Low Back Pain

Chiropractic for Acute Low Back Pain

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According to the European Spine Journal, Chiropractic care was proven to be an effective treatment for acute back pain (pain that occurs suddenly and is often more sharp and severe).

“The European Spine Journal published guidelines for treating acute LBP and Radiculopathy:

o Employ: Manual therapy, exercise, and patient education about prognosis, warning signs, and advice to remain active.

o Avoid: routine use of imaging, extra-foraminal steroid injections, acetaminophen, NSAIDs, and opioids.

If you or someone you know suffers from back pain, follow the proven advice and call our office today.”

Source: Stochkendahl, M.J., Kjaer, P., Hartvigsen, J. et al. National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Eur Spine J (2018) 27: 60.

Lumbar Radiculopathy? That sounds ridiculous!

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Your nervous system is basically a big electrical circuit. Your spinal cord transmits all of the electrical nerve impulses between your brain and lower back. From there, individual nerves emerge from your spine then travel to supply sensation and movement to a specific area of your buttock, legs and/or feet. This allows you to move and feel sensations like touch, heat, cold and pain. Anything that

interferes with this transmission can cause problems.

You have been diagnosed with a “Lumbar Radiculopathy”. This means that one or more of the nerves emerging from your lower back has become irritated or possibly pinched. This often results in pain, numbness or tingling in the specific area of your leg that is supplied by the irritated nerve. The term “Sciatica” is often used to describe this condition, because most (but not all) “lumbar radiculopathies” involve the sciatic nerve which supplies the back & outside of your thigh and calf. Symptoms of a lumbar radiculopathy may vary from a dull ache to a constant severe sharp shooting pain. Your symptoms are likely aggravated by certain positions or movements.

To solve this problem, we will treat the source of your nerve irritation. It is important for you to follow your treatment plan closely and be sure to tell us immediately if you experience any progression of your leg pain, numbness or weakness.

Lumbar Degenerative Spondylolisthesis

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Your lumbar spine (low back) is made up of five individual vertebra stacked on top of a bone called the sacrum. To allow for flexibility and movement, there is a cushion or “disc” in between each level. As we age, our discs and joints can wear and become thinner from a process called arthritis. This leads to additional changes, including loosening of the ligaments that hold your vertebra in place.

The term “degenerative lumbar spondylolisthesis” means that one of your vertebra has shifted forward on top of the one below as a result of arthritis and loosening ligaments. The condition usually comes on after age 50 and affects women six times more frequently than men. Degenerative spondylolisthesis occurs most commonly at your second lowest spinal level. (L4-5)

Sometimes, spondylolisthesis develops silently, but most patients report episodes of back pain that have occurred for many years. Patients often report increased pain when standing or when rising from a sitting position. Pain tends to increase throughout the day. If your nerve openings have become narrowed, the nerves may be pinched, and you may experience pain radiating into your legs. Leg symptoms that shift from side to side are characteristic of degenerative spondylolisthesis. Leg pain and tingling are fairly common, but be sure to tell your doctor if you notice more significant symptoms, like leg numbness, heaviness, weakness, loss of bowel or bladder function, or impotence.

Studies have shown no advantage for surgery over conservative care for most cases of degenerative spondylolisthesis. Approximately one-third of patients will experience progression of symptoms over time, and only 10-15% will ever need surgery to correct the problem. Fortunately, the majority of patients will benefit from treatment and exercises to help stabilize their spine.

You will need to perform your exercises consistently for sustained improvement. You should also try to add some type of aerobic exercise to your daily routine. Stationary cycling is a very good choice, and other options include water walking and swimming. Avoid wearing high heels. You may find some benefit for your arthritic symptoms by taking 1500mg of Glucosamine Sulfate each day. Using a hot pack for 10-15 minutes directly over your lower back may provide some benefit.

Lumbar Spondylolisthesis

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Your spine is made up of 24 individual vertebrae all stacked on top of each other. The lowest five vertebrae are referred to as your lumbar spine. Each vertebra has two basic components: the “body” and the “arch.” You can envision this as a coffee mug lying on its side. The cup would represent the vertebral body, and the handle would represent the arch. The spinal cord travels through each of

the vertebral arches on its way from your brain to your tailbone. The term “lumbar isthmic spondylolisthesis” describes a condition where your arch has broken free from its anchor on the vertebral body, allowing the vertebral body to slide forward. Lumbar spondylolisthesis typically affects the lowest lumbar vertebra, L5, or occasionally the second lowest, L4.

The condition is sometimes caused by trauma, but more often follows a “stress fracture” involving the arch of the vertebra. This break and slippage is thought to result from repetitive movements, especially hyperextension (arching back) and rotation. The break usually happens during childhood but does not always cause symptoms when it occurs. Many times, the condition will lie dormant until later in life. Lumbar spondylolisthesis is present in six to seven percent of the population and affects males twice as often as females. The problem is more common in those who participate in sports. Some sports predispose children to this “break and slip”. Athletes who participate in gymnastics, rowing, diving, football, wrestling, weight lifting, swimming, tennis, volleyball, and track & field throwing sports (i.e. discus, shot put, etc) are at greatest risk.

The pain usually starts in your back but may radiate into your buttock or thigh. Your pain usually intensifies with standing upright for prolonged periods of time or leaning backwards, especially during heavy activity. Some women report increased symptoms during the later stages of pregnancy. Be sure to tell your doctor if you notice pain, numbness or tingling in your groin, a loss of bowel or bladder function, fever, night sweats, pain extending beyond your knee, or weakness in your legs.

Your doctor will “grade” your spondylolisthesis based on the percent of the vertebral body that has slipped forward. Your doctor will try to determine if your spondylolisthesis is “active”, meaning a recent break or “inactive”, referring to a long-standing problem. If your doctor has determined that your spondylolisthesis is new and has a chance of worsening, you may need to stop certain activities or sports for a period of time until your fracture heals. Sometimes a lumbar brace is used to help you recover more quickly. Patients with a long-standing “inactive” spondylolisthesis may benefit from a combination of treatments including stretching and strengthening. You should limit leaning backwards or sleeping on your stomach. Females should avoid wearing high heels.

Pregnancy Related Low Back Pain

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Pregnancy-related LBP

Researchers estimate that between 45-75% of pregnant women will experience low back pain at some stage of their pregnancy.  (1-5) Up to 33% rate their pain as severe. (6) Pregnancy-related low back pain (P-LBP) leads to lower quality of life, restricted activity, and disability – with almost 25% of pregnant women taking sick leave for LBP.  (2,7-11) The recurrence rate for pregnancy-related low back pain is 85-90%.  (11-14) Consequently, almost 1 in 5 women who report P-LBP during an initial pregnancy will avoid future pregnancies due to fear of returning symptoms.  (15) 

Pharmacologic options during pregnancy are limited, however a new study highlights a conservative alternative. A December 2017 systematic review of 102 studies found moderate-quality evidence suggesting manipulation had a significant effect on decreasing pain and increasing functional status in pregnant and post-partum women with LBP. (16)

This concurs with prior research showing that almost 75% of women undergoing chiropractic manipulation report significant pain reduction and clinically significant improvements in disability. (17,18) Postpartum LBP also responds favorably to spinal manipulation – approximately 10 times better than watchful waiting. (19)

Our providers strive to deliver safe and effective evidence-based care for your patients. Incorporating gentle manipulation with the appropriate exercises generally provides significant relief in very few visits.  

 

References
1. Wu WH, Meijer OG, Uegaki K, Mens JM, van Dieën JH, Wuisman PI, et al. Pregnancy related pelvic girdle pain (PPP), I: terminology, clinical presentation, and prevalence. Eur Spine J 2004;13:575–89.
2. Pierce H, Homer C, Dahlen H, King J. Pregnancy related low back and/or pelvic girdle pain: listening to Australian women. Abstract presented at the XI International Forum for Low Back Pain Research in Primary Care, Melbourne, Australia, 15–18 March 2011.
3. Diakow P.R.P., Gadsby T.A., Gadsby J.B., Gleddie J.G., Leprich D.J., Scales A.M. Back pain during pregnancy and labor. J Manipulative Physiol Ther. 1991;14(2):116–118.
4. Berg G., Hammer M., Moller-Nielsen J., Linden U., Thorblad J. Low back pain in pregnancy. Obstet Gynecol. 1988;71:71–75. 
5. Mogren IM, Pohjanen AI. Low back pain and pelvic pain during pregnancy: prevalence and risk factors. Spine . 2005 Apr 15;30(8);983-91. 
6. Hall J, Cleland J, Palmer J. The Effects of Manual Physical Therapy and Therapeutic Exercise on Peripartum Posterior Pelvic Pain: Two Case Reports. Journal of Manual and Manipulative Therapy. 2005;13(2): 94-102 
7. Wellock VK, Crichton MA. Symphysis pubis dysfunction: women’s experiences of care. Br J Midwif 2007;15:494
8. Kristiansson P, Svarsudd K, von Schoultz B. Back pain during pregnancy: a prospective study. Spine 1996;21:702-9.
9. Wu W, Meijer OG, Jutte PC, et al. Gait in patients with pregnancy-related pain in the pelvis: an emphasis on the coordination of transverse pelvic and thoracic rotations. Clin Biomech 2002;17:678-86.
10. Owens K, Pearson A, Mason G. Symphysis pubis dysfunction: a cause of significant obstetric morbidity. Eur J Obstet Gynecol Reprod Biol
11. George JW, Skaggs CD, Thompson PA, Nelson DM,  Gavard JA, Gross GA. A randomized controlled trial comparing a multimodal intervention and standard  obstetrics for low back and pelvic pain in pregnancy. Am J Obstet Gynecol 2013 Apr; 208(4):295.e1-7
13. Sabino J, Grauer JN. Pregnancy and low back pain. Curr Rev Musculoskelet Med. 2008 Jun; 1(2): 137–141.
14. Mens JMA, Vleeming A, Stoeckart R, Stam HJ, Snijders CJ. Understanding peripartum pelvic pain. Implications of a patient survey. Spine. 1996;21(11):1363–70. 
15. Wang SM, DeZinno P, Fermo L, et al. Complementary and alternative medicine for low-back pain in pregnancy: a cross-sectional survey. J Altern Complement Med. 2005;11(3):459-464.
16. Franke, Helge et al. Osteopathic manipulative treatment for low back and pelvic girdle pain during and after pregnancy: A systematic review and meta-analysis
Journal of Bodywork and Movement Therapies , Volume 21 , Issue 4 , 752 – 762
17. Shaw G. When to adjust: chiropractic and pregnancy. J Am Chiro Assoc. 2003;40(11):8-16
18. Murphy DR, Hurwitz EL, McGovern EE. Outcome of pregnancy-related lumbopelvic pain treated according to a diagnosis-based decision rule: a prospective observational cohort study. J Manipulative Physiol Ther 2009;32:616-24.
19. Schwerla F, et al. Osteopathic manipulative therapy in women with postpartum low back pain and disability: A pragmatic randomized controlled trial. J Am Osteopath Assoc. 2015 Jul;115(7):416-25.

Lumbar Spondylo-what?

~ Dr. Robert Speirs DC ~ Leave a comment

Your spine is made up of 24 individual vertebrae, all stacked on top of each other. The lowest five vertebrae are referred to as your lumbar spine. Each vertebra has two basic components- the “body” and the “arch.” You can envision this as a coffee mug lying on its side. The cup would represent the vertebral body, and the handle would represent the arch. The spinal cord travels through each of the vertebral arches on its way from your brain to your tailbone.

The term lumbar spondylysis describes a condition where a part of the arch breaks free from its anchor site on the vertebral body. This condition most commonly occurs during adolescence while bones are hardening. When we are young our bones have taken shape but they have not yet become hardened. Think of this as a clay coffee mug that has not yet been fired in the kiln. During adolescence, our bones transform from this softer clay to a more brittle bone.

The condition is sometimes caused by trauma but more often is a “stress fracture” to the arch of the vertebra. This defect is thought to result from repetitive movements, especially hyperextension and rotation. The condition is more common in people who were born with a small or weak arch- think of a coffee mug handle with a very thin brittle attachment.

Lumbar spondylolysis usually affects the lowest lumbar vertebra- L5, or occasionally L4. Most patients are 10-15 years of age when they are diagnosed with the condition, although sometimes symptoms do not present until adulthood. It is more common in those who participate in sports. Some sports predispose children to this problem. Athletes who participate in diving, wrestling, weight lifting, track, football and gymnastics have the highest incidence of spondylolysis.

The pain usually starts in your back but may radiate into your buttock or thigh. Your pain usually intensifies with standing upright for prolonged periods of time or leaning backwards. You should limit movements that involve hyperextension, like leaning backwards. Females should avoid wearing high heels.

Your doctor likely performed x-rays or an MRI to make the diagnosis of spondylolysis. If your doctor has determined that your spondylolysis is new and has a chance of worsening, you may need to stop certain activities or sports for a period of time until your fracture heals. Sometimes a lumbar brace is used to help you recover more quickly.

What is Lumbar Stenosis? 

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The term stenosis means “narrowing” of a tube or opening. Spinal stenosis means that the tube surrounding your spinal cord and nerve roots has become too small, and your nerves are being compressed. Stenosis can arise in different ways. Sometimes, people are born with a spinal canal that is too small. Other times, the canal may have been narrowed by surgery or conditions like disc bulges. Most commonly, spinal stenosis arises from chronic arthritic changes that narrow the canal. This type of stenosis usually develops slowly over a long period of time, and symptoms show up later in life.

Patients with stenosis often report pain, tingling, numbness or weakness in their legs. Lower back pain may or may not be present, but leg symptoms are usually more bothersome. You may notice increasing symptoms from standing or walking and relief while sitting because the available space in your spinal canal decreases when you stand, walk or lean back and increases when you sit or flex forward. Walking down hill is usually more uncomfortable than walking up hill. You may notice that when you walk with a shopping cart or lawn mower, you are more comfortable, as this promotes slight flexion. Sleeping on your side in a fetal position with a pillow between your knees may be most comfortable.

The natural course of spinal stenosis is variable. Most patients notice their symptoms stay about the same over time, while others are divided into fairly equal groups who either improve or worsen. Be sure to tell your doctor if you notice that your legs become cold, swollen or change color. Likewise, tell us if you notice a fever, unexplained weight loss, flu-like symptoms, excessive thirst or urination, numbness in your groin or loss of bladder control.

While there is no non-surgical cure for stenosis, we offer potent treatments to help ease your symptoms. Treatment is focused on helping improve your mobility so that you can walk and function better. You will be given exercises to help with conditioning. You should avoid activities that increase your pain, including heavy lifting or those that cause you to extend your back, like prolonged standing or overhead activity. When you are forced to stand, you may find relief by slightly elevating one foot on a stool or bar rail. You may find relief while washing dishes if you open your cabinet door and alternately rest one foot on the inside of the cabinet to provide a little bit of flexion. Recumbent cycling is often a more tolerable alternative to walking or running. Some patients report relief by using an inversion table.

Our exercise of the month

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The Semi-Stiff Dead Lift

 

Begin standing with your thumbs on your rib cage and your fingers on the crests of your hip, making sure not to approximate your fingers throughout the exercise.

Stand on one leg with your knee bent only slightly.

Slowly flex forward from the hips moving your chest toward the floor, making certain not to flex your back. Return to an upright position.

Repeat 15 repetitions on each leg once per day or as directed.

I’m getting old Doc… Getting old….

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Your lumbar spine (low back) is made up of 5 individual vertebrae stacked on top of a bone called the “sacrum”. To allow for flexibility and movement, there is a cushion or “disc” in between each level. As we age, these discs can wear and become thinner over time. This leads to additional changes, including bone spurs and narrowing of the opening where your nerves exit your spine.

This process is called “lumbar spondylosis”, or simply, “arthritis”. This problem most commonly involves the vertebra at the very base of your spine, which bear the highest loads.

Lumbar arthritis is exceptionally common, affecting people as young as 20 and becoming extremely likely by age 70. How quickly you develop low back arthritis is largely a trait you inherited from your parents. Other factors may play a role, including a history of trauma, smoking, operating motorized vehicles, being overweight and/ or performing repetitive movements (i.e. lifting, twisting, bending or sitting). Men seem to be affected slightly more often than women.

Symptoms often begin as back and buttock pain that gradually worsens over time. Stiffness may be present upon arising in the morning. Pain is relieved by rest or light activity and aggravated by strenuous work. Sometimes your nerves can become “pinched” in narrowed openings where they exit your spine. This can cause “sciatica” which results in pain, numbness, or tingling radiating into your leg along the path of the irritated nerve. Be sure to tell your doctor if you notice any weakness or if you have fever, abdominal pain, change in bowel or bladder function, or pain in your groin crease.

Arthritic changes can be seen on x-rays, but interestingly, the amount of wearing does not seem to correlate directly with the severity of your symptoms. People with the same degree of arthritis may have symptoms ranging from none to severe. Most researchers believe that the symptoms of osteoarthritis are not the direct result of the disease, but rather, from the conditions that preceded the disease and those that develop subsequent to it, like joint restrictions and muscle tightness. Fortunately, those conditions are treatable and our office has a variety of tools to help relieve your pain.

In general, you should avoid repeated lifting and twisting and take frequent breaks from prolonged sitting, especially in motorized vehicles. Avoid any position that causes an increase in radiating pain. Low-impact activities, like walking, stationary cycling, water aerobics, and yoga may be helpful.

Ouch! My Back Went Out!

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Your spine consists of 24 individual vertebrae stacked on top of each other. Flexible cushions called “discs” live between each set of vertebrae. A disc is made up of two basic components. The inner disc, called the “nucleus”, is like a ball of jelly about the size of a marble. This jelly is held in place by the outer part of the disc called the “annulus”, which is wrapped around the inner nucleus much like a ribbon wrapping around your finger. The term lumbar disc lesion means that your disc has been damaged.

Disc lesions start when the outer fibers of the disc become strained or frayed. If enough fibers become frayed, this can create a weakness and when the disc is compressed, the outer fibers may “bulge” or “protrude” like a weak spot on an inner tube. If more fibers are damaged, the nucleus of the disc may “herniate” outward. Since the spinal cord and nerve roots live directly behind the disc, bulges that are accompanied by inflammation will likely create lower back pain that radiates into the buttock or the entire lower extremity. This condition is called sciatica. If the disc bulge is significant enough to create a mechanical compression of your nerve, you may also experience loss of your reflexes and weakness. Be sure to let our office know if you notice progressive weakness or numbness, any numbness around your groin, any loss of bowel or bladder control or fever.

Surprisingly, disc bulges are present without any symptoms in about 1/3 of the adult population. Another one third of adults will experience pain from a lumbar disc at some point in their lifetime. The condition is more common in men. Most lumbar disc problems occur at one of the two lowest discs- L5 or L4. Smokers and people who are generally inactive have a higher risk of lumbar disc problems. Certain occupations may place you at a greater risk, especially if you spend extended periods of time sitting or driving. People who are tall or overweight have increased risk of disc problems. The condition is uncommon in children and is most common between the ages of 40 and 60.

Researches have shown that disc bulges and sciatica may be successfully managed with conservative care like the type we will provide.