As unfortunate as it is, loss of normal spinal curvature and poor posture are extremely common. Given the amount of time we spend staring at various screens—whether sitting at an office desk or walking down the street—it’s not surprising that our bodies are being affected. It’s also not surprising that back and neck pain has become the second most frequent reason for visiting a doctor.
Many people presenting with back and neck pain also suffer from a loss of normal spinal curvature. Luckily, there are a number of treatment options that can be used to restore the normal curve and to help patients relearn good posture. Broadly speaking, loss of the normal curve most commonly involves one of three conditions: lumbar hyperlordosis, scoliosis, and abnormal kyphosis. Each has a number of curve rehabilitation techniques associated with it.
Patients with lumbar hyperlordosis (also known as “swayback” or “saddle back”) have developed an exaggerated arch in the lower back (the lumbar region of the spine) that typically makes the buttocks and belly appear more prominent. The treatment approach will often depend on the severity of the abnormal curve and the amount of mobility that still exists in this area of spine. If the curve is not flexible, then it is more likely that treatment will be necessary.
Since hyperlordosis places unusual stress on the vertebrae and spinal discs, failing to seek treatment increases the risk of accelerated spinal degeneration, disc herniation and other structural problems. These, in turn, can cause pain and limit function. Over time, other areas of the body—including the hips, legs and internal organs—may also be affected.
Chiropractors are experts in diagnosing and treating a wide range of musculoskeletal conditions that affect the back and neck. Depending on the situation, they may use a combination of chiropractic adjustments, spinal molding blocks and foam rolls to restore the normal curve. They will also work closely with patients to make postural adjustments, strengthen core muscles and increase range of motion. When a child has hyperlordosis, treatment may involve a brace, which helps to ensure that the abnormal curve doesn’t worsen as he or she grows.
For the most severe and painful cases of hyperlordosis, surgery may be necessary. The objective of this surgery is to correct the severity of the curve and provide additional support for the body’s frame. Such surgery may involve metal rods, hooks, or screws. Surgeons may also use a bone graft to stimulate new growth and strength.
The word “scoliosis” is more widely recognized than hyperlordosis among the general public. It refers to an abnormal c- or s-shaped lateral curvature of the spine—one that is apparent while looking at an individual from the front or back. In some cases, a patient’s head may appear off-center or one shoulder or hip may be higher than the other.
In about 80% of cases, the cause of scoliosis is not known. This is generally referred to as “idiopathic”. Scoliosis may also be “functional” (an abnormal curve develops because of a problem elsewhere in the body), “neuromuscular” (a curve is caused by abnormally formed vertebrae) or “degenerative” (the curve is the result of deterioration, damage or weakness in the spine’s supporting structures—bone or soft tissue—during later years).
Treatment options for scoliosis depend on the severity and location of the curve, its cause and the likelihood of it getting worse as the patient gets older. Treatment typically involves braces for children and adolescents if their spinal curves are between 25 and 40 degrees. However, the brace’s straightening effect only lasts as long as the patient wears it. Those with a curve beyond 40 degrees to 50 degrees are often candidates for scoliosis surgery. As WebMD puts it, “The goal is to make sure the curve does not get worse, but surgery does not perfectly straighten the spine. During the procedure, metallic implants are utilized to correct some of the curvature and hold it in the correct position until a bone graft, placed at the time of surgery, consolidates and creates a rigid fusion in the area of the curve. Scoliosis surgery usually involves joining the vertebrae together permanently—called spinal fusion.”
Abnormal kyphosis is an outward curvature of the thoracic spine (middle back) that results in a “hunched forward” or “hunchbacked” appearance. It is often caused by poor posture. In these cases—referred to as “postural kyphosis—a chiropractor can reduce the hump by prescribing lifestyle changes and strengthening exercises that improve posture. He or she may also use a variety of spinal adjustment techniques to reduce pain and inflammation, calm muscle spasms, restore range of motion and slow the rate of disc degeneration in the middle back.
Knee pain is one of the most common orthopedic ailments treated by chiropractic physicians. This isn’t too surprising when you stop to think about it. After all, the knee absorbs an enormous amount of stress and is designed to bend in only one direction. At the same time, though, many of the movements we make (particularly in sports) force the knee to bend slightly in other directions while still requiring it to support the full weight of the body in motion above it. If the biomechanics are off or the joint and surrounding muscles aren’t strong enough, this is a recipe for potential knee pain and injury.
But athletics don’t account for as much of today’s knee pain as you might suspect. The larger culprits are obesity and sedentary lifestyles. You may not realize it, but this combination isn’t just bad for cardiovascular and metabolic health. It’s also bad for musculoskeletal health! All that extra weight adds to the daily wear and tear on the body’s frame—bones, muscles, and joints. But especially the knees! We suspect this is one of the key reasons we’re seeing a dramatic increase in some types of knee surgery as well as full knee replacements among patients who are still relatively young.
That’s the bad news. The good news is that it doesn’t have to come to this. The chiropractic approach to knee pain starts with prevention and favors early, conservative treatments that don’t involve the risks associated with surgery and drugs.
Wear the proper shoes for your needs and use custom orthotics if appropriate. If your feet are overpronated (roll to the inside) or supinated (roll to the outside), or if you have fallen arches, it can affect your biomechanics when you stand, walk or run. Over time, this can lead to compensation higher in the body that produces uneven wear and tear on your knees and increases the risk of injury. The same thing is true for your hips and back.
Your chiropractor can analyze the structure of your foot as well as your posture and gait (the way you move when you walk and run) to assess your biomechanics. If necessary, he or she may recommend custom orthotics as well as exercises or changes to your biomechanics in order to relieve pain, prevent future problems and (if you’re an athlete) improve performance.
Be smart about how you exercise and listen to your body. This can be a particular problem for “weekend warriors.” Many middle age adults (more men than women) overestimate the physical condition they’re in. They often can’t or don’t exercise regularly during the week but still want to go all-out in weekend competition. This can contribute to an overloading of the muscles, tendons, and ligaments in knees that aren’t strong enough to handle the sudden surge in physical demands. It’s not surprising that acute knee injuries and/or an accumulation of micro-tears are frequently the result.
Lose weight if you need to—and the sooner the better. Any high-impact activities are extra hard on the knees if you’re overweight, but exercise is clearly critical to burning more calories and reversing the situation. What can you do? The answer is to focus on lower-impact activities that burn lots of calories while saving your joints until you achieve a more normal weight. Swimming, rowing and cycling are all good candidates.
It’s important to recognize and get ahead of this issue early, since being overweight or obese can lead to chronic joint problems, which can reduce your ability to be active. This in turn increases the risk that you’ll gain even more weight in the future. One of the best ways to reduce unnecessary wear-and-tear on your knees, hips and back and to avoid the vicious cycle of weight gain, musculoskeletal pain and inactivity is to lose extra pounds EARLY!
Increase your strength and flexibility. Concentrate on strengthening and stretching the hamstrings, quadriceps, hip flexors and the vastus medialis oblique (VMO) muscles, since these provide the greatest support to the knees and ensure that the patella tracks properly. Women are especially prone to improper patellar tracking, which places more stress on the ligaments of the knee. This creates a popping or grinding sound when you bend the knee, often accompanied by pain. Yoga and Pilates are good ways to keep the muscles, tendons and ligaments of the leg and knee strong and flexible.
Get regular chiropractic treatment. A well-trained and experienced chiropractic physician will be able to perform a variety of specialized adjustment, manipulation and mobilization techniques that can relieve pain and improve function in the knees. In certain cases, manual therapies such as chiropractic care may offer just as much benefit to knee injury patients as arthroscopic surgery. A group of researchers who recently published their findings in the Canadian Medical Association Journal looked specifically at the effectiveness of a common procedure called “arthroscopic meniscal debridement” for age-related meniscus tears in middle-aged patients and concluded that more conservative (non-surgical) treatment should actually be the preferred first-line option.
Know your options. All of this is NOT to say that surgery isn’t sometimes necessary or helpful to relieve pain and help people lead an active, healthy lifestyle. Knee replacement surgery offers new mobility to patients whose joints have been compromised and has allowed millions of people to be active once again, when previously they would have had to be confined to a wheelchair.
However, we believe that patients should explore more conservative options before deciding on surgery. Chiropractic care and other manual therapies have many advantages over treatments that involve surgery and drugs. This has been pretty well established when it comes to relieving chronic back and neck pain and restoring mobility. Now there’s new evidence that this may apply to a common knee injury as well. For instance, a recent study conducted in Finland found that patients who underwent a partial meniscectomy to address problems related to torn knee cartilage were actually no better off than patients in a control group who received a “simulated” surgical treatment (the surgical equivalent of a placebo). And another recent study demonstrated that physical therapy was just as effective as knee surgery for patients with both a meniscal tear and osteoarthritis.
So—in our view—the best thing you can do is to take good care of your knees NOW, before the need for surgery arises. Remember—the things you do today can prevent serious problems tomorrow. Call or visit our office today to learn more!