​There is a lot of confusion regarding whether to use heat or ice when you have pain.  Both therapies are inexpensive and effective when used properly.  This article will reveal when it is appropriate to use either option.

Pregnancy is a very exciting time for a woman. However, it can come with many physical changes that can cause back pain. It is estimated that 50 percent of pregnant women will experience an episode of back pain during pregnancy. 
The rapid changes in a woman's body over a relatively short amount of time during pregnancy causes changes in hormones, changes in mechanical forces on the ligaments, and changes within the body as it accommodates the fetus.  These changes, along with added weight gain,  contribute to the possibility of back pain.

Relaxin
Relaxin is a hormone that is essential throughout pregnancy. Relaxin levels are highest in the first trimester and it acts on the uterus and blood vessels to better support the pregnancy. At the end of the pregnancy, relaxin plays a role in preparing for delivery. It acts on the ligaments to loosen and increase their flexibility. ​The flexibility in a woman’s spine increases the lumbar curvature, called lordosis, to shift the center of gravity forward, keeping it over the pelvis. This prevents her from falling forward as the fetus grows. This increase in lordosis also helps minimize the force acting on the muscles and ligaments. Due to the extra mobility in the ligaments, a woman is more likely to have a hyper-mobile spine and pelvis.  This can also be more common after having multiple children and it increases the probability of back pain. 

Get Active!
Postural changes and exercise can be helpful to prevent and manage back pain. Try the following:

* Make sure that you are walking daily.
* Avoid prolonged sitting. Move around frequently
* When sitting, keep your knees below your hips, with an angle greater then 90 degrees in your hip joints.
* Sit backwards on a kitchen chair.
* When on an exercise ball, keep your knees below your hips.
* When seated, keep your back upright, not leaning backwards.
* When standing, swing your hips in a figure-of-eight motion.
* Avoid carrying another toddler on your hip.

These postural habit changes may also help support the positioning of baby to facilitate less potential for painful back labor, or necessity for birth interventions.

It is very important to maintain cardiovascular and strength conditioning activities. If you were exercising regularly prior to pregnancy, you should be able to continue moderate intensity exercise. Moderate intensity exercise is classified as being able to maintain a conversation while exercising. If you are not able to maintain a conversation,  you are working too hard. If you were running before pregnancy, you should be able to continue running while pregnant. Pregnancy is not the time to take up running. You should avoid exercises that have the risk of falling, contact sports, heavy resistance training and exercises that require lying on the back after the first trimester. (https://www.myvmc.com/pregnancy/exercises-to-do-and-avoid-during-pregnancy/). Studies of women who maintain exercise throughout pregnancy have decreased risk of gestational diabetes, decreased Cesarean section rates, and improved postpartum recovery time. If you are experiencing low back pain or pelvic girdle pain, water exercise is great alternative. 

Activity Fact: Studies show that by the third trimester, the baby moves about 30 times each hour! Babies know before they are born how important it is to move!

​(This article was written by: Dr. Melendy from the Neepawa Chiropractic Centre)

Back pain will effect 80% of the population at some time in their life and is the leading cause of disability and absenteeism from work.  The majority of back pain is due to mechanical causes including sprains, strains, instability or degeneration.  
However, there can be times when your back pain is caused from internal structures of your body rather than from joints and muscles.  

How Pain Works
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Pain is our signal to tell us that something is wrong with the body. We have many types of sensory nerves giving us information about temperature, vibration, touch, stretch, pain, smell, sound, taste, and sight. A common example of this can be found with back pain. When a joint is not properly stabilized by the surrounding muscles, the force going through the joint causes a strain of the surrounding tissues. There is an extra stretch to the  the muscles and ligaments, provoking a pain signal to the brain.  This type of pain mechanism is easy for the brain to localize in the body.
Referred pain is a different type of signal, and there are several theories of how this works. One theory is that many organs have sensory nerves that work through complex pathways, and these signals can converge at the same spot as sensory nerves from the skin, muscles and joints. The body reads sensory information from the periphery more often than the organs, and therefore assumes the pain is from this area and referred pain occurs.  A common example of this is the heart. Cardiac pain in is often felt in the chest, arm, jaw, mid-back, and neck.  A kidney infection may be felt as a mid back ache.  You may have shoulder tip pain after having laparoscopic surgery.

 The most common organs of the body to cause spinal pain are the following:
Head - brain aneurysm, tumor, or lesion
​Neck and shoulder - heart, lung, diaphragm, and thyroid gland
Mid back - stomach, pancreas, gall bladder, liver, and heart
Low back - kidney, bladder, colon, reproductive organs

How to Determine the Source of Pain

When uncertain if your pain is coming from the back, there are four general rules to consider:
1. The mechanism of the injury is the most obvious tool to tell you if pain is from muscles and joints. If you have a trauma or repetitive strain injury, the pain is most likely from the muscles and joints. 
2. If it hurts when you use the joints and muscles around the sore area, it is most likely joint or muscle pain as the cause.  Pain when activating and/or stretching a muscle is a sign pain is not coming from the organs.   (i.e.  If the pain is originating from an internal structure, such as your kidney, you should be able to move about and not provoke or make the pain worse.)  Often muscle and joint pain is characterized by being "sharp" and "pulling".  Referred pain is characterized by being a "deep and achy" pain.
3. If you are experiencing abnormal activities with one of your body systems along with back pain it might not be the back causing your problems. (i.e. If you have low back pain and are noticing that the color of your urine is more red than normal and that it hurts to urinate, you might have kidney problems, not back problems.) You should think about your own medical history, and consider whether a previous issue is recurring, or possibly progressing.
4. If your pain does not subside with rest and lasts longer than usual, you need to consider a secondary source to your back pain.  Most uncomplicated muscle and joint problems heal within 6 to 8 weeks. Persistent pain is a sign that the pain can be more than just a nagging back. 

Conclusion
​
There are circumstances when your back pain may be coming from an internal structure.  Listen to your body and use the information provided to determine if your pain is originating from the back or from the internal organs.  Always consult a trained health care provider to help determine the cause of your pain. 

Activity Fact: Women are 3 times more likely then men to experience throat and jaw symptoms when having a heart attack.

Sciatica is a term used to describe leg pain that originates from the lower back.  Some also use it as a diagnosis to represent a low back nerve that has been impinged or "pinched". Either way, sciatica can be a very painful and debilitating condition that causes the patient to experience leg pain, numbness, weakness, and hyper-sensitivities. The pain mostly occurs in one leg and can be located in the front, side, or back of the leg and sometimes radiates from the low back all the way to the foot.  Often sciatic pain is worse with forward bending, sitting, heavy lifting, straining, and coughing. A test used to help diagnose sciatica is the straight leg raise.  This can be performed sitting or laying down.  If pain occurs down the leg, or worsens, when the leg is lifted between 30 and 70 degrees, it is positive for nerve root irritation. 
About 90% of sciatic pain will resolve within 6 weeks with conservative care without any long term complications.  In rare cases people can have rapid loss of strength in their leg and even loss of bowel or bladder functions.  If this occurs, it is necessary to seek medical attention as soon as possible.  

Causes of Sciatica
​
a) Lumbar Disc Bulge or Herniation
​The most common causes of sciatic pain is due to a disc herniation or a disc bulge. The strong elastic tissues of the outer disc wall can stretch causing the disc to bulge towards the spinal nerve. Or it can rupture causing the soft center material of the disc to come out producing a herniation that causes pressure on the nerve root passing by. The most common levels for this to happen at is the L4-5 and L5-S1 levels.

 b) Low Back Referred Pain
Many structures of the low back will radiate pain down the leg and mimic a nerve root impingement. Most commonly are the pelvic and lumbar spinal joints and the muscles around these areas.  Irritation from conditions such as strained muscles or sprained joints, cause referred pain down the leg.   When sciatic pain is coming from the back and not the nerve, a person will have a normal straight leg raise, pain is aggravated by arching the back and relieved by bending forward, and the pain usually doesn't travel past the knee.   In 17% of the population the  sciatic nerve passes through the periformis muscle located deep in the buttox area. Periformis syndrome is when the nerve is pinched by this muscle and leg pain occurs. 

c)Spinal Degeneration
Arthritic changes occur in the low back with injury and ageing.   Bone spurs can develop and bother the nerve roots when instability of the low back occurs.  Spinal stenosis is also a condition secondary to spinal degeneration where the spinal cord canal or the nerve root foramen, (bony outlet) become closed in causing nerve root irritation. Natural dehydration of the disc, and resultant  shrinking can also cause stenosis. 

Treatment for Sciatica

You must see your medical doctor if your symptoms involve loss of strength or bowl and bladder control.  Surgery is likely the answer. Evidence is lacking on who is the best sciatic candidate for lumbar disc surgery but early intervention is more effective.
A 2012 study in the British Medical Journal showed that compared with conservative therapy, surgical treatment provided faster relief from back pain symptoms in patients with lumbar disc herniation, but did not show a benefit over conservative treatment in midterm and long-term follow-up. 
  In less severe sciatica, the best treatment is to first avoid aggravating factors such as too much sitting, forward bent posture, and lifting.
Research shows that narcotics, muscle relaxants, and anti-inflammatory medications can help to lessen symptoms, but do not eliminate sciatica any faster. Traditional methods of bed rest or traction also do not help you heal faster. 
Conservative care is a safer and often more effective treatment for sciatic pain.   If the pain is generated by the joints and muscles of the back, your symptoms will resolve quickly. A trained practitioner in physical medicine can provide you with the correct  exercises to help regain mobility and function in the injured area. Properly prescribed lumbar extension, core stability , and postural correction exercises can all help relieve sciatic pain generated from a disc issue.