Did you know that the most common musculoskeletal issue is low back pain? Statistics show that 80% of the population will suffer from a low back condition at least once in their lifetime! Low back pain is a general term, and many conditions can be the culprit for causing your pain in the lower back, hips and legs.
Lumbar stenosis occurs when there is a narrowing of the spinal canal in the lumbar vertebrae (low back). This can result in compression of the spinal cord, which can lead to pain, numbness, discomfort and radiating symptoms. The majority of stenosis is due to the natural aging process, however, there are other causes.
Degeneration of the spinal column is inevitable with aging and may reflect normal changes in an aging spine. This does not necessarily always result in lumbar stenosis but is often the most common cause. These may be seen on x-ray or MRI and may or may not be a cause of pain.
Lumbar strains and sprains are common injuries that can contribute to low back pain. A lumbar strain occurs when there is an injury to the muscles of the low back. A sprain, on the other hand, is an injury to the ligaments or joints; both, however, have similar pain and symptom patterns. When these muscles or ligaments become injured, it can lead to dysfunctional movements, and cause instability in the spine. Patients suffering from this diagnosis often have pain when attempting to walk, sit, exercise and can even occur during sleep.
However, with the proper education, you can protect yourself from many of these causes. The primary sufferers of this condition, especially chronic cases, often are in poor physical condition with weak stabilizing muscles. Desk jobs can make this condition worse. This type of patient usually has poor sitting posture, which can lead to a weakening of your spinal erectors and destabilize the spine, contributing to the condition. The importance of a h5 core and training your spinal muscles cannot be overstated.
In cases where the injury stems from a problem related to overuse, poor posture or improper exercise, there are steps that can be taken to help avoid these injuries from happening. Proper instruction about your postural habits can reduce the detrimental effects of sitting on the spine, as well as education about correct lifting form can reduce these episodes of low back pain and help you build a healthy spine.
Facet syndrome is a common injury that can contribute to back pain. Over half of facet syndrome cases occur in the neck, and a third occurs in the low back. Facet joints are the small joints in the back of the spine that are responsible for much of rotational movement and limits side-to-side movement. The pain is often worst when moving from a sitting position to a standing position or moving from a bent-over position back to an upright standing position.
However, with the proper education, you can protect yourself from many of these causes. The primary sufferers of this condition, especially chronic cases, often are in poor physical condition with weak stabilizing paraspinal muscles. Desk jobs can also worsen this condition. This type of patient usually has poor sitting posture, which can lead to a weakening of your spinal erectors and destabilize the spine, contributing to the condition. The importance of a h5 core and training your spinal muscles cannot be overstated.
The lumbar spine is made up of five bone segments called vertebrae. In between each vertebra are flexible intervertebral lumbar discs, which act as shock absorbers for the spine. The intervertebral discs are composed of two components, a tough outer ring of fibrous tissue called the annulus fibrosis, and a jelly-like center inside the annulus fibrosis called the nucleus pulposus. The structure is then held together by ligaments on the front and the back of the vertebrae. Additional support is provided by muscles of the trunk.
In most cases, lumbar disc disease is the result of-of a normal aging process called disc degeneration which causes structural changes in the normal disc. As we age, the disc begins to lose fluid and become dried out causing the disc to compress. This may lead to the breakdown and degeneration of tough outer ring of the disc (annulus fibrosis) allowing the inner core (nucleus pulposus), to bulge out. This is considered a bulging disc. This puts pressure on the outer ring of the disc, which may cause low back pain.
As further degeneration of the disc continues, or with continued stress on the lumbar spine, the inner jelly-like core may rupture out from the outer ring causing a ruptured, or herniated, disk. Once the inner nucleus herniates through the outer ring, pain in the lower back may improve. However, the fragmented disc material can inflame or put pressure on the spinal nerves leading to an increase in sciatic leg pain, weakness, numbness, or changes in sensation in one or both legs. Most disc herniations occur in the lower lumbar spine at L4-L5 and L5-S1 levels. Occasionally, severe trauma can cause a normal disc to herniate or may cause an already herniated disk to worsen.
Lumbar disc disorders may include one or a combination of the following symptoms: Intermittent or constant lower back pain and/or pain in the buttock, leg and/or foot pain, numbness or a tingling sensation in the leg and/or foot, weakness in the leg and/or foot, decreased reflexes in the knee or ankle, and changes in bowel or bladder function. The symptoms will vary depending on if and where the disc has herniated, and what spinal nerve root is affected. Leg pain is usually greater than low back pain with disc herniations and nerve root involvement. However, if there are only annular tears without herniation, the pain will be localized to the low back and buttock.
The onset of pain can be sudden or gradual after an injury. Pain may follow heavy lifting, twisting, or straining activities or repetitive stress trauma. However, patients may not recall a prior injury or a precise time the condition began because it is often preceded by frequent episodes of less severe low back pain that usually resolved. Pain is usually characterized by a sharp, shooting, or electrical pain that may be aggravated with movement, changing positions, sneezing, coughing, or prolonged sitting and standing. The pain is usually relieved with rest and a recumbent position.
Conservative care should be your first course of treatment to manage lumbar disc disorders, but treatment will depend on the clinical presentation, your age, overall health, and tolerance to therapies. With disc herniations, the first few days of care will focus on centralizing (reducing) leg pain, decreasing inflammation, and preventing further neurological loss by decompressing nerve root impingement and reducing the disc herniation. Osseous mobilization and manipulation and soft tissue therapy may be administered as tolerated.
Home care will consist of pain-relief repetitive positional exercises and lumbar stabilization exercises. We will also educate you on ways to protect your lower back, positions to avoid, and how to manage activity. In most cases, bed rest will not be recommended as the sooner you are up and moving, the better the prognosis. Once pain and inflammation have decreased, we will continue working on lumbar stabilization and progress into proprioceptive training. We will evaluate muscle imbalances using posture and movement patterns with the goal of restoring good biomechanics and core body strength. Your home care will emphasize the progression of stabilization protocols and corrective exercises. If you fail to respond to conservative treatment, or in cases of severe neurological loss, a referral for a surgical consultation will be recommended.
At MN Spine and Sport, we build a short, concise treatment plan for you that targets the direct and indirect cause of the pain. Many of our low back pain patients receive a combination of Chiropractic adjustments, manual therapy, corrective rehab exercises, and much more. Our goal is to have you achieve lifelong resolution of the pain, not just a temporary fix.
Neck pain and Headaches are a very common issue in our society and understanding the causes and prevention of them will go a long way to leading a healthy and pain-free life. Here are some of the most common conditions we see in our office.
Upper Crossed Syndrome describes a type of common muscle imbalance. This occurs when the neck flexors and the middle back become weak while the pectoral muscles and the muscles at the base of the skull become tight.
This produces a familiar pain pattern at the base of the neck and the shoulders, as well as joint dysfunction at the base of the skull and shoulders.
The best way to combat this problem is, of course, to prevent it before it starts. If possible, minimize sitting for long periods of time and take frequent work breaks to take short walks around the office to reset your posture.
Headaches come in many varieties, and nearly everyone experiences this type of pain at some point in their lives. The common symptom of all headaches is of course characterized by pain. Different types of headaches cause pain in different regions of the head and have unique pain sensations. Some portion of people experiencing headaches can be characterized as migraines. Migraines often feature symptoms such as nausea, vomiting or sensitivity to lights.
Since there are so many different types of headaches, as well as causes and symptoms, it is important to get a proper diagnosis so that you can better treat the cause. An assessment of your lifestyle habits is an effective way to diagnose common contributing factors that may be causing your headaches.
For example, addressing your sleeping habits; making sure you get the proper amount of sleep and are getting high quality (restful) sleep. In addition, a healthy, balanced diet that is free of any substances that you may have a sensitivity to or may be a trigger for headaches is important for managing headaches.
Posture and body habitus can be huge contributing factors and may be some of the simplest to diagnose and manage. Treatment such as soft tissue modalities as well as chiropractic adjustments coupled with posture analysis and therapeutic exercise can be a simple and effective way of managing headaches of this type.
Cervical strains and sprains are some of the most common injuries sustained to the cervical spine. A cervical strain is when an injury occurs to the muscles of the cervical spine. A sprain, on the other hand, is an injury to the ligaments or joints; both, however, have similar pain and symptom patterns.
Patients suffering from this diagnosis often have pain when attempting to move the head and neck, especially at end ranges of motion. Another symptom that sufferers’ may experience is frequent headaches, which may not seem directly evident to the patient that the source of the headaches may be caused by their cervical strain or sprain.
Some of these injuries are impossible to avoid, such as automobile accidents and whiplash injuries. At this point your next course of action is to seek treatment, usually with ice in the days immediately following the injury as well as therapeutic modalities such as interferential electrical stimulation, manual therapy, laser, and/or PEMF.
In cases where the injury stems from a problem related to overuse, poor posture or improper exercise, there are steps that can be taken to help avoid these injuries from happening. Proper instruction in ergonomics in the workplace, fixing posture and instilling healthy habits, as well as receiving the proper knowledge in exercising can help build a better foundation for a healthy spine for life.
Discogenic Pain Syndrome is a condition that results from soft tissue damage and associated irritation of the fibers of intervertebral discs. Intervertebral discs are cushions found between each vertebra of the spine that work as shock absorbers to protect the vertebrae by helping dissipate the forces applied to the spine and to help facilitate movement. The cervical discs are found between the vertebrae of the spine in the area we think of like the neck.
Intervertebral discs consist of an outer annulus fibrous, made up of tough, fibrous connective tissue, which surrounds a gel-like center called the nucleus pulposus. The outer third of the annulus fibrous is innervated by nerves and contain pain and mechanical receptors which mediate pain transmission from structural damage to the intervertebral discs or indirectly through chemically mediated inflammation.
Cervical disc pain can arise from a variety of reasons, whether by injury or a degenerative condition. In most cases, the condition can be treated to allow the person to continue his or her active lifestyle.
The symptoms will vary depending on whether the condition is caused by a herniated disc or by a degenerative disc. With a herniated disc, some people will not experience pain in the neck but will have radiating pain, tingling, and numbness down the arm or around the shoulder blade due to pressure put on the nerve root. Discogenic pain due to an injury can result in immediate pain or pain shortly after the injury. Headaches (usually cervicogenic) can also result from cervical disc pain.
Treatment for cervical discogenic pain will depend on the clinical presentation. Conservative treatment can successfully manage many cervical disc herniations. Initial treatment will focus on controlling pain and inflammation. Once pain and inflammation have decreased, early rehabilitation will help prevent chronic pain and disability. This will consist of osseous manipulation, soft tissue therapy, spinal decompression, activity as tolerated, and pain-free range of motion exercises.
Late rehabilitation will be administered as the condition improves and will include stabilization exercises, patient education, and postural training. Education in proper training, biomechanics, and a home exercise program will help strengthen the spine and decreases the likelihood of future injury. If you fail to respond to conservative treatment, or in cases of severe pain, diagnostic imaging (x-ray, MRI) will be warranted, and an orthopedic consult may be necessary.
Cervical Radiculopathy is a dysfunction of the cervical nerve roots resulting in various neurologic findings. The cervical spine consists of seven cervical vertebrae and eight cervical nerve roots. Cervical radiculopathy can result in pain, numbness, or weakness and though the problem occurs at the nerve root of the cervical spine, these symptoms will often radiate to parts of the body controlled by that nerve.
In younger patients, cervical radiculopathy is usually the result of a disc herniation or an acute injury causing foraminal impingement of the exiting nerve. In the older population, cervical radiculopathy is usually due to foraminal narrowing from osteophyte formation, decreased disc height, or degenerative changes. In elderly patients with osteophyte formation, repetitive neck movements may result in a more insidious injury.
Cervical radiculopathy due to sports injuries can result from several mechanisms. Typical these injuries occur from forced extension, lateral bending, or a rotation mechanism, which closes the foramen and results in the exiting nerve root being injured.
The condition may follow a neck injury or be of insidious onset, and there may be a history of multiple episodes of previous neck pain or arthritis of the cervical spine. The pain may range from deep aching to severe burning neck pain.
Usually, the pain will be referred to the shoulder blade, which might be described as shoulder pain. If the radiculopathy progresses, radicular arm pain (“sharp, shooting, electrical”) or sensory changes (“numbness, tingling, loss of sensation”) may develop down the arm and into the hand. Arm symptoms will depend on which nerve root is involved.
Occasionally, a motor weakness may develop of the shoulder or arm. Certain neck positions which cause increased foraminal narrowing may increase the pain. The symptoms may be relieved by lifting the arm over the head which decreases the tension at the nerve root.
Initial treatment will focus on reducing pain and inflammation and prevention of further neurological loss. The focus will also be on centralizing (reducing) any radicular symptoms by decreasing nerve root compression and pressure within the herniated discs. This will consist of manual traction and pain-free active non-resisted ranges of motion while avoiding positions that increase neck and arm symptoms.
A cervical pillow at night can be helpful in maintaining the neck in a neutral position and limiting head positions that cause foraminal narrowing. Electrotherapy modalities may be used to help reduce any associated muscle pain and muscle spasms. Once pain and inflammation have decreased, therapy will progress to restore full range of motion and mobility of the neck and shoulder.
This will include muscle stretching, strengthening and proprioceptive training, and corrective exercises as tolerated. Cervical manipulation and soft tissue therapy may be administered as tolerated and if it does not cause an increase in symptoms. If you fail to respond to conservative treatment, or in cases of severe neurological loss, a secondary consultation with a neurologist or neurosurgeon will be recommended.
Injuries related to auto accidents, slip and falls and other personal injury accidents are traumatic injuries! This simply means that the injury was significant in nature and directly caused by the accident, and not over time like an over-use injury. When a traumatic injury occurs, muscles, soft tissues, ligaments, joints, discs, and possibly bones may be damaged.
When the injury occurs to these structures, inflammation and altered movement can last for weeks, months and even years if not addressed and treated properly. If left untreated, your body will try to heal itself in a less than ideal way by laying down scar tissue. This causes the muscles that were damaged to become either chronically weakened or tight. If these injuries are not addressed and treated, the biomechanics of the region will be altered for the long term. Most of the time, treatment is a necessity because your pain level may be too intense not to seek treatment.
One mistake that many accident victims make is not seeking care for their pain because they do not believe they were really hurt. The sooner you seek treatment after the accident or injury, the better. Many times, the pain may not start right away, or only lasts for a few days following the accident, then comes back within a couple of weeks. These patients always wish they would have taken care of their body right away, instead of seeking treatment a few weeks or months after the injury or accident.
If you are suffering from an automobile accident, slip and fall or other personal injury accident, MN Spine and Sport has treatment options for you! At MN Spine and Sport, you will be treated with the same care as our professional athletes. You will not just be another auto accident patient, like many other personal injury clinics. We will take the same amount of care that our patients have grown to love and expect.
Work injuries occur to an employee during their normal work duties. There are many types of injuries, however lower back injuries are the most common. There are many causes including slipping, falling, tripping, lifting, computer work, repetitive motions and even car accidents.
We have treated many work injuries over the years and offer many treatment modalities, such as laser, PEMF, acupuncture, chiropractic, manual therapy, traction, and exercises. We also work with insurance companies and your attorney to get you the care you need! Our number one goal is to get you back to your life as soon as possible!
At MN Spine and Sport, we treat athletes of various levels, from the weekend warrior to the professional athlete. If it’s a sport, we have treated an injury related to it! MN Spine and Sport has in-depth experience with working with athletes, both amateur and professional. The combination of biomechanical assessments, in-depth examinations and unique treatment protocols gives athletes an edge in rehabilitation and quick return to play!
Overuse injures can be caused by abnormal movement patterns in the area of injury or elsewhere in the body. The abnormal movement patterns, combined with the requirements of the sport, place excessive strain on the injured area, causing pain, inflammation and compensatory movements.
During the initial exam, our patients go through a series of functional examinations in conjunction with a chiropractic and sports recovery exam to determine the diagnosis and underlying cause of the injury. In addition, our athletes are also assessed and/or consulted on possible sport-related causes to their injury. Every sport has its physical demands and common injuries. Part of complete care for an athlete is addressing the biomechanical insults of the sport as well as the body. Therefore, we take a functional approach, looking at the whole body, not just the area of injury! From our global examination, we create a customized treatment plan unique to the athlete and injury.
MN Spine and Sport, we tie in our knowledge and experience in strength & conditioning with our treatment protocols. Dr. Schreiber is board certified in rehabilitation and uses this knowledge to analyze the mechanism of injury and to make recommendations on training programs in conjunction with your treatment plan. Because of the demands of bodybuilding and weightlifting, over-use injuries are very, very common. By nature, this sport/activity produces muscular imbalances if the person does not carefully intertwine mobility, recovery and specific prehab protocols in their program. Prehab is simply corrective exercises that are meant to target weaknesses and dysfunctions in the individual to prevent injury.
The main problem with most resistance training exercises is that the superficial “beach” muscles are the only muscles trained. These muscles then grow bigger, stronger and more powerful. However, if you do not train the stabilizers around these large muscles, you have a perfect recipe for over-use injuries. These injuries can be anything from a strain, tendonitis, too severe enough that surgical options may have to be explored. Our goal is to address and treat the injury before the thought of surgery is ever a reality, then develop a prevention program for the present and future.
What is Chronic Pain?
Chronic pain is defined as pain that lasts longer than six months that has failed multiple trials of conservative care. It can be mild to severe and impacts each patient differently. Chronic pain can persist for weeks, months, or years – and take a serious toll on a patient’s physical and emotional well-being.
What Causes Chronic Pain?
Chronic pain has many potential causes. Typically, chronic pain stems from conditions or injuries to the various structures in the body (the muscles, joints, nerves, etc.). When an area of the body is injured it sends a signal through the nerves to the brain, where it is registered as pain and then sent back to the injured body part. This is the internal process that occurs when you stub your toe or break your arm. The signaling mechanism can be disrupted and pain persists where acute pain recovers over time causing the pain to remain despite the tissue healing. During the healing phase of injury, the body can lay down scar tissue, which can also be a source of pain if not properly rehabilitated.
At MN Spine and Sport, we have many treatment modalities, such as laser, PEMF, acupuncture, manual therapy or manipulation designed to relieve and/or eliminate pain. We will work with your other providers and refer you for co-management, if needed.
Today, the majority of time at work is spent sitting. Whether seated at a desk, computer, or in a car, the strain placed on the body can be equal to or greater than manual labor jobs. The human body was meant for movement; sitting for prolonged periods of time places repetitive strain on the body, leading to dysfunction and pain. If you think you are suffering from a sitting related pain or injury, please read through this section to understand the possible causes.
The reality of sitting over a long period of time is that the human body becomes de-conditioned. “De-conditioned Syndrome” is a by-product of a sedentary lifestyle combined with a job that requires minimal physical activity. When our lifestyle or job lacks physical activity, our postural muscles become over-used/tight and our prime mover muscles become under-used/weak. Over time this causes significant muscular imbalances, joint restrictions and repetitive strain on certain structures. The actual sitting becomes an over-use injury, which cause the muscles or become tight and weak, creating a cycle of injury.
Two common syndromes we see amongst desk/computer workers are Anterior Head Carriage and Upper Crossed Syndrome. Anterior Head Carriage, also known as forward head carriage, is a postural fault or tendency the body exhibits because of upper cross syndrome. Simply put, it’s when the head is held in a much more forward position than it is supposed to be, causing repetitive strain, pain and further dysfunction.
The easiest way to tell if someone has anterior head carriage is to stand normally while drawing an imaginary line from the top of their head down through the middle point of their ankles. If the person has a proper standing posture, the line should go through the middle of their ear and the middle of their shoulder. If their ear is in front of their shoulder, they have anterior head carriage. You will realize that given the normal American lifestyle of sitting in front of computers, that many people have anterior head carriage. In no way is this a diagnosis and any symptoms related to this should be evaluated by a doctor.
Because it is an abnormal body position, anterior head carriage can cause several symptoms, including headaches, neck pain, upper back pain, tight muscles, trigger points, muscles aches, and decreased range of motion. Aside from poor posture, anterior carriage can also be caused by joint restrictions in the neck and mid back. If joint restrictions exist, flexing the neck forward decreases pressure placed on the posterior joints (facet joints) which could be an unconscious attempt for the body to alleviate symptoms or pain. The increased flexion only causes more work on the muscles in the back of the neck, increasing the symptoms associated with anterior head carriage.
Upper crossed syndrome, also known as “student syndrome” or “corporate syndrome”, is a pattern of tight and weak muscles the body develops based on one’s postural tendencies. The most common trait for someone with upper crossed syndrome is tight upper traps (a muscle in between the edge of your shoulder and your neck) and sometimes right at the posterior base of your skull. This is a very common occurrence in today’s population. The people this affects the most are those that sit all day, usually in front of a computer or at a desk. Due to poor ergonomics, most people in these situations either find themselves leaning over a desk to read, or hunched over at a computer, typing all day. In order to maintain this unnatural position, the body must continually contract certain muscles.
Many people are told that they must live with jaw pain, headaches, numbness, and facial pain. In fact, there are many treatments that can be done to alleviate this condition.
Dr. Schreiber is the only provider in the area that conservatively treats TMJ pain. He has spent many hours of continuing education and specializes in the conservative treatment of tempro-mandibular conditions.
There are many causes of TMJ dysfunction. Any problem with the bones, joints, muscles or connective tissues around the joint can cause TMJ. Some of the more common causes include the following:
There are two joints, one on each side of the face, that are connected by the one jawbone. If muscles on one side of the face are h5er or tighter than the other, they will pull the jawbone to one side when it is opening and closing. This causes uneven wear and tear on the joints. Any muscle in the body become h5er with use and weaker with disuse; the jaw muscles follow this same rule. When one side of the jaw is used more than the other side of the jaw, like chewing on one side consistently (especially with gum chewing), the h5er muscles pull tighter and cause the jaw to move unequally.
The disc within the joint can become locked in one place and stop gliding with the jawbone. If this happens it can block the motion of the TMJ so that the mouth cannot open all the way.
The muscles around the jaw connect to the front and back of the neck. Poor posture, with the shoulders rounded and the head forward, causes stress on all the muscles around the neck, including the jaw muscles. This frequently contributes to TMJ pain.
A TMJ examination includes a thorough examination of the muscles, ligaments, joints, posture, movement patterns and gait, as well as discussing past injuries and lifestyle habits that may be contributing to your condition.
Many TMJ conditions respond well to conservative treatment, and do not require surgery. Treatment at MN Spine and Sport may include manual therapy, mobilization, laser, acupuncture, PEMF and exercises.
Federal law requires drivers of commercial motor vehicles and pilots to receive regular physical examinations by a licensed medical examiner. Your safety and the safety of others is our utmost concern! Dr. Schreiber is specially trained, has passed the Federal Motor Carrier Safety Administration (FMCSA) certification exam and the FAA Basic Med Certification, and has been listed on the National Registry of Certified Medical Examiners (NRCME).
Dr. Schreiber can appropriately determine medical fitness for duty. They understand the regulations and prevent drivers and pilots from being inappropriately disqualified. We recommend that you schedule your appointment at least one month prior to your certification expiring to account for the unforeseen.
What do you need for your appointment?
The purpose is to screen for physical and medical conditions that might put the student at risk for participation. This examination does not replace your annual checkup or wellness exam with your primary care provider for immunizations and important age appropriate health guidance. If the student athlete is currently under medical care that requires further follow up prior to clearance for athletic participation, the student athlete will be referred to the appropriate medical provider.
The Minnesota PPE form is valid for three years. An annual health questionnaire is required every year. Any major health changes on the annual questionnaire may require a PPE to be conducted sooner. It is our opinion that a properly performed sports physical should be done on an annual basis. The reason for this is because of rapid changes of the physiology and biomechanical aspects of the adolescent body. The evaluation can screen for those minor and subtle changes and make appropriate treatment and/or training recommendations.
The PPE evaluation in our office is very thorough. We conduct all the required recommendations of the medical portion of the evaluation. In addition, we spend the time to evaluate the overall flexibility and strength of the athlete. We use this information to give recommendations on injury prevention, strength program needs and, in some cases, direct to the proper diagnosis of an injury. When an accurate injury diagnosis is made, we can recommend a treatment plan that will expedite the recovery process.