For some people back pain is little more than discomfort, whereas for others it can leave them immobile. Lower back pain, being an extremely debilitating condition, will likely have a higher success rate if intervention is initiated sooner rather than later.
Lower back pain is experienced by up to eighty per cent of people at some stage of their lives and, although it is believed by many that its main cause is injury through accident, the most common reason is that of stress to the muscles and joints of the back through normal, everyday activities (or inactivity’s). These can be: sitting badly or for too long in one position; poor general posture; incorrect lifting, bending and even sleeping.
The lower back area and core muscles support a significant amount of our body weight and, as a consequence, rely heavily on the strength of the vertebrae and supportive soft tissue in and around our spine. To have these vertebrae out of position (or subluxated) for even a short period of time can lead to anything from mild discomfort to severe disablement. If the spine is not in correct alignment, areas of weakness can occur, resulting in irritation of nerves in the spine, or in a bulging disc, which can place pressure on the spinal cord.
Pain is a warning from the brain that something within the structure of the body (or the brain) is not functioning as it should. Through chiropractic care the appropriate adjustment is carefully applied depending on the location and type of pain. It is worth remembering that even though pain can subside within a few days it may still be a sign of an underlying condition and should be checked by a qualified health professional without delay.
Masking the symptoms (pain) of lower back problems doesn’t solve the real problem – that of ‘what has caused the pain to appear in the first place’? Treating the symptoms should only ever be a very short-term measure to diminish the pain and to make you more comfortable until you can get the cause addressed.
Following a study of the treatment of lower back pain, the Ontario Ministry of Health stated, ‘On the evidence, particularly the most scientifically valid clinical studies, spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for lower back pain.
Until you are checked by a professional chiropractor or health care provider, here are a few things you can do and questions to ask yourself in order to help prevent lower back pain.
- Avoid sudden bending, twisting or sharp movement
- Check that you are adopting a correct posture during the day
- How is your posture while sitting at work? Is your spine curved or (relatively) straight? (This includes things like a supportive chair, a well-placed computer monitor and a workstation layout that does not require a lot of twisting and turning)
- How firm is the mattress on your bed?
- Do you get regular exercise? Even a low-impact exercise such as walking for a half hour each day will loosen the joints and muscles in the back and thus keep them active
- Don’t take to your bed – this is the least likely treatment to get rid of your lower back pain
- Don’t wear shoes with high heels
- Do wear comfortable flat or low-heeled shoes
Remember that a visit to your chiropractor often provides more immediate relief. It appears to be most helpful in the early onset of back pain.
Is chiropractic safe and effective for treating low back pain?
Chiropractic is the largest, most regulated, and best recognized of the complementary and alternative medicine (CAM) professions. CAM patient surveys show that chiropractors are used more often than any other alternative provider group and patient satisfaction with chiropractic care is very high.
– Meeker, Haldeman (2002), Annals of Internal Medicine
Time and again, chiropractic is shown to be a useful, safe and preferred method for back pain. At Omagh Chiropractic, spinal manipulation (chiropractic treatments/adjustments) is combined with manual therapy, trigger point and myofascial therapy, and therapeutic exercise in order to provide you with the fastest results. Unlike most other treatment methods for low back pain (injections, medication, surgery), chiropractic is generally not associated with serious side effects. The most common side effect is a temporary increase in spinal pain. Most often, after the initial increase in discomfort is preceded with relief and increased range of motion. The Chiropractor at this practice is highly trained and skilled in the art and science of chiropractic adjustments.
Facet Joint Dysfunction
What is Facet Joint Dysfunction?
Facet joints are relatively tiny joints which join vertebrae and allow for motion of the spine. Joint dysfunction occurs when a joint becomes fixed and painful; this can happen anywhere in the spine (neck, midback, low back). Generally, you’ll experience reduced range of motion and pain in the region of the joint. Often, muscle spasm or guarding is also present. Additionally, specific pain referral patterns are often found. In certain individuals, joint dysfunction has a propensity to recur.
How is Joint Dysfunction Diagnosed?
Specific orthopedic tests are performed to diagnose joint dysfunction. In addition to these tests, static and motion palpation are utilized; this is when the practitioner uses his/her hands and specific motions to determine if the joint is the pain generator. Joint dysfunction is not seen on X-ray, MRI or CT; however, diagnostic imaging may be ordered to rule out a more serious condition.
What are the Options for Facet Joint Dysfunction?
At Omagh Chiropractic, the two primary methods utilized for joint dysfunction include manipulation and mobilization; myofascial therapy may also be used to treat the surrounding muscles. Additionally, specific therapeutic exercises for stretching and strengthening are commonly prescribed. Speak with your Doctor of Chiropractic if you have any questions regarding the risks and benefits.
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Chiropractic and Lumbar Disc Herniation
What is Disc Herniation?
The intervertebral disc is the connective tissue between the vertebrae (bones of the spinal column). The disc is composed of a nucleus pulposus which is surrounded by annular fibers. When the nuclear material breaks though the annulus, it is considered a bulge, protrusion, herniation or sequestration. A herniation can occur anywhere in the spine but they are most common in the lumbar region (low back). Many asymptomatic individuals have disc herniations that are evident on MRI; it is important to understand that pain generation is not necessarily from the disc herniation itself. Symptoms arise when the surrounding tissues (such as nerves and the spinal cord) are affected. Radiculopathy (commonly called sciatica when in the lumbar spine) is a diseased condition of the nerve root; a common cause of radiculopathy is disc herniation.
How is Disc Herniation Diagnosed?
The gold standard for diagnosing disc herniation is MRI. However, it is important to note that the MRI should correlate with the findings present during a clinical examination. Doctors of chiropractic are trained to recognize the signs and symptoms of disc herniation. Be sure to share any symptoms that are experiencing with your health care provider. Please be aware that certain symptoms associated with back pain are an indication of a more serious condition. If you notice changes in bowel, bladder or sexual dysfunction contact your nearest emergency health care provider.
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2. Mangialardi R, Mastorillo G, Minoia L, Garofalo R, et al. Lumbar disc hernation and cauda equina syndrome. Considerations on a pathology with different clinical manifestation. Chir Organi Mov. 2002 Jan-Mar; 87 (1):35-42.
What is Lumbar Disc Derangement?
The intervertebral disc is the connective tissue between the vertebrae (bones of the spinal column). The disc is composed of a nucleus pulposus (gelatinous material at the center of the disc) which is surrounded by annular fibers. Lumbar Disc Derangement (otherwise known as discogenic pain) is a condition of the low back where the disc becomes painful. Lumbar Disc Derangement is thought to be caused by multiple small tears that develop in the disc; nuclear material seeps out into these tears and irritates the nerve endings in the outer portion of the disc.
How is Lumbar Disc Derangement Diagnosed?
Although the gold standard for the diagnosis of Lumbar Disc Derangement is a discogram, this type of assessment is invasive, painful, expensive, and time-consuming. A discogram is a procedure where dye is injected into the disc; if the dye leaks into the periphery of the disc and if the injection reproduces the pain, the test is considered positive. Another test that is sometimes performed is an MRI; this testing may reveal changes in disc anatomy (such as a disc bulge); however, anatomical alterations are commonly seen in people who do not have disc pain. Therefore, it is sometimes difficult to determine if the disc is in fact the pain generator solely by reading an MRI.
The McKenzie protocol is the primary method of Lumbar Disc Derangement diagnosis employed at Omagh Chiropractic. It is a procedure in which the spine is moved in various directions to detect a symptomatic response that is characteristic of Lumbar Disc Derangement. The clinician looks for “centralization” which is a reduction of pain or movement of pain from the legs or buttocks into the back.
1. Carragee EJ, Lincoln T, Parmar VS, Alamin T.A gold standard evaluation of the discogenic paindiagnosis as determined by provocative discography. Spine 2006; 31(18):2115-2123.
2. Jensen MC, Brant-Zawadzki MB, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. NEJM 1994; 331 (2): 69-73.
3. Donelson R, Aprill C, Medcalf R, Grant W. A prospective study of centralization of the lumbar and referred pain as a predictor of symptomatic discs and annular competence. Spine 1997; 22 (10): 1115-1122.
4. Clare HA, Adams R, Maher CG. A systematic review of efficacy of McKenzie therapy for spinal pain. Aust J Physiother 2004; 50: 209-216.
5. Gudavalli MR, Cox JM, Cramer GD, Baker JA, Patwardhan AG. Intervertebral disc pressure changes during a chiropractic procedure. BED-Advances in Bioengineering 1997; 36:215-216.
Are Disc Injuries Common Problems?
The term ‘slipped disc’ is used quite frequently as a diagnosis for back pain, but contrary to popular belief, disc herniation’s are not a common problem. The most common cause of sciatica is referred pain from the muscles, joints and ligaments of the spine. Not disc injuries (see Part II of Disc Injuries and Sciatica). It is estimated that approximately 3-5% of patients who consult a physician with lower back pain do so as a result of a disc herniation. The annual incidence is only in the region of 0.1 – 0.5% of the general population between the ages of 24 and 64 years and it is most commonly seen in the ages between 30 to 50 years. Although not common, a disc injury can potentially be a very serious injury. It is the sort of injury that sometimes requires surgery but fortunately only in a small number of cases. It is important to know that it isn’t the herniation per see that causes the pain, but the inflammation. In a study where they took MRI scans of people who were without symptoms, they found that up to 4 in 10 people had herniated discs!
So, the good news is that it is not always necessary to remove the disc herniation by surgery!
However, surgery is sometimes necessary, especially if your bowel and bladder control is affected. These may be symptoms of a rare but important complication causing a, so called, cauda equina syndrome.
If you experience any changes in your bowel or bladder control, or numbness in the ‘saddle’ area, you should consult the hospital as soon as possible. The symptoms are reversible when treated quickly!
There is currently good evidence in the literature that chiropractic manipulation is beneficial for patients with disc herniations.
It appears to be more effective than sham manipulation, placebo, traction or rest and pain medication, even injections and nerve root blocks (Santilli et al 2006 and Snelling 2006, Jordan et al 2008).
Chiropractic manipulation for disc herniations is safe according to Oliphant (2004). He estimates the risk for causing a further disc herniation or serious complications such as cauda equina syndrome to be one in 3.7 million.
Delay in treatment and unnecessary increased duration of symptoms tends to have a negative impact on the prognosis, therefore early treatment is imperative (NICE 2009).
The ‘wait and see’ approach has been pointed out as being the wrong approach when it comes to back pain generally (Waddell et al 1999 and NICE 2009).
It might be even more detrimental in cases with nerve root compromise because compression of vascular structures within the nerve leading to hypertension within the nerve and intra-neural fibrosis, this may lead to irreversible damage.
To just prescribe pain- and anti-inflammatory medication, and advocate rest for 6-8 weeks followed by a neurosurgical or orthopaedic opinion does not appear to be in the patient’s best interest.
A combination of chiropractic manipulation with the right exercise rehabilitation programme to improve the function, and added psychological and pharmacological support would be an evidence-based, patient-centered, multi-diciplinary treatment that might well be in the patients best interest.
How long will it take to get better?
Your Chiropractor will discuss with you the frequency of visits required for treatment. The healing process takes time and varies from person to person, often depending on the severity of the condition and the history of the complaint.
However, how active and compliant you are in your own treatment will influence your recovery time.
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13. Snelling NJ., Spinal manipulation in patients with disc herniation: a critical review of risk and benefit. Int J Osteopath Med 2006;9:77–84.
14. Waddell G, McIntosh A, Hutchinson A, Feder G, Lewis M, (1999) Low Back Pain Evidence Review, London: Royal College of General Practitioners, Royal College of General Practitioners , 14 Princes Gate, Hyde Park, London SW7 1PU.
What is Myofascial Pain?
Myofascial Pain (aka Myofascial dysfunction) is caused by focal areas of hypersensitivity (trigger points) that develop in muscle tissue. Muscle pain may be caused by trauma, injury, poor posture, stress/anxiety (leading to high levels of muscle tension), overuse, or immobility. Myofascial pain can develop in any muscle, and pain may be felt in the jaw, neck, back, pelvis, upper extremity or lower extremity. Persistent myofascial pain may lead to weakness (due to muscle underuse), migraine, TMJ dysfunction and difficulty sleeping. Long term and wide-spread myofascial pain may develop into fibromyalgia in certain individuals.
How is Myofascial Pain Diagnosed?
Myofascial pain is diagnosed via history and physical examination. Palpation of the painful tissue is the most commonly used diagnostic procedure; this is when the practitioner uses his/her hands to determine if trigger points in the muscle are generating the pain. Myofascial pain is not seen on X-ray, MRI or CT; however, diagnostic imaging may be ordered to rule out a more serious condition. Your Doctor of Chiropractic may also order blood work to rule out drug reactions and other conditions which may also cause muscle pain.
1. Porter, Michael. An Introduction to Neuromuscular Therapy. Duval County Medical Society. January 2004.
2. Simon D, Travell J, Simons L. Myofacial pain and Dysfunction: The Trigger Point Manual, Vol 1(2). 2nd Edition. Baltimore: William and Wilkins; 1999.
3. Lowe, John C. Hypertonic Fascia. Chiroweb. Aug. 2004.
Kids Get Back Pain Too
Did you know that 50% of children and young adults under the age of 20 experience back pain and 15% suffer from chronic back pain? Although disorders of the spine are less common in children, the pediatric population is not immune to musculoskeletal pain. Many young people are involved in aggressive sporting activities that may increase their risk of injury. At Omagh Chiropractic, we treat the common causes of musculoskeletal pain with non-invasive and modified (depending on the patient’s size) techniques.
In a Canadian study published in 2003, pediatric back pain patients between the ages of 4-18 were evaluated and managed by a chiropractor. The study concluded the following: “Patients responded favorably to chiropractic management, and there were no reported complications.” The study also indicates that “‘Important’ improvement was seen in 62% and 87% on the visual analogue [a pain measurement scale] and subjective scales, respectively, within a 6 week course of management.” If you know a young person who is struggling with low back or other musculoskeletal pain, the doctors at Omagh Chiropractic may be able to help.
1. Hayden JA, Mior SA, Verhoef MJ. Evaluation of chiropractic management of pediatric patients with low back pain: a prospective cohort study. J Manipulative Physiol Ther 2003 Jan; 26(1):1-8.
What is Sciatica / Pinched Nerve?
The sciatic nerve is a long, wide and branching nerve that travels from the low back into the buttocks then down to the feet. When this nerve or its roots becomes irritated or inflamed, pain, numbness and weakness may ensue along its course. This is commonly referred to as a “pinched nerve” though the degree to which the nerve is actually being pinched can vary. Sciatica isn’t a disorder, per se; rather, it is a set of symptoms. The symptoms include pain (generally pain radiating into the buttock, thigh, and calf), pins and needles/tingling and decreased muscle strength. Often the pain becomes worse with activities that increase pressure including coughing, sneezing and bearing down when going to the bathroom. Rarely bowel, bladder and sexual dysfunction are reported; this may be a sign of a medical emergency (cauda equine syndrome)-if you are currently experiencing any of these symptoms, a visit to your nearest emergency room is warranted. It is important to recognize and treat the cause of sciatica. The most common cause is disc herniation. Other common causes include piriformis syndrome (spasm of the pirifomis muscle puts pressure on the sciatic nerve), stenosis, pregnancy and bone spurs (osteophytes). Less common and more serious causes of sciatica include bone tumors, nerve tumors and infection.
Sciatica means ‘leg pain’ and is the name given to a pain in the leg when the cause is an injury in the lower back. The term ‘sciatica’ comes from the name of the largest nerve running down the back of leg, the sciatic nerve. Some people might argue that the term sciatica should only be used when the leg pain is caused by a disc injury. Maybe, strictly speaking that is the true meaning of the word, but unfortunately the term is used loosely for any leg pain that is caused by the back, and there are many causes of sciatica.
There are two main classifications of sciatica: 1. Neurogenic pain, and 2. Referred pain:
Sciatica from neurogenic pain: pain from the nerve. It is usually a sharp, burning, shooting pain with a constant background ache that never goes completely. It is often associated with a feeling of ‘pins and needles’, hot and cold sensation, numbness and muscle weakness. The leg pain is usually worse than the back pain. In addition, there are abnormal neurological findings. Such as reflex changes, objective weakness and sensory changes, and abnormal nerve tension tests.
Sciatica from referred pain: is pain due to a muscle and joint problem in the back. It is usually a dull, achy pain, but can also be sharp in nature. It does not usually cause a feeling of ‘pins and needles’, hot and cold sensation, numbness or muscle weakness. The pain is usually worse in the back than it is in the leg. In addition, there are no abnormal neurological findings. Such as reflex changes, objective weakness and sensory changes, or abnormal nerve tension tests.
How is referred pain generated?
Many of the nerve endings converge and share the same nerve cell-pool in the spinal cord and as the signal travels up the spinal cord to the brain the signal ‘lands’ on the same area as pain signals from another part of the body.
It is important to know this when you attempt to diagnose a problem, because without an accurate diagnosis the treatment is bound to fail.
One of the most well known examples of referred pain is having left arm pain during a heart attack.
Care of Sciatica
It always pays to be proactive, if you use the wait and see approach you are more likely to have long term pain.
Some advisers suggest that he should wait for 6 weeks and hope that you will be one of the lucky ones who do not need surgery. And they suggest you should rely on painkillers, swimming and walking as a treatment method.
Considering that you have any functional, mechanical problem that has led to the disc injury, it makes sense that you approach it from a functional perspective.
First of all a diagnosis has to be made before any treatment can start.
A chiropractic examination, which includes a neurological examination, can find out what the cause of your leg pain is, so the most appropriate so the best care can be given.
The first step is to stop injuring the disc by making sure you avoid bending, lifting and sitting. You can walk as an exercise, but be careful with swimming. Restoring the function and to deal with the inflammation are the most important things to do to get you back on your feet.
Once you have reached a certain level of improvement, your Chiropractor can help you with an appropriate exercise programme.
Surgery should be a last resort and is sometimes necessary, especially if bowel and bladder control is affected. These may be symptoms of a rare but important complication causing a, so-called, cauda equina syndrome.
If you experience any changes in your bowel or bladder control, or numbness in the ‘saddle’ area, you should consult the hospital as soon as possible. The symptoms are reversible when treated quickly.
How long will it take to get better?
Your Chiropractor will discuss with you the frequency of visits required. The healing process takes time and varies from person to person, often depending on the severity of the condition and the history of the complaint. However, how active and compliant you are with your own care will influence your recovery time.
We suggest that you expect a couple of months rather than a couple of weeks, but this varies from person to person.
1. Miller KJ. Physical assessment of lower extremity radiculopathy and sciatica. J Chiropr Med 2007 Jun;6(2):75-82.
2. Santilli V, Beghi E, Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J. 2006 Mar-Apr;6 (2): 131-7.
Pregnancy and Back Pain
Is Chiropractic Safe During Pregnancy?
“Chiropractic care during pregnancy is an extremely safe and effective way of managing low back pain and sciatic pain.”
-Dermot Gillan (Chiropractor)
Another often-asked question in our practice is “How safe are chiropractic procedures during pregnancy”?
Many women experience back pain during pregnancy due to the extra and unusual weight placed on the spine. Provided that the chiropractic procedure is carried out gently and with the extra care required in order not to create any detrimental affect on the expectant mum or baby, there is no good reason why chiropractic wouldn’t provide relief from discomfort.
In fact studies have shown that by providing a consistent programme of chiropractic care for the mum-to-be in pregnancy the nervous system and spine display healthy benefits before, during and after the birth. In fact, one study in which chiropractic adjustments were incorporated during many patients’ pregnancy revealed that the need for painkillers during delivery was reduced by half. There is certainly no need to cease chiropractic care due to pregnancy – posture is equally important at any time, perhaps even more so during pregnancy. As with anything else in life where common sense rules should be applied, and particularly involving the body, provided that care is sensitively followed there is little likelihood of anything untoward resulting.
Regular adjustments as deemed necessary by the chiropractor should be carefully considered allowing for the individual circumstances. Post natal chiropractic has also been found to have beneficial effects for a return to normal spine and pelvic posture.
In short, and as a general rule, chiropractic care may be applied safely through all stages of pregnancy and thereafter.
Chiropractors work on the principle of reducing interference so the nervous system and body can work better. Providing that any symptom or condition is occurring as a result of nerve interference from vertebral subluxation, there is a very good chance that it will improve with chiropractic care. At our clinic in Omagh, many women and their children have benefitted immensely from being under Chiropractic care throughout their pregnancy, which is gentle and safe for both mother and child.
Pregnancy and Low Back Pain
Pregnancy is an exciting time full of countless body changes. All of the hormonal fluctuation, weight increase, and posture changes can really take a toll on an expectant mother’s body. Many women experience nausea early in the pregnancy. However, as time passes, complaints such as low back pain and other body discomfort begin to dominate the daily problems. It is estimated that 50% of women experience low back pain during pregnancy. The reasons for low back pain during pregnancy might seem obvious, but there are actually very specific reasons pregnancy causes low back pain.
Body Changes During Pregnancy
As a pregnancy progresses, there are some striking posture changes and weight changes that take place. The protruding abdomen causes the normal curve in the low back to increase in size. A small “dip” in the low back is normal. Often during pregnancy, the weight of the large abdomen will pull the spine forward and cause the curve in the lower back to increase. This places a lot of stress on the joints of the lower back, which can lead to low back pain. Another change that takes place during pregnancy is the hips expand laterally to help stabilize and support the additional weight in the abdomen. As the hips and pelvis open up to make room for the baby, additional stress is placed into two joints in the back of the pelvis called the sacroiliac joints. The sacroiliac joints are where the pelvis connects to the spine, and they are located between the low back and the buttocks. Too much pressure in the sacroiliac joints can cause one-sided low back pain, pain with walking, and pain when transitioning from standing to sitting.
Hormone Changes During Pregnancy
Any of these posture changes alone is enough to cause low back pain, but the hormone changes during pregnancy complicate the problem even more. During pregnancy, hormones that relax and soften ligaments are produced. The softening of the ligaments is important to make space for the baby during birth. However, the softening of the ligaments can also cause joints to become too mobile. This can cause a bone to slip and become fixated in an improper and painful position. This is most common with the pelvic bones, and can lead to low back pain, pain with prolonged sitting, and even pain down the back of the leg.
Relieve Pregnancy Back Pain
What can you do to minimize back pain during pregnancy? Staying active is important to maintaining a healthy pregnancy. While there are certain conditions that prevent physical activity during pregnancy, the majority of expectant mothers can continue light physical activity, such as walking or swimming, until close to delivery. There are also some easy at home stretches you can perform to keep your low back and hips mobile during pregnancy. Stand up with your feet hip width apart and your hands on your hips. From this position you can perform gentle side bending, rotate your hips in small circles, slowly lean forward and back to stretch the spine, or rotate your waist and upper body in small circles. These stretches will help you maintain mobility in your low back and pelvis during the pregnancy.
Chiropractic for Pregnancy Back Pain
If you continue to experience back pain during pregnancy, chiropractic care is a drugless and safe way to help you relieve your back pain. Studies have shown up to 84% of women report relief of their back pain during pregnancy following chiropractic care. Chiropractic adjustments help restore normal alignment and motion to joints that have become misaligned or fixated. Gentle stretching can also be used to relieve the muscle tension that often builds up in the muscles of the low back. Another benefit of chiropractic care during pregnancy is a decrease in labor time. One study has shown women receiving chiropractic care during pregnancy have a 25% reduction in labor time compared to average labor times. Special adjusting procedures are used during pregnancy. These adjustments are safe for both the mother and the baby, and can clearly lead to some tremendous benefits.
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