Pain Relief Chiropractic

Serious falls can lead to a number of negative outcomes in older adults, from impaired mobility to loss of independence to early death. Thus, steps that can be taken to reduce the risk for falls will not only potentially result in a longer life, but also help support a higher quality of life in those remaining years.

Research has shown that seniors with a history of falls tend to have impaired balance and reduced muscle strength (especially in the back)—both of which are associated with advancing age. Let’s see if addressing these areas can reduce fall risk and what role chiropractic care may play in the process.

In one study, researchers compared three fall prevention approaches (educational classes, home safety assessments, and exercise training) and found that participants in the exercise group had the lowest risk for falls. Another study compared exercise on a stationary bike versus movement-based exercises using a video game system (called exergames). The results showed that the participants in the exergames group experienced greater improvements in mobility and balance. Taken together, these studies suggest that a movement-based exercise approach is effective for reducing fall risk, which coordinates with the research that shows that older adults with a history of regular exercise are less likely to have a serious fall.

A 2020 study involving active-duty military personnel with chronic back pain found that adding chiropractic care to a rehabilitative program featuring isometric and balance-focused exercises resulted in improved back pain, function, muscle strength, and balance compared with a control group that received no care. In another study, researchers observed that a twelve-week chiropractic treatment program was effective in improving sensorimotor function in older adults, which is associated with a reduced fall risk.

Finally, an analysis of data from 39 studies involving 17,626 seniors found that those with pain in the neck, lower back, hip, knee, and foot were more likely to exhibit poor balance, especially those with a history of chronic musculoskeletal pain. The results from these various studies suggest that older adults can reduce their risk for serious fall by addressing current musculoskeletal complaints—of which chiropractic care is an excellent choice—and regularly engaging in exercise to improve balance and strength.

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.

The cauda equina (Latin for “horse’s tail”) is made up of many nerves that travel down and exit out the sides of the lumbar spine and sacrum (tail bone) and transfer information (motor and sensory) to and from our legs and brain.

If the cauda equina becomes compressed, the resulting cauda equina syndrome (CES) is characterized by symptoms such as severe low back pain (LBP); numbness and weakness in the legs, buttocks, and perineum (pelvic floor region); weakness of bowel and/or bladder control causing incontinence; and sexual dysfunction.

Potential causes for CES include a severe herniated disk in the lumbar spine (most common cause); narrowing of the spinal canal (called spinal stenosis); a lesion or tumor that applies pressure on the cauda equina; an infection, fracture, or trauma (such as a car crash); or a birth defect.

Cauda equina syndrome is typically diagnosed in the following ways: 1) the patient’s history—often of acute LBP with radiating leg symptoms; 2) a neurological exam to assess sensation, strength, gait, and reflexes; and 3) advanced imaging, such as an MRI or CT scan, of the lower back.

If CES has a fast onset, the patient should seek emergency care. Surgery may be required to avoid permanent sexual dysfunction, loss of bowel and/or bladder control, and in some cases, paralysis of the legs.

If the onset of CES is gradual, then a non-surgical approach such as chiropractic care may be appropriate. Doctors of chiropractic are trained to identify and diagnose CES, but chiropractors usually see these patients long after the initial symptoms since most patients go directly to the ER due to their severity. However, a team of healthcare providers comprising of chiropractors, primary care physicians, physical therapists, occupational therapists, social workers, and/or mental health counselors can manage LBP and other residual problems associated with CES. As with all conditions that result in permanent impairment, those afflicted often need to manage symptoms to obtain an optimum quality of life that chiropractic care can greatly facilitate.

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.

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.

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.

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.

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.