

Previous studies have also showed that you should get get up 35 times a day or get up about every 15 minutes throughout the day.

For many of our patients in the Christiansburg, Radford, and Blacksburg area, the struggle after successfully completing physical therapy has been finding a way to continue to exercise and keep moving afterwards.  Valley Sports & Spine Clinic and Valley Active are committed to finding a personal exercise plan to keep you regularly moving for a healthy lifestyle.

 

Good Luck!

 

Dr Ethan Colliver

The cure to low back pain?

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BackPainSMRegenerative Medicine may hold the cure to chronic low back.  Low back pain is commonly due to painful lumbar discs.  There are many treatments, but to-date there has never before been a cure.

Regenerative Medicine works to repair, replace, or restore normal function to injured body parts.  For example, mesenchymal precursor cells are throughout the body and can differentiate into bone, cartilage, tendon, and even muscle and nerve cells.  Your body uses these cells after injury to help heal and to avoid scarring.  Researchers have been able to harvest large numbers of these cells from bone marrow and have used them to help heal knee, hip, and other joint injuries.

Mesenchymal stem cell displaying typical ultrastructural characteristics. Robert M Hunt 1997

 

One study used concentrated precursor cells from patients’ bone marrow to help relieve lumbar disc pain.  Twenty-six patients with disc pain and MRI evidence of early degenerative disc disease had mesenchymal precursor cells injected into 1 or 2 discs and were observed for 12 months.  Researchers found that the average improvement in disability was 56.8% and a 58% improvement in pain.

Another research group separated out mesenchymal precursor cells to inject into patients with painful discs and found that those patients were 3 times more likely to have 50% relief in pain and disability than patients who received a placebo.

Why is this exciting?  Most treatments for low back pain last a few weeks.  This treatment shows improvement for at least 12 months. Most mesenchymal precursor cell research shows improvement out to three years.  Also, these past two research papers show evidence of reversing of disc degeneration. That is like regenerating a degenerated disc. That is exciting!

At Valley Sports & Spine Clinic, we have used Regenerative Medicine techniques for four years with great success and continue to find new applications for Regenerative Medicine techniques for our patients.

We are committed to not just covering up the symptoms but helping to restore your function and truly heal.

Good Luck!

Dr Ethan Colliver

What is Really Causing Your Back Pain?

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 Back pain can be a result of height, weight, or posture. Treatments are available for symptoms, but core exercise is the proven method to relieve pain for good.

 

Most people will experience back pain at some point in their lives. Back pain can be caused by an acute injury or from long-term wear and tear on the spine and joints of the back. During evaluation by a physiatrist a holistic approach frequently uncovers the root cause of the pain, and the answer is much simpler than many would suspect.

Frequent Causes of Back Pain

  • Height – While it may seem surprising, your height has a lot to do with your lower back pain. The spine is stabilized by your core muscles which sit in your abdomen. For a tall person, or anyone with an especially long torso, these muscles have to work harder to hold up the spine than the core muscles of a shorter person.
  • Weight – People gain weight differently, and much of this is attributed to genetics. While many women gain weight in the lower half of their bodies, creating what is known as the pear shape, more frequently men gain weight in their trunk or abdomen. Protruding abdominal weight can throw off the body’s natural center of gravity and cause it to be more forward and further away from the spinal column. As a result, the back has to work harder to stop from pitching forward. This is also a common source of lower back pain in pregnant women as their muscles work to hold up the spine and support the weight of the growing womb.
  • Posture – Your mother was not kidding when she would tell you to stand up straight. Posture affects the entire body, whether it is good or bad. Good posture helps to reinforce spinal alignment and connective tissue. This is especially important when exercising, as poor posture can cause over- or under- development of a muscle group and uneven muscle tone which can make posture worse and add more stress to the back.

Correcting the Problem

  • Medications – While many people would like to use a medication to fix their pain, the recommendation for medication is minimal. Non-Steroidal Analgesics (NSaids), such as ibuprofen or naproxen, are effective at relieving pain associated with inflammation, but that is the extent of their usefulness. The pain can only be temporarily relieved with medication therapy.
  • Helpful Therapies – Spinal Manipulation Therapy (SMT) has proven to be an effective method of pain relief for many patients suffering from low back pain. SMT is the practice of applying controlled pressure to a joint in the spine and is commonly performed by a Doctor of Osteopathic Medicine (DO), physical therapist, or chiropractor.
  • Massage can be very effective at relieving back pain associated with stress.  Massage helps to normalize muscle tone and joint alignment, can normalize blood and lymphatic flow to an injured area, and can help release built-up toxins in tense muscles. An added bonus of massage is the overall mental stress relief it can provide which can directly correlate to feeling pain in the body.
  • Acupuncture is the application of pressure to specific points in the body that may relieve pain associated with the nerves. People who use acupuncture regularly find that their pain is greatly reduced over time.

The Cure   

The only proven method of preventing future back pain is with regular exercise and strengthening. It is important to consult your physiatrist before attempting any exercises as certain exercises may be better for you than others.

For more information about back pain, please visit our website at http://valleysportsandspine.com and learn how Valley Sports & Spine Clinic can relieve your pain for good.   

What’s in a breath?

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Put simply, a lot!

Next to the heart, the diaphragm is the most important muscle in the body. Recent research shows that dysfunction of the diaphragm is associated with low back pain.  The diaphragm is a large muscle separating the chest from the

abdomen, is the primary breathing muscle, as well as part of the core muscles.

The core muscles are a spherical boundary of muscles that surrounds the abdominal cavity. They include the: diaphragm, pelvic floor, lumbar musculature, abdominal muscles and rectus abdominis. These muscles work together to stabilize the spine, pelvis, hips, and support the function of chest and abdominal organs.

 

Gray's picture of diaphragm. Note the circumferential attachments to back, ribs, and sternum.

Gray’s picture of diaphragm. Note the circumferential attachments to back, ribs, and sternum.

Proper breathing requires the diaphragm to flatten and descend into the abdomen with inspiration, and doming upwards into the chest cavity with exhalation (there is much more, but to keep it simple we will stop there).  Because the diaphragm connects from the back to the front of the body, it requires coordinated muscle activity from the anterior abdominal muscles and core muscles, in order to function efficiently.

Dysfunction from the diaphragm can occur from a problem with the muscle itself or from any of the components of the core musculature; examples include: smoking, prior abdominal or pelvic surgery, deconditioning, abdominal hernias, open heart surgery, etc.  A less efficient diaphragm leads to overactivity of the secondary breathing muscles (intercostals, scalenes, and sternocleidomastoids), and back muscles.  Dysfunction of the diaphragm can also lead to core dysfunction.  This cascade of events can then lead to back pain, neck pain, pelvic floor problems, hip problems, etc.

Without addressing the function of the diagphram, exercises to treat neck pain, back pain, pelvic floor problems, and hip problems can fail.  Treatment should be aimed at restoring the function of the diaphragm through special breathing exercises that work on coordinating the activity of the diaphragm with core musculature and restoring balance to the secondary breathing muscles.

Valley Sports and Spine Clinic has trained alongside select physical therapists from Blacksburg, Christiansburg, and Radford to develop techniques, adapted from the Postural Restoration Institute, for evaluating and treating diaphragm problems.  If you have neck pain, back pain, urinary incontinence, bowel difficulty, or hip problems, you may need to have your diaphragm function evaluated and treated. We can help!

Good Luck,

 

Ethan Colliver, DO

Valley Sports & Spine Clinic Giving you Back your Life

 

Where will the next generation of Physicians come from?

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emg2The Practice of Medicine has alwaVCOM students practicing nerve conduction studies on each otherys been a blend of science and art.  Medical school lays the foundations for the science portion; however, the art comes from the guidance given by established physicians. In fact, you graduate medical school with a Medical Degree but cannot practice medicine until you do an internship where you train under the tutelage of an Attending Physician.

 
VCOM students practicing nerve conduction studies on each other

 

This week I helped the Physical Medical & Rehabilitation club at Edward Via College of Osteopathic Medicine learn about electrodiagnostic medicine.  This is a group VCOM medical students who have a particular interest in learning about physiatry. Electrodiagnostics include nerve conduction studies and electromyography and all physiatrists learn how to perform them over the course of 3-4 years of training. We discussed  how these studies can help patients with sciatica, carpal tunnel syndrome, neck pain, low back pain, peripheral neuropathy, myasthenia gravis, or myopathy.

After some didactics, I even had a brave volunteer allow us to practice on her so that everyone could see how to perform and interpret these studies!  I was so impressed with the students genuine interest and thoughtful questions.  By the end, all students were able to practice zapping their friends.  This experience will give the students empathy and insight for when they are faced with ordering this test for a patient in the future.

I am fortunate and privileged  to have interested students I can guide along the path to Physician.  Thank you VCOM PM&R club!

 

 

Good Luck!

Valley Sports & Spine Clinic Giving you Back your Life

Dr Ethan Colliver

 

Your back hurts… because of your ankle!

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No, I am not disregarding the earlier post about toilets. Let me explain. After my freshman year in college, I worked as a housepainter for two weeks. That career choice came to a screeching halt after I fell off a roof and shattered multiple bones including my left ankle. I now have a very stiff, arthritic ankle. It doesn’t even dorsiflex to neutral. In my twenties, I began having back pain and didn’t know why. I was sedentary but thin and very busy with my medical training.  I eventually realized that I had a lumbar disc herniation with occasional right leg pain. Why?

Disc herniations  happen when you have excessive flexion or twisting through a disc.  We bend over more than a thousand times a day which requires squatting.  Squatting requires full hip flexion, knee flexion, and ankle dorsiflexion.  The picture below shows a natural full squat with a lot of ankle dorsiflexion.

lady squattingNotice her degree of ankle dorsiflexion. Also, note how upright her lumbar spine is.  Her upper body is leaning on her thighs thus taking the stress off the lumbar spine which is in essence “hanging” from  her thoracic spine and not taking any significant torque.

Below is an example of a Western squat, in which the person comes up on their toes in order to get down.

Note her degree of ankle dorsiflexion.  Also, note how perpendicular her spine is to being upright.  This creates more torque on the lumbar discs than the upright posture and thus more stress on the discs.

I believe taking the weight off the heels leads to increased calf muscle activity, which leads to hamstring overactivity and inhibition of the hip muscles (ie- gluts), which lead to overactivity of lumbar paraspinal muscles and increased stress on lumbar spine.  This aligns with the work of the great Neurologist, Dr Janda.

 

 

In the above picture on the left, lack of ankle flexibility prevents her from squatting further.  If she squats further with same angle in her ankle, then she will have to lean back and thus lose her balance (also, her lumbar spine is now more parallel to the ground and thus more stressed).  In the picture on the right, having a lift under her heels allows her to keep her center of balance forward (and her lumbar spine more upright) and do a deeper squat.  This is a happier lumbar spine!

In short, healthy backs require full range of motion and strength of the whole chain.  From the lumbar spine, pelvis, hips, knees, ankles and feet.  When you have back pain, the whole system must be assessed.  The back pain is often a result of a problem elsewhere in the chain.

Good Luck!

Valley Sports & Spine Clinic
Giving you Back your Life
Dr. Ethan Colliver

 

Owww…. My disc hurts!

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One of the most common causes of low back pain is lumbar disc pain.  The disc has an outer layer made up of cartilaginous (annulus fibrosus) layers surrounding a gel-like center (nucleus pulposus). There is one disc between each bony vertebral level in our low back.  According to Stuart McGill, PhD, it behaves more as a ball-bearing joint than a “shock absorber” (that is for a later topic).  The anatomy allows us to bend our low backs with great flexibility in all directions. The outer third of the disc is innervated by sinu vertebral nerves, meaning that it can transmit pain signals coming from the low back.  The annulus fibrosus is thinnest near to where the nerves to our legs are traveling in our spinal canal.

A disc injury is a tearing of the outer layer allowing the inner gel to work its way to the outside of the disc. The tearing and subsequent leakage of disc material causes a lot of inflammation in the spinal canal. This inflammation can cause back pain, muscle spasms and irritate the nerves to the leg, causing leg pain. If the disc material causes pressure and compression of the nerves of the legs, this can lead to weakness.

Stuart McGill PhD showed that the lumbar disc material can herniate through the outer layer (annulus fibrosus) in as little as 20,000 repetitions of forward flexion or twisting through the lumbar spine. It is unlikely to cause a disc herniation if you bend backwards or sideways. Stooping, sitting, and bending at the waist are causes of disc herniation and subsequently back or leg pain.

His research also has shown that humans will bend forward over 1,000 times a day and backwards only 150 times a day. With this in mind, it is easy to see how we can cause a disc herniation just by doing our day-to-day routines. However, we move in ways that are safe for our discs, such as backwards, very rarely. Therefore, WE CAUSE LOW BACK PAIN BY THE WAY WE MOVE!

There is good news. Proper lifting mechanics can decrease your risk of lumbar disc herniations and back pain. For example, professional weightlifters lift extreme amounts of weight in a squatting position and you find that they do not get disc herniations more frequently than the general population. Why is this? They have proper strength and flexibility within their core, pelvis, and in their hips.

 

Most treatments for low back pain are reactive, meaning that treatment is started after someone is already experiencing back pain.  Most treatments do not decrease your risk of future back pain. Research shows that the only thing to decrease your risk of future low back pain is exercise. So again I encourage you to get into that exercise program and if you have pain with exercise, ask for help from a physical therapist and physician.

Good luck!

Valley Sports & Spine Clinic
Giving you Back your Life
Dr. Ethan Colliver

 

Your back hurts because you’re pooping wrong!

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Low back pain in Western society is very common.  Studies suggest up to 90% of Americans will have an attack of back pain and 26.4% have had back pain in the past 3 months.  Koreans have a lifetime chance of around 60% and 15% chance of having back pain in the past year.  Why the difference?  Squatting may be one of the most important things for your back pain and your health, and American toilets don’t let us do it.

 

Western toilets became common the late 19th century.  Prior to that, most people would squat to eliminate, over time sitting became a sign of being “civilized”.  With that change came a decrease in communicable disease like cholera but also brought new diseases like appendicitis, hemorrhoids, and back pain.

One of the best treatments for preventing back pain is proper exercise.  Exercise should focus on flexibility and strength training.  A full squat requires full hip flexibility and great hip, pelvic, and core strength to perform properly.  Asian or squat toilets require the user to perform a full squat to eliminate.  Now, if the average person uses the bathroom 4-7 times a day, that is an opportunity to do a great exercise for your back and health 4-7 times a day.  Further benefits may include decreased constipation, hemorrhoids, diverticulitis, appendicitis, and possibly colon cancer.

asian squat

You can take advantage of a squatting toilet without spending $1000 to install one in your house.  I recommend two products: Squatty Potty for a beginner and a Squat Platform for an advanced full squatter.

Valley Sports & Spine Clinic
Giving you Back your Life
Dr. Ethan Colliver