Custom-Made Foot Orthotics For Back Pain

Custom-made foot orthotics are becoming very popular these days. Generic over the counter shoe inserts are available at every drug store and pharmacy and it's hard to go a day without watching a television infomercial claiming instant relief through the mail. Custom-made foot orthotics can be purchased from podiatrists, orthopedic doctors, physical therapists, and chiropractors. These inserts, when made correctly, can help with a wide variety of foot issues including plantar fasciitis, heel spurs, metatarsalgia, and neuromas. The correct foot support can help patients who deal with chronic ankle sprains, hammer toes, bunions, and corns. But most people do not realize that foot orthotics can be extremely effective in treating issues above the foot ankle including shin splints, knee pain, hip pain, and yes, even chronic low back pain. Chiropractors especially, stand behind the concept that correcting the alignment and biomechanics of the foot can directly relieve stress and pain from the above skeleton.

In order to fully understand the relationship between the feet and the rest of the body you must first understand the role of the foot and its place in the human skeleton. Each foot is equipped with 3 arches that help it work properly. The arches consist of 2 arches that run long wise down the feet which are called the medial and lateral longitudinal arches and one transverse arch that travels across the ball of the foot. The arches have many purposes but for the sake of this article the most important task is to aid in weight bearing by offering shock absorption for the weight of the body. The arches help to balance the body when standing and walking. The arches have an elastic property which allows the foot to flatten out after foot strike and return to its original shape when weight is taken off.

Because of the fact that we are biped and unfortunately spend most of our waking day on our feet, the feet are the foundation of our body. And over time these arches can begin to flatten and lose its elasticity. Now if this happened symmetrically to both feet it would not be as much of an issue but for one reason or another feet tend to flatten more on one side than the other. This leaves us standing crooked. If the foundation of the body is not properly aligned and supported then the integrity of the structures above are in jeopardy. Good thing for us, our bodies have an innate intelligence that will tighten muscles, rotate joints, and curve our spines in order to level us out. And it is this undetected process that leads to knee pain, hip pain, low back pain, and in some case even scoliosis. To better understand this concept the analogy of a skyscraper can be useful. If we were to gradually raise up the foundation of the Sears Tower on one side of the building it would affect the structure as a whole. Initially the structures would begin to lean to the opposite side but eventually the beams and supports would curve back to hold it from falling over. This would put compressive forces on the concave side of the supports and stretching forces on the convex side. If we were some how able to raise the foundation enough on one side we would start to see tearing and destruction throughout the lower part of the building and eventually the building would collapse.

The biomechanics of this process in the foot is referred to as pronation which is a fancy term for the flattening of the foot. As the arches fall over the years it causes the foot to flatten. This flattening can cause plantar fasciitis, heel spurs, neuromas, and ankle injuries. When the foot flattens it sets off a kinetic chain through the leg and the low back. First as the foot flattens it causes the tibia in the lower leg to rotate. This rotation can lead to shin splints, stress fractures of the tibia, and puts rotational stress on the knee which can cause ligament tears, arthritis, and generalized knee pain. The next step up the kinetic chain is the drop in the hip and an inferior tilt to the sacrum on side of foot pronation. This can cause hip arthritis, bursitis, and tendinitis and most common of all, low back pain. The sacrum is the base of the spine so when it leans to one side it causes the spine to lean just as in the skyscraper analogy. This puts stress and pressure on the spine and can lead to disc injuries, spinal arthritis, sciatica, and generalized low back pain. In severe chronic cases it can even lead to a curving of the spine called scoliosis. We can have all these issues because of improper alignment of the feet.

Here is where custom-made foot orthotics comes to the rescue. Using a casting or molding system your doctor can make an orthotic insert that properly supports your feet in an even and balanced position that relieves stress off the ankles, knees, hips, and low back. Over the counter insert can provide some support and some cushioning but just remember, these same inserts are used for people of all different shapes, sizes, ages, and injuries. Your health care professional is trained to know what type of orthotic is needed for your specific case and condition.

Discogenic Low Back Pain - Symptoms, Treatment & Pain Relief Options

How is your lower back doing lately?

Do you suffer from discogenic low back pain, or want to know more about it?

1.) Introduction

Lower back pain is not as uncommon as one may think. Ninety percent of the adult population has experienced back pain in their life. Every year, fifty percent of the work force in the United States complains about back discomfort on some level. Lumbar discomfort can result from spinal stenosis, disc herniation or lumbar sprain, for example. It can also be caused by a degenerative condition such as discogenic low back problems. Discogenic refers to having one or more intervertebral discs as the source of the pain.

2.) Discogenic Low Back Pain Symptoms

Discogenic low back pain can simply be pointed to aging. During our body's aging process, several changes will occur. For example, our skin will continue to lose its elasticity, or our hair will turn gray. Aging also affects our spine, especially the intervertebral discs. During the first stage of intervertebral disc degeneration, one may not feel symptoms, and severe pain is usually absent. However, as the degenerative process continues, that is the time one will experience low back discomfort.

There are activities and involuntary movements that trigger the pressure on intervertebral disc such as bending forward, sitting, sneezing and coughing. These activities can elevate the pain on people suffering from discogenic low back pain. Radiculopathy, which can include leg pain that resulted by applying pressure on the nerves of one's lower back, is also associated with discogenic low back pain.

In diagnosing if one has a discogenic ailments, a physician may do a discography, which is a procedure wherein discs that are thought to be the cause are injected with a contrast dye to be seen under fluoroscopy. This procedure will allow the physician to assess the discs by knowing their shape and size. Similarly, the injection of contrast dye may reveal the pain pattern of the sufferer that will help pinpoint which disc is the source of the pain.

3.) Non-Surgical Treatment for Discogenic Low Back Pain

It is important to emphasize that surgery is not the only option in treating discogenic low back pain. Non-surgical treatments that are heralded by many doctors as effective are available.

One of non-surgical treatments available is physical therapy. This includes transcutaneous nerve stimulation (TENS), ultrasound and forms of massage are used in combination to relieve pain. Strengthening exercises for the lower back and abdominal muscles and stretching are applied in physical therapy.

4.) Back Support & Its Benefits

Back braces have been found to be effective tools in relieving pain and aiding the recovery of a low back pain sufferer. Back braces help alleviate the pain in the back area significantly and this should not be over looked. Many patients who have used back braces have seen a huge improvement in their situation. These supports can also foster proper posture to help speed up the recovery. Lumbar back supports are known to restrict certain movements that will further cause pain in your back. What is great about back braces is that they are created to give support directed to the lumbarsacral spine to help relieve the pressure off the lower back. Many physicians will also recommend them to the patient that have discogenic back pain. If you are interested in this alternative treatment and support, it is important to choose a back brace that is light and hardly noticeable when worn under a t-shirt then this conservative treatment option can really help you.

*This is health information. We obviously believe in the use of a well designed back supports, and our experience is positive with them. However, it is best to talk to your doctor about medical advice pertaining to your particular situation.

Stomach and Lower Back Pain - Is There A Connection?

Can stomach pain and back pain be related? The answer is it depends. Recently a friend contacted me about having both stomach and back pain. Because of my own experience he was asking for my advice. The first bit of advice I gave him was that stomach and back pain could be serious and to call his doctor immediately.

Obviously I am no doctor and I avoid trying to diagnosis someone's medical problem. However when someone is complaining of pain in both the stomach and back chances are it is more than just a strained back muscle. Usually what is happening is that the stomach problem is radiating to the back making then person believe he has a problem in both areas when it's probably originated in the stomach or pelvic area.

So what are some of the causes of stomach pain? Well they can be different for men and women. Women are more prone to pain in both areas. Pregnancy and or menstruation are two causes of stomach pain in women. Pelvic inflammatory disease is another. Men also have some medical conditions that are unique to them. One of them is an inflammation of the prostate called Acute Prostatitis. This can cause pain in the stomach and lower back. Seminal Vesiculitis is another condition related to the prostate. This condition is the inflammation and degeneration of the seminal vesicles.

Common to both men and women are the following:

Kidney Stones: Boy if you have had them you know how painful they can be and how that pain spreads through your lower back.

Acute Pancreatitis: Your pancreas is a large gland located behind the stomach. It's job is to secrete digestive enzymes into the small intestine. When the pancreas becomes inflamed this is known as Pancreatitis.

Abdominal Aortic Aneurysm: Is a swelling of the Abdominal Aorta. Most of the time this occurs at or below the kidneys so you can see how this would affect the back and or stomach.

All these conditions are very serious and require urgent medical care. In my friend's case he had Acute Prostatitis and is receiving treatment which has eased his back pain by treating the prostrate. So what my friend thought was pain caused by muscle pull after a weekend of tennis turned out to be much more serious. Fortunately he did not delay in seeing his doctor. The lesson here is sometimes what you think is a back pain can be an infection in the pelvic area that radiates to the back. There obviously is a connection between stomach pain and back pain, but it is one that must not be ignored. So if you are having discomfort in both the back and stomach area chances are it is pretty serious and needs a doctor's attention as soon as possible.

Middle Back Pain - Causes, Treatment And Prevention

Middle back pain is something that is common to many men and women around the world. Both young and old suffer from middle back discomfort thanks to the variety of hobbies and sports they take part in and the work tasks that they must perform every day. The good thing about middle back dis-ease relief is that the solution to your problems is fairly easy.

12 vertebra form the middle back, also known as the thoracic (mid back) section of your spine. There is cartilage between the different vertebra, which are designed to protect the sensitive spinal cord that runs from your brain down to the rest of your body.

Causes
Wear and tear on the discs and cartilage can be among the causes of mid back pain as well as injury or actual medical issues such as degenerative disc disease, fibromyalgia, osteoporosis, rheumatoid arthritis, sciatica, scoliosis and quite a few other disorders.

This list is not meant to scare you, it is just meant to drive home the point that there are a lot of causes of middle back problems and you should see a physician for a diagnosis before undertaking any sort of treatments for severe back pain relief. This way, you can be sure that your therapy is working to help your mid back pain issues and not making them worse.

If your mid back pain causes are muscular in nature and not a problem with your discs or cartilage, a daily regimen of middle back pain exercises can stretch and strengthen your muscles enough to avoid injury.

Middle back injury can often be caused by a sudden motion of the back that twists one of the vertebra out of place. This out of place vertebra pinches the spinal cord and sends pain signals up the nerve to register in your brain.

One of the most frequent causes of middle back injury is simply bending or twisting to reach something. If you do it at the wrong angle, you'll feel a sudden pain in your middle back. It's surprising how severe this pain can be!

When this kind of back problem happens, you are often feeling a pinched nerve. The muscles then swell up to protect the vertebra around them.

The swelling of the muscle is the most common type of back pain, and many people who exercise and work out a lot find themselves suffering from thoracic (mid back) pain. The pain can range from a mild ache in the muscles to a pinched nerve to an acute, chronic pain that is very disconcerting.

Another common cause of is a herniated disk, and this type of back pain is also very common. The herniated disc is a disc that is overworked to the point that a bulge forms between the discs in the spine. This can be very painful, as the bulge pushes the vertebra against the spinal cord.

Those with poor posture often suffer from middle back pain, as the poor posture of their body pulls and puts strain on the already tired back muscles. When you have bad posture, you are causing your middle back to work overly hard and you can cause serious back pain. this is a time when back exercises will strengthen your muscles and help you maintain a better posture.

Arthritis is another cause of middle back pain, though that is mainly for people that are advancing in years. Younger men and women CAN suffer from arthritis in their spinal cord, though it is far less common than arthritis in older people.

The good news is that for the most part, medical treatments won't require surgery and don't need to be long, drawn out affairs. Often doing something as simple as taking an over-the-counter anti inflammatory back pain medications such as ibuprofen or acetaminophen - and rest - is all that is necessary to restore your upper and middle back to it's original, healthy state.

Treatment
Rest is usually the first thing prescribed by doctors and therapists treat your center back injury. Since the most frequent cause is tired, inflamed muscles, the best solution is to rest and allow the muscles to recuperate from their exertions.

If you are trying to avoid or recover from middle back injury, it is important that you rest and not do anything that would irritate the already tired muscles. No lifting, carrying, bending or twisting. Remember, a pain warning is your body's way of telling you to stop doing something.

Prevention
Then, start a long term back stretching and strengthening exercise program. A few minutes a day is all it takes and it'll help not only your mid back but your upper and lower back areas as well.

It is important to take care of your back if you feel middle back pain, and you need to do your part to ensure that your back has time to return to normal health by resting and letting the muscles recover from their exertions.

Yoga Causes Back Pain

It is a well known fact that Yoga is good for you, that it makes your joints more supple, increases muscle strength and is ideal for back pain sufferers. Or is it?

Many people, myself included, have tried some of the many yoga DVDs and books, hoping for some relief from back pain, only to discover that far from fixing the problem, yoga exacerbates it. Why should this be? Surely something that is purported to be so good for me should not be causing pain? I started to wonder if I was doing something wrong, not following instructions properly, and that somehow it was my fault. but have now discovered that yoga can indeed worsen certain back conditions. This was not the case, however, I was not doing anything wrong, the exercises were unsuitable and should really have come with a health warning.

Many reputable yoga teachers and practitioners of course, do issue a warning that unilateral movements can stress the sacroiliac joint. Poses such as the tree pose and warrior 3 where need you to balance on one leg are not recommended. Deep standing yoga poses also stress the sacroiliac joint. This is the joint that connects the spinal column with the pelvis. It is a joint that has little movement but can be affected by arthritis. Lower back pain is often caused by strain or inflammation of this joint and many yoga poses can either cause or exacerbate these problems.

A very popular yoga method - Ashtanga yoga - is practised by many of us who are too busy for the slower, more contemplative practises. It is vigorous and athletic and has a fast pace of movements and many yoga classes and DVDs now use the Ashtanga yoga method. I would strongly advise you to approach it with great care and stop immediately if you notice any pain or strain whilst doing the asanas. This was the method that hurt my back the most, with pain both in the waist and pelvic area.

The best sort of yoga is the more traditional gentle and slow yoga movements. These do not involve quick changes and you will find it easier to judge if the movements are doing you good or causing you pain before it is too late.

If you like the idea of yoga exercises and feel that they would suit you, then the best approach would be to do a very limited number of the easiest positions for a very short space of time - 5-10 minutes is preferable - then wait 24 hours to see how you feel. It is possible that you may have some minor muscle stiffness if you do not usually practice yoga, but it should not be anything more than this. Any pain or worsening of your back pain or any new pain means you should stop immediately. If yoga does not work for you then it doesn't work - it is as simple as that. Find something else like Pilates or swimming. Do not feel that you are missing out, there is the perfect exercise regime out there somewhere for you.

Do I still practice yoga? The answer is no. I have found my own methods of back health and although friends sometimes urge me to give it another go, I always decline. I go caving and walking and riding too, but would not risk damaging my back again practicing yoga.

Yoga, in my opinion, is for people without any back problems. It can prevent injury, but it will not cure it.

The Lumbar Multifidus Muscle & Chronic Low Back Pain

It is well known that within the general population, 60-80% of individuals will experience an episode of low back pain (LBP) during their lifetime, with many experiencing more than one episode.

Spinal stabilization therapy has become very popular for treating LBP, and appears to be more effective over time than minimal intervention and exercise therapy alone. It has also been observed to reduce pain and disability associated with low back pain, as well as medication use and recurrence rates. Increasing our understanding of the mechanics of the low back - specifically with respect to the ability to stabilize the spinal "Neutral Zone" - was critical to the development of this exercise approach. From a rehabilitation and exercise perspective, our focus has shifted to strengthening and reactivating the stabilizing muscles of the spine, while encouraging proper motor control and "grooving" proper movement patterns. The lumbar mutifidus muscle(s) play a key role in stabilizing the spine. Therefore, neuromuscular training directed at 'neutral zone' stabilization is thought to impact these muscles and the outcome of LBP, disability, recurrence and prevention.

To quickly review, the "Neutral Zone", originally proposed by Panjabi, is defined as the part of the range of intervertebral motion, measured from the neutral position, in which spinal motion can occur with minimal non-muscular, passive resistance from spinal structures.

Lumbar multifidus muscles (LMM) are important stabilizers of this neutral zone, and dysfunction in these muscles is consistently associated with low back pain in existing studies. This dysfunction may be the result of reflexive inhibition from the spine leading to atrophic changes in the LMM musculature and fatty replacement that can be visualized on MRI.

This article discusses the role of LMM in recurrent (chronic) low back pain and reviews several literature-based approaches pertaining to the assessment and treatment of LMM dysfunction. The "Additional References" section below can serve as a resource for those interested in more information on this topic.

Multifidus Function:

Multifidus are important stabilizers of the lumbar region, and account for more than two-thirds of the stiffness in the spine when it is in the neutral position.

LMM is divided into deep in superficial fibers: the deep fibers span 2 segments and are tonically innervated; while superficial fibers span 3-5 levels and function physically. This anatomical architecture makes it suitable mechanically as well as anatomically for optimal stabilization.

Multifidus Atrophy and Low Back Pain:

The pathological process that involves the LMM and can accompany LBP closely includes LMM atrophy and replacement of this muscle with fat (this can also occur after low back surgery). This is typically classified as: none, slight and severe in imaging studies. Such changes have been demonstrated in adults with LBP, and do not appear to be correlated with Body Mass Index.

"Dorsal ramus syndrome" (low back pain with referred leg pain) produced by the irritation of structures supplied by the dorsal ramus (i.e. facet joints and LMM) might very well explain atrophic changes observed in the LMM after injury. In turn, abnormalities of the LMM might explain referred leg pain in the absence of other MRI abnormalities such as obvious disc or neural compromise.

Advanced imaging (MRI) of the lumbar multifidus can measure atrophy and fatty replacement with good inter-observer reliability.

Multifidus Atrophy and Reflexive Inhibition:

LMM is divided into five distinct myotomes, each innervated by a single spinal segment - medial branch of the dorsal ramus - which also innervates the zygapophyseal joints. The shared innervation suggests that nociceptive input from the facet joints could result in reflexive inhibition and subsequent atrophy of the LMM at the same level.

LMM atrophy seen in the human spine as a result of reflexive inhibition is caused by afferent feedback from the zygapophyseal joint. This in turn impedes the voluntary activation of the LMM. The inhibitory response might explain (at least in part) the efficacy of manual approaches such as manipulation and mobilization directed at the facet joints.

In animal models, rapid onset of LMM atrophy can occur within as little as three days after experimentally induced nerve root injury.

LMM atrophy tends to be local in studies comparing multifidus size and symmetry between chronic low back patients and healthy asymptomatic subjects.

LMM atrophy is typically associated with reduction in the ability to voluntary contract the muscles.

There is also evidence to suggest that those with LBP and LMM atrophy demonstrate a significantly decreased ability to perform isometric contractions of the multifidus muscle.

Clinical Application & Conclusions: Multifidus Atrophy - Treatment:

In one study a randomized group of patients were allocated into three programs: i) stabilization training, ii) stabilization training combined with dynamic resistance, and iii) stabilization training with dynamic-static resistance. CT scan was used to monitor LMM development over 10 weeks of training. Conclusions indicated that concentric and eccentric contraction phases were critical to induce LMM re-growth.

Exercise specifically designed to increase the ability to contract LMM improves functions and reduces LBP disability.

In general, the research supports the concept that the LMM are critical stabilizers for the lumbar spine neutral zone, and that atrophy in these muscles is strongly correlated with low back pain & dysfunction. It has been suggested that the atrophy perpetuates an inhibitory feedback loop that begins with pain in the spine and can be associated with additional areas sharing the same segmental innervations (i.e. from the dorsal rami of the spinal nerve), which would include the intervertebral disc and facet joints. The sequela to this is mostly likely reflexive inhibition of the multifidus and fatty replacement of that musculature, subsequent weakening of the area, and insidious dysfunction and pain.

It was noted that LMM atrophy can exist in the general population, including highly active and elite athletes. This may be one reason for the high recurrence of low back pain - particularly after traumatic episodes where LMM atrophic changes occur. This would further suggest that conditioning of the LMM is an integral part of low back function - not only from a rehabilitation perspective but also as a prophylactic or preventive measure for promoting general back health...as always, GET YOUR PATIENTS EXERCISING!

3 Uncommon Causes of Chronic Lower Back Pain in Women

Almost every woman has complained of suffering from lower back pain at some time in her life. Whether acute or chronic, lower back pain seems to target the females of our species to a much greater degree than our male counterparts.

The layman (or woman) generally describes the area which is painful as the 'lower back' which, by definition, could be anywhere from the top of the hips to the coccyx (or tail bone at the very end of the spine). The medical profession commonly defines 'lower back' as being the area between the top of the legs and the bottom of the rib cage. Even though these descriptions of the location of the pain vary, it can be assumed that it is around the area where the upper half of the skeleton meets the lower half. It is this meeting point which bears most of our bodies' weight and, because we are also able to twist sideways and bend over double, it is thus at great risk of a huge array of problems.

The most common causes of lower back pain are the well known culprits of lifting items which are too heavy, twisting in an unnatural way (as when trying to prevent a fall), sports injuries or knocks received in a car accident, for instance. All the symptoms of the dreaded lower back pain caused by the above reasons will slowly disappear if one simply rests and does not do anything too physical for a week or two and, if necessary, taking an over the counter anti-inflammatory or pain killing medication.

The major problem associated with lower back pain is when the pain persists over a period of time and either does not go away completely, or does not respond to simple medication and rest, as described above. The diagnosis then becomes more complex, the symptoms become chronic and a host of testing needs to be done in order to pinpoint the exact cause - and thus the treatment plan - to ensure that the patient is able to continue with her normal day to day existence.

The 3 uncommon causes of your chronic lower back pain could be:

• Arthritis - both osteoarthritis and rheumatoid arthritis attack points in the body which have previously been damaged or weakened; and the lower back is therefore a prime target which get progressively more stiff and painful the older one gets;


• A herniated or ruptured disc - the little gel-filled cushion between each vertebra which gets more brittle with age and, when forced out of its correct place, may press on a nerve; and


• An unknown or undiagnosed compression fracture which could be caused by osteoporosis (or thinning of the bones).

Stress, depression and tension have also been shown to have an adverse affect on lower back pain, especially the chronic version of the syndrome. It is therefore recommended to consult your doctor if your pain persists for more than two weeks and does not respond to rest and over the counter medications.