Posts

Overcoming Lower Back Pain with Chiropractic

Different Types of Low Back Pain

/in , , /by

Common Causes of Low Back Pain

Low back pain is a very common issue experienced by the the general population at some point in life. Estimates vary but on average, about 38% of the general population experience low back pain in a year period.(2) Low back injury symptoms include: localized soreness, stiffness, and pain, radiating pain (pain into lower extremity), and possibly tingling and numbness into the lower extremity. The focus of this post will look at the common low back conditions we treat at our Mission Valley office.

First and foremost, we recommend seeking professional help from a certified sports chiropractor to correctly diagnose the low back injury. At our San Diego based sports injury clinic, we have seen many joint and disc injuries previously diagnosed as a “muscle strain” by a different provider. Simple diagnoses do patients no favors and will likely cause further harm!

Disc Injury

Let’s start by discussing what I would consider the most time intensive injury to resolve. Disc injuries have the following characteristics: occur in younger people (20-40 year old), common in athletes, associated with a memorable mechanism of injury (squatted and felt a “pop” in back), recurring back injury, worse with bending forward, muscle spasming, pain in the back with cough/sneeze/bowel movement, may have radiating pain (sciatica), and may have numbness/tingling in the lower extremities.

Joint pain

Lower back joint pain is characterized by the following: occurs in middle aged to older individuals (40-65+) with no mechanism of injury (gradually worsened) or younger people with a mechanism of injury (football player tackled in low back), worse when bending backward, sharp localized pain in low back, muscle spasming, possible pain into buttocks/thigh. The image below shows healthy low back joints. They can be injured with hyper extension or excessive bending through the spine

Piriformis Syndrome

Piriformis syndrome may be from acute spasming of the piriformis muscle (muscle runs from the tail bone to the outer hip) or from chronic tightening of the muscle. It is characterized by: pain in the buttocks, single sided sciatic symptoms, worse with sitting, no low back pain, worse with stretching hamstrings, and painful “knots” in the gluteal muscles/piriformis muscle. It is often misdiagnosed as a back related issue due to the symptoms of pain traveling down the leg. Check out our more thorough blog posts on piriformis syndrome found here: Piriformis Syndrome: Overview and Causes, Piriformis Syndrome Part II- Evaluation, and Piriformis Syndrome Part III- Treatment.

Piriformis Syndrome low back pain

Low Back Muscle Strain

Please reread disc and joint causes of back pain. Both cause low back muscle spasming or muscles “locking up”. This is why doctors not certified to treat sport injuries diagnosis many low back injuries as a muscle strains. Technically they are not wrong because low back muscles are usually strained or spasmed when the deep structures (disc/joint) are injured. If you see a provider and they do not perform an evaluation including range of motion, orthopedic/neurological testing, and palpating (physically touching your back), get a second opinion. Once more serious conditions are ruled out, low back muscle strains are usually: local to the low back, muscle is sore/tight to touch, usually injured due to quick movements, and back muscles are often weak.

Special Types of Low Back Pain

Athletes with low back pain, especially in particular types of sports that involve repeated bending through the spine, may develop significant low back pain. Small fractures or stress reactions can occur to the pars interarticularis; a small portion of the vertebrea that when fracture can cause spondylolisthesis. Other injuries can involve the disc herniating into the end plate of the vertebral body of the low back. These types of injuries are confirmed with imaging (x-ray, MRI) but can be considered as a working diagnosis based on a thorough history and physical exam. If you have a sport related low back pain, please get evaluated by one of our Mission Valley sports chiropractors.

Treatment

In a recent review article discussing conservative management of low back pain, several methods are described as primary treatment choices for acute and chronic low back pain. For acute low back pain, chronic low back pain, and chronic low back pain with leg pain, a trial of spinal manipulative therapy with supplementary treatments such as exercise, massage, and patient education is recommended.(1) Specific types of exercises are prescribed based on the practitioner’s experience and patient’s tolerance. In other words, each person with low back pain may receive different exercises based on their presenting symptoms. Decreased pain and symptoms we found after short term (1-3 months) and long term (6-12 months) follow ups.
Initial treatment for low back pain is recommended between 4-8 visits over a 4 week period. (1)

Low back pain sports chiropractor

At our office in Mission Valley, we customize treatment plans for each and every low back pain patient we see. For example, if a patient has a diagnosed disc injury in their back, extension based exercises for the low back may offer significant relief for one patient, yet cause terrible pain in the next patient with the exact diagnosis. Evaluation in person by a certified sports chiropractor will be able to determine the correct treatment approach. We utilize the latest techniques including spinal manipulative therapy, Active Release Technique, Graston Technique, and rehabilitative exercise.

References
Brussieres, A. E. et al. (2018). Spinal manipulative therapy and other conservative treatments for low back pain: a guideline from the canadian chiropractic guideline initiative. Journal of Manipulative and Physiological Therapeutics. 0 (0), 1-29.
Hoy, D. et al. (2010). The epidemiology of low back pain. Best Practice and Research Clinical Rheumatology. 24 (5), 769-781.

Sciatic Nerve Glide

Piriformis Syndrome Part III- Treatment

/in /by

Piriformis Syndrome Treatment

The two main goals of treatment are 1) to relief irritation to the sciatic nerve and 2) address any functional problems that may be contributing.
If the sciatic nerve is inflamed the first step is to decrease aggravation from compression. Things to avoid are leg crossing, sitting on your wallet, and sitting on hard surfaces.  Things you should begin doing are applying ice to the piriformis, stretching of the piriformi, and taking oral anti-inflammatories (as directed).  Stretching every 2-3 hours (while awake) is a key to the success of non-operative treatment. Prolonged stretching of the piriformis muscle is accomplished in while lying on your back with the hip flexed and passively adducted/internally rotated (see picture).  Another exercise that can be helpful to decrease irritation between the piriformis and sciatic nerve is a nerve gliding exercise.  This exercise tensions the sciatic nerve and allows it to move relative to the piriformis. It is sometimes called nerve flossing to better describe how the nerve moves through other structures.  Two types of nerve gliding exercises are pictured below. (Pictures from http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=53203)
 Sciatic Nerve GlideSciatic Nerve Tensioner
Manual therapy can be extremely helpful in releasing tension on the sciatic nerve and addressing functional deficits.  Soft tissue therapies, including myofascial release and Graston®, aimed at releasing tension and muscular adhesions within the piriformis can be beneficial.  Chiropractic spinal adjustments can help address functional contributions from the spine such as sacroiliac joint hypomobility and low back dysfunction.  Hyperpronation of the foot can be addressed through orthotics in the short term and foot strengthening in the long term.  Pronation is a normal foot motion however overpronation may lead to increased external rotation of the hip with walking putting tension on the piriformis and sciatic nerve.
Treatment may take several months of consistent work and it is important not to get discouraged. As long as there is no progression of neurological symptoms conservative treatment is the best option. Your symptoms should be monitored by a healthcare practitioner to ensure there is no progression.
-Dr. Kevin Rose, DC
Q Angle

Piriformis Syndrome Part II- Evaluation

/in /by

Clinical Diagnosis

Piriformis syndrome occurs most frequently between ages 40-60 and is more common in women than men.  Some reports suggest a 6:1 female-to-male ratio for piriformis syndrome; , possibly because of biomechanics associated with the wider quadriceps femoris muscle angle (ie, “Q angle”) in the pelvis of women. Reported incidence rates for piriformis syndrome among patients with low back pain vary widely, from 5% to 36%.

Q-Angle

The most common  symptom of patients with piriformis syndrome is increasing pain after sitting for longer than 15 to 20 minutes. Many patients complain of pain over the piriformis muscle (ie, in the buttocks), especially over the muscle’s attachments at the sacrum and medial greater trochanter. Symptoms, which may be of sudden or gradual onset, are usually associated with spasm of the piriformis muscle or compression of the sciatic nerve; these symptoms include radiating/shooting pain or tingling or numbness in the back of the thigh, leg, or foot.  These symptoms must be evaluated by a healthcare provider to differentiate the possible causes.  Patients may also complain of difficulty walking and of pain with internal rotation of the involved leg, such as occurs during cross-legged sitting or walking. X-rays or an MRI offer little help in directly diagnosing piriformis syndrome but may be used to rule out other causes of sciatica such as a herniated disc in the lumbar spine.

Functional Evaluation

There are many functional abnormalities that may have either caused or resulted from this condition.  Once the diagnosis has been made, these underlying, perpetuating biomechanical factors must be addressed.

Functional biomechanical deficits associated with piriformis syndrome may include the following:

  • Tight hip external rotators including pirifromis
  • Tight adductors (groin)
  • Hip abductor weakness
  • Lower lumbar spine dysfunction
  • Sacroiliac joint hypomobility
  • Hyperpronation of the foot and prolonged toe-off

Functional adaptations to these deficits include the following:

  • Ambulation with the thigh in external rotation
  • Functional limb length shortening
  • Shortened stride length

Next post will discuss treatment options for piriformis syndrome