I have had several questions about back pain in pregnancy recently. Studies suggest that about half of expectant mothers have back pain issues by late second trimester, though that seems low to me from the number of ladies I see with it. Accordingly, I, who have not been pregnant ever, will share some common questions and some answers.
Bodies are designed with balance in mind. When you sit, stand, or walk, your muscles and skeleton work in concert, efficiently managing your body mass as it moves or holds its position against gravity. Your sense of equilibrium is the result of an amazing and complex series of command and control impulses in your nervous system going into the brain from the periphery and to the extremities from the brain. As King David put it, we are "fearfully and wonderfully made."
In the course of pregnancy, 35-40 pound weight gain is common, and some moms gain considerably more. As pregnancy progresses, much of this weight concentrates itself around that marvelous bundle that will need a name, 2 o'clock feedings, and clothes. The result is an increase in the curve in the lumbar spine—at the base of the back—that puts pressure on that part of the spine, especially the facet joints of the vertebrae.
Robert Hayden, DC, PhD, FICC
Sometimes a patient and their physical, emotional, and spiritual struggles will bring you to tears. Though emotionally taxing, the work we do is uniquely rewarding when we can help.
Ron is a small guy, about 5’6” and 130 pounds. He has tried to gain weight without success, making him the envy of many who gain weight despite their best efforts. He came to the clinic with lumbar pain that radiated down his right leg into the back of his calf. Provocative orthopedic and neurological testing led to the conclusion that the problem was between his L5 vertebra and the sacrum on the right side, as something was hitting the first sacral nerve root that serves the back of the calf and the bottom of the foot. This could be disc material, a bone spur, or (likely) a combination of the two.
Back in the 60s, the word "hip" entered our lexicon with the meaning "cool," or "the pinnacle of what is it." That generation is older, and the focus of "hip" is more anatomical.
A hip is a ball and socket joint. There is a round, regularly shaped head of the femur, or thigh bone, that fits into a round socket in the pelvis. It is padded with cartilage and lubricated with a fluid made inside the joint space. They are designed to last us a lifetime with normal wear and tear.
Sometimes these joints do not form perfectly in utero. Occasionally the socket is too shallow, causing him dislocation of the hip. This is easily tested and is part of the neonatal exam as soon as a baby is born.
Many of the "hip" generation are older now. Many of these were health-conscious and took up jogging, tennis, handball, basketball, and other sports to stay fit. High impact sports increase the rate of wear and tear on a hip. The ladies in this generation are about the right vintage to have osteopenia or osteoporosis, conditions that soften bones, making them more brittle and easier to break.
By Robert Hayden, dC, Phd, FICC
Mac first presented for care in August 2012 with a chief com- plaint of lumbar pain, radiating down the left lateral leg to the ankle. It was worse with weight- bearing, described as approximately 5/10 in intensity, without numbness or tingling. His pain was made worse with long periods of sitting (more than 30 minutes), and ameliorated some by walking, more by lying down. He worked in a place that sold auto parts, so lifting, bending, twisting, and walking on concrete floors for long hours were part of his daily expectation.
He is a 67-year-old Caucasian male who lives with his wife of 35 years. He had a pleasant disposition and appeared in no acute distress at the time of his first exam. He denied vices (smoking, alcohol abuse, recreational drug history). At 5’11” tall and 238 pounds, he was moderately heavy.
In the late 19th century, a Wells Fargo station agent name Lester Moore was confronted by an angry patron whose package was damaged in transit. In the course of the argument, the patron, Hank Dunstan, pulled his gun, as did Lester Moore. Both died in the ensuing gunfight. Mr. Moore's epitaph on the grave marker is famous: "Here lies Lester Moore, four slugs from a .44, no Les, no more." The "less is more" principal is the focus of this discussion.
Cory is a healthy-looking, slender, athletic 22-year young man who presented with an unusual problem. It is unusual for both the magnitude of the condition and apparent lack of provocation for it. His story is relevant for us because it illustrates the impact of the choices of treatment options available to us.
A quote attributed to Thomas Jefferson, but which may have been edited, nevertheless expressed his views on learning. "An educated citizenry is a vital requisite for our survival as a free people," he might have said. Regardless of the historical source, I can think of no angle from which the assertion might be assailed. I could not agree more with the statement, so it gives me reason for concern as a citizen, taxpayer, and small business owner in Griffin.
My personal observation is that significant numbers of Griffin-Spalding County youth appear to have serious knowledge deficits ranging from functional illiteracy to perhaps something worse. Nationally, half of adults in the U.S. cannot read a book on eight grade reading level, and 45 million of those read below fifth grade level.
To be clear, however, there are two issues raised in the paragraph above. One is adult literacy, and this is being addressed by the Griffin-Spalding Literacy Commission with the heroic work of Terry Huddleston and others whose results are inspirational. The other is illiteracy in the product of our Georgia schools.