Dr. Jeffrey I. Kennis,  D.C.,CCSP
205 Commercial St.
Boston, MA 02109

( 617)720-2329




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By bchiaramonti@officite.com
October 15, 2018
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If you have issues with your back, you may have been surprised at how hard it can be to arrive at a correct diagnosis and treatment plan.

See Getting an Accurate Back Pain Diagnosis

medical professionals reviewing x-ray

Your doctor will typically take your symptoms and medical history into account when making a diagnosis.
 Lower Back Pain Symptoms and Diagnosis

If you have ever wondered why this is, look no further. Here are 4 big reasons why back pain is hard to both treat and diagnose:

See Back Pain Overview: A Guide for Understanding Back Pain

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1. Diagnostic challenges

There are numerous potential issues when it comes to diagnostic tests. But the preeminent problem is that there is no single diagnostic test that can provide an accurate back pain diagnosis.

See Back Pain Diagnosis: Diagnostic Tests for Indicators of Back Pain

So then, many diagnostic tests have limited value, and some may even be controversial. Of course, this does not mean that your medical professional cannot accurately diagnosis your back condition. For example, certain common conditions, like a lumbar herniated disc that leads to sciatica symptoms, can often be diagnosed quickly and accurately through a variety of tests, questions, and image scans.

See Diagnosing a Lumbar Herniated Disc

But the inadequacy of any single diagnostic test helps to explain why you may receive different diagnoses from different doctors.


See Introduction to Diagnostic Studies for Back and Neck Pain

2. Trial and error

It is important to note that even if you correctly identify the underlying problem with your back, this does not necessarily dictate the proper treatment plan. There is typically more than one way to treat a back condition, and finding the treatment that works best for you can often times be a process of trial and error.

See Back Pain Treatment: Non-Surgical Options for Pain Relief

For example, some people with leg pain caused by a disc problem find that an epidural steroid injection provides great pain relief. Others find that it has no effect at all. So it is important you work closely with your doctor, and are clear and honest about your symptoms and the effectiveness of various treatments.

See Injections for Back Pain Relief

3. Subjective experience

Pain is a very personal experience. What may be mild back pain to one person can feel severe and overwhelming to another. This means that the same condition can require completely different kinds and levels of treatment for different people. For example, over-the-counter medication may be sufficient to treat the pain from a common back condition for most people. But your subjective experience may dictate that you need a more robust treatment plan to handle your intense pain.

See Medications for Back Pain and Neck Pain

4. Back pain can lead to a lack of sleep

The majority of people with chronic pain suffer from some sort of sleep problem. This can create a painful cycle, as a lack of sleep can make your pain worse; and more intense pain can make it more difficult to fall asleep.

See Chronic Pain and Insomnia: Breaking the Cycle

All this means that it may be difficult to treat your chronic back pain because you need to treat both your pain and your sleep problem. This can be tricky, as you have to try to juggle and combine two treatment plans into one cohesive whole.

See Pain Management for Chronic Back Pain

With all the above factors, along with the advances in imaging and treatments, no one doctor can be an expert in regards to all spinal problems. This makes it all the more important for you to educate yourself on your symptoms, conditions, and treatment options. The more you know, the better chance you have of finding meaningful and lasting pain relief.

See Causes of Lower Back Pain

Learn more:

Non-Surgical Treatments for Lower Back Pain

Lower Back Pain Symptoms

By bchiaramonti@officite.com
October 15, 2018
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Foam rollers—you’ve probably seen these cylinders in the gym or being used by athletes on the sidelines of a game. Did you know that they may be just the thing you need to ease your neck strain?

See Neck Strain: Causes and Remedies

man with neck pain

Foam rolling and other forms of massage can help ease pain when it originates in the neck muscles. SeeCervical Spine Anatomy and Neck Pain

Foam rollers have become a popular way for people to treat muscles with self-myofascial release, or self-massage. Experts think they work by increasing blood flow to the muscles and alleviating soft tissue adhesions, sometimes referred to as muscle "knots" or "trigger points."

See Trigger Point Exercises for Neck Pain

An analysis of 12 high quality studies found that massage can provide short-term pain relief for those with idiopathic neck pain, compared with standard care.1

See Neuromuscular Massage Therapy

Foam rolling is specifically to relieve muscle pain, so if you have neck pain that’s caused by a problem such as degenerative disc disease or arthritis, check with your doctor before you attempt using a foam roller.

See Cervical Osteoarthritis (Neck Arthritis)

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Tips for foam rolling safely and effectively

If you’re ready to try foam rolling to ease your neck pain, keep these tips in mind:

See Cervical Spine Anatomy and Neck Pain

See Causes of Lower Back Pain

  • Foam rollers should be used on muscle, not bone or joints. Avoid using it horizontally on your neck, directly over your spine. Instead use it vertically, rolling out from either side of your spine.
  • Slowly roll the foam roller until you find a tender spot or trigger point. Then apply gentle, steady pressure to that spot until pain subsides, but no longer than 60 seconds.
  • Foam rollers should cause slight pain or discomfort as they release muscle knots, but not severe pain. If you feel sharp or stabbing pain, stop immediately.
  • Avoid using a foam roller on your lower back, since back muscles are rarely the cause of low back pain and foam roller may make other low back conditions worse.
  • Because muscle knots in your neck or shoulders can be hard to reach, you may find that a theracane or trigger point massager works better for you than a foam roller.

See Neck Pain Treatment

Combined with stretching exercises, physical therapy, and medication, foam rolling can be a simple and effective way to relieve neck pain.

See Neck Stretches

Learn more:

Chronic Neck Pain: What Condition Is Causing My Neck Pain?

What to Consider Before Starting Exercises for Neck Pain

By bchiaramonti@officite.com
October 15, 2018
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Understanding the anatomy and inner workings of your spine will help you stay mindful of how to best protect your spine as you go through your day. This top-to-bottom guide to the spinal anatomy can help you understand the potential problems.

See Spinal Anatomy and Back Pain

Thoracic vertebrae

The spine is comprised of three sections: cervical, thoracic, and lumbar.
 Spine Anatomy Interactive Video

Your neck is susceptible to strain or injury

The spine begins at the base of the skull in a section called the cervical spine. This consists of 7 vertebrae and extends through your neck to your upper back.

See Cervical Vertebrae

Acute neck pain is most often caused by a muscle, ligament or tendon strain (such as from a sudden force or straining the neck). These injuries will usually heal with time and nonsurgical treatments to alleviate the pain (such as ice/heat, medications, chiropractic or osteopathic manipulation, etc).

See Treatment for Neck Pain

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If your neck pain lasts longer than two weeks to three months—or if you experience mainly radiating symptoms like arm pain, numbness or tingling—there is often a spinal problem. The most common examples are:

Your middle back is not usually a source of pain

The 12 vertebral bodies in your upper and middle back make up the thoracic spine. The firm attachment of the rib cage at each level of the thoracic spine provides stability and structural support and allows very little motion, which means that thoracic spine injuries are rare.

See Thoracic Spine Anatomy and Upper Back Pain

However, irritation of the large back and shoulder muscles or joint dysfunction in this area can be very painful.

See All About Upper Back Pain

Thoracic vertebrae

A disc herniation in the lumbar spine can put pressure on the nerve root, causing radiating pain down the back of the leg (sciatica). Watch Lumbar Herniated Disc Video

Your lower back is the most prone to injury

Your lower back (lumbar spine) has the least structural support and endures the most strain, making it the most frequently injured area of the spine.

Watch Lumbar Spine Anatomy Video

The motion in the lower spine is divided between five motion segments, although a disproportionate amount of the motion is in the lower segments (L4-L5 and L5-S1). Consequently, these two segments are the most likely to be injured. For example, a herniated disc in this area can cause pain and possibly numbness that radiates through the leg and down to the foot (sciatica).

See Sciatica Causes

Most short episodes of lower back pain are caused by muscle strain. Even though this doesn't sound like a serious injury, pain in the low back can be severe.

See Pulled Back Muscle and Lower Back Strain

But, as with the cervical spine, if pain lasts a few months or is accompanied by radiating pain or tingling in the legs and feet, a structural problem with the vertebrae or discs is the likely culprit.

See Cervical Discs

The base of your spine can cause pain too

Below the lumbar spine is a bone called the sacrum, which makes up the back part of the pelvis. This bone is shaped like a triangle that fits between the two halves of the pelvis, connecting the spine to the lower half of the body.

See Sacrum (Sacral Region)

The sacrum is connected to part of the pelvis (the iliac bones) by the sacroiliac (SI) joints. Pain here is often called sacroiliac joint dysfunction, and is more common in women than men.

See Treatment Options for Sacroiliac Joint Dysfunction

The coccyx, or the tailbone, is at the very bottom of the spine. Pain here is called coccydynia and is more common in women than men.

See Coccydynia Symptoms

Take advantage of the many educational videos and articles we have provided on our site to become an expert on your spinal anatomy. Understanding how your spine works, and how things can go wrong, can help you take steps to protect and strengthen it.

Learn more:

Spinal Cord and Spinal Nerve Roots

Causes of Pain in the Lumbar Spine

By bchiaramonti@officite.com
August 17, 2018
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The claim that lower back pain can lead to stress is not a controversial statement. But what about the other way around?

See Stress-Related Back Pain

Is it possible that stress is the primary cause of your lower back pain? Read on to find out the answer.

See Back Pain Causes: Overview of Conditions That Can Create Back Pain

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How does stress lead to lower back pain?

Before we discuss whether stress is the cause of your lower back pain, let's quickly look at how stress may lead to lower back pain. There are numerous theories on this topic, but what most have in common is the idea that psychological and emotional factors lead to a physical change that results in your lower back pain.

See Causes of Lower Back Pain

If stress is the cause of a person's lower back pain, it is easy to get caught in a cycle of pain. In this cycle, a person refrains from physical activity due to a fear of pain and/or injury. In response, the person's muscles become deconditioned, which in turn increases their pain. This cycle amplifies as the new pain leads to even less physical activity.

See How Does Stress Cause Back Pain?

Diagnosing stress-related lower back pain

The first thing to know about diagnosing stress-related lower back pain is that you should not self-diagnose. Your pain may be caused by a serious medical condition, and so you need to consult with a qualified medical professional.

See Specialists Who Treat Back Pain

As a general rule, the symptoms of stress-related lower back pain are similar to fibromyalgia symptoms. These symptoms include:

  • Back and/or neck pain
  • Diffuse muscle aches
  • Problems with sleep and general fatigue
  • Pain that is not isolated to only spot

See Lower Back Pain Symptoms

To confirm the diagnosis of your pain, you doctor will typically ask for your medical history and perform a physical examination (in part to rule out any major problems).

See The Diagnosis of Stress-Related Back Pain

The pain is not all in your head

When it comes to stress-related lower back pain, it is important to remember that this type of pain is real. It is not imagined or made up, but is just as real as if your back pain was caused by an accident or trauma.

See Chronic Pain As a Disease: Why Does It Still Hurt?

In recognition that your stress-related back pain is real, you and your doctor may work together to treat your pain with any combination of the following:

  • Physical therapy
  • Pain medications
  • Counseling and/or therapy
  • Psychological pain management techniques

See Treatments for Stress-Related Back Pain

If you suspect stress may be the cause of your lower back pain, schedule an appointment with your doctor as soon as you are able. You may find meaningful relief, and in turn be able to return to your favorite activities and hobbies.

Learn more:

Miscellaneous Causes of Low Back Pain

Managing Stress, Depression and Chronic Back Pain

By bchiaramonti@officite.com
August 17, 2018
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Cold and heat therapy may both provide effective relief from your lower back pain—but how do you know which one to use?

See Heat Therapy Cold Therapy

Read on for helpful advice on deciding whether you should use ice or heat to treat your lower back pain.

See Early Treatments for Lower Back Pain

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Ice in the first 24 to 72 hours

As a general rule, it is best to apply cold therapy to your lower back in the first 24 to 72 hours following your lower back injury. The application of cold therapy can minimize your inflammation and swelling—which in turn may reduce your pain. In addition, ice can decrease your tissue damage and numb your sore tissues.

See Ice Packs for Back Pain Relief

There are numerous options for cold therapy, including a frozen bag of vegetables, frozen gel packs, and a frozen towel. Regardless of which option you choose, make sure to note the following precautions:

  • To avoid ice burn, place a cloth between your skin and whichever source of cold you select.
  • Apply cold therapy for no more than 20 minutes at a time. You can apply cold therapy 8 to 10 times per 24 hour period.

Watch: Video: How to Make 5 Quick and Easy Ice Packs

Use heat to encourage healing

After your initial swelling and inflammation has subsided, heat therapy can be utilized to encourage healing in your lower back. The application of heat therapy stimulates blood flow to the area, which brings restorative oxygen and nutrients. Additionally, heat can inhibit the transmission of pain signals to your brain and decrease your stiffness.

See How to Apply Heat Therapy

There are two basic categories for heat therapy: dry and moist. Dry heat may leave your skin feeling dehydrated, but many people feel it is easier to apply. Heat therapy may be more difficult to apply, but it can aid in the penetration of heat into your muscles.

Watch: Video: How to Make a Moist Heat Pack

If you have diabetes, an open wound, or dermatitis it is best to avoid heat therapy altogether.

What about chronic lower back pain?

All of the above advice addresses when to use heat and ice following the first occurrence of lower back pain after an injury. But what about chronic lower back pain?

See Types of Back Pain: Acute Pain, Chronic Pain, and Neuropathic Pain

The simple answer is that there is no right answer. Finding the balance between cold and heat therapy for chronic lower back pain is a process of trial and error—and what might work for one patient may not for another. But when it comes to exercise, many people with chronic back pain find heat therapy helps to warm up their muscles beforehand, while cold therapy helps with pain and inflammation afterwards.

See Heat Wrap Therapy Can Reduce Post-Exercise Low Back Pain

Additionally, if you do suffer from extended or chronic lower back pain make sure to receive care from a qualified medical professional. Relying on self-care for too long may make your back pain worse.

See Pain Management for Chronic Back Pain

I hope all of the above advice will help you determine if cold or heat therapy is right for you, which in turn may help you find meaningful relief from your lower back pain.

Learn more:

How to Use Ice Massage Therapy for Back Pain

Benefits of Heat Therapy for Lower Back Pain

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Chiropractor - Boston, Waterfront Chiropractic, 205 Commercial St., Boston MA, 02109 617-720-2329