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Pregnancy and Back Pain

Peripartum Pelvic Pain: Pain in the pelvic region, for which a clear-cut diagnosis has not been made, is termed peripartum pelvic pain. This pain may start during pregnancy, or within three weeks of delivery.

Anatomically, pain presents itself most commonly in the following areas:

sacroiliac joints at the posterior superior iliac spine (42%)

the groin areas (53%)

coccyx (33%)

pubic symphysis anteriorly (77%)

and occasionally other areas of the pelvic and upper legs.

Rarely does pain occur below the knee. Pain tends to be influenced by posture and is associated with a waddling gait.

In approximately 80% of pregnancies, back pain is usually localized, but the site may vary. Although long-term pain is very rare, short-term pain tends to be dominant. Usually during the third trimester, 50% of pregnant patients will experience back pain. The prevalence of postpartum period pain falls to approximately 9% in decreasing order as follows: sacral, lumbosacral, lumbar, cervicothoracic, and remaining areas. Chiropractic care is extremely helpful during and after pregnancy. We have special tables to accommodate for pregnancy.

Disc Herniation: The prevalence of pain during the first nine months is thought to be 90% versus non-pregnant controls. For the same period of time, the non-pregnant controls had a 20% prevalence of pain. Although the pain may be severe, disc herniation, which is exceedingly rare during pregnancy, is not to be blamed. Disc herniation presents at the same rate as non-pregnant women—or at approximately 1:10,000 (one in 10,000).

Pain Indices With respect to age and smoking, there has been no demonstrated difference in pain indices. However, a slight increase in peripartum pain has been demonstrated with higher body mass, more pregnancies, and a previous history of pain during pregnancy. Also, younger women tend to have more intense pain when compared to older women. A third of women describe their pain as disabling, restricting their activity, and a costly handicap. Approximately 10% of women describe their pain as extremely disabling.

Etiology of Pain The etiology of pain is probably related to a combination of mechanical, metabolic, circulatory, and psychosocial contributing factors. One-third of the patients who experience pain starting during the first trimester when mechanical forces are not a significant force are highly indicative that the most probably cause is due to a change in hormonal influence.

It is believed that hormones cause change at the insertion point of ligaments to the bone. A higher concentration of ligaments in the lower spine may suggest the cause for a higher incidence of back pain in the multiparous mother who has had more exposure to hormonal influences.

Furthermore, an increase in premenstrual pain has occurred in a large majority of women whose pain has been suggestively influenced by hormonal changes. There has also been found to be higher serum relaxin levels in women with peripartum pelvic pain. There is some evidence to suggest that a different set of receptors is sensitized in the lower spine during pregnancy by hormones. Therefore, it is believed that most of the pain is secondary to hormonal changes rather than actual chemical stresses.

Lumbar Lordosis: It has been thought that lumbar lordosis is increased during pregnancy. However, in reality with x-ray studies, it has been demonstrated that lordosis decreases during pregnancy. Therefore, overall pain may be due to the muscles and ligaments combined with some alteration in blood flow to the pelvic musculature and ligaments.

Treatment The treatment recommendations for pelvic pain in most obstetrical and gynecological textbooks are poor. Patients are instructed to avoid excessive weight gain, exercise to strengthen the back muscles, maintain correct posture, and to wear sensible shoes (not high heels).

Some activities do cause or aggravate pain. The most common are: 30 minutes of standing or walking, carrying a full bag of groceries, standing on one leg, climbing stairs, turning over in bed, intercourse, bending forward, stepping in or out of bed, and driving for 30 minutes.

Many treatment options are available: including a pelvic belt (by prescription), exercise, appropriate rest, medication, massage, chiropractic, and standard back exercises.

To recover and remain pain-free, follow the treatment plan your doctor has outlined. Make sure you have regular check-ups, and tell you doctor if you are not getting better.

Connection to Back Pain: Most people know that obesity contributes to the development of coronary heart disease, diabetes, high blood pressure, and colon cancer. However, did you know that obesity is a contributing factor to back pain? It is true. Being overweight or obese can significantly contribute to symptoms associated with osteoporosis, osteoarthritis (OA), rheumatoid arthritis (RA), degenerative disc disease (DDD), spinal stenosis, and spondylolisthesis.

The spine is designed to carry the body’s weight and distribute the loads encountered during rest and activity. When excess weight is carried, the spine is forced to assimilate the burden, which may lead to structural compromise and damage (e.g., injury, sciatica).

One region of the spine that is most vulnerable to the effects of obesity is the low back; the lumbar spine. Lack of exercise and bodily conditioning leads to poor flexibility and weak muscles in the back, pelvis, and thighs. This can increase the curve of the lower back, causing the pelvis to tilt too far forward. Further, this is detrimental to proper posture and as posture weakens, other regions of the spine (neck) may become painful.

You may try to dismiss the cause of some of these spinal disorders to the process of normal aging. It is true that with age body tissues can cause changes to spinal anatomy2. However, if you are overweight or obese, chances are you have, or will have, back pain. You may have or develop one of the following conditions:

Osteoporosis A sedentary lifestyle coupled with an unbalanced diet can affect the density, or strength of the bones (spinal vertebrae). When the structural architecture of a vertebral body is compromised, it is at risk for fracture. Vertebral fractures can be painful and disabling. If you have been diagnosed with osteoporosis, you have probably lost between 25-30% of desirable bone density. If the diagnosis is osteopenia, bone loss has been in the range of 10-15%3.

Osteoarthritis (OA) and Rheumatoid Arthritis (RA) The joints in the spine are called facet joints. Excessive body weight places unnatural pressure and stress on the joints during movement and at rest.

Low Back Pain Obesity may aggravate an existing low back problem and contributes to recurrence of the condition.

General Unhealthy posture accounts for neck and back pain. A level of physical fitness is necessary to properly support the spine.

Development of Obesity Industrialization and modernization has had a tremendous impact on our food. For example, food can be purchased just about anywhere. No longer is it necessary to expend physical effort to hunt and forage for food. There are vast numbers of processed food products available and labor-saving devices (e.g., microwave ovens) to cook food. The market for many convenience foods and kitchen devices came about when women entered the work force.

Childhood obesity is on the rise due to many factors that include sedentary behavior (e.g., computer games), eating when not hungry, television advertising high-calorie ‘tasty’ foods, and even genetics.

According to the Surgeon General’s “Call to Action to Prevent and Decrease Overweight and Obesity,” 40% of adults in the United States do not participate in any leisure-time physical activity and less than 1/3 engage in at least 30 minutes of physical activity most days4.

Another consideration is where meals are eaten. In 1992, 38% of the food dollar was spent on foods eaten away from home5. It can be difficult to control what you eat and how the food is prepared (e.g., fried versus broiled) at a restaurant; especially ‘fast food’ establishments.

If you are overweight, obese, or working at maintaining a healthy weight, there are many tools available to empower your efforts.

As you probably already know, back pain is a very common complaint. About three in four adults will experience back pain during their lifetime—and that number may very well rise, given our aging population and recent trend of obesity.

Low back pain (pain in your lumbar spine) is the most common. Most back pain comes from sprains and strains caused by stressful movements: lifting something without using proper techniques or a sudden twisting motion are just two examples of how you can hurt your back.

If your back pain is caused by a muscle sprain or strain, the rate of healing depending on how severe the sprain or strain is. Sometimes scar tissue and fibro-adhesions will develop after injury making this region more succeptable to re-injury. Your recovery can also be helped along by modest medical attention such as over the counter anti-inflammatory medication and pain management if necessary. Furthermore, chiropractic care is the best conservative treatment for low back pain. Other treatments that are beneficial include: stretching, exercise, ice packs, and massage.

Sometimes, though, back pain is caused by a more severe spinal condition, such as a herniated disc or spondylosis. Chiropractic care in 90% of these cases can help resolve these symptoms and manage the patient’s chronic condition. Depending on the severity of your pain and its cause, you may require more involved medical help, such as pain management in addition to chiropractic care; and in severe cases surgery.

But please keep this in mind: just because you have back pain doesn’t mean you’ll need serious medical attention or surgery. It does mean that you’re in good company and that you have an array of treatment options to get you feeling better.

As you can see from the image below, your back, or spine, is made up of many parts. First, we’re going to look at the bone structures. Your backbone, also called your vertebral column, helps support a lot of your body weight, and it protects your spinal cord. You have 33 vertebrae (bones) that make up the vertebral column. In the image, they’re labeled as “Vertebral Body.”

Parts of the Spine

Your spine is divided into regions: there’s your neck (cervical spine), mid-back (thoracic spine), and low back (lumbar spine). At the bottom of your spine, you also have the sacrum and the coccyx, which is commonly called your tailbone. Your iliums or hips then attach to the sacrum.

The vertebrae in your neck are labeled C1-C7, meaning that you have seven vertebrae in that region. Most adults have 12 vertebrae in the thoracic spine (T1-T12), which goes from your shoulders to your waist. Then there are five vertebrae in your low back (L1-L5), and below that, your sacrum is made up of five vertebrae between the hipbones. By the time you’re an adult, these five bones have fused into one bone. The coccyx is made of small fused bones at the very tail of your spine (hence the tailbone).

Your spine also has facet joints, which are on the posterior side (back) of your vertebrae. These joints (like all joints in your body) help facilitate movement and are very important to your flexibility. They are surrounded by a ligamentous capsule that can become inflamed and become a cause of low back pain know as facet syndrome. Patients who wear high heels or place their back into extension will aggravate this condition.

Another vertebral bone structure that’s labeled in the image is the pedicle. These are on either side of your vertebrae, and they are part of the “walls” for your spinal canal.

In between your vertebrae, you have intervertebral discs (also labeled on the image). These act like pads or shock absorbers for your spine as it moves. Each disc is made up of a tire-like outer band called the annulus fibrosus and a gel-like inner substance called the nucleus pulposus.

Together, the vertebrae and the discs provide a protective tunnel (the spinal canal) to house the spinal cord and spinal nerves. The spinal cord gives off branches or pairs of nerves at each level of the back. These nerves exit neural foramens and extend into various parts of the body, where they help you feel and move.

Your back also has muscles, ligaments, tendons, and blood vessels. Muscles are strands of tissues that act as the source of power for movement. Ligaments are the strong, flexible bands of fibrous tissue that link the bones together, and tendons connect muscles to bones and discs. Blood vessels provide nourishment. These parts all work together to help you move.

Back pain may be a result of injury to any or all of these body parts. Injury to the muscles, ligaments, tendons can result in sprains or strains. Injury to bones, nerves, or blood vessels may be more serious. Also, the outer layers of the intervertebral discs can get tears or cracks, allowing the annulus fibrosus or nucleus pulposus to bulge out. Any of these injuries can cause inflammation and pain.

Back pain is its own symptom. However, there are various ways to feel back pain, and your symptoms depend on what is causing your pain and where it is affecting your spine.
Your back pain may be acute or chronic. Acute pain lasts four to six weeks, but chronic pain is persistent, long-term pain—sometimes lasting throughout life. At times, people with chronic pain can aggravate or exacerbate their condition resulting in acute pain.
Back pain may be sudden and sharp—or it may be dull. Pain may occur with movement, and it may even occur with coughing and sneezing. You may also have numbness in your arms or legs. (Leg symptoms are often referred to as sciatica caused by a pressured or impinged nerve.)
It’s important to treat your back pain properly. Contact your physician or chiropractor—and seek immediate attention if you have back pain with any of the following emergency signs:

• Pain is increasing in intensity and getting worse
• Pain affects every day activities
• Moderate symptoms
• Groin or leg weakness or numbness
• Arm or hand weakness, tingling, or numbness
• Loss of bowel or bladder control
• Because there are a variety of causes of back pain, it’s vital to know the exact cause of your pain, and your doctor will help figure that out.

It is not uncommon for individuals to hurt their back and not realize how they did it—but your back certainly does, and the pain is trying to tell you something. Or you may not know that something is wrong with your spine until a stressful movement aggravates the condition. Some common causes of back pain include:

Aging

Ligaments thicken, shorten, and discs dry out with age—that’s just part of what happens to us as we grow older. These age-related changes in the spine may lead to disorders that create pressure on your spinal nerves—meaning that you’ll have symptoms such as pain, numbness, or weakness. Degenerative disc disease is an example of an age-related spinal disorder. Over time, your discs can lose their normal structure and function. That is just wear and tear, but it can result in a bulging disc or a herniated disc and pain. Sometimes, the bulging or herniated disc can pressure a nerve, causing pain that travels to another part of your body. For example, a herniated disc could push on a nerve in your low back and send a shooting pain down your leg (also known as sciatica). Pain that travels from the origin to another part of your body is called radiculopathy. You can experience cervical radiculopathy, which affects your arms mainly, or lumbar radiculopathy, which affects your legs.

Daily Life

Just getting through every day takes its toll on your body. Stress and emotional tension can cause muscles to tighten and contract, resulting in pain and stiffness. Since we carry most of our weight in our backs, that’s where we can feel the end result of tense daily living: tight muscles and painful movements. Also, the way you’re getting through your day could be the cause of your back pain. Poor posture—standing for long periods of time or sitting incorrectly—can cause back pain (so watch out while you’re at the office). Low back pain is often associated with heavy physical work, lifting or forceful movement, bending or twisting, or awkward positions. If you don’t use proper lifting techniques while hefting a box of books, for example, you can really hurt your back. Even healthy, normal activities can cause muscle sprains and strains, which can lead to back pain. Gardening, tennis, horseback riding, biking, and even golf can all potentially hurt your back.

Injuries and Accidents

You can fracture a spinal bone in a fall or a car accident. If you have osteoporosis, a condition that weakens your bones, you’re much more prone to fracturing a bone. You can have a sports-related injury, such as pain caused by being tackled too many times in football. These are the sudden, unexpected causes of back pain that most likely require immediate medical attention.

Obesity

Being overweight puts pressure and stress on the back, especially the low back. In addition, carrying excess weight aggravates other health conditions such as osteoporosis (weak bones), osteoarthritis (joint pain), rheumatoid arthritis (an autoimmune disease), degenerative disc disease (described above in the aging section), spinal stenosis, and spondylolisthesis.

Secondary Metastatic Cancer

Unfortunately, cancer that has spread from another organ can affect the spine. In males usually prostate cancer affects the lower back; in females ovarian, breast, or uterine cancer may affect the spine. There are other organs that may spread to the spine but these are the most common. In these situations most treatment consists of palliative care for which a pain management physician would be helpful. In these instances injections or vertebralplasty / kyphoplasty will be helpful as the spine is fragile when cancer is involved. Chiropractic care is not an option.

Why Consult a Chiropractor

Chiropractic offers gentle, effective, and time-saving approaches to treat your low back pain. Chiropractic is a drugless, non-surgical system of health care. One important principle of chiropractic involves returning motion to the spine. Restricted spinal motion—when the spine doesn’t move as well as it should—can cause back pain.

Chiropractors emphasize spinal manipulation (or adjusting the spine) as a means of correcting spinal joint restrictions and relieving pain, treating disc injuries, improving alignment and posture, and promoting health and wellness.

Chiropractic has developed a number of treatment approaches in addition to traditional spinal adjustments. These treatment approaches help chiropractors address a wide range of back pain conditions.

Low back conditions that respond to chiropractic care include:

• back sprain or strain injuries
• spinal joint restriction syndromes
• facet joint sprain
• sacroiliac sprain
• lumbar disc injuries that don’t require surgery
• radicular pain or symptoms of numbness in the lower limbs
• spinal stenosis
• various types of chronic low back pain

Before deciding which approach or approaches are for your pain, the chiropractor will do a thorough examination to diagnose the specific cause of your pain.

How a Chiropractor Diagnoses Back Pain

Even if you go to the chiropractor complaining of low back pain, he or she will evaluate your spine as a whole. The chiropractor will check your neck (cervical spine), mid-back (thoracic spine), and low back (lumbar spine). It’s important to examine the entire spine because even though it’s just your low back that hurts, other regions of the spine may be affected.

Your chiropractor will determine areas of restricted joint motion, disc injury, muscle spasm, and ligament injury. One way the chiropractor does that is through motion and static palpation of each unit of motion in the spine. These diagnostic techniques are unique to chiropractic. Motion and static palpation is an examination by means of movement and touch. The chiropractor will feel for tenderness and tightness, and then he or she will examine the spine to see how well each spinal joint moves.

The chiropractor will also analyze how you walk and look at your overall posture and spinal alignment. Those details will help your chiropractor understand your body mechanics and how well your spine is working and moving.

The chiropractic examination includes standard physical and neurological exams. You’ll also go through your past medical history with the chiropractor. The chiropractor may have you get imaging tests (such as x-rays or MRIs) and laboratory tests in order to help him or her diagnose the cause of your back pain.

After the examination, the chiropractor will be better able to create an effective treatment plan for your back pain.

Possible Chiropractic Treatment Approaches for Back Pain

The exact treatment plan depends on your diagnosis. Your chiropractor may use a combination of spinal manipulation, manual techniques, and therapy instruments.

Some possible spinal manipulation treatment approaches are:

Specific spinal manipulation:

Sometimes called spinal adjusting, spinal manipulation is an active, hands-on care that returns motion to the spine. With a return of normal spinal mechanics, muscles relax and pain is resolved. In specific spinal manipulation, the chiropractor identifies the joints that are restricted or show abnormal motion (also called subluxations). He or she then returns motion to the joint with a gentle thrusting technique.

Flexion-distraction technique:

This is a gentle, non-thrusting type of spinal manipulation. This treatment is still hands-on, utilizing a specialized table to assist the chiropractor. It’s especially useful in treating bulging discs and ruptured (herniated) discs.

Thompson Technique:

This utilizes tables with drop mechanisms that enable the doctor to use a hand on thrust that mobilizes the joints when the mechanism hits its resting or normal position. This is highly helpful with pelvic and sacral torsion or a pelvis that is torqued.

Instrument-assisted manipulation:

This is another non-thrusting technique. Using a hand-held instrument, the chiropractor can apply force without thrusting into the spine. This is especially appropriate in older patients with degenerative joint syndrome.

To treat your back pain, the chiropractor may also use various manual therapies. These are used to treat soft tissue (ligaments and muscles, for example) injuries. Some possible manual therapies are:

Trigger point therapy:

The chiropractor identifies specific hypertonic (tight), painful points on a muscle (these spots or areas are pockets of inflammation). Then he or she puts direct pressure (using the fingers) on these points to relieve the tension and / or break up the inflammation.

Stretching:

Here are some important things to keep in mind as you do these low back stretches:

Manual joint stretching and resistance techniques or post isometric stretching: this technique enables the practitioner to fool our body’s defense mechanisms / stretch receptors. By doing so we are better able to further lengthen tight muscles.

Therapeutic massage:

Myofascial release in simple terms is passive shortening and lengthening of the muscle while placing direct pressure over trigger points.

Instrument-assisted soft tissue therapy:

The chiropractor uses instruments to perform repeated strokes over the area(s) of restriction. Research has shown that instrument-assisted soft tissue therapy increases the number of fibroblasts in the area. Fibroblasts are special cells that help heal injuries, including muscle injuries. If there are more fibroblasts, then the strained muscle, for example, can heal faster.

In addition to spinal manipulation and manual techniques, the chiropractor may use various instruments to treat muscle inflammation. These modalities are used to relax the muscles. Some examples are:

Ultrasound:

By increasing blood circulation, an ultrasound helps reduce muscle spasms, cramping, swelling, stiffness, and pain. It does this by sending sound waves deep into your muscle tissues, creating a gentle heat that enhances circulation and healing.

Interferential electrical stimulation:

This uses a low frequency electrical current to stimulate your muscles and pain fibers.

Exercise:

reinforce the improved joint mechanics (return of normal spinal motion); your chiropractor will prescribe therapeutic exercises.

Prevention and Whole Person Care Chiropractors are “whole person” doctors who view back pain as unique to each patient. Therefore, they don’t focus on just your back pain. Chiropractic care includes nutrition, stress management, and lifestyle goals (because all of those can add to back pain, so you need to address them if you really want to relieve your pain).

Chiropractors emphasize prevention as the key to long-term health—another example of chiropractors looking at the whole person, not just the painful problem. Preventing low back pain is vital to the chiropractic approach to care.

If you have back pain, you have many treatment options to choose from, including alternative treatments. Your doctor may even suggest treatments such as acupuncture, herbs, or massage as part of your treatment plan. These options are called “alternative” because they’re an alternative to “traditional” medicine, which generally means medications, injections, and surgery.

Many patients have reported that alternative treatments and nutrition have helped relieve their back pain. You may want to try:

Acupuncture or Acupressure:

These alternative treatments developed in China. Practitioners believe that you have an energy force called your Chi (it can also be spelled Qi, but both forms are pronounced “chee”). When this force is blocked, you can develop physical illness, such as back pain. Therefore, you need to free up your body’s Chi channels, which practitioners call your meridians. Acupuncture and acupressure work to restore a healthy, energetic flow of Chi. Acupuncture uses very fine needles, and practitioners insert them into precise points in your body’s meridians—exactly where is determined by your symptoms. The needles, which contain no medication, are left in for 20-40 minutes. Research has shown that the presence of the needles causes your body to release certain neurochemicals, such as endorphins, and they help in the healing process. Acupressure works along the same principles as acupuncture, except practitioners use their thumbs, fingers, and elbows to target the specific Chi points.

Herbal Remedies:

Before trying any herbal remedies, do your research and talk to your doctor. There may be side effects that you’re unaware of—an herbal remedy could interfere with a prescribed medicine you’re taking, for example. Some herbal remedies you may want to consider for your back pain are:

Anti-inflammatory:

natural supplements and diets are very helpful for reducing inflammation. For example, bromelain when taken in-between meals is a great proteolytic enzyme to decrease inflammation. Products that we carry in the office include bromelain and several other ingredients known to decrease inflammation. Omega 3, 6 are very helpful for not only improving good cholesterol, but, for decreasing arthritic inflammation in general. A product made by Metagenics known as UltraInflammX, is powerful for acute situations and general whole body inflammation. In addition to foods that are anthocyanoside-rich such as cherries and blueberries. Some individuals have food allergies that contribute to inflammation, identifying these foods and eliminating them is the key to reduce whole body inflammation.

Capsaicin Cream:

Capsaicin is what makes chili peppers hot, and it can also relieve your pain. It just temporarily reduces your pain, though, so you’ll need to keep re-applying, probably around 4-5 times a day. It may take several weeks for you to feel significant relief from capsaicin cream, so just because it doesn’t work right away, don’t give up.

Devil’s Claw:

Devil’s claw comes from southern Africa, where it has been used for centuries to treat fever, arthritis, and gastrointestinal problems. It works as an anti-inflammatory. Today, it’s used for conditions that cause inflammation and pain, like osteoarthritis. You can take it in a capsule.

White Willow Bark:

The white willow led to the development of aspirin in Europe. If you don’t want to take the synthetic version (aspirin can irritate the stomach), use white willow bark. It’s for conditions that cause pain or inflammation, like osteoarthritis. It also provides relief for acute back pain.

Massage:

A Spine Universe survey in early 2008 showed that back pain patients are very satisfied with massage as a treatment option. It actually had the second highest patient satisfaction rating. Considering that many cases of back pain are caused by muscle strain and overuse, it’s wonderful news that massage is a worthwhile treatment option. A massage can help release muscle tension and relieve muscle inflammation and pain.

General Back Health:

Let’s face it: even if you don’t have back pain right now, you probably have had it at some point—and you’ll probably have it again. To keep your back healthy, you should try to keep it strong, mobile, and flexible. Going through these easy stretches will help you do just that. Consider incorporating them into your normal exercise routine or making them something you do when you first get up every day. Seeing your chiropractor on a maintenance basis is preventative in avoiding exacerbations or aggravations of a new or chronic condition.

Back Surgery:

You may be fearful of back surgery, but in fact, only 5% of people need surgery to treat back problems. Your pain may be severe, but most conditions do not require surgery. Surgery is reserved for the most severe cases of back pain (spinal cord impingement, structural deformity, severe cases of spinal stenosis).

Surgery should be considered only after you’ve tried several months of non-surgical treatment. Many surgical procedures can be performed using minimally invasive techniques—meaning less “cutting” or entering the body. These techniques result in smaller incisions, shorter hospital stays, less pain after surgery, and a faster recovery.

Some typical spinal surgeries include:

Facetectomy: A procedure that removes a part of the facet (a bony structure in the spinal canal) to increase the space.

Foraminotomy: A procedure that removes the foramina (the area where the nerve roots exit the spinal canal) to increase the size of the nerve pathway. This surgery can be done alone or with a laminotomy.

Laminoplasty: A procedure that reaches the cervical spine (neck) from the back of the neck, which is then reconstructed to make more room for the spinal canal.

Laminotomy: A procedure that removes only a small portion of the lamina (a part of the vertebra) to relieve pressure on the nerve roots.

Micro-discectomy: A procedure that removes a disc through a very small incision using a microscope.

Spinal Laminectomy: A procedure for treating spinal stenosis by relieving pressure on the spinal cord. A part of the lamina (a part of the vertebra) is removed or trimmed to widen the spinal canal and create more space for the spinal nerves.

If your doctor recommends surgery, always ask the purpose of the operation, results you can expect, and possible complications. Feel free to ask for a second opinion if back surgery is suggested; this is your right. Your doctor will be happy to refer you to a specialist to re-evaluate your condition.

Posture and Proper Lifting

Tips to Minimize Stress at the Desk

• Don’t lean over the desk for prolonged periods of time.
• Don’t sit too far from the work and/or with the back unsupported.
• Raise or lower the chair to the proper height so the knees are bent at a 90-degree angle.
• Keep the elbows bent at a 90-degree angle. The elbows may rest on the work surface.
• Don’t bend or twist the neck to cradle the phone against the shoulder.

How to Maintain a Neutral Spine While Standing: The feet should be placed slightly apart with the knees straight and chin tucked in to maintain a neutral spine. Do not stand in one position for a prolonged period of time; shift the weight from one foot to the other frequently. Using a footstool to elevate each foot from time to time may be helpful.

Proper Posture Proper posture means maintaining the natural curve of the spine (neutral spine). Not only should proper posture be used when standing or sitting, but also it should be incorporated into all activities of daily living—thereby minimizing the amount of harmful stress the spine must bear. Proper posture is so important that it may be one of the first things the physical therapist teaches the patient.

What does proper posture look like? Imagine a plumb line hanging from the ear lobe. When proper posture is assumed, the plumb line will drop straight down the middle of the arm to the ankle.

Why is this so important? Poor posture and incorrect body mechanics are two of the leading causes of neck and back pain.

Spine Safety: Carrying

First take a look at the object to be moved. If it appears to be too heavy or cumbersome, find help!

Consider where the object is going. Are there obstacles along the way? If so, move them out of the pathway.

Depending on the shape of the object, try to hold it at the side and bottom while keeping it close to the body. Remember to keep the back straight. Carry the object with the elbows slightly bent. An extra tip…Carry a balanced amount of weight in each hand. For example, when carrying multiple shopping bags or luggage pieces, split the load in two.

The shoulders should be held slightly back and level.

Each ear should line up with the shoulders.

The chin is slightly tucked and the pelvis is shifted forward so the hips are aligned with the ankles.

Spine Safety: Lifting

First take a look at the object to be moved. If it appears to be too heavy or cumbersome, find help!

If there are obstacles in the way, move them before lifting the object.

Maintain good posture and keep the head properly aligned. Try to get as close to the object as possible and bend at the knees.

Spine Safety: Reaching

Consider the size, weight, and location of the object. Use a sturdy stool or ladder if necessary. Don’t even think about standing on tiptoe!

Next, directly face the object and get as close to it as possible. One hand could be used for additional support. Try not to look overhead for prolonged periods of time. This could cause unnecessary stress to the neck. An extra tip…Store items that are used often within easy reach. This may mean rearranging shelves and/or closets.

Don’t lift yet! Make sure the feet are slightly apart and flat on the floor. To turn, instead of twisting the body, pivot with the feet. This will help to provide a stable base of support.

Keep breathing and tighten the stomach muscles. Smoothly lift the object using the arms and legs…not the back!

And remember: Poor posture and incorrect body mechanics are two of the leading causes of neck and back pain.

Different Types of Lumbar Conditions:

Spondylosis: also known as spinal osteoarthritis, can be considered another part of getting older. It means degeneration of the spine from wear and tear, but not everyone will have symptoms as a result of spondylosis. The Spine Universe Spondylosis Center thoroughly explains this disorder, from symptoms and causes to the most common treatments.

Degenerative disc disease (DDD) affects people usually 30 and over because it is caused by the effects of aging on the spine. The intervertebral discs can become stiff and rigid, causing pain and other symptoms. However, there are many treatments, including physical therapy, medications, exercise, and surgery.

Spondylolisthesis is when one vertebra slips forward slip over the one beneath. Here in the Spine Universe Spondylolisthesis Center, you’ll learn about the spondylolisthesis grades, the difference between degenerative and isthmic spondylolisthesis, and why some people don’t have back pain with this condition.

Spinal stenosis: is a condition that the canal that houses the spine cord becomes narrow pressuring the cord which can cause moderate and severe neck and lower back pain. The most common cause of spinal stenosis is aging. Obviously we can not prevent this, but spinal stenosis “prevention” is about practicing certain habits to extend the health of your back. If you already have spinal stenosis, getting regular exercise and using proper body mechanics may help reduce the chances of your spinal stenosis from getting worse. Contact your chiropractor who will be well versed in tailoring these exercises to your needs.

Diagnostic Imaging

You may need to have imaging tests done to help your doctor diagnose the cause of your lower back pain.

You may have an x-ray, which can show the narrowed disc space, fractures, bone spurs (osteophytes), or osteoarthritis. A computerized axial tomography scan (a CT or CAT scan) or a magnetic resonance imaging test (an MRI) can show a bulging disc or a herniated disc. MRI is the gold standard for detecting impinged or pressure against a nerve root that eventually joins other nerves making up the sciatic nerve.

Bone scan: This will help your doctor detect spinal problems such as osteoarthritis, fractures, or infections. You will have a very small amount of radioactive material injected into a blood vessel. That will travel through your blood stream and be absorbed by your bones. More radioactive material will be absorbed by an area where there is abnormal activity-—like an inflammation. A scanner can detect the amount of radiation in all your bones and show the “hot spots” (the areas with more radioactive material) to help your doctor figure out where the problem is.

CT myelogram: In this test, you’ll have a special dye injected into the spinal fluid around your spinal cord and nerves. (Before that happens, the area will be numbed.) Then you’ll have a CT scan done. The image will provide a detailed anatomic picture of your spine, especially of the nerves and the surrounding bone. The doctor will look for areas of compression, or pressure, on the nerves

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Tension/Cervicogenic

Accounts for 80% of all headaches. Characteristics found with this type of headache:

• Starts as a tight feeling over the sub-occipital muscles.
• Usually follows stressful situations and/or related to ergonomics coupled with food allergies.
• Acute tension headaches generally clear initially with over the counter analgesics or with rest.
• Chronic tension headaches may persist through the night and may continue beyond any definable stress period.
• Typically insistence of co-workers or family is a good indicator of serious chronic tension headaches.
• Slight dizziness, decreased concentration, tightness throughout the para-spinal musculature and scalp.

Migraine (Classic V.S. Common)

Common accounts for 90% of migraine headaches-Classic 10%. Classic is a neurological migraine with aura. Aura is a disturbance of nervous function, such as: spots, waves, areas of incomplete vision. In addition these headaches are pulsitile and hemicranial or one sided. Common migraine typically is hemicranial without any aura.

Sensitivity to light and noise, headaches have a duration of a day or two.
Have been linked to dietary intake. Such as, chocolate, cheese, fatty foods, oranges, tomatoes, and onions. These foods are high in tyramine the amino acid that has been proven to trigger a migraine (allergy type reaction).
Alcohol, exposure to glare, sudden jarring and rapid change in the barometric pressure will trigger these headaches.

Basilar migraine-uncommon variant of a migraine.
Blindness, visual disturbances through both visual fields, poor articulated speech, equilibrium difficulties, ringing in the ears, confusion, loss of consciousness, throbbing and occipital in nature.

Cluster or Horton’s cephalgia

Most common in men and alcohol always precipitates no matter how much is consumed.

20-40 years of age, individuals are usually awakened by this headache and the duration is approximately an 1.5 hours.
Starts as a rapid onset of tingling in one nostril followed by a sensation of a red-hot poker feeling up the nostril and/or acid being poured into the eye.
Occurs 2-3 times per night, 2-3 times per year, daytime attacks less frequent.

Withdrawal

Headaches that are the result of illegal drugs, prescription medication, alcohol (hangover), and caffeine.

Intracranial Hematoma and/or Sub-arachnoid hemorrhage*

No trauma with insidious onset. Sudden onset of back, neck and head pain.

Intracranial Lesions*

Progression of an acute condition with a change in pattern over several weeks.

Changes in personality, continuous incapacitating headaches. Anyone with night pain/sweats or headaches should rule out an intracranial lesion.

Arnold-Chiari Malformation*

Congenital herniation of the brainstem and lower cerebellum through the foramen magnum.

*Note: 5, 6, and 7 are ruled in/out with magnetic resonance imaging.

Supplements and self-help for headaches

Magnesium, 250 to 500 milligrams up to 3 (t.i.d.) times per day.
5-hydroxytryptophan (5-HTP)-100mg 3 (t.i.d.) times per day. Tension/Migraine headaches cause an increase in the breakdown of serotonin this results in a decreased pain threshold. The precursor to the production of serotonin is 5-HTP.
Vitamin B6: 25 mg 3 (t.i.d.) 3 times per day.
Fever-few-herb plant that has vasoconstrictor properties.
Fish or Flax seed oils.
Place a cold pack over ones head and submerge your hands in warm water during an acute headache.

Dietary and Lifestyle Recommendations

Consume a diet that focuses on whole, unprocessed foods (whole grains, legumes, vegetables, fruits, nuts, and seeds).
Eliminate alcohol, caffeine, and sugar.
Identify and control food allergies.
Get regular exercise.
Perform a relaxation exercise (deep breathing, meditation, visualization) 10 to 15 minutes each day.
Drink at least 48 ounces of water per day.

Chiropractic care

Evaluation of ergonomics, lifestyle, food allergies, and postural complications with recommendations to resolve these issues.

Treatment utilizing ishcemic compression, strain counter-strain, massage, ultrasound therapy, interferential current therapy, mobilization/adjustments to the cervical and thoracic spine, and exercise tailored to correct ones posture and provide regional stabilization.
Adjustments help relieve paraspinal musculature/zygapophysial joint tension and adhesion’s that occur to allow improved inter-segmental motion and decrease nociception. The muscles and vertebral joints have nociceptive fibers where pain is transmitted through or to each spinal nerve for that respective muscle and/or vertebral level.

Patients that suffer from cervicogenic headaches who have tried conservative chiropractic care should consider manipulation under anesthesia (MUA). The MUA procedure has helped resolve my patient’s headaches 90% of the time on average.

Learn more about about MUA.

Note: there is a possibility that the two blood pressure measurements will not be on the same line. (ie: 210/90 mm Hg). If this is the case, use the systolic measurement to determine the follow up recommendation.

Some commonly asked questions

Arthritis is a disease that begins in the joints of the body, which may later cause complications in the skeletal and nervous system.

Joint Anatomy: Joints are meeting places between the bones or between cartilage and the bone. The entire joint is enclosed in a joint capsule of connective tissue. The capsule is connected to both bones within the joint, to support, stabilize, and hold them together.
The joint capsule encloses a cavity, lined with a synovial membrane. The membrane is filled with synovial fluid, which acts as a lubricant and provides nourishment to the cartilage that covers the tips of the two bones that meet and move within the joint.

Joint Motion: Proper joint motion allows the cartilage to be compressed, squeezing fluid out like water squeezed out of a sponge. When at rest, the sponge-like cartilage absorbs fluids, taking in nutrients that it needs to grow, heal, and function normally.

In the doctor’s office, treatment consists of joint manipulation, to effect the eventual proper functioning of the joints.

In the office and at home, the exercise regimen designed especially for your treatment will assist in the same goal of promoting health and the proper functioning of the joints.

Joint Irritants: Joints must absorb the fluid from the surrounding synovium. This synovium is very sensitive, being an ultra-filtrate of the blood. Therefore, potential irritants must be removed from the blood so that they do not eventually reach the joint and slow your recovery. There are a number of common irritants to the joint hat fall into the following three categories:

1) Allergies: Allergic-reaction by-products are deposited in the joint and cause inflammation. The most common allergens are the following:

* Dairy Products * Grain (Primarily Wheat) * Peanuts * Eggs * Chocolate
*Citrus * Sugar * Nitrate Group (Tobacco, Potato, Tomato, Eggplant) * Mold

Allergens can be detected by blood tests or by a process of fasting followed by the introduction of one food into the diet at a time.

2) High-Fat-Diet: This particularly includes red meat, dairy products, and fried foods. They tend to increase pain and inflammation.

3) Identifying a Leaky Gut: A gut with larger pores allows absorption of substances that are normally excreted. This will cause irritation to the joints as well as other complications.

Joint Pain Relief: Effective pain relief is achieved through improving proper joint motion and the removal of potential irritants. Pain is also aided by specific nutrients, which we recommend in the form of the following preparations.

Niacinamide (Vitamin B3), Relief: This nutrient is very effective for pain relief and improving joint mobility. One tablet of Relief is taken six separate times per day.

Tumeric, Relief and Inflavanoid: This is a natural herb supplement that has provided pain relief due to its anti-inflammatory and anti-arthritic properties.

Vitamin E, Relief and E-Selenium: This fights inflammation and reduces the pain of osteo-arthritis as effectively as the non-steroidal anti-inflammatory drugs in domethacin and phenylbutazone. Vitamin E also helps to fight cartilage destruction.

Fish Oils (EPA-DHA) and fatty acids (GLA). They are able to selectively block inflammatory destructive agents and allow the good anti-inflammatory agents to continue working.
This is very important when a patient has a rheumatoid arthritis or any other inflammatory arthritis. The proper ratio is three EPA-DHA for every one GLA capsule.

Vitamin B6 (Relief and Cortico B5-6). A B6 deficiency symptom is swelling of the synovial tissue in the joints and tendons. B6 reduces pain, swelling, tenderness and numbness.

Vitamin B5 (Relief and Cortico B5-6) and Vitamin C (Ultra Potent-C). These give the adrenal glands support to produce their own cortisone, which offers anti-inflammatory properties. Vitamin C (Ultra Potent C) protects the joint against erosion and acts as a lubricant for the joint.

Joint Nutrition: The proper nutrition required to promote healing includes the following:

Amino Acids and minerals such as Magnesium, Manganese, and Iron (Collagenics) promote healing of bone and cartilage.

Microcrystalline Hydroxyapatite Con-centrate (Cal Apatite). It has been found to increase bone density and restore bone whereas calcium alone can only slow, or at best, stop the process of bone loss. In order to absorb Ca2+ (Calcium) active vitamin D is needed in the colon. Active vitamin D is made when the skin is exposed to sunlight, or if it is taken orally in the active form. Cod liver and evening primrose oils have the active form. Typically, vitamin supplements contain inactive Vitamin D.

Fibromyalgia is a chronic pain condition diagnosed when the patient has 11 out of 18 tender points that are tender to less than four pounds per square inch of pressure, and a chronic non-restorative sleep disturbance lasting more than four months. It is accompanied by a number of changes in the central nervous system and endocrine system that contribute to the symptoms

Are there other conditions that can be misdiagnosed as fibromyalgia?

There are a number of conditions that can be mistaken for fibromyalgia (FMS). The most common is myofascial pain syndrome. Every fibromyalgia patient has myofascial pain (MPS) but myofascial pain patients do not have fibromyalgia. The MPS patients sleep for about four hours before their pain awakens them. FMS patients wake-up every 90 to 120 minutes. The MPS patients typically have six to eight tender points. Some patients have perimenopausal sleep disturbances waking them up at 3 AM and develop myofascial pain or have arthritis.Some doctors are not careful about diagnosis and just put sleep disturbances and pain together and call it fibromyalgia.

Other conditions that can masquerade as fibromyalgia are:

1) Vestibular injuries to the inner ear and balance system.

2) hypothyroidism-low thyroid can make one achy and fatigued.

3) arthritis can create muscle pain and stiffness.

4) Parkinson’s can make you stiff.

5) Lyme’s disease creates full body aching and pain.

In our clinic, diagnosis is the most important part of treating fibromyalgia. It is very important to make sure the diagnosis is correct so we can treat the right condition with the right treatment protocol.

Fibromyalgia seems so confusing. Why are there so many symptoms, and why doesn’t anything work in all FMS patients?

Five different types of fibromyalgia:

In our clinic we have found that FMS seems to start five different ways. The confusing picture becomes clearer when you realize that there are five different types or causes of FMS.

1) Neck Trauma: This type is associated with neck injuries after an auto accident or intubation for anesthesia during surgery, or a fall/lifting accident.

2) Stress and Allergies: This type is associated with chronic prolonged stress, and food or mold allergies.

3) Toxicity: This type is associated with exposure to organic chemicals such as pesticides or solids.

4) Genetic: This type is associated with genetic influences because so many people in the family have it. People inherit food allergies and enzyme system requirements. Enzymes help perform the chemistry your body needs to perform it’s daily functions. They help you make serotonin and allow your liver to detoxify the chemicals you encounter every day.

5) Viral:some people develop fibromyalgia after flu like illness or after being immunized to go overseas.

Where does the pain come from?

FMS patients have full body pain from two different nerve sources depending on how they acquired fibromyalgia.

Class C pain fibers:this form of pain comes from class C pain fibers that carry diffuse non-localized pain. Different kinds of the nerves carry different kinds of pain information. Class C pain fibers respond to chemical stimulation from histamine, inflammatory chemicals and tissue damage. The stress, toxicity, genetic, and viral types of fibromyalgia get their pain from these fibers.

The Spinal Cord and the Brain: in our clinic we think that patients who get FMS after an auto accident have a disc injury that irritates the spinal Cord and changes the way the brain receives pain messages.

Why do fibromyalgia patients feel so awful and have so many symptoms?

This question is a little more complicated but the answer makes sense when you put all the information together. Before this question is answered a part of the nervous system needs to be identified/defined.

One component of our nervous system is called the “Autonomic Nervous System”. This nervous system is divided into two divisions:

1) Sympathetic division (fight or flight)-when our environment threatens us our body has to respond and this aspect of the nervous system kicks in. For example, if you are being chased by a tiger your adrenalin will be activated and blood flow to all parts of your body will increase. Most likely you will not fall asleep or feel relaxed while being chased by a tiger.

2) Parasympathetic Division (rest and digest)-when our environment is relaxing our body will respond accordingly and this aspect of the nervous system will kick in. For example, if you had a large dinner and you sit down next to a warm fire most likely your body will rest/relax and digest.

Fight or Flight: once the pain or other stress starts the sympathetic nervous system reacts as if a tiger is chasing you through the woods. All of the things that would be helpful if you are being chased through the woods by a tiger can become a problem when they go on for weeks or months at a time.Fight or Flight, Leaky Gut and Food Allergies:your cortisol (stress chemical released by the adrenal gland) levels go up so you can fight the inflammation created by the tiger’s bite assuming he caught you. Unfortunately, cortisol can make your gut thin and allow small molecules and food to leak out. 80% of the immune system is clustered around the gut and the immune system can develop antibodies to the food you eat. Immediate food reactions (IgE) make you turn bright red and fall over when you eat something you’re allergic to. Delayed allergies (IgG) reactions come from antibody complexes that are gobbled up by white blood cells (Macrophages). The macrophages essentially get indigestion and secrete histamine when they get too full of the IgG complexes.Class C pain fibers react to the histamine and it can create the pain or make it worse. Sometimes patients start with one type of FMS and end up with pain and fatigue caused by food allergies added to whatever else started the problem.

Fight or Flight and Progesterone:when your stress level has been high for a while the hypothalamus and the brain secretes a chemical called CRH (corticotrophin releasing hormone). This chronic stress hormone directly inhibits the brain hormones that tell your ovaries to secrete progesterone. Progesterone allows you to become and stay pregnant. Why would your brain want you to become or stay pregnant if a tiger has been chasing you for months at a time? When you are not pregnant and you do not get enough progesterone compared to estrogen you get fatigued, depressed, crave sweets, do not sleep well, and gain weight. Does this sound like FMS?Fight or Flight and Thyroid: when CRH is secreted in chronic stress it directly inhibits thyroid stimulating hormone (TSH), so even if you were hypothyroid your thyroid stimulating hormone could not go up to tell your thyroid to make more thyroid hormones. The CRH also inhibits the conversion of the Therefore, they are cold and fatigued all the time, gain weight, and have dry skin and are constipated. Does this sound like FMS? inactive T4 hormone to the active T3 hormone by inhibiting the enzyme that does the converting. If you have all this fight or flight stimulation to your heart and adrenal stimulation to your organs you do not want your thyroid stimulating everything at the same time so the brain tries to quiet the thyroid in times of chronic stress. In summary, FMS patients feel and act hypothyroid but their TSH levels do not go up or cannot go up because TSH is held down by CRH.Fight or Flight and Thyroid: when CRH is secreted in chronic stress it directly inhibits thyroid stimulating hormone (TSH), so even if you were hypothyroid your thyroid stimulating hormone could not go up to tell your thyroid to make more thyroid hormones. The CRH also inhibits the conversion of the inactive T4 hormone to the active T3 hormone by inhibiting the enzyme that does the converting. If you have all this fight or flight stimulation to your heart and adrenal stimulation to your organs you do not want your thyroid stimulating everything at the same time so the brain tries to quiet the thyroid in times of chronic stress. In summary, FMS patients feel and act hypothyroid but their TSH levels do not go up or cannot go up because TSH is held down by CRH.Therefore, they are cold and fatigued all the time, gain weight, and have dry skin and are constipated. Does this sound like FMS?Fight or Flight and Sleep: when you are under stress your adrenal glands put out more cortisol so you can deal with the stress. Therefore, the production of serotonin, which helps you sleep, is impaired. I will explain why…In FMS the stress can be from pain caused by a neck injury or from prolonged life stresses. If a tiger were chasing you through the woods you would not need to sleep. You would need extra proteins and niacin to repair the tissues in danger from the tiger. As a result, your body diverts the amino acid tryptophan away from serotonin production and towards protein synthesis. Tryptophan is only 1% of the amino acids you consume. The reaction that makes tryptophan into 5-hydroxytryptophan (5-HTP) and then into serotonin is just three steps and needs B-6 and an enzyme, but stress and elevated cortisol can impair the conversion. Fight or Flight and Growth Hormone: CRH inhibits the production of growth hormone directly by inhibiting the production of growth hormone releasing hormone from the brain. In an adult 85% of growth hormone is produced during deep sleep. You need adequate serotonin to get deep sleep. But what happens if you do not get enough serotonin? If you do not get serotonin you do not get deep sleep, if you do not get deep sleep you do not get growth hormone. In an adult growth hormone is only secreted during stage four sleep and fibromyalgia patients never get to stage four sleep.

Growth hormone allows the muscles to import amino acids for tissue repair from the wear and tear created during daily activities. If you do not get serotonin, you do not get deep sleep, you do not get growth hormone, you do not get tissue repair. This results in soreness from any level exertion or muscle work. Does this sound like FMS?

Are there any treatments that work?

The medical community uses pain medication; sleep medication to treat the symptoms, antidepressants to improve mood, and serotonin thereby reducing pain perception. Many FMS patients are held by these drugs but continue to have problems with function and quality of life even with drug therapy. Fibromyalgia is not a Prozac deficiency!

In our clinic we tailor the treatment to the type of fibromyalgia. In general we use specific supplements to help the body produce more energy and repair the injured and damage tissues. We use nutritional supplements to help the enzyme pathways function better and actually force them to work in the ways we want them to work, and help the tissues repair themselves.

FMS from neck trauma: we use physiotherapies to calm the spinal cord and relieve the pain. Once the pain is gone the body reacts as if the tiger is sleeping at the end of the driveway and begins to repair itself. Recovery takes about 4 to 6 months depending on how long you have had the condition. Not everyone recovers but most patients improve. We use supplements to help speed the recovery time.

FMS from stress: we perform blood testing for IgG food allergies and send the blood via FedEX to a laboratory operated by an immunologist in North Carolina. Patients avoid the IgG allergic foods for about 4-6 months and then can eat them once every four days. The macrophages stop getting indigestion because the IgG antibodies go into storage. The fatigue and aching caused by the histamine released from the macrophages just goes away. We use microcurrent to speed up this process because it gives the body free energy that it does not have to work for. We use supplements and microcurrent to help the adrenals and the gut to recover.

Genetic FMS: one inherits their body chemistry, your enzyme systems and food allergies. We help the body chemistry to function better with supplements and use them to actually push it in the right direction. We use microcurrent to help this process as well.

Toxicity Exposure FMS: organic or fat-soluble chemicals can dissolve themselves into the fat that lines the nerves. The C class pain fibers become irritated and cause pain. We help the nerve recover by using microcurrent to re-polarize the membrane and some supplements that help the nerve detoxify and rebuild. Lipoic acid is an antioxidant that crosses the blood brain barrier and helps the brain and liver recover from toxic insult. We use 200 mg twice a day and it seems to be very helpful. The body uses essential fatty acids to build the walls of new nerves. Most Americans do not get enough of the right kind of essential fatty acids. Fried foods, red meat and cream have the wrong kind of fatty acids that tend to cause inflammation or make the wrong kind of membrane. Cold-water fish and olive oil (uncooked) make the right kind of fats to decrease inflammation and make new nerves properly. We use EPA/DHA (fish oils) to do this.

Immune or Viral Type of FMS: this is the one type we do not see much and it is one that we have but most difficulty treating. There are ways of improving function and comfort but the recovery has been difficult to achieve.

Sleep: 5-HTP is the shortest safest way to get serotonin. 100 mg of 5-HTP before bedtime helps with sleep digestion and stops bruising. The studies done on 5-HTP show it to be as effective as the major antidepressants but with fewer side effects. We can only use 5-HTP when the patient is not on an SSRI antidepressant, such as, Zoloft, Paxil or Prozac.

Progesterone: most fibromyalgia comes on in women who are of perimenopausal menopausal age. Many physicians forget that women need progesterone to help them make energy and feel good. Lack of estrogen causes hot flashes and sleep disturbance. Lack of progesterone causes fatigue, depression, water retention and weight gain. After salivary hormone testing we use progesterone cream to help women feel better and get their hormones in balance. You need progesterone even if you have had a hysterectomy, although your M.D. may not know this. Sometimes we work with the medical physician or naturopathic physician to determine the hormone regimen that works best for you.

Exercise: exercise helps your body to fight stress, fatigue and depression. We recommend walking and warm water swimming or anything you can arrange/tolerate or enjoy.

Relaxation: visualization and relaxation exercises help to reduce chronic stress and lower the stress hormone levels. Any method that works for you whether it is formal meditation, listening to tapes or watching a relaxation video is just fine.

Avoid: repetitive exercises, swimming and cold water, cold in general, overhead arm use, immobility, sustained yoga postures, and emotional distress.

General advice:

Take it easy. Simplify your lifestyle. Pace yourself. Take time to meet your own needs. Use your available time to do things you find rewarding or satisfying.

Be persistent!

Be positive!

Be determined!

Accept the diagnosis!

Reject the verdict!

Fibromyalgia does not come from space and jump on you. It comes from some very predictable sources that can be addressed and helped.

The most important thing you need to know about fibromyalgia is that it is curable. Not in every case. Not in every patient. But is curable often enough that a cure should be the intended goal of therapy.