Exercise and Chiropractic

Cardiovascular and strengthening exercises combined with chiropractic care are important in the management of low back pain.

If a patient has a history of heart problems, it is important for the patient to consult with not only the doctor of chiropractic but their primary care physician to be certain that they can tolerate cardiovascular fitness-promoting activities. Specific instructions are given by the chiropractor with respect to proper exercise for the patient's condition before beginning any exercise program.

In general, a reasonable amount of exercise performed daily and utilizing enjoyable activities is recommended for patients undergoing chiropractic treatment.

Exercise Benefits

Many studies have reported the importance of exercises in managing acute and chronic low back pain, strengthening the low back, preventing and keeping back patients working, and to improve quality of life. The strength of the abdominal muscles was also found to be able to differentiate between those with vs. without chronic LBP.

Overall and when combined with chiropractic care, aerobic exercise helps promote proper digestion, keeps the muscles in proper tone and promotes better circulation. Walking briskly around the block at least once or twice is a convenient and popular activity.
Also, many forms of work and/or household tasks can function as an exercise program. The important point is to exercise!

Types of Exercises

There are many applicable back exercises that are available for patients also undergoing chiropractic care for lower back pain. One can classify the chiropractic patient into a flexion or extension biased category to determine the variety that is best for that patient. For example:

- If a patient feels best when bending over (flexion biased), exercises that promote low back flexion such as pulling the knees to the chest, posterior pelvic tilts, bending forward from a sitting position and others are usually helpful.

- If a patient is least symptomatic in extension, especially if leg pain centralizes or diminishes (extension biased), prone press- up type exercises usually yield the best results.

Other exercises that can help reduce lower back pain include:

-Strengthening of the pelvic (trunk) stabilizing muscles

-Stretching of the hamstrings, adductors, and other overly short or tight postural muscles

-Proprioceptive or balance promoting.

Benefits of Back and Abdominal Exercise

Weak and/or overly tight supporting muscles can have painful spasms and suffer injuries themselves,
which then prevent them from supporting the spine as needed. Compromised muscles can also lead to problems with bone structure of the spine due to poor posture from the weak muscles, thereby creating an increased risk of back pain/ injury.

Consequently, developing combined strength in stomach muscles and back muscles can:

- Reduce the likelihood of back pain episodes

- Reduce the severity of back pain

- Protect against injury by responding efficiently to stresses

- Help avoid back surgery in some cases

- Facilitate healing from a back problem or after spine surgery

- Improve posture.

Reported Efficacy of Exercise in
Chiropractic Care

According to the Scientific Commission of the Council on Chiropractic Guidelines and Practice Parameters (CCGPP):

- Strong evidence supports exercise as being at least as effective as other non-surgical treatments for chronic low back pain

- Moderate evidence supports use of a graded-activity exercise program in occupational settings for subacute lower back pain

- Some evidence shows that exercises are no more effective than other nonsurgical treatments for acute lower back pain.

As with any chiropractic treatment, it is important for chiropractors to perform a focused reevaluation of an exercise program following its initial therapeutic trial to determine its effectiveness. Using spinal range of motion as a measurement of the effectiveness of exercise is just one way in which chiropractors can make such determinations.

Call your St. Charles chiropractor, Dr. Mario Awwad, to schedule your New Patient Special.  At ABChiropractic Family & Wellness, we specialize in chiropractic adjustments, decompression, massage therapy and most importantly, RESULTS!  Call 636-916-0660 and speak with Karen or Rachel to schedule your life changing appointment today.

Mattress Guidelines for Sleep Comfort

The right mattress can really help one have a good night's sleep and wake up feeling rested and refreshed. Sleeping on the wrong mattress can cause sleeplessness, back pain, and overall aches and pains. For people with a back problem, a mattress that isn't a good fit can make the pain worse.

When searching for the best mattress, remember that mattresses are largely a matter of personal preference. There is no single type of mattress or bed that works well for all people, and there is no best mattress for back problems. Likewise, there
is no single sleep position known to be best for all people. This is due to several factors:

- There are many causes of back problems, and different back conditions may respond better to specific types of beds, mattresses and sleep positions.

- There is a high degree of personal preference for mattresses, and what works well for one person may not work well for another.

- There is very limited scientific study published on mattresses and back pain, and findings from the studies that have been completed are inconclusive.

- Overall, the causes of back pain can be quite complex, and it’s difficult to isolate whether or not a person's mattress has played a significant role in improving the pain or making it worse.

The bottom line is that the type of mattress that is best for any particular person is really a matter of personal preference.

The type of mattress one uses is not the only factor for patients with pain and sleep difficulty. Many other factors need to be considered that may affect sleep, including:

- Medication side effects

- Irregular sleep patterns

- Caffeine/alcohol/tobacco use

- Sleep apnea

- Anxiety/stress

If comfort is not the only thing making sleep difficult, it is advisable for the patient to consult his or her family physician to discuss other possible causes and treatments for sleeplessness.

Experiencing significant or persistent back pain may indicate an underlying back condition that has nothing to do with the mattress. It is always advisable for people with back pain to consult with a health care provider for a thorough exam, diagnosis, and treatment program.

As a reminder, sleep comfort is first and foremost a matter of personal preference. No one should expect that switching mattresses or beds will cure their lower back pain, and changes in the type of bed or mattress used should be made solely for the sake of comfort.

Sleep Positions for Back Conditions

An important factor that can influence individual preferences for mattresses, beds and sleeping positions is the specific back condition a person has. For example:

- Osteoarthritis. Patients with pain from osteoarthritis of the facet joints may prefer to sleep on their sides with their knees curled up (in the fetal position). This helps open up the facet joints in the spine and can relieve any corresponding pressure. Alternatively, sleeping in a reclining chair or an adjustable bed that allows the head and knees to be elevated can also relieve pressure on the facet joints.

- Degenerative Disc Disease. Patients with pain from degenerative disc disease may prefer to sleep on their stomach as this can relieve pressure on the disc space. Patients may feel most comfortable using a relatively firm mattress and placing a flat pillow under the stomach and hips, which can further reduce stress on the lower back.

- Spinal Stenosis. People with pain from spinal stenosis may prefer to sleep on their sides with their knees curled up (in the fetal position). This helps relieve pressure on the nerve root. Sleeping in a reclining chair or an adjustable bed that allows the head and knees to be elevated can also relieve pressure on the nerve.

- Bursitis. Patients who have inflammation of the bursa over their hips (greater trochanteric bursitis) can be especially susceptible to pain from a mattress that is too firm. If the mattress is too hard, a new mattress with thick padding on top, or placing an egg crate foam
mattress cover over the old mattress, can help provide some relief from the firmness.

- Hip Pain. Patients with hip pain who sleep on their sides can usually find some pain relief by placing a pillow between their knees. This decreases stress across the hip.

- Herniated Lumbar Disc. The most comfortable sleep position depends on the position of the disc. For a paracentral disc herniation (most common), patients will tend to do better lying on their stomach. For a foraminal herniated disc, sleeping on the side in a fetal position is usually better tolerated.

In general, elevating the knees slightly by placing a pillow under them while lying on the back can help many general forms of low back pain. Many patients also find that this is the most comfortable way to sleep after spine surgery.

Call ABChiropractic Family & Wellness, your St. Charles Missouri Pain Relief Center at 636-916-0660.  We offer chiropractic adjustments, decompression and massage therapy.  Sports physicals and work physicals are also offered.

Leg Pain & Numbness: What Might These Symptoms Mean?

Leg pain can range from a mild nuisance that comes and goes, to debilitating pain that makes it difficult to sleep, walk, or engage in simple everyday activities. The pain can take many different forms ‐ aching, searing, throbbing, or burning, and it can be accompanied by other symptoms, such as a pins‐and‐needles sensation, and/or leg or foot numbness or weakness.

Leg Pain Symptoms and Descriptions

Leg pain may be caused by a problem in the leg, but often starts with a problem in the lower back, where the sciatic nerve originates, and then travels along the path of the nerve (called sciatica).

For this reason, diagnosis of anyone with leg/foot pain, and/or leg/ankle/foot weakness or numbness should include an exam of the lower back.

Not all leg pain derived from low back problems presents the same way. Leg pain caused by a low
back problem is often accompanied by additional symptoms, such as leg numbness or weakness, or foot pain, and the type of pain may vary widely from patient to patient.

Typical descriptions of leg pain and accompanying symptoms include:

Burning pain.

Some experience a searing pain that at times radiates from the low back or buttocks down the leg, while others complain of intermittent pain that shoots from the lower back down the leg and occasionally into the foot. Words used to describe this type of burning leg pain include radiating, electric or shooting pain that literally feels like a jolt. Unlike many forms of low back pain that can often be a dull ache, for many, leg pain can be excruciating and nearly intolerable. This type of burning pain is fairly typical when a nerve root in the lower spine is irritated, and it is often referred to as sciatica.

Leg numbness or tingling.

Anyone who has had a leg or foot "fall asleep" and then gradually return to normal can imagine what numbness in a leg would feel like. Not being able to feel pressure, or hot or cold, is unnerving. Unlike the short-lived numbness of an asleep limb, numbness coming from a low back problem can be nearly continuous and can severely affect a person’s quality of life. For example, it can be difficult or almost impossible to walk or drive a car if one’s leg or foot is numb. Typical symptoms can range from a slight tingling sensation to complete numbness down the leg and into the foot.

Weakness (foot drop) or heaviness.

Here, the predominant complaint is that leg weakness or heaviness interferes significantly with movement. People have described a feeling of having to drag their lower leg and foot or being unable to move their leg as quickly and easily as needed while walking or climbing stairs, for example, because of perceived weakness or slow reaction. Patients with foot drop are unable to walk on their heels, flex their ankle, or walk with the usual heel-toe pattern.

Constant pain. 

This type of pain is normally felt in the buttock area, so it is not technically leg pain but it may accompany some form of pain felt in the legs. It may also be pain that occasionally radiates past the buttock into the leg. This type of pain is usually described as "nerve pain," versus an aching or throbbing pain. It is typically present only on one side, and is commonly called sciatica or lumbar radiculopathy. It may often be relieved by stretching, walking or other gentle movement.

Positional leg pain.  

If leg pain dramatically worsens in intensity when sitting, standing or walking, this can indicate a problem with a specific part of the anatomy in the ow back. Finding more comfortable positions is usually possible to alleviate the pain. For example, bending over may relieve pain from spinal stenosis, while twisting (as in a golf swing) can increase facet joint related groin, hip and leg ache.

There are many spinal conditions that may cause leg pain, foot pain, and other lower extremity symptoms. Most successful treatments are based upon having an accurate anatomic diagnosis for the basis of a specific pain syndrome. Chiropractors are well suited to oversee the diagnosis and treatment of these situations.

Call 636-916-0660 and schedule your new patient exam at ABChiropractic Family & Wellness.  Our office is conveniently located in St. Charles, Missouri.  Our office is easily accessible from either highly 70 or 94.  Dr. Mario Awwad specializes in fast pain relief of leg pain.  

Sources of Whiplash Pain

When the cervical spine (neck) is subject to whiplash, there is usually a combination of factors that contribute to whiplash pain in the neck and back, and ultimately need to be addressed individually by a chiropractor, who maintains a "holistic" view of the patient's whiplash pain. This article explains how chiropractors approach treating neck pain, back pain, and/or other whiplash symptoms, and help patients prevent chronic whiplash pain.

Whiplash Pain Management for Joint Dysfunction

Joint dysfunction from whiplash occurs when one of the joints in the spine or limbs loses its normal joint play (resiliency and shock absorption). A chiropractic technique called motion palpation gently moves the joint in different directions and assesses its joint play. When a joint develops dysfunction, its normal range of movement may be affected and it can become painful.

Muscle Dysfunction from Whiplash Injuries

When joint dysfunction develops, muscles are affected by becoming tense and overactive or inhibited and underactive. In either case, these muscles can develop trigger points that may necessitate whiplash treatment involving muscle relaxation or stimulation.

Trigger points are areas of congestion within the muscle where toxins accumulate and can irritate the nerve endings within the muscle and produce pain. This whiplash pain can occur in the muscle itself or can be referred pain (perceived in other areas of the body).

The muscle can also send abnormal neurological signals into the nervous system, which can then cause disruption of the ability of the nervous system to properly regulate muscles in other parts of the body, leading to the development of faulty movement patterns.

Faulty Movement Patterns and Whiplash Pain

It is thought that the intense barrage of pain signals from a traumatic whiplash injury to the cervical spine can change the way the nervous system controls the coordinated function of muscles.

The disruption of coordinated, stable movement is known as faulty movement patterns which cause increased strain in the muscles and joints, leading to neck pain and back pain. They can involve the neck itself or can arise from dysfunction in other areas of the body such as the foot or pelvis.

Instability is also considered part of faulty movement patterns. There are two types of instability that can occur in whiplash:

- Passive—the ligaments of the neck are loosened, making it more susceptible to whiplash pain; and

- Dynamic—the nervous system disruption causes a disturbance in the body’s natural muscular response to common, everyday forces.

Instability can cause even mild, innocuous activities difficult to perform as they often exacerbate the
whiplash pain.

Whiplash Pain from a Herniated Disc

The force of whiplash can cause injury to the discs between the vertebrae, and small tears can develop. If the gelatinous middle of the disc seeps out, it can irritate the nerve endings in this area. This is known as disc derangement.

Occasionally, the gel can seep all the way out and press on a nerve root exiting the spinal cord behind the disc, known as disc herniation.

A herniated disc may involve whiplash pain in the neck as well as sharp, shooting pain down the arm and possibly neurological symptoms such as numbness, tingling and muscle weakness.

Chiropractic Treatments for Whiplash

Each case of whiplash is different so it’s not possible to generalize about the chiropractic whiplash treatment.  Chiropractors commonly employ different chiropractic treatments for whiplash, often including:

- Manipulation
- Muscle relaxation and/or stimulation
- Various exercises
- Ergonomic and lifestyle changes.

Preventing Chronic Pain from Whiplash

After sustaining whiplash injuries, it is fairly common for people to suffer from chronic neck pain. Chiropractors can detect certain factors in a patient’s history and chiropractic exam to better determine patients who may be more susceptible to chronic pain from a whiplash injury. This process will identify when aggressive preventative measures should be taken for patients who may be at a greater risk of developing chronic neck pain from whiplash injuries.

Call Dr. Awwad at ABChiropractic Family & Wellness in St. Charles MO at 636-916-0660 to schedule your new patient consultation and discuss possible treatment options.

Choosing the Best Mattress for Lower Back Pain

Sleeping on the wrong mattress can cause or worsen lower back pain. Lack of support from a mattress reinforces poor sleeping posture, strains muscles and does not help keep the spine in alignment, all of which contribute to low back pain.

Sleep comfort is also sacrificed if a mattress does not match one's individual preferences.  A mattress that provides both comfort and back support helps reduce low back pain, allowing the structures in the spine to rest and rejuvenate during the night.

Choosing the right mattress can be difficult.  The following practical guidelines are designed to help patients with low back pain choose the best mattress for both back support and sleep comfort:

1.     Personal preference should ultimately determine what mattress is best. There is no single mattress style or type that works for all people with low back pain. Any mattress that helps someone sleep without pain and stiffness is the best mattress for that individual.  Patients with low back pain should choose the mattress that meets their standards for comfort and support and allows them to get a good night's sleep.  Understand and inquire about the physical components of the mattress.  The coils or inner springs of a mattress provide the support.  Different mattresses vary in their number and arrangement of coils.

 2.    Padding on top of the mattress comes in many different thicknesses.  Mattress depths typically range anywhere from 7 to 18 inches deep.  Choosing the number of coils, type of padding and mattress depth should be determined by individual preferences.

 3. Find a mattress with back support.  A good mattress should provide support for the natural curves and alignment of the spine.  The right amount of back support also helps the patient avoid muscle soreness in the morning.  While there is not much clinical data about mattresses, one study found that medium-firm mattresses usually provide more back pain relief than firm mattresses.

 4.    Achieve a balance between back support and comfort.  Overall comfort while sleeping on the mattress is equally important as sufficient back support.  Sleeping on a mattress that is too firm can cause aches and pains on pressure points.  A medium-firm mattress may be more comfortable because it allows the shoulder and hips to sink in slightly.  Patients who want a firmer mattress for back support can get one with thicker padding for greater comfort.

 5.    Know when it's time to get a new mattress.  If an old mattress sags visibly in the middle or is no longer comfortable, it is probably time to purchase a new one.  Putting boards under a sagging mattress to keep it from sagging in the middle is only a short-term fix for the sagging; a new mattress is still needed.

Some Considerations

       Shop for the best value and quality of the mattress, not price.  Mattresses with more coils and thicker padding tend to be higher quality and also more expensive; however, a higher price does not guarantee that the mattress is more comfortable or more supportive.  Mattress stores often have sales and promotions, so it is a good idea to comparison-shop for the best price after finding the right mattress.

       Be aware of mattress advertising gimmicks.  Claims that a mattress is orthopedic or medically-approved should be viewed skeptically.  There has not been extensive medical research or controlled clinical trials on the topic of mattresses and low back pain.  The individual must determine whether or not extra features on a mattress make it more comfortable or supportive.

       Give the mattress a test-run before buying.  To sample mattresses, people can try sleeping on different makes and models in hotels or at other people homes before going to a mattress store.  When shopping at the store, shoppers should lie on the mattress for several minutes to decide if it is a good fit. If two people will be sleeping on the mattress, both should test it at the same time to make sure they have enough space and are both comfortable on the same style of mattress.

      Purchase mattresses from stores and companies that are trustworthy. Consider the customer service offered by the mattress store, such as delivery options, warranty, and removal of old mattresses and the stores return policy. Look for mattress stores where customers can return a mattress if they are not satisfied with the quality or comfort after sleeping on it for a significant amount of time (i.e. a couple of weeks to a month).

     To help preserve the quality of a new mattress, it should be repositioned every six months to ensure that the mattress is evenly worn. This includes rotating 180 degrees and flipping the mattress lengthwise on a regular basis. The Better Sleep Council advises against putting a mattress on a box spring/foundation that is not made to go with the mattress, as this may decrease the life of the new mattress.

Call ABChiropractic Family & Wellness in St. Charles Missouri at 636-916-0660 to schedule your appointment with a doctor of chiropractic to help with deciding which mattress is best.

How to Support Your Back Every Day

When you're living with chronic back or neck pain, your daily routine can get complex, including making appointments, insurance paperwork, time off work, treatment regimens to follow, etc. While these are important aspects of managing your pain and recovery process, there are simple things you can do (or stop doing) on a daily basis to help your condition.
Good posture and body mechanics (the way you perform your activities all day, everyday) can substantially improve the way you feel at the end of your day.
Support your spine while sitting at your desk or in your car
Sitting for prolonged periods of time can be a major cause of back pain. Sitting is a static posture, which can add a tremendous amount of pressure to the back muscles and spinal discs. Additionally, sitting in a slouched-over or slouched-down position can overstretch the spinal ligaments and increase the pressure on your spinal discs.
Sitting with your back relatively straight and with good support is essential to minimize the load (strain) on your back. Especially when you sit for prolonged periods of time, you need to provide your lower back with support for the inward curve of the lumbar spine (lordosis). Here are a few tips for good posture and support for your lower spine while sitting at a desk or while driving:

Make sure your chair is set up so your knees are bent at about a 90∞ angle. Two fingers should slip easily between the bottom of your thigh and the chair.
The backrest of your chair should push your lower back forward slightly. Place a small pillow, rolled up towel, or orthopedic support on your chair to accomplish this or get a new office chair that provides support if you can.
Your buttocks should be pressed against the back of the chair, and your back should be straight.
It's a good idea to have arm rests on your office chair that place your elbows at a 90-degree angle.
Place some support under your feet to elevate them slightly and take some of the load off of your lower spine. Sit with your knees slightly higher than your hips to eliminate much of the pressure on your lumbar spine.
Don’t sit on anything that would throw your spine out of alignment (i.e., a wallet in your back pocket).
Don't slouch or slump in your office or car seat.  This puts extra pressure on your spine and stress on the lumbar discs. Use the back of the chair to provide support for your back.
Sit up straight and keep your chin pulled in (avoid keeping your chin and head thrust forward).
Sit as close to your desk as possible.
Your computer screen or reading materials should be at eye level.
Some people prefer furniture that promotes more muscle activity, such as a Swedish kneeling chair, standing desk, or a Swiss exercise ball, rather than a chair that provides complete support. Purchasing a good ergonomic office chair that provides optimal back support may also be helpful.
On the phone a lot?  Consider investing in a headset to take the strain off your neck, or try using the speakerphone. Avoid cradling the phone on your shoulder.
If you are in a great deal of pain, try to avoid driving. If possible, have someone else drive, and lie down in the back seat with your knees slightly bent. You can place a blanket or pillow under your knees to support them, as well as a small pillow under your head.
Move about during the day

A healthy body can only tolerate staying in one position for relatively short periods of time. You may have noticed this on an airplane, at your desk, or at a movie theater when sitting is uncomfortable after just a short time. Even with correct posture, holding the same position slowly takes the elasticity out of the tissues, and stress builds up and causes discomfort.
Keep your joints, ligaments, muscles, and tendons loose by moving about and stretching on a regular basis throughout the day:

Stand up while talking on the phone. Be sure to stand with one foot slightly in front of the other, or place one foot on something a few inches off the ground; avoid standing straight with your knees locked.  Stretch your hamstrings twice each day. To help you remember to do this on a regular basis, link the stretching to a part of your daily routine, such as when you brush your teeth in the morning and evening, or when you first get to work and before you head home. Flexible hamstrings will significantly reduce the stress on your lower back.
When you return to your seat after moving around, use an alternate posture for just a few moments and some of the tissue elasticity needed to protect your joints will return.
Paying attention to your posture and movement throughout the day and while sleeping at night will help you manage your pain and maintain good spine health.

Call 636-916-0660 to learn more back safety tips and to schedule your personalized new patient consultation and exam with Dr. Mario Awwad at our St. Charles office.

The New Health Epidemic: Sitting Disease

Si􏰀ng all day is linked to harmful effects of our overall health, and it can actually cause and/or worsen many back or neck problems.
The fix? Grab a stand up desk and find out just how easy it is to improve your health by commi􏰀ng to si􏰀ng a li􏰁le less every day. Your spine ‐ and your overall health ‐ will thank you.

Why a Standup Desk?
Global studies show we spend an average of 7.7 hours a day sitting.1 How much time do you actually spend sitting in an average day? Nonprofit JustStand.org makes it easy to find out with their online sitting calculator.

You sit a lot—so what?
People who sit most of the day are at an elevated risk for non- accidental back injuries. Load on the discs in your spine is actually less when you are standing versus when you are sitting (intradiscal load 100 kg vs 140 kg sitting). If you suffer from lumbar degenerative disc disease, this difference in pressure can make a big difference.

Studies show that prolonged sitting leads to diabetes, heart disease, cancer, obesity, depression, and early death. Mayo Clinic endocrinologist James Levine, an outspoken advocate for standing more, has studied the effects of too much sitting. He comments, "Today, our bodies are breaking down from obesity, high blood pressure, diabetes, cancer, depression and the cascade of health ills and everyday malaise that come from what scientists have named sitting disease."

Naturally, when we stand we fidget and move around more than we would if we were sitting. Use this calorie-burn calculator to see how many more calories you'll burn by standing for all or part of 

your workday - it adds up! The weekly incremental calorie burn by using a standup desk can add up to an 830 extra calories per week, or about a pound a month!

According to a study that examined mortality in women, those who are inactive and sitting for more than 6 hours a day are 94% more likely to die prematurely. Men - you are not off the hook! Your sedentary lifestyles increase your risk of cardiovascular mortality by 82%.

Standing while you work on your computer requires the core muscles to be engaged. A strong core leads to better overall health and better back health.

Start Working at a Standup Desk - Your Body will Thank you!
Here is how to counteract the potentially negative effects of Sitting Disease:

*Purchase (or make) a standup desk, and make sure to follow these guidelines to maintaining healthy standing posture: Good Posture Helps Reduce Back Pain. Sit-to-stand desks are also growing in popularity, giving you flexible options throughout the day.

*Start out alternating between standing and sitting. While you are sitting, office ergonomics can help lower the risks associated with prolonged sitting in an office chair, such as neck strain, lower back pain, and leg pain.

*At first, only stand for 2 hours each day to allow your muscles to get used to the new arrangement.
*To make sure you stand... Assign an activity like phone or email time to standing only, or download a free alarm or put one in your mobile phone to remind you when to stand. 

Take the first steps to living a healthier lifestyle by committing to stand a little more every day. Also, get up and move around as often as possible. When sitting, make sure to take advantage of an ergonomic chair.

Call ABChiropractic Family & Wellness in St. Charles, Missouri at 636-916-0660 for a free consultation or ask about our New Patient Promotion.

Starting an Exercise Ball Program

Many treatment programs for low back pain incorporate use of an exercise ball (also called a stability or fitness ball) to strengthen the core muscles in the stomach and back that support the spine. Exercise ball exercises clearly work and have been adopted in non-rehabilitation exercise programs by athletes and fitness buffs looking to cross-train and strengthen their core muscles.
This article provides several simple steps to choose, get familiar with, and benefit from using an exercise ball on a regular basis.


Choosing the Right Exercise Ball
Physical therapists, exercise trainers, Chiropractors, and other professionals have constructed several guidelines to use when selecting the proper exercise ball size.
When sitting upright on an exercise ball:
Feet should be flat on the floor - with an even weight distribution.
Knees should be level or slightly lower than the pelvis - creating an angle of 90 degrees or slightly greater at the hips and knees (thighs parallel to ground or pointing down slightly).
Pelvis, shoulders, and ears should be in a vertical line ó the body should not be leaning in any direction as a counter-balance.  Bouncing up and down lightly will usually produce this alignment. Exercise balls generally come in five different diametrical sizes to be accordingly used by people of differing body compositions.
It is important to note that height alone is not the only factor in determining ball size. Because the exercise balls are flexible and offer resistance, weight is also an important factor.
A general guideline for height correspondence to diameter of exercise ball is as follows (assuming average body weight is proportional to height):

Ball Diameter Your Height
45cm 5í and under
55cm 5í1î - 5í8î
65cm 5í9î - 6í2î
75cm 6í3î - 6í7î
85cm 6í8î and taller

If body weight to height is larger than the average proportion, sitting on the exercise ball will compress it down more, so try using the next larger exercise ball size in order to maintain the 90-degree rule. Another factor to keep in mind is that most exercise ball sizes have some adjustability to them. If the angles at the hips and knees are much greater than 90 degrees, some air can be released to compensate and vice versa.
Bear in mind, releasing air from the exercise ball will cause it to lose air pressure. As the ball flattens out, this will actually make it more stable, as it has a larger contact area with the resisting surface and the body. This means that stabilizing and balancing exercises will become easier and will lose some effectiveness.
Exercise balls also lose pressure because of stretching from regular usage. Therefore, as the ball ages, it may require further inflation. On the other hand, adding excessive air to the exercise ball will increase the difficulty of balancing and stabilizing, as the contact area decreases.

Starting an Exercise Ball Program
Just sitting on an exercise ball is active and requires the core body muscles to work to hold the body upright and balanced on the ball. Until sitting on the exercise ball feels comfortable, it is often a good idea to not have the ball fully inflated - a slightly deflated exercise ball is more stable.
Sit in the center of the ball with both feet firmly on the ground about shoulder width apart. If this is difficult, then use a wider stance.
The knees should be in line over the ankles.
Shoulders should be in line over the body (not hunching forward) and the head squarely over the neck (not leaning forward).
One can easily sit on the exercise ball while working at a desk or computer workstation and use it as an alternative to a traditional office chair. Others prefer to sit on it while watching television. Whatever the use, sitting on an exercise ball at some point of the day is helpful to strengthen the core muscles that support the spine.

Beginning Stretches
There are several stretches that are easy to do when starting to use an exercise ball. These stretching exercises help with proprioception, or the sense of the position or parts of the body relative to the rest of the body, and with balance. Each of these stretches should be done slowly 8 to 12 times.
Move the hips from side-to-side. While sitting on the exercise ball (as described above) and keeping the knees still, move the hips gently from side to side. Pause for a second at the end of each sideways movement to allow for a gentle stretch.
Move hips from front-to-back. While keeping the knees still, place hands on the knees and rotate the hips forward by tucking the buttocks first under the pelvis, and then push them out behind the pelvis. All the motion should be limited to the hip area, not the knees or chest.
For more exercise ball routines and exercises, visit http://www.spine-health.com/wellness/exercise/how-start-exercise-ball-program

Call Dr. Mario Awwad, your St. Charles Missouri at 636-916-0660 to discuss any health concerns prior to starting any exercise program.

Ice/Heat Therapy

Heat or cold therapy can provide a surprising amount of pain relief for most types of back and neck pain. Muscle strains and pulls are some of the most common causes of back pain, and can be soothed with heat and cold therapy.
Cold packs help reduce inflammation and numb a painful area while heat packs help increase circulation to a specific area of the body and can promote healing.
It's easy to make a hot or cold pack with materials you already have at home.  Making hot or cold packs yourself is convenient, because one will be ready whenever you need it, and it could save you some money.

Homemade Gel Ice Packs
These homemade gel ice packs are more comfortable than a bag of frozen peas, because they mold better to your body without the lumps and bumps.
They can be made for under $3.
What you need:
1 quart or 1 gallon plastic freezer bags (depending on how large you want the cold pack)
2 cups water
1 cup rubbing alcohol
Instructions:
Fill the plastic freezer bag with 1 cup of rubbing alcohol and 2 cups of water.
Try to get as much air out of the freezer bag before sealing it shut.
Place the bag and its contents inside a second freezer bag to contain any leakage.
Leave the bag in the freezer for at least an hour.
When it's ready, place a towel between the gel pack and bare skin to avoid burning the skin.

Home-Made Pain Relief
Sometimes the simplest solutions are best.  Here we show you how to make your own gel ice pack or moist heat pack, and a simple low back massager to help ease your discomfort until you can get in to see your chiropractor.

Homemade Moist Heat Packs
Heat therapy increases circulation to aching muscles, and provides pain relief. There are two types of heat therapy, dry and moist.
Electric heating pads bring a dry heat, which some people find to be less comforting than moist heat. Moist heat packs are less dehydrating to the skin, and they allow heat to absorb better into the skin and relieve pain faster.
What you need:
Cloth container (sock, fabric)
4-6 cups filling (e.g. uncooked rice, flax seed, buckwheat, oatmeal)
Needle and thread (optional, but recommended)
Flair (ribbon, fragrant oils; optional)
Instructions:
Fill your container with the filling.
Tie or sew the container shut.
Add soothing aromatherapy before you microwave, if you want.
Microwave container for 1-3 minutes.
Whether you are using cold or heat therapy, do not apply them for more than 15 minutes at a time. The best way to apply either heat or cold is to alternate 15 minutes on and 15 minutes off for an hour or two.

Do-It-Yourself Massage
What you need:
6 tennis balls
A roll of duct tape
A floor
10-15 minutes daily
Instructions:
Align the tennis balls in a figure eight, and then use as much duct tape as needed to secure the balls in this shape. When completed, the compact tennis balls/duct tape contraption will look like a peanut.
Place the tennis balls on the ground and then lie on them face up, keeping the knees bent. The tennis balls should be parallel to your waist and centered just above the†lumbar spine†(lower back).
Attain balance and comfort, and then raise both arms with your fingers pointed towards the ceiling. Keep your arms as straight as possible.
Beginning with either your right or left arm, slowly lower your arm backwards toward your head (visualize a reverse tomahawk chop without the speed). Once again, keep your arms as straight as possible and feel free to bend your neck backwards when moving your arms.
Bring the arm backwards to the ground, hold this position for a couple of seconds, and then slowly bring it back to its original starting position.
Now repeat the same action with the other arm.
Alternate and complete for each arm four more times. Through-out this process, the tennis balls simulate the knuckles of a massage therapist.  For more information or to discuss your injuries with a licensed chiropractic physician, call your St. Charles Chiropractor, Dr. Mario H Awwad, to discuss treatment options if you are a candidate.  Dial 636-916-0660 and speak with Natalie, Karen or Rachel to schedule your appointment for you or your entire family.  You can also visit www.ABChiropractic.com.

Mario Awwad
Director, ABChiropractic Family & Wellness

Could My Back Pain be Caused by Stress?

No one would disagree that having back and neck pain causes stress, but what about the other way around? Could stress be the primary cause of back pain?
How does stress cause back pain?   There are a variety of theories about the causes of stress related back pain. Importantly, the overriding tenet in all of these theories is that emotional factors cause some type of physical change resulting in the back pain.
In most theories of stress-related back pain, the pain cycle continues and is exacerbated as the pain leads to the patient becoming timid and anxious about daily activities. The pain cycle is characterized by:
The patient becomes unnecessarily limited in many functions of daily life, as well as leisure activities
This decrease in activities is due to the patient's fear of the pain and injury
This fear may be made worse by admonitions from doctors (and/or family and friends) to take it easy due to some structural diagnosis (which may actually have nothing to do with the back pain).
The limitations in movement and activity lead to physical de-conditioning and muscle weakening, which in turn leads to more back pain
Of course, this cycle results in more pain, more fear, and more physical de-conditioning along with other reactions such as social isolation, depression and anxiety.
The diagnosis of stress-related back pain.  The diagnosis of stress-related back pain is often made by a thorough medical history and physical exam. Patients must be cautious in trying to self-diagnose stress related back pain, as there may be a serious medical condition (such as a tumor or infection) causing the pain. A good medical examination can usually rule out the more serious structural causes of back pain in a great majority of patients.
For cases of stress-related back pain, the history of onset of back pain is often quite variable. The pain may start with an identifiable incident, or it may start insidiously. For instance, it is not uncommon for the pain to start with an incident such as a lower back sprain or strain, only to have it continue as the result of emotional factors long after the injury has healed.
In many cases there may be MRI findings such as a disc bulge or degenerative disc disease when stress-related back pain is the actual culprit. In these instances, the MRI findings are not clinically significant and ultimately determined not to be the cause of the pain.
The overall characteristics of stress-related back pain include symptoms such as:
Back pain and/or neck pain
Diffuse muscle aches
Muscle tender points
Sleep disturbance and fatigue
In many stress-related back pain cases, patients complain of the pain moving around.
In general, symptoms of stress related back pain are similar to those of fibromyalgia.
Treatments for stress-related back pain. The multi-disciplinary approach to treating stress related back pain includes evaluation of, emotional, cognitive and environmental factors.  Thus, the multi-disciplinary formulation will look at the relative contribution of the following factors:
Physical, including de-conditioned and weak muscles, nerve irritation, etc.
Emotional, including depression, anxiety, anger, etc.
Cognitive, such as negative thoughts, pessimism, hopelessness, etc.
Environmental, such as loss of job, financial problems, etc.
This approach then develops a treatment program based upon how much each factor is thought to be influencing the pain. A multi-disciplinary program may include such treatments as:
Treating the physical factors using stretches and exercises recommended by your chiropractor
Treating the physical and emotional factors through appropriate medications (often including anti-depressants or muscle relaxants)
Treating the emotional and cognitive factors through psychological pain management techniques and biofeedback
Treating the environmental factors through counseling or therapy
The idea of multidisciplinary treatment of back pain has been around for at least 25 years. It has been shown to be quite successful; although, the key factor in treatment outcome is the motivation of the patient to complete a rehabilitation approach.

Call ABChiropractic Family & Wellness in St. Charles, Missouri at 636-916-0660 and speak with Karen, Natalie or Rachel to schedule your new patient appointment.  Don't forget, we also offer massage therapy performed by a licensed massage therapist.