Dr. James A. Doran, D.C.

When it comes to treating middle back (thoracic) pain, the duration of the actual treatment is quite short, but the number of visits can vary. Obviously, the goal is to provide relief as quickly as possible, but it's important to understand that healing takes time.

First off, it's crucial to pinpoint the cause of your middle back pain. This involves a thorough examination and possibly X-rays. Once we understand what's causing the pain, we can develop a personalized treatment plan.

Treatment for middle back pain can involve a combination of therapies, including acupuncture, chiropractic, or dry needling. We often prescribe exercises to strengthen and stretch the muscles in your back, posture correction techniques, and possibly some lifestyle changes.

The duration of your treatment plan can vary from person to person. Some people might find relief relatively quickly, while others may need more time. The cause of your pain (acute vs. chronic) and your lifestyle (desk work vs. heavy lifting) will affect the length of your treatment.

Fortunately, because of the anatomy of the middle back compared to the neck (cervical) and lower back (lumbar), it typically improves faster than these other conditions. Most of the patients in our office find noticeable relief within two to four visits.
Ultimately, the goal of your treatment should be to alleviate your current pain but also to address the underlying issues to prevent it from coming back in the future. So while the exact timeline for treatment can vary, our focus is always on helping you get back to feeling your best as efficiently and effectively as possible.

Knee arthritis is a condition where the cartilage in the knee joint wears down over time, resulting in pain, stiffness, and swelling. Unfortunately, once you have arthritis in your knee (or any joint), it does not go away. However, there are treatments that can help manage the symptoms and slow down the progression of arthritis.

Exercises to strengthen the muscles around the knee, losing weight if necessary, using assistive devices like braces or canes, and certain medications can all help to relieve pain and improve function. In some cases, more advanced treatments like injections or surgery may be recommended.

Some important and often overlooked treatments for knee arthritis are acupuncture, chiropractic, and shockwave therapy. Chiropractic adjustments to the knee and lower back can help slow the progression of arthritis by improving joint function. Acupuncture and shockwave therapy are also helpful for pain relief and reducing inflammation in the joints

As a seasoned chiropractor, I frequently remind patients with herniated discs about the potential harm of certain activities. The activities listed below, if not avoided, can exacerbate your condition and prolong your recovery. It's important to be aware of and avoid these activities if you have a herniated disc: 1. *Heavy Lifting*: Avoid lifting heavy objects, especially with poor posture or using your back muscles instead of your legs. This can strain your spine and worsen the herniation. Whenever lifting anything heavy, keep the object close to your body to limit strain on the spine. The reason for this is that lifting heavy objects with poor posture or using your back muscles can put excessive pressure on the discs in your spine, potentially worsening your herniated disc. 2. *High-Impact Exercises*: Running, jumping, or high-impact aerobics can put excessive pressure on the spine and exacerbate herniated discs. Opt for low-impact exercises like swimming, walking, or cycling instead. 3. *Twisting or Jerking Movements*: Avoid sudden jerking or twisting movements, particularly when lifting or reaching. These actions can further compress the discs and aggravate the herniation. Examples include kettlebell exercises, tennis, and golf. Any motion that combines flexion and extension can cause and/or worsen a disc herniation. 4. *Prolonged Periods of Sitting or Standing*: Sitting and standing for extended periods can increase pressure on the spine. To reduce strain on your back, alternate between sitting, standing, and walking throughout the day. If you spend long periods on the computer, practicing good office ergonomics is vital. 5. *Bending Forward*: Activities that involve bending forward at the waist, such as picking up objects from the ground with straight legs, gardening, or vacuuming, should be minimized. Instead, bend at the knees and keep your back straight when lifting. You should also always attempt to keep your feet pointed in the direction you pick up or put down an object. 6. *Poor Posture*: Maintain good posture while sitting, standing, and walking to prevent additional stress on the spine. Avoid slouching or hunching over, as this can exacerbate herniated discs. For example, sitting with a rounded back or standing with your shoulders hunched forward are signs of poor posture. 7. *Contact Sports*: Participation in contact sports or activities that involve sudden impacts or collisions should be avoided, as they can increase the risk of further injury to the spine. It's importabt to understand that each person's disc herniation is unique. The severity (grade) and location of the herniation, as well as the age of the patient, all play a role. Therefore, it's not just beneficial, but essential to seek guidance from a qualified healthcare professional, such as a chiropractor or orthopedic specialist. They can provide personalized advice tailored to your specific situation, including suitable exercises, lifestyle modifications, and treatments. This professional guidance is the cornerstone of managing your herniated disc and promoting healing.

A chiropractor is a great place to start if you've thrown your back out. A chiropractor can access the cause of your pain and if it's not a chiropractic problem, they can refer you to the right provider to address your specific injury. In the meantime, icing the area of pain is typically the best way to begin treating a back or neck injury. If you are also having a lot of muscle tightness or spasms, you can use heat in that area. However, be sure to follow up with ice on the spine nearest to the injury. Heat will help relieve muscle spasms but will also worsen the inflammation in the joints. Muscle tightness is often just the body's way of protecting a joint injury. Using only heat in that area can result in a "rebound effect" that simply worsens the muscle spasm.

The severity of your injury will affect how long it takes to heal. The best way to determine that is with an MRI. This will determine if you have a herniation, bulge, or misalignment. Most soft tissue injuries will heal within 4-6 weeks. A classic symptom of disc herniations is pain radiating down an arm or leg. However, these symptoms can also be caused by a spinal misalignment. If you think you may have a herniated disc, visit an experienced
doctor of chiropractic for an exam and x-rays. The results of these tests will tell your doctor how best to approach your treatment and determine if you need any additional testing.

Chiropractic adjustments to the ankle will help restore motion to fixed joints, relieving ankle pain. A chiropractor will also examine the lower back to determine if your foot and ankle pain is related to a lower back problem. The spinal nerves that exit from the base of the spine travel down the leg and to the foot. In the meantime, icing the ankle and wearing a supportive ankle brace can help to reduce pain and protect against further injury.

Lying on your back or side are the best positions to sleep in. When on your back, it is helpful to place a small pillow under your knees to help relieve pressure from the lower back. When on your side, a pillow between the knees is also helpful. Using the right pillow is also very important. There are many types of cervical support pillows to choose from. If you are a side sleeper, choose a firm pillow that is roughly the same thickness as the space between your ear and the outside of the shoulder. If you are a back sleeper, a pillow that supports the cervical curve (lordosis) is best.

The nerves that exit from the lower back branch out and travel down the leg. When there is pressure on those nerves it can cause pain, numbness, or burning to radiate down the nerve's pathway. Pain radiating down the leg from the lower back is commonly referred to as "sciatica". Icing the lower back and NSAIDS can provide some temporary relief but addressing the cause of the problem is the only thing that will provide long-lasting relief. Chiropractic adjustments, acupuncture, ice, and physical therapy treatments like electric muscle stimulation and ultrasound are all helpful in treating your injury. When an injury like this occurs, it's best to start with ice on the lower back and if that doesn't provide fast relief, schedule an appointment with your chiropractor to find the true cause of your pain.

Chiropractic adjustments can help speed the healing of any joint injury. The "new and improved" method for treating joint injuries is RAISE. Rest, Adjust, Ice, Stabilize, Elevate. Chiropractic adjustments help mobilize injured joints so that they heal properly. Wrapping a joint and not allowing it to move freely will cause scar tissue to develop, possibly creating a permanent change in your ankle's range of motion (ROM). Of course, your chiropractor should examine the injured ankle and take x-rays (if necessary and they haven't already be done) to make sure your ankle is not broken.

If the rib is truly "dislocated," you should go to an Emergency Room. Fortunately, that is EXTREMELY rare. It is very common for a rib to become "subluxated". This means the joint is stuck and not moving correctly. A chiropractor can find and mobilize these joints. A subluxated rib can be very painful, affecting your ability to work, exercise, and even breathe. Chiropractic adjustments can provide fast relief from rib pain.

The specific exercises needed to correct your posture depend on the particular problems with your posture. Proper "textbook" posture creates a straight line from the ear down through the shoulder, hip, knee, and ankle. For most people, their posture problems come from an increase in the forward curve (kyphosis) of the thoracic spine. This creates a "hunchback" appearance. To correct this specific problem, the muscles of the upper back should be strengthened, and the chest muscles should be stretched. Poor posture can also be improved by consciously correcting your posture by pulling your shoulders back and tucking your chin. As a reminder, pick a color you see frequently and every time you see this color, correct your posture.

Depending on the cause of the pinched nerve, it can take days, weeks, or even longer. Best case, it is simply some muscle tightness or spasm putting pressure on the nerve. Worst case, it could be a herniated disc requiring surgery. If the pain in the neck is radiating or traveling down the arm or up into the head, schedule a visit with your chiropractor to have it evaluated. In the meantime, ice is the best place to start. Apply it to the area where the pain starts, 20 minutes on and then 20 minutes off. Be sure to keep a thin towel or t-shirt between you and the ice pack to prevent any frostbite or skin irritation.

Why does my back crack when I stretch? Every time I stretch my back cracks. Is it normal? Should I see a chiropractor? *The cracking noise you are hearing is from gas and fluid interacting in the small joints that connect the bones (vertebra)* *in the spine together**. Normally, each of the bones in the spine moves a small amount to give us our full range of motion. When one of the bones is stuck (subluxated), the others need to move more to make up for that. That is the "popping" and "snapping" you hear. Those noises also mean that the spine isn't working properly. A chiropractor will find the bones in the spine that aren't moving properly and adjust them.*

Most patients will get some immediate relief after a chiropractic adjustment. Whether your back pain is a chronic problem or the result of a recent injury, it may take several adjustments before seeing any relief.

Medications can work quickly but they are simply masking your problem. Imagine driving down the road and your car makes a funny noise so you turn up the radio. The problem is still there, you just can't hear it. Truly making positive changes in the body takes time. Just like losing weight, straightening your teeth, or getting in shape to run a 10 k.

Give your chiropractor time to work on your problem and follow their directions on icing, stretching, and ergonomics. Even if you don't get relief from the first adjustment, very soon you will notice less pain, increased ROM, and better mobility. Most chiropractic patients present with problems that began weeks or months earlier so they can take time to resolve.

The fall on your bike undoubtedly affected the joints in your neck. With an acute injury, the joints connecting the bones together will swell, and the muscles will tighten to splint the injury. An untreated cervical injury like yours often turns into chronically tight neck muscles and headaches. Left untreated, the pain can begin to radiate into the shoulders, arms, and eventually the hands.

Whoever examined you after your fall was probably focused on the head injury, a potentially more severe problem. Alternating hot and cold on your neck can provide some relief, but to resolve your problem, have the injury evaluated by a chiropractor as they specialize in spinal injuries.

Pressure on nerves in the neck (cervical spine) is the most common cause of radiating arm pain. The lower cervical spinal nerves travel down the arm to the fingers. Try applying ice to the base of the neck when the arm is bothering you. If the ice helps, a chiropractor can help you with your problem.

Chiropractic adjustments restore motion to segments in the spine that are fixed (subluxated). The adjustment removes pressure from the nerves that exit between the vertebrae and relieves nerve pain.

Sleeping on your back or side helps relieve lower back pain. Placing a small pillow under your knees while on your back or between the knees when lying on your side is also helpful.

Stomach sleeping leads to neck and lower back pain and should be avoided. If you are a stomach sleeper, use a pillow between the knees while lying on your side to help prevent rolling onto your stomach while asleep.

Maintaining good posture takes work. Long workdays (and weekends) spent sitting, hunching over phones, tablets, and laptops, and long commutes to the office take a toll. Fortunately, there is always time to fix your posture.

Chiropractors take an overall, full-body approach to help with posture. They use chiropractic adjustments to correct spinal misalignments, which cause pain, muscle spasms, and poor posture.

Chiropractors are especially well suited to correct bad posture. Although they deal with the entire musculoskeletal system, chiropractors spend most of their time ensuring the spine is healthy. Because when the spine is healthy, the rest of the body tends to function better.

Correcting your posture isn't just about looking better, standing taller, and feeling more confident. It's also about your health in general. People with poor posture constantly put extra pressure on the discs in the spine, which increases the risk of back pain and injury.

Posture correction is usually a process that takes time. Depending on the severity of your poor posture, you could be standing up straighter in just a few weeks. If you're experiencing pain from poor posture, chiropractic care can provide relief in as little as one to three sessions.

But posture correction isn't all about chiropractic visits. There are things that you can do on your own time to help correct the imbalance.

How long it takes to correct your posture fully depends on the severity of your condition. While not an overnight fix, chiropractic can significantly improve your posture and pain levels. Once you have addressed the mechanical causes of your poor posture, you will still need to work on your posture "habits."

There are many causes of poor posture. Improper lifting can contribute to bad posture. Often it isn't just one thing but a combination of the following: stress, lifestyle, mood/emotions, weight gain, pregnancy, carrying heavy backpacks, and wearing high heels.

Therefore, fixing posture is more complex than just remembering to stand up straight.

Many people only realize they have bad posture once they start experiencing pain or stiffness. Posture isn't something most of us are conscious of until it needs fixing. So, here are some signs you have bad posture: Regular headaches, pain in the front of the shoulders, neck pain, stiff upper back, rounded upper back (also known as a Dowager's Hump), rounded shoulders, and forward head position.

There are different types of poor posture. Each of these requires slightly different methods to fix. Below are some common types of poor posture and exercises that can help.

Forward head posture, also called "tech neck," is exactly what it sounds like. It's often the result of leaning the head and neck forward to look at our phone, read a book or type on a keyboard.

Lateral Neck Stretch
Sit (or stand) in a chair with good posture, meaning your shoulders back and your head in a neutral position. Tilt your left ear sideways toward your left shoulder, keeping the right shoulder relaxed. To increase the stretch, grasp the bottom of your chair with your right hand. Stretch to both the left and right, switching hands as needed. Hold this stretch for at least 30 seconds for 2-3 sets. Then, switch directions. Keep your upper body relaxed and pain-free.

Neck Rotation Stretch
Again, sit in a chair, avoiding poor posture. Ensure the neck is neutral (slightly tucked) before starting. Rotate your head to the right, looking over your right shoulder. When you can't go any further, place your left hand on your cheek and gently apply pressure and hold. Do not force this stretch and keep your neck in a neutral position. Hold for 5-10 seconds and then switch to the other side. Repeat 10-20 times total on each side.

Fixing tech neck is generally a matter of muscle strengthening and spinal alignment combined with good habits. Set an alarm when reading or working on the computer. It's best to spend at most 30 to 40 minutes at your computer without changing position.

"Hunchback" posture is another term for kyphosis, which can result from poor posture (slouching) or be congenital. Either way, this is usually characterized by rounded shoulders, creating a hollow chest and an unnaturally rounded upper back. Another term for this is Dowager's hump. Either way, chiropractic can help. People with a "hunched" back due to poor posture can benefit significantly from chiropractic care. Exercises to help this include:

Chest Stretch
Stand sideways in a doorway or door and stand tall. Bend your elbow 90 degrees and bring them up to shoulder height with your hand up and facing forward. Place your upper arm and elbow against the doorway and lean into it to feel a stretch in your chest. Thirty seconds to one minute works well. Repeat on the other side.

Upper Back Isometric Exercise
Lie on your stomach, facing the floor, and your arms straight in front of you. Pull your elbows at your sides as much as you can. Hold in this position for 5 to 10 seconds, and then return your arms in front of you. You should feel the contraction in your back muscle when you hold this position. Next, you can lift your chest a few inches off the floor to engage your back muscles more efficiently.

Poor posture can cause all kinds of problems throughout the body. It can make one's shoulders uneven, cause hip misalignments, and weaken the spine's structure. Many people who suffer from bad posture also suffer from back pain. They have trouble sleeping with back pain and doing everyday activities that give their lives meaning.

For better or worse, we aren't going to stop using our phones and tablets, which are major causes of bad posture. For starters, limit your phone and tablet time, and most importantly, move! "Motion is lotion"! We were designed to move, not to spend our days sitting in front of a computer or steering wheel.

Set a timer for yourself to get up, walk, do some jumping jacks, stretch, or do anything that doesn't involve sitting! Any position can become painful if held for too long. The exercises listed above, along with chiropractic adjustments, can all help to improve your posture.

Chiropractic adjustments take just a few minutes to perform. However, before adjusting your spine, your chiropractor will take a thorough history of your injury and examine you to determine what needs to be adjusted and the best technique to use for your adjustment. An initial visit can take as long as an hour when a consultation, exam, and x-rays (if necessary) are done.

After the first visit, you can expect adjustments to be brief. Keep in mind that your chiropractor may also use additional therapies like electric muscle stimulation, acupuncture, or trigger point work to help address your problem and this can take some extra time.

Sciatica is is caused by a bone in the lower back pinching on a nerve. A chiropractor can find the misaligned vertebra and with an adjustment, remove that pressure. Chiropractic adjustments are a safe way to treat sciatica without resorting to dangerous drugs or painful surgeries.