Acute Back Pain
Defined as the early onset of pain, lasting less than six months. It is in the acute phase of pain that treatment can be the most effective.

Bulging Disc
A disc bulge is less serious than a disc herniation. When a disc is forced out of its normal resting position, due to excessive spine pressure, it is said to bulge. If it touches the nerve root it will cause severe pain.

Chronic Back Pain
Pain lasting more than six months. Its ability to last so long is usually due the excessive amount of time a person allows the pain to go untreated. When the body is subjected to chronic pain, inflammation of the surrounding muscles becomes a large contributor to the overall pain profile a person experiences.

Cervical
The neck

Cervical Spine
The first seven vertebrae of the spine.

Compression
In terms of spinal health it can be thought of as the flattening of the discs as a result of gravity, and the multitude of other activities in life that lead to spinal compression like jumping, riding in a car, etc.

Decompression
A reversal of compression.

Degenerative Disc Disease (DDD)
A natural part of the aging process where the fluid filled center of our discs dry out with time and leads to a collapse of one vertebrae onto another. This is only a problem when the nerve exiting the spinal cord in pinched, causing severe pain.

Disc
A cushion between all vertebrae

Extension
Anatomically speaking its backward bending of the body. Any motion where a body segment is taken behind the body is said to be extension. A great example is arching your back. This places the spine in extension

Flexion
The opposite of extension. Flexion is taking the body forward in relation to midline. Practically every motion we perform during our day is in flexion. Bending over to tie your shoe is an example of extreme flexion.

Foramen
A foramen is a narrow hole in the vertebral column where nerve roots come away from the spinal cord. Each vertebrae has a hole on the left and one on the right. So if there are seven cervical vertebrae, twelve thoracic vertebra and five lumbar vertebrae then there are 24 vertebrae and 48 foramen. It is here where most nerve pain originates since it is very close to the vertebral discs.

Foramenal Stenosis
A narrowing of the foramen.

Herniated Disc
Each vertebral disc has a fluid filled center called a nucleus pulposa. If sufficient forces are placed on the spine this fluid call herniate into the canal where a nerve exits the spinal cord, causing severe pain.

IDD Therapy
Intervertebral Decompression Device. A computer controlled device that allows for decompression of the spine. This is a very significant ability since it will open up the foramenal.

Inflammation
A natural and healthy response to soft tissue (muscles, tendons and ligaments) damage. However, since most damage to soft tissue is repetitive, the injury to the tissue never stops. In other words your pain is most likely persistent or chronic since you are probably repeating everyday the same action that led to the injury. Inflammation must be controlled before healing can begin.

Lumbar Spine
The last five vertebrae of the spine

Sciatica
A condition of pain in the sciatic nerve. Sciatica is a very common type of back pain. It is characterized as pain going down the back of the leg.

Soft Tissue
Muscles, tendons and ligaments

Spinal Canal
The large central hole of all vertebrae that houses the spinal cord as it comes off the brain and down the back.

Spinal Stenosis
A narrowing of the spinal canal

Thoracic Spine
The middle twelve vertebrae of your back. All thoracic vertebrae have a rib attached.

Vertebrae
The individual bones of the spine.

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The Physiologic Beginnings of Back Pain

First, we as humans are predisposed to back pain because our eyes and hands are in front of our bodies obligating us to flex (or bend) with practically every movement we ever make. As a result of this, flexor muscles (in the front of our trunk) become strong and the extensor muscles (the back of our trunk) become weak and long creating a muscle imbalance. This is problematic because a strong flexor muscle will pick up a heavier load than the extensor muscle can stabilize. Over time this places increasingly heavier loads on the anterior (front) aspect of the intervertebral disk which in turn places an increasingly strong posterior “push” on our disk causing them to bulge or herniate. So, as this imbalance continues to grow, our posture is compromised leading to a cascade of negative events that spiral into a loss of balance, mobility, safety with even more back pain.

Secondly, we are also constantly bathed in a field of compressing gravity. Gravity together with the other compressive forces of life such as walking, jumping etc. conspire to cause back pain. Therefore it makes sense that a treatment plan of extension and decompression will relieve us. This leads us to my entire philosophy of back pain and its treatment.

The Marriage of Traditional Physical Therapy and New Technology

Prior, The Healthy Back Clinic’s unique approach to effective back care, a patient had two choices.

Physical therapy

Physical therapist could only address low back pain with strengthening. Remember, this is not effective because you have to remove the pain before you can effectively strengthen.

Surgery

A surgeon could only offer injections, drugs or surgery. Surgery is rarely effective. Outcomes to either approach are unpredictable and not as good as the patient would like. This is because the pressure on the nerve must be removed first before any corrective strengthening can begin. By using new technology to relieve pain first allows exercises to progress uninterrupted with much better outcomes.

True pain relief will come only after the mechanical insult of the underlying cause has been addressed. 95% of lumbar pain is secondary to stenosis resulting from varying degrees of disk herniation and/or degenerative disk disease. I am addressing the condition of back pain with a combination of ultra modern spinal decompression technology with traditional physical therapy strengthening techniques. Spinal decompression or IDD therapy does three important functions necessary for long term relief of back pain. One, pressure within the spinal column is decreased so that a negative pressure is created between the vertebra encouraging the disk to migrate back into position. Secondly, the foramina are opened and nerve pressure is decreased or eliminated and thirdly, circulation across the vertebral endplates is increased. Increased circulation is further enhanced by the oscillation of pressure provided by IDD therapy.

Now, a person can pursue an exercise program with much improved motivation and compliance. This is a crucial second step. The lumbar paravertebrals, transverse abdominis muscle and the multifidi must be strengthened to in order to maintain posture and maintain a pain free state.

The absolute foundation upon which all musculoskeletal health sits is posture and core strengthening.

How IDD Therapy Works

IDD therapy works much the same as traditional traction except for two important and crucial distinctions. These unique capabilities of IDD therapy are incredibly safe and effective to alleviate back or neck pain by removing the pressure being placed on the impinged nerve.

First, IDD (Intervertebral Decompression Device) will differ
from traction in that traction will begin the loading process or “pull” by going from 0 pounds to X pounds in a straight line. This allows the lumbar paraspinals to anticipate the direction of pull and respond with increased tone and resistance. This will increase pain substantially since we are now pulling on spastic and inflamed tissue. Compare this to IDD therapy which will load the spine in a sinusoidal curve so that the body cannot anticipate and resist. Instead the lumbar paraspinals relax and true decompression of the spine proceeds.

Secondly, once the predetermined amount of tension has been achieved
with traditional traction it can only hold a static pull. Whereas IDD will oscillate with five pounds positive and then negative. This pumping action enhances the circulation of blood, water and nutrients through the vertebral body endplates and will inhibit neuronal firing of spasmodic muscles . Now a true spinal decompression can occur.

Remember, a nerve can be impinged in two ways:

1. Degenerative disc disease leads to foraminal stenosis and subsequent nerve impingement or

2. A disc can bulge or herniate into the foraminal space and impinge the exiting nerve root. Either way IDD can effectively open up the spinal vertebrae to create a negative pressure between the vertebrae and encourage the disk to migrate back into position or in the case of DDD open up the foramen and relieve the nerve pain.

The Treatment Protocol

• First, decrease the pain with spinal decompression (IDD Therapy)
• Corrects disk herniation and relieves the nerve pain
• Decreases stenosis and relieves the nerve pain
• Improves vertebral circulation and relieves pain
  
• Secondly, strengthen the lumbar paraspinals, the transverse abdominus and the multifidi to support the spine the way they are supposed to and give long term pain relief.

Treatment combination of IDD therapy, PNF and strengthening with further emphasis on postural correction.

Effective treatments rely on a persons ability to participate in 10 to 15 sessions of IDD therapy.

Patient education is a key component to achieving good outcomes.

ALSO: During all phases of treatment we must constantly manage inflammation with ice and over the counter anit-inflammatories. Back pain is naturally a condition of tissue inflammation.

Treating the Whole Person

Once a person is out of pain a simple four minute exercise program can continue to strengthen the muscles of the lumbar spine. We use theraballs to correct the muscle imbalance between trunk flexors and trunk extensors has been corrected you are shielded against future injury. Add to this a walking program and you have an inclusive exercise regimen that leaves nothing out on you way to a healthier and safer level of independent mobility.

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