The Most Common Causes of Knee Pain

The knee bears significant importance in an individual’s ability to move freely. The slightest injury could result in pain and discomfort.  More significant knee damage might precipitate mobility issues that might interfere with a stricken person’s mobility and lifestyle. Studies compiled by the Centers For Disease Control (CDC) have concluded that many Americans, ranging in age, suffer from knee pain and that such discomfort has increased in incidents by significant percentages over the last two decades.

Let’s examine the knee, the bodily structure’s important working components, the types of injuries and illnesses that may cause knee pain and how such condition is diagnosed.

Anatomy of the Knee

knee pain

Hard Structures Of The Knee Joint

The knee joint is surrounded by four hard structures or bones which are medically classified as the femur, tibia, patella, and fibula.


The femur is not only the longest but the strongest bone in the human body, which extends from the hip to the knee. This bone provides the support that enables the muscles of the upper leg to function.


Also known as the shinbone, this second longest bone inside the human body is one of two bones that connect the ankle to the knee. The shinbone helps support the body’s weight and allows individuals to flex and maneuver the lower regions of their legs.


More commonly referred to as the kneecap, this structure is located between the shinbone and femur. The patella’s major function is to provide protection for the softer tissues located in the knee.


Also situated in the lower leg, this bone runs parallel to the tibia and, along with that structure connects the knee and ankle thus enabling the muscles and tissues of the lower leg to properly function.

Soft Tissues Of The Knee

In addition to bones, the knee is comprised of several soft tissue structures that promote the joint’s ability to move, flex and support the body’s weight when an individual stands, walks, exercises or engages in any other activity requiring leg movements. Soft tissues are referred to in medical terms as cartilage, ligaments tendons, muscles, capsules and bursa. Noted knee soft tissues include: the meniscus, the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the lateral collateral ligament (LCL) and the medial collateral ligament (MCL).


The knee contains two cartilage-filled structures known as menisci. The menisci provide a protective space that prevents the femur and tibia from coming into contact.  They act like a shock absorber within the knee joint.

Anterior Cruciate Ligament (ACL)

This piece of soft tissue connects the tibia and femur. The ACL’s other primary responsibility is to keep the tibia from sliding into the femur.

Posterior Cruciate Ligament (PCL)

The PCL also conjoins the femur and tibia. However, the other main purpose of this ligament is to prevent the tibia from sliding into the femur from a backwards angle. Both ACL and PCL help maintain the knee’s stability and prevent the primary joint from overextending.

Lateral Collateral Ligament (LCL)

Located directly outside the knee proper, the LCL joins the femur’s outside bottom region to the fibula’s external top end. In addition, this structure controls the amount of force the knee is typically exposed to.

Medial Collateral Ligament (MCL)

Situated inside the knee proper, this collection of soft tissue connects the femur’s bottom, inside region to the fibula’s internal top section. The MCL’s other major duty is to prevent the force from impacting the knee’s inner region. Both the MCL and LCL also limit the amount of side-to-side motion the knee experiences.

Knee Muscles

Muscles located in or around the knee are the quadriceps, hamstrings, and calves.


The “quads” as they are sometimes nicknamed, extend from the thigh to the knee and enable the knee joint to extend and the leg to move.


These muscles are located in the back of the legs and also extend from thigh to knee. These structures support the legs but also enable individuals to bend and flex their knees.


The calf muscles extend from the knee to the foot and support the knee’s ability to support and flex the lower leg regions.

Knee Joint Capsule

The knee capsule is located atop the knee and joins the kneecap, tibia, and femur together. Moreover, the capsule contains a lubricating liquid known as synovial fluid. This substance flows through the capsule and ensures that the knees hard structures remain strong and flexible.


The knee bursa is a fluid-filled structure surrounding separating the knees bones and tendons, which prevent such structures from coming into contact during movement.

Function of the Knee

knee pain treatment

The knee is integral to leg mobility. Because the joint is designed to flex and bend like a hinge, people with healthy knees are able to bend, flex and exercise their legs. Moreover, knee joints are created to withstand a great deal of pressure, which enables the structures to support a person’s weight when they stand, walk, run or engage in any kind of physical activity. The knee joint also connects the hard structures and soft tissues of the lower leg with their counterparts situated in the limb’s upper part.

The knee provides us with a great deal of motion and mobility.  Unfortunately, it also is vulnerable to wear and tear as well as injury due to its constant use.  Those who protect the knee and care for their knees often go through life without much difficulty.  However, those who overuse their knees or face injuries may often end up with pain or other issues down the road.

Conditions that Cause Knee Pain

A variety of injuries and illnesses might precipitate knee pain. The discomfort experienced by the stricken individual will depend upon several factors including the specific location of the injury or illness, the condition’s severity, as well as external issues such as the patient’s:

  • Age
  • Weight
  • Physical condition
  • General health

Furthermore, knee pains could arise from acute injuries, damage precipitated by overuse of joint, in addition to several chronic medical conditions.

Acute Knee Injuries

Acute injuries are typically the result of blunt trauma caused by sudden accidents such as automobile wrecks, falls, or athletic injuries.  In cases of significant impact, fractures of the bones of the knee could occur.

Acute injuries that could impact the knee include:


Fractures are breaks to any of the bones surrounding the knee joint. These bone cracks can range in severity from a slight break to complete and total shattering of the hard structure in question. The most severe bone breaks could result in the impacted bone protruding through the afflicted person’s skin.

Mild fractures of the bone can cause some pain or inflammation, but does not always prevent loss of mobility.  However, moderate to severe fractures can cause more intense pain, significant swelling and lack of mobility.

Ligament Tears

Some of the most commonly seen mishaps are ligament tears. Often occurring during an awkward fall, unusual stretching or knee extension or excessive application of force to the impacted knee region, the ACL, PCL, LCL or LCL could be subject to significant trauma that could culminate in a partial or full-blown tear. Ligament tears are sometimes also referred to as sprains. Sprains are typically graded in terms of the tear’s severity ranging from grade 1 (minor) to grade 3 (severe).

Regardless of the specific ligament involved, tears often produce intense pain. Additionally, such events typically cause a significant degree of swelling and could result in limited mobility issues or, quite possibly, the complete inability to move the impacted knee or stretch the affected leg. The severity of associated symptoms might also vary depending upon the injury’s severity.

Meniscus Tears

When the knee is exposed to unexpected trauma or is stretched or flexed beyond its normal capacity, the cartilage contained within each structure’s menisci can tear. Meniscus tears may develop suddenly or damage contained within said structures may develop over time and eventually result in full-blown tears.

The condition can, however, produce symptoms that might indicate an acute problem. Such manifestations include knee swelling, as well as pain that can lead to difficulty engaging in everyday activities such as climbing stairs or walking uphill.

Muscle Strains

Strains related to the knee muscles often happen as the result of the quadriceps and hamstrings being overextended. In severe instances, said muscles can be torn. Sports related activities like running, jumping or stretching often precipitates knee-based muscle injuries.

The most common physical manifestation of an acute knee muscle injury is sharp pain in the front or back of the impacted leg muscles. Depending on the severity of the pull, swelling might occur. Moreover, more serious injuries may also result in the stricken individual’s inability to bend or stretch their knee.

Overuse Injuries

Overuse injuries usually occur as the result of prolonged exercise or activities that tax the knee and its internal structures. Some of the more common injuries precipitated by overuse are:


Athletes or anyone who repeatedly bends their knees is at risk of developing bursitis. The condition results when the bursa becomes inflamed. Symptoms usually include mild to moderate pain and swelling on or surrounding the stricken person’s kneecap. If the pain is bad enough, the affected person might experience some degree of difficulty walking.


Tendonitis occurs in tendons, soft tissue structures connecting muscles to bones. Among the most common knee tendon to fall prey to this condition is the patellar tendon, which conjoins the shinbone and kneecap. Repetitive exercise can strain the structure thus resulting in mild to moderate pain and inflammation near the kneecap.

Knee Dislocation

Also precipitated by prolonged periods of exercise or other forms of overuse, a dislocated knee typically occurs when the kneecap shifts out of position. Symptoms of a dislocation can include pain and swelling toward the knee’s top.

Chronic Medical Conditions


This type of arthritis impacts joints such as the knee. Often affecting people older than 50-years-of-age or those who have sustained previous knee injuries, osteoarthritis is categorized by swollen, painful and stiff knees that may be difficult to move or bend. Once the condition arises, it typically worsens over a gradual period until treatment is administered.

Rheumatoid Arthritis

This form of arthritis can be quite serious and result in pain and swelling in affected joints like the knees. Rheumatoid Arthritis, or RA as the condition is known to certain medical practitioners, can cause significant illness and disability.


This ailment occurs when the body experiences a buildup of a substance known as uric acid. When uric acid forms excessively, it typically crystallizes and collects around joints such as the knee. Gout pain often occurs at night, can be extreme and result in mobility problems.


A doctor might need to employ several steps and diagnostic tests to determine the exact cause of one’s knee pain. First, the physician will perform a physical examination and ask the patient questions related to when the pain started, the severity level and the activities the patient did or still doing that may cause the pain.

After the examination is performed, the physician might order further diagnostic tests based upon the specific conditions said professional may suspect. Such tests include:

Radiological Tools

Tests like X-Rays or Magnetic Resonance Imaging (MRI) studies give doctors the ability to examine bodily structures such as bones or soft tissues and thereby determine the specific injury or ailment that has occurred. Conditions like sprains, fractures, and arthritis might be discovered following a radiological test.


This is a medical procedure that entails a physician extracting fluid from the knee. Once the fluid sample is taken, the substance is transferred to a laboratory where doctors can study its contents and determine if it contains any potential pain-inducing precipitators. Diagnoses of ailments like arthritis, gout, and bursitis can be made after employing this technique.

Blood Tests

Blood samples might be administered to diagnose specific ailments such as arthritis and gout.


Knee pain can be debilitating. On certain occasions, such discomfort might be the result of a short-lived, relatively minor problem. In other cases, knee pain might indicate the presence of a more significant injury or illness requiring diagnosis and treatment.

For some mild to moderate causes of knee pain, the recommended treatment protocol could include rest or the administration of over-the-counter pain and inflammation relievers. However, when discomfort is precipitated by more serious injuries or illnesses, remedial efforts might require physical therapy or surgery. Your treatment will depend upon the severity of the condition, as well as your age, health and potential tolerance to specific therapeutic protocols. Speak with us to know more.


Shoulder Pain and its Causes


Are you suffering from aches and pain in your shoulder? Shoulder discomfort may impact up to 67% of Americans during some point during their lifetime. ( Although this statistic is surprising, examining the design and purpose of the shoulder can provide some enlightenment as to why this particular joint is prone to injury.

shoulder painThe shoulder joint is a very complex joint—and it is one of the largest joints in the body as well. Designed to be extremely mobile, the shoulder joint moves in such a way as to allow us to raise an arm overhead, toss a set of keys on a desk, and lift a heavy object. This joint can move freely in a variety of positions. But this extreme flexibility comes at a cost: the shoulder joint is not as stable as some other major joints in the body. This causes the shoulder joint to be prone to pain from overuse, wear-and-tear, or even damage to one of the muscles, ligaments or tendons.

Shoulder pain can drastically impact the performance of normal daily tasks. Damage to the structure of the shoulder can prevent a person from doing things such as lifting a gallon of milk out of a refrigerator. It can cause intense pain when that same person tries to go to sleep at night. It can even cause such sensitivity to touch that minor pressure on a particular portion of the shoulder can cause great discomfort. When shoulder pain and discomfort is impacting someone’s daily routine, it is time to seek out medical attention in order to determine the correct course of action that will provide relief of pain and correct the underlying issue.

Taking a look at the structure of the shoulder can provide some enlightenment as to where injury commonly appears and why this leads to pain.

Shoulder Anatomy

The upper arm bone, called the humerus, fits inside the shoulder blade, called the scapula. The glenohumeral joint serves to attach the arm to the body. This is sometimes referred to as a ball-and-socket type of construction.

The collarbone is connected to the acromion (a bony structure that projects from the scapula, found at the highest portion of the shoulder) by the acromioclavicular joint (also called the AC joint). (

Another joint found in the shoulder is the sternoclavicular (SC) joint. The SC joint is found where the collarbone meets the breastbone. (–conditions/sternoclavicular-sc-joint-disorders/)

In addition to several joint structures, there is a major group of muscles that directly impacts the shoulder’s ability to move in a wide range of direction while maintaining some stability. This collection of muscles and tendons is referred to as the rotator cuff. (

How the Shoulder Should Move

The shoulder should allow the arm to move in a variety of positions. The shoulder typically is able to achieve forward flexion, which is movement where a straight arm is raised in front of the body, palm down. It should be able to perform abduction, which consists of movement where a straight arm is raised to the side of the body, palm down. The shoulder should be able to move in an external rotation, where the elbows are at the person’s side, palms facing each other. The shoulder is then able to rotate the hands outwards while the elbows remain against the side of the body. Finally, the shoulder should allow for some internal rotation, which occurs when the arm is placed behind the back, with the elbow in a bent position. (

In determining how well, or how poorly, a shoulder joint is functioning, a medical professional may measure the above positions to see if the range of motion is within normal limits or not. After seeing the range of motion, the medical professional will often conduct additional strength testing.

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Conditions Related to Poor Shoulder Mechanics or Injury

Rotator Cuff Problems

The rotator cuff, consisting of several muscles and tendons whose purpose is to stabilize the shoulder, is used much of the time that you use your shoulder. There are several conditions that can result from mechanical problems in the rotator cuff. Overusing the rotator cuff can lead to a condition called tendinitis. This injury causes the rotator cuff area to become inflamed. Bursitis is another inflammatory type of injury that results when the fluid-filled sacs located between tendons and bones in the rotator cuff become inflamed.

Rotator cuff tears (tears in the rotator cuff muscles) often will result when the shoulder is overused or when there is an acute injury. The rotator cuff also can be torn following an accident or a bad fall. It can also tear as a result of daily wear-and-tear on someone who is very active or aging. Usually a rotator cuff tear results in more significant pain.

Some of the more common symptoms of a rotator cuff injury include:

  • Patient is avoiding particular activity that causes pain
  • Patient does not retain full range of motion
  • Patient experiences pain when sleeping on the shoulder suspected of injury
  • Patient experiences pain upon light touch or manipulation of the shoulder
  • Patient experiences pain when stretching to reach something overhead or to move something heavy with that arm
  • Patient is experiencing weakness in the arm (especially when trying to raise the arm above shoulder height)

Anyone experiencing any of these possible symptoms for more than a week should arrange to see a medical professional.


Scapular Pain

Another shoulder problem that may require medical intervention is pain in the scapular region (pain located between the shoulder blades). Someone experiencing scapular pain may have a dull aching pain located in the upper back. Occasionally there may be mild shooting pains associated with this as well.

This type of pain is usually caused by a mild strain to a tendon or a muscle, often caused by lifting something heavy without assistance. It can also be caused by poor posture, especially in an office worker who must sit at a desk or work on a computer for hours at a time.

In most instances, this type of pain resolves on its own and does not require any medical intervention. Some things that a person suffering from mild scapular pain can do to alleviate pain is to apply warm compresses to the area to relax muscle tissue, do some gentle stretching or even consider massage therapy.

There are, however, some instances when scapular pain is indicative of a more serious underlying medical condition. Some examples of this include:

  • Rotator cuff tear
  • Fracture of the spine
  • Spinal disc injury (bulging or herniated disc)
  • Narrowing of spinal cord, called spinal stenosis
  • Arthritis of the spine or neck joints
  • Compression of nerves (impingement)
  • Various cancers, and even
  • Heart attack (especially among women)

Looking at the serious nature of many of the possible underlying causes of scapular pain, it is advisable to seek the advice of a medical professional if you are experiencing pain between the shoulder blades that persists or is in conjunction with other symptoms. If the pain is sharp or extreme, and involves pain in the chest and/or breathing difficulties, emergency medical treatment should be pursued immediately.


Thoracic Spine Pain

The thoracic spine region ranges from the bottom of the neck to the top of the lower back. This region is often referred to as the mid/upper back. There are instances where pain in the thoracic area may cause pain and discomfort that is felt throughout the body. Sometimes there is referred pain that is felt in the shoulder region. In this case, the shoulder pain is a sign of an underlying condition, but the underlying condition is not caused by a mechanical defect or injury to the shoulder itself.

Impingement Symptoms

Another common cause of shoulder pain is called impingement. Impingement refers to a pinched nerve. If there is a pinched nerve in the spine, that condition is called radiculopathy. This can occur when there are changes, usually over time, in the bones and cartilage near a nerve bundle or nerve roots. When the changes lead to inflammation, it can result in pressure being exerted on the nerves. When this occurs, it can result in weakness, burning or even the loss of feeling in the shoulder itself, the arm, or hand. These symptoms can even be felt all the way to the fingertips.


One way to determine if the symptoms you are experiencing may be caused by a pinched nerve as opposed to another shoulder injury is that the pain is experienced in only one shoulder. You may feel sharp pain at the site that is the probable location where the actual impingement is taking place. You may feel pins and needles feelings all the way down the arm. The symptoms may grow worse as you turn your head to one side or the other.


Degenerative Joint

Another shoulder injury or condition that may be the cause of pain and weakness is one of several different types of degenerative condition. Shoulder joints are subject to a great deal of wear and tear. Arthritis can develop as the joint becomes unstable. It can cause pain in the joint, inflammation, and limit the range of motion.

The two main kinds of degenerative arthritis that can occur in the shoulder are osteoarthritis (abbreviated OA) and rheumatoid arthritis (abbreviated RA).

Osteoarthritis is more common than any other type of arthritis in the shoulder. Osteoarthritis develops as a result of wear and tear in a joint. The resulting symptoms of this type of arthritis include tenderness, stiffness and pain.

Another common type of arthritis that can develop in the shoulder joint is rheumatoid arthritis. Since rheumatoid arthritis is an autoimmune condition, it can result in the development of pain in both shoulders at the same time, as compared to one shoulder.

Some symptoms of rheumatoid arthritis include:

  • Warmth and tenderness in the shoulder joints
  • Swelling of the joints
  • Stiffness in the shoulders, often in the morning
  • Fever
  • Loss of weight with no apparent reason
  • Tired, fatigued feeling
  • The appearance of bumps underneath the skin in the arms or the shoulders (these are called rheumatoid nodules)


Evaluating Your Shoulder

If your shoulder pain is severe enough or is beginning to impact your daily activities, it is time to consult a medical professional. At this point, you will have several expectations. First, you want your healthcare provider to determine the underlying medical condition causing your pain and discomfort. After your provider makes that determination, he or she can develop an intervention plan to alleviate pain and resolve the problem. The ultimate goal is to enable you to return to an active lifestyle.

You can expect several things as you meet with your healthcare professional. You will be given an extensive questionnaire regarding your symptoms: what symptoms are you experiencing, when did they begin, how do they impact your life, and more. Your provider will meet with you and probably do a range-of-motion evaluation. This is where they’ll will check weakness in your shoulder during certain types of arm positions.


At this point, your healthcare provider may send you for x-rays as a first step. There are some changes in the bony structure of the shoulder that are possible to see by way of a non-invasive x-ray. Your provider can even see some degenerative changes in an x-ray.


Your healthcare provider may decide to do an ultrasound of your shoulder. This method of testing is especially helpful in examining the rotator cuff. An ultrasound is very helpful in discovering if shoulder impingement is involved in the shoulder condition. It is also useful in determining if there is shoulder instability involved.


If your provider suspects that there is underlying damage that is not evident by the x-rays, your next step will probably be an MRI. An MRI is a magnetic resonance imaging scan. The MRI utilizes a magnetic field combined with radio waves to produce images of the shoulder joint.

The MRI can reveal detailed images of the bones, muscles, tissues and tendons in the shoulder joint. Your doctor can use this information to diagnose the cause of pain in your shoulder and to obtain a better understanding of the underlying condition that is causing the shoulder problems.

Some of the advantages of an MRI are that it is non-invasive, it is not painful, and it reveals a wealth of information about the area that is the subject of the scan.



Your doctor may decide to do an arthography in conjunction with your MRI. This involves injecting contrast into the shoulder joint prior to the MRI. This enables the MRI to reveal even more details. It is especially helpful in revealing information about the lining of the joint itself and the supporting structures.

The Difference Between Joint Pain and Muscular Pain

When someone is in pain from an as-yet undiagnosed ailment, it is sometimes difficult to determine exactly where the pain is originating from. Pain can be referred pain (originates in one place but is perceived to be felt somewhere else). If the pain is muscle pain, muscles spasms are often also indicated. Exercising the area may alleviate the muscle spasms because lactic acid is released during mild exercise or massage.

Compare this to joint pain. With joint pain, there are no accompanying muscle spasms. Joint pain often includes inflammation of the area, which means stiffness may accompany joint pain.

It is important to spend time concentrating on the exact symptoms you are experiencing prior to the first visit with the medical professional who will be determining the cause of your pain. This will help your doctor determine the best treatment plan for your particular condition.

Returning to an Active Lifestyle

With many individuals, the shoulder pain they have been dealing with has reduced their normal activity levels. Some people who are dealing with rotator cuff tear may have given up some recreational activities they used to enjoy; they may have faced work restrictions. For such a patient, having a successful surgical intervention means a return to active lifestyle after having appropriate physical therapy following surgery.

Consulting a medical professional who is well-experienced in dealing with the various causes of shoulder pain is your first stop if your shoulder pain is interfering with your lifestyle. Once an appropriate course of treatment has been determined, if that treatment involves surgery, it is imperative that you follow all recommendations from the physician post-treatment. This means keeping the shoulder in the sling for the recommended period of time, attending all physical therapy appointments and doing everything that is asked of you. Taking the allotted time to recover from the surgery will allow your body to heal. Getting plenty of rest and staying hydrated are important. Your provider will have information advising you how best to prepare for your surgery and what to expect afterwards.

Ultimately, if you are experiencing shoulder pain that is impacting your normal daily activities, it is something that is damaging to your quality of life. Making the decision to pursue treatment is one of the best decisions you can make. Since there are so many possible underlying conditions that can be diagnosed by medical examination and testing, it is likely that there are medical interventions available that will improve your quality of life.

A return to an active lifestyle is within reach.

You just have to take the first step.


Many people suffer from neck pain and low back pain at some point during their life. You may be surprised to find that back pain impacts 80% of Americans. People who deal with low back pain will find that it impacts nearly every aspect of life. Back pain, regardless of the location or cause, may do more than cause pain at the site of the injury or medical condition.

Neck and back pain can substantially impact the ability to perform normal daily tasks, the ability to sleep, the ability to perform job requirements, and even the ability to engage in healthy exercise. Even though a majority of people suffer from back pain, many individuals do not seek medical attention. This is unfortunate, as there are multiple options a healthcare professional can recommend as part of an overall treatment plan.

But what causes neck and back pain? Young adults may suffer from neck and back pain as well as older individuals, so age is not determinative, although degenerative changes in the spine often result in back pain for older adults. Some people are born with spinal conditions that may lead to low back pain. In others, it may be an incident of acute injury, such as a car accident or a fall, which leads to back problems. Other factors that may contribute to low back problems include being overweight, failing to exercise regularly, and participating in repetitive tasks that are part of your work requirements may result in back problems. (1)

Many times, low back pain results from changes in the intervertebral discs in the spinal column. A look at the structure of the spine may provide some insight and context as to how the condition of the discs can cause resulting pain or weakness. (2)

What Is the Intervertebral Disc

The spine is a column of irregularly shaped bones, stacked one on top of the next. Each vertebra is somewhat rough: it is this rough surface that actually allows the attachment of the intervertebral discs. (3)

The intervertebral discs are found between each vertebra. These discs perform several very important jobs: they serve as a natural shock absorber, absorbing the motion of the vertebra. The discs also hold the vertebra together. These discs also allow the movement of nutrients into the spinal column.

Each disc is comprised of a gel-like core that is surrounded by a strong outer layer. The spinal column, then, is constructed of a column of vertebrae, with intervertebral discs found between each vertebrae. Directly behind the vertebrae and the discs is the spinal canal; the spinal canal holds the spinal nerves.

A closer look at the anatomy of the intervertebral discs provides a better understanding as to how these discs may end up as the ultimate culprit of a great many instances of back and neck pain.

Anatomy of the Intervertebral Discs

spinal-discThe intervertebral discs have a strong outer surface and a soft inner core. One way to picture the disc is to imagine a jelly doughnut. The exterior, called the annulus fibrosis, consists of rings of flexible collagen. The interior, called the nucleus pulposus, consists of a mix of water and proteins that combine into a gel-like substance. Surprisingly, the interior of the disc is comprised of 80% water. The nucleus pulposus allows the discs to absorb the action of the vertebral column. By serving as a shock absorber, the discs allow the spine to flex and bend.

In addition to the two major parts of the intervertebral disc, the annulus fibrosis and the nucleus pulposus, located between the disc and the vertebra there is a cartilaginous endplate that actually connects each disc to the vertebrae.(4)

It is important to note that each disc is comprised of 80% water at birth. The water-based content allows the disc to be pliable. (5)

Spinal Disc Problems and Symptoms

Let’s look at the main causes of spinal disc issues. These include:

  • Bulging disc
  • Herniated disc (also called slipped disc or prolapsed disc)
  • Degenerative disc disease, and
  • Pinched nerve

The Symptoms of Spinal Disc Problems

Often an individual who is experiencing pain attributes it to being overworked, considering it as something akin to a severe back strain. Minor pain in the neck or back may be the only symptom an individual experiences. Many people choose to treat this type of nagging pain with over the counter pain medication and either the application of heat or ice to the area that is hurting. For these individuals, the pain may resolve in short order without any additional medical intervention required.

For other individuals, the pain resulting from a low back issue may be severe. The individual may be unable to return to their work duties because the pain is so debilitating. They may even suffer from sleep issues caused by the pain. There are more complications that can arise when someone is experiencing spinal problems: for example, nerve involvement.  The most commonly know nerve condition to be involved with back pain is called sciatica.

Sciatica results when a herniated or bulging disc, in the lower back, is actually pressing onto or irritating the sciatic nerve . This creates pain that begins in the area of the compression. But the pain does not end there. This nerve pain then may travel down the nerve from the spine into the hip or buttocks and on down the leg. It is not uncommon for sciatica to cause pain all the way to the back of the knee and, in some cases, even into the foot.

The pressure on the nerve often causes pain, numbness and tingling. The individual may experience weakness when walking or rising. In some instances, the individual may experience the leg ‘giving out’ on them; in other words, suddenly the leg is not holding up the body’s weight. The pain caused by sciatica can be severe. Someone experiencing sciatica should seek out the services of a healthcare professional to ascertain the cause of the pain and to determine a course of treatment. (6)

Here is a list of some of the symptoms that may be indicative of spinal back problems:

  • Pain
  • Inflammation
  • Loss of range of motion
  • Radiating pain
  • Muscle spasms
  • Weakness
  • Legs “Giving Out”
  • Numbness
  • Pins-and-Needles Sensation

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Bulging Disc

One common diagnosis among individuals suffering from neck or back pain is a bulging disc; this is when a portion of the disc bulges out of place. The entire disc is somewhat displaced beyond what would be considered its normal boundary. This is usually caused by wear and tear over time. Many individuals have bulging discs and do not even realize it because they are not experiencing any pain. However, injury can also cause a bulging disc.(7)

To give you a better idea of what a bulging disc may look like, think of an inner tube that someone might float on down a lazy river. The wall of the inner tube should be strong. However, like a bulging disc, if a weakness occurs in a small section of the tube, you may see the tube expand (or bulge out).  The wall is not completed torn, but it has significantly weakened.

Herniated Disc

A herniated disc, often referred to as a slipped disc, occurs when a small portion of the inner nucleus of the disc protrudes through the outer surface. The outer annulus fibrosis may have developed a crack through which a portion of the soft inner material may protrude. Although this can occur at any point in the spine, this type of condition usually occurs in the lower portion of the back. (8)

Herniated discs are more likely to produce pain than bulging discs. This occurs if the disc protrudes into the spinal canal where it can irritate nerve roots. In many cases painful inflammation will also develop. (9)

Herniated discs can develop over time, in the case of an aging individual; they can also result from a trauma or even during strenuous physical activity. (10)

When a herniated disc presses on a nerve, radiating symptoms often occur in the shoulder or arm (in the case of a herniated disc in the neck) or in the the buttock or leg (in the case of a herniated disc in the lower back).

Degenerative Disc Disease

intervertebral-discDegenerative disc disease can occur when one or more of the spinal discs are weakened through wear and tear over time. Since the discs serve as a shock absorber between the spinal vertebrae, the entire spinal system may become weakened. Those areas under the most stress will often be at greatest risk for degenerative changes.

As the years pass, spinal discs eventually become dehydrated. As stated earlier, discs are comprised of 80% water at birth. As the water is lost over time, this eventually results in the discs becoming stiffer. This will prevent them from adjusting to compression the way they used to do. This is a normal part of the aging process, but that does not take away from the fact that it can cause serious back pain. (11)

Individuals suffering from degenerative disc disease may experience pain throughout the back, shooting pains in arms and/or legs, numbness or weakness.(12)

Symptoms that may indicate degenerative disc disease:

  • Mild to moderate, continuing spinal pain
  • Painful flare-ups at the site of the damaged disc
  • Sensitivity to touch, caused by inflammation
  • Sharp shooting pain in the buttocks, hips, back of leg, caused by pinched nerve
  • Weakness, instability, feeling that back will ‘give out’

With degenerative disc disease, the pain may improve when the individual incorporates short walks into their day. This serves to alleviate the pressure on the damaged disc. Upon walking that pressure is now placed upon joints and muscles, leading to temporary pain relief. Several short walks may provide more relief than one strenuous walk. Gentle stretching before and after walking also proves to be beneficial.

Conversely, there are other movements or positions that can cause pain to increase. Sitting for long periods of time often leads to an increase in pain and stiffness when the individual rises. Bending and twisting often leads to serious pain located in the area of the damaged disc. (13)

Pinched Nerve Due to Disc Problems

A pinched nerve can create severe pain. In some cases a damaged disc itself is not painful; instead, the pain results when material protruding from the damaged disc pinches, or irritates, a nerve. One term used for this type of pain is radicular pain. This type of pain includes sharp shooting pain that radiates outward from the site of the nerve.

In addition to the sharp shooting pain, other symptoms of a pinched nerve include tingling sensations, numbness or weakness. This weakness can be something that persists over time, or it could come on suddenly. When this happens, the affected limb may give out without warning. (14)

Sciatica is a condition that can result from a pinched nerve in the lower spine. If material is protruding from a disc into the sciatic nerve space, it can create pain and inflammation. The irritated nerve root can result in severe pain that radiates down the back into the hip or buttocks. The pain traveling down the sciatic nerve can lead to pain behind the knee. Patients describe the pain as shooting, searing, or burning. In some instances the pain may feel like an electric jolt, and can be excruciating. (15)

Ways to Alleviate Symptoms of Pinched Nerve

When a herniated disc is compressing a nerve, inflammation usually develops at the sight of the compression. Nerve pain can be quite severe, so an individual suffering from a pinched nerve should consult a medical professional for treatment.

One approach to alleviate some of the discomfort caused by a pinched nerve is to apply ice packs to the spinal area that is affected. The ice is initially used to reduce any additional inflammation in the area.

An individual suffering from a pinched nerve should rest the area as much as possible. Getting adequate sleep and rest can allow the damaged nerve time to recuperate.

In addition, significant amounts of forward bending of the area is not recommended as this can push the contents of the disc back into the nerve.  Repetitive lifting or lifting heavy objects should also be avoided until healing has occurred.

Medical Intervention

When someone is suffering from low back pain, there are many effective treatment options available. Making the decision to see a medical professional who treats low back pain may do more than alleviate painful symptoms: it may prevent more serious consequences from developing. A medical professional will develop a treatment plan appropriate to the injury or medical condition diagnosed. Generally, non-surgical intervention will be tried first, to see if that will alleviate pain and discomfort.

Non-Surgical Intervention

Non-surgical intervention is usually conservative in nature. The healthcare professional and the patient will look at options that the patient can incorporate into his or her present lifestyle and job tasks. Conservative treatment may include gentle massage, the application of ice, chiropractic care, physical therapy, the use of anti-inflammatory medications, and even a round of oral steroids to reduce inflammation.

If conservative methods are not effective after four to six weeks, your healthcare provider may decide to be more aggressive in treating the ongoing pain and discomfort. A physician may prescribe narcotic pain medication to achieve pain relief. In addition, a physician may recommend epidural steroid injections in the area of the damaged intervetebral disc.

Surgical Options

In cases of severe low back pain where an MRI has confirmed that damage to a disc is causing the pain, there are surgical options available. Surgical options include removing part of the damaged disc or performing a spinal fusion. Other surgical options, depending upon the condition of the disc, may involve surgery to decompress the disc space. Spinal surgery should always be seen as a last option, after all other conservative options have been attempted.


The intervertebral discs of the spine perform an important function. They help to cushion the spine, allow for motion in the spine and add stability.  However, the discs can also break down with overuse or injury causing a variety of painful and problematic conditions in the neck, middle back or low back areas.

In addition to localized pain and problems, the discs can also cause pressure upon nerves that can result in radiating numbness, tingling, pain and weakness.

Should you be experiencing symptoms as a result of disc problems, you should seek advice from a healthcare professional to hopefully fully resolve your condition.

belden village chiropractic













Introduction to Cold Laser Therapy

If you are experiencing problems with chronic inflammation or painful arthritis, you may be surprised if your doctor offers you the option of laser therapy. Don’t be alarmed: you won’t be facing a bizarre device that looks like it was used in the latest science fiction movie. Your physician is actually on the cutting edge of medicine by deciding to implement the use of cold laser therapy.

cold-laser-therapyCold laser therapy is a method of medical treatment that is nor commonly known by most individuals. Although it has been in use for years, you may have never heard of it. When most people think of laser surgery, they picture the operating room, where a surgeon is using a laser to cut into the body of a patient during surgery. And although there are special lasers that are used in invasive surgical procedures, that is a totally different type of laser altogether.

So what is a laser? Laser stands for Light Amplification by Stimulated Emission of Radiation.(1) A laser is, essentially, a beam of light. High energy is concentrated within that beam of light. As the light is focused in a particular area of the body, the light is absorbed by the body’s mitochondria; this leads to a chain reaction, causing the body’s natural healing ability to accelerate. More and more physicians and other medical professionals are using the technology of cold laser therapy in their treatment of a variety of medical ailments.

Cold laser therapy uses low power light in order to stimulate the healing process. (2) Cold laser therapy is used in many different medical applications, as will be explored in this article.

What is Cold Laser Therapy? (also called low level laser therapy)

Cold laser therapy, also known as low level laser therapy (LLLT), is a type of medical treatment that utilizes a specific type of laser to treat patients suffering from acute or chronic conditions. The laser uses a specific wavelength of light that interacts with the body’s tissue. This type of therapy is believed to speed up the body’s natural healing process, as the light is absorbed by the body’s mitochondria, which increases the energy production within the cells. (3)

What Are the Classes of Cold Lasers?

The F.D.A. has classified medical lasers into categories of surgical vs. non-surgical. Class 3A and 3B are non-surgical lasers: they cannot be used to cut tissue. Class 3A lasers are used to aid in the healing of superficial wounds and are generally not used to penetrate beneath the surface of the skin. Class 3B lasers, however, are designed to penetrate through the skin where they can aid in healing deep tissue and joint issues. (4)

What is Cold Laser Therapy Used For?

There is a wide variety of medical applications that can benefit from the use of low level light therapy. Since LLLT is a non-invasive treatment option, many medical professionals are jumping onboard and using it in their practices.

For dentists, the cold laser can aid in treatment of mouth sores and ulcers, hastening the healing process. They are also finding it is useful in the treatment of pain from Temporomandibular Joint Injury (TMJ). Dentists and oral surgeons are using LLLT following extractions to reduce swelling and hasten the healing time. It is used in cases of dry socket, and it is used following dental implants. (5) More and more dentists are finding the cold laser therapy can greatly enhance their ability to offer relief to their dental patients.

For pain management clinicians, cold laser therapy is something that can be added to a patient’s pain management plan. Think of it as another layer in the overall care for the individual suffering from chronic pain. Cold laser therapy offers a non-surgical treatment that may provide greatly needed relief for patients.

For the family doctor, cold laser therapy enables the physician to find an innovative way to enhance medical care for the patients. For the woman suffering from arthritis, cold laser therapy can provide relief by decreasing inflammation. For the high school athlete, the physician can treat sports-related injuries by decreasing inflammation and by enhancing the body’s own ability to heal itself. The applications of cold laser therapy are practically endless, as additional medical specialty groups are finding ways to utilize this technology to help patients feel better.


The most common reason physicians are consulted in the US is due to pain. With one-third of Americans experiencing chronic pain, physicians are looking for effective treatment options for their patients, while also keeping in mind the need for the lowest risk possible. The common pain therapies in use today include anti-inflammatory drugs, steroid injections, pain medications and surgical intervention. (6)

Keeping all of this in mind, it is clear why physicians are beginning to turn to cold laser therapy as a viable option for patients suffering from chronic pain as well as those suffering from short-term situations when pain is experienced, like in the instance of a muscle strain or whiplash.

In cases where someone is suffering from chronic pain, a medical professional may choose to use cold laser therapy in combination with therapeutic massage in order to decrease chronic pain symptoms. The use of cold laser therapy does not necessarily take the place of other modalities of pain management; instead, it can be used to enhance the treatment of chronic pain.

Pain management clinicians and other medical professionals use cold laser therapy to treat individuals who are suffering from chronic pain. In some instances, cold laser therapy is used in conjunction with therapeutic massage in order to decrease chronic pain symptoms. Cold laser therapy would be another tool for the physician to use to reduce pain.

In chronic pain situations, doctors often recommend medications that reduce swelling, or inflammation. They may also offer pain medication to reduce the level of pain the individual is dealing with on a daily basis. Many pain management clinics can provide steroid injections or even use radiofrequency to decrease sensation in an area of nerve tissue.

There are a variety of circumstances when your physician may suggest the use of cold laser therapy for pain issues. These include:

  • Pain and stiffness from arthritis
  • Back pain
  • Carpal tunnel syndrome (hand/wrist pain)
  • Pain connected with fibromyalgia
  • Pain in the knee
  • Neck pain
  • Tendonitis



low-level-laser-therapyCold laser therapy is used by a variety of medical professionals. For example, dentists sometimes use cold lasers when they are treating inflammation in a patient’s mouth; they may also use it to treat mouth ulcers.

Physicians may use cold laser to decrease inflammation from numerous conditions such as arthritis or other situations where inflammation is present. By lowering inflammation, the body’s own healing process can begin.

Inflammation can increase the pain a patient is experiencing. For example, if a patient who suffers from herniated or bulging discs develops inflammation in an area of their spinal column, the inflamed tissue can actually press upon particular nerves, leading to pain that appears in other areas of the body. Inflammation in the lower spine can cause a patient to experience pain that runs down the back of their leg and even all the way down to their foot if the inflammation is impacting the sciatic nerve. Physicians are exploring ways that cold laser therapy can be used to treat a variety of causes of inflammation to determine if they can decrease pain and discomfort their patients are experiencing.


Some physicians are using cold laser therapy to promote faster healing. By releasing stored energy the cold laser speeds up the cellular repair. It also widens arteries and veins around the injury site, allowing more nutrients to reach the damaged area. Cold laser even improves white blood cell activity. In addition, the laser stimulates collagen, an essential protein that is key in repairing wounds and other injuries. (7)

Physicians may choose to use cold laser therapy to aid in the repair of acute injuries such as:

  • Muscle sprain or strain
  • Repetitive motion-caused injury
  • Sports injuries like tennis elbow, tendonitis, shoulder injuries

The Safety of Cold Laser Therapy

When individuals are offered the option to allow their doctor to utilize cold laser therapy in their treatment, one of the main concerns expressed by patients centers around the safety of the device. The two main issues are the possibility of eye damage and concerns about possible burns resulting from the heat produced by the laser.

Vision Safety

Since lasers produce a high intensity light, your medical provider should advise you that you should not look directly at the laser emitter. Some medical offices will provide the option of wearing safety goggles in order to prevent possible eye injury. (8)

Heat Production

Lasers that are used during actual surgery are used in order to cut, burn and/or vaporize tissue during the surgical procedure. The lasers used in this type of situation are often referred to as hot lasers. This is a different type of laser than the cold laser. In cold laser procedures, the rays of the laser will penetrate the skin but will not burn it. In other words, unlike surgical lasers, the cold laser does not heat up the skin tissues upon which it is focused. Some patients do feel a slight warming in the area being treated, as the increased blood circulation that results may create a mild sensation of warmth.

Other Safety Concerns

Cold lasers should not be used in the general region of the heart in patients who have pacemakers in place; anyone with a pacemaker who is offered the option of cold laser therapy needs to discuss this with their cardiac professional in order to obtain appropriate guidance.

Women who are pregnant should discuss the use of cold lasers with their physician for current recommendations.

There are other guidelines and recommendations for physicians to consider when they are determining whether or not cold laser therapy is appropriate for a particular patient. The treating physician should have the patient’s medical history in mind when deciding if cold laser therapy is appropriate for the individual.

Super Pulsed Cold Lasers (see Multi Radiance Medical)

In addition to the typical low level cold laser, there is a class of LLLTs called super pulsed cold lasers. This type of cold laser emits controlled pulses of light at a high power for a short length of time. The series of controlled pulses is able to better penetrate the skin without burning the body’s tissue.

The benefits of super pulsed cold lasers include:

  • Better penetration. This type of laser achieves enhanced penetration of the skin.
  • Quicker Action. This type of laser is able to act faster than the traditional cold laser.
  • No Heat Sensation. This type of laser uses a series of pulses that are so short in duration that they do not cause any sensation of heat.

What Is The Typical Cold Laser Therapy Regimen?

Keeping in mind that each individual treatment plan will vary greatly, the typical cold laser therapy treatment takes place over a course of weeks. On average, it can take 8 to 30 treatment sessions for maximum effect to be achieved. In some instances, a patient may expect to have 2-4 treatments per week. It is up to your medical professional to determine the frequency of sessions and the length of the overall treatment, which depends upon the type and severity of medical condition under treatment. (9)


If you are considering cold laser therapy, your physician has determined that this therapy should provide beneficial treatment of your particular physical ailment. Make sure that your medical provider is aware of your medical history, and do not be reluctant to ask questions. The use of cold laser therapy is becoming more and more common each day, thanks to its low risk profile and the wide variety of medical ailments that benefit from its use. If your physician or clinician is recommending it for your particular ailment, cold laser therapy may just be the answer to what ails you.











The feet are absolutely the foundation of the entire human body. Your feet literally cover tens of thousands of miles during your lifetime. If there is a problem with the feet due to some abnormality or medical condition, the result often shows up in other areas of the body, typically the knee, hip or even lower back. Foot pain can also lead to a serious reduction in activity level.

A recent podiatric survey done by the American Podiatric Medical Association (APMA) found that a majority of Americans (77%) stated that they have dealt with foot pain.(1) With that percentage in mind, it is highly likely that you will deal with foot pain at some point during your lifetime. Fortunately, advances in technology have made it possible for customized orthotics to be created for individuals that can improve improper mechanics and alleviate pain.

In order to determine how best to treat pain associated with improper foot mechanics, let’s first take a look at the basic anatomy of the foot and ankle.

The Foot and Ankle

The foot and ankle are amazing structures made of bones, muscles, tendons and ligaments. Feet are designed to be flexible, and to move in different ways in order to enable us to stand, walk, run and leap. The ankle, which must undergo great stress, is surrounded by ligaments that are designed to enhance stability.

The foot has three main sections:

  • The forefoot, where we find toes and long bones called metatarsals
  • The midfoot, where we find a collection of bones that create the arches of the foot, and
  • The hindfoot, where we find the heel and ankles in the foot

Considering the multitude of moving parts that are located within the feet, it is clear that there are numerous possibilities where foot damage can occur, leading to foot pain.


The arches of the feet are a crucial feature of the underlying foundation. The arch is where the foot absorbs a vast amount of pressure each time we take a step.

There are three arches in the foot. These are the anterior transverse arch, the medial longitudinal arch and the lateral longitudinal arch. If there is a lack of support underneath the arches, persistent pain may result.

For some individuals, certain shoes may not supply proper support which can be remedied by the addition of appropriate arch supports. In other instances, such as when a person has a condition such as plantar fasciitis, the addition of arch support may actually eliminate most of their pain.

Flat Feet

For individuals who suffer from a condition referred to as ‘flat feet’, which occurs when the arches in the foot have collapsed to the point that most of the sole is in contact with the ground, there may be a need for artificial arch support. This medical condition can lead to a wide variety of additional chronic pain issues.

Now that we have considered the basic mechanics of the structure of the feet, let’s look at proper foot movement.

How the Foot Should Move

There are two phases involved in walking: the stance phase and the swing phase.

Normal Foot Movement

Stance phase. This is the time when the foot is actually in contact with the ground. Surprisingly enough, this phase is almost two-thirds of the entire walking cycle.

Swing phase. This is the time when one of the feet is in contact with the ground whereas the other foot is in the air. The foot that is in the air actually goes through several stages to complete the swing phase.

Here are the stages of swing phase:

  • Heel strike. This begins when the heel of the foot touches the ground and lasts until the entire foot is in contact with the ground.
  • Early Flatfoot Stage. This begins when the entire foot is on the ground during the person’s stride. This stage is where the foot acts as a cushion for the pressure of the body’s weight. This stage ends when the center of gravity has reached a neutral position.
  • Late Flatfoot Stage. This begins when the center of gravity has shifted ahead of neutral, and ends as the heel begins to lift up.
  • Heel Rise. This begins when the heel propels the body forward.
  • Toe Off. This is when the toes lift off the ground. Once this has occurred, the swing phase is complete. The cycle of taking a step begins again.

The mechanics of running are very similar to that of the walking gait, although the speed of the phases is increased. When running, the mechanics of gait includes a ‘float phase’, when both feet leave the ground during the stride. (2)

Abnormal Foot Movement

As one is walking or running, abnormal foot movement can create unusual stress, creating chronic pain issues. One such movement is called pronation.

Overpronation can occur when the foot rolls upon landing on the ground or when standing. Underpronation can occur when there is inadequate rolling of the foot after landing on the ground, leading to excessive pressure on the outside of the foot.(3) Both of these conditions, when taken to the extreme, can result in a variety of medical complications and/or pain issues.

Abnormal foot movement, which we refer to as poor foot mechanics, can place pressure on joints over time, resulting in chronic pain issues.

Conditions Related to Poor Foot Mechanics

What are some common conditions related to poor foot mechanics? Let’s look at four of them.

Plantar Fasciitis

The plantar fascia is a ligament that runs the length of the foot, running from the heel to the tip of the foot. In cases where the arches of the foot are very high or very low, this ligament may be stretched to the point that the tissue becomes aggravated. When inflammation of this type occurs, the resulting pain can be severe. This is a common complaint in many individuals.

Ankle Pain

When the feet are not properly supporting the weight of the individual, it results in increased pressure on the joints above the ankle, typically the knee and hips. This pain can even extend to the lower back. One common cause of ankle pain is flat feet, or collapsed arches.

Knee Pain

There are many causes of knee pain. Poor foot mechanics can have a definite impact on the knee. In cases where ankle mobility is limited, it can result in pain to each joint above the ankle: the knee, the hip and even as far as the shoulder.(4)

Ankle mobility issues can also hamper the foot’s ability to toe off to move the body forward. A problem with ankle mobility is a common cause of overpronation as discussed earlier that may lead to knee problems.

Hip Pain

Poor foot mechanics can also lead to issues within the hip joint, resulting in chronic pain. If an individual’s feet roll in towards each other, it can result in a twisting action. The stress that results can be cumulative and even have a cascading-type effect. Once the feet are out of alignment, they can lead to pressure on the ankle joints. If the ankle joints become unstable, they can lead to a twisting action through the knees and upwards into the hip joints. The result is often pain and, in some instances, erosion of the impacted joints.

An individual suffering from foot or ankle pain usually goes to see their family physician, or in some instances, a podiatrist. There are several ways that a medical professional can evaluate the feet to determine what can be done to alleviate the pain.

Evaluating Your Feet

If poor foot mechanics are suspected as the culprit causing pain, an evaluation will be done to determine what is wrong. Two of the newer tools for this type of evaluation include multi-step gait analysis and 3D foot scanning.

Multi-step Gait Analysis

One relatively new technique that allows for detailed analysis of an individual’s foot is by use of a computerized multi-step gait analysis system. This allows for scanning of the individual’s gait while in motion. The platform records the individual’s footsteps and then provides data on the force exerted on the foot as well as the pressure placed on the foot. By identifying gait abnormalities, this device can aid in the development of a plan to alleviate pain.

An additional benefit of this device is that it can be used to evaluate improvements that take place following treatment. Comparisons can be drawn, as the data gathered prior to treatment can then be compared to data gathered in the midst of treatment and at the culmination of treatment. This allows for professionals to tweak the treatment plan as necessary to obtain optimal results.

3D Foot Scanning Systems

The use of the laser foot scanning system has resulted in advances in the creation of customer-specific orthotics that are based upon the individual’s unique foot shape. These scanning systems obtain highly accurate digitized images of the foot.(5)

Today there are even portable scanners, allowing medical professionals and orthotic specialists ease of access to accurate and detailed information of an individual foot. These scanners allow for images to be obtained while the foot is in a resting position and in various weight-bearing positions.

Once the scan is complete, 3D representations can be viewed on a computer screen. These images can then analyzed by a computer program to inform the creation of an individualized custom orthotic.

Once a diagnosis is determined, a custom orthotic device is often part of the recommended treatment plan.

The Difference Between General Shoe Inserts and Custom Orthotics

General Shoe Inserts

In-store kiosks where you can have your foot problem diagnosed by a machine are found in many of your local pharmacies and superstores. You may have seen them before: you stand on top of a platform and the machine evaluates where you place the most pressure on the bottom of your feet and then recommends a particular product. But do these over-the-counter diagnostic tools really work?

Off-the-shelf insoles or shoe inserts can make an ill-fitting or uncomfortable shoe feel a little better. But consumers should be aware that the wrong insole can actually exacerbate a pre-existing condition.

This is where custom foot orthotics come into play. With a custom orthotic, a medically trained individual evaluates the foot, taking into consideration the medical complaints and pre-existing conditions that may come into play with causing the pain in the foot, knee or hip.

Custom Orthotics

A custom foot orthotics will be custom made in order to align your foot and ankle into what would be the more anatomically correct position. It will be designed to correct the specific foot imbalance that is personal to your foot. With the ability of this device to conform to your foot, it can lower stress and strain and work to bring your feet—and body—back into alignment.

Back in Action Through Proper Foot Mechanics

Once the underlying medical explanation for foot pain has been reached, in many instances the addition of a properly-manufactured custom foot orthotic can improve gait, reduce pain and allow the individual to return to increased activities.

Current technological advances in 3D scanning in order to create custom foot orthotics are viewed as one of the optimal means available to improve foot mechanics. (6)

If you are suffering from foot or other joint pain that may be associated with poor foot mechanics, perhaps it is time to consider consulting a professional about the medical avenues that are available to you.

Your feet will thank you for you.


If you have been having problems with your feet, ankles, knees or hips, the issues may be arising from poor foot mechanics.  Call us today to schedule a 3D foot scan at 330-493-0009.










Whether you’ve had low back pain for a few days or a few months, the results are the same.  Low pain pain hurts, it causes many to have difficulties with simple daily tasks and it can certainly put people in a grumpy mood.

If you have low back pain you are certainly not alone.  In fact, experts believe that 80% of the population will experience a bout of low back pain within their lives.  Take a look at some of these statistics.

  • Low back pain impacts 31 million Americans at any one time.
  • Back pain is the number 1 cause of lost work days in the U.S.
  • Low back pain is the leading cause of disability for those under 45 years of age.
  • Approximately 2/3 of the costs of
  • Americans spend $50 billion on back pain every year

Those who suffer from back pain understand how disabling it can be.  Some can have localized pain that remains in one are of their low back while others may have pain that radiates into the buttock area or leg.  In addition the type of pain can also vary.  Some suffer from deep aching while others may feel sharp pain, especially with specific movements.

Whatever the symptoms feel like, the cause of the pain is what most, who experience low back pain, what to better understand.  Where is the pain coming from?

The Structures of the Lower Back

In order to understand where pain comes from, we first must understand the basic normal anatomy of the low back.  So, let’s have a quick anatomy lesson of the low back region.

treatable low back painThe lower back is made up of 5 lumbar vertebrae, separated by intervertebral discs (jelly doughnut-like structures).  These vertebrae surround and protect the spinal cord and the large nerves that descend from the lower cord.  These vertebrae also allow movement when we bend forward, backward, side to side or even rotate. Nerves exit out of the sides of the vertebral areas and these nerves descend into the pelvis, buttocks, legs and feet.

The base of the low back is called the pelvis.  The pelvis is made up of several strong bone structures called the sacrum and one pelvic bone on each side of it.  The tailbone, or coccyx, sits at the bottom.  This area is also a region where many nerve structures are found.

In front of the pelvis and vertebra are a variety of organs including the intestines, reproductive structures, bladder and other important soft tissue.

On top of, and surrounding the vertebrae and pelvis are vast muscular structures that gives us the ability to move.  Other additional important soft tissue elements, like ligaments and tendons, attach the many structures found in this area together.

Common Causes of Low Back Pain

Now that we have a better understanding of the normal low back structure, let’s talk about the potential causes of low back pain.  There are many ways that low back pain can occur.  Most forms of low back pain occur with treatable outcomes.  However, some forms of low bak pain provide signs that other, more ominous problems exist.  This is why you should always be evaluated when you have low back pain that isn’t resolving.

Soft Tissue Pain

Overuse or injury to muscle, ligament or tendon can cause pain in that particular area.  Often those with muscle injuries describe the pain as ‘sharp’ when the injury happened, but then changes to a dull ache or throbbing sensation.

Soft tissue pain is usually isolated to the specific area of the involved muscle(s) and the pain will increase should you try to engage that specific muscle.  For example, if you strain the right lower back muscles while lifting, trying to use these large muscles again will often aggravate the problem.

Mechanical low back pain

Mechanical spine pain (often called subluxation) occurs when the free-flowing movement of the spinal joints is not working properly.  This abnormal motion pattern (or lack of motion pattern) can cause the area to become inflamed or produce abnormal pressures on small structures in the area, like nerves, causing pain.

Mechanical low back pain can cause pain (dull ache or sharp) that is generalized in the area, but has been known to cause radiating symptoms when a nerve become involved.

Disc herniation or disc bulge

disc herniationSeparating the vertebrae are padded structures, called intervertebral discs.  These discs are like jelly doughnuts (with a jelly-filled center).  Discs provide the cushion that provides shock protection and also allows for the movement of one vertebrae on another.

Discs are susceptible to certain types of injuries.  Most commonly, the disc structure tears and the jelly-like substance inside can ooze out of the disc.  This can in itself cause pain, however, if that jelly-like substance pushes out far enough and comes in contact with a nerve, the pain can significantly elevate.  Because of the nerve involvement, this can cause the symptoms of nerve pain.

Tears in a disc can occur because of aging of the disc or due to a sudden injury.  Those occurring from sudden injury often cause a sharp pain directly over the affected area.

Pelvic Pain

The pelvis is the strong bone structure that serves to protect us and supports the hips that allows us to move.  This region has a significant amount of soft tissues including tendons, ligaments, muscles and nerves.  Although the strength of this area is superb, pain in this area can also be concerning.

Since there are so many ‘connections’ in the region (hips, sacroiliac joints, lumbosacral joint) there are many possibilities of cause of pain.  Pain in this area can often feel “deeper” and feel dull and achy or be sharp in nature.

Nerve Pain

Nerves are delicate structures that are found throughout our bodies that carry signals to and from the brain.  In the low back, the nerves that come off of the lumbar spine are slightly larger and traverse into the buttock area, legs and feet.

If a nerve is irritated, in any way, symptoms may occur.  This includes pain, numbness, tingling, burning or even weakness of muscle.  Since nerves extend for some distance, the symptoms may occur throughout the entire extent to the nerve involved.

Previously we spoke of disc herniations.  It is common that a disc herniation, which involves a nerve and the compression of that nerve, causes a variety of symptoms.

Nerve involvement can also occur when muscles, which can form the tunnels for the nerves, tighten and pinch off the nerve.  This is called a nerve compression syndrome.


Low back pain can also occur following an injury to the low back region.  This may involve a variety of structures, like bone, muscle, nerve, etc.  Severity levels of pain due to injury can depend upon the severity of the injury.  However, the severity of pain and the severity of injury are not directly related.  In other words, a person can have a serious injury with little pain. In contrast, another person can have a minor low back injury with significant pain.

The types of injuries are varied.  Injuries can be anything from lifting incorrectly to a car accident.  Injuries that include trauma are always worrisome due to the possibility of fractures or internal damage.

Degenerative Changes

Another common cause of low back pain is degenerative changes of the spine.  With ‘wear and tear’ and injuries, the spine can build up arthritis over time.  These arthritic changes can cause ‘bony bridges’ to osteoarthritis and low back painform in the area, which take up the needed space for nerves.  A very common type of arthritis of the joints is called osteoarthritis.

Osteoarthritis can increase in severity over time.  It can begin as minor changes on the ends of the bones.  In time, these change can continue to worsen causing other structures, like nerves, to become involved.  Severe osteoarthritis can cause bones to fuse together causing reduced motion, pain and trapped nerves.

Those who have chronic osteoarthritis often complain of dull achy pain in the region where the osteoarthritis has formed.  It is not uncommon to have several joints simultaneously degenerating.




These are seven causes of low back pain that with proper treatment, can resolve fully or often receive significant pain relief.

With the common occurrence of low back pain, it is necessary for those low back pain sufferers to find the proper healthcare provider that is able to both properly identify and effectively treat their type of low back pain.

As you can see, not every person has the same cause of their low back pain.  Without understanding the source of the pain, a proper treatment plan for resolving the condition is simply not possible.

Fortunately, there are certain providers that can identify and properly treat low back pain and get you on the road to recovery.

Managing Pain With Out Prescription Drugs

pain management

For sufferers, chronic pain can be debilitating. Whether that chronic discomfort comes in the form of back pain, neck pain, a head ache or something else, it can have a serious negative impact on your quality of life. It can also interfere with work. In the worst cases, chronic pain can result in job loss. And, while family and friends are often sympathetic, they may not fully understand.

You can treat chronic pain conditions with a variety of medical therapies such as opioids and muscle relaxers, but medical therapies generally carry side effects. Even those that are relatively safe may carry side effects when taken for an extended period of time.

Sometimes the best treatments are alternatives to standard medical treatment. They do not involve drugs that carry the possibility of side effects. This can reduce the risks for using these treatments long term and make them a better option. Here are some chronic pain conditions and some of the medical and alternative treatment options available for dealing with chronic pain.

Chronic Pain Conditions

Chronic pain affects approximately 100 million Americans. That is more Americans than suffer from diabetes, heart disease, stroke and cancer combined. 20% of Americans report a difficulty sleeping as the result of pain. The costs to the American people in terms of treatment, lost wages and lost productivity were estimated to be between $560 billion to $635 billion in 2010. Here are some of the three most common types of chronic pain reported.

Headaches– Everyone has headaches now and again. Chronic headaches, however, are characterized by a frequency of at least two a week or 15 a month for a period of three months or more. Approximately 45 million Americans suffer from chronic headaches, with twice as many women suffering than men. While the causes for chronic headaches are not well understood some possible causes can include stress, inflammation, injury or even a brain tumor. If the headache is a migraine, other symptoms may include nausea and light sensitivity.

Back Pain– 80% of adults suffer from back pain at some point in their lives. It is one of the leading reasons for job-related disability claims and is a major contributor to missed work days. Most back pain is short-term. It is considered chronic when it has persisted for 12 weeks or more– even after the perceived underlying causes have been treated. Roughly 20% of people who suffer from back pain will develop chronic back pain.

Neck Pain– Chronic neck pain is neck pain that persists for longer than three months. It is generally believed to be initially precipitated by an injury. 15% of people who report suffering from chronic pain, suffer from chronic neck pain. Like all chronic pain, chronic neck pain prevents the sufferer from being able to function fully.

Current Medical Treatment Methods for Chronic Pain

The medical profession has developed a number of ways for treating chronic pain from injections to pills. Here are some of the most commonly used types of treatment.

NSAIDs and Acetaminophen– NSAID stands for non-steroidal anti-inflammatory drugs and include medications such as ibuprofen which can generally be purchased over the counter. Acetaminophen is also a medication that can be purchased over the counter. These are popular for an acute or short-term pain. Be careful not to take more than 4000mg of acetaminophen in 24 hours as serious side effects may occur.

Tricyclic Antidepressants– Tricyclic antidepressants have been found useful in treating pain when taken at lower doses than are used to treat depression. To be effective these medications must be taken every day whether pain is present or not.
Anti-Seizure- Anti-seizure medications can be helpful with burning or shooting nerve pain. Like tricyclic antidepressants, in order to be effective, they must be taken every day whether pain is present or not.

Opioids– When used properly these can be good for treating certain types of pain such as post-surgical pain and pain associated with cancer treatment. It has been shown to be less effective on nerve pain.

Muscle Relaxers– Muscle relaxers are generally only prescribed for short-term use due to the likelihood of forming a dependence. They can be effective in treating lower back pain, muscle tension and mobility.

Injections of Nerve Block– There are several different types of nerve block that can be employed. Most involve injecting a numbing or blocking agent or a steroid to reduce inflammation at or near the area of the pain.

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Possible Side Effects of Common Treatments for Chronic Pain

While many medications offer varying levels of effectiveness for treating pain, for every medication there are possible side effects. Those side effects can occur because of misuse, overdose or a personal biological intolerance. Here are some of the possible side effects of the most common treatments for chronic pain.

NSAIDs and Acetaminophen– While these drugs are fine for short-term use, taken over an extended period of time they can result in disastrous consequences. Negative effects may include harm to the kidneys, blood clotting and digestive problems. Also, because some opioid medications contain acetaminophen, over-the-counter medications should not be taken with prescription drugs to avoid overdose.

Tricyclic Antidepressants– Side effects may include blurred vision, nausea, dry mouth, changes in weight, low blood pressure, rash, increased heart rate and sexual dysfunction. This medication may increase the risk of seizure for people who experience seizures.

Anti-seizure -People taking anti-seizure medications may experience weight gain, drowsiness and dry mouth. Anyone with a history of kidney stones, kidney disease or glaucoma may not be able to take these medications.

Opioids– The most common side effects of opioid use are constipation and drowsiness. Physical dependence can occur when taken regularly over a long period of time. Addiction can occur as the result of physical dependence. More recently, the overprescription of opioids has become a major concern.

Muscle Relaxers– Possible side effects of muscle relaxant use includes dry mouth, drowsiness or dizziness and urinary retention. Most notably, however, is the possibility of forming a dependence if used in appropriately or over an extended period of time.

Injections of Nerve Blocks– Most common side effects include pain or numbness at the injection site. Some may include facial drooping or difficulty swallowing.

Alternative Treatment Methods

Over the past couple of decades there has been a growing interest in alternative mind-body therapies for treating chronic pain. While many medications offer some benefits, when you take into account the possible side effects, it’s no wonder. As sufferers look for ways to avoid harmful potential side effects of accepted medical therapies, there have been more people willing to try traditional medicines and alternative treatments. While medical research into these therapies is limited, there have been enough people reporting relief to keep interest in alternative therapies alive. Here are a few of the most popular therapies people are trying to manage their chronic pain.

Acupuncture– Acupuncture is a traditional Chinese therapy. It has been gaining ground in the treatment of chronic pain such as back pain, neck pain and knee pain. Many people also swear by it for treating migraines. It involves stimulating certain points on the body by inserting thin needles into the skin. When performed by a well-trained specialist with clean needles, this therapy is generally considered safe.

Diet and Exercise– Hypocrites famously said, “Let thy food be thy medicine and let thy medicine be thy food.” Nearly everything we eat either contributes to inflammation or reduces it. Processed foods, excess fats, sugars and salt all contribute to inflammation. Whole plant foods tend to decrease it. Choosing a diet such as the Mediterranean diet, can go a long way toward reducing inflammation.

Similarly, exercise has also been shown to be useful in the management of chronic pain. Having an exercise program can help you to stay flexible and manage pain better. You should not begin an exercise regime without professional guidance. Some exercises that are popular for those who suffer from chronic pain include low impact work outs like swimming, yoga and walking.

Chiropractor– 22 million Americans visit chiropractors every year, many of whom are seeking assistance with pain. Chiropractors provide care that allows the body to function properly.  They use gentle spinal adjustments to reduce stress related interference with the nervous system, thus allowing the body to resume normal function and, in effect, heal itself. Chiropractic care has been shown to be a safe and effective in treatment for many types of pain.

Massage– Receiving a minimum massage of one hour a week has been shown to improve functionality in people suffering from chronic pain. It helps to relieve stress and reduce pain. Studies showed massage therapy to be more effective on back pain than on neck or shoulder pain or headache. It is considered a safe therapy.

Meditation/ Relaxation– There are several things that fall into this category. They include meditation, relaxation techniques, autogenic training, hypnosis and self-hypnosis. They all center around retraining your brain to relax and deal better with not only stress but pain– especially as stress has been shown to intensify one’s experience of pain. These therapies are recommended to be used in conjunction with other treatments and not on their own.

Low Level Laser Therapy– This type of therapy has only been used in the United States since 2002 although it has been used in Europe and Asia much longer. In one U.S. trial, people who were given low level laser therapy were 70% more likely to report a reduction in chronic pain than those who received a placebo treatment. Where high powered lasers are used in medicine to cut or destroy tissue, low level lasers (cold lasers) are believed to stimulate cell function and relieve pain.

TENS therapy– TENS stands for transcutaneous electrical nerve stimulation. It involves using a device about the size of a pocket radio with two electrodes and attaching those electrodes to your skin. They are placed at the location of the pain or at a pressure point where they create an electrical circuit that sends current through your nerve fibers. People often experience less pain at this time. Effective settings for this device are best determined by a doctor, physical therapist or acupuncturist. Once a professional has instructed the patient in how to use the device, patients can often manage treatment themselves. TENS treatment should always only be initiated with the assistance of a medical professional. When done properly, this treatment is considered safe.

Chronic pain can be debilitating. It can hamper one’s ability to work, get a decent night’s sleep and just to function in general. The most widely accepted medical treatments involve administering powerful drugs to patients, all of which– even the most safe– carry some risk of side effects. Risk of negative effects increases with long-term use of medications. Patients who wish to manage pain with out the constant threat of side effects, risking dependance, addiction or overdose have been increasingly seeking out alternative treatments and traditional remedies that they hope or have reason to believe will have less risk of side effects.

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The American College of Physicians Recommends Chiropractic Treatment for Low Back Pain

treatment of low back painMore than 80% of Americans experience low back pain at some point in their lives. These people may be interested to learn that the American College of Physicians has recently released new recommendations regarding the best way to treat low back pain. According to the new guidelines, a patient’s first resort should be noninvasive, drug-free treatments like spinal manipulation by a Doctor of Chiropractic or superficial heat. These types of treatments have high rates of success in alleviating back pain, and do not come with the major risks associated with treatment by drugs or surgery.

How the recommendations were selected

The American College of Physicians (ACP), a national physician’s group that uses scientific knowledge to recommend treatments for patients, released their new recommendations in February of this year. They reviewed several systematic reviews of scientific research on the treatment of low back pain and compiled their findings in the new guidelines document. The systematic reviews were summaries of the most rigorous scientific experimental research from the past several decades, so patients can be assured that these recommendations are based on the best scientific evidence.

The reasons behind the new recommendations
Diagnoses of low back pain ranges from acute cases (lasting less than 4 weeks) to chronic (lasting more than 12 weeks), and can be debilitating for many people who experience it. Treatment options include natural, noninvasive methods like chiropractic adjustments, heat application, and particular exercise regimens, as well as more invasive and risky methods like medication and even surgery. The new guidelines note that medication has a low rate of success in treating back pain and can cause serious side effects, while noninvasive methods have few risks or side effects.

When assessing the success of treatment options, the ACP considered several positive outcomes. These outcomes included decrease or disappearance of pain, improvement in back-specific and overall functioning, increased quality of life, return to work from disability, and patient satisfaction. The ACP also considered the adverse effects of treatments, which was a major reason for the recommendation that prescription of medication should be a last resort. They noted that even taking medicines as gentle as over-the-counter acetaminophen may lead to liver damage over time. Patients who struggle with low back pain for several weeks or more are at an even greater risk for suffering from side effects. This means that natural, noninvasive treatment is especially important for chronic cases.

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Types of noninvasive treatment
The recommendations from the ACP include many different types of noninvasive and non-drug treatments. They stress the importance of first attempting to ease pain using non-drug treatments, and moving on to prescription medicines only if you have tried several different types of therapies and have not seen improvement. The recommended “first response” therapies fall into three main categories, which are physical treatments, lifestyle changes, and stress reduction treatments.

The physical treatments are the most likely treatments to help people with a recent onset of low back pain, since acute back pain is most often related to physical problems as opposed to chronic stress or something similar. These physical treatments include spinal alignment by a chiropractor, low level laser therapy, massage, and superficial heat application. All of these treatments can correct different root problems, so your healthcare provider should be able to help you select which method to try first.

The second category of noninvasive treatments is lifestyle changes. Depending on the source of your low back pain, particular exercise regimens may help alleviate your pain long term by strengthening certain muscles or making them more limber. Your doctor or a physical therapist can help you select exercises to appropriately treat low back pain or lose weight.

The third category includes stress reduction treatments, which can help alleviate back pain caused by chronic stress. These types of therapies include cognitive behavioral therapy with a licensed psychologist, which will train you to handle stress more effectively and healthfully. Your doctor may also recommend practicing breathing exercises in stressful situations or making a regular practice of mindfulness meditation. Yoga is also commonly used for stress reduction.

Out of these three categories, the physical treatments have the possibility of treating the broadest range of root problems because they can help with low back pain related to stress and weak muscles, but also can treat other sources of pain. Spinal alignment by a licensed chiropractor is a particularly beneficial treatment.

What is chiropractic treatment?
Many Americans haven’t sought treatment from a chiropractor because they do not understand what their treatment methods are or inaccurately believe that they may not understand their condition. However, the truth is that chiropractors have a great deal of specialized training before they are allowed to practice. In fact, they earn a doctorate degree (a DC, or Doctor of Chiropractic) just like your primary care physician has earned a doctorate degree (likely an MD, or Medical Doctorate, or a DO, a Doctor of Osteopathic Medicine). Chiropractors attend a college or university  and an additional four-year Doctor of Chiropractic degree. Many chiropractors also train under more experienced chiropractors before they earn their degree. So if you know someone who warns you that chiropractors are less qualified, you can tell them their fears are unfounded and ill informed.

Your visit to a chiropractor will begin in a similar manner to your visits with a primary care physician. The chiropractor will ask questions about your general medical history and your current low back pain, such as when it began and how frequently you experience this pain. Your chiropractor will likely do some diagnostic tests, like checking the range of motion of your spine, and this will help your chiropractor to more accurately pinpoint the source of your pain. Your chiropractor may also use techniques like X-rays to get a better look at your spine. Low back pain can often be treated with spinal alignment, so your chiropractor will probably recommend this treatment.

In addition to spinal adjustments, many chiropractors offer other types of treatments that are recommended for low back pain, such as massage therapy, physical therapy, and laser therapy. These are all included on the ACP’s recommendations for treating low back pain. Your chiropractor will help you choose the most appropriate and beneficial treatment for your needs.


Spinal Manipulation
Spinal manipulation (or spinal adjustment) is a standard procedure that chiropractors use often. It typically involves repositioning the vertebrae or joint. Although this can sometimes cause temporary, minor discomfort, this discomfort won’t last long. Most often, patients report a feeling of relief.

In certain cases (for example, if you have osteoporosis or particular health issues), your chiropractor may use a gentler approach known as spinal mobilization. Spinal mobilization can take many forms. Sometimes your chiropractor may help your lower spine to stretch using a series of slow, repetitive rocking motions. In other cases your chiropractor may use equipment like an Activator tool or a drop table. You chiropractor will choose the method that has the highest likelihood of alleviating your particular problem with minimal negative effects.

Good chiropractors will also explain why they have chosen particular treatments and how it will help you before beginning. Patients shouldn’t be shy about asking questions and providing as much information as possible.

Low Level Laser Therapy

Low level laser therapy, often called ‘cold laser therapy‘ is also a treatment that can be used to resolve low back pain.  By directing specific wavelengths of light into the painful area, the cold laser can increase the cellular activity in the region, can reduce inflammation, and can allow for improved healing.  Combining the recommended therapies can have added improvements.

Benefits of the new low back pain recommendations

In addition to having higher rates of success, the new recommendations for treating low back pain come with a host of benefits for patients. Many of the recommended treatments are less expensive than buying medicine regularly. They also don’t come with side effects associated with pharmacologic treatment, which can cause liver damage, stomach ulcers, allergic reactions, and more.

Additionally, patients now have the option of getting treatment much closer to home since most people can find excellent chiropractors in their area. For example, people suffering with low back pain who live in the area of Canton, Ohio can easily find a chiropractor near them. Seeking treatment at a nearby location is an excellent way to ensure that you have easy access to good care and can visit as often as necessary. Because follow-up visits for maintenance are often recommended for low back pain, choosing a treatment option that’s conveniently located can help you to feel your best more often. Belden Village Chiropractic & Wellness Center is especially convenient because they offer multiple methods of noninvasive, non-drug treatment for low back pain. Having easy access to superior treatment can change patients’ life for the better.

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