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Back Damaging Posture: Chiropractic Correction


Aaron was a final-year high school student and keen soccer referee. Complaining of mid-back pain, especially after he had refereed three or even four matches in a single day (which he often did). He experienced this same pain when he was sitting studying, but it was more prevalent after refereeing. He also advised me his quadriceps appeared to fatigue a whole lot more than the rest of his muscles after running around a whole lot. Scientific spine specialist, Dr. Alexander Jimenez takes a look at the case.

My first assessment of Aaron's spinal posture was that he was quite kyphotic (bent forwards) through his torso, with accompanying cervical spine flexion -- in sitting he simply flexed forward all the way through his spine.

He experienced his mid-back pain when he strove to extend or straighten himself up, so when he corrected his stance that the pain came on. The erector spinae muscles in their own mid-back proved very developed and seemed like thick ropes.

When I assessed Aaron's lumbo-pelvic stability, things got really interesting. I was seeking the way gluteus maximus and the psoas major muscles were performing, each of which help to control the impartial position of the pelvis under load. He'd shake all around the area.

To assess psoas major, I asked Aaron to sit and control the natural arch in his low back (neutral posture) as he lifted and hauled his bent leg in flexion past 90° (just an easy knee elevator). He was not able to maintain the leg even slightly off the floor without slipping together with his low back.


Finally I asked him to stand on one leg and feel the gluteal muscle activating on that side, while swinging the other leg through as if he were running. Initially he couldn't trigger his gluteal muscles without a great deal of concentration. When he tried to perform the leg swings without moving his anus, he almost fell over.

The runner needs to have quite an upright posture, letting the upper body to flex forward slightly, but not too much. The gluteus maximus gives a small amount of hip extensor muscle torque but much more importantly, it controls the upright position of the pelvis on the hip. Without this the body would just bend ahead. Isolated hip flexion is also necessary, in order that the lower back is kept in its neutral arch when the runner initiates the swing phase.

As soon as I examined Aaron's running posture, he had been very flexed at the hip, almost leaning over at about a 25° angle. He was managing to maintain his lower back neutral, however, the erector spinae muscles were working extremely hard in this place. He explained that he could feel this occurring and was hoping to liven up -- but he'd been doing this through his chest. This overuse of the erector spinae muscles are what had led to his growing mid-back pain.

The thoracic spine is affected substantially by the placement of the spinal column in all positions, from sitting postures to swinging a golf club, throwing a ball or running. The mid-back requires a stable platform in the lumbar spine where to execute its freedom functions. This is especially important in throwing sports but is also crucial in activities like swimming.

Thoracic spine motion in running should mainly involve rotation as this helps to counterbalance the hip flexion moment produced at the opposite hip. Over-activity at the thoracic extensors is counterproductive not only for performance but also for injury.

Treatment

But we also needed to correct the pelvic muscle weaknesses that were acting on the thoracic spine and hip. I instructed Aaron to stand and operate tall throughout his hip place, with his gluteals, to take the load off the thoracic erector spinae. To be able to strengthen the gluteals so that they were up to the job, I made him to carry out the one legged bridges (see Figure 1). And in standing, I tied a piece of tubing around the ankle of one leg, and that he then utilized to mimic the running swing phase while he concentrated on keeping his pelvis fairly still on his stance leg (see Figure 2).




We also needed to tackle the quadriceps muscle fatigue. My theory here was that he was overusing his quads as a consequence of poor hip flexion when running. Insufficient hip flexion and upward drive would generate a shallow swing stage. This would cause one to plant his foot early, creating a braking kind of activity which forcibly ceased ahead propulsion of the body. It was like he had been thumping down on the floor with each step rather than maintaining forward momentum.

Aaron's symptoms eased up quite quickly once he managed to fix his functioning posture and recruit his stabilizing muscles. I encouraged him to continue his exercises for the next six to eight months so that he would fully integrate the muscular recruitment routines into his running technique.

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Professional Scope of Practice * The information on this blog site is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Blog Information & Scope Discussions Welcome to El Paso's Premier Wellness and Injury Care Clinic & wellness blog, where Dr. Alex Jimenez, DC, FNP-C, a board-certified Family Practice Nurse Practitioner (FNP-BC) and Chiropractor (DC), presents insights on how our team is dedicated to holistic healing and personalized care. Our practice aligns with evidence-based treatment protocols inspired by integrative medicine principles, similar to those found on dralexjimenez.com, focusing on restoring health naturally for patients of all ages. Our areas of chiropractic practice include Wellness and nutrition, Chronic Pain, Personal Injury, Auto Accident Care, Work Injuries, Back Injury, Low Back Pain, Neck Pain, Migraine Headaches, Sports Injuries, severe sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Complex Injuries, Stress Management, Functional Medicine Treatments, and in-scope care protocols. Our information scope is limited to Chiropractic, musculoskeletal, physical medicine, wellness, contributing etiological viscerosomatic disturbances within clinical presentations, associated somatovisceral reflex clinical dynamics, subluxation complexes, sensitive health issues, and/or functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and has identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies that are available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how they may assist in a particular care plan or treatment protocol; therefore, to discuss the subject matter above further, please feel free to ask Dr. Alex Jimenez, DC, APRN, FNP-BC, or contact us at 915-850-0900. We are here to help you and your family. Blessings Dr. Alex Jimenez DC, MSACP, APRN, FNP-BC*, CCST, IFMCP*, CFMP*, ATN* email: coach@elpasofunctionalmedicine.com Licensed as a Doctor of Chiropractic (DC) in Texas & New Mexico* Texas DC License # TX5807 New Mexico DC License # NM-DC2182 Licensed as a Registered Nurse (RN*) in Texas & Multistate  Texas RN License # 1191402  Compact Status: Multi-State License: Dr. Alex Jimenez DC, APRN, FNP-BC, CFMP*, IFMCP*, ATN*, CCST