Low back pain can be extremely debilitating and can interfere with every aspect of life. There are several causes, making a correct diagnosis extremely important.
Low back pain is the most common musculoskeletal condition affecting adults. It can become highly debilitating and interfere with every aspect of life. Finding a correct diagnosis is the first step in managing low back pain.
Finding the exact diagnosis is sometimes challenging due to the close proximity of structures of the spine. For example, the discs and the facet joints (small joints in the back of the spine) are only millimeters away. Also, most of the symptoms of low back pain have overlapping features. Although these challenges exist, a thorough exam with a qualified spine specialist can be a great start to getting solutions.
Finding a good chiropractor or spine specialist can be the first step to getting your low back pain answers. During the initial exam, you will want to discuss where it hurts, how long it's been an issue, and what activities make it feel worse or better. For example, does it hurt more with sitting, standing, walking, bending, sleeping, putting on socks and shoes, etc.? Also, what movements or activities help give relief? Finding the answers to these questions can provide clues to the cause of pain.
The next phase of an exam should consist of orthopedic tests to help further identify which low back structures are injured. During orthopedic testing, you move or resist movements to increase or decrease pressures on different joints and muscles. Fining the precise movements that aggravate or relieve the pain helps determine the cause of low back pain.
Imaging such as x-ray and MRI are other options for diagnosing low back pain. However, several causes of back pain don't show up on imaging. For example, an x-ray does not show disc bulges, SI joint dysfunction, early facet joint pain, or muscle spasms. Also, imaging is not recommended unless pain persists longer than six weeks or has not responded to 6 weeks of therapy.
The best treatment options for low pain depend on the diagnosis or classification. We've already discussed how to diagnose low back pain. In some cases, classifications can be helpful as well. There are several ways to categorize low back pain, which help predict which treatments will be most successful.
Combining several therapies is also helpful in treating and managing low back pain. Some of the more common treatments include; spinal manipulation, myofascial release, decompression, stretching, rehabilitation, and acupuncture.
The final yet essential component is taking a holistic approach to addressing contributors to the pain. Including how well you move and the balance and symmetry of alignment. For example, most chronic or recurring back pain sufferers have joint restrictions in their mid-back or within a hip, and sometimes both. Neck misalignments also contribute to low back pain. Finally, core stability and strengthening will be necessary for the best outcomes.
Disc injuries are the most common reason for low back pain. The first phase of a disc injury is a disc bulge. Bulges happen when the disc's outer layers start to unravel or tear. Next, the inside gel-like fluid can travel through the tears, causing pain once it gets to the outside layers of the disc. If the disc bulge comes out far enough, it can irritate the nerve leading to more severe pinched nerve pain and sciatica.
More severe and acute disc bulges may require NSAIDs, ice, or even corticosteroids to address the inflammation. In addition, spinal decompression is an excellent way to create more space around the nerve. Gentle forms of manual therapies such as myofascial release and spinal manipulation can also help promote a healing response and relieve pain. Finally, specific stretches in the hips or spine can help regain mobility and minimize muscle tension around the injury.
In the later phases of therapy, rehabilitation is necessary to minimize the risks of future episodes. Strengthening the core and surrounding muscles can make the spine more resilient, allowing optimal protection.
The second phase of disc injuries is degeneration. Once the disc's outer layer starts to unravel and tear, it can slowly progress. When this happens, the disc loses some of its height and ability to protect against forces.
Although degenerative disc disease (DDD) sounds scary, it is a normal part of aging. There is no fix or cure for DDD. Instead, management strategies are necessary to lessen the symptoms.
Spinal manipulation, stretching, and myofascial release are great management options for degenerative disc disease. In addition, a therapy that we've found extremely helpful is cox flexion distraction. This technique uses a unique table that allows the spine to be stretched forward and side while getting a massage. Cox flexion-distraction relieves muscle tension while also improving mobility.
The facet joints are the small joints along the back of the spine. When the source of pain is from these joints, it's referred to as facet syndrome. Facet joint pain can happen after bending or lifting or from sustained pressure during standing.
Facet joint-related pain also becomes more prevalent in people with degenerative disc disease. As the disc loses height, more pressure becomes placed on the facet joints.
Spinal manipulation is especially beneficial for mobilizing and nourishing the facet joints. As previously mentioned, for degenerative disc disease, Cox-flexion distraction is also an excellent option for chronic facet joint pain. Finally, stretching and myofascial release help relieve muscle tension, reducing stress on those joints.
Spinal stenosis describes the spinal canal narrowing and is often the result of degenerative disc disease and facet arthritis. When the canal narrows, nerve pathways are compromised, resulting in chronic nerve pain.
Decompression therapies and cox flexion distraction help open the nerve pathways, relieving nerve pain. Myofascial release and stretching are additional complementary therapies to reduce pain and tension. In complicated cases, surgery is recommended for spinal stenosis.
The sacroiliac joint (SI joint) is the connecting joint between the sacrum and ilium. When the SI joint becomes injured, the pain can feel similar to sciatica. Sometimes SI joint is brought on after a particular injury. In other instances, it's the result of cumulative trauma over time.
The first phase of treatment for the SI joint is to promote healing and relieve pain. Therapies such as stretching and myofascial release are excellent in the first phase. In addition, spinal manipulation helps reset the joint and relax surrounding tight muscles.
The second phase of treatment for the SI joint is to begin rehabilitation. Strengthening the surrounding hip, butt, and core muscles is necessary for long-term success.
When it comes to managing low back pain, being educated on your particular injury is crucial. There is not one stretch or exercise that works for everyone. There are multiple types of injuries, each requiring a unique approach and personalized treatment plan. When you work with members of our team, you'll get an individualized approach.
Whether you're looking for answers and solutions to a complicated condition, or just need a body tune-up, our office can help.
We specialize in leading, non-invasive therapies that restore alignment, enhance movement, and promote healing.
Sciatica is the term used for sciatic nerve pain that goes down the back of a leg. It can be from a disc bulge, pinched nerve, or tight muscles in the back of the hip.
Disc bulges (or herniations) occur when the fluid from the inside of a disc leaks out and presses against a nerve. The best course of treatment utilizes a combination of therapies.
Common causes of hip pain are hip impingement, bursitis, tendinosis, arthritis, and sciatica. Our office gets you a correct diagnosis then begins the appropriate therapies.
Common causes of shoulder pain are rotator cuff, labral tears, muscle imbalances, or pinched nerves from the neck. We will get you the correct diagnosis and appropriate therapies.
Neck pain can be caused by strained muscles, inflamed discs, pinched nerves, or irritated joints. It is often complicated by incorrect posture, lack of stability or muscle imbalances.
Pinched nerves are incredibly painful. They will also get inflamed and swollen which in turn puts more pressure on the nerve. A quick diagnosis and treatments are extremely important.
Many common types of headaches are associated with muscle tension and or joint restrictions. Common headaches treated are tension headaches, cervicogenic headaches, and migraines.