How many people have back issues, but do not take the necessary steps to alleviate them? Back pain can be caused by a multitude of different avenues; however, back pain in the exercising community can quickly turn into a problem that spans throughout the entire body. Ignoring back problems can cause a series of new problems elsewhere due to the kinetic chain. For instance, a deformed spinal column can alter normal body posture in order to make sure the head and pelvis are aligned (“How Scoliosis,” 2017). The spinal curvature that is created from the body correcting itself to maintain head-pelvis alignment causes further imbalances, specifically affecting the way that the arms, legs, shoulder girdle, and pelvic girdle are orientated (“How Scoliosis,” 2017). There are many problems with the spine that can cause great issues with exercising, and chiropractic care can resolve a majority of them. The anatomy of the spine, chiropractic care throughout the lifespan, and the benefits and problems with chiropractic care contribute to proving that having proper spinal alignment is crucial to making sure that the full benefits of exercise are achieved. Chiropractic care is an easy way to ensure that this alignment is maintained.Anatomy and Physiological MechanismsThe spine consists of a series of irregular bones that compose the cervical, thoracic, and lumbar vertebrae. The primary function of each bone in the vertebral column is to protect the spinal cord, help bear the weight of the appendicular skeleton, and serve as an attachment site for ligaments and muscles (Bogduk, 2005). Additionally, each vertebrae obtain similar anatomical characteristics. These include a body, which assists in weight bearing and forms the vertebral foramen when combined with the vertebral arch. The structure of the vertebral arch is completed by two laminae, which are compressed plates that fuse in the median plate, as well as pedicles. Pedicles, or “little feet,” are the bony columns which posteriorly project from the vertebral arch. On the inferior and superior borders of the pedicles are notches that create lateral openings called the intervertebral foramen, which are innervated by spinal nerves. In addition, there are seven processes that project from the vertebral arch. The first two projections are called the spinous transverse processes, and they serve as the attachment sites for muscles and ligaments. (Marieb & Hoehn, 2013, p.220). Furthermore, the open space that encloses the spinal cord is the vertebral foramen (Bogduk, 2005 p.3). The cervical vertebrae is the superior part of the spine, which consists of the smallest and lightest vertebrae of the column (Marieb & Hoehn, 2013, p. 221). The anatomical appearance of the cervical vertebrae is composed of seven bones that articulate in a concave fashion, with the first set having a unique function. The first cervical vertebra, also known as the atlas or C1, contains no body and obtains a more ring-like appearance. The second cervical vertebra, axis or C2, has a dens, used as an axis for rotation of the atlas and allows one to rotate their head from side to side, which protrudes superiorly to articulate with the posterior aspect of the atlas as a synovial joint (Marieb & Hoehn et al,.2013; Dodwad, Khan, & An. n.d.). C3 through C6 have the anatomical features of a pedicle, body, and transverse process and assist with preventing excessive lateral flexion. Articulation between the inferior articular process and the superior articular process forms a spinal facet, which helps with motions such as extension and flexion of the cervical spine. The seventh cervical vertebra is a transition point from the (mobile) cervical to a more (rigid) thoracic vertebra. At the center of each intervertebral disc is the nucleus pulposus, which aids in shock absorption. Anteroposterior translation can also occur throughout the spine, although coronal plane movement is restricted by the uncinate process. Additionally, the end plate, serving as the growth plate, functions as a barrier and allows for the diffusion of nutrients (Dodwad, Khan, & An. n.d.).The thoracic vertebrae, unlike the cervical, consists of twelve bones. Overall, the thoracic vertebrae have a convex appearance, while serving as the main attachment site for the ribs. Like the cervical vertebrae, the thoracic contain a body, transverse process, and intervertebral discs. The body of the vertebrae have superior and inferior costal facets, which permit articulations with the true, false, and floating ribs. The thoracic vertebrae also contain a superior and inferior articular facet which limits extension and flexion. Furthermore, the vertebra obtain a distinguished spinous process that is oriented in a downward position (Marieb & Hoehn, 2013, p. 222).While both the cervical and thoracic vertebra provide supportive functions to the head, neck, and ribs, the lumbar vertebrae have the function of providing support on weight bearing, transmit bending and tensile forces (Bogduk 2005). To perform this function, the five lumbar vertebrae utilize the entire vertebral body for loading in the horizontal plane, and the superior and inferior flat surfaces of the vertebral body support for longitudinally applied loads (Bogduk 2005). The posterior elements of the lumbar, the articular processes, spinous processes, and laminae, are made to be adapted to sustain different forces acting on the vertebra. The posterior elements receive all of the muscular forces acting on the vertebra. When a force acts on the inferior articular processes or the spinous process, the force is placed onto the laminae next. This is important because the stability can be compromised if the laminae gets injured. Three joints are formed when there are two lumbar vertebrae articulated together. These include the zygapophysial joints that are formed by the articulation of the inferior articular processes with the superior articular process, and the remaining joint is formed between the vertebral bodies. When looking at two articulated vertebrae from the side, the articular processes seem to be arching towards one another forming a bridge between them (Bogduk 2005). In addition, the lumbar vertebrae can perform extension, flexion, and even lateral flexion (Marieb & Hoehn, 2013, p. 222). Benefits of Chiropractic CareChiropractic is a medical profession that focuses mainly on the correlation between the structure of the spine and the nervous system. Dr. Josh Axe (n.d.) writes about how chiropractic medicine also establishes how that relationship may affect the protection and restoration of health. There are many benefits to chiropractic care that outweigh the risks. The body has the astonishing, inherent capability to heal itself under the appropriate conditions. When compared to other treatments for pain and injury, like over-the-counter medications, chiropractic’s method provides a safe and effective alternative and is considered a more natural way for our body to heal on its own (“What is Chiropractic,” n.d.). Since the nervous system plays a vital role in our body and controls each and every cell and organ, chiropractors often focus on the health of the spine and making sure that it is accurately aligned (Axe, n.d.). Specifically, Ted Kaptchuk and David Eisenburg (1998) write that chiropractors specialize in therapy and mainly spinal manipulation, which is the most significant alternative to medicine when it comes to chiropractic treatment.The stance of chiropractic treatment being observed as alternative medicine is a controversial topic that is consistently evolving. It is written that “some of the primary fundamentals of chiropractic treatment include the ideology of utilizing biomechanics and manual therapy toward correcting and treating misalignments of the skeletal system” (Kaptchuk & Eisenburg, 1998). One of the most popular and common therapeutic methods that a chiropractor performs is known as spinal manipulation, or chiropractic adjustment. The main goal of this procedure is to repair joint mobility by placing a controlled, sudden force into the immobile joints, possibly resulting in tissue injury (“What is Chiropractic,” n.d.). Tissue injuries can occur due to many different situations like inaccurately lifting an object or weight that is too heavy, or the reoccurrence of some type of stress. Overall, spinal manipulation or chiropractic adjustment restores the mobility of joints or tissue, relieving any pain and tightness of the muscles, allowing them to heal. A major benefit of utilizing this therapeutic procedure is that it has been known to rarely cause prolonged discomfort or pain. Although some patients may undergo soreness or aching after treatment, it usually disappears within 12 to 48 hours after the procedure (“What is Chiropractic,” n.d.). Chiropractic care has been proven to help with back pain. Research by Dr. Josh Axe (n.d.) into the effects of chiropractic care uncovered several key points of information. Dr. Axe found that patients with chronic low back pain treated by chiropractors showed greater improvement and satisfaction one month following treatment compared to patients treated by family physicians. He also says that it is recommended that people who are experiencing major back problems first try chiropractic treatment before resulting to back surgery. Not only are chiropractic adjustments known to help prevent the progression of scoliosis, Dr. Axe also mentions that muscular rehabilitation has also been shown to help improve their scoliosis curvatures. In studies today, many people have seen a 10 to 30 percent decrease in their scoliosis curvatures because of their participation in chiropractic therapy (Axe, n.d.).The benefits of chiropractic care also apply to athletic performance. Athletes like Michael Phelps, and Joe Montana have been treated by chiropractors before in their life to help improve their performance and relieve muscle soreness or pain (Axe, n.d.). Kevin Barton (2014) writes that chiropractic care for athletes can enhance their flexibility, keep them from getting injured, as well as helping them to maintain a good posture, range of motion, and agility. As a matter of fact, some NFL teams hire chiropractors to be on staff so that they are able to care for the players when they need adjustments, help with stretching, and exercises (Axe, n.d). One of the most neglected characteristics of chiropractic care is that it improves with our everyday life, as well as athletic performance, and exercise. Other major benefits of utilizing chiropractic care are to boost the immune system, relieve muscle tension, reduce inflammatory cytokines, and increase energy levels (Axe, n.d.). Complications From Chiropractic CareTwo types of outcomes have been seen within the patients that have received chiropractic care for spinal injuries or pain, thus being “benign” and “serious.” The benign problems consist of radiating pain, headaches, dizziness, nausea, and tiredness as the serious problems consist of vertebrobasilar artery strokes, cervical disk herniation, and lumbar disk herniation and cauda equine syndrome.In a study conducted by Sidney M. Rubinstein (2008), clinical analysis demonstrated that the benign symptoms seemed to occur at the beginning of treatment and after the first treatment which leads many to believe that there are indeed consequences to the plan of the chiropractic treatment. Gaining an understanding for these symptoms more thoroughly, it has been shown that pre-disclosed headaches at the beginning of treatment leads to the development of neck pain or soreness throughout the chiropractic treatment. Subsequently, it has also been shown that pre-disclosed neck pain before treatment leads to a greater degree of headaches during the treatment. As it is shown above, it can be relevantly assumed and demonstrated that most if not all benign problems within chiropractic care is a result of the symptoms of the patient before the treatment rather than during the treatment. While the benign symptoms are viewed as highly treatable and regulated, the more serious symptoms or problems pose a different problem for the patient. Vertebrobasilar strokes have led many people to believe that the cause is not natural but due to spinal manipulative therapy, which is a practice used by chiropractors. Studies show that the correlation between the two are not linked between those over the ages of 45 but have been linked to those under this age, for they had received chiropractic care before the time of the stroke (Rubinstein 2008). In another study conducted by Edzard Ernst (2002), arterial dissection which leads to vertebrobasilar stroke was the most common extreme or serious problem that was caused by chiropractic care. While the results for this occurrence are not as strongly correlated with chiropractic care, it is evident that this outcome is a possibility that can occur during spinal manipulative therapy. During cervical disk herniation, it has been shown that a high velocity thrust on the cervical spine leads to an increase in the complication of the herniation (Ernst 2002). This thrust can be illustrated by the increase in force on the cervical spine demonstrated by chiropractors during the spinal manipulation of the care (Ernst 2002). As the force increases on the spine, the complications increase and the risk of a more serious injury becomes probable. Examining the first two severe problems caused by receiving chiropractic care, this brings us to the final problem: lumbar disk herniation and cauda equine syndrome. Like cervical disk herniation, this problem has many similar symptoms and problems with chiropractic care. Indifferently, this problem occurs in the lower back instead of the upper region of the spine. In a study conducted by Willem J.J Assendelft and colleagues (1996), the results showed that all but five cases occurred in the lumbar region and most lead to cauda equina syndrome, which affects the performance of the bundle of nerve roots called the cauda equine. Like the prior problems within the serious category, this was in result of the extreme forces put on the section of the spine which led to these complications and eventually led to surgical intervention to fix the problem. Prevention Across the LifespanIn order to receive the full benefits of exercise, the musculoskeletal system must be in the proper condition. The term “proper condition” in this context is referring to having a full range of motion and being aware of any injuries in the body that could affect performance. The vertebral column, or spine, is a component of the musculoskeletal system and can be manipulated. This manipulation is referred to as spinal manipulative therapy, or SMT, is used by chiropractors and can be used for a variety of things, including relieving muscle and joint pain, and helping to prevent it. An effective way to help ensure that the spine is in proper alignment is to never have to fix a spinal problem, but prevent it from happening in the first place. One way to do this is to begin receiving chiropractic care at a young age while the spine is still developing and any potential issues are caught early. Although there is not much research done on pediatric chiropractic care, it is noted that, as typical for the body in general, taking care of the spine while young is going to have an effect on its condition in later years.Spinal ConditionsThroughout athletes’ careers, their primary concern is to increase their performance while minimizing injury to their skeletomuscular system. Unfortunately, the majority of athletes will fall victim to a serious injury that has the potential to be career ending. As mentioned earlier, it is crucial that the spine is cared for and monitored at a young age in order to reduce the number of injuries that may result later in life. On the other hand, some ailments of the spine, such as scoliosis, may arise spontaneously. According to Latalski and colleagues (2017), scoliosis is found in 0.2-0.6% of the general population, and the cause of 70-90% of these cases are unknown. When discussing the possible explanations for scoliosis, Latalski cited the work of Somerville (1952), Smith (1991), and Drobyshevskiy (2014). Respectively, they believed that scoliosis developed due to changes in the sagittal profile, a transverse plane deformity, or because of the local internal lateral fixation of the dura mater in the spine. Because scoliosis progresses at the highest rate during the adolescent growth spurt (Latalski et al., 2017), it is likely to affect the lives of the many young adults who participate in sports during this critical time of growth. Based on the principles of the kinetic chain, if the spine is altered in one direction or the other, movements at the shoulder, hip, knee, and ankle joints are likely to be adversely affected. This may result in increased pain and frustration while playing, so it is vital that treatment be implemented early in the process. One solution to reducing skeletomuscular pain in sports activity is through chiropractic therapy.In the 2013 World Games, 897 athletes used chiropractic care as a means of pain relief (Nook, Nook, & Nook, 2016). In this particular study, Nook and colleagues (2016) also noted that the sports that utilized chiropractic care the most were bowling, water skiing, fistball, and wushu. Throughout the Games, the most frequently treated regions were the thoracic spine, lumbar spine, cervical spine, and the sacroiliac joint (Nook et al., 2016). It is interesting to note that the heavily treated regions are all major parts of the spine, signifying that the spine must be in good health in order for the skeletomuscular system to be in peak performing condition. According to Nook and colleagues (2016), 87% of patients reported an immediate reduction in pain. This finding leads researchers, as well as athletes, to believe that chiropractic therapy can be used as a helpful tool in the recovery process from injury due to physical activity. As it can be seen, chiropractic care is one of the foremost, safest solutions for back pain. This care goes hand in hand with one of the most debated resolutions for any type of medical care for any type of medical injury; however, it can be shown through research and data that it is most effective. When performing exercise, it is important to maintain proper form and alignment in every aspect of our body, especially the spine. When a spinal injury occurs as a result of exercise, one of the most effective, natural ways for our body to heal itself is through chiropractic care. From the profession, to the benefits, and even to the symptoms, as a whole this type of care illustrates how maintenance of the alignment of the spine can be easily cared for. To this day, chiropractic care is continuously developing. In order for chiropractic care to continue to be as successful as it has been, research is always important and can provide constant changes within this profession. Knowing the importance and benefits of chiropractic care before being treated is something that should always be focused on. Furthermore, in the future there is a high possibility that it could be viewed as the only effective way to treat a spinal injury.
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