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Maintenance or Wellness Adjusting is when you come in periodically for a “tune up” to make sure that your vertebrae are staying in the correct alignment. Coming in for these periodic adjustments helps prevent the vertebrae from getting too far out of place and causing your original pain to return.
¨ Many people ask how often should I come in for a maintenance or wellness adjustment—and part of my answer is that it depends on the your age, your physical activities, and your underlying condition. Let me give some general guidelines. For someone who has had their initial problem corrected and wants to come in on a maintenance or wellness schedule—it ranges between every 2 weeks to once every 8 weeks.
- ¨ The older you are—the more frequently you should get adjusted—simply because your body has gone through a lot more and has more wear and tear on it.
- ¨ Someone who is sedentary all the time should come in a little more often than someone who is moderately active (who walks, swims, exercises).
- ¨ Someone who plays physical or contact sports or has high activity levels will come in more often—every 2—4 weeks, especially if you play football, soccer, cycling, lacrosse, horse back riding, rodeo, roping, etc.
- ¨ The same for people who have physically demanding jobs in construction, ranching, farming, and mechanics.
- ¨ People who don’t have any disc injuries, osteoarthritis, reversed neck and/or low back curves, or neck or back surgeries can usually go between 6—8 weeks for adjusting,
- ¨ People who do have any of those structural conditions have had their pain syndromes for awhile and should come in a little more frequently between 3—6 weeks.
The bottom line is, if you are not on a regular maintenance schedule and you start to feel stiff and sore for more than a couple of days, you should call and come in for an appointment, before things get too far out of adjustment. It is easier to correct something before it gets too acute.
Many people have low back pain at one time or another in their life time. It could be just a short episode where you overdid some work and have an achy feeling for a couple of days and then it completely resolves itself with no more pain. It could also be where you have weeks, months, and years of low back pain that started as a simple ache, but which has progressively grown worse over the years to be a strong ache or sharp pain. It could even limit what you would normally do like walking, sitting for prolonged periods of time, and even keep you from good sleep at night.
What is the Cause? There can be a number of different causes for low back pain. You may have overworked some lumbar muscles which in turn have pulled a vertebrae out of place. You also could have irritated the disc (the padding between the two vertebrae). This typically causes deep ache and/or sharp pain when you move wrong. You may even be slightly off center (antalgic) as the body tries to take additional pressure off of the disc.
With chronic low back pain, you may not even remember how you originally hurt your low back, but the vertebrae and sacrum are usually out of alignment and there may even be a slight to moderate curve (scoliosis) in the low back. You started off with some low back pain for a couple of weeks with it getting better on and off, and then it eventually becomes sore all the time.
Chiropractic treatment helps to realign the vertebra, balance out the muscles, and takes pressure off the disc and the nerve roots. Dr. Zager also gives all her patients at Zager Chiropractic Services strengthening exercises and stretches that will help you prevent future back pain and will increase your flexibility and the mobility of your spine.
Stretches: Back Rocks: lying on your back, bring one knee up to your chest, then the other knee. Then bring both your knees up to your chest and pump your knees. This exercise puts a lot of motion into you low back and sacrum.
Low back ranges of motion: standing or sitting, lean forward (with your hands on your thighs), lean back slightly, turn to the right and the left, and lean to the right and left. Do not go past a point of pain, and always do pure movements.
Ice: Use an ice pack for 10 – 15 minutes at a time. This helps take some of the inflammation out of the area.
Heat: You can use heat (moist heat is the best – i.e. a hot shower), but you MUST follow it up with 10 – 15 minutes of ice, otherwise you will stiffen up after the heat.
Strengthen your Core Muscles: your core muscles include your stomach, back muscles, buttocks, and thighs. These all need to be strengthened and BALANCED with each other. See our website www.zagerchiro.com for Core Exercises or join one of Dr. Zager’s core exercise classes to learn these exercises.
The First Annual Healthy Living Day be held on April 10th from 10 am until 2 pm at Zager Chiropractic Services at 2840 Business Loop 181 N, Floresville, TX. This mini-seminar day will provide information on a wide variety of common conditions such as low back pain and headache, as well as self help topics like how to do core exercises, nutritional tips, exercises for kids, correct lifting techniques, and relaxation techniques. It is free of charge and refreshments will be provided.
Click here to sign up for the class or Call (830) 393-6554
 Your spine is made up of 24 vertebrae and sacrum. There are 7 cervical (neck), 12 thoracic (midback – your ribs are attached to them), and 5 lumbar (low back) vertebrae. Between each set of vertebrae is an intervertebral disc (IVD) which acts like a cushion. Your nerves exit between each set of vertebrae through a foramina (hole or opening). When your vertebrae are misaligned, they can put pressure on the nerves as they exit.
For the Thanksgiving holiday lifting the turkey in and out of the oven is one of the most common ways that people hurt their backs. However, for Christmas it is wrapping all those presents! Yes, even I wrap my presents on the floor, but if you can do it at a table you will be better off.
When you are on the floor and constantly leaning forward, of course you also reach and twist, your back muscles become tired and stressed. When they are tired and stressed, they are much more vulnerable to getting injured. One of the preventative measures is to make sure you sit on your knees and can move around. Also remember to face what you are doing; if you are constantly twisting – especially one way – your back is prone to injury. Take lots of little breaks to stand up and stretch.
If you do hurt your back, the first step is to stop what you are doing! Then put some ice on your back – you can also use Biofreeze – for at least 10 minutes. Use heat after the first day, and remember to alternate heat and ice always ending with ice. Call Dr. Zager to schedule an appointment, the sooner the better.
Arm pain is a pretty broad topic, because it includes direct injuries to the arm as well as injuries to the neck, cervical nerves, and shoulder joint complex. I will focus on the neck and cervical nerve injuries in this article, and will do separate articles on the shoulder joint complex and the direct injuries/conditions of the arm like carpal tunnel and tennis elbow.
Normal Anatomy
The nerves that exit out between each set of cervical (neck) vertebrae innervate the shoulder, arm, and hand. (The spinal nerve is like a large cable with thousands of individual nerve fibers in it.) The spinal nerves exit and then some of them, reform to make the brachial plexus, which in turn then split apart and innervates different aspects of the shoulder, arm and hand. Part of what chiropractors and medical doctors do is to assess through physical findings and tests where the injury to the nerve is occurring (before, at, or after the brachial plexus).
Symptoms – Cervical radiculopathy
When a spinal nerve is impinged upon or compromised by a vertebral subluxation (a vertebrae that is misaligned, and stays misaligned) then the signals to arm/hand change. For some the symptoms that are felt include tingling, numbness, sharp pain, itching, no feeling, or there is no difference in the feeling of the arm. If the nerves that are compromised are to the muscles, then the muscles won’t know to contract and move your arm or hand. It is muscle weakness rather than pain that is the symptom. It can also be any combination of the above symptoms, again depending on which nerve fibers are being affected.
How do the nerves get impinged or compromised?
The spinal nerves come off of the spinal cord inside the vertebrae (see image) and then exit through the Intervertebral Foramina (IVF) to go out through the neck and down into the shoulder, arm, and hand. Think of the IVF as the mouth to a cave opening that the nerve exits from. The cervical vertebrae above and below do move. When the vertebrae move out of place and stay out of place they can impinge the spinal nerve. Think of the vertebrae as the soil around the opening of the cave, if there is a collapsing or a landslide of that soil, it is going partially close off the opening to the cave, and the nerves have less room to exit, but they still have to exit, so they are compressed or impinged.
How do the vertebrae get out of place to begin with?
There are lots of reasons for the cervical vertebrae to get misaligned. Injuries playing sports, car accidents (even minor ones), neck strains and sprains, falls, sleeping wrong over long periods of time, poor posture, improper computer work station ergonomics, and repetitive movements always to the same side. All or any of these can cause the vertebrae to get misaligned. However, it is not just a misalignment that causes the problem, it is that vertebrae has stayed out of place and there has been constant pressure on the nerve. Additionally, disc bulges, disc degeneration and osteoarthritic spurs can also compromise the spinal nerve – these are again indications that the condition has been there over a long period of time.
How do you fix or correct the problem?
Many times simple chiropractic adjustments (replacing the misaligned vertebrae) and specific exercises to strengthen the neck muscles and increase mobility will be sufficient to reduce the symptoms. However, the longer you wait, the more damage is being done, and the longer it will take to recover.
Let’s again start with some basic anatomy of a normal disc (Intervertebral disc or IVD). The discs are essentially cushions between every set of vertebrae (bones of the spine). The only areas, which do not have discs, are between the skull and C1 (atlas), and between C1 (atlas) and C2 (axis). The sacrum is really 5 vertebrae that have fused together naturally, hence no true discs. All of the discs make up about ¼ of your height, therefore when your discs begin wearing down and degenerating, you start to shrink in height.
The normal disc has 2 parts to it. Think of it like a jelly donut. The outer part of the disc is called the annulus and has tough fibers laid down in rings. The inner part of the disc is called the nucleus pulposa and is more of a gelatinous material. It works like a ball bearing and a pivot point between the two vertebrae.
There are five types of disc injuries: disc irritations, disc bulges, disc tears, disc ruptures, and disc degeneration. Disc injuries can happen anywhere in the spine. Most people have lumbar (low back) disc injuries, but cervical (neck) and then thoracic (midback) injuries also happen. A disc irritation is where you have dome some heavy lifting, a lot of improper or repetitive bending, or you have strained your back. Sometimes you can hear a “pop” in your back and then feel pain. This is when the disc can become irritated, which is inflamed. Just as when you get an injury to an ankle or other joint, when it is inflamed it gets swollen and is very irritable or sore. The disc itself doesn’t have very many pain nerve fibers, but all of the surrounding tissue do. Every movement is subject to pain, because the entire disc is irritated. The pain may be simple soreness, but it can also be sharp locally. There is typically not any radiating (pain going down legs or arms) at this point in the injury.
Disc bulges are when some of the outer annular fibers have been torn and the integrity of the disc is now compromised. As the name implies, the disc bulges out. The bulge can be either very local (focal) or broad based (across the entire back of the disc). The bulge is usually graded as a minimal, moderate or severe bulge depending on how far out it bulges. The bulge can also be to the side of the disc – which may impact or press on some of the exiting nerve roots, or it may be in the back where it may impact or press on the spinal cord, or a combination of these. Disc bulges don’t typically happen to the front of the disc.
Disc tears are when the annulus fibers have actually torn, but no nucleus pulposa has been extruded out of the disc. This is more severe than a disc bulge, because the future likelihood of a complete rupture is higher. This also is after repeated bulges, and it means that the disc has lost some if not more of the fluid within the disc. Unless it was caused by a “severe” accident, it means that the low back has typically had many injuries and is a chronic condition.
A disc rupture – typically called an extruded disc – is where the annulus fibers have torn, and the nucleus pulposa or part of it has actually pushed out side of the disc and is floating around either the spinal cord or the spinal nerves. The danger with this injury is that the extruded material can press on a variety of nerve components and do a lot of damage and cause a tremendous amount of pain. Much of this pain is severe, sharp, and can easily radiate down arms or legs.
Disc degeneration is when the discs have lost fluid and they have actually worn down over time. This condition is due is a chronic condition. Once you lose the disc, you can’t ever get it back; however, it doesn’t mean that you will constantly be in pain. See a previous post on disc degeneration for more information on that condition.
Treatment for disc injuries can vary; however, the first thing to do is to give the disc some rest. Stop the activity that is irritating it. Use of ice for 10 – 15 minutes at a time will help, you can alternate with heat (a hot shower); however, you must always end with ice. Laying on your side or back for 30 minutes at a time will also take some pressure off the disc. Prolonged bed rest is not all that effective. Gentle walking and swimming(backstroke and freestyle, no butterfly) are good to keep motion in the low back without a tremendous amount of pressure on the disc. Prolonged sitting will typically aggravate your disc.
From a medication standpoint, anti-inflammatories will help reduce the inflammation of the disc. There are over the counter and prescribed medications. One of the things that happens with disc injuries, is that the muscles in the back contract and try to splint the area trying to prevent further damage. Muscle relaxants may be helpful, but a double pull lumbar support will probably do more to give your muscles some relief.
Chiropractors, will assess whether the disc is too inflamed to work on directly in their initial assessments. If there is too much inflammation, they will use some techniques (stretching, disc decompression, ice, topical analgesics, and physcial therapy) to reduce that and then they will adjust (align) the spine allowing the discs to have their normal biomechanics. Additionally most chiropractors will recommend specific back exercises to help strengthen your back so you don’t have future episodes of disc or low back pain.
The main thing to remember is that the earlier you intervene and get chiropractic adjustments, start appropriate exercises, and learn how to lift and work correctly, the sooner you will feel better, and the less prone you will be to future injuries.
Many people have disc degeneration and never really know it. Just because you have disc degeneration, doesn’t mean you have pain or stiffness all the time. Disc degeneration is the sign that you have an underlying problem causing the degeneration.
Let’s first talk about the normal aspects of the discs (Intervertebral Discs or IVDs). The discs are essentially cushions between every set of vertebrae (bones of the spine). The only areas, which do not have discs, are between the skull and C1 (atlas), and between C1 (atlas) and C2 (axis). The sacrum is really 5 vertebrae that have fused together, hence no true discs. All of the discs make up about ¼ of your height, therefore when your discs begin wearing down and degenerating, you start to shrink in height.
The normal disc has 2 parts to it. Think of it like a jelly donut. The outer part of the disc is called the annulus and has tough fibers laid down in rings. The inner part of the disc is called the nucleus pulposa and is more of gelatinous material. It works like a ball bearing and a pivot point between two vertebrae.
Why does disc degeneration begin? When you have vertebrae that are misaligned for a long time, you get abnormal wear and tear on the discs. Think of the bottom of your shoes and if you constantly walk on one side of your foot, you are going to wear down that part of your sole faster. It is the same with the discs between your vertebrae. If you have had a misalignment (subluxation) for a long time the disc is going to wear down.
You can also have disc degeneration from repeated injuries to your discs. If you have had frequent or severe low back injuries where you had strained your low back muscles, you may have also inflamed (irritated) the disc, or if the injury was severe enough you could have bulged, herniated, or ruptured the disc. (See disc injuries for more information on the types of disc injuries.) When the disc has actually been injured, it loses it’s normal integrity and can begin to degenerate. If you have vertebral misalignments, this further adds to the disc degeneration that is going on.
Disc degeneration can be minimal all the way to completely wearing down the disc and the two vertebrae actually fusing together. When the disc is completely degenerated and the bones fuse together, the two vertebraes act as one unit in spine biomechanics. You then need to be careful that the discs above or below then don’t start degenerating.
You can minimize the degeration by first getting your vertebrae aligned properly by a chiropractor, and by keeping as much motion into the spine as possible (see exercises for the back). The properly aligned spine/vertebrae will reduce the wear and tear on the discs. Also by keeping mobility in the spine, you let your body function and adapt better, thus reducing degeneration.
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