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Chiropractic and Exercise is Perfect Combination for Back Pain Treatment

An estimated 60-80% of people will suffer from low-back pain at least once in their lifetime. However, the treatment of chronic lower back pain is complex, and the outcome remains unpredictable. Doctors are advised to recommend that patients follow a program of active exercise to alleviate their symptoms. However, patients may be reluctant to do so because of their pain.

A recent study compared the effects of chiropractic treatment followed by exercise versus a placebo or 'sham' treatment followed by the same exercise. The researchers hypothesize that chiropractic adjustments – which are believed to induce an immediate analgesic effect – may enhance the benefits of exercise for patients with lower back pain.

The study involved patients with chronic, non-specific lower back pain. The first group received spinal adjustments plus active exercise therapy. The second group received a detuned ultrasound 'sham' treatment followed by active exercise. Both groups underwent eight treatment sessions over 4 to 8 weeks.

The analgesic effect of spinal adjustments were measured by evaluating pain intensity both before and immediately after each therapeutic session. Periodically, researchers also evaluated participants' disability, fear-avoidance beliefs, and erector spinae and abdominal muscle endurance (measured with Sorensen and Shirado tests).

The participants who received spinal adjustments experienced a better immediate analgesic effect, along with lower disability and a trend toward lower pain levels. The researchers concluded that manual therapy, immediately followed by active exercise, tends to induce a more significant decrease in pain reduction in patients with chronic lower back pain. These results confirm that chiropractic is an appropriate treatment for chronic low-back pain.

While exercise has long been a crucial component of chiropractic care, this study provides further evidence of the efficacy of combining exercise with chiropractic adjustments for relieving chronic pain.


Balthazard P, et al. Manual therapy followed by specific active exercises versus a placebo followed by specific active exercises on the improvement of functional disability in patients with chronic non specific low back pain: a randomized controlled trial. BMC Musculoskeletal Disorders 2012; 13: 162. doi:10.1186/1471-2474-13-162.


Acupuncture FAQ


What is Acupuncture?

Acupuncture is an ancient technique based in eastern traditions that has been utilized
for over 4,000 years. Using small, thin needles inserted into the skin, acupuncture can tap into
an individual’s unique system and energetic field. I like to compare this energetic field to the
electrical system inside a house, the energy is continuously working and present even though
you can’t physically see it. Acupuncturist can be thought of as the “electricians” of the human
body and mind, rewiring, recalibrating and fine tuning to find the perfect balance of energy that
can be sustained in this specific house or body. Each body (house) is uniquely different, and
deserves careful consideration before implementing any kind of action or change to the entire
Acupuncture takes the whole individual into consideration and uses a holistic approach
to regain that unique internal balance. Acupuncture is gentle, relatively safe and can be utilized
on most people in most situations. Depending on the case, acupuncture treatments can
produce both immediate and prolonged effects, with continued care leading to optimal results
and outcomes. In the United States, acupuncture is performed by a licensed acupuncturist (LAc)
and can be practiced in most states. Given the holistic approach, certain health and emotional
issues can be addressed using a different perspective, treatment plan, and outcomes than
through the typical lens of western medicine that westerners are accustom to. This is why so
many people turn to acupuncture as a last resort to assist in their disease recovery process, not
realizing these skills and modalities could have been utilized earlier in life and earlier in the
disease process. Holistic acupuncture treatment can really change lives, advocating for
individuals and ultimately giving the power back to the patient, where they can now take an
active role in their healing journey.


How does Acupuncture work?

From a western standpoint, acupuncture creates “micro-traumas” to the area of skin that is
needled, signaling cells to come to that region and help repair the damage. This increases blood
circulation, activates neurotransmitters (like Serotonin and Dopamine), releases endorphins,
works on pain receptors in the brain and decreases inflammation.
From an eastern standpoint, we have these lovely streams of energy lining our body called
meridians or channels. These channels act like river ways and work to nourish corresponding
organs and tissues when energy is flowing freely. Just like a river, when energy gets stuck, things
start to back up and don’t flow as smoothly. In the body when the flow in channels get stuck
those organs and tissues become deprived of energy and nourishment. Acupuncturist can use
these channels to address many ailments by activating our innate healing capacity and identity
the root cause of illness instead of merely addressing symptoms.


Are there side effects?

The most common side effects of acupuncture include bruising, bleeding or soreness at the
area of the needles. Some dizziness and a feeling of light headedness are also possible during
and after treatment, which is why it is important to eat something before coming to your
acupuncture treatment.


Does it hurt? What should I expect?

During acupuncture, we typically let the needles “cook” for about 20-30 minutes. You might
feel a variety of sensations during acupuncture. You might feel absolutely nothing at all or you
might feel a tiny bite just when the needle goes in. However, once the needle is placed you
shouldn’t feel any pain. During treatment, you might feel warmth, pressure or a grabbing
sensation around the needles, you might also feel energy traveling from one place to another.
After treatment, most people get off the table feeling relaxed, calm and have a sense of

Is Acupuncture right for me?

Yes! Acupuncture can be utilized on most people in most situations. Commonly treated issues
include musculoskeletal pain, joint pain, digestive issues, gynecological health, anxiety and
depression, immune support, headaches and migraines, and more.

Come see for yourself 


Preventing Whiplash With Head Restrain

Whiplash injuries are an expensive and painful problem in the US. Experts estimate that we spend $29 billion per year in treating the pain and disability that can result from a rear-end collision.

But there are steps you can take to protect yourself from whiplash injury. The key to good whiplash protection is your head restraint. Numerous studies have shown that most people have an improperly adjusted head restraint, commonly called a head rest.

Whiplash injury occurs when your torso moves in one direction while your head moves in another direction. This can put hundreds of pounds of force on the delicate ligaments of your neck.

The key to good head restraint positioning is to eliminate or reduce the amount of space that your head can move. By doing that, it reduces the strain put on your neck. Your head restraint needs to be placed so that the back of your head is level with the middle of the restraint, and your seat needs to be positioned so that your head is very close. You want to have a maximum of 2.5 inches between your head and the restraint.

While car crashes are often out of your control, you can properly adjust your head restraint to reduce the chance of neck injury during a rear-end collision.

If you've already been injured in a crash, it's important to get treatment right away. Research suggests that chiropractors can provide effective treatments for many patients with whiplash-associated disorders.

Call your chiropractor in Lake Oswego, Dr. Rami Layous and his team are specilized in the treatment and rehabilitation after auto accident.



Lake Oswego Car Crashes and Long-Term Pain

Lake Oswego auto injury pain treatmentIf you live in Lake Oswego and you've been in a car accident, you need to know that you don't have to suffer from chronic symptoms.

Research Supports Chiropractic Helps With Chronic Pain after an Auto Injury

We treat lots of auto injury sufferers in our Lake Oswego office, and many of these people are struggling with chronic pain caused by an old accident. As a matter of fact, research shows that a significant proportion of rear-end crashes result in pain and disability even ten years after the initial trauma.

Dr. Rami Layous is here to help you avoid developing chronic pain by helping to restore the natural function of your spine soon after a collision.

The most common causes of chronic issues are reduced flexibility of your spine and the formation of scar tissue in your spine. The ligaments of your spine can easily be harmed during a collision, and chiropractic care works by reducing inflammation and restoring normal motion.

We Can Help With Chronic Pain and Auto Injury Recovery

If you're nearby our Lake Oswego office, and you've been hurt in a car wreck, don't wait to get care. Dr. Rami Layous is here for you. Give us a call today at (503) 914-4955 for an appointment or for more information.


Safety of Chiropractic Neck Adjustments Confirmed

Spinal manipulation therapy is a widely-accepted method for treating back pain, neck pain, and headaches. Although previous studies have pointed to the safety of chiropractic neck adjustments, there has been some concern about the effect of the forces applied during spinal manipulation of the neck. It has been argued that there is the possibility of damaging the internal carotid artery (ICA) by such force. Previously, little was known about the strains sustained by the ICA during spinal manipulation therapy. In a recent study, researchers sought to examine the mechanics of the ICA during neck manipulation to determine whether spinal manipulation causes strains in excess of those experienced during normal everyday movements.

The researchers measured strains applied to the internal carotid artery (ICA) during neck spinal manipulation treatments. Peak and average ICA strains were measured in 6 cadaver spines during cervical spinal manipulation performed by chiropractic doctors. These number were compared with the corresponding strain experienced during diagnostic testing of the head and neck to simulate normal everyday movements.

The researchers found that ICA strains were no different during chiropractic manipulation of the neck than during normal everyday movements. Therefore, cervical spinal manipulation performed by trained chiropractors does not appear to place undue strain on the ICA.

Earlier research has also demonstrated the safety of chiropractic neck adjustments. In an extensive literature review from the medical journal Spine, researchers analyzed data from 28,807 chiropractic patients receiving a total of 50, 276 adjustments of the cervical spine.  Among the thousands of adjustments made, the only negative side effect reported was temporary, mild dizziness; no serious side effects were reported.

Studies show that chiropractic neck adjustments can reduce pain in patients with neck disorders,whiplash, dizziness, and headaches.


Herzog W, Tang C, Leonard T. Internal Carotid Artery Strains During High-Speed, Low-Amplitude Spinal Manipulations of the Neck. Journal of Manipulative and Physiological Therapeutics 2012; pii: S0161-4754(12)00156-X. doi: 10.1016/j.jmpt.2012.09.005.


Steroid Shots Ineffective For Back Pain

Many patients get steroid shots to temporarily relieve pain from a pinched nerve in the back or lumbar spinal stenosis. However, there is little evidence to show the long-term effectiveness of this treatment. A new study suggests that the injections may even do more harm than good.

A team of researchers recently examined data from a previous study on back pain in order to determine whether patients who received epidural steroid injections (ESI) experienced improved clinical outcomes, or a lower rate of surgical interventions, than patients who did not receive such injections. Patients with lumbar spinal stenosis who received ESI were compared with patients who did not receive the injection over the course of the four-year study.

At the start of the study, ESI patients expressed a higher preference for nonsurgical treatments. However, ESI did not appear to help these patients avoid surgery. Those who ultimately underwent surgical treatment experienced a longer surgical duration and longer hospital stay than those who had not received the injections. Over the four-year study period, there was significantly less improvement in physical function among ESI patients, even among those who went on to have back surgery. These results suggest that steroid injections are associated with worse outcomes in the treatment of spinal stenosis.

Earlier research has also questioned the efficacy of epidural steroid injections for treating chronic back pain and sciatica. What's more, spinal injections have been linked to bone loss and fractures in elderly patients.


Radcliff K et al. Epidural steroid injections are associated with less
improvement in patients with lumbar spinal stenosis: A subgroup analysis of the spine patient outcomes research trial. Spine 2013; 38 (4): 279-291.


Chiropractic Cuts Headache Pain By 71%

Trigger point therapy reduced cervicogenic headache pain by 71% for patients in a new study. The patients also experienced a 59% reduction in neck pain symptoms, as well as improved range of motion and muscle function.

Trigger point therapy is a treatment commonly used by chiropractors to relieve trigger points (TrPs), or hyperirritable spots of pain located in taut bands of skeletal muscles. Earlier research has shown that chiropractic spinal adjustments are effective for cervicogenic headache, but few studies have tested the efficacy of trigger point therapy for the condition.

In a new preliminary study, researchers tested the effects of trigger point therapy for the treatment of cervicogenic headache. Twenty patients were randomly assigned to receive either trigger point therapy (TrP therapy) or a sham treatment for three sessions during a one week period. The treatments were applied to active trigger points located in the neck.

Patients receiving TrP therapy experienced markedly better outcomes than the sham group. TrP therapy patients had significantly improved neck range of motion and increased functioning of the deep cervical flexor muscles. They also had substantially reduced pain sensitivity, neck pain, and headache. On average, patients' headache pain scores dropped from a 7.6 out of 10 to a 2.2, or about a 71.1% reduction. Their neck pain scores also decreased from a 7.4 to a 3.0 after treatment, or about a 59.5% reduction.

More research is needed to understand why TrP manual therapy lead to these improvements. It has been hypothesized that trigger points play a role in the development of headache, since earlier studies have reported trigger points present in patients with tension headache, cluster headache, and migraine. However this is one of the first studies to confirm the presence of trigger points in people with cervicogenic headache, and to suggest that trigger point therapy can help.

Chiropractors frequently use trigger point therapy in conjunction with spinal adjustments, spinal mobilization, and exercise rehabilitation. This study adds further evidence of the efficacy of chiropractic care for cervicogenic headache.


Chiropractic Can Boost Athletic Performance

Many athletes utilize chiropractic treatments following an injury or a strenuous workout. New research suggests that athletes could also boost their athletic performance through chiropractic adjustments.

The study involved 18 professional Brazilian judo athletes. Half received chiropractic adjustments to their cervical spine, located in the neck. The other half received a placebo treatment. Researchers examined the effect of the treatment by evaluating the athletes' grip strength, because judo relies heavily on muscle forces in the hands and arms.

The researchers measured grip strength before and after each cervical spinal manipulation. Following just three treatment sessions, the athletes in the chiropractic group had an overall improvement in grip strength of 10% on the left side and 16% on the right side, which is considered statistically significant. The placebo group did not experience significant improvements in grip strength. After analyzing the data, the researchers concluded that the chiropractic care enhanced grip strength in judo athletes.

Additional research is needed to fully understand the benefits of chiropractic care for athletes, though this study shows exciting results. In 2010, another study showed chiropractic sports interventions substantially reduces the risk of lower-limb injuries among football players. Chiropractic care offers a number of potential benefits for athletes, including injury prevention, enhanced recovery, and improved peak performance.



Cervicogenic Headache

What is cervicogenic headache

Headaches affects almost half of the population and almost 25% of all headaches arise from problems in the neck, most commonly, limited movement of the joints in the upper cervical spine which initiate a painful cycle of stiffness, muscle tightness and joint inflammation. This may cause irritation to the sensitive nerves leading from your neck into the back of your head.

Cervicogenic headaches are usually one-sided, but sometimes they may present on both sides. Often radiates from the base of the skull towards the top or the head and sometime reach over the eyes.


What triggers it?

Most commonly trauma like motor vehicle accident, or any other head trauma. It may be triggered also by awkward movements and postures like slouched or forward head posture that become very common with the use of smart phones and tablets.


How Can We Help?

At Back N’ Line Chiropractic and Wellness we provide the following treatments
  • Chiropractic manipulations or adjustments restore the proper motion between the vertebrae in neck which will improve flexibility, relieve pain and reduce joint inflammation and nerves irritation.
  • Soft tissue manipulation or myofascial release which will target taut bands and knots or trigger points in the muscles leading to improved circulation, pain relieve and break down adhesion or scare tissues.
  • Acupuncture treatments has tremendous success in relaxing tight muscles, reducing inflammation and blocking pain signals.
  • Therapeutic exercises which target tight or weak muscles with specific stretching and strengthening to help increase tissue flexibility, build strength, ease pain, and reduce the chance for re-injury

Lake Oswego Back Pain Treatment

Lake Oswego back pain treatment by Dr. Rami LayousMost of us suffer from back problems at some point in our lives. Researchers estimate that nearly 1 out of 3 adults deal with some kind of regular spinal pain. Dr. Rami Layous and our talented staff see many back pain cases in our Lake Oswego office, and we've found that chiropractic care is an effective way to not only help you recover from back pain, it's also an excellent way to avoid future issues.

Research Shows Chiropractic Helps With Chronic Back Pain

A recent article from the University of Utah verifies what our Lake Oswego patients have reported: your Lake Oswego chiropractor is the best first option for an episode of back pain.

In this paper, 747 patients were treated for low back pain. Each person was evaluated based on the first person they sought treatment with, whether it was a primary care physician, a chiropractor, or a physiotherapist.

What the researchers found is that the subjects who first saw a chiropractor had fewer advanced imaging tests and fewer surgeries.

Other studies have found the same results. A 2012 study found that chiropractic patients had the best functional recovery and pain relief for chronic back pain.

Chiropractic works by restoring the natural, pain-free function of your spine. Dr. Rami Layous and our team help your body heal with gentle chiropractic adjustments that don't use drugs or risky surgical procedures.

Dr. Rami Layous Can Help Patients Find Comfort From Back Pain

If you live near our Lake Oswego office and would like to get out of pain, give our office a call today at (503) 914-4955 for an appointment.


Fritz JM, Kim J, Dorius J. Importance of the type of provider seen to begin health care for a new episode of low back pain: associations with future utilization and costs. Journal of Evaluation in Clinical Practice. 2015(Sep 29).

Cecchi F, et al. Predictors of functional outcome in patients with chronic low back pain undergoing back school, individual physiotherapy or spinal manipulation. European Journal of Physical and Rehabilitation Medicine 2012;48:371-8.