Tag Archives: low back pain

 Rethinking Pain from Lumbar Disk Herniation

1 Jun

Lumbar disk herniation occurs when one of the cushioning disks between the bones in the
lower back becomes damaged, allowing the soft inner material to push outward. A disk
herniation itself may not cause symptoms, and studies show that many adults have positive
findings on MRI without pain. However, when a herniated disk irritates nearby nerves, it can
lead to localized low back pain and/or symptoms like sharp, shooting pain into the leg.
Traditionally, pain and disability related to lumbar disk herniation have been attributed primarily
to nerve compression. However, more recent research suggests a more complex picture—one in
which the nervous system, including the brain, plays an important role in ongoing pain.
When the body detects injury, it releases inflammatory chemicals to begin the healing
process. While helpful, these chemicals can also irritate or sensitize nearby nerves, making them
more responsive and increasing pain signaling. Over time, this can lead to increased sensitivity in
the nervous system—a process often referred to as central sensitization. In this state, the body
becomes more reactive, and even normal movements may trigger pain. In some cases, the disk
may heal enough that it is no longer the primary source of pain, but the nervous system remains
overly sensitive to non-painful stimuli.
Doctors of chiropractic commonly use a treatment called spinal manipulative therapy,
often referred to as chiropractic adjustments. These techniques are used to help improve motion
in the joints of the spine and reduce mechanical stress in the area. In addition, research suggests
that adjustments may influence the nervous system by affecting how pain is processed and by
influencing neurochemicals involved in pain regulation. When combined with a gradual return to
normal movement, patient education, and targeted exercises, this approach may help reduce
sensitivity in the nervous system and support a return to more normal function.
Many patients with lumbar disk herniation recover without invasive procedures such as
surgery. Early conservative care may be especially helpful, as it may reduce the risk of the
nervous system becoming overly sensitized. Addressing both the physical and neurological
components of pain may improve long-term outcomes.
Supporting spinal health through daily habits is also important. Staying active,
maintaining overall health, and engaging in regular physical activity—including movement and
appropriate loading—can help support the spine. Movement plays a key role, as it helps deliver
nutrients to the disks and keeps the surrounding structures healthy and functioning properly.

Brent Binder, D.C.

4909 Louise Dr. Suite 102

Mechanicsburg, PA 17055 (717) 697-1888

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Spinal Manipulation for Lumbar Disk Lesions

1 May

The majority of low back pain cases are classified as non-specific in nature, meaning they
are not attributable to an identifiable, single structural cause such as a fracture, infection, tumor,
or nerve compression. But, in roughly 5–10% of cases, the cause of localized pain in the lower
back can be linked to injury to the intervertebral disks—which sit between each of the lumbar
vertebrae and function as shock absorbers while facilitating spinal movement. If a nearby nerve
root is affected, the patient may experience symptoms that radiate along the course of the nerve
into the leg. What role, if any, can chiropractic play in managing lumbar disk–related low back
pain?
When a patient presents with low back pain, the chiropractor evaluates specific patterns
to determine whether a disk lesion may be contributing to the patient’s symptoms. Disk-related
pain is more likely when symptoms worsen with sitting, bending, leaning forward, or lifting, and
improve with standing, walking, or extension-based movements. Pain may be centralized in the
low back or refer into the buttock or thigh. In some cases, symptoms can extend further down the
leg. A particularly important clinical finding is centralization, where pain that radiates into the
leg moves back toward the spine during repeated movements.
In contrast, findings such as localized tenderness, pain primarily with extension and
rotation, no change in symptoms with repeated movement, or pain unaffected by loading patterns
suggest that a disk may not be the primary pain generator. Advanced imaging is typically not
recommended as an initial step in the diagnostic process. This is because a significant portion of
middle-aged adults have disk abnormalities visible on MRI that are often asymptomatic, and
treating these findings may not benefit the patient. Imaging is more appropriately reserved for
cases involving red flags such as progressive neurological deficits, bowel or bladder dysfunction,
or suspicion of serious pathology such as cancer, infection, or fracture.
The goal of treatment is to reduce mechanical stress on the affected disk and surrounding
structures, particularly when herniation is irritating nearby nerve roots, allowing the condition to
improve over time. Doctors of chiropractic often use a multimodal approach that may include
spinal manipulation or mobilization, soft tissue therapies, physiotherapy modalities, traction,
therapeutic exercise, and postural education. Patients who continue to experience significant
symptoms after 6–12 weeks may be referred for further evaluation. Fortunately, the prognosis is
favorable. Studies show that more than 4 in 5 cases of lumbar disk herniation improve with
conservative care and do not require surgery.

Brent Binder, D.C.

4909 Louise Dr. Suite 102

Mechanicsburg, PA 17055 (717) 697-1888

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Core Strengthening to Reduce Low Back Pain Risk

2 Apr

Low back pain is one of the most common and disabling conditions worldwide. It’s estimated that
nearly 200 million acute episodes of low back pain occur each year, of which roughly 20% persist for longer
than three months. With the aging of the global population combined with the obesity epidemic, low back pain
is expected to become an even more substantial physical health issue in the coming decades.
Because weakness in the core muscles that help stabilize the spine has been linked to up to a threetimes increased risk of new-onset low back pain, improving endurance and control in this muscle group may
help reduce one’s risk. The core muscles include the abdominals, back, and gluteal muscles. In addition to
stabilizing the spine to help stay upright, strong core muscles are important for maintaining balance through
proprioception and for supporting the wide range of motion the trunk performs—from rotation, to bending
forward, to side-bending, and backward movement. Key core-strengthening exercises include:

  • Front plank: Lie face down and prop yourself up on your elbows under your shoulders. Lift your body
    onto your elbows and toes (or knees for an easier version). Keep your body in a straight line from
    shoulders to heels, tighten your stomach and glutes, and avoid letting your hips sag or rise. Hold 10–
    30 seconds, repeat three to five times, working up to a 60-second hold.
  • Side plank: Lie on one side with your elbow directly under your shoulder. Lift your hips off the floor
    so your body forms a straight line from shoulders to feet. Keep your core tight and don’t let your hips
    roll forward or backward. For an easier version, bend your knees and lift your hips. Hold 10–25
    seconds per side and repeat three to five times.
  • Bird dog: Start on hands and knees with hands under shoulders and knees under hips. Tighten your
    stomach slightly and keep your back flat. Slowly extend one arm forward and the opposite leg
    backward. Keep hips level and avoid arching your back. Hold for five to ten seconds, return to start,
    then switch sides. Do eight to twelve repetitions per side.
  • Glute bridge: Lie on your back with knees bent and feet flat on the floor about hip-width apart.
    Tighten your stomach and squeeze your glutes. Lift your hips until your shoulders, hips, and knees
    form a straight line. Avoid arching your lower back. Hold three to five seconds at the top, then slowly
    lower. Perform ten to fifteen repetitions for two to three sets.
  • Dead bug: Lie on your back with arms straight up and knees bent at 90 degrees. Tighten your stomach
    gently so your lower back stays flat against the floor. Slowly lower one arm overhead and extend the
    opposite leg toward the floor. Only go as far as you can without your back arching. Return to start and
    switch sides. Perform eight to twelve slow, controlled repetitions per side.
    Further strategies to reduce the risk of low back pain include maintaining a healthy weight; improving
    workstation ergonomics; practicing good posture, especially when sitting and lifting; engaging in regular lowimpact aerobic exercise such as walking or swimming; following a balanced, minimally processed dietary
    pattern (such as a Mediterranean-style diet); avoiding tobacco use; and stretching before and after physical
    activity, especially the hamstrings which are often overly tight in low back pain cases. While these practices
    may not completely prevent low back pain, they can improve the changes for a speedier recovery as well
    reduce the risk of recurrence.

Brent Binder, D.C.

4909 Louise Dr. Suite 102

Mechanicsburg, PA 17055 (717) 697-1888

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The Pain Mechanisms of Chronic Low Back Pain

4 Mar

In simple terms, chronic low back pain is pain affecting the lumbar spine region that lasts
longer than three months. However, chronic low back pain is not simply acute (new) low back pain
that has failed to resolve. Rather, it often reflects an overlap of two or even three distinct pain
mechanisms, each of which may need to be addressed to achieve an optimal outcome: nociceptive,
neuropathic, and nociplastic pain.
Nociceptive low back pain arises from injury or irritation of non-neural tissues, including
muscles, ligaments, tendons, and joints. This type of pain is typically localized and may feel achy,
throbbing, or sharp with movement or certain positions. During a physical examination, a doctor of
chiropractic can often reproduce symptoms with palpation or specific movements. The term nonspecific low back pain is commonly used to describe pain that is predominantly nociceptive in
nature.
Neuropathic low back pain is caused by damage or disease affecting the nervous system
itself. In the context of chronic low back pain, this is most often associated with disk herniation
compressing a nerve root, degenerative changes (such as arthritis) narrowing the spaces through
which nerves travel, or postsurgical nerve injury. This form of pain is commonly described as
burning, shooting, or electric and often radiates along the course of the affected nerve. Patients may
also experience non-painful neurological symptoms, including numbness, tingling, weakness, or
altered reflexes.
Nociplastic low back pain typically develops over time in response to an initial injury or
episode of pain. This pain is characterized by altered pain processing within the nervous system and
is often associated with widespread or shifting pain patterns, heightened pain intensity, and increased
sensitivity to touch or movement. Patients with nociplastic low back pain may restrict movement and
daily activities out of fear of worsening their condition (kinesiophobia), describe pain in amplified or
distressing terms, feel poorly equipped to manage their symptoms, and commonly report poor sleep
and elevated stress. Coexisting conditions such as headaches, irritable bowel syndrome, or
fibromyalgia are also more prevalent in this population.
Because chronic low back pain often includes a combination of nociceptive, neuropathic, and
nociplastic components, treatment approaches must be individualized. A multimodal care plan may
include manual therapies, targeted exercises, physical modalities, and anti-inflammatory strategies
aimed at restoring normal motion and function to affected nerves, joints, muscles, tendons, and
ligaments. In addition, chiropractors may employ pain education and graded activity exposure to
address nociplastic factors and help patients regain confidence in movement. When appropriate,
referral to a medical physician or specialist may also be indicated—all with the goal of helping the
patient return to normal activities of daily living in the safest and most pain-free manner possible.

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The Evidence Map of Low Back Pain Treatment Options

5 Jan

Low back pain is extremely common and remains one of the leading causes of disability worldwide, resulting in substantial healthcare utilization and cost. Because of this broad impact, identifying and implementing effective, safe, and cost-efficient strategies to diagnose, manage, and prevent low back pain is essential to improve patient outcomes and reduce overall healthcare burden. In 2022, researchers conducted a comprehensive analysis of the available evidence for ten commonly recommended treatments for low back pain—five medication-based and five non-medication-based—drawn from multiple clinical practice guidelines:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) work by blocking the COX-1 and COX-2 enzymes responsible for producing prostaglandins, which influence pain sensitivity, inflammation, fever, and tissue blood flow. Evidence supports short-term improvements in pain and disability, but use is limited by potential side effects such as stomach irritation, increased bleeding risk, kidney strain, and caution in patients with certain heart conditions.
  • Acetaminophen (paracetamol) also blocks prostaglandin production, but its effects are largely restricted to the central nervous system. Importantly, available evidence shows little to no meaningful benefit for pain, function, or quality of life in patients with low back pain.
  • Opioids blunt incoming pain signals and alter how the brain interprets pain. Due to risks of misuse, dependence, and overdose, guidelines recommend restricting their use to severe acute pain or postoperative situations and strongly discourage long-term use.
  • Muscle relaxants can reduce muscle spasm through several central mechanisms. Evidence supports short-term symptom relief, but high-quality evidence is limited, and side effects—including drowsiness, dizziness, cognitive slowing, dry mouth, low blood pressure, nausea, drug interactions, and dependence—must be carefully considered.
  • Antibiotics are intended to treat infection. Evidence supporting their role in low back pain management is weak, inconsistent, and not broadly applicable.
  • Psychological or behavioral therapies can be especially valuable for patients with persistent or recurrent low back pain, as psychological factors strongly influence whether patients engage in behaviors that support or hinder recovery.
  • Staying active and avoiding bed rest are strongly recommended. Activity helps maintain function, reduce disability, and speed recovery.
  • Reassurance—emphasizing that low back pain is common, manageable, and rarely dangerous—reduces fear and catastrophizing and lowers the risk of progression to chronic pain.
  • Exercise, including both general physical activity and targeted movement strategies, provides modest but meaningful improvements in pain and disability. Exercise also reduces recurrence risk.
  • Manual therapy, which includes manipulation and mobilization, helps restore normal movement to the spine and associated tissues, reducing pain and disability. Practitioners often combine different manual techniques based on examination findings, patient preference, and clinical training and experience.

The great news is that doctors of chiropractic frequently employ a multimodal treatment approach that includes manual therapy, exercise, reassurance, and activity recommendations—among the most strongly supported options in this evidence map!

Pain Relief Chiropractic

4909 Louise Drive Suite 102

Mechanicsburg, PA 17055

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Risk Factors for Postpartum Low Back Pain

1 Dec

It’s estimated that as many as 50–70% of new mothers experience low back pain and
related disability, which can hinder their ability to carry out daily activities such as household
chores, self-care, and meeting the physical demands of infant care—including feeding, lifting,
and carrying. When severe enough, these physical limitations can contribute to stress, anxiety,
and postpartum depression, further interfering with the mother’s ability to bond with her
newborn and diminishing her overall quality of life. What are the underlying causes of
postpartum low back pain?
Interestingly, some risk factors may be present even before conception. Research
suggests that being overweight or obese, physically inactive, or exposed to occupational risk
factors such as whole-body vibration, poor ergonomics, and frequent lifting can set the stage for
low back pain both during pregnancy and after delivery. Women with a prior history of low back
pain are also at elevated risk for symptoms during and following pregnancy.
As the baby grows, the center of mass shifts forward in the body. To compensate, the
pelvis tilts anteriorly and the lumbar spine increases in lordosis, placing added stress on the
lumbar intervertebral disks and facet joints. The stretching of the abdominal muscles can reduce
spinal stability, while hormonal changes that prepare the pelvis for childbirth can increase joint
laxity, further affecting stability in the lower spine and pelvic region. To compound these effects,
expectant mothers may experience fluid retention, deconditioning from reduced activity, sleep
positions that strain the lower back, and psychosocial factors such as stress and anxiety that
heighten pain perception.
Childbirth itself can also contribute to postpartum low back pain. The physical effort of
pushing during delivery can strain the lower back, and the hormonal changes that allow for
ligamentous laxity during pregnancy may persist afterward, leaving the spine more susceptible to
mechanical stress. In cases of cesarean delivery, factors such as spinal anesthesia, post-surgical
immobilization, and prolonged bedrest can further delay recovery and exacerbate pain.
Unfortunately, it’s a common misconception that postpartum low back pain will simply
resolve on its own. In reality, studies suggest that up to 1 in 5 new mothers with low back pain
will develop chronic symptoms lasting a year or longer. While some risk factors for postpartum
low back pain are beyond a woman’s control, others—such as maintaining an active lifestyle,
avoiding prolonged inactivity, and seeking chiropractic care to help restore proper joint motion
and function in the lumbar spine during and after pregnancy—can play a key role in prevention
and recovery.
Brent Binder, D.C.

4909 Louise Dr. Suite 102 Mechanicsburg, PA 17055 (717) 697-1888

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