Bertolotti syndrome is something has not been heard of when it comes to lower back pain, but diagnostic work has uncovered a common congenital condition. Back pain is experienced at some point by all of us. Around two-thirds of the population will develop low back pain in their life, and more than half will develop chronic low back pain or pain that has lasted more than six months. Low back pain can be challenging in finding the root cause. Diagnostic work is required through� X-rays and MRIs. These tests can identify a lesser-known cause of mechanical low back pain called Bertolotti syndrome.
Bertolotti Syndrome
This congenital condition’s name comes from Italian physician Mario Bertolotti. It is in 10 to 20 percent of the population, �with or with no lower back pain. Bertolotti syndrome happens when the last lumbar vertebra, known as the lumbosacral transitional vertebra/LSTV. This vertebra and the sacrum become fused together or create a false joint due to an enlarged transverse process.
This can be bony bumps on the vertebrae where muscles and ligaments attach to the lumbosacral transitional vertebra. When the LSTV and sacrum fuse together, known as sacralization or pseudo-joint, it does not generate pain. It�s just the way that an individual’s anatomy has been since birth. Only when it causes lower back pain that it is called Bertolotti syndrome.
Causes
Low back pain that leads to inflammation and reactive muscle spasms brought on from Bertolotti syndrome can be caused by:
Asymmetrical structures of the lumbar vertebrae. If the LSTV is fused to the sacrum and iliac bone, these are the wings of the pelvis, which can place unwanted stress on the sacroiliac joint, which can cause pain that is felt above the buttocks.
A�pseudo-joint does not have the cushion or lubrication between the bones like real joints to absorb shock. This causes bone-on-bone grinding, which can be quite painful and can lead to osteoarthritis. This can also generate added stress on the discs of the pseudo-joint.
Sacralization fusion can decrease the spine�s mobility. This can speed up the wear and tear of the vertebrae and shock-absorbers of the intravertebral discs.
Added non-equal force/s on the muscle tissues that surround the lower back. This can be caused by the spine not being properly�aligned causing muscle imbalance/s and fatigue. Both sides of the back can be affected, but when tightness and muscle spasms in the low back and pelvis present, it’s usually only on one side.
Symptoms
Most individuals usually never know they have a sacralization or pseudo-joint. These are often found accidentally from an X-ray for something unrelated. But when symptoms present they can vary from person to person and usually appear in adulthood�in the 20s or 30s.
These include:
Low back pain that is localized and does not spread/radiate down the legs
Pain or discomfort in or around the sacroiliac joint
Stiffness that comes out of nowhere or difficulty moving a certain way with pain present
Symptoms improve once the individual sits or lays down
Diagnosis
Bertolotti syndrome can be diagnosed based on medical history, physical exam, and X-rays. A physical exam can include a recreation of the movement/s that triggered the pain/discomfort. An X-ray of the low back and pelvis will reveal any bony abnormalities.
Treatment
Bertolotti syndrome can be effectively managed with non-invasive treatments. These� include:
Improperly and overdoing repetitive rotation/s and extension/s through work or just movements that have become second nature are injuries just waiting to happen. Lifestyle changes and re-learning how to move properly will ease the strain on the affected area.
Over the counter pain medication/s like�Advil, Aleve, or Tylenol.
Chiropractic/Physical therapy can help build low back areas and increase mobility.
Local anesthetic and spaced out intervals of corticosteroid injections to the affected nerve/s to reduce inflammation.
Platelet-rich plasma (PRP) uses the body�s platelets to reduce pain, inflammation, and healing the damaged joints through an injection.
Prolotherapy treatment uses concentrated local anesthetic and dextrose injected into the low back area to enhance the body�s natural healing.
Radiofrequency ablation uses heat to numb the affected nerves around a pseudo-joint so that pain reduces.
Surgery is the last resort and is usually done to eliminate a pseudo-joint. It can also consist of reducing or removing an elongated transverse process�and can be performed as a same-day or outpatient procedure.
If you or someone you know is dealing with some form of idiopathic low back pain and doctors can’t seem to pinpoint the cause. Bertolotti syndrome could be a suspect, therefore it’s best to seek a spine specialist near you that can help.
Tendonitis can be a painful condition that occurs when tendon/s that connect bone/s to muscle/s become damaged/injured. This can be from overuse of the particular tendon/s or using them in an improper fashion. Whatever the case, the result is inflammation, pain, and swelling. With injury/s where the tendon is stressed/strained to the point of injury, the soft tissue around the area can also be affected. More than 4 million�people�a year in the U.S. seek some form of medical treatment for�tendonitis symptoms.
Common types include:
Achilles tendonitis
Runner�s knee
Golfer’s elbow
Jumper’s knee
Pitcher�s shoulder
Swimmers shoulder
Tennis elbow
Other tendons in the body can also experience symptoms. Symptoms usually occur at the point where the tendon attaches to the bone and include:
Pain as a dull ache, especially when moving the limb or joint
Tenderness
Moderate swelling
The�wrist,�fingers, Achilles tendon, and ankle can all become inflamed from the condition. Primary care physicians are the ones to usually diagnose the injury. Once there is a definitive diagnosis, a non-surgical non-invasive treatment plan is the first recommended option. If these do not work then surgical procedures could be discussed. Chiropractic care is a first-line option that many physicians recommend.
Proper Rehabilitation Makes a Difference
This is usually from improper or incomplete healing.�Many individuals resume normal activities/chores as soon as the pain goes away. This is a mistake, as this is the time when continued care for the injury needs to be observed to heal completely. For this reason, tendonitis tends to recur. This inflames the area of the original injury which can then become aggravated, causing more pain. But more importantly, this aggravation can lead to a re-injury in the same area, which can be more severe the second time around. Chiropractic can help the tendon heal completely and help prevent re-injury to the area.
Chiropractic
Tendonitis symptoms can resemble other conditions, therefore the first step is confirmation. A doctor may use X-rays, MRIs, or CAT scans to make a positive diagnosis. A chiropractor will work with the patient in developing a treatment plan that is effective, and customized to the patient�s needs. The core of the treatment is focused on the root cause of the problem, and not just alleviating the symptoms.
With severe inflammation, a chiropractor will utilize inflammation reducing techniques like bracing, rest, ice, electrical muscle stimulation, ultrasound, low-level laser therapy, massage, and physical therapy. The focus is to loosen the tendon/s to reduce inflammation so that the treatment can continue to the next phase. Once the inflammation is under control, a chiropractor might start:
Massage
Physical therapy
Joint manipulation
Strength exercises
If the individual has limited joint mobility then joint manipulation and adjustments could be the best option.
Treatment Plan
Initial pain often subsides or even disappears after the first two to three weeks. This does not mean that the injury is fully healed. Many patients mistakenly believe that once the pain is gone the condition is gone. This is not true. Inflammation could decrease over the first three weeks, however, complete healing takes around six weeks and longer.� Scar tissue forms during this time which is how the body repairs the injury.
Once the injury is repaired the scar tissue has to be broken down so the area can regain mobility and flexibility. A chiropractor will use specialized techniques to break down the scar tissue. This could also�include massage and ultrasound to help in the process.�Mild stretching exercises could also be incorporated into the plan. As the tissues heal fully then a therapeutic exercise regiment can continue in the aid in breaking down the scar tissue further. These exercises will work the muscles but do not involve the tendons.
Better Health
Tendon inflammation can be healed completely and chiropractic care can help in achieving this. Chiropractic medicine takes the entire body approach, which means that everything is connected in some way. So if there is a form of pain in one place, it does not mean that that spot is where the source of the pain is coming from. It could be somewhere completely different, and so the chiropractor is going to work both areas and possibly others to alleviate the cause and not just alleviate the symptoms. Chiropractic medicine also includes diet, supplemental help, and lifestyle choicesthat can help the healing process and overall health. Once treatment is complete the individual can typically return to normal activities without the risk of re-injury and re-inflammation.
PODCAST: Dr. Alex Jimenez, chiropractor in El Paso, TX, and Victoria Hahn discuss the fasting-mimicking diet and the ProLon Fasting Mimicking Diet program developed by Dr. Valter D. Longo. The ProLon Fasting Mimicking Diet is a high-fat, low-calorie intermittent fasting diet that may promote fat loss and reduce blood sugar, inflammation, and cholesterol, similar to other fasting methods. Valter D. Longo is an Italian-American biogerontologist and cell biologist known for his research studies on the role of fasting and nutrient response genes on cellular protection aging and diseases as well as for proposing that longevity is regulated by similar genes and mechanisms in many eukaryotes. Only a few research studies have been carried out to date regarding the fasting-mimicking diet and more research is needed to validate its benefits. �- Podcast Insight
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Burning, numbness, tingling, and pain can be felt in the back, lower back, legs, and feet. A lot of times these symptoms spread out/radiate from one part of the body into another area. Sciatica is an example of pain that radiates into an extremity, in this case, the back of the leg. Nerves originate from the spine and are divided/separated into sensory and motor nerves. The sensory nerve/s give the sensation to the skin known as dermatomes. Dermatomal patterns act as a map on the body.
Example: Dermatomes on the torso of the body react to the thoracic spinal nerve roots, the arms react to the cervical spine nerve roots, and the legs react to the lumbar spinal nerve roots.
Dermatome Location – Corresponding Spine Level
Shoulders – C4, C5
Inner/Outer Forearms – C6, and T1
Thumbs and Little Fingers – C6, C7, C8
Front of Thighs – L2
Middle, Sides of Both Calves – L4, L5
Little Toes – S1
A physician might use a piece of cotton, a swab, pin, or paperclip to test the symmetrical feelings in the arms and legs. Abnormal responses could be a sign of a nerve root problem.
Tendon Reflexes
Most individuals have experienced a physician tapping the knees with a rubber hammer. The normal response is a kick. This is a reflex, which is an involuntary muscular response generated by the hammer tapping the tendon. When the reflex responses do not present, this could mean that the spinal cord, nerve root, peripheral nerve, or muscle has been injured/damaged in some way. Absent reflexes are also clues to other conditions/injuries. An abnormal reflex response could also be caused by a disruption of the sensory (feeling) or motor (movement) nerves and sometimes both. Determining where the neural problem might be, a physician will test reflexes in various parts of the body.
Reflex Tested Areas – Corresponding Spine Level
Upper Arm Biceps – C5-C6 Cervical Spine
Forearm Distal Radius – C6-C7
Elbow Triceps – C7
Abdominal – T8, T9, T10, T11, T12, Thoracic
Knees/Thighs Patellar, Quadriceps – L3, L4 Lumbar
Ankles – S1 Sacral
Neurological Exams for Neck/Back Pain
Muscle Strength/Tone
Muscle strength and tone measurements are another way to diagnose nerve deficits. Depending on the symptoms/condition/injury/s there are different ways to evaluate muscle strength:
Stepping on a stool
Standing on the heels
Standing on the toes
Hopping in place
Performing knee bends
Gripping an item in each hand
Muscle strength is graded and recorded in the patient’s chart.
A physician will test the body’s muscle tone by passively flexing and extending the arms and legs. Normal muscle tone will respond with a slight resistance to passive motion. Other movements test for proximal (trunk/torso) and distal (distant) weakness. Muscle symmetry is also taken into account.
Neurological Tests
If necessary a spine specialist might order neurological studies like a Nerve Conduction Study (NCS) or Electromyogram (EMG), to measure nerve performance.
Imaging Studies
MRI and/or CT scans of the spine can be ordered to help the spine specialist/chiropractor make a correct diagnosis, as well as help in creating a plan of treatment.
Conclusion
A neurological exam, along with a mechanical examination consisting of movement of the arms, legs, and torso, can significantly help doctors in making the correct diagnosis. Examination results are then correlated with the patient�s history, illness, and diagnostic studies. Once the diagnosis is made an appropriate treatment plan is discussed. This will begin with non-surgical strategies but if those fail, then surgical intervention could be considered.
Grains, legumes, and beans, such as kidney beans, lima beans, black beans, soybeans, and lentils, have high amounts of lectins. Other foods with high amounts of lectins include wheat and seeds of the grass family, such as barley, buckwheat, corn, millet, oats, and rye, legumes, including peanuts, and soy, nightshade vegetables, such as peppers, eggplant, and potatoes as well as dairy products, especially those originating from grain-fed animals. In the following article, we will discuss the most harmful lectins.
Most Harmful Lectins to Avoid
Most lectins can trigger inflammation and develop what is known as “advanced glycation end-products. C-reactive protein, by way of instance, is one of many lectins found in the human body that is used as an inflammatory marker. Lectins are considered to be immunotoxic because they can stimulate a hyperimmune response. Lectins are also considered to be neurotoxic and cytotoxic because they can damage nerves and cells, ultimately causing apoptosis or cell death, among other well-known health issues.
Moreover, lectins can increase blood viscosity by attaching to red blood cells. This makes red blood cell “sticky” which can result in abnormal blood clotting. Several lectins, such as WGA, can also affect endocrine function and change gene expression. Lectins may even promote leptin resistance, ultimately increasing the risk of excess weight and obesity. These factors can increase the risk of developing other health issues. If you believe you may have any health issues caused by eating lectins, you may want to avoid:
Corn
Corn-fed meats including most meats sold in grocery stores. Avoid eating factory farmed, corn-fed meat by eating certified grass-fed meat labeled by the American Grass-fed Association.
Cashews, peanuts, and unfermented soybean products. Eat fermented varieties, such as miso, natto, tamari, and tempeh.
Milk with casein A1. Casein A2 is the normal protein found in milk from buffalo, goats, sheep and some Jersey cows. Unfortunately, most cows produce casein A1 and most store-bought milk has casein A1, even if it’s organic. Casein A1 proteins develop beta-casomorphin that can attach to beta cells in the pancreas and result in an autoimmune response. Drink raw milk from organic, grass-fed, casein A2-producing cows. Jersey cows may produce either casein A1 or A2, so make sure to check with the farmer to confirm the type of milk being produced. Avoid milk from Holsteins because they produce casein A1.
How to Make High-Lectin Foods Safe to Eat
After eliminating foods with high amounts of lectins from your diet, you can further decrease lectins in your diet by:�
Peeling and deseeding fruits and vegetables. The skin, or hull, and seeds of many fruits and vegetables have high amounts of lectins. By way of instance, you’ll want to remove the seeds from tomatoes and peppers before eating them.
Choosing white grains over brown grains. Healthcare professionals suggest that white rice is preferable over brown rice because �those who eat rice as their staple grain have always stripped the hull off brown rice before they eat it. That’s because the hull contains all the harmful lectins.� Avoid lectins by choosing organic grains and using yeast or sourdough which effectively breaks down gluten and other harmful lectins.
Sprouting grains, beans, and seeds. Sprouting deactivates lectins although there are several exceptions. Do not sprout legumes. By way of instance, lectins are actually enhanced when sprouting alfalfa.
Eating fermented foods. Fermentation effectively decreases harmful lectins. A wide variety of vegetables can be fermented, ultimately boosting their health benefits.
Using a pressure cooker. The best way to neutralize lectins when cooking is to use a pressure cooker. Healthcare professionals recommend that, �If you’re cooking with beans, tomatoes, potatoes and quinoa, the pressure cooker is your best bet however, it won’t even touch the lectins in wheat, oats, rye, barley or spelt.� Avoid slow cookers since the low cooking temperatures are insufficient to remove lectins.
Tips to Decrease Lectins in Beans and Potatoes
If you choose to eat beans, it’s important to prepare and cook them properly because eating raw or undercooked beans can be harmful towards your overall health. Phytohemagglutinin is a toxin commonly found in many varieties of beans and they are especially high in raw, red kidney beans. According to the U.S. Food and Drug Administration (FDA) eating as few as four or five raw beans may cause phytohemagglutinin toxicity. To decrease lectins in high-lectin foods, consider doing the following including:
Soaking beans in water for at least 12 hours before cooking, making sure to change the water frequently. Adding baking soda to the soaking water will further neutralize lectins in beans.
Discarding the soaking water and rinsing the beans.
Cooking for at least 15 minutes on high heat or using a pressure cooker.
Lectins in potatoes, which are a member of the nightshade family, can also be reduced by cooking, although only by 50 to 60 percent. On a positive note, however, most potatoes have digestive-resistant starch which consists of complex starch molecules that resist digestion in your small intestine. These starches slowly ferment in the large intestine where they act as prebiotics that feed healthy gut bacteria. Because of this, healthcare professionals believe that we should only limit and not eliminate lectins from our diet.
Why You Should Only Limit & Not Eliminate Lectins
Healthcare professionals believe that lectin damage is associated with glyphosate contamination. Scientists make a strong case against lectins due to their potential to be harmful to your overall health. Given the number of foods with high amounts of lectins, however, it would be almost impossible to completely eliminate them from your diet. The list of lectins found in vegetables alone is lengthy and several lectins can actually provide a variety of health benefits if these are consumed in moderation.
Many vegetables with high amounts of lectins also have polyphenols which are micronutrients with antioxidants that play a fundamental role in preventing and reducing the progression of diabetes, heart disease, cancer, and neurodegenerative conditions. Polyphenols are also considered to be prebiotics because they increase the ratio of beneficial bacteria in your gut, which is another important factor for disease prevention and weight management, among providing various other well-known health benefits.
Lectins are proteins in plant- and animal-sources that can be harmful to a person’s overall health because they can attach to cell membranes. Grains, legumes, and beans, such as kidney beans, lima beans, black beans, soybeans, and lentils, have high amounts of lectins. Other foods with high amounts of lectins include wheat and seeds of the grass family, such as barley, buckwheat, corn, millet, oats, and rye, legumes, including peanuts, and soy, nightshade vegetables, such as peppers, eggplant, and potatoes as well as dairy products, especially those originating from grain-fed animals.According to healthcare professionals, eating too many foods with high amounts of lectins can cause nerve damage, lead to cell death, and even promote inflammation while others can change blood viscosity, interrupt endocrine function, and even affect gene expression. However, healthcare professionals argue that eating some foods with lectins can be beneficial as long as these are cooked and consumed properly.�– Dr. Alex Jimenez D.C., C.C.S.T. Insight
The scope of our information is limited to chiropractic, musculoskeletal, and nervous health issues or functional medicine articles, topics, and discussions. We use functional health protocols to treat injuries or disorders of the musculoskeletal system. Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. To further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.�
Curated by Dr. Alex Jimenez D.C., C.C.S.T.
References:
1. Bulletproof.com, Revenge of the Beans
2, 9, 17, 18, 22. Precision Nutrition, All About Lectins: Here’s What You Need to Know
3. Healthline April 1, 2015
4. Authority Diet, Dietary Lectins: What Are They and Should You Be Concerned?
5, 8. My Domaine June 25, 2017
6. Krispin.com October 18, 2017
7. Gundry MD May 23, 2017
10. Carbohydrate Research February 1980; 78: 349-363
11. Critical Reviews in Biotechnology 2000; 20(4): 293-334
12. Krispin.com October 18, 2017
13. Superfoodly October 8, 2017
14, 15, 16, 19. Gundry MD May 23, 2017
20, 21. U.S. Food and Drug Administration August 20, 2015
23. Youngmeagher.com, InstaPot Review 2017
24. Today’s Dietitian September 2012; 14(9): 22
Podcast: Metabolic Syndrome Explained
Metabolic syndrome is a collection of risk factors that can ultimately increase the risk of developing a variety of health issues, including heart disease, stroke, and diabetes, among other problems. Central obesity, high blood pressure, high blood sugar, high triglycerides, and low HDL are the 5 risk factors associated with metabolic syndrome. Having at least three of the five risk factors may suggest the presence of metabolic syndrome. Dr. Alex Jimenez and Dr. Mario Ruja explain the 5 risk factors associated with metabolic syndrome, in further detail, as they recommend diet and lifestyle modification advice and guidelines to help people with metabolic syndrome improve their overall health and wellness. From eating fiber and staying hydrated to exercise and better sleep, Dr. Alex Jimenez and Dr. Mario Ruja discuss how diet and lifestyle modifications can help improve the 5 risk factors associated with metabolic syndrome to ultimately prevent the risk of developing a variety of other health issues, including heart disease, stroke, and diabetes. – Podcast Insight
Neural Zoomer Plus for Neurological Disease
Dr. Alex Jimenez utilizes a series of tests to help evaluate neurological diseases. The Neural ZoomerTM Plus is an array of neurological autoantibodies which offers specific antibody-to-antigen recognition. The Vibrant Neural ZoomerTM Plus is designed to assess an individual�s reactivity to 48 neurological antigens with connections to a variety of neurologically related diseases. The Vibrant Neural ZoomerTM Plus aims to reduce neurological conditions by empowering patients and physicians with a vital resource for early risk detection and an enhanced focus on personalized primary prevention.
Food Sensitivity for the IgG & IgA Immune Response
Dr. Alex Jimenez utilizes a series of tests to help evaluate health issues associated with a variety of food sensitivities and intolerances. The Food Sensitivity ZoomerTM is an array of 180 commonly consumed food antigens that offers very specific antibody-to-antigen recognition. This panel measures an individual�s IgG and IgA sensitivity to food antigens. Being able to test IgA antibodies provides additional information to foods that may be causing mucosal damage. Additionally, this test is ideal for patients who might be suffering from delayed reactions to certain foods. Utilizing an antibody-based food sensitivity test can help prioritize the necessary foods to eliminate and create a customized diet plan around the patient�s specific needs.
Gut Zoomer for Small Intestinal Bacterial Overgrowth (SIBO)
Dr. Alex Jimenez utilizes a series of tests to help evaluate gut health associated with small intestinal bacterial overgrowth (SIBO). The Vibrant Gut ZoomerTM offers a report that includes dietary recommendations and other natural supplementation like prebiotics, probiotics, and polyphenols. The gut microbiome is mainly found in the large intestine and it has more than 1000 species of bacteria that play a fundamental role in the human body, from shaping the immune system and affecting the metabolism of nutrients to strengthening the intestinal mucosal barrier (gut-barrier). It is essential to understand how the number of bacteria that symbiotically live in the human gastrointestinal (GI) tract influences gut health because imbalances in the gut microbiome may ultimately lead to gastrointestinal (GI) tract symptoms, skin conditions, autoimmune disorders, immune system imbalances, and multiple inflammatory disorders.
Formulas for Methylation Support
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Proudly,�Dr. Alexander Jimenez makes XYMOGEN formulas available only to patients under our care.
Please call our office in order for us to assign a doctor consultation for immediate access.
If you are a patient of Injury Medical & Chiropractic�Clinic, you may inquire about XYMOGEN by calling 915-850-0900.
For your convenience and review of the XYMOGEN products please review the following link. *XYMOGEN-Catalog-Download
* All of the above XYMOGEN policies remain strictly in force.
Modern Integrated Medicine
The National University of Health Sciences is an institution that offers a variety of rewarding professions to attendees. Students can practice their passion for helping other people achieve overall health and wellness through the institution’s mission. The National University of Health Sciences prepares students to become leaders in the forefront of modern integrated medicine, including chiropractic care. Students have an opportunity to gain unparalleled experience at the National University of Health Sciences to help restore the natural integrity of the patient and define the future of modern integrated medicine.
Research has found that vertebrogenic chronic low back pain could be caused by a lumbar vertebral endplatechange that involves the basivertebral nerveand is not disc-related. The underlying cause of chronic low back pain can be very difficult to diagnose. The intervertebral discs are a common suspect, but when disc-related treatments don�t ease the pain, the root problem could be something else. Researchers are exploring an overlooked area with the vertebral endplates being the cause of vertebrogenic low back pain.
Research has found that there are more nerves in the vertebral endplates than in the spinal discs. More nerves can mean higher potential/increase in pain. And like the other areas of the spine such as the discs and joints, vertebral endplates can also degenerate, also increasing the risk for pain.
Vertebral Endplates and Basivertebral Nerve
The vertebral endplates line the top and bottom of each vertebral body. These are the round, thick, weight-bearing bones in the spine. The vertebral endplates are made of cancellous or spongy bone and function as the barrier between each disc and the vertebrae.
The low back/lumbar spine takes the most weight. That can be a significant amount of pressure on the structures in the low back. The endplates are situated between a cushioned disc/s and the hard, bony vertebral body making them vulnerable to degeneration and nerve damage contributing to chronic low back pain. The endplates and vertebral bodies consist of a network of intraosseous nerves.
Intraosseous nerves live within the bone.
The basivertebral nerve� BVN is an intraosseous nerve that winds through the vertebral bodies. This nerve feeds into each spinal bone through the back of the vertebral body and then branches out with nerves going towards the top and bottom vertebral endplates. Research has shown that although these nerves are inside the bone they can send pain signals from a damaged vertebral endplate that could result in vertebrogenic low back pain. This is why it has been�recently linked it as a possible cause of chronic low back pain.
Nerve pain in the spine has been linked with discs that have degenerated. A doctor, chiropractor/spine specialist refers to this as discogenic pain. But with new research, an understanding of the function the vertebral endplates and BVN play in the sensation of pain has been realized and this is where the term vertebrogenic pain comes from. If a doctor discovers that the endplates could be the source of your chronic low back pain, they might use this term.
Vertebral Endplate Pain Diagnosis
Like most back pain conditions diagnosing vertebral endplate pain can be just as challenging. This is because diagnostic imaging scans typically don�t pick up mild to moderate endplate damage. A classification scale known as Modic changes helps doctors identify vertebrogenic pain.
Modic changes or MC are areas that show up on an MRI showing bone marrow damage that has been linked to low back pain. The name comes from the doctor that classified them in 1988, Dr. Michael Modic. Modic changes help doctors and spine specialists see and understand the connection between endplate damage and chronic low back pain.
2 types were identified that show a connection between vertebral endplate damage and chronic low back pain:
Type 1
This type shows a�development� in the vessels of the vertebral body, that includes:
Inflammation
Edema, which is a collection of excess fluid
Endplate changes like a split or crack/s in the endplate
Type 2
This type reveals changes in the bone marrow like fatty deposits that have taken the place of bone marrow.
If the lumbar MRI shows Type 1 or Type 2 MC, a doctor could recommend a conservative treatment plan that could include:
These could be utilized in conjunction with spine specialist care in addressing symptoms and pain. However, if the pain does not ease or reduce with conservative treatment, a doctor could suggest an outpatient procedure.
Candidates for this procedure usually qualify meeting the following:
The individual has struggled with chronic low back pain for at least 6 months
The pain has not reduced/eased up with at least 6 months of conservative care
MRI shows Type 1 or Type 2 Modic changes�that correlate symptoms of vertebrogenic low back pain
The procedure uses fluoroscopy or an x-ray video. A thin tube called a cannula is inserted into a vertebral pedicle. A pedicle is a structure that sticks out from the back of the vertebra. The cannula tunnels its way to the basivertebral nerve. The doctor then runs the Intracept Radiofrequency generator into the path of the nerve and ablates destroys/removes any obstructions in the nerve with the help of the frequency generator. Since it�s a minimally invasive procedure, it can be performed in an outpatient clinic, allowing the patient to go home the same day.
The device/tool used in the procedure is not implanted in the spine. It is removed once the procedure is done.
Expectations as to how long the pain relief will last depends on:
The severity of the condition
Post-physical therapy
Type of work
Diet
Exercise
One study showed the benefits to last up to two years.
If�nonsurgical treatment has not worked for at least six months talk to your doctor about basivertebral nerve ablation for vertebrogenic chronic low back pain. There are risks and benefits both of which should be discussed in depth.
Endplate or Disc and the Root Cause
The intervertebral discs are often the more common cause of low back pain. But they might not be the root cause of spine pain. More research is going on with the role the vertebral endplates play in spine health. As more patients are being diagnosed earlier then better long-term outcomes will follow.
That eating sweets does not relieve cravings for sugar?
That you must have sweets after meals?
Hormone imbalances?
If you are experiencing any of these situations, then your blood glucose levels are dramatically fluctuating up and down. It might be an early indication of hyperinsulinemia in your body.
When it comes to the body, many people often try to make sure that their body is healthy and strong by eating the right food, exercising regularly, and even getting a routine check-up from their primary healthcare providers. Even though people can achieve this, sometimes harmful pathogens like autoimmune diseases, metabolic syndrome, and chronic illnesses can affect the body. When harmful pathogens attack the body from the inside, it can cause the body to dysfunction, especially the body’s system. Many people have found ways to dampen the effects that harmful pathogens have caused in their bodies. However, there are some people who are autoimmune compromises or even have diabetes have taken the necessary precautions to make sure that they are in control of their bodies.
It is surprising that when people are controlling their insulin levels, they are accustomed to think that insulin is a blood sugar-regulating hormone. Research shows that when the blood glucose rises in the body, insulin is being secreted in the body to help bring the blood glucose down a bit. This is a partial stimulation known as insulin-sensitive glucose transporters, and this is one of the many roles that insulin provides that are unrelated to the body’s blood glucose. When the blood glucose levels are rising and falling dramatically in the body, it can cause anyone who has diabetes to go into DKA or diabetic ketoacidosis.
Chronic Hyperinsulinemia
Studies have found that when diabetic individuals are keeping an eye on their blood glucose levels, they go on a ketogenic diet to keep their ketones under control. It is a surprise to many people that insulin is not required for cellular glucose uptake. The research study mentioned that when individuals are in a deficient carbohydrate diet, their bodies can regulate and control the production of the ketone bodies, causing a harmless physiological state known as dietary ketosis. The study even mentioned that when ketone bodies are flowing from the liver to the brain, it can be used as fuel. When this happens, spare glucose metabolism is very similar to the mechanism of spare glucose that is oxidizing fatty acids as an alternative fuel.
There is another study that shows that the use of exogenous insulin in individuals who have type 1 diabetes may need to suppress the free glucagon secretion that facilitates glucose transport into their cells. The hormone glucagon has a stimulatory effect on fuel production from the liver and can even modulate the hepatic glucose uptake and the hepatic glycogen synthesis in the body. The study even shows that the hormone glucagon has been longed dismissed as a minor contributor to metabolic diseases in the body. Not only that, but glucagon can even increase hepatic glucose from the liver to the brain and ketone production in the body.
Research on Hyperinsulinemia
What is interesting is that when insulin�s myopic focus is related to blood glucose. Research shows that many people have missed a host of health problems that can occur in the presence of average glucose in the body, but it is known as chronically elevated insulin. The research study showed that when there is a lack of insulin in the liver, it causes glycogenolysis and gluconeogenesis are being activated. When this happens, it can further enhance an overproduction of hormones like glucagon and cortisol, which can stimulate the process of insulin deficiency. A study has found that when a person has chronically elevated insulin or hyperinsulinemia, it can develop cardiometabolic diseases even if elevated glucose is absent. This is due to fasting glucose being part of a routine check-up and chronically elevated glucose.
Studies have shown that chronic hyperinsulinemia is the main factor in POS (polycystic ovarian syndrome) and that there is a high prevalence of undiagnosed insulin resistance with patients who have Parkinson’s disease. Chronic hyperinsulinemia can contribute to insulin resistance, as studies show that this factor can alter lipid metabolism in the body. The research study even shows that insulin sensitivity can be determined by hyper-insulinemic and can lead to weight gain, raised plasma triglycerides, and free fatty acids in the body.
Chronic hyperinsulinemia can be present long before there is a rise in blood glucose. Research shows that there are at least five stages in the progression of diabetes, and it can indicate any metabolic dysfunction that is happening in the body. In one study, it showed that there is an association between hyperinsulinemia in the fasting state and the development of diabetes. The study mentioned that basal hyperinsulinemia in adults who are normoglycemic could constitute an independent risk factor for metabolic deterioration to dysglycemia and can even help identify healthy subjects that may have an increased risk for diabetes.
Conclusion
All in all, if someone wants to make sure that their insulin levels are functioning correctly, they will have to be in a very low-carbohydrate ketogenic diet and keep an eye on their blood glucose levels. Individuals that are living with a condition due to chronic hyperinsulinemia, there are effective ways to manage this condition and even preventing it. Many people should start eating healthy, nutritional food, exercise regularly, and start developing healthy habits in order to achieve an overall sense of health and wellness. Some products are beneficial to regulate blood glucose by providing support to sugar metabolism with hypoallergenic nutrients, enzymatic cofactors, metabolic precursors, and phytonutrients.
The scope of our information is limited to chiropractic, musculoskeletal, and nervous health issues or functional medicine articles, topics, and discussions. We use functional health protocols to treat injuries or disorders of the musculoskeletal system. Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. To further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.
References:
Dankner, R, et al. �Basal State Hyperinsulinemia in Healthy Normoglycemic Adults Heralds Dysglycemia After More Than Two Decades of Follow Up.� Diabetes/Metabolism Research and Reviews, U.S. National Library of Medicine, July 2012, pubmed.ncbi.nlm.nih.gov/22865584/.
Hogg, Elliot, et al. �High Prevalence of Undiagnosed Insulin Resistance in Non-Diabetic Subjects With Parkinson’s Disease.� Journal of Parkinson’s Disease, U.S. National Library of Medicine, Feb. 2018, pubmed.ncbi.nlm.nih.gov/29614702/.
Manninen, Anssi H. �Metabolic Effects of the Very-Low-Carbohydrate Diets: Misunderstood �Villains� of Human Metabolism.� Journal of the International Society of Sports Nutrition, BioMed Central, 31 Dec. 2004, www.ncbi.nlm.nih.gov/pmc/articles/PMC2129159/.
Morita, Ippei, et al. �Chronic Hyperinsulinemia Contributes to Insulin Resistance under Dietary Restriction in Association with Altered Lipid Metabolism in Zucker Diabetic Fatty Rats.� American Journal of Physiology. Endocrinology and Metabolism, U.S. National Library of Medicine, 1 Apr. 2017, www.ncbi.nlm.nih.gov/pubmed/28143857.
Sonksen, P., and J. Sonksen. �Insulin: Understanding Its Action in Health and Disease.� British Journal of Anaesthesia, 1 July 2000, bjanaesthesia.org/article/S0007-0912(17)37337-3/fulltext.
Team, DFH. �Hyperinsulinemia: An Early Indicator of Metabolic Dysfunction.� Designs for Health, 12 Mar. 2020, blog.designsforhealth.com/node/1212.
Unger, Roger H, and Alan D Cherrington. �Glucagonocentric Restructuring of Diabetes: a Pathophysiologic and Therapeutic Makeover.� The Journal of Clinical Investigation, American Society for Clinical Investigation, Jan. 2012, www.ncbi.nlm.nih.gov/pmc/articles/PMC3248306/.
Weir, Gordon C, and Susan Bonner-Weir. �Five Stages of Evolving Beta-Cell Dysfunction During Progression to Diabetes.� Diabetes, U.S. National Library of Medicine, Mar. 2004, pubmed.ncbi.nlm.nih.gov/15561905/.
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