Tag Archives: low back pain

Small Hip Muscle Linked to Back, Buttock, and Leg Pain

1 Oct

While a herniated disk is a well-known cause of sciatica—pain that travels from the lower
back into the buttock or down the leg—it is not the only one. In some cases, a small muscle deep
within the hip called the piriformis may contribute to similar symptoms. Understanding how this
muscle functions can help explain why identifying the true source of radiating leg pain is sometimes
complicated.
The piriformis is located beneath the larger muscles of the buttock. It stretches from the
lower part of the spine and pelvis to the upper portion of the thigh bone. Although relatively small, it
plays an important role in stabilizing the hip and pelvis and helping rotate the hip outward. These
functions contribute to activities such as walking, climbing stairs, changing direction, and
maintaining balance.
When the piriformis becomes tight, irritated, or does not function normally, it may affect the
way the hip and pelvis move and contribute to pain in the buttock or surrounding areas. Just beneath
the piriformis—or, in some people, passing through portions of the muscle—runs the sciatic nerve,
which travels from the lower back into the leg. In some individuals, irritation or entrapment of the
sciatic nerve near the piriformis may also produce pain, tingling, numbness, or aching that travels
down the back of the leg.
A recent literature review concluded that piriformis syndrome is frequently overlooked
because its symptoms can closely resemble conditions such as a lumbar disk injury or sacroiliac joint
dysfunction. Some estimates suggest that piriformis syndrome may account for approximately 5% to
8% of cases involving low back, buttock, or leg pain, but diagnosing the condition remains
challenging because there is no single test that confirms it. Instead, healthcare providers rely on a
careful history and physical examination and, when necessary, imaging or other testing to evaluate
alternative causes.
Because evaluating suspected piriformis involvement requires looking beyond the location of
the pain itself, a chiropractor may assess hip mobility, muscle strength, flexibility, posture, walking
mechanics, and tenderness around the hip and pelvis in patients presenting with lower back, buttock,
or radiating leg pain. Specific examination procedures can help determine whether the piriformis
may be involved while helping distinguish it from other possible causes, such as a lumbar disk
problem or nerve compression in the spine.
When appropriate, conservative treatment by a doctor of chiropractic may include soft tissue
techniques to reduce muscle tension, manual therapy to improve movement in the spine and pelvis,
stretching and strengthening exercises, and guidance on activity modification—all with the goal of
reducing pain, improving function, and promoting healthier movement patterns.

Brent Binder, D.C.

4909 Louise Dr. Suite 102

Mechanicsburg, PA 17055

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Lumbar Instability: Looking Beyond the Spine

1 Sep

While an episode of low back pain may begin after lifting, sleeping in an awkward
position, or engaging in physical activity, these events often act as triggers rather than the
underlying cause. In many cases, the factors that make the lower back vulnerable have been
present for months or even years. One such factor is lumbar instability, which occurs when agerelated changes, muscle weakness, or repetitive mechanical stress reduce the ability of the
ligaments, intervertebral disks, facet joints, and muscles to stabilize the spine. As a result, the
vertebrae may move excessively, placing greater stress on the pain-sensitive tissues in the lower
back. There is growing evidence that structures beyond the lumbar spine—particularly the
muscles that control the hips and pelvis, including the gluteal muscles and hamstrings—can also
influence lumbar stability.
The gluteal muscles and hamstrings play an important role in supporting healthy
movement and helping maintain proper control of the pelvis during everyday activities. When
these muscles are weak, the pelvis may not remain as stable during walking, bending, lifting, or
climbing stairs. This can alter the way forces are transferred through the pelvis and lower back,
increasing stress on the joints, disks, ligaments, and muscles of the lumbar spine.
The gluteal muscles, particularly the gluteus medius and gluteus maximus, are important
for controlling pelvic position and limiting excessive movement during standing and walking.
Weakness in these muscles may contribute to altered posture and movement patterns that place
greater demands on the lower back. Likewise, weak hamstrings may be less able to help control
hip motion and pelvic movement during activities such as bending, lifting, or climbing stairs.
A December 2025 study provides further support for this concept. Researchers evaluated
129 young adults, including 67 with lumbar instability, to better understand the relationship
between muscle function and low back pain. The investigators found that weaker hamstring
muscles and reduced hip mobility were associated with greater low back pain and higher levels
of disability.
These findings reinforce the notion that the body functions as an interconnected system.
Low back pain may not originate solely from the lumbar spine itself. Instead, weakness or
limited mobility in the muscles and joints surrounding the hips and pelvis can alter posture,
movement, and the way forces are distributed throughout the body. Doctors of chiropractic are
trained to evaluate musculoskeletal conditions and assess how the spine, hips, pelvis, and
surrounding muscles function together. Following a thorough examination, they can develop an
individualized, multimodal treatment plan to address contributing factors, improve function,
relieve pain, and support long-term spinal health.

Brent Binder, D.C.

4909 Louise Dr. Suite 102

Mechanicsburg, PA 17055

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Lifestyle Risk Factors for Chronic Low Back Pain

6 Aug

Chronic low back pain is defined as back pain that lasts for three months or longer. It
affects millions of adults and is one of the leading causes of disability worldwide. It’s
estimated that more than 600 million individuals worldwide are living with chronic low back
pain at any given moment. While injuries, age-related changes, and certain medical
conditions can contribute to persistent back pain, research suggests that several modifiable
lifestyle habits may also influence the likelihood that back pain develops or becomes
chronic:

  • Prolonged Sitting – Sitting for more than six hours a day can increase stress on the
    lower back, reduce muscle activity, contribute to stiffness, and promote physical
    deconditioning over time.
  • Physical Inactivity – Regular movement helps maintain the strength, flexibility, and
    endurance needed to support the spine. Inactivity may contribute to muscle weakness,
    reduced mobility, excess body weight, and lower physical resilience.
  • Elevated Stress – Chronic stress can increase muscle tension, disrupt sleep, heighten
    pain sensitivity, and affect how the nervous system processes pain signals. Individuals
    under ongoing stress often report greater pain intensity and slower recovery.
  • Smoking – Smoking has been linked to reduced blood flow to spinal tissues,
    increased inflammation, impaired healing, and accelerated age-related changes in the
    spinal discs. Smokers are more likely to develop chronic low back pain and often
    report more severe symptoms.
  • Unhealthy Diet – Poor nutrition may contribute to inflammation, reduced tissue
    repair, excess body weight, and metabolic health challenges. Low protein intake may
    also contribute to loss of muscle mass, including the muscles that help support and
    stabilize the spine.
    In addition to chiropractic care, which may include spinal manipulation, other manual
    therapies, and therapeutic exercises, patients with chronic low back pain are often
    encouraged to address these modifiable risk factors. Not only can this support recovery, but a
    healthier lifestyle may also reduce the risk of future episodes of back pain.

Brent Binder, D.C.

4909 Louise Dr. Suite 102

Mechanicsburg, PA 17055

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When the Cause of Low Back Pain Isn’t Obvious

1 Jul

Low back pain is one of the most common health complaints in the world and one of
the leading reasons patients seek chiropractic care. For many patients, the first question is,
“What is causing the pain?” The answer is not always simple.
In general, low back pain can be divided into two categories: specific and nonspecific low back pain. Specific low back pain refers to cases where a clear underlying
pathology can be identified. Examples include fractures, infections, tumors, inflammatory
diseases, or disc herniations with significant nerve compression. These conditions are
important to recognize because they may require medical intervention or specialized care.
Fortunately, these more serious causes account for only about 10–15% of low back pain
cases.
That means approximately 85% of cases are considered non-specific. The term nonspecific does not mean the pain is imaginary or that nothing is wrong. It simply means there
is no single obvious structural problem that clearly explains the symptoms. This can
sometimes surprise patients who expect an MRI or X-ray to reveal one identifiable cause.
However, research has shown that many common imaging findings—such as disc bulges,
arthritis, or spinal degeneration—are also frequently found in people with no pain at all.
Today, non-specific low back pain is understood to be multifactorial and may involve
a combination of joint irritation, muscle dysfunction, reduced mobility, physical
deconditioning, repetitive strain, stress, poor sleep, inflammation, and nervous system
sensitization. Sometimes the pain begins after an injury. Other times it develops gradually
with no clear trigger. This complexity is one reason why back pain can vary so much from
person to person and why effective treatment often requires an individualized approach.
Clinical guidelines for non-specific low back pain typically emphasize conservative
care, movement, and an activity plan whenever possible. Chiropractic care can be an
excellent option for many patients with low back pain. Doctors of chiropractic are trained to
evaluate the spine and musculoskeletal system, identify red flags that may require medical
referral, and provide conservative treatment for many common back pain conditions.
Treatment may include spinal manipulation, mobilization, soft tissue therapies, exercise
recommendations, postural guidance, and patient education.

Brent Binder, D.C.

4909 Louise Dr. Suite 102

Mechanicsburg, PA 17055

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 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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