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Rehabilitation


Don’t Let a Lifetime Be Defined by Scoliosis
Rehabilitation
Written by Clayton Stitzel. D.C. and Joshua Woggon, D.C.   
Monday, 21 February 2011 12:20

scoliosisblue2Now that genetic pre-disposition testing for scoliosis progression risk is available, An Early Stage Intervention Program has also been developed to provide scoliosis patients a non-bracing, non-surgical treatment option that allows them to take immediate action in the prevention of the next stage of the standard treatment process.

The three medically-sanctioned methods of scoliosis treatment—observation, bracing, and surgery—have been around for decades. A great deal of research has been done on the risks and benefits of each option. However, the general conclusion of this research suggests that a new paradigm is desperately needed, as there are many conflicts and inadequacies present in the current model.

Observation Only or the “Watch & Wait” Stage

Once an individual has been diagnosed with scoliosis, no treatment is initially prescribed, and no action is immediately taken, until the cobb angle has progressed to 25 degrees.  At this point, bracing is typically prescribed. This period, which is termed "watch & wait," consists only of regular visits to an orthopedic.

Spinal brace treatment (generally recommended for curvatures 25 degrees and larger)

If there ever was a time when a patient could benefit most greatly from chiropractic, therapeutic exercise, or non-surgical intervention, it would undoubtedly be during the mild stages of the disease—before the muscles and tissues of the body have been deformed by months or even years of compensating for the abnormal twisting and bending of the spine.

Bracing dates back to approximately 650 AD, when Paul of Aegina suggested bandaging scoliosis patients with wooden strips. The first metal brace was developed by Ambroise Pare in the 16th century. Today, there is a bewildering assortment of braces in use, ranging from the venerable and bulky Milwaukee brace, to the traditional TLSO braces such as the Boston and the Wilmington brace. There are "part-time" braces, designed to be worn at night: the Providence brace, and the Charleston brace. There are also "dynamic corrective braces" (SpinCor), which may use soft, elastic materials and claim to be able to do more than simply stabilize the progression of scoliosis.

This dizzying variety is further complicated by the fact that not every doctor prescribes the braces to be used in the same manner, and not every patient may follow their doctor's recommendations to the same extent. As a result, research is often conflicting in regard to the true effectiveness of bracing in scoliosis treatment. Some studies have shown very little difference between patients who wore the brace for the prescribed time.  In every case, all corrective benefit is lost very quickly once the patient stops wearing the brace.

Spinal fusion surgery (Generally recommended of curvatures 40 degrees and larger)

Those patients for whom bracing fails to prevent the progression of their scoliosis are left with only one option: surgery. Those who are confronted with this choice may be told that having a metal rod fused to their spine will not impair their daily activities, and will reduce the rib arch and improve their cosmetic appearance. However, research has consistently shown that surgery—which primarily focuses upon the sideways bending, and does little to address the rotation of the spine (and hence the rib protrusion)—will actually cause the rib arch to worsen (Chen 2002, Goldberg 2003, Hill 2002, Pratt 2001, Weatherly 1980, Wood 1991, Wood 1997).

The rate of hardware failure is virtually 100% over the course of a normal lifetime. It may occur immediately after the surgery or several years later, but one or more components of the hardware placed inside the body is highly likely to fail or break. The author of one study stated, "One would expect that, if the patient lives long enough, rod breakage will be a virtual certainty". Another study found that, amongst seventy-four patients who underwent the surgery, failed fusion occurred in 27% of patients within a few years after the procedure.

The truth of the matter is that scoliosis is an abnormality of the spine which involves much more than merely a sideways curve. Yet the "effectiveness" of surgery is measured only by the degree to which it can reduce the lateral deviation through the application of brute force, and a fused spine is every bit as abnormal and dysfunctional as a scoliotic spine.

We can alter the natural course of this disease by identifying which patients are at the highest risk for severe progression via genetic testing (Scoliscore) and by implementing an aggressive, non-invasive Early Stage Scoliosis Intervention program that re-trains the brain’s involuntary postural controls centers before the spinal curvature reaches the 30 degree "buckling" point.

 

Dr Stitzel graduated from Palmer College of Chiropractic in 2002. Dr Stitzel practices in Lititz,PA and specializes in scoliosis rehabilitation. Dr Stitzel is a former director of the CLEAR-Institute and lectures both nationally and internationally on the topic of scoliosis rehabilitation.

Dr. A. Joshua Woggon, a 2010 Graduate of Parker College, is the Clinic Director  of the CLEAR Scoliosis Treatment and Research Clinic on the campus of Parker College of Chiropractic in Dallas, Texas (www.clearscoliosisclinic.com), and the Director of Research for CLEAR Institute, a Non-Profit Organization dedicated to advancing chiropractic scoliosis correction (www.clear-institute.org).  He can be contacted at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .


 
Oh, Baby, My Back Hurts
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Rehabilitation
Written by Dr. Joe Ventura   
Monday, 21 February 2011 00:00

As if the prospect of morning sickness, constipation, rashes and changes in hormone and wardrobe weren’t daunting enough, 80% of pregnant women will develop back pain and almost 100% will develop poor posture. The pain can last up to three months past the delivery date. Typically pain is experienced in the following areas:pregnantbelly

  • Hip Joints
  • Low Back
  • Mid-back
  • Neck
  • Shoulders
  • TMJ or Jaw joint

Unfortunately, the poor posture can become permanent.

It’s easy to see why. First there are the hormone changes that help relax ligaments and joints throughout the body. Next is the extra weight. Here is a breakdown of weight gain for a woman of normal weight.pregnancychart

The Body’s Balance System

The human body has a magnificent system of adapting to keep us upright under many different conditions. This “Balance Control System” is comprised of two parts; Sensory (Where am I) and Motor (What am I going to do). But this adaptation comes at a price. As the extra 25 or so pounds are added to the woman’s general mid-line area, the initial reaction is for the Center of Gravity and Center of Mass to shift forward. However, the body’s Balance Control System kicks in and begins a slow but steady realignment of the pelvis, spine, head and shoulders to act as a counter-balance for the extra weight of pregnancy. Eventually the Center of Gravity shifts backward. This short term solution can have long lasting consequences.

The spinal changes are very predictable.

  1. Pelvis tilts forward
  2. Mid back drifts backward
  3. Head/Neck assume a position in front of the shoulders (know as Forward Head Posture)

How This Affects the Spinepregnancyskeleton

The natural “S” shape curve of the spine is created from the attachment of muscles and ligaments. Any changes in the curves of the spine will cause some muscles to stretch
and some muscles to shorten, both situations contributing to instability in the spine. This instability leads to chronic tension in certain muscle groups and increased strain on joints.

The study of Physiology tells us that a muscle kept in a stretched position will eventually elongate its fibers and become weak (Stretch Weakness). Conversely, a muscle held in an over-relaxed position will shorten its fibers and also become weak (Short Weakness). Because the postural changes are so predictable, it is clearly understood which muscle groups are involved and whether they have become stretched or shortened. Unfortunately  after delivery and the loss of the extra weight normally gained during pregnancy, the mother’s posture does not “snap” back into place. The stretched and shortened muscles stay that way until there is an intervention. That Intervention is known as Posture Reprogramming™.

The Shear Truth

pregnancyspineAs if all this wasn’t enough, other forces come into play to create a low back that is less stable and more prone to create chronic pain and discomfort. Shear forces to be exact. In a person with normal posture, downward Gravitational and directional shear forces work with the body to “lock” joints into position under load, thereby providing strength and stability to the spine. In a pregnancy posture, the Gravitational forces remain essentially the same, but the shear forces change direction in such a way as to open the low back joints, providing less stability in the spine. The body’s exquisite feedback system senses this and the muscles in the low back become tighter in an effort to take up the slack.

First the bad news: Poor posture is NOT self-correcting.

Now the good news: Poor posture can be corrected in as little as four weeks!

Identifying Poor Posture Through the Use of the Posture Numberpregnancytop

Correcting posture begins with a simple non-invasive digital analysis to establish the patient’s Posture Numbertm. This number is used to identify and quantify the extent of the poor posture, and provide guidelines for the cost of posture reprogramming.

Next a series of gentle spinal mobilization sessions will be started and a set of custom stretches and exercises will be assigned. A special therapeutic cushion may be prescribed. These protocols are designed to reverse spinal muscle changes and reprogram muscles back to their original positions. This process takes about four weeks. 

About the Posture Reprogramming Stretches and Exercises

Because the pelvic and spinal changes are so predictable, it is possible to map which muscles will undergo “Stretch Weakness” and pregnancymiddlewhich will exhibit “Short Weakness”. With that knowledge, a Posture Reprogramming professional can create an exercise program to strengthen the muscles that have become stretched, and a stretching program for the muscles that have become shotened.

In addition to these maneuvers, a new therapeutic cushion that helps reduce  the effects of Forward Head Posture may be recommended. It’s called Posture Blocks™ (Patent Pending).

Gravity Works Against You All Day Long. Now, Make It Work For You!

The special contours and foam density of the Posture Blocks cushion causes the person’s body weight, along with the pull of Gravity, to stretch muscles that need to be stretched and relax muscles that need to be relaxed. Imagine an exercise program that works simply by doing no more than lying on the floor!

Here are some of the innovative features:pregnancybottom

  • Adjustable Headrest allows the head to assume a neutral or slightly backward position simultaneously stretching the muscles in the front of the neck and relaxing the muscles in back.
  • The soft neck bridge encourages a normal curve in the neck.
  • Special cut-out encourages external rotation of the shoulders.
  • The upper back bridge exerts a gentle forward force that relaxes the back and expands the chest area.
  • The upper back bridge has a gentle decline to the low back area.

The special features of the Posture Blocks cushion are so unique the company was awarded a Patent Pending designation by the USPTO. 

Reimbursement for Posture Reprogramming

Although there is an ICD-10 code for Abnormal Posture  (R29.3), third-party reimbursement for abnormal posture is rare and is generally considered an out of network service, Most insurance companies will allow its use as a compound or complicating code. This essentially means that Posture Reprogramming is a cash based service. The fee is based on the results of the posture exam. The Posture Pro software will generate a Posture Number™, which is the accumulation of deviations from normal. The general fee guideline is $50 for every Posture Number unit of deviation. For the average patient that would be in the $500-$1,000 range for the Posture Reprogramming.

Using the Posture Reprogramming System a doctor of chiropractic can market this service directly to pregnant patients or to local OB/GYN clinics.

Conclusion

Back pain and postural changes from pregnancy are both inevitable and manageable. If started early, a prescribed exercise and stretching program can help reverse muscle changes and improve posture during and after the pregnancy. A new therapeutic cushion, the Posture Blocks, shows great promise in helping with this universal problem.

 

Joseph Ventura D.C. is owner of VenturaDesigns, a 32 year company that develops software and marketing strategies for the chiropractic profession. Dr. Ventura can be reached at (888) 713-2093 or at This e-mail address is being protected from spambots. You need JavaScript enabled to view it


 
Posture Reprogramming and Athletic Performance
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Rehabilitation
Written by Dr. Joe Ventura   
Monday, 24 January 2011 17:28


T
o coax the most out of the human body during training or actual performance, there are certain principles, or building blocks that must be present. Good breathing, proper nutrition, hydration and intensity are just a few of these principles. But, at the top of the list is good posture.

Proper posture extends performance, reduces injury, speeds healing, builds more muscle and increases efficiency. Good posture also releases more energy to the primary muscles of the task at hand by not having to engage “secondary” postural muscles.

posturereprogramming

What is Good Posture?

For the purpose of this article, the focus will be on postural alignment from the side. Normal, neutral posture is present when a plumb line passes through five anatomical landmarks: Center of the ear, center of the shoulder, greater trochanter, center of the knee and just in front of the ankle.

This is illustrated in the picture on the left. Notice how straight the black plumb line is.

posturereprogramminghamstringsThe most common abnormal posture profile is illustrated on the right. The head sits forward of the shoulders, the upper back has drifted backward and the pelvis has tipped forward. This is commonly known as Forward Head Posture (FHP). Notice the straight plumb line we expect to see in good posture now has a substantial curve in FHP. It’s been estimated that 80% of the general population has varying degrees of FHP.

Why Forward Head

Posture Is Detrimental to Athletic Performance

First and foremost, FHP places an abnormal stress on every core muscle. For example, in FHP the pelvis tips forward, causing the hamstrings in back to stretch and pre-load. This tilting also causes the Quads in front to shorten and become weak. Here’s an illustration of that.

The hamstring muscles attach to the bottom of the pelvis, the ischial tuberosity. The Quads attach to the front of the pelvis.

When the pelvis tilts forward in Forward Head Posture, it causes the hamstrings to stretch and the quads to shorten. Physiology of the body tells us that a muscle that is stretched and held in that position for a long period of time becomes weak (Stretch Weakness). Conversely, a muscle that is shortened and held in that position also becomes weak (Short Weakness). Having these two things happen to antagonistic muscle groups is quite detrimental to performance.

If one only focused on the effects of FHP on the hamstrings and quads, the need to identify FHP in the athlete becomes apparent.  However, due to compensatory changes in the spine and other areas, these kinds of muscle changes occur up the entire kinetic chain, causing compromises in the integrity of the low back, changes in breathing, changes in shoulder positioning, range of motion deficiencies, and instability of the neck motor unit.  As far as the professional athlete and weekend warrior is concerned, there is nothing good about bad posture.posturereprogrammingrehab

The Posture Reprogramming SystemTM

Forward Head Posture can be corrected. Recognizing FHP is the first step in correction.  While a quick visual check to see if the head is resting over or in front of the shoulder can provide a visual clue of the presence of FHP, it cannot quantify the full extent of the problem and it can’t be used to track progress. To do that, you need a method of capturing and measuring posture. The Posture Reprogramming SystemTM developed by the author utilizes a software program called Posture ProTM to analyze static posture and to track progress over time.  By capturing digital images of static posture and using the Posture Pro software to plot screen coordinates that represent anatomical landmarks known to be either level or plumb in neutral posture, the operator can establish baseline posture. Future exams can then track progress by comparing to the baseline values. Posture Pro has several methods of tracking progress.  One of the most effective methods is to create a plot graph of all the exams.

Yes, You Can Change Posture in as Little as Four Weeks

The author has found the profession’s biggest hesitation to focus on posture is the lack of posture correction education, either in or out of school.  For the past ten years, thousands of doctors of chiropractic around the world have been changing posture using a three-fold approach.  First, is spinal mobilization. This is a general spinal manipulation of the spine and pelvis to ensure joint mobility in advance of the changes about to happen in the muscles.  Second is the patient performing a specific set of exercises and stretches to target the muscles involved in FHP. These maneuvers were developed by John Christman, Ph.D., and refined by the author. The third protocol is the prescription of a set of Posture BlocksTM (Patent Pending). These foam cushion shapes are designed to use the weight of the body, the pull of Gravity and the resistance of the foam to stretch and relax different areas of the FHP target area.  Using spinal mobilization techniques, specific muscle stretches and exercises and utilizing a special therapeutic cushion at home, the muscles attached to the pelvis, shoulders, spine and head can be reprogrammed back to their original neutral positions. In a healthy, motivated person, this can mean a return to neutral posture in about four weeks.

Reimbursement for Posture Reprogramming

Although there is an ICD-10 code for Abnormal Posture (R29.3), third-party reimbursement for abnormal posture is rare and is generally considered an out of network service. Most insurance companies will allow its use as a compound or complicating code. This essentially means that Posture Reprogramming is a cash-based service. The fee is based on the results of the posture exam. The Posture Pro software will generate a Posture NumberTM, which is the accumulation of deviations from normal. The general fee guideline is $50 for every Posture Number unit of deviation. For the average patient, that would be in the $500-$1,000 range for the Posture Reprogramming.

Using the Posture Reprogramming System, a doctor of chiropractic can market this service to health clubs and high school, college or professional sports departments, as well as private athletes, as a method of performance screening and enhancement.

 

Joseph Ventura D.C. is the owner of VenturaDesigns a private company specializing in Chiropractic Consulting services and software development, He is the developer of the Posture Reprogramming System, His full bio can be found at www.posturepro.com/bio2.htm. He can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it


 
High School Athletes - The new injury prevention plan
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Rehabilitation
Written by Tim Maggs, D.C.   
Monday, 24 January 2011 17:24

athletesstructuralfingerprint32 years ago, when just starting in practice, I contacted our local high school football coach and offered my services to his team.  A couple times a week I would work on any players who asked for help.  As great as the job seemed, it was short lived.  As soon as the school physician got wind of my involvement, I was introduced to the politics of sports.  The athletic director informed me I was not to come onto the campus again.

So, my simple goal was to get back onto campus, and through the front door this time, not some side door where no one knew I was there.  Along the way, I’ve learned a lot.   We live with a broken sporstmedicine system, and this age group is all but ignored.

 

Here’s the deal:

Just about all healthcare decisions are based upon health insurance guidelines. Most high school athlete’s care will depend upon what their insurance covers.  So, they have to be injured before they can do anything.  Anyone in the healthcare delivery industry knows that health insurance coverage is shrinking at a severe rate (increased co-pays and deductibles with decreased coverage) and, unfortunately, the care of high school athletes is jammed underneath this broken healthcare system umbrella.  Athletes, especially middle and high school athletes, have needs that are much different and far greater than the needs of the general population.  These needs are ignored.

All middle and high school athletes receive a physical prior to the season beginning, but the majority of this examination is a medical exam, i.e., eyes, ears, nose and throat.  Yes, these tests are needed, but the biomechanical exam, which checks the muscular, neurological and skeletal systems, is absent.  The examiner will perform a scoliosis screening.  (This is like saying the absence of terminal cancer means you’re healthy).  As in, there’s a lot more to biomechanics than a scoliosis screening.

We live in a reactive healthcare system dictated by economics.  These kids are never looked at until they’re hurt.  Secondly, our front line docs (primaries) are not trained in biomechanics, therefore, are not qualified to accurately diagnose or treat these injuries.  The “System” then kicks into a costly referral system, going from the primary to the orthopedist to the physical therapist or chiropractor, and the treatment goal is to get rid of the pain/injury.  No biomechanics involved.

The New York Giants and Chicago Bulls used a conditioning pyramid, with the base of that pyramid containing 6 categories; aerobic capacity, body composition, joint mobility, strength endurance, core strength and aerobic capacity.  These professional athletes needed to pass tests in all 6 categories before they could enter the weight room.  In almost every high school in this country, kids begin aggressively working out with weights with questionable supervision and absolutely no biomechanical evaluations.  This egregious omission WILL produce devastating long term detrimental effects.

injuredathleteWhen an athlete becomes injured, the goal is to reduce the symptoms, but never correct the underlying problem.  Fig. 1 shows an example of the biomechanical imbalances that exist in all of us, and it is these imbalances that lead to the majority of injuries in athletes.  These imbalances originate in the feet (our foundation) and if this imbalance is not addressed, we have a limited potential in balancing the rest of the structure.

We’re sitting on a ticking time bomb.  Many of these kids suffer with low level injuries that don’t meet the criteria for taking action.  But, all of these kids have mild to extreme biomechanical faults, and our current sportsmedicine system prefers to perform joint replacements and prescribe a lifetime of pharmaceuticals later rather than address the issues now.

 

Possible solutions

Chiropractors and Physical Therapists—You’re the biomechanical providers out there, so you need to step up.  The first step is to get to the schools and educate the families and coaches.  Then offer your services for a complete biomechanical exam for all athletes, not just those injured.  This should take place before the season begins.  A biomechanical exam can be found at www.StructuralManagement.com.  Prescribe flexible custom orthotics as a first step in balancing their biomechanics.

Family Drs.—Admit this isn’t your specialty, and work with the families to find a chiropractor or physical therapist who will help with the biomechanical needs of the athlete.

Athletic Directors—Realize you are the lynchpin to all parents and athletes in your school district.  Your role is critical.  Work with those who are capable of providing more biomechanical information to this group.  Don’t settle for that age old response, “We’ve done fine without this so why do we need it now”.

Coaches—You’re the ones who have the most contact with these athletes.  Teach them about prevention and the importance of being disciplined in taking care of themselves.  Help to build the bridge between families and biomechanical providers in your communities.  Small injuries are warning signals.  Please don’t promote the “No Pain, No Gain” mantra.  Realize that pain is a warning signal for underlying biomechanical imbalances.

Parents—Don’t stop until you find someone who will perform a biomechanical exam on your child.  It will help detect the predictable sights of injuries, and will uncover the reasons why chronic injuries persist.  And, encourage corrective recommendations.

Other than that, have a great month.

 

Dr. Maggs currently practices full time, while also lecturing for Foot Levelers. He is the developer of The Structural Management Program, as well as the 10 Week Webinar Series, "How to Build Your High School Athlete Practice".  He can be reached at 1-518-393-6566 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it . His website is www.StructuralManagement.com

 
Back Injuries in the Young Athlete
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Rehabilitation
Written by Kirk Lee, D.C.   
Monday, 24 January 2011 00:00

hurtathlete

B
ack injuries in adolescents are not very common, but add participation in athletics and you increase the opportunity of experiencing some form of low back pain. According to Micheli, back injuries of young athletes are a significant phenomenon, estimated to occur in 10 to 15 percent of participants1. The prevalence will vary, based on certain sports. In sports like gymnastics back injuries are 11 percent whereas, in football linemen, it has been recorded as high as 50 percent2.

Back injuries can occur from single episodes of blunt trauma -—like being pushed or hit in the back-— to repetitive microtrauma (overuse) from activities of repetitive lumbar extension from practicing sports like gymnastics and diving. Commonly seen back-related injuries in adolescents can result in fractures, which usually are not associated with the severity of a cervical spine fracture that can lead to catastrophic spinal cord injuries. Acute disc herniation, contusions, sprains, strains, spondylolysis and spondylolisthesis, facet syndromes and lordotic low back pain are common. Injuries associated with flexion can be both Atypical and Typical Scheuermann’s Kyphosis, compression or end plate fractures. All of these mechanisms will result in and contribute to vertebral subluxation complexes.

All of these mechanisms will result in and contribute to vertebral subluxation complexes.

I would like to focus on just one of the above-mentioned conditions due to it being commonly missed diagnostically. This is “lordotic low back pain.” As doctors of chiropractic, we commonly see adolescents in our office with low back pain that ranges from many causes, and often the patient or parent cannot give a mechanism of injury. One of the most important consideration factors when treating an adolescent is to first determine if they are going through a growth spurt.

Let us look at Elyse, a 12-year-old female gymnast who enters our office with low back pain. Elyse complains of lower back pain which she describes as being on and off for several weeks in duration. The severity ranges from a 0 to a 10 on a pain scale and can change for no related reason. Today, the pain is at a 10, which is why the appointment was made. History indicates Elyse is an active gymnast who practices four days a week, averaging about two hours per practice. Some days the pain restricts her practice time. She describes that location of the pain varies from along the tops of both hip bones (crest of the ilium) to the middle of her low back. Both mother and Elyse deny any recent fall or trauma in the last six months.

Examination shows a normal 12-year-old in height and weight. She can heel-toe walk normally. Balance and coordination appear normal. Ranges of motion demonstrates full ranges of all extremities, cervical spine, and dorsolumbar spine with exception of pain on dorsolumbar extension and restricted flexion that was less painful. Palpation notes symmetrical tightness of the lumbar musculature with no spasms. Palpation of the iliac crest and especially the lumbar spinous process bring about a response of soreness.

Based on our examination findings, we determine the need for lumbar radiographs. The AP view shows a nice straight spine with no rotation. It also shows normal height and formation of the vertebrae with no wedging. Iliac crest and femoral heads all are equal in comparison. Open growth places are noted along the iliac crest and pelvis. The lateral view also shows normal vertebral heights and disc heights. No evidence of degeneration, fracture or other pathology. With additional viewing of the lateral film, we note a slight hyperlordosis of the lumbar spine with no interruption of George’s line.

I am sure I am not the only DC who has looked at an X-ray and found very little of anything structurally wrong on the films. You then question yourself as to how you are going to explain to the parents and child why they are experiencing such pain. It’s easy when we can reference a scoliosis, or point out disc wedging caused by misaligned vertebrae, rotated spinous processes, and phases of disc degeneration. But what are we going to tell the parents and child now as to why Elyse is having low back pain and why she needs chiropractic care? What are we going to adjust? Yes, chiropractic care should be part of everyone’s health program, but we have a child in pain that is looking for answers to why she hurts.

This is why this condition is commonly misdiagnosed. The key diagnostic signs here are the areas of pain, restricted flexion and extension ranges of motion, and the only radiographic finding is the hyperlordosis of the lumbar spine. Above all, the key sign is her age, because she is going through a growth spurt!

This is a time that the spine and its supporting tissues are usually very elastic and pliable.

In this case, as the lumbar vertebrae are growing, the thoracolumbar fascia is not stretching at the same rate. This phenomenon is what causes the hyperlordosis of the lumbar spine. The fascia is so strong and isn’t expanding, so the growing lumbar vertebrae have no place to go but forward, causing the increased hyperflexion. Considering the anatomy of the fascia and where it originates from across the iliac crest, the body is actually causing a tractioning on the apophysis. The low back pain can be caused from the lumbar spinous processes being jammed upon each other.

Commonly, when we adjust this patient, the lumbar spine is very tight and you will usually not get any movement of the spine. The patient may tell you it was very painful when the lower back was adjusted. I am sure as we described this episode, many of you were able to recall patients of this age that you encountered with the same scenario, and often we lose this patient because he or she gets discouraged because the episodes of pain are so sporadic. More commonly than not, on the days the pain is worse, they are going through a growth spurt.

This patient is truly a chiropractic patient. We must be able to educate the patient and parents on what is actually happening during the child’s development. This is a time that the spine and its supporting tissues are usually very elastic and pliable. Therefore, monitoring structural alignment during these episodes of growth is essential to maintain good spinal development and prevent possible structural problems from developing in the future. Additional considerations you could recommend to help with pain are stretching and use of an anti-lordotic brace.

A 1980 graduate of Palmer College of Chiropractic, Dr. Kirk Lee is a member of the Palmer College of Chiropractic Post Graduate Faculty and Parker College of Chiropractic Post Graduate Faculty. He has lectured nationwide on sports injuries and the adolescent athlete, and currently practices in Albion, Michigan.

References:

1. Micheli, LJ. “Back Pain in Young Athletes.” Arch Pediatr Adolesc Med 149:15-18, 1995.

2. Mundy, DJ. “Epidemiologic study of sports and weight lifting as possible risk factors for herniated lumbar and cervical disc.” Am J Sports Med 21:854-860, 1993.


 
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