Pain Relief Chiropractic

We’ve all been told—especially as children—to stop slouching and to stand or sit up straight. As it happens, this is great advice to keep the spine healthy and reduce the risk for a painful low back condition.

 A landmark 1981 study calculated the amount of pressure placed on the intervertebral disks in the lower back in various positions. A neutral standing position places about 100 pounds per square inch (lbs/in²) of pressure on the disk in the low back and laying supine (facing up) cuts the pressure dramatically to 25 lbs/in². On the other hand, when subjects stood leaning forward or sat slouching forward, the pressure placed on the lower back disks jumped as high as 275 lbs/in². All this added pressure can place the disks at increased risk for injury, which can have a dramatic effect on a patient’s ability to carry out their daily work and life activities.

To maintain and improve one’s posture (either standing or sitting), Harvard Medical School recommendations the following:

1. Visualize: Think of a straight line that passes evenly through the ears, shoulders, hips, knees, and ankles (when standing). Then imagine a strong cord attached to the top of the head pulling you upwards, making you taller (i.e., “stand tall”).
2. Shoulder blade squeeze: Sit up straight in a chair, relax the arms with the shoulders down (no shrugging), breathe deeply, and draw the shoulders back and squeeze the scapulae together keeping the chin tucked in. Repeat three to four times.
3. Chest stretch: Stand facing a corner and place your forearms and palms on each of the two walls and straddle your feet one in front of the other. Lean forward until there’s a strong stretch in the chest muscles. Hold for 20-30 seconds and take deep breaths.
4. Arm-across-chest stretch: Raise the right arm forward to shoulder height and bend at the elbow. Grasp the right elbow with the left hand and gently pull it across your chest until you feel a strong stretch in the right shoulder and arm. Hold for 20 seconds and repeat on the opposite side and repeat three times.

What about individuals who already have injured or degenerated lumbar spinal disks? What can they do to sit as pain-free as possible? In a 2018 study, researchers evaluated lumbar disk patients as they sat in various types of chairs and found that a kneeling chair is best for keeping the spine in a neutral posture, reducing the pressure on the disks. Additionally, a study published in 2021 showed that trunk muscle activity increases when patients with chronic back pain slouch forward, which means poor posture isn’t even relaxing.

In addition to providing advice and exercises for improving posture, your doctor of chiropractic can provide treatment to restore normal movement to the lumbar spine to reduce low back pain and disability.

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 pelvic floor is the muscular “hammock” that carries the weight of the viscera located in the pelvis. If these muscles become too loose or too tight, an individual may experience urinary (or fecal) urgency or incontinence, sexual dysfunction, pelvic organ prolapse, as well as pain in the pelvic region and even in the lower back.

This condition, known as pelvic floor dysfunction (PFD), most commonly affects women (95% of PFD patients are female) with advancing age and a history of multiple childbirths. Many women have PFD but often do not complain about it due to embarrassment or “just accepting it as part of having babies” or “just part of aging.” However, the condition can be addressed so that its effect on quality of life is reduced, and a doctor of chiropractic may play a role in managing the condition.

Patients with weak pelvic floor muscles (hypotonic PFD) often benefit from Kegel-type exercises where the patient “pulls-up” (or “draws inwards”) the perineum, as if to stop or prevent urination and/or defecation. Unlike classic Kegel exercises with a short hold time (more rapid frequency), PFD exercises should be done with 10 second holds and gradually increase the number of reps to 30 to obtain muscle fatigue. Although some doctors recommend doing these exercises virtually anywhere and anytime, the KEY is to do them very consciously (using visualization)!

It is important to AVOID abdominal bracing (tightening up the abdominal muscles) because this INCREASES the pressure against the pelvic floor. Keep the stomach, buttocks, and inner leg muscles relaxed, and don’t hold your breath. Try exhaling as you do the exercise. When you sense a sneeze or cough coming, squeeze the pelvic floor to support the bladder.

For patients with tight (hypertonic) pelvic floor muscles, studies recommend manual therapy, scar tissue manipulation, modalities (ultrasound or e-stim), massage, breathing re-training, cognitive behavioral therapy, and meditation.

Both hypotonic and hypertonic PFD may be co-managed with an OB/GYN or the patient’s medical physician with supporting care provided by their doctor of chiropractic. A doctor of chiropractic can address musculoskeletal issues in the pelvic region and lower back with manual therapies (including manipulation and mobilization) to reduce pain and relieve pressure on the pelvic floor. The good news for individuals with PFD is that the condition is manageable, and you don’t have to accept it as a normal consequence of life!

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.

For the older adult, pain that radiates into the leg is a common complaint. This process, called neurogenic claudication, occurs when the spinal cord and/or nerve roots are pinched as they exit the arthritic spine (a condition called spinal stenosis). However, there is another degenerative condition that can cause pain in the legs called peripheral vascular disease, and it can be quite challenging to differentiate between vascular and neurogenic claudication.

Peripheral vascular disease (PVD) is a slow, progressive narrowing, blockage, or spasm in a blood vessel that can affect any blood vessel outside of the heart including arteries, veins, or lymphatic vessels. This hardening of the arteries most often affects the legs and feet, although it can affect any organ, including the brain. The most common cause is atherosclerosis, which is the buildup of plaque inside the vessel wall that narrows the blood vessels in one or both legs. This depletes blood flow, and as a result, oxygen and nutrients can’t easily reach their intended destination. Other causes can include injury to the affected part, irregular anatomy of the muscles and ligaments, and infection.

The first symptom of PVD is typically painful leg cramping during exercise that is relieved with rest. This usually occurs after a certain length of walking time, which gets shorter as the disease progresses. This experience is similar to symptoms reported by patients with spinal stenosis, and as such, individuals with PVD may find themselves consulting with a doctor of chiropractic about what they suspect is a musculoskeletal condition. So how does a doctor of chiropractic differentiate leg pain from PVD from leg pain from spinal stenosis associated with dysfunction in the lumbar spine?

One study that administered questions to patients with either neurogenic claudication (NC) or vascular claudication (VC) found that specific symptoms could help in the diagnostic process. For example, if standing still does not trigger pain, NC could be ruled out. On the other hand, NC is likely if standing triggers or increases pain, bending or leaning forward relieves pain when symptoms are above the knees, and sitting provides relief. Patients with VC are more likely to experience leg pain down to the calf that is relieved by standing still. For a definitive diagnosis, a referral for more advanced diagnostics may be required.

Doctors of chiropractic frequently treat patients with spinal stenosis with neurogenic claudication and will refer a patient to a vascular specialist or their medical physician if PVD is suspected so the patient can be provided with appropriate care.  

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 current available research notes that 52% of all opioid prescriptions are for patients with low back pain, and over two million Americans suffer from opioid use disorder (OUD), with 47,000 dying from OUD in 2017. In light of the opioid epidemic, the high cost of diagnostic tests and invasive treatment, and the low level of patient satisfaction with such care, researchers from the Boston University School of Public Health set out to find better options for the management of low back pain. Their findings revealed that a patient’s INITIAL choice of healthcare provider plays an important role in their prospects for a successful outcome from the perspective of both the patient and the insurance company.

This prompted a major health insurance carrier to send a notice to their policy holders promoting initial care for low back pain with either a doctor of chiropractic (DC) or physical therapist (PT). The carrier notes that this move is expected to reduce the use of spinal imaging tests by 21%, spinal surgeries by 21%, and opioid prescriptions by 19%, leading to lower costs for employers and plan participants.

This recommendation is not only in line with guidelines from the American College of Physicians that non-drug, non-surgical care should be the initial course of treatment for the low back pain patient, but also a growing body of research on the effectiveness of non-surgical, non-drug approaches for managing low back pain:

• A 2020 study found that 22% of patients who initially visited their primary care doctor (PCP) received a short-term opioid prescription, with those first consulting with a PT or DC being 85-90% less likely to require an opioid prescription.
• A 2015 study found patients who first sought care from a DC were not only more satisfied with their care than those who visited a PCP first, but the overall treatment costs were lower.
• Back in 2013, researchers reviewed data from Washington state worker’s compensation cases and found that 43% of 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 study published in 2019 found that low back pain patients were less likely to see DC/PTs vs. PCPs when the insurance plan had greater restrictions on DC/PT visits (higher co-pays, deductibles, participation in programs such as a health savings account). The authors stated long-term economic and social benefits would result if health insurance benefit designs were changed to encourage LBP patients to see DC/PT provider types.

BOTTOM-LINE: It’s becoming increasingly clear that conservative treatment approaches like chiropractic care should be strongly recommended for patients with low back pain and other musculoskeletal conditions. Not only will this lead to a reduced use of potentially harmful opioids and the issues that can stem from their misuse, but there will also be cost savings for patients and insurers. As with most health conditions, the sooner a patient seeks care, the greater their likelihood for 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.

Low back-related leg pain (LBRLP) is a common condition that drives patients into primary care clinics, including chiropractic offices, but these cases are often complex, and determining the underlying cause can be clinically challenging. Let’s take a look at the current treatment strategies for LBRLP.

To begin with, the patient’s doctor will need to determine if the leg pain is radicular or referred in nature as this will help indicate which structures or soft tissues in the lower back will need to be addressed. The term “radicular” is reserved for the presence of nerve root compression or a pinched nerve root, most commonly caused by a herniated low back disk. Referred leg pain arises from a ligament, joint, or a tear in the outer layer of the disk (which can precede herniation).

Some clinical signs and symptom that support radicular leg pain include a more specific geographic tracing of leg pain that often exceeds the level of the knee affecting the outer foot (S1 nerve), the top of the foot (L5 nerve), or the inside of the foot (L4 nerve). In radicular LBRLP, there may also be neurological loss such as sensory impairment and/or muscle weakness in a specific area or in certain muscles that can help determine the specific nerve(s) involved. Patients often describe referred leg pain as a generalized deep ache or numbness that often stays above the knee. It’s also possible for the patient to have multiple contributing causes for their LBRLP, which can make the diagnostic process more complex.

From a treatment standpoint, studies show a lack of long-term benefits for managing LBRLP with prescription medication, epidural corticosteroid injections, and surgery. However, there is evidence that spinal manipulation—a treatment provided by doctors of chiropractic—is more effective than no treatment, passive modalities, and exercise in managing LBRLP. In fact, a 2019 survey of 1,907 chiropractors revealed that 81% often treat patients with LBRLP.

More recent research suggests combining spinal manipulative therapy with exercise, and patient education may provide even better results for patients with LBRLP.  This makes sense as there have been several studies showing that a multimodal management approach for low back conditions such as degenerative joint and/or disk disease, spinal stenosis, and disk herniations is often superior to a single treatment strategy.

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.