Lumbar extension

Lumbar extension is a vital part of the mobility of your lower back; if you can't bend backwards, and to the side, you'll be stooped forwards long before your time.

You will often see older folk, and some not so elderly, walking as though they are stuck in a flexed position. Bending forwards as in picking something off the floor is usually painless, but extension causes immediate discomfort in the lower back and perhaps down the leg.

This may be due to Parkinson's disease, but more usually because of severe wear and tear in the facet joints in the lower back.

So, the chronic loss of extension is more common in the older person, and more usually affects the mid lower back, and the femoral nerve. That would cause pain on the side and front of the thigh, and the inner lower leg.

Of course the sciatic nerve can be affected too, and sometimes both.

There is a solution; lumbar extension exercises. However, they must be done with great circumspection and I of course would recommend that you do it under the direction of your chiropractor.

Not just because I'm trying to chisel your hard earned dollars out of your wallet, but because this action can provoke a nasty pinched nerve. Do these exercises very carefully.

Lumbar extension

The lumbar facet joints mediate lower back extension. After a serious slipped disc, the upper vertebra settles lower on its mate below; this means that the facets start to ride on one another causing degenerative change. 

The secret is to exercise those facet joints gently into lumbar extension daily. Do it forcibly and you'll set up a pinched nerve and pain down your leg. Don't do it at all, and you'll end up stooped forwards, looking like an old man or woman long before your time.

The facet joints are lined with hyaline cartilage; it's bathed in synovial fluid which must be replenished daily. Movement provides the pump that drives fresh nutrients into the joint, and removes the waste  products of cartilage metabolism.

In my book and, busy on my sixty eighth orbit of the sun, this chiropractic has been around the block a good few times, a disciplined daily lower back exercise programme is vital for those suffering from chronic lower back pain. I do them myself, having had severe femoral nerve damage two years ago. I was lucky to escape the knife, thanks to excellent chiropractic care from a colleague; my daughter.

The worst that can happen is that the lower facet changes shape to such an extent that it allows the upper vertebra to slide forwards, catching the nerve root in a pincer; it's known as an anterolysthesis, and sometimes called a spondylolysthesis. All in all, it's best to keep mobilising those facet joints to keep them healthy.

In between acute episodes of lower back pain, when you will most likely need a course of chiropractic adjustments, that's the time to exercise your facets at home on a daily basis using these lumbar extension exercises.

Tomorrow I'll add some photographs of the exercises.

Yes, that's me up the ladder drilling holes to hold that escutcheon plate in place around the flue. Notice how my back is in extension; it was exactly this posture that set off a severe case of femoral nerve neuropathy in a patient recently. He had no back pain, just severe anterior thigh pain and weakness of the knee. He was lucky to escape surgery with chiropractic help.

An aside: A woodstove heating system with a flue passing through the bedroom above is a wonder in any home. This is the stove downstairs in the lounge, the flue passes through the bedroom above. Magic!

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› Lumbar extension

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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I have left alone. After seven treatments his pain and stiffness is 50 percent better, and he is happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti-inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He is doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost pain-free. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he is well pleased; sixty-five percent better after three treatments.

5. Mr T is a wise man; he has taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily stroll has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift; he has a short leg.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. X-rays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65-year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88-year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done. 

10. Mr X is a 71-year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a few months ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It is a non-complicated upper cervical facet syndrome, and she is doing well.

12. Mr D is a 38-year old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he could not sleep on that shoulder.

13. Mr D, a 71-year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors should not be treating the elderly most medical sites state but that is so much bunkum.

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Interesting questions from visitors

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Knowing that up to 70 percent of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there is a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong. Give plenty of detail if you want a sensible reply.

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