Upper Back Pain from a Thoracic Herniated Disc

A herniated disc in the upper back can occur when the inner gelatinous material of an intervertebral disc leaks out of the inside of the disc. A thoracic herniated disc can cause upper back pain and other symptoms, such as radiating pain or numbness.

Specific symptoms of a thoracic herniated disc are usually different depending on where the disc herniates, as the herniated disc material in the upper back can either impinge on an exiting nerve root or on the spinal cord itself.

Thoracic Degenerative Disc Disease

Thoracic disc disease is conceptually similar to disc disorders in the cervical and lumbar spine, but symptomatic lesions (anatomical problems related to the symptoms) are far less common.

The most common location for thoracic disc disorders is at the thoracolumbar (the thoracic and lumbar parts of the spinal column) junction (T8-T12) in the mid back. The true incidence is unknown because many thoracic disc disorders do not cause thoracic back pain or other symptoms, and they comprise only a very small percent of all herniated disc treatment surgeries.

In one study, 90 asymptomatic patients (with no pain or other symptoms) were evaluated with thoracic MRI scans. These were the findings:

• 73% of patients were found to have disc abnormalities in the upper back, such as a thoracic herniated disc or thoracic degenerative disc disease
• 37% specifically had a thoracic herniated disc
• 29% had radiographic evidence of spinal cord impingement identified on the MRI.

These patients were followed for 26 months and none of them developed thoracic back pain from their thoracic disc disorders.1

The fact that so many people had thoracic herniated discs but no pain or symptoms is important to mention, as it shows that people may have both upper back pain and a thoracic herniated disc, but that the disc disorder may not be the cause of the thoracic back pain – it may just be an incidental finding.

In fact, there are many causes of upper back pain that are much more common than a herniated disc, and a correct diagnosis of the cause of the patient’s pain is more important than whether or not an MRI scan shows a thoracic disc herniation.

References:

1. Wood KB, Garvey TA, Gundry C, Heithoff KB: Magnetic resonance imaging of the thoracic spine. J Bone Joint Surg Am. 77:1631-1638, 1995.

CALL ABChiropractic Family and Wellness at 636-916-0660 to see how chiropractic can help.  We are located in St. Charles MO, 63303.  We are your St. Charles Pain Relief Center.

Chiropractic Adjustment

A chiropractic adjustment, also known as chiropractic manipulation, manual manipulation, or spinal manipulation, is a common therapeutic treatment for lower back pain.18

A chiropractic adjustment refers to a chiropractor applying manipulation to the vertebrae that have abnormal movement patterns or fail to function normally.

The objective of this chiropractic treatment is to reduce the subluxation, with the goals of increasing range of motion, reducing nerve irritability and improving function.

Chiropractic Adjustment Description

A chiropractic adjustment typically involves:

• A high velocity, short lever arm thrust applied to a vertebra
• An accompanying, audible release of gas (joint cavitation) that is caused by the release of oxygen, nitrogen, and carbon dioxide, which releases joint pressure (cavitation)19
• A relieving sensation most of the time, although minor discomfort has been reported (that usually lasts for a short time duration) if the surrounding muscles are in spasm or the patient tenses up during this chiropractic care.

It should be known that joint cavitation or cracking does not occur at times, typically as a result of significant muscle splinting or the patient not being adequately relaxed during the chiropractic manipulation. At times like this, it is sometimes best for the chiropractor to apply ice, have the patient rest, or do electrical stimulation and massage prior to attempting the chiropractic adjustment.

Chiropractic Adjustment Techniques

There are many different manipulative techniques that can be utilized in chiropractic, and there is a certain skill level and "art" involved with high velocity, low amplitude adjustment or manipulation. It is perhaps more important for the chiropractor to determine when not to apply the adjustment.

Chiropractic Adjustment Side Effects

View Chiropractic
Videos

The most common reaction to a chiropractic adjustment is aching or soreness in the spinal joints or muscles. If this aching or soreness occurs, it is usually within the first few hours post-treatment and does not last longer than 24 hours after the chiropractic adjustment. Application of an ice pack often reduces the symptoms relatively quickly.

Call our St. Charles, Missouri office at 636-916-0660 to schedule your new patient appointment for you and your family to see if Chiropractic treatments can help you.  ABChiropractic Family & Wellness in St. Charles MO offers a variety of chiropractic adjustments as well as decompression and massage therapy.  

Mario H Awwad D.C

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.