Heat vs. Cold Therapy: When to Use Ice and When to Use Heat for Back Pain

Are you an athlete, fitness enthusiast, or someone struggling with chronic pain or mobility issues? In Atlantic County, NJ, sports chiropractic care is revolutionizing how individuals recover from injuries and enhance their performance.

Written by Charlie Annunziata, DC Low back pain (LBP) is the second most common symptom-related reason for clinician visits in the United States (skin disorders was number one) and is THE most common indication for Chiropractic care. In fact, up to 84% of the US population has been found to report LBP symptoms at some point during their lifetime. However, the etiology of LBP is not well understood considering the evidence that people without LBP have structural changes and many LBP patients have no structural changes on imaging studies of the lumbar spine. Long and colleagues performed a standardized mechanical assessment on 312 patients with LBP, with and without sciatica. They were able to successfully subgroup 230 (74%) of these patients, however 26% of the patients did not fit into a subgroup (Long A, 2004). So, the question remains: how do health care providers best assess people with LBP in order to develop a specific and successful treatment recommendation? Might we look beyond the spinal column for the source of, or contributor to, pain and loss of function? Research now shows that limited hip internal rotation can significantly contribute to low back pain. This may be caused by hip joint variants but more commonly by trauma causing adhesion of the hip joint capsule or even prolonged sitting which over activates the hip flexors and abductors and under activates the hip extensors and adductors. This article explores the relationship between hip mobility and lower back health, highlighting how restricted hip internal rotation can lead to various issues in the lumbar spine. Biomechanics Hip internal rotation plays a crucial role in normal gait, balance, and functional movement. When this range of motion becomes restricted, it forces compensation in other parts of the body, particularly the lumbar spine (Sadhegisani, 2015). This compensation can lead to several problems: Lumbar Over-rotation: Reduced hip mobility causes the lumbar spine to over-rotate during everyday movements, increasing pressure on intervertebral discs, muscles, and ligaments. Pelvic Dysfunction: Limited internal rotation, especially when asymmetrical, can cause pelvic imbalances that pull the lower spine into abnormal positions. Altered Biomechanics: The lack of hip internal rotation changes overall movement patterns, altering the natural biomechanics of the spine and pelvis. What Does the Research Say? The correlation between limited hip internal rotation and low back pain is elucidated in many recent studies. Sadhegisani reported that asymmetrical and limited hip internal rotation ROM were common findings in patients with LBP. Reduced and asymmetrical total hip rotation was also observed in patients with LBP. However, none of the studies explicitly reported limited hip external rotation ROM. Proving that not all hip rotation ROM affects low back pain, just internal rotation. Ellison et al. reported that deficits in hip internal rotation are related to both LBP and sacroiliac joint pain (JB, 1990). Another study found that patients with low back pain and positive hip findings such as a positive anterior hip impingement test, FABER test, and/or log-roll test, have more pain and worse function compared to those without positive hip findings. Research has also demonstrated that a loss of hip internal rotation can prevent the pelvis from rotating properly over the stance limb during gait, affecting the coupling mechanics of the sacrum and lumbar spine (Yoon, 2024). What Causes Hip-related Low Back Pain? The development of low back pain due to limited hip internal rotation can occur through several mechanisms such as compensatory spinal motion, pelvic and lumbar muscle imbalances, and repetitive stress syndrome (Sadhegisani, 2015). When hip rotation is limited, the spine may compensate by rotating, extending, or flexing more than it should. Restricted hip mobility can lead to muscle imbalances through overactivity and tightness related muscles such as the piriformis, potentially compressing the sciatic nerve. Repetitive stress injuries also come into play. Even small amounts of repeated rotation in the spine, compensating for lack of hip mobility, can produce microscopic injuries to spinal structures over time. How to Make the Diagnosis Limitations in hip internal rotation can be diagnosed through several assessments such as: Seated Test: The patient sits on the edge of a treatment table with feet dangling, knees and hips flexed to 90 degrees. They are asked to keep their knees together while moving their ankles apart. The Chiropractor may apply overpressure to add a passive component. Prone Test: With knees together and flexed to 90 degrees, the ankles are allowed to fall apart. Overpressure can be applied for a passive component. Gait Observation: While assessing gait you may notice movement compensations such as overpronation of feet, knee valgus, reduced step length, external rotation of the foot during stance phase, increased lumbar and knee extension.

Don’t wait for discomfort to set in—call us today at (609) 365-8881 or (856) 691-6055 or reply to this email to schedule an appointment.

The Snowball Effect of a Weak Hip Abductor Muscle Written by Charlie Annunziata , DC What is your hip abductor and why is it so important when you have pain or dysfunction in your lower back and legs? Think of your hip abductor as a side butt muscle. When it's weak, it can cause a domino effect of problems, such as pain in the low back, knee, hip and even as far down as the foot because of how crucial this muscle is in stabilizing the pelvis and controlling leg movement. Recent research has shown that about 70% of low back pain patients have hip abductor weakness. How It Impacts Different Body Parts Wobbly Hips : This muscle helps keep your hips stable. When it's weak, your hips can become wobbly, especially when you're standing on one leg (like when you walk). This wobbliness can stress your lower back. Low Back Pain: A weak hip abductor can result in increased arch in your lower back and subsequent intervertebral disc compression. It may also cause the body to compensate by relying on other muscles to work overtime. When your side butt muscle is slacking, other muscles must pick up the slack. One muscle in your lower back (called the QL) often works extra hard, which can make your back stiff and painful. Knee Pain: A weak hip abductor muscle can cause the knee to rotate inward, causing the patella to rub against the femur which is known as patellofemoral pain syndrome or runner's knee. This inward rotation creates an imbalance during walking or running, potentially causing lateral meniscus problems and patellar tracking issues. Hip Pain: The most prominent symptoms of a weak hip abductor are hip pain and stiffness. This will cause a muscle on the front of the hip called the TFL to work too hard leading to a forward tilt of the pelvis and pain on the side of your thigh called iliotibial (IT) band syndrome. Foot Pain: As discussed previously, weakness in the hip abductor causes the leg to rotate inward, placing abnormal strain on the foot and causes the arch in the foot to drop. This can lead to pain in the bottom of the foot that does not seem to go away, a condition known as plantar fasciitis. Additional Consequences: A weak hip abductor can also decrease stability and balance which can lead to falls, and abnormal walking patterns which can increase the risk of hip, knee, and foot injuries.  How do we fix this? It is important to understand that strengthening these abductor muscles will prevent or alleviate most of these conditions, improve overall lower body function and reduce pain. First, we diagnose if your pain is caused by a weak hip abductor muscle through specific tests and then determine what is causing the muscle weakness. We then use treatments such as Active Release Technique, pelvic balancing and targeted exercises and stretches designed for you as a unique patient to get the abductor muscle nice and strong. So, let’s say you have been shoveling snow. Every time you lift the snow-weighted shovel and rotate your lower body you are contracting your hip abductor muscle. If that muscle is weak, your body will compensate and cause a “snowball” (pun intended) effect of your hip raising up causing compression and pain in your lower back, your knee rotating inward putting pressure on the inside of your knee as well as causing your knee cap to rub against your femur bone, and the arch in your foot to collapse causing plantar fascia pain. Don't let muscle weakness hold you back from living your best life. Our experienced team of physicians use advanced diagnostic techniques to pinpoint the root cause of your discomfort, providing personalized treatment plans tailored to your unique needs. Whether you're an athlete, active professional, or simply seeking improved mobility, we are committed to getting you back to feeling strong and confident.

Lumbar Spine Facet Joints Karishma Patel, DC Facet Joints are one of many sources of lower back pain. If you have localized lower back pain with the pain starting from 30degrees to 60degrees of lumbar flexion, it may be due to facet joints. What are facet joints? Facet joints link the top and bottom vertebra together. They also allow you to bend forward, extend backward, and assist you in side-to-side movement. Patients who constantly bending over with a weighted load in front of them usually have facet joint hypertrophy, degeneration, and arthritis. For example: Gardeners, Police Officers, Construction Workers, Cyclists, Weight Lifters, etc. Why does this happen? Even though your facet joints help your spine move, they are not supposed to do majority of the work. Your core stabilizing muscles, including your glutes and diaphragm (yes, this also means breathing techniques) are supposed to assist you in movement. If these muscles are inactive, your facet joints are over worked causing a lot of localized, across the back, lower back pain. Get your movement assessed to see which muscle groups are inactive causing you to have a deeper issue. Call to make an appointment today!

Many bodily functions rely on electrolytes to help with organ and nerve function. The most important function being small electric current that passes through nerves to help the brain transfer messages to organs, muscles, and tissue. Electrolytes provide the electric charge that helps the brain communicate to the rest of the body and the body communicate its status back to the brain. Potassium, chloride, calcium, sodium, potassium and magnesium are the most common electrolytes your nerves need. These electrolytes help move nutrients into the cell and move waste out of the cell. If there is an inadequate amount of electrolytes, this imbalance of waste/nutrient in the cell can cause fatigue, decreased energy and brain fog. Other symptoms of having an electrolyte imbalance are latency in rebuilding and repairing damaged tissue (bruising, wounds take longer to heal), increased muscle cramping, and dehydration. When we exercise and exert energy, we lose electrolytes through sweat which causes our bodies to feel fatigued. The more intense the workout and the hotter the temperature, the more electrolytes and water will be lost. When the amount of electrolytes in your body is low, you may experience headaches, confusion, and drowsiness. Here are the functions of each electrolyte and whole food options that you can add to your diet in order stay balanced. You can also add Pedialyte Electrolyte packets to your water to ensure you are replenishing electrolytes readily without adding the calories. Sodium – helps contract and relax muscles; mixed nuts with sea salt Chloride – maintains blood pressure and blood pH; olives, seaweed, rye, tomatoes, lettuce, and celery Potassium – provides electrical nerve conduction, moves nutrients into the cell; spinach, kale, baked potato, peas, avocado, sweet potato Calcium – builds and maintains strong bones, facilitates heart health and nerve function; tofu, leafy greans, bok choy, butternut squash Magnesium – controls energy production, stabilizes blood glucose levels, prevents heart disease; salmon, chicken, almonds, cashews, spinach, dark chocolate, broccoli

Our muscles hold on to tension which cause pain due to chronic physical, mental, and emotional stress. Muscle tension is a reflex reaction to stress; it’s the body’s way of guarding against even more injury or pain. With sudden onset of stress, the muscles tense up all at once, usually in the neck/upper back, shoulders, and/or lower back. Tension is released once the stress passes. However, with chronic stress, your nervous system will hold on to tension and it will accumulate over time in your muscles. This is how chronic pain starts. Chronic stress causes the muscles in the body to be in a more or less constant state of guardedness. When muscles stay taut and tense for long periods of time, this may trigger other reactions of the body and even promote stress-related disorders such as tension type headaches and migraines, nerve compression, disc bulges, and joint pain. Most patients will come into our office and say, “I’ve had this problem for a couple months/years, I’m not really too sure what started it.” This is one of the first signs of chronic stress related muscle pain. What determines whether or not an injured person goes on to suffer from chronic pain is how they respond to injury. Individuals who are fearful of pain and re-injury, who seek a cure for the injury generally have a worse recovery than individuals who maintain regular visits to the chiropractor and do moderate physical activity. Our office provides relaxation techniques and other stress-relieving therapies to reduce muscle tension, decrease the incidence of certain stress-related disorders, and increase a sense of well-being. Muscle manipulation, spine maintenance, and joint care can help reduce long term wear and tear, it does not matter how sedentary or physically active you are. Maintenance care helps keep muscle tension, stress, and joint pain away long term and keeps the nerve tissue healthy.  Give us a call and let’s see how we can help you reduce stress signs and symptoms.

Chiropractic care focuses on protecting and enhancing the communication pathways of the spinal cord, spine, nerves, muscles, and joints, thus safely managing pain and a range of conditions without the use of pharmaceutical medication. The spine not only acts as the main support for our body, it also protects the spinal cord, which connects a large part of the peripheral nervous system to the brain. This is why a minor injury to the spine or overuse of muscles can significantly alter a body’s strength, sensation, and performance. Spinal adjustments are helpful in reduction of pain and increase in function. Chiropractic care can also help joint pain such as shoulder, elbow, wrist, hand, hips, knees, and ankle. Muscles, ligaments, and cartilage connect to bones creating a joint made for movement. If a joint is stuck or not mobile, it stops sending information to the brain or it may increase pain signals to the brain. When you have decreased communication between the joint and muscle, you will have decreased function and often times increased pain. Chiropractic care restores mobility of the joint and increases communication between the joint and the brain. This allows for reduction of pain, better movement of the joint, and injury prevention. Joints and muscles rely on each other. If one is not moving properly other structures will also be affected causing pain with movement. A study conducted by the National Institutes for Health (NIH) reveals that spinal manipulation or mobilization is the most effective treatment for patients with acute, subacute, and chronic low back pain, migraine, headaches and dizziness. It also proves to be an effective treatment for several joint and muscle conditions. Midback adjustments also offer healing benefits to people with neck pain. Long-term care also helps you avoid future aches and pains, as your chiropractor can detect and correct minor misalignments before they become symptomatic.  Please reach out to us for we can explain how the science of pain is affecting you. 856-691-6055

What your pain medication is doing to you A study that tested the attributes of anti-inflammatory ability and absorption of curcumin with boswellia, and black sesame seed oil against acetaminophen revealed that the herbal combination was just as effective and worked as quickly as acetaminophen with both methods averaging about an hour for results. The difference is that the curcumin with boswellia, and black sesame seed oil approach is much safer. Acetaminophen drastically lowers glutathione which is a key health-promoting antioxidant made in the body. A growing body of research suggests acetaminophen reduces a person’s capacity to feel empathy for another’s pain or joy. In fact, due to the way it works in the brain, some researchers have called acetaminophen a “social analgesic” because it cuts off the ability to socially connect at a basic, human level with other people. There are 600+ medications with acetaminophen. This creates a frightening picture of the way this drug can emotionally separate us from one another. When you thinking of stress, fatigue, and social isolation that most people experienced during the pandemic, finding a different approach to managing pain is critical. Curcumin, boswellia, and black sesame seed oil can be apart of that approach. These three botanicals can make an excellent addition to your regime to help them feel better and support their muscles and joints with ingredients that are safe, effective, and do more than just mask pain.