BACK PAIN & SCIATICA
ABOUT BACK PAIN
Low back pain (LBP) is the fifth most common reason for physician visits, affecting nearly 60-80% of people throughout their lifetime. Weather you have a chronic nagging pain or if you have recently experienced a strain or in acute sharp pain we can help!
Often after you have an X Ray or an MRI to diagnose your low back pain you will receive a report that has a lot of big word medical jargon that can be a bit overwhelming and scary. Do not be alarmed! Bring in your X Ray or MRI report and we can decode the information and come up with a treatment plan to get you out of pain and keep you out of pain.
Herniation- Lumbar disc herniation (LDH) is a common low back disorder. It is one of the most common diseases that produces low back pain and/or leg pain in adults. A herniated disc is a displacement of disc material (nucleus pulposus or annulus fibrosis) beyond the intervertebral disc space. This herniation process begins from failure in the innermost annulus rings and progresses radially outward. The damage to the annulus of the disc appears to be associated with fully flexing the spine for a repeated or prolonged period of time. The nucleus loses its hydrostatic pressure and the annulus bulges outward during disc compression. Other names used to describe this type of pathology are: prolapsed disc, herniated nucleus pulposus and discus protrusion.
Stenosis - Lumbar spinal stenosis (LSS) is a degenerative condition in which there is diminished space available for the neural and vascular elements in the lumbar spine secondary to degenerative changes in the spinal canal. This compression can also cause radiating pain and numbness to the buttock, thigh, or leg particularly during walking or standing for a long time. The pain reduces usually when a patient is in resting, sits down or bends forward. Spinal stenosis is related to ageing, affecting mostly individuals over the age of 60 years. Not all patients with spinal narrowing develop symptoms, so the term "spinal stenosis" refers to the symptoms of pain and not to the narrowing itself.
Classically, lumbar spinal stenosis presents as pain exacerbated by prolonged ambulation, standing, and with lumbar extension, and is relieved by forward flexion and rest. Neurogenic claudication is an important feature of lumbar spinal stenosis.
Symptoms are typically bilateral, but usually asymmetric. Low back pain, numbness, and tingling are present in a majority of patients. Numbness and tingling in lumbar spinal stenosis involve usually the entire leg, and rarely involves only a single nerve root distribution. Approximately 43 percent of the patients experience weakness. Patients may also report walking upstairs being easier than walking downstairs, as the back is forward flexed with stairs climbing.
Spondylolisthesis Is the slippage of one vertebral body with respect to the adjacent vertebral body causing mechanical or radicular symptoms or pain. It can be due to congenital, acquired, or idiopathic causes. Spondylolisthesis is graded based on the degree of slippage (Meyerding Classification) of one vertebral body on the adjacent vertebral body. Spondylolisthesis should be treated first with conservative therapy, which includes physical therapy, rest, medication and braces.
Strains - Lumbar strain accounts for 70% of mechanical low back pain. It is defined as over stretch injury or tear of paraspinal muscles and tendons in the low back. Much of the knowledge of lumbar strain is extrapolated from peripheral muscle strains.
In strains, the muscle is subjected to an excessive tensile force leading to the overstraining of the myofibres and consequently to their rupture near the myotendinous junction.
Lumbar strain can originate in the following muscles: M. erector spinae (M. iliocostales, M longissimus, M. spinalis) M semispinales, Mm multifidi, Mm rotators M. quadratus lumborum M. serratus posterior. The onset of lumbar strain could be sudden after trauma or gradual due to persistent stress. The clinical presentation includes pain in the lumbar muscles or nonspecific pain. The pain could be exacerbated during standing and twisting motions, with active contractions and passive stretching of the involved muscle increasing the pain. Other symptoms are point tenderness, muscle spasm, possible swelling in and around the involved musculature, a possible lateral deviation in the spine with severe spasm and a decreased range of motion.
The hallmark symptom of sciatica is pain. The type of pain can vary: it may be sharp, feel like electric shocks, discomfort or numbness. Pain is a result of irritation of the sciatic nerve and can be constant or intermittent. The pain may be worsened by certain movements like coughing or sneezing (these movements increase the intraabdominal pressure). Sitting, bending, prolonged standing or rising from a sitting position can aggravate or increase the pain. Pain is located along the distribution of the nerve and can be felt in the back, buttocks, knee and leg. It only radiates to one side of the leg and can result in reduced power, reflexes and sensation in the nerve root. Also gait dysfunction (toe walking, foot drop and knee buckling), pins and needles or abnormal sensation are frequent neurological symptoms. It is possible to have sciatic symptoms as a result of a herniated disk, lumbar stenosis, or spondylolisthesis.
How We Treat:
With Low Back Pain and Sciatica, we will first determine what is causing the pain or neurological symptoms. This will include and extensive evaluation taking in to consideration the history, past injuries, and lifestyle as well as muscle testing, range of motion testing, along with a variety of special tests to discern the underlying cause. Then, together we will develop a Plan of Care that will address the underlying dysfunction, correct muscle and joint imbalances, and reduce the chronic tension that exists. This is done with Manual Therapy including soft tissue manipulation as well as joint manipulation to rebalance and restore mobility along with a comprehensive and unique Therapeutic Exercise program including the Gyrotonic Method to allow your body to become stronger and function more optimally. The overall goal is not only to reduce and eliminate pain, but to correct patterns to reduce the chance of recurrence.