Our bones are constantly remodeling, a balance between the cells that breakdown and the cells that rebuild bone.  When we place excessive demands on an area (from something like excessive running or walking) there can be a net balance of bone breakdown, which can result in a stress fracture. 

What is a Stress Fracture?

A stress fracture is a painful bone injury that can affect anyone.  Common with runners and military personnel, stress fractures are most frequent in the lower extremity.  The symptoms are often confused with those of shin splints or medial tibial stress syndrome.  Specifically, the metatarsals (small bones in the foot) and the tibia (the bone in our leg below the knee) are common sites. 

Stress Fracture – Diagnosis

X-ray is often the first step in diagnosing a stress fracture. Unfortunately, it is not the most sensitive tool for detection.  The literature suggests that on average, pain is usually present between two weeks and three months before an x-ray will detect a stress fracture.  In addition, 85% of stress fractures are missed on the first x-ray and follow-up x-rays only detect them 50% of the time.  Therefore, bone scans or magnetic resonance imaging (MRI) are more useful for detecting stress fractures, but x-rays can serve as a good starting point.  Your medical doctor or your chiropractor can refer you for the appropriate x-rays.

Stress Fracture – Treatment

The primary treatment for a confirmed stress fracture is rest.  In doing this, the bone is allowed to remodel with the net balance in favour of bone building (instead of breakdown).  At present, there are no proven methods for preventing stress fractures in the lower extremities, but there is some research that suggests shock absorbing insoles being potentially helpful.  Common sense would perhaps indicate that a gradual progression of mileage and distance for runners and walkers would help the bone in adapting to increased demands.

Physiotherapists Burlington Ontario

As always, we do our best to bring the most current and accurate information to our clinic and our website. If you have been referred for chiropractic or physiotherapy, have a running related injury or think you may have a stress fracture (or shin splints), call our physiotherapy clinic in Burlington.  We can help! 905.220.7858!  info@burlingtonsportstherapy.com

References
Arendt E, Agel J, Heikes C et al. Stress injuries to bone in college athletes: a retrospective review of experience at a single institution. American Journal of Sports Medicine 2003; 31(6):959-968.
Moran DS, Evans R, Hadad E. Imaging of lower extremity stress fracture injuries. Sports Medicine 2008; 38(4): 345-356.
Rome K, Handoll HH et al. Interventions for preventing and treating stress fractures and stress reactions of bone of the lower limbs in young adults. Cochrane Database Syst Rev. 2005; 2:CD000450.
Shaffer SW, Uhl TL. Preventing and treating lower extremity stress reactions and fractures in adults. Journal of Athletic Training 2006; 41(4): 466-469.
Yeung EW, Yeung SS. Interventions for preventing lower limb soft-tissue injuries in runners. Cochrane Database Syst Rev. 2001; 3: CD001256.
Yochum TR, Rowe LJ. Essentials of Skeletal Radiology 1996, Williams and Wilkins.

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If you’re experiencing lower back pain and wondering if your sitting posture is aggravating your condition, you may be right.  The following are some of suggestions…

Low Back Pain and Curvature

Several studies have found that a flat or flexed spine (pictured on the right) causes the lower back muscles to relax.  Although this may sound beneficial, it places a greater strain on passive structures like intervertebral discs, ligaments and joint capsules.  A flexed posture would likely aggravate a lumbar disc herniation (“sciatica” or “slipped disk”).  Lumbar lordosis (pictured on the left) loads the various structures of the lower back more evenly so that one area is not exposed to excessive forces.

Low Back Pain and Sitting

Many people are under the impression that once ideal sitting posture is attained you will be safe from pain or injury. This isn’t really true. According to several studies published in very credible journals, mixing up your posture keeps the joints lubricated and helps to prevent sustained loading of a single structure. This strategy would be helpful for many types of lower back pain including arthritis, facet joint irritation, disk bulge or disk herniation and spondylolisthesis.

Low Back Pain and Muscular Support

As mentioned previously, it is not ideal to have the muscles completely relaxed. A recent study published in the journal Clinical Biomechanics looked at female office workers and their sitting posture throughout the workday. Interestingly, they found that the muscles in the lower back were very inactive while seated. The authors of the study found that this was a response to their spines being in subtle flexion (slightly rounded forward, or “flat” in the lower back). As a result of this lowered muscular activity, the subjects of the study endured a sustained stretch of passive structures in the lower back, ultimately causing pain and dysfunction. A gentle contraction of various abdominal and lower back muscles is recommended to help support the spine and dissipate the load on passive structures.

Low Back Pain – Ice or Heat?

This is a relatively simple topic.  For most people, ice of short duration (ten minutes on and ten minutes off) is a safe bet in cases of acute injury.  For more chronic cases, the advice is a little different.  In our Burlington clinic we usually recommend those patients with chronic lower back pain to try both ice and heat to see what works better for them.  Personally, I usually feel that ice is a safe bet in most circumstances.  Of course, this blog never intends on providing direct advice…always consult with a healthcare practitioner before “self treating” any injury. 

Low Back Pain Clinic in Burlington

Are you experiencing low back pain and looking for a clinic in Burlington Ontario?  Our clinic offers various treatment options for patients experiencing lower back pain. Provided through our Chiropractors and Physiotherapists, we offer active release therapy, graston technique, laser therapy and traditional modalities like interferential current (IFC) and ultrasound.  Feel free to contact us for an appointment or for more information – 905.220.7858 info@burlingtonsportstherapy.com.

References
Corlett EN. Background to sitting at work: research based requirements for the design of work seats. Ergonomics 2006; 49: 1538-15546.
Mork PJ, Westgaard RH. Back posture and low back muscle activity in female computer workers: a field study. Clinical Biomechanics 2009; 24: 169-175.
Pynt J, Higgs J, Mackey M. Milestones in the evolution of lumbar spinal postural health in seating. Spine 2002; 27: 2180-2189.
Williams MM, Hawley JA et al. A comparison of the effects of two sitting postures on back and referred pain. Spine 1991; 16: 1185-1191.
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Many people with chronic lower back experience low back stiffness in the morning after waking.  This can occur for many reasons but it does beg the question, what is the best mattress for lower back pain?

The Word on Mattresses from a Burlington Ontario Chiropractor

Back Pain and Mattress Selection

A 2003 study published in the journal “The Lancet” investigated this topic.  Subjects of the study were either given a medium-firm or a firm mattress to sleep on for a 90 day period.  Throughout this period patients were asked to rate the level of pain while in bed, rising from bed and pain throughout the day, as well as the level of perceived disability throughout the day.  At the end of the 90 day period the results suggested that a mattress of medium firmness improves pain and disability among patients with chronic non-specific low back pain.

So a Firm Mattress is the Best for Lower Back Pain?

A different study published in the journal Spine compared three different mattresses; the waterbed, a foam mattress and a hard futon mattress.  After a one month trial it was found that the waterbed and foam mattress were better for back pain and sleep when compared to the hard mattress, albeit the differences were small.

So What is the Best Mattress for Back Pain?

Yes, the research is conflicting…there is no easy answer.  Although a hard mattress is commonly believed to have a positive effect on low back pain, the published research fails to support this theory.  Therefore, mattress selection is personal and subjective…our best advice is to shop around and find a mattress that suits your individual needs! 

Back Pain and Sleep…

Unfortunately this blog has been unable to provide you with an easy answer for back pain and sleeping.  The reality is, there is no perfect posture or perfect mattress that will eliminate lower back pain.  Our Chiropractic Clinic in Burlington usually recommends alternating your sleeping postures (perhaps try side-lying with a pillow between your legs…stomach sleeping usually isn’t recommended) and rotate your mattress regularly.  If you find that your mattress won’t allow your spine to stay in a “neutral” position it may be time to go mattress shopping.  Need help?  We can help! If you’re experiencing lower back pain and you live in the Burlington area, feel free to give us a call.  Our Burlington Chiropractors can help with your pain and also offer long-term strategies for exercise and sleep.  Call us at 905.220.7858.  info@burlingtonsportstherapy.com

References
Bergholdt K, Fabricius RN, and Bendix T. Better Backs by Better Beds? Spine 2008; 23: 703-708.
Kovacs FM, Abraira V, Pena A, et. al. Effect of firmness of mattress on chronic non-specific low-bacl pain: randomized, double-blind, controlled, multicentre trial. The Lancet 2003; 362: 1599-1604.

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Recently I was lucky enough to go to Costa Rica for a week of surfing. Needless to say it was a great time, but as I’ve experienced in the past, my shoulders are now paying the price.  For this week’s blog I thought I’d suggest a few exercises for any fellow novice / occasional surfers out there. With some diligence, you’ll either catch waves easier or avoid the type of pain I’m currently experiencing!

Standing Extension – Stand with the elbows close to straight, squeezing the shoulders back and down. From the approximate height shown, extend the arms to a neutral position, primarily activating the latissimus dorsi muscle.

Prone Paddle – While lying with the arm outstretched overhead, pull the resistance down the length of your body, mimicking the surfing paddle. The resistance can be moved up and down to challenge different components of the paddle movement.

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The incidence of injury among distance runners is estimated to be between 37-56%.  Of these, pain in the area of the patellofemoral joint (near the “knee-cap”) is one of the most common complaints.  Thankfully, some recent research has uncovered some of the risk factors for this condition.

Patellofemoral Syndrome Risk Factors

Traditionally, it has been understood that the risk factors for patellofemoral pain have been related to different aspects of the knee.  Some of these include malalignment of the patellofemoral joint, imbalance in the muscles around the joint, weakness in the quadriceps or abnormalities in the bone.  Interestingly, the scientific research has not been able to agree on whether fallen arches have any bearing on this condition.

Patellofemoral Pain and Running Impact

A 2008 study published in the British Journal of Sports Medicine has helped to identify that patellofemoral pain can be related to impact.  Specifically, they found that those who developed patellofemoral pain ran with a higher impact (at footstrike) in the outside of the heel and in the second and third toes (during push-off).  So what does this mean? 

Run Lighter for Patellofemoral Pain?

Traditionally, patellofemoral pain has been attributed to alignment factors.  Given the new literature, we now know that it can also be related to impact.  Although we don’t recommend that you change your running technique without the help of a qualified professional, you may want to lighten your step if you’re known to be heavy on your feet! 

Physiotherapy for Patellofemoral Syndrome

Treatment for patellofemoral syndrome can vary.  Frequently (but not always) the goal of treatment is to manually treat and “release” the lateral structures of the quadricep, hamstring and the iliotibial band combined with strengthening aimed at the gluteals and the inside of the quadricep.  Quite often, this involves the use of active release technique and graston technique.  For more information, please contact us at 905.220.7858  info@burlingtonsportstherapy.com

References

Powers CM, Chen PY, Reischl SF et al. Comparison of foot pronation and lower extremity rotation in persons with and without patellofemoral pain. Foot and Ankle International 2002; 23: 634-640.

Thijs Y, Clercq D, Roosen P, Witvrouw E. Gait-related intrinsic risk factors for patellofemoral pain in novice recreational runners. British Journal of Sports Medicine 2008; 42: 466-471.

Wen D, Puffer JC et al. Lower extremity alignment and risj of overuse injuries in runners. Med Sci Sports Exerc 1997; 29: 1291-1298.

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