Lumbar Spine Treatment

Low Back Pain: Did You Know This About Low Back Pain?

If you have low back pain (LBP), you are certainly not alone. Almost everyone at some point has back pain that interferes with work, daily activities, and/or recreation. Americans spend at least $50 billion each year on LBP. It is the most common cause of job-related disability and a leading contributor to lost work time. Back pain is second to headaches as the most common neurological condition in the United States. Fortunately, most occurrences of LBP go away within a few days. Others take much longer to resolve or lead to more serious conditions (1).

Acute Vs. Chronic

There are two types of low back pain acute and chronic. Most episodes of acute LBP last from a few days to weeks, are not neurological and usually do not carry a high level of surgical risk. The cause of LBP can be difficult to isolate because often, while the cause is cumulative where multiple events over time, the last activity the patient recalls is bending over for a pencil. This, by itself is not likely to cause an acute onset of LBP. Low back pain can be caused by trauma such as sports injuries, work around the house such as garden work, car accidents, and others. Chronic low back pain, by definition, is LBP that lasts more than 3 months and the cause can be more difficult to identify and is often cumulative and superimposed on a prior condition such as degenerative disk or joint disease. A real problem is the rate of recurrence or, chronic, recurrent low back pain where pain may subside but returns at various rates of frequency and duration. This category affects a high percentage of the population and represents the true challenge in spine care management (1, 2).

As people age, their bone strength and muscle stretch, strength and tone usually decreases due to lack of activity. When the disks begin to lose fluid and flexibility, their ability to cushion the vertebrae and function as shock absorbers also decreases. Disks can tear, bulge, and/or herniate which results in localized LBP and/or radiating pain that follows the course one or more of the 31 pairs of nerve roots (eg., sciatica down the back of the leg).

Soft tissues such as joint capsules and ligaments lose their capacity to stretch and can tear more easily, resulting in a sprain or strain (muscle/tendon injury). Other conditions that either cause or contribute to LBP include arthritis, obesity, smoking, pregnancy, stress, poor posture and/or physical health, and can lead to unsatisfied patients if these co-contributors are not properly identified and discussed. Less commonly, LBP can be caused by a more serious condition such as cancer, fracture, infection, spinal cord compression, and various internal conditions (3). Emergency care may be indicated in these circumstances.

At Boca Health Care Center, Dr. Rosen will perform a complete examination, consider other contributing causes, and will treat the problem(s) causing the LBP condition. If needed, working with other allied health care providers will be arranged. Exercise, dietary recommendations, ergonomic or work modifications, spinal manipulation, spinal decompression using the DRX 9000 machine, neuromuscular re-education, neuromuscular massage will all be considered to help eliminate or control of the LBP. Methods of self-managing the LBP will be emphasized.

Oh, My AchingLeg?

Certain low back conditions give rise to more than just low back pain. For example, leg pain can be more intense than low back pain, even though the cause of the leg pain is coming from the low back. When this happens, many patients complain that they have sciatica, which refers to radiating pain that starts in the low back and extends down into the leg. When the intensity of leg pain is worse than the low back, it can make patients wonder, where is my problem really coming from?

To understand this better, a short anatomy lesson is appropriate. The spine can be divided into two halves, front and back. The structures in the front half include the larger, heavier bones called vertebral bodies and the shock absorbing cushions that lie between the vertebral bodies called the intervertebral disks. The disk is like a jelly donut where the center is liquid-like and the outer portion is a tough, criss-cross pattern cartilage arranged like the rings on a tree stump. There are also ligaments that hold the vertebrae and disks tightly together. The back half of the spine includes the spinal cord, nerve roots, as well as the small joints of the back called facet joints. Every movable joint has a joint capsule that helps lubricate the joint and limits the amount of movement, along with surrounding ligaments. The larger, heavier vertebral bodies and shock absorbing disks carry the majority of the weight (approximately 80%) while the smaller facet joints carry much less weight (only 20%) but are more responsible for guiding the movements of our back.

When leg pain is present, it can be caused by either a pinched nerve, or, an inflamed facet joint.

When a nerve is pinched, the cause is usually from the intervertebral disk where the jelly-like center leaks out and presses on the nerve that goes down the leg, commonly referred to as a herniated disk with sciatica. This type of pain is quite specific, easy to describe and often extends below the knee to the ankle or foot. It can include muscle weakness, numbness in certain areas of the leg, and bending forward increases low back and leg pain while bending backwards reduces the leg pain (and sometimes the LBP).

When a facet joint capsule tears (technically, called a sprain), the pain is referred down the leg in a generalized, non-specific manner, usually described as a deep ache, often hard to describe and usually does not go below the level of the knee. Here, it feels better to bend forward and worse to bend backwards, of which neither movement changes or affects the leg in a specific way. Disk related leg pain carries a potential for surgery if all non-surgical approaches fail, while facet joint referred leg pain rarely requires invasive treatments or surgery.

The good news is that both of these sources of low back and leg pain are very treatable In our office! The important point to remember is that obtaining prompt treatment, when symptoms first appear is best as waiting and hoping it will subside on its own often results in a longer treatment course and is less satisfying for all concerned.

Could Your Feet Or Hips Be At Fault?

The body is an interconnected whole and needs to be looked at as such in order to get at the root of a spinal problem. We are all familiar with low back trauma, bending and stooping in awkward positions to lift something from a trunk, or the slip and fall on ice. In these examples, it’s easy to see how the trauma preceded the low back pain.

But sometimes pains in the low back are not so easy to figure out. One area of the spine could be compensating in posture for another, inhibiting a vertebral joint’s ability to fully recover. Or maybe you’re suffering from the cumulative affects of microtrauma over time.

Such is the short leg; about 1/10 people will have an anatomic difference in leg length of up to one centimeter. This short leg causes the pelvis to incline to one side providing an uneven support for the base of your spine. It’s a little like walking with one foot in a small ditch. The uneven pelvis then causes a lumbar scoliosis, which must be further compensated from above.

But a short leg can also be functional, due perhaps to a small or collapsed arch of the foot. This can account for up to 5 mm of leg length difference. Do you have a history of having flat feet or have you ever sprained one of your ankles? The sprained ankle can damage ligaments to such a degree that the normal arch of the foot can no longer be maintained.

Depending on the degree of the problem we may be able to help your low back pain by correcting a problem in the foot. Many in-shoe orthotics are available to correct a fallen arch. If the problem is very severe, you may also need a visit to a podiatrist.

In any case, it’s important to consider the foundation of a spinal problem, and it can be as simple a problem as bad foot posture that is affecting how your low back functions. Also, problems in the sacroiliac joint or hips can affect how the lower spine moves.So pay attention to where the pain is located, but also consider that other joints nearby may be affecting your recovery as well.

As a doctor of chiropractic, my office is fully equipped to handle problematic low back conditions that dont seem to clear up in response to what you’ve tried in the past. Have your feet been checked? Has someone looked at your posture carefully?

There are many causes of LBP. Some of the obvious include over lifting/carrying, performing a task for too long or with too many repetitions, and sitting or standing in one position for too long. However, frequently LBP seems to occur for no apparent reason, or at least none that can be clearly identified. One of the most basic causes of LBP is simply standing on two, rather than four legs. When comparing a 4-legged to a 2-legged subject, arthritis of the spine and disc degeneration occurs much earlier in those of us with two legs. This is due partially because 2/3rds of our weight is supported by the low back and pelvis. In addition, vertical loading occurs in the 2-legged subject whereas the load is distributed between four legs in a horizontal fashion in the 4-legged species. Other less obvious causes of LBP include physical characteristics such as flat feet (fallen arches), a short leg resulting in a tipped pelvis, carrying too much weight, being out of shape/weak muscles, as well as hereditary factors. Non-physical characteristics include diet, exercise participation, lifestyle, stress and other psychological conditions such as depression, anxiety, bipolar disorders, and others. Hence, treatment must address the entire person, not just the low back since often, several of the characteristics mentioned here are present and often participating in the cause for LBP.

Because many of these characteristics are not properly attended to, LBP tends to be recurrent, where multiple episodes come and go over time. In years past, health care providers would focus the majority of their attention on the physical characteristics of LBP and when treatment results was ineffective, the blame was placed on the psychological aspects for which little, if any, treatment was offered. However, over the last 20 years, the shift towards treating the whole person or, adopting the biopsychosocial model (bio- = physical, psycho- = mental, and social = how LBP is perceived and affects daily social interaction) has been emphasized as the appropriate approach when managing patients with low back pain. No longer should the psychological aspect be ignored but rather, identified and treated so that this significant barrier to recovery can be properly managed.

Regarding treatment, unless someone presents with a red-flag which, for LBP sufferers include cancer, fracture (especially unstable fractures), cauda equine syndrome (spinal cord pinching resulting in bowel / bladder control loss), or infection, immediate/emergent care is not required. A careful health history followed by appropriate tests can usually identify these red flags. Otherwise, surgery for LBP is not recommended until at least 4-6 weeks of treatment with non-surgical approaches are first utilized and, an identifiable lesion can be identified that clearly is causing the presenting complaints and clinical findings. Chiropractic has an obvious advantage over specialty care when considering non-surgical treatment of LBP. Both physical and emotional issues are identified and a team approach with other health care providers when required is ordered. Moreover, all the international guidelines published for treating LBP recommend spinal manipulation BEFORE most of the other non-surgical approaches are tried due to medication side-effects and, the successes reported in many studies where spinal manipulation is performed.

1. http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm
2. http://www.spine-health.com/conditions/lower-back-pain/lower-back-pain-symptoms-and-treatment-options Bigos S, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults. Clinical Practice Guideline. Rockville, Md: US Department of Health and Human Services, Public Health Service, Agency for Health

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