Archive | Back Pain RSS feed for this section

The Lower Back, Leg Pain, and Sciatica

3 Dec

The roots of the sciatic nerve exit the spine through several levels in the lower back, join in the buttock region, and travel down into the lower extremities. When pressure is applied to the sciatic nerve in the lower back area, it can generate pain and other sensations down the nerve into one of the legs—a condition we commonly refer to as sciatica.

In younger and middle-aged adults, the most common cause of sciatica is a herniated disk in the lower back in one or more locations. Because of the structure of the sciatic nerve, the characteristics of the patient’s symptoms can direct their doctor of chiropractic on where to look for potential causes in the lower back:

  • S1-2 Level (S1 nerve root): outer foot numb, difficulty walking on toes, weak Achilles tendon reflex
  • L5-S1 Disk (L5 nerve root): inner foot numb, weak big toe and heel walking, no reflex changes
  • L4-5 Disk (L4 nerve root): shin numb, weak heel walking, patellar tendon reflex loss
  • L3-4 Disk (L3 nerve root): medial knee numb, weak walking up steps, weak patellar tendon reflex
  • L2-3 Disk (L2 nerve root): front of thigh pain/numb, weak walking up steps, positive patellar reflex
  • L1-2 Disk (L1 nerve root): groin pain/numb, weak squat and steps, no deep tendon reflex
  • T12-L1 Disk (T12 nerve root): buttock numb, weak lower abdominal muscles, possible spinal cord compression

In sciatica patients under 55 years of age, the two lowest disks in the lower back—the L4-5 and L5-S1—are the culprit 95% of the time. The good news is that a systemic review of 49 published studies found that spinal manipulative therapy, the primary form of care provided by doctors of chiropractic, is an effective non-surgical treatment option for relieve local and radiating pain in patients with a herniated disk in the lower back.

Even though sciatic pain is often initially sharp and severe, most cases can by successfully managed non-surgically within three to six weeks; however, a referral to a specialist or a referral for advanced imaging (such as an MRI) may be necessary to identify additional pain sources if the patient’s pain persists. Surgery is usually restricted to those who have neurological loss and/or bowel or bladder control problems (the latter may become emergent in order to avoid permanency). As with many musculoskeletal conditions, the sooner one seeks care in the course of the disease, the more likely (and the faster) they will achieve a successful treatment outcome.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Groin Pain: The Low Back, Hips, and Pelvic Floor

5 Nov

In addition to neck pain and back pain, patients seek chiropractic care for many musculoskeletal conditions, including groin pain. Pain in the groin area can emanate from a myriad of causes from issues involving the reproductive organs, the renal/urinary system, the lymph glands, a pelvic flood disorder, a hip joint condition, and even a lumbar disk herniation.

For a patient with groin pain, the first thing a doctor of chiropractic will likely do is review the patient’s history and conduct a thorough examination to rule out health issues that may be better suited for the patient’s medical physician. The examination will look for potential dysfunction in the pelvis, hip, and low back that can be addressed with chiropractic care.

While musculoskeletal issues in the lower back are typically localized to that area of the body, if a spinal disk herniates and places pressure on the spinal nerves, it can lead to symptoms down the leg and even into the torso and groin. Likewise, issues in the hip like osteoarthritis, labral tears, and hip bursitis can refer pain to the groin.

Chiropractic care for these conditions will include manual therapies to restore joint motion, specific exercises to strengthen/stretch the affected ligaments and muscles, and recommendations to address inflammation, such as supplements/vitamins or ice/heat instruction.

Pelvic floor disorder (PFD) is a common condition that describes the inability to correctly relax and coordinate the pelvic floor muscles, which can lead to issues with urination and defecation, among other things. The pelvic floor is like a sling of muscle holding the pelvic organs. Our pelvic floor muscles contract and relax when we go to the bathroom. Losing the ability to relax the muscles can lead to the inability to defecate or urinate, and losing the ability to contract the muscles can result in incontinence.

Fortunately, once more serious causes are ruled out, it’s possible to resolve PFD using biofeedback, pelvic flood exercises, and relaxation techniques, all of which may be provided by your doctor of chiropractic or in conjunction with a related healthcare professional. There is the possibility that issues may be present in two or even all three areas that your doctor of chiropractic will address concurrently in order to reach a satisfactory treatment outcome.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Low Back Pain and Cycling

5 Oct

Cycling is regarded as a highly enjoyable and effective form of exercise. However, there is some confusion about how posture while riding can affect the lower back and whether cycling is helpful for recovery from lower back pain.

Bicyclists ride with either a round-back, flat-back, or curved-in back, which is based on the degree of pelvic rotation and spinal flexion. It appears that the choice of posture when riding a bike is primarily related to seat height, seat angle or tilt, and handlebar type.  Some handlebars offer multiple options as to where you can place your hands, such as on the grips (most upright), on the bar closer to the stem (middle position), or on the drops—the lowest option offered on the curl under/racing type of handlebars.

One might think that flat-back posture would be best for the lower back, simply because it avoids the two extremes. However, this position is associated with increased wind resistance and will likely be avoided by more serious cyclists who are looking to ride as efficiently as possible. One pilot study looked at the lumbar spine angle of young adult recreational cyclists as they utilized all three postures in ten-minute intervals with different bike configurations and found that the “curve-in back” position caused by gripping the drops resulted in the greatest increase in spinal flexion over time. For individuals with a low back condition, this increased spinal flexion could result in increased pain and related symptoms over time.

Another study looked at how a bike is fit, the position of the cyclist, and the perception of comfort, fatigue, and pain. Here, twenty cyclists rode in three of nine potential positions for 45 minutes at 50% of their peak aerobic power output. The three positions were defined by two parameters: knee flexion angle (20°, 30°, 40°) and trunk flexion angle (35°, 45°, 55°), in a random order. The results showed that having the trunk upright (not bent forward) and the seat height adjusted so the knee flexion angle was 30° was the most comfortable position for participants. Additionally, the researchers found that tilting the seat forward lessened low back pain in those with the condition.

As part of the recovery process for low back pain, doctors of chiropractic often encourage patients to exercise. Because of it’s low-impact nature, as well as being highly enjoyable, cycling is a great option. However, it’s important to make sure your bike it fitted so that you can comfortably ride with good posture and as to not exacerbate your condition.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Choose Chiropractic FIRST for Low Back Pain

10 Sep

When it comes to a condition like low back pain, does it matter what type of healthcare provider a patient initially visits for treatment? A study published in 2015 looked at this question and found that the type of healthcare provider a patient initially consulted had a dramatic effect on both their short-term and long-term prognosis.

In the study, researchers monitored 719 patients with low back pain, 403 of whom initially consulted with a medical physician and the rest first sought care from a doctor of chiropractic. The results showed that the patients in the chiropractic care group not only experienced a greater reduction in their low back pain, but they were also more satisfied with their experience. Additionally, the average cost of treatment for the chiropractic patients was $368 (US dollars) lower than the average cost of treatment in the group that received care from their medical doctor. The study clearly favored chiropractic care as the initial treatment choice for patients with low back pain.

In a 2019 study, researchers reviewed medical records from over 216,000 patients without a history of opioid use and who had new-onset back pain to see if initial provider choice influenced future prescription narcotic use. The data showed that 22% of patients received a prescription for an opioid in the short-term; however, patients who consulted with a doctor of chiropractic first were even less likely to require either a short-term or long-term prescription than those who visited a medical doctor initially. The authors of the study concluded, “Incentivizing use of conservative therapists may be a strategy to reduce risks of early and long-term opioid use.”

Another study followed a set of 2,870 acute and chronic low back pain patients for four years. The research team observed that chiropractic care provided more favorable short-term outcomes for patients with chronic back pain, while both acute and chronic low back pain patients reported better outcomes in the long term, especially in chronic patients with leg pain extending below the knee.

Seeing a chiropractor first can also reduce the chances a patient will require a surgical procedure to address their back pain. A 2013 study published in Spine looked at data from Washington state worker’s compensation cases and found that 43% of injured workers with a back injury who initially consulted with a surgeon ended up having surgery while just 1.5% of those who first received chiropractic treatment eventually had a surgical procedure for their back pain—a massive difference.

TAKE-HOME MESSAGE: Seek chiropractic care FIRST to receive the most satisfying, efficient, and cost-effective approach for managing acute or chronic low back pain!

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

Spinal Stability and Low Back Pain

3 Aug

When it comes to managing a low back condition, the goal of chiropractic treatment is for the patient return to their normal daily activities as soon as possible. This not only means addressing low back pain but also low back disability, including impaired postural control and reduced spinal stability, which can manifest in reduce position sense, increased postural sway, and impaired balance.

Movement control and spinal stability are controlled the deep muscles, the superficial muscles, and the nervous system that sends information to and from the brain. Dysfunction in ANY of these can result in lumbar spine instability.

To complicate matters, when an injury is present, the body will alter its neuromotor patterns as a protective mechanism. However, this can lead to some muscles becoming overworked while others may become deconditioned. If unaddressed, additional musculoskeletal conditions may result in nearby parts of the body, which explains why patients will often present with multiple seemingly unrelated complaints.

In addition to manual therapies like manipulation and mobilization to restore proper joint movement, treatment for low back pain may also include core stabilization/strengthening exercises and balance exercises.

For abdominal strengthening, one exercise that works well is a spine-sparing sit-up. Place the hands behind the lower back to prevent flattening of the lumbar curve and lift the head and chest as a unit a few inches off the floor, hold for ten seconds, and repeat to tolerance (five to ten reps to start out with).

To strengthen your sides, try a side-bridge or side-plank (from feet or knees), holding for ten seconds and repeating as tolerated.

To strengthen the back, try the front plank. Rest on your forearms in a push-up position for ten seconds and repeat as tolerated. The bird dog is another good exercise. Kneel on your hands and knees and raise the opposite arm and leg without twisting the trunk and hold for ten seconds, repeat with the other arm/leg.

For improved balance, stand on one leg with your eyes open or closed (if able) as long as you can. This stimulates the neuromotor system.  Be safe, and do these in a corner to prevent falling!

Make these exercises a habit. Consistency will help improve low back function and you’ll reduce your risk for a future episode of low back pain!

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.

A Link Between Back Pain and Urinary Incontinence

14 Jul

While under chiropractic treatment, it’s not uncommon for a patient to report improvement for an issue that seems unrelated to their chief complaint. For example, a patient with a temporomandibular disorder may experience an improvement in their jaw symptoms following treatment to the neck or upper back. Or treatment to improve hip function may also benefit the ankle or knee. In this article, we’re going to look at how treatment for low back pain may help a patient who also has urinary incontinence (UI) issues.

There are many potential causes for UI, but one contributing factor is weak pelvic floor muscles. Thus, it makes sense that treatment to address impaired pelvic function may benefit some UI patients. A 2018 Cochrane systemic review concluded that pelvic floor muscle training (PFMT) is more effective than either a sham treatment (placebo) or no treatment for some individuals with UI.

This is where back pain comes into play. It’s estimated that back pain will affect more than 80% of us during our lifetime. We often adjust how we perform everyday activities to avoid pain, both consciously and unconsciously. These abnormal movements can place added stress on other parts of the body. In the case of the lower back, altered function in the hips and pelvis is common.

A November 2019 study published in the Journal of Craniovertebral Junction & Spine concluded that individuals with lumbar degenerative disk disease, spondylolisthesis, and failed back surgery syndrome are more likely to exhibit abnormal spino-pelvic alignment. Overtime, these individuals can develop secondary conditions in the hip or pelvis, which can impair the function of soft tissues, including muscles, in the region. Or likewise, injury to the hips/pelvis can lead to dysfunction in the lower back, which may be why the patient sought care in the first place.

Doctors of chiropractic are trained to review a patient’s case history and conduct a thorough examination on the whole patient in order to identify contributing factors for the patient’s chief complaint. Hence the importance of noting all symptoms, even those that seem unrelated or may be embarrassing. If a low back pain patient’s history notes UI and the examination identifies abnormal pelvic posture, then treatment will likely address improving function in both the pelvis and low back to achieve a successful outcome.

This information should not be substituted for medical or chiropractic advice. Any and all healthcare concerns, decisions, and actions must be done through the advice and counsel of a healthcare professional who is familiar with your updated medical history.