Our ability to stand upright allows us many advantages in mobility, awareness, and other areas. Maintaining a standing posture places stress on many body parts, however, especially on our back and neck. Our posture has a significant impact on how vertebrae are aligned, and poor posture can cause debilitating, and potentially chronic, pain.
In this season premiere episode of Kentucky Health, host Dr. Wayne Tuckson welcomes a Louisville-based chiropractor to discuss the prevention and treatment of back problems and ways to maintain good back health.
Dr. Mark J. Smith operates Smith Chiropractic in Louisville. A native of the Derby City, he received his doctorate degree in chiropractic from Sherman College in Spartanburg, S.C., and has been in practice since 1994.
“A chiropractor specializes in musculoskeletal complaints,” Smith says. “I typically will evaluate a patient, and we’ll perform a physical exam. We’ll use radiology exams such as X-ray and MRI to detect musculoskeletal, typically misalignments of the spine. Once we detect those, we diagnose these musculoskeletal complaints and determine what type of treatment is effective in treating those different types of issues.”
Diagnosing and Treating Spinal Problems
Smith uses four models of vertebrae to illustrate how spinal composition can deteriorate and cause back pain. In a normal vertebral alignment, the disc positioned between each vertebra is thick and provides ample cushion, and the intervertebral foramen – an opening between each pair of vertebrae that allows spinal nerves and ligaments to pass through and out into the body – is of normal width.
In three other models, the disc is presented in successive stages of deterioration. It may lose its thickness and lead to bone spurs in the vertebrae or osteoarthritis, or it may bulge into the intervertebral foramen and cause pressure on the spinal nerves.
When the spinal nerves become compressed, a patient may feel pain in one or multiple body parts. The pain can be local or can radiate into an extremity such as a leg or an arm, “but it’s always the nerve that is impinged that is causing the pain,” Smith explains.
Smith presents a series of X-rays showing a patient with neck pain. When first examining a patient, Smith says that he looks for proper alignment of the spinal column and also symmetry in the muscles that support the spine. For patients without a chronic degenerative problem, back or neck pain often starts when a muscle becomes strained. That leads to inflammation, which compresses the spinal nerves.
Structural misalignment is another cause of pain. Smith will examine his X-rays and also conduct a physical exam to determine if the spine has shifted. Spines can shift due to repetitive motion or through injury. He will also check for scoliosis, a lateral curvature in the spine that usually occurs during the years before puberty. If the curvature is severe, Smith refers the patient to a spinal specialist.
When conducting a physical exam, Smith is looking for range of motion. “Ultimately, a chiropractor’s job is to determine that the patient is able to move like they should.”
In two video clips, Smith conducts a chiropractic exam and then treats a patient. He begins the exam by lifting the patient’s legs, flexing her knees, rotating her torso, pressing her head down, and asking her if she feels pain. After looking at X-rays, he places the patient face-down on a high-low table and checks for leg length symmetry and spinal alignment.
When treating the patient, Smith starts with 10-15 minutes of electrical muscle stimulation and heat to loosen the muscles around the spine. He then performs spinal manipulation with his hands and with an instrument called an electrical activator, which is applied to specific areas on the spine. Finally, he places the patient on her back and on top of what is called an inter-segmental traction table or “roller table.” The table has rollers underneath the padding that lift the spine up and down.
“Typically, chiropractic is going to be hands-on treatment,” Smith says. “It’s manual therapy, and we’re actually moving the patient’s spine, feeling the muscles.”
Daily Decisions That Can Prevent Back and Neck Pain
“Patients ask all the time, ‘What can I do to prevent (back pain)?” Smith says. The number one thing Smith says is, pay attention to your body. Without overdoing it, perform stretches and exercises that will increase mobility and stability or strength, “to protect you when you go out and do the things that you like to do.”
Another video clip covers some of Smith’s recommended exercises. He shows his patient how to do straight leg raises, knee bends, and torso twists to stretch leg and hip muscles. Smith advises people to work with health care providers of all types to prevent injury and promote spinal health, whether they be personal trainers, physical therapists, or chiropractors.
“Typically, we’ll send patients home with videos, with pamphlets of exercises that they can do by themselves… that will help the lumbar spine and cervical spine function better,” he says.
Smith also has advice for persons who have to sit for long hours during work each day. He recommends sitting for no more than 90 minutes at a time before taking a walking break. People with sedentary jobs should do more stretching to improve muscular length and prevent the spine from getting compressed. He also says that these persons should have a chair with strong lumbar support.
For people talking long drives, Smith touts the lumbar support function in car seats, and advises travelers to stop every two hours to get out of the car and move about. And there are also best practices to use while sleeping to ensure spinal health, he adds.
“Ultimately, a firmer mattress is good,” Smith says. “Sleeping on your back, with a pillow under your knees is ideal, with a support under your neck, that would be the ideal position. A side sleeper is going to be okay with a pillow between their knees. A stomach sleeper is going to put a lot of stress on their neck, so we don’t like to see that. But a firm mattress is often times the way to go.”
