Throughout Episode 23, Ashley Brewer and Dr. Alex meet to discuss lower back pain and how it relates to scoliosis. Lower back pain is one of the most common reasons employees miss work, so it definitely deserves its own episode.
During Ashley's conversation with Dr. Alex you'll hear:
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Hello, and welcome to the show. I'm Ashley Brewer, your host. Today, I'll be joined by Dr. Alex from South Florida Scoliosis Center in Miami. For episode 23, we discuss the topic of Low Back Pain and How It Relates to Scoliosis. If you suffer from low back pain and don't have scoliosis, you will still want to tune in, as Dr. Alex provides extremely helpful advice for individuals who are living with or without scoliosis. Here's a bit more about Dr. Alex before we get started. Dr. Alex received his doctorate in Chiropractic from Life University with a minor in Nutrition and has been practicing chiropractic for over 15 years. He also holds a degree in Physical Therapy from the University of Miami and has been certified to treat scoliosis since 2007. Dr. Alex is a member of the International Chiropractic Scoliosis Board. As always Dr. Alex brings charisma and a plethora of knowledge and information to the table in today's discussion. Episode 23, let's go!
You're listening to Life Beyond the Curve, a podcast brought to you by CLEAR Scoliosis Institute. Each week, we interview experts in the industry, answer your pressing questions, and empower you to take control of your scoliosis diagnosis and live life to its fullest. Enjoy the show.
Hey, Dr. Alex, welcome to Life Beyond the Curve. It is always great to have you.
Hi, Ashley, great to be here today.
So today we are going to be talking about low back pain. And the reason I believe this topic is very, very important is, according to the National Institute of Neurological Disorders, low back pain is one of the most common reasons people miss work. So I know this is a very broad topic, and there are a variety of reasons why people may experience low back pain, but let's, let's start there. What are some of the reasons people may experience back pain? I know for you as a chiropractor, that's a broad question, but let's just start with some of them.
Yeah. So that is a really pretty well-known study, actually, that was done that, um, work comp and HR put together a research study. And I can't cite the study because I don't know the dates, but they wanted to see, okay, what's costing them money? And one of the things that was costing them money was employees not being able to go to work because of this lower back pain. So this is how this study came to be. Now, most of the time, what people don't realize is lower back pain is not usually just a sudden thing, right? Because everybody expects to be low back pain, I fell, I had a car accident, I bent over and picked something up, and that's what they associate low back pain with. But what they don't realize is once you're there, you have probably had dysfunction or lack of normal function for a really long period of time.
The number one culprit is usually sitting, right? So, sitting, we really start to change the mechanics in our spine because muscles get tighter and looser based off of how you're actually sitting. Now, there was a saying that, uh, Formica is like cabinets, right? So Formica is just basically thin pressed layers of wood. What actually happens is over time, that is exactly what happens to your butt. You know? So your butt starts to get flat, believe it or not, from all this sitting, but at the same time, the spinal position starts to change as well, because there's muscular attachments that run from the back into what's quote, unquote, the butt or the pelvic area in the lower back. So you don't realize it, but just sitting here, listening to me talk, right. You know, you're probably in a bad position, whether you have pain or not, that will eventually lead to some kind of low back disorder. So that's the most common one.
That makes sense. Yeah, go ahead.
Yeah. Now I, look, this, I could have diarrhea of the mouth here because there's so much to talk about. So cut me off when you're ready. Right? So sitting is, like I said, is the most common one, but let's go to the next one. So you sit eight hours a day because most people are working eight hours a day. Now, if you're working from home, because we're in the middle of pandemic, now you have to think, okay, I'm not in an office in a proper office chair. I'm sitting on my couch, or I'm slouching over my kitchen table or my dining room table or whatever, where you're on a laptop. And now you're like really hunched over and curl into diving the computer, which again is obviously in another terrible position. But now let's go into sleep patterns, right? So most people, let's say they hope to get five to eight hours of sleep, maybe more, maybe a little less, but how are you sleeping at night? One of the worst things that you could do is sleep on your stomach and people don't realize that. And the reason that happens is, again, it changes the biomechanics in through the spine. So the way you sit, let's say eight hours a day at work, then the way you sleep, let's say minimum five hours a day at work, you're already right there. And almost 15 hours of a 24 hour a day. Right? So that's a big issue that people don't realize, is those are two simple things that you take for granted. Now let's talk about driving. Some people have a five minute commute. Some people have a two hour commute, and some people, their job is driving and they're driving all day. So they're not sitting properly.
If the proper position is not in the chair, You're going to start to have problems. Then you also have the road being bumpy or sitting off to the side or putting a wallet on one butt cheek uh, in your back pocket, which is a Seinfeld episode, I think we talked about that in a previous episode. So those are the sitting things that people just don't pay attention to. And it could start with something simple like that. Then we talked about sleeping, right? So best position to sleep is usually on your back or on your side, as long as it's not your stomach. That's good. When you're on your back, one of the key things I tell people is stick to one pillow. You don't have to use two, three, four pillows, because once you start to do that, you start to crank your neck forward, and that starts to shift your whole spinal position. So that's one. When you lie on your side in bed, you gotta pay attention to the height of your pillow, right?
So if you're lying on your side, if the pillow's too small, your head and shoulder are almost touching. The pillow is too big, the opposite is going to happen, is your head's going to crank the complete opposite way. So everybody asks me, what kind of pillow should I get? What kind of bed should I get? Well, the key is this: for bed purposes, just get yourself something that supports you, right? Again, bed, most beds last eight to 10 years, or eight to 12 years, find a price point that you're happy with, test a bunch of different beds in that price point and see what you like, but I'll tell you more firm is better, right? So the more support you have is better, right? So you don't have to spend 10,000 bucks. If you want to spend $500, say, okay, I'm going to, I'm going to test everything in that $500 range and try different mattresses.
And nowadays the technology is so great that you just have to find a price point you're comfortable with, find one that you like and just go with it, right? So for sleep purposes, again, get yourself a good mattress, get yourself one pillow, just support yourself properly so that your spine is in neutral, whether you're lying on your back or on your side. And what I mean by that is if you're on your side, your pelvis and your head should be balanced with a spine straight in between. So if you're lying on your side, the head shouldn't be higher or lower than your pelvis. If you're lying on your back, you should kind of be in a neutral position. Some people sleep with neck rolls. Those are fine. Some people sleep with cervical pillows. Those are okay, but my only problem with those cervical pillows is a lot of people toss throughout the night where they're just going to lie onto their side and that cervical pillow's now too small, and now they start to get a different problem. So that's the sleep one.
So now we've dealt with the fact that you sit for extended periods of time at home, at work, at school, you know, while you're commuting, then we deal with the fact that you're sleeping in a bad position and you're already losing. Now, let's talk about those that say, I'm healthy, I work out all the time. Okay, you work out all the time, but you use really bad mechanics or really bad posture when you're doing that. So another issue, right? How many people come into me because they hurt themselves at the gym, doing deadlifts, doing CrossFit. Why CrossFit now? Why does CrossFit get such a bad name? For those out there, listening to this, it's because it's a high demand activity where most people use really bad range of motion. So if you use proper range of motion, you were educated in proper range of motion, shouldn't be a problem. But when you try to go fast, hard, and heavy, and you're not using proper range of motion, the system is going to break down. It's just like a machine. Eventually you stick a, you stick a, a wrench inside the, the wheel of the bike, the spokes of the bike, you're going to flip over. It's the same thing. When you're working out, you got to use the proper mechanics.
So I don't know if you're familiar with Insanity Max 30 as a program or not, but I'm very, I'm an avid beach body workout girl. And I actually years ago, uh, herniated a disc doing Insanity Max 30. And it's because of exactly what you're talking about. There's a ton of jumping in this, in this type of workout that you do. And I knew my body was fatigued and mental Ashley that said, no, you're going to freaking finish this. Instead of saying, just slow down, clean up your form, your muscles are tired, you can't do this anymore. The other Ashley took over and was like push through. And so I did it with horrible form and I hurt my back so badly that I almost could not get out of bed for two weeks and then could not do that same program for years, again, because of that injury. So you're preaching to the choir right here. All of this stuff is very, very important. So the things you're talking about are things that really take the body out of that normal position, the sleeping, the sitting, the working out and not using proper form. And that can eventually lead to things like low back pain. How, because there are so many different things that can cause low back pain, how does someone actually know what's causing their low back pain?
Yeah. So again, that's why we're here, right? So my job is not just to treat a patient, but to educate a patient, right? My job is to help people get their families to understand how can they have long quality of life without any problems. Because there's a saying that says, make time for your health before your health, makes time for you, right? And what that means is don't wait until it's too late, right? Because there's people that, by the time they get around to taking care of themselves, by the time they say, I can't afford it, or by the time they say, I can't, you know, make time in my schedule, your health is going to make you make time eventually. And then it's really going to cost you a lot. And what I mean by that is, don't wait until your body breaks down and don't wait until you say, Hey, there's an opportune time because there's never going to be an opportune time with this. You just got to say, I need to start taking care of myself and then get in there and get, get it going, because you'll see a big difference right away.
People find the time and they find the money when they're losing their health. But for some reason, we often don't have time and don't have money when we feel as though we are healthy. So I think that's a very important concept that you brought up. So this is kind of a very broad question, and I'm not sure where you'll take it, but what are your general recommendations, like for a human being without scoliosis? I know this is a scoliosis podcast and we'll get there, but without scoliosis, who's experiencing low back pain, what type of general recommendations would you give that person? Other than the things you just talked about, about being careful how they're sitting and how they're sleeping?
Yeah. So obviously the first answer is get to one of us, right? Find somebody on the CLEAR website, find a chiropractor that knows what they're doing. And that's the easiest, because right away, you're going to start to go to a professional that's going to understand your condition and be able to guide you and help you with specifics, right? Now, going back to just some basic things that you can do, right? So we talked about all the things that might cause it, but let's talk about some of the things that will help. So just on your own, um, diet's a big one, right? So anti-inflammatory foods are really big, right? And people don't realize it, but they walk around inflamed because of what they put in their mouth. And what I mean by that is processed foods, sugars really cause an inflammatory response. So, uh, diet is a big one.
Dehydration is another one. People don't drink enough water. Uh, people walk around and pretty much dehydrated regularly. And what I tell people is the formula for hydration is this:, whatever your body weight is cut that in half. That's the amount of ounces of water that you should drink. So a 200 pound man or female, whatever, 200 pound person should drink a hundred ounces of water. So that's just to maintain normal activity that helps form and function. That helps muscle function. And when I say that much, I mean water, I don't mean soda. I don't mean tea, I mean water. Coffee does not count, coffee's a diuretic. So if you're going to drink the coffees or the teas, you have to compensate one for one. But--
I have a tip on water for you guys because I, when I was pregnant, for some reason, struggled with water intake and my midwife gave me the best tip ever. So I have, I know you can't see me, but I have this water bottle here. And she told me that I needed to make sure that I filled an empty--that water bottle at least three times. So what she had me do was put three rubber bands around my water bottle. And every time it was empty, I got to take a rubber band off. And I'm telling you, so this was years ago. My daughter is 14. Now people are like, Ashley, you drink so much water, it's insane. But I learned that habit by adopting something simple like that. And water is pretty much all I drink outside of my two cups of coffee a day.
Yeah. So it's funny because people don't realize this, but you and I have been on a video conference and I also have this very large Yeti water bottle. And it's actually 64 ounces, and I drink two of those a day. Uh, and, and you know, what I want to tell people is if you're not used to doing this, you want to consume as much as you can before lunchtime, because after lunchtime, if you wait until later, you're going to be up all night peeing, you're gonna wake yourself up and have to go to the bathroom all the time. So going back to it, uh, drinking lots of water, uh, proper diet we talked about. So those two things, and then any type of activity that involves movement, right? So, uh, unfortunately again, in our society, we're kind of relegated to sitting on the couch or on the computer. You need to get up and do simple activities.
And I'm not saying you have to work out and go to a gym or anything like that. Just start to walk, you know, make a simple habit of just getting out of the house and walking around and work on those 10,000 steps, right? 10,000 steps is a really common thing that you hear about. But if you're doing 30 to 60 minutes of walking a day, you will see such a dramatic change in your body's ability to heal and function better, right? So we've got, uh, eating right. We've got drinking water, we've got walking. Uh, we live in Florida, so it's easier for us to do this, but swimming is one of the best things that you can do because there's no impact from gravity on the body. There's no pressure on the joints and you're doing full body movements. So if you're in a warmer place, if you can get to a pool or the ocean or somewhere that you're warm, um, swimming is probably one of the best activities. In practice, I've been in practice 20 years now, and the people that I see the healthiest when they're oldest are the people that walked, um, swam, and played tennis for whatever reason.
It's interesting that you say that. My grandma, she immigrated to Canada from the Netherlands and she swims every day. And she still swims everyday, like in her eighties, every single day, she swims without fail and like, Oh, she's just the cutest little grandma and super, super healthy.
Yeah. And that's the key. And then the ones that I see that are the worst are the runners and the heavy, heavy, you know, bodybuilders that they just break their joints down in this constant theme of, you know, putting above normal pressure on the joints and body. So again, those simple things are really great way to just start to try and do things on your own until you can get to a professional that can help you.
Now, since this is a scoliosis podcast, I do want to talk about scoliosis and back pain, but something that shocked me when I first started working with people with scoliosis, which I did see them when I, I used to work at a chiropractic office and I would see patients with scoliosis on a fairly regular basis, but what shocked me is I knew what a normal x-ray should look like and seeing an x-ray with scoliosis, where there's a very abnormal curvature of the spine, I thought a hundred percent that every single one of those people would have to feel that, like they they've got to feel that. But I know not everybody deals with pain related to scoliosis. How often do you see patients with scoliosis who experience low back pain and then just, what's your thought process on that?
Yeah, that's a great question because I get that asked of me a lot. Scoliosis patients, believe it or not, typically don't have back pain. I would say seven out of 10 don't have back pain, uh, which is just a great testament to the body and its ability to function and compensate. But, uh, it's not the typical thing that brings somebody into the office. The patients, okay, so three out of 10 patients have back pain. What--I'm sorry, three out of 10 scoliosis patients have back pain. There's a couple of determining factors that usually show that to me. Uh, number one, it's a lumbar curve, meaning it's primarily lower back, when you do have just a lower back lumbar curve off to the side or scoliosis there. Um, that is one thing that I see is a little bit more common that causes a discomfort, and then older patients, uh, and by older, I mean, 50, 60, 70s, that again had that lower back curve that if they didn't have it, when they were younger, the discomfort, they had it later. Uh, and again, it has a lot to do with hormones and menopause when they get older and the body's inability to stabilize itself, or the patient not being properly trained in stabilization exercises that help to avoid any problems that come with that.
So you and I have talked before that scoliosis is the most complex spinal condition that, that's out there. So what does scoliosis care for a patient who has low back pain, like, what does that look like in your office?
So every patient is different, right? So that's the hard part, is to say, this is what they do, but every scoliosis case is different, just like every patient is different, and essentially it's finding what can be done to help their body function properly, right? So if you think about it, a scoliosis is defined by, typically, any type of curve that's greater than 10 degrees, right? So that would look like a small C or like an S depending on how many curves are involved, uh, may, may look like a rainbow, or it may look like an M or w depending on the side, sideways. Those are the typical presentation. Now, if you're standing and gravity goes through your body, think about that bend in that spine and how muscles on one side have to be tighter and shorter, and how muscles on the other side have to be longer to compensate for that position.
Now, those attachment points, you don't realize it, but they work every single moment of your waking day that you're sitting or standing. So the only time they're not working is when you're lying down. Why? Because gravity is pushing through your body. You're either pushing down while you're standing, or pushing down while you're sitting, straight down through the body. And the gravity has to disperse force to those muscles, to those ligaments, to those joints, to those discs. And what happens is that's how you get disc herniations for most patients. If it's not, if it's not a traumatic onset, it's these really bad positions where, over time, the body just says, Hey, we can't handle this anymore. And then all of a sudden, boom, the disc ruptured because of bad mechanics, or the joint has degenerative problems because it's been stuck in a position for a long time. And that's when all of a sudden you're looking for help, and you're forced to make time for your health at that point.
Yeah, for sure. So if somebody is listening and either has low back pain, or low back pain and scoliosis, what's the last piece of either advice or education that you would want to leave them with?
So listen to your body, right? And that's really an important thing that people don't realize is, those aches, those pains, that hurt that you feel is your body talking to you. It's your body's way of saying, Hey, there's something going on here, you need to get this looked at. And most of us are so busy, uh, throughout the day with work, with wives, with your husbands, with your kids, uh, that you don't pay attention to those little signals until they become really loud signals. So don't wait until it's something that it's tremendous and severe, and now you can't walk. Start when it's minor, because that's the best time to get to it, is when you don't realize, okay, maybe I have something going on or, you know what? I just want to get checked out. I just have heard that it's going to help me. So let me go get checked out.
There's nothing like preventative, right? You brush your teeth your whole life so that you don't lose them. So they don't fall out on you. Take care of your spine your whole life so it doesn't blow out on you. You're only given one spine, you got to maintain it properly. So my response to that question is, find a professional. To me, CLEAR doctors are trained in the most complex condition of the spine, so you're never going to go wrong finding one of these guys. Okay? Yes, go to any chiropractor. These guys are well-trained, but scoliosis doctors specifically have so much advanced training that I'm always going to push them towards them first because their qualifications are above and beyond.
Yes, I agree. Listen to your body and find a professional. I have not listened to my body before, and I dealt with the repercussions of that. So I kind of had that mentality of like, no, it's not going to happen to me, or I'm stronger or tougher, I'm going to be okay, I'll push through. And fact of the matter is, is it, it can, and your is smart and gives you those signs and signals for a reason. So--
Yeah, it never happens to us until it happens to us.
Exactly. Well, Dr. Alex, as always, it is a pleasure to connect with you and I look forward to our next episode.
Thank you so much for having me, have a great day.
You, too, thank you. To stay up to date on all of the latest scoliosis information, make sure you like our Facebook page. You can find us by searching for CLEAR Scoliosis Institute. There's more to come next week.
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