by Ray Wilbur, DC
In doing this work over the past 3 decades, most non-injured patients respond quickly to treatment. When they don’t (for example seeing the same symptoms and findings for several visits), there is usually a culprit to be found in their daily routine either at home or work that is re-creating their problem.
So in these cases part of the treatment involves helping the patient become a “Good Detective” in identifying the primary culprit. When a perpetuating factor can be identified, not only will it possibly eliminate or greatly reduce the need for further treatment, it can prevent future problems.
1. Poor or prolonged sitting with rounded shoulders and forward head carriage (almost always present) with upper back, lower neck and between the shoulder blades pain. The detrimental effects of our ever increasing sedentary lifestyle cannot be overstated.
2. Sleeping in the “fetal” position. Sleeping on your back with a too soft mattress, or on your side with a too firm mattress (the latter will often perpetuate hip or shoulder pains). Too thick or thin pillows can perpetuate neck pain, stiffness, and/or headaches.
3. Driving with the seat too far back and/or the steering wheel too far away, or the seatback reclined back leading to poor driving posture.
4. Bad computer ergonomics; most commonly reaching too far to use a mouse (your elbow should stay at your side). This would also include prolonged use of handheld devices with a “hunched over” posture.
5. Smoking: While we all know that tobacco use is closely associated with cardiovascular disease and certain types of cancer, an AMA study in the 80’s showed that smokers tend to suffer earlier and more severe spinal degenerative changes due to reduced blood flow to the vertebrae as a result of nicotine.
6. Standard American Diet (SAD): Numerous studies have shown the SAD diet to be pro-inflammatory and a major contributor to most disease processes. The patient who has diffuse inflammation is the one who complains, “everything hurts”. As a general rule, if one can increase their intake of plant based, unprocessed foods and decrease the intake of animal protein and refined carbohydrates (including most sugars), they will be heading in the right direction.
7. Foot problems/leg length discrepancies: Many lower back problems are perpetuated or aggravated by poor lower extremity mechanics. This could be an old ankle sprain, hip replacement resulting in unequal leg length, or excess foot inward rolling (hyperpronation) just to name a few.
8. Lack of muscle tone/core strength: As we age and our joint cartilage and discs become thinned, the tension of our joint stabilizers (ligaments) can become more loose or lax resulting in joint instability and pain. The good news is that healthy muscle tone can help overcome this problem. A recent study showed that the combination of resistive exercise combined with manipulation produced the best and longest lasting results for patients with back pain.