The Sweet (Dis-)Satisfaction of Self-manipulation

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I frequently hear “the clicking makes it feel better …”, until it doesn’t. For many seeking chiropractic care, they have experienced spinal manipulation via their own hand, by others who are untrained or have seen it performed on Youtube. Some are self-proclaimed spinal manipulators who cannot control their frequent, daily habit. But, is self-manipulation creating more harm than good?

Effects of self-manipulation:

  • Creates hypermobile joints that make audible clicking noises.

  • Does not address the underlying causes of muscular imbalances.

  • Will result in osteoarthrosis via a piezoelectric effect – the creation of calcific bone spurs around the joints. 

Opt for stability and not hyper-mobility by:

  • Seeing a Doctor of Chiropractic for professional spinal manipulation.

  • Correcting weakness of the multifidi (deep back muscles) through targeted corrective exercises.

The combination of chiropractic care and functional corrective exercise training is a highly effective and evidence-based treatment.

Is Blue Light Giving You a Headache?

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From Paris to London on the EuroStar, practically everyone we know spends too much time in front of a computer screen. Consequently, our eyes are bombarded with harmful blue light emitted by computer screens, tablets and phones. I often treat patients suffering from head aches, neck and jaw pain, shoulder tension and anxiety, all aggravated by prolonged computer usage. In many cases, I happily recommend IZIPIZI anti-blue light glasses because wearing them makes the time I spend in front of the computer tolerable. They are light, stylish, comfortable and good value for money.
You should know that I have not received any compensation for this endorsement, but I hope that I will receive a pair of the tortoise, C- shaped, screen glasses to make it IZI to work at home.  

How pain can alter motor (movement) programs


Pain, injury and inflammation can result in immediate and often dramatic changes in movement programs that is when and how much muscles contract, co-activate, coordinate relax and recruit.

I once had a patient who was salsa dancing and suddenly his back became immobilized and he was unable to move normally. He said his fellow dancers thought that he was joking. He was not joking.

Chiropractic adjustments improve smoothness of lumbar (lower back) spinal motion, acceleration, and angular velocity.

Lumbar motion changes in chronic low back pain patients.

Mieritz RM, DC, PhD, Bronfort G, DC, PhD et al. Spine Journal 2014

Comments: This 2014 paper uses a “high tech” equipment (Spine Motion Analyzer) to quantify not only the overall range of motion (ROM), but the quality of motion based on angular velocity, acceleration, & smoothness of motion (aka jerk index) which is based on the number of changes in acceleration throughout a particular ROM. The results document that chiropractic adjustments improved all measurements of improved quality of motion, but several exercise programs which were also evaluated improved only half of the measurements. Importantly, this study is the first to document that chiropractic adjustments improved smoothness of motion but the exercises did not. The paper notes that simply measuring end range of motion and not quality of motion is not sensitive enough to detect important clinical improvements of motion that occur with chiropractic adjustments. 

Methods: This study assesses changes in lumbar regional motion in 199 Low Back Pain (LBP)Patients (>6 weeks to 12 weeks) with (w) or w/o leg pain &/or neurological signs (18-65 yrs) over 12 weeks of care. Lumbar spine kinematics were determined using a high tech instrumented spatial linkage system (CA 6000 Spine Motion Analyzer; OSI, Union City, CA, USA) to measure angular velocity, acceleration & smoothness of motion at 2 pre-treatment visits & 1 follow up visit after 12 weeks of treatment. ‘Low tech’ ROM measurements describe functional range but little about the quality of the motion. Simple ROM has limited use as a measure of treatment outcomes or as a stand-alone measure of disability. Addressing the patterns & quality of the motion rather than just the end ROM may be more responsive measures. ‘High tech’ 3D spinal motion analysis may aid in describing patient movement & changes with various treatments & remedy deficiencies in the quantification of LBP impairment. 

The lumbar region spinal motion data were analyzed relative to 3 treatment modalities: 

  1. High-dose, supervised exercise (20 supervised sessions of high reps of core exercises)
  2. Low-tech trunk exercise (2 supervised sessions w PT training & advice & then exercise on their own)
  3. Spinal Manipulation (SM) (2 visits/wk for 12 wks of HVLA side-posture).

Results: Lumbar region motion parameters were altered over 12 weeks in all groups, but only the chiropractic spinal manipulation group changed significantly in all outcomes, and the exercise groups in half of the motion parameters analyzed. Spinal Manipulation group changed to a smoother motion pattern of motion but the exercise groups did not. The hypothesis that LBP Patients would move more smoothly after Spinal Manipulation was confirmed. 

Conclusion: This study provides evidence that spinal motion changes can occur in CLBP Patients over a 12-week period and that these changes are associated with the type of Treatment.

What’s the strongest over the counter pain killer?

How to relive Back Pain fast
Lower back pain relief products

A recent study about the pain relieving effects of paracetamol may surprise you.

Conclusion: paracetamol is no better than placebo at speedy recovery from acute episodes of low back pain or improving pain levels, function, or quality of life, according to the first large randomized controlled trial comparing the effectiveness of paracetamol with placebo for low back pain. The findings further question the universal endorsement of paracetamol as the first choice painkiller for low back pain according to the authors.

Williams CM et al. Efficacy of paracetamol for acute low back pain: at double-blind, randomized controlled trial. The Lancet, 2014; DOI: 10. 1016

The paracetamol for low back pain study (PACE): Randomized Control Trial (RCT) of 1652 subjects with an average age of 45 years with acute low back pain from 235 primary care centers in Australia receive up to four weeks of paracetamol (aka) acetaminophen randomized into three treatment groups:

  1. Regular doses consisted of three times per day the equivalent to 3990 mg per day
  2. As needed maximum 4000 mg per day or
  3. Placebo

All subjects received advising reassurance and were followed for three months.

Results: there are no differences in the number of days to recovery found between the treatment groups.

  1. median time to recovery was 17 days in the regular paracetamol group,
  2. 17 days envy as needed paracetamol group, 
  3. 16 days in the placebo group.

Paracetamol had no effect on short-term pain levels, stability function sleep quality or the quality of life.

The number of subjects reporting adverse events was similar between the groups.

The author conducting the study suggested simple analgesics, such as paracetamol, may not be of primary importance in the management of acute low back pain. The results suggest we need to re-consider the universalparacetamol recommendation as a first-line treatment for low back pain he added that it would be interesting to see whether advice and reassurance (as provided in our trial) might be a more effective treatment than pharmacological strategies for acute episodes of low back pain.

Pain avoidance and increased muscle activation

Ready to break out of the cycle of episodic lower back pain worsened by training?

The gluteal, hamstring and quadriceps muscles are the largest muscles, which can best control the upper body. The gluteal muscles actually function more as external hip rotators than hip extensors. Gluteal muscle activation spares the back, especially when activating a hip hinge motion. 

Let me show you how to turn your exercise routine upside down.

Tread Carefully

Despite decades of spinal research, by Stuart McGill PhD, showing overwhelming evidence that spinal discs have a finite number of bending/twisting perturbations that can lead to disc injury, this information is not common knowledge.  Add a morning routine of abdominal crunches to a poorly conditioned back and you may significantly increase your risk of experiencing unnecessary disc injury.

Irrespective of what studies show, stability ball crunches may be contraindicated for some individuals. Does your trainer know in which category you belong?

A stability ball is not only effective for training the abdominal muscles, but, with correct placement, can significantly increase muscle activity when compared with traditional floor crunches. 

Ball placement is critical for matching the appropriate overload to the condition level of the user.

Spine Sparing, Load Sharing: Rehab Summit 11, 2008
Sternlicht E, Rugg S, Fiji LL, et al. Electromyographic Comparison of a Stability Ball Crunch with Traditional Crunch. Journal of Strength Conditioning Research: 2007; 21:506-9.

Understanding the viscous cycle of injury causing vertebral joint instability and vertebral joint instability causing injury.

Ohtori S, MD, PHD, et al. Pathomechanisms of discogenic low back pain in human and animal models. Journal Spine, March 20, 2014.

Hyper mobility (movement beyond the normal range of motion) is a major factor inducing discogenic (disc related) low back pain. Hypermobility is induced by loss of structural integrity, decreased hydration and an in ability of the affected vertebra and surrounding structures (vertebral motion segment) to withstand load or motion. 

Next, decreased hydration within the central disc, nucleus pulpous, results in decreased disk pressure and reduced disk height. Disc degeneration is characterized by fibrotic tears and clefts within the disc nucleus and annulus with the central nucleus pulposus eventually extruding through the tears and clefts.

Disc herniations are very painful events leading to pain avoidance behavior, increased inactivity or sitting for prolonged periods. Inactivity results in muscle atrophy and eventual fatty infiltration replacing muscle fibers.