Pain: symptom or disease?

Chronic pain chiropractor

Pain is one of the most intricate sensations that a human being can feel because at times it can be primarily dictated by biology and neurology, while at other times can be heavily influenced by psychology.

Whether or not an individual has a “high pain tolerance” or they’ve “had pain for so long they don’t know life without it”, pain cannot and should not be ignored. It is a signal from your body that something is not functioning properly within your body and needs correction. Sometimes this correction is as simple as a change in position (sitting to standing) and in other cases, pain can be an indication of something significantly more severe occurring.

Is all pain created equal?

As stated above, pain can vary from an acute episode lasting a few seconds (touching a hot piece of food) to an unrelenting, disability pain (kidney stones), and everywhere in between. There are instances where joint, muscle and nerve pain can be abolished rapidly by using a simple directional exercise, adjustment or manual therapy technique.

These forms of pain are predominantly driven by neurology and a signal that a specific intervention or movement is necessary to “reset” the pain signal. When an area of the body does not move well, the body will put “caution tape” around that area in the form of muscle tonicity and pain in order to protect the area and prevent further damage.

If pain has so many causes and mechanisms, how do we address it?

Pain has so many sources and each individual responds differently to pain, which means that attempting to diagnose every condition and attach a pain number to that diagnosis will not cut it. Disc herniations affect every individual differently, some feel no symptoms, others feel excruciating pain even if the MRI looks similar. On the other hand, if one patient can have disabling. 7/10 back pain with no MRI or orthopedic findings while another individual can have 7/10 pain and continue to “train through the pain”.

Pain itself must be assessed and addressed on a case by case basis, starting with proper classification or sub-grouping.

Classification of musculoskeletal conditions is the critical first step in finding an appropriate solution for pain. In our clinic, we use both the Mckenzie method of classification as well as the Pain Mechanism Classification system. With these two systems, we are able to determine if a condition is primarily inflammatory, a mechanical joint issue, a nerve condition or a central nervous system disorder presenting. We are going to summarize the “behaviors” of each of these painful conditions below.

If you are currently experiencing pain or have had pain before, you likely will be able to place yourself into one of these four categories. Once we are able to properly categorize which group your specific pain belongs in, we then have a great starting point for how to approach treatment and individualize your care.

What are the characteristics of inflammatory pain, how do we treat it?

When pain is driven primarily by inflammation, we are generally going to see discoloration of the tissue and/or swelling. This particular type of pain is common after an acute injury such as an ankle sprain. When an individual sprains their ankle, for example, the first step to treatment is taking bodyweight off of that area and reduce the swelling with ice and anti-inflammatory medication.

After a few days of ice and compression, the area may be ready to start gentle movements and therapy can commence. Often times a mechanical condition is underlying to an inflammatory condition so we will first focus to control the inflammation and take a mechanical approach afterward if warranted.

If a patient has inflammatory or chemical pain that is chronic in nature, there may be an underlying health condition that causes a consistent chemical reaction in the body that needs to be assessed using advanced testing and resolved with a functional medicine approach rather than a physical medicine approach.

What are the characteristics of mechanical pain, how do we treat it?

Mechanical pain is the most common type of pain condition that we see in our office. These types of conditions can be acute or chronic but symptoms are very movement and position-specific.

For example, lower back pain that is made worse with sitting and bending over, but feels better with walking. When we have clear condition behaviors such as this we are generally able to resolve these conditions quickly using chiropractic adjustments, manual therapy, and specific exercise prescribed for that condition.

Chronic mechanical conditions can be related to poor tissue healing and chronic injury resulting in fibrosis and scar tissue being laid down in an area. This type of condition will present with repeated pain in one or a few movements that are no variable in nature.

For these types of conditions we will use active release technique, instrument assisted soft tissue therapy and repeated movements to remodel the tissue. This process of remodeling biology, however, is not as rapid as mechanical pain driven by neurology.

What are the characteristics of nerve pain, how do we treat it?

Nerves are some of the most resilient and complicated tissues in our body. All of our sensation and muscle function is transmitted through our nerves. They are the road between our central nervous system (brain and spinal cord) and the outside world. Nerve pain can be the most frustrating and debilitating but also able to be treated rapidly if the appropriate intervention is applied.

Nerve pain is unique in that it may present with burning, tingling, shooting pain, numbness, tingling, and weakness which can be felt locally or can peripheralize (ex. sciatica). In our clinic, this form of pain is generally treated with gentle soft tissue therapy to desensitize, specific chiropractic adjustments to relieve nerve pressure and specific stretches to restore a tight to nerve to resting length and tension.

What are the characteristics of central pain, how do we treat it?

Central pain is pain that may or may not be related to any orthopedic or neurological findings. Generally, pain that is central in nature is chronic and may be related to a traumatic event. If an individual decides to “live with the pain” and does not seek treatment at the appropriate time, they may still experience pain in an area of the body long after that area has healed.

Additionally, if an area has repeated experienced trauma, your central nervous system may send constant and unrelenting pain signals to the area. This specific type of pain is normally treated with patient education and graded exposure to activities. When the body is slowly re-introduced to activity couple with appropriate pain education, even chronic and central pain can be resolved completely over time.

If an activity is painful, should I stop?

What happens when we ignore pain?

When pain is ignored or an individual becomes content living with pain, this is what will ultimately lead to disability. Pain in itself can be debilitating but when not assessed and treated, the long term disability is the only outcome. When individuals first experience pain in an area, they will modify one or two activities at first to avoid the pain, but eventually, any activities using that area of the body become painful. When you ignore pain over time, it becomes chronic, disabling and engrained in your neurology.

All pain should be address because no one deserves to live with pain. Though the pain may not always resolve rapidly or entirely, there are always opportunities to find relief and continue doing the activities you love.

If you are currently dealing with pain and ready to get back to what you love. Please reach out to us, we’re here to help!

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5 Ways to Avoid Injuries in Your CrossFit Gym

5 ways to avoid injuries in your CrossFit gym

Over the last ten years, CrossFit and functional group exercise have exploded onto the fitness scene, particularly in South Florida. It is difficult to drive more than one block through Hallandale Beach or Aventura without seeing a CrossFit box, boot camp, or other group fitness gym setting.

Not only do individuals enjoy the high-intensity nature of the classes themselves, but also the challenge of learning and applying new movements in the gym.

Performing challenging movements at high speed or intensity can be an excellent way to get into great shape but can also put you at risk for a sports injury if you are not taking the right steps in and out of the gym to keep yourself healthy.

In the steps below, we are going to walk you through 5 ways to make sure you stay healthy in the gym but also improving your fitness and maximizing your performance on a regular basis!


5 ways to avoid injuries in your CrossFit gym

The Miami Spine and Performance Team at Prestige Fitness Aventura


5 ways to avoid injuries in your CrossFit gym


1. Find the “hardest thing you can do well”

Every individual that has stepped foot in a CrossFit or functional fitness gym for the first time looks around and may feel intimidated by the individuals around them performing movements they’ve never seen, with weights they’ve never touched at speeds they don’t think possible.

Prior to joining a CrossFit box, most individuals have not performed a single barbell snatch, let alone. 30 snatches at 135 pounds consecutively for time.

To start your CrossFit journey, the first principle you must become comfortable with for long-term success is the concept of  “scaling” or modifying a workout in a way that meets your current fitness, strength, and skill level.

CrossFit workouts were originally written to be standardized so that one individual could measure his or her success against other competitors across the country. Over time, however, to accommodate individuals of skill levels and different backgrounds, the concept of “scaling” was introduced to keep members safe while still providing them with the appropriate fitness stimulus.

When it comes to making significant gains in fitness over the long term, injury prevention and incremental fitness gains are key. Find the hardest movements and workouts that you can complete with sound technique and train them with intensity regularly.


Be sure that your body is prepared for the task


2. Be sure that your body is prepared for the task

Taking on a new workout regimen can be challenging and intimidating but ultimately very rewarding.

The human body is an incredible organism capable of tremendous physical capacity, and that capacity should be challenged regularly. It is critical that before partaking in new forms of exercise, you take the time to be sure that your body is ready to handle the demands you are about the place on it.

Every new task you ask your body to perform in the gym requires a certain level of physical capacity for the execution of the movement to be safe and efficient. Often, individuals will jump into a new exercise regimen early in the year only to stop in the first month due to injury or overtraining.

Before partaking in a new physical exercise regiment, get a thorough assessment from a movement educated physician or sports-based chiropractor that can help identify deficiencies early and give you strategies to prevent injury as you embark on your fitness journey.

Even if you don’t feel any pain at the moment, getting a “movement-based” physical exam from a sports-based chiropractor and checking to make sure that all of your joints are moving adequately can pay huge dividends in the long run of injury prevention and help set a path of success for you during your journey towards health and fitness.


3. Train to improve your joints capacity

When most individuals think about training physical capacity, the phrases that generally come to mind are “endurance,” “strength,” “skill,” etc. Most individuals neglect to actually take time to train the capacity of their joints.

For example, to perform a technical and efficient snatch, you must have adequate ankle dorsiflexion, hip flexion, and thoracic extension, shoulder flexion, and wrist extension.

Often athletes use the movement itself to train capacity, i.e., snatching to improve mobility. This is a misconception in how the body adapts.

First, the proper environment in your body must be established via the joint range of motion and proper muscle activation, and the exercise (in this case, the barbell snatch) is simply the expression of that physical capacity.

Not only does improving the physical capacity of the joints decrease the chance of shoulder injuries, disc herniations, and other sports injuries but also allows you to efficiently train the capacity of your skill and fitness.

If, for example, you do not have the necessary prerequisites in upper body mobility to perform a proper handstand, you will struggle immensely with performed handstand pushups for repetition and for time.


Train to improve your joints capacity


How do you go about preparing your joints for exercise?

It all starts with a thorough assessment! Miami Spine and Performance is one of the few chiropractic clinics in Hallandale Beach trained in Functional Range Conditioning (FRC), which is a system that uses a specific joint assessment to design a corrective exercise system specifically tailored to your body.

If you are interested in receiving a full-body joint-by-joint assessment and an individualized corrective program, click below!

Schedule an Appointment!


4. Use diet and hydration to gain an edge

Injury prevention is not a one-dimensional process; there are several factors even unrelated to the physical capacity that can improve your body’s ability to adapt to exercise safely. Two of which are hydration and nutrition.



It is no secret that South Florida can be very humid during certain times of the year, which can put you at risk for dehydration even if you aren’t visibly sweating.

Because our muscles are nearly 70% made up of water and most of our body’s metabolic processes require adequate hydration, if you are not keeping up with regular water consumption, as well as electrolytes, you may be putting yourself at risk for dehydration, cramping or predispose yourself to a muscle strain during activity.



In addition to hydration, nutrition can play a crucial role in how your body recovers and adapts to training. There are a lot of excellent resources for general nutritional recommendations as far as good sources of proteins, vegetables, fruits, and fats to help your body perform optimally.

If you are looking to take your training to the next level, we highly recommend you see a physician specializing in nutrition that can create a custom-tailored program based on your medical history, training schedule, and blood chemistry. At Miami Spine and Performance, we offer Functional Medicine and nutritional consultations for athletes and individuals looking to optimize their health and improve performance for the gym.


5. Take time to deload regularly

The last factor in managing your training load, staying injury-free, and performing at a high level is taking regular deloads in training to allow your body to recover.

Every 6-8 weeks, it is recommended you take one week to reduce the intensity and volume of exercise by at least 50% and take advantage of recovery modalities in your community. One of the most beneficial ways to recover properly during hard training and your deload is to regularly visit your Hallandale beach chiropractor at Miami Spine and Performance.

Some examples of recovery modalities utilized at our practice:

  • Chiropractic adjustments
  • Active Release Technique
  • Fascial Stretch Therapy
  • Instrument Assisted Soft Tissue
  • Normatec Compression
  • Compex Recovery System
  • Dry Needling

Blending chiropractic manipulation with manual therapy and specific rehabilitation exercises can help decompress your joints from hard training, restore your muscles to proper function, and address any nagging injuries you may be experiencing. If you are just starting your fitness journey or are looking to stay injury-free during your training please give us a call or book online for a comprehensive assessment.

If you are currently participating in crossfit workouts and are currently injuried or would like to prevent future injuries and optimize performance, please give us a call at 754-231-8338 or book online at

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Understanding Lower Back Pain

Understanding Lower Back Pain

Understanding Lower Back Pain – Is it an epidemic?

Lower Back pain is one of the most common reasons an individual visits a doctors office. Over 80% of Americans suffer from lower back pain at some point in their life, and 50% of these individuals have multiple occurrences within 1 year’s time of their first episode. Many companies, large and small are seeing increases in medical cost as it related to back pain as well as a greater number of disability claims. These increase in costs and disability are driven by poor diagnostics, over-utilization of procedures, rising costs of invasive procedures/medications, increased length of disability claims and high recurrence of injury. Current research in the field of orthopedic spine pain indicates that the following factors result in increased disability during the course of treatment for the presenting complaint: early MRI, multiple MD providers, more than 5 MD visits, specialist consultations, early use of narcotics. Conservative care has been shown to be highly effective in many cases as a first line of strategy to avoid the stress and pitfalls of invasive therapy.

What can cause lower back pain?

There are a number of sources of lower back pain and even more predisposing factors that make understanding lower back pain a challenging puzzle and ultimately an epidemic.  Lower back pain can be caused by a seemingly harmless activity such as sitting in a poor posture to more serious conditions involving internal organs referring pain to the low back. The wide range of conditions responsible for lower back pain is why it is very important to get a thorough assessment once you start to feel symptoms.

                               Specific Lower Back Conditions

understanding lower back pain worker in the officeDegenerative Disc Disease: DDD is a commonly diagnosed condition associated with the normal aging process of the spine. When you are younger, your spinal discs function as the perfect shock absorbers, but as you get older the disc(s) slowly loses hydration and the space between vertebrae decreases. Because degeneration is a normal part of aging, not every individual with degeneration will experience pain, so if you are experiencing lower back pain and have been told you have “DDD”, be sure to see a clinician that performs a thorough movement assessment.  

Disc Herniation: Disc herniations are one of the most frequently diagnosed conditions of the spine but unfortunately because diagnostics are heavily reliant on imaging (MRI primarily), disc herniation can be misdiagnosed as the pain generator or even operated on inappropriately due to a lack of understanding of the source of pain thus a thorough movement assessment is needed to compliment and confirm imaging findings. A disc herniation occurs when the disc material called “nucleus pulposus” leaves the outer casing called the “annulus fibrosus”. The severity of a herniation can range anywhere from a minor bulge (nucleus still within the annulus) to a disc sequestration in which the discal material is displaced into the spinal canal. A more severe disc herniation will produce symptoms into the leg and can potentially cause neurological deficit (weakness, numbness, tingling).

Lumbar Stenosis: Similar to degenerative disc disease, lumbar stenosis is often found in individuals over the age of 60. An individual with stenosis will prefer a bent-over posture and will generally feel discomfort walking around and standing for too long. Also, an individual with stenosis may not only feel symptoms in the lower back but down the leg as well. Physiologically, the stenosis is narrowing of the spinal canal itself that can be caused by bone spurs, hardening on the disc and herniation into the canal, spondylolisthesis (vertebra slips forward onto the bone below it) and a number of other space occupying lesions.

Facet Syndrome: Facet joint syndrome is a painful condition of the spine involving degenerative arthritis of the joints that connect the lateral ends of the vertebrae that ultimately results in poor movement and inflammation in the area leading to pain. Facet syndrome can also come as a result of aging, but staying active, maintaining good spinal mobility and performing strength training for the core can help prevent and/or mitigate symptoms of spinal discomfort. Inflammation of the facet joint itself can result in muscle spasm as well as referred pain into the lower back, buttock and lateral hip. An X-ray can help point out areas of degeneration but does not necessarily correlate to the cause of symptoms for this reason it is critical that an appropriate orthopedic and neurological exam follow an X-ray for the diagnosis of a facet issue.

Understanding Lower Back Pain patient treatmentHow do we treat lower back pain?

The treatment for lower back pain is largely dependent upon dependent upon the findings of the orthopedic and neurological exam. If you are experiencing a neurological deficit (weakness, numbness, tingling) or pain that does not change with position, it is likely you may benefit from a referral to a pain medicine specialist or orthopedic doctor. If the pain is above the knee and intermittent (comes and goes with specific positions), it is more likely that your condition can be resolved with conservative therapy which may include chiropractic manipulation, soft tissue therapy and therapeutic exercise. The specific “diagnosis” must be supplemented with a functional diagnosis that includes a thorough history, palpation as well as a movement exam. X-ray and/or MRI imaging does not provide your healthcare provider with sufficient information to construct a treatment plan designed to reduce pain and improve function long term.

What are a few ways you can prevent future occurrences of lower back pain?

A few of the predisposing factors for lower back pain include being overweight, smoking, being physically inactive, poor posture, aberrant breathing, limited motion in the upper back and restricted hip range of motion. 

  • Breathing is one of the most overlooked aspects of spinal stability and decompression. Due to aesthetics and stress, individuals generally with through their chest and use the superficial musculature of their neck (scalenes, SCM, Upper trapezius, pec minor) to create a forceful inhale. Learning to breathe using your diaphragm and expanding your abdomen at 360 degrees can assist with spinal stability, improved posture as well as spinal decompression.
  • Posture can be a critical piece of the puzzle when it comes to preventing lower back pain. The lumbar spine naturally has a lordotic curvature (concave) which means that it can be easily irritated by spending excessive amounts of time in the reverse position (rounded out). Unfortunately due to the nature of a lot of jobs requiring time at a computer, on flights or at a desk, individuals are required to sit for a long period of time in a disadvantageous position. This can be offset by using a “lumbar pillow” to assist in maintaining the natural curvature and taking frequently microbreaks to move you spine through a full range of motion. 
  • Improve the range of motion in the joint surrounding you lower back (Thoracic Spine/Upper back as well as hips) can also help relief excessive tension on your spine. In general, the thoracic spine and hips are more mobile joints meant to provide a lot of the movement during activities such as walking, running, squatting and twisting. If the hips and upper back cannot provide adequate movement for these activities, the low back will take excessive load and can potentially be predisposed to injury.

Got a Question about lower back pain?

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3 key factors to consider as a chiropractic patient

chiropractic patient

Many individuals today are frustrated with the current state of healthcare and feel let down. As the chiropractic patient, you deserve to be listened to, assessed thoroughly and guided down a clear path to resolution and success. Often times, those who are injured find themselves more frustrated and confused after seeing a healthcare provider than before. A thorough evaluation and conservative care are not factored into the game plan and as a result, individuals don’t find lasting resolution to their condition. In this article, we will speak specifically about musculoskeletal pain and injuries.

chiropractic patient 3 fundamentals puzzle

There are 3 fundamental aspects of care you deserve as chiropractic patient

  1. Comprehensive Evaluation and Assessment
  2. Conservative Treatment Options
  3. Prevention Training

Comprehensive Evaluation and Assessment

When patients go to visit their primary care physician or specialist, they are generally given a proper history and consultation but the musculoskeletal system is generally assessed very minimally or not at all. Doctors seldom assess movement, muscle tone or joint function but rather defer to orthopedic tests and potentially diagnostic imaging, followed by medication to “manage” your condition and advice to rest.

As a patient it is important to understand what you should expect from a comprehensive musculoskeletal examination. Following you exam you should be given a clear diagnoses as well as indirect causes for the condition at hand. This should be communicated clearly so that there is no misunderstanding between the physician and patient.


In order determine an appropriate working diagnoses, an evaluation should include at a minimum:

A thorough history & consultation

Functional Movement Assessment

Orthopedic and neurological exam

Muscle and joint palpation

When a healthcare provider includes the 4 above categories in the evaluation, he or she will be able to provide you with a working diagnosis and ultimately the appropriate course of care. At this point, conservation treatment options can be discussed and treatment plan can be custom tailored to your needs.

Conservative Treatment Options

Patients deserve a comprehensive, hands-on approach to their pain or injury. Most chiropractic patient presentations can be classified into a specific group that responds to a particular therapy or combination of therapies. This may include a combination of chiropractic adjustments, manual therapy, rehabilitation exercises, training advice, nutrition counseling or acupuncture. You may not need all of the above conservative therapies, but generally some combination is required for excellent clinical outcomes.

Conservative treatment is not about a “one size fits all” approach. From your first encounter through your treatment plan, every step should be customer tailed to your assessment findings and goals.

Prevention Training

One of the most frustrating occurrences for both the patient and the doctor is the re-aggravation of a condition that has already “resolved”. For most conditions, recurrence is over 50% within one year of an episode and this can be due to many factors. Work life, sport, exercise, lack of education can all contribute to recurrence of a musculoskeletal injury. When being treated for a condition and concluding a treatment plan you should expect to discuss the following with you healthcare provider:

  • Activities of Daily Living: Ergonomics advice related to activities performed on a regular basis in your life
  • Return to Work or Sport: Proper time frame and modifications
  • Body Awareness and Preparation: lifting, moving, bending, posture
  • Corrective Exercise: Mobility and/or Stability exercises custom to you
  • Desk Ergonomics: How to take micro breaks and use proper posture while at work
  • Proper Equipment: running shoes, weight belts, braces, etc.
  • Skill/Technique training: Exercise or Sport technique from a trained professional

In Summary, as a chiropractic patient there are many potential roadblocks that can prevent you from achieving efficient and lasting relief when working with a healthcare provider for a musculoskeletal injury. The first step is being an informed patient and understands what is to be expected from a quality healthcare experience. I have outlined key points below that you as an informed patient should expect from a provider treating you for a musculoskeletal condition.

  • A comprehensive assessment including a thorough history, functional movement assessment, hands-on palpation of joints and soft tissue structures.
  • An exam that assessment more than just the area of complaint but the body as a whole to determine the root cause of the presenting complaint. For example a lack of hip mobility and stiffness In the middle back can often contribute to symptoms in the lower back due to over-stress.
  • A specific diagnosis based upon the findings in the history and comprehensive exam
  • All conservative treatment options explained and discussed in detail as well as an opportunity to ask the physician questions
  • Advice beyond pain resolution but also education and training in how to prevent future recurrences or aggravations


Miami Spine and Performance

1250 E. Hallandale Beach Blvd. #305
Hallandale Beach, FL 33009

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We’re proud to provide chiropractic care to Hallandale Beach, Aventura, Hollywood and surrounding areas.