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Chronic Back Pain

Back Clinic Chronic Back Pain Team. Chronic back pain has a far-reaching effect on many physiological processes. Dr. Jimenez reveals topics and issues affecting his patients. Understanding the pain is critical to its treatment. So here we begin the process for our patients in the journey of recovery.

Just about everyone feels pain from time to time. When you cut your finger or pull a muscle, pain is your body’s way of telling you something is wrong. Once the injury heals, you stop hurting.

Chronic pain is different. Your body keeps hurting weeks, months, or even years after the injury. Doctors often define chronic pain as any pain that lasts for 3 to 6 months or more.

Chronic back pain can have real effects on your day-to-day life and your mental health. But you and your doctor can work together to treat it.

Do call upon us to help you. We do understand the problem that should never be taken lightly.


The Beneficial Properties Of Yoga For The Body

The Beneficial Properties Of Yoga For The Body

Introduction

When many individuals look for ways to relax after a stressful event in their daily lives, many people have an exercise regime that allows them to take their minds off of their hectic lives. When finding the proper exercise, it is best to consider that everybody is different and has different fitness levels. Many individuals could be dealing with chronic issues that affect them drastically and with so much pain in their bodies. When these chronic issues overlap with muscle and joint pain, it can make the body dysfunctional while potentially being involved in environmental factors. Yoga is a low-impact exercise that helps tone muscles, relax tension in the body, and focus on deep breathing. Today’s article looks at the benefits of yoga for the body, how chiropractic care works together with yoga, and different yoga poses can help manage various chronic issues. We refer patients to certified providers specializing in musculoskeletal treatments to help many individuals with musculoskeletal problems affecting their bodies. We also guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is the solution to asking our providers insightful questions. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer

SpineMed

The Benefits of Yoga For The Body

Have you been dealing with chronic stress affecting your quality of life? Have you been dealing with bladder or gut issues constantly? What about feeling muscle stiffness in your back, neck, shoulders, or pelvic regions? Some of these symptoms are signs that you could risk developing musculoskeletal problems associated with pain. Dealing with musculoskeletal issues related to pain can make a person feel miserable and have stress affecting their bodies. Yoga is a low-impact exercise that doesn’t put pressure on the joints and will provide a full-body workout through strengthening and stretching weak muscles. Yoga has many benefits for many individuals that are dealing with the following:

  • Muscle weakness
  • Back pain
  • Neck pain
  • Pelvic Pain
  • Arthritic symptoms
  • Cardiovascular issues
  • Chronic stress

Studies reveal that environmental factors are involved in non-specified chronic pain in the spine, overlapping musculoskeletal disorders causing many individuals to try to find relief. Many individuals incorporate yoga because it is a safe and effective way to alleviate various forms of back, neck, or pelvic pain causing issues to the body. Yoga utilizes gentle stretching and strengthening of weak, injured muscles while increasing blood circulation to promote healing in the body. 

 

Chiropractic Care & Yoga

When people are dealing with health conditions or injuries that have affected their bodies, it can make them feel frustrated and think their injuries are taking forever to heal. Many individuals don’t realize that incorporating yoga practices provides impressive health benefits while mirroring the similar foundations of chiropractic care. Both chiropractic care and yoga provide many beneficial results to an aching body that needs a good stretch and ready the body to heal itself naturally. Chiropractic care includes spinal manipulation to the spinal joints while reducing inflammation and strengthening weak muscles. Yoga allows the body to increase its flexibility and stamina, reduces stress and blood pressure, and provides a better sense of breathing and balance.


Yoga For Chronic Pain-Video

Have you felt muscle stiffness in your neck, back, or body? Have you felt sluggish or overly stressed from your day-to-day lives? Do you want to improve your balance? If you have been experiencing these issues affecting your quality of life, why not incorporate yoga as part of your exercise regime? The video above shows that yoga poses for chronic pain affect the body, including the neck, back, and pelvic regions. Studies reveal that yoga can help relieve intense neck pain while improving pain-related function disability. Yoga allows the muscles to not only relax but strengthen them as well. Yoga can also help improve the body’s range of motion through deep breathing and give more awareness of how the body holds tension in places a person hasn’t realized they were holding onto.


Yoga Poses For Different Issues

When a person does yoga, they will go through various poses and repeat them constantly as their body begins to get used to the movements. This allows the body to challenge itself and helps the individual focus more on deep breathing. A good example would be an individual taking a yoga class due to experiencing pelvic pain. By going through each yoga pose, many individuals suffering from pelvic pain will reduce the pain intensity while improving their quality of life. Below are some yoga poses that anyone can do to reduce pain associated with their back, neck, or pelvis.

Bridge Pose

  • Lie on your back
  • Bend both knees while placing the feet on the floor at hip-width apart
  • Arm on the sides with palms facing down
  • Press feet to the floor and lift the hips as you inhale
  • Engage the legs and buttock 
  • Hold 4-8 breaths and exhale to lower the hips back to the ground slowly

 

Cobra Pose

  • Lie on your stomach with hands near the chest just under the shoulders and fingers facing forward
  • Keep elbows close to sides
  • Press hands on the floor and slowly lift your head, chest, and shoulders while slightly bending the elbows by inhaling
  • Exhale to go back down slow and rest your head

 

Cat-Cow

  • Be on all fours, hands under the shoulders and knees under hips (Think like a table)
  • Inhale to lower your core to the floor as your head looks up to the sky
  • Exhale slowly to lower your chin to the chest as you round your back
  • Continue fluid motion for a minute

 

Forward Bend

  • Be in a standing position, and feet are at a hip distance apart
  • Lengthen the body as you lean forward while keeping the knees slightly bended
  • Place hands on either legs, yoga block, or the floor (Whichever makes you comfortable)
  • Tuck the chin into the chest, letting the neck and head relax
  • Gently rock your head side to side to relieve tension in the neck and shoulders
  • Slowly roll up to a standing position allowing the arms and head to be the last to rise

 

Supine Spinal Twist

  • Lie on your back while your knees bent and feet flat on the floor
  • Extend arms out of the side and place palms down on the floor
  • As you inhale, breathe into the gut and lower limbs
  • Exhale to lower knees on the left side (Look at the opposite way to slowly stretch the neck and shoulder muscles)
  • Pay attention to the stretches for 5 breathes as well as the lengthening sensations on the ribs
  • Return the knees to the middle and repeat on the right side

 

Child’s Pose

  • Sit back on the heels with the knees together (For added support, you can use a rolled-up blanket under your knees)
  • Bend forward and walk hands in front of you
  • Gently rest your forehead on the floor
  • Keep arms extended in the front while focusing on relieving tension in the back as the upper body falls to the knees
  • Stay in that pose for 5 minutes

 

Conclusion

Incorporating yoga as part of an exercise regime allows the individual to focus on deep breathing while calming the mind. Yoga is a low-impact exercise that helps strengthen weak muscles associated with pain and inflammation. Yoga provides a full-body workout that benefits many people dealing with chronic pain. Utilizing yoga as part of a daily practice might help individuals learn to be calm and practice mindfulness.

 

References

Busch, Fred. “Healing Benefits of Yoga.” Spine, Spine-Health, 27 Jan. 2004, www.spine-health.com/wellness/yoga-pilates-tai-chi/healing-benefits-yoga.

Crow, Edith Meszaros, et al. “Effectiveness of Iyengar Yoga in Treating Spinal (Back and Neck) Pain: A Systematic Review.” International Journal of Yoga, Medknow Publications & Media Pvt Ltd, Jan. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4278133/.

Li, Yunxia, et al. “Effects of Yoga on Patients with Chronic Nonspecific Neck Pain: A Prisma Systematic Review and Meta-Analysis.” Medicine, Wolters Kluwer Health, Feb. 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6407933/.

Saxena, Rahul, et al. “Effects of Yogic Intervention on Pain Scores and Quality of Life in Females with Chronic Pelvic Pain.” International Journal of Yoga, Medknow Publications & Media Pvt Ltd, 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5225749/.

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The Gallbladder & The Parasympathetic Nervous System Function

The Gallbladder & The Parasympathetic Nervous System Function

Introduction

The digestive system in the body helps with the process of digesting food that the host consumes. The food being digested goes through a bio-transformation where it turns into nutrients and is stored in the intestinesliver, and gallbladder, where it turns into bile to be excreted out of the system to ensure a healthy functional gut system and body. But when disruptive factors like poor eating habits or gut issues start to affect the body and gallbladder, this causes many problems that can make an individual miserable. This affects their quality of life since they are dealing with painful issues in their bodies that overlap the primary source risk profiles. Today’s article looks at the gallbladder, how it functions with the body and parasympathetic nervous system, and how referred shoulder pain and gallbladder dysfunction are connected. We refer patients to certified providers specializing in gastroenterology and chiropractic treatments that help those with issues that affect their shoulders and gallbladder. We also guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is the solution to asking our providers insightful questions. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer

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What Is The Gallbladder?

The digestive system comprises the mouth, the internal organs from the GI tract, the liver, the gallbladder, and the anus, where food is consumed, digested, and excreted out of the body to keep it healthy. The gallbladder is a small organ that store and releases bile at the appropriate time into the intestines to be mixed with the digested foods to be excreted out of the body. This pear-shaped organ inflates and deflates like a balloon when it stores and releases bile while having a casual relationship with the nerves and hormones that help regulate the gallbladder functioning properly. Studies reveal that the ganglia become the target of causing the hormone cholecystokinin and the parasympathetic nerve to up or downregulate the neurotransmission to the gallbladder. This causes the gallbladder to be functional in the body.

 

What Are Its Functions In The Parasympathetic Nervous System?

So what are the functions that the gallbladder provides to the body? For starters, the parasympathetic nervous system allows the body to rest and digest the consumed food to be turned into nutrients. The parasympathetic nervous system also provides gallbladder stimulation as studies reveal that the gallbladder receives innervation from the parasympathetic nervous system connected to the vagus nerve that transmits information to the spine and the brain. Keeping and releasing bile from this pear-shaped organ helps regulate the gastrointestinal tract. This causal relationship between the gallbladder and the parasympathetic nerve is essential because the body needs to know when to store and release bile from the gallbladder, or it might trigger some issues that can do more harm to the body and even affect the gallbladder itself.


Do You Have Shoulder Pain?- Video

Have you been experiencing gut issues causing a sharp or dull ache in your back or sides? How about questionable shoulder pain that seems to come out of nowhere? Or are your experiencing inflammation in your digestive system? Many of these symptoms are signs of visceral-somatic pain affecting the gallbladder. Visceral-somatic pain is defined when there is damage to the organ, and it starts to affect the muscles in a different location in the body. The video above gives an excellent example of visceral-somatic pain in the gallbladder and the shoulder. Now many people wonder how shoulder pain is the mediator of the gallbladder? Well, inflammation in the liver and gallbladder causes the nerve roots to be hypersensitive and compressed. This leads to overlapping profiles, triggering pain in the shoulder muscles and associated with upper mid-back pain.


Referred Shoulder Pain & Gallbladder Dysfunction

 

Now say the individual is experiencing shoulder pain; however, when they rotate their shoulder, there is no pain? Where is the source of shoulder pain localized, and what is causing the issue? And why is it correlating to the gallbladder? This is known as referred pain, where the source of pain is poorly localized when it is located elsewhere. Studies reveal that gallbladder dysfunctions like cholecystitis might be associated with acute thoracolumbar shoulder pain. So what does this mean? It means that any referred pain that is the causation of shoulder pain gives the impression that something is wrong with the gallbladder. This would provide much-needed information when individuals are being examined by their physicians.

 

Conclusion

The body needs the digestive system to help process food the host consumes and excretes for a healthy functioning system. The gallbladder stores and releases bile to the digested food. This ensures that the nutrients and bile are transported and passed out of the body. When disruptive factors cause gut issues and affect the gallbladder, it can correlate to different problems impacting the body. An example would be gallbladder issues associated with shoulder pain. This is referred to as pain, which is from an affected organ and associated with the muscle in a different location. This can make the individual feel miserable and wonder what is going on with their shoulders when it might be something associated with their gallbladder. Available treatments can provide better knowledge to determine the problem and how to alleviate the issues.

 

References

Carter, Chris T. “Acute Thoracolumbar Pain Due to Cholecystitis: A Case Study.” Chiropractic & Manual Therapies, BioMed Central, 18 Dec. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4683782/.

Jones, Mark W, et al. “Anatomy, Abdomen and Pelvis, Gallbladder.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 8 Nov. 2021, www.ncbi.nlm.nih.gov/books/NBK459288/.

Mawe, Gary M., et al. “Nerves and Hormones Interact to Control Gallbladder Function.” Physiology, 1 Apr. 1998, journals.physiology.org/doi/full/10.1152/physiologyonline.1998.13.2.84.

Medical Professional, Cleveland Clinic. “Gallbladder: What Is It, Function, Location & Anatomy.” Cleveland Clinic, 28 July 2021, my.clevelandclinic.org/health/body/21690-gallbladder.

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Viscerosomatic Pain Affecting Thoracic Spine

Viscerosomatic Pain Affecting Thoracic Spine

Introduction

The spine has three areas: cervical, thoracic, and lumbar in the back, encased with muscles, tissues, ligaments, and joints that help protect the spinal cord from injuries. With the spinal cord being part of the central nervous system, this long cord has many nerve roots that are spread all over the body and help function each section of the body. When the back muscles become damaged or injured in the thoracic region of the spine, it can cause painful symptoms and other issues that correspond with the thoracic spine. Today’s article will look at the thoracic spine, how back pain in the upper-mid section of the back, and how visceral referred pain affects the thoracic region in the body. We refer patients to certified, skilled providers specializing in osteopathic and chiropractic treatments that help those suffering from chest pains and thoracic back pain. We also guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is critical for asking insightful questions to our providers. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer

 

Can my insurance cover it? Yes, it may. If you are uncertain, here is the link to all the insurance providers we cover. If you have any questions or concerns, please call Dr. Jimenez at 915-850-0900.

6_Houston_Hypertension

The Thoracic Spine

 

Have you been experiencing herniation in the upper-mid section of your back? Have you felt chest pain occur frequently? Do your back muscles feel stiff or constantly ache even after you stretch? All these symptoms are signs that affect the thoracic region of the spine. Research studies have defined the three spinal areas: the cervical, thoracic, and lumbar help keep the upper half of the body upright. The thoracic area of the spine has added support from the rib cage and allows the body to rotate and flex the upper body. The thoracic region of the spine is also the first curvature that is tight enough to protect the vital organs and loose enough to allow respiratory movement in the body. Additional research studies have also mentioned that the thoracic segments in the spine are susceptible to injuries that can affect the back entirely. The thoracic segments can succumb to structural alterations, disc herniation, and even trauma in the spine from environmental factors like lifting or carrying heavy objects, muscle strain, and forceful impact. 

 

How Thoracic Pain Affect The Body

When the thoracic region of the spine begins to suffer from environmental factors or traumatic events, it can affect the body and aggravate the nerves that encase the spinal column. Research studies have found that when the thoracic spine has succumbed to injuries, it can affect the upper half of the body. Structural changes in the thoracic T 1 through 3 regions of the spine can cause the cervical area to develop neck pain. This causes restricted segmental mobility in the cervical and thoracic regions of the spine. Another research study has mentioned that individuals suffering from thoracic pain will often complain about paravertebral pain aggravated by prolonged standing, hyperextension, and even hyper rotation in the thoracic spinal column. When this happens, it can cause discomfort to the individual and limit their range of motion since their muscles are stiff. Thoracic pain can even affect the corresponding muscles connected to the body’s internal organs.


Referred Pain Affect The Thoracic Spine-Video

Have you felt muscle stiffness in your upper-middle back? Have you been dealing with neck or chest pain? Have inflammatory issues affecting your esophagus? Many of these are signs and symptoms of visceral referred pain affecting the thoracic region of the spine. The video above explains how visceral referred pain can affect the thoracic spine and the corresponding muscle and organs in the area. Research studies have defined pain as damaged nociceptive sensory nerves that affect the peripheral tissues in the face. The broken nerve roots can affect one portion of the body but also a different section of the body. Additional research studies have also found that visceral pain affecting the thoracic regions of the spine can impact the cardiovascular system. This is due to hypertension caused by chronic stress from environmental factors.


Visceral Referred Pain Affecting The Thoracic Region

 

Research studies have noticed that thoracic spinal pain can become a common site for inflammation, degenerative discs, and other issues contributing to pain and disability in the spine. Visceral pain is a complex disorder that can cause the surrounding muscles and organs in the thoracic region to be compromised. When the body is suffering from visceral referred pain, the thoracic region of the spine will also begin to suffer. Additional research studies have found that visceral referred pain that affects the thoracic neurons will also affect the esophageal and cardiac input to the cardiovascular and gut systems. When the affected thoracic neurons begin to cause heart and esophageal problems, these two organs become hypersensitive due to noxious stimulation.

 

Conclusion

The spine has three areas: the cervical, thoracic, and lumbar, which help keep the body upright and is encased with muscles, tissues, and ligaments that protect the spinal cord from injuries. Injuries that affect the thoracic regions of the back can cause problems to the corresponding muscles and the internal organs, especially in the gut and cardiovascular systems. These organs become hyper-sensitive and can make the body develop hypertension and other issues that can make the body dysfunctional. When individuals realize that their upper-middle back pain in the thoracic region can affect their cardiovascular system, they can find ways to treat their back pain and prevent cardiovascular issues from forming.

 

References

Briggs, Andrew M, et al. “Thoracic Spine Pain in the General Population: Prevalence, Incidence and Associated Factors in Children, Adolescents and Adults. A Systematic Review.” BMC Musculoskeletal Disorders, BioMed Central, 29 June 2009, www.ncbi.nlm.nih.gov/pmc/articles/PMC2720379/.

Brumovsky, P R, and G F Gebhart. “Visceral Organ Cross-Sensitization – an Integrated Perspective.” Autonomic Neuroscience: Basic & Clinical, U.S. National Library of Medicine, 16 Feb. 2010, www.ncbi.nlm.nih.gov/pmc/articles/PMC2818077/.

Gkasdaris, Grigorios, et al. “Clinical Anatomy and Significance of the Thoracic Intervertebral Foramen: A Cadaveric Study and Review of the Literature.” Journal of Craniovertebral Junction & Spine, Medknow Publications & Media Pvt Ltd, 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC5111324/.

Joshi, Shriya, et al. “Thoracic Posture and Mobility in Mechanical Neck Pain Population: A Review of the Literature.” Asian Spine Journal, Korean Society of Spine Surgery, 3 June 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6773982/.

Murray, Greg M. “Guest Editorial: Referred Pain.” Journal of Applied Oral Science : Revista FOB, Faculdade De Odontologia De Bauru Da Universidade De São Paulo, 2009, www.ncbi.nlm.nih.gov/pmc/articles/PMC4327510/.

van Kleef , Maarten, et al. “10. Thoracic Pain.” Pain Practice : the Official Journal of World Institute of Pain, U.S. National Library of Medicine, 2010, pubmed.ncbi.nlm.nih.gov/20492577/.

Ward, John, et al. “Immediate Effects of Upper Thoracic Spine Manipulation on Hypertensive Individuals.” The Journal of Manual & Manipulative Therapy, Maney Publishing, Feb. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4459143/.

Waxenbaum, Joshua A, et al. “Anatomy, Back, Thoracic Vertebrae – Statpearls – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 12 Aug. 2021, www.ncbi.nlm.nih.gov/books/NBK459153/.

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Alleviating Back Pain From Auto Accident Injuries

Alleviating Back Pain From Auto Accident Injuries

Introduction

Everybody is always moving in their vehicles as they go from one place to another in less time. Sometimes accidents happen as vehicles collide with each other and cause excruciating pain to the body as it lunges forward, causing back and neck pain to the individual. These are physical effects on the body, but the emotional impact also takes a toll on the individual. It can cause a person to become miserable and affect their quality of life. Today’s article discusses the effects of an auto accident are cause the back and body, as well as how non-surgical decompression therapy can help alleviate the pain in the back from an auto accident. Patients are referred to qualified, skilled providers specializing in spinal decompression and non-surgical treatments. We go hand in hand with our patients by referring them to our associated medical providers based on their examination when it’s appropriate. We find that education is valuable for asking critical questions to our providers. Dr. Jimenez DC provides this information as an educational service only. Disclaimer

 

Can my insurance cover it? Yes, it may. If you are uncertain, here is the link to all the insurance providers we cover. If you have any questions or concerns, please call Dr. Jimenez at 915-850-0900.

94 patient retro study

The Effects Of Auto Accidents On The Back

 

Have you suffered from back pain after a vehicle collision? What about experiencing whiplash or neck pain? Or has your lower back been feeling stiff and aches more? Many of these symptoms are signs that the spine, back, and neck all have suffered from the effects of an auto accident. Research has shown that the impact of a person in an auto accident causes the body to rapidly lunge forward and back after a complete stop, causing damage to the body, especially on the spine. After the auto accident has occurred, many individuals don’t feel the effects of the injuries that are caused by auto accidents sometimes until the day after the accident. This is due to the adrenaline in the body, which is both a neurotransmitter and a hormone and is fully turned on to the max. Additional information has stated that many individuals suffer from low back pain after a motor vehicle collision. Even if the accident was non-lethal, the impact can cause strain on the lower back muscles and compress the spinal nerves, making them irritated. 

 

How The Body Is Affected

Research studies have shown that the impact of an auto accident may cause the body to have non-fatal physical injuries but also cause psychological trauma that can affect a person’s psyche. Many people that have experienced an auto accident will have various emotions that leave them in shock. During that process, emotions like distress, helplessness, anger, shock, and frustration are presented as the individual who was in the accident experience these negative emotions. Additional research also found that many individuals can experience low back pain episodes reoccurring along with the emotional presence that they are feeling. Fortunately, there are ways to alleviate low back pain caused by auto accidents and can help restore the spine to its functionality.


Spinal Decompression Therapy Alleviates Auto Accident Injuries- Video

Have you experienced low back pain after a car accident? How about feeling the effects of muscle stiffness on the neck and low back the day after? Do emotions like stress, frustration, and shock affect your quality of life? These are signs and symptoms of what a person is going through after being involved in an auto accident and dealing with neck and back pain. There are ways to treat neck and back pain through decompression, and the video above explains the impressive effects of what decompression does to the individual. Decompression is a non-surgical treatment that allows gentle traction to alleviate the flattened spinal disc and take the pressure off the aggravated nerves surrounding the spine. The gentle traction also pumps the nutrients back to the dehydrated discs while increasing their heights. This link will explain what decompression offers and the impressive results for many individuals who suffer from back or neck pain due to an auto accident.


How Spinal Decompression Helps Relieve The Spine After Auto Accidents

 

After a person suffers from an auto accident, they experience pain in their spine and back the day before or after. Many individuals who suffer from low back pain, neck pain, and whiplash from auto accidents tend to find ways to alleviate the pain in their spine. One of these treatments is spinal decompression. Spinal decompression allows the individual to sit on a traction table in a supine position and be strapped in. Research studies have mentioned that spinal decompression is a non-surgical treatment for many individuals suffering from low back pain. In contrast, the traction machine slowly but gently pulls the spine to relieve the pain caused by a spinal injury due to an accident. This will provide effective recovery for many individuals suffering from low back pain. Additional information also mentioned that the effectiveness of decompression could reduce the inflammatory markers induced by the aggravated nerve roots through negative pressure, thus causing relief to the back.

 

Conclusion

Overall, suffering low back pain or neck pain after an auto accident is nerve-wracking for many individuals. The emotional and physical trauma caused by a motor vehicle collision can dampen a person’s mood, and the residual pain afterward can affect their quality of life. Utilizing decompression for non-surgical treatments can provide beneficial results in restoring functionality back in the spine and alleviating the pain the person is in. When people use decompression, they can get back to their activities and become pain-free from their lower back.

 

References

Daniel, Dwain M. “Non-Surgical Spinal Decompression Therapy: Does the Scientific Literature Support Efficacy Claims Made in the Advertising Media?” Chiropractic & Osteopathy, BioMed Central, 18 May 2007, www.ncbi.nlm.nih.gov/pmc/articles/PMC1887522/.

Kang, Jeong-Il, et al. “Effect of Spinal Decompression on the Lumbar Muscle Activity and Disk Height in Patients with Herniated Intervertebral Disk.” Journal of Physical Therapy Science, The Society of Physical Therapy Science, Nov. 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC5140813/.

Nolet, Paul S, et al. “Exposure to a Motor Vehicle Collision and the Risk of Future Back Pain: A Systematic Review and Meta-Analysis.” Accident; Analysis and Prevention, U.S. National Library of Medicine, July 2020, pubmed.ncbi.nlm.nih.gov/32438092/.

Nolet, Paul S, et al. “The Association between a Lifetime History of Low Back Injury in a Motor Vehicle Collision and Future Low Back Pain: A Population-Based Cohort Study.” European Spine Journal: Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, U.S. National Library of Medicine, Jan. 2018, pubmed.ncbi.nlm.nih.gov/28391385/.

Salam, Mahmoud M. “Motor Vehicle Accidents: The Physical versus the Psychological Trauma.” Journal of Emergencies, Trauma, and Shock, Medknow Publications & Media Pvt Ltd, 2017, www.ncbi.nlm.nih.gov/pmc/articles/PMC5357873/.

Toney-Butler, Tammy J, and Matthew Varacallo. “Motor Vehicle Collisions – Statpearls – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 5 Sept. 2021, www.ncbi.nlm.nih.gov/books/NBK441955/.

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Traction Therapy Provides Relief From Lumbar Stenosis

Traction Therapy Provides Relief From Lumbar Stenosis

Introduction

The lower half of the body consists of the low back, hips, legs, and feet to stabilize the upper body. The motor-sensory function helps the lower portion of the body move the leg muscles and sense when the lower back muscles are in pain. The lower back muscles help twist and turn the upper body without feeling discomfort or pain when it is in motion. Many ordinary factors put the lower back muscles to the test, which can become a nuisance later on if not treated right away. Factors like lifting and carrying heavy objects, being hunched over, and injuries can affect the lower back while causing immense pain to the lumbar spine. When injuries occur in the lower back, unwanted symptoms start to take effect, causing the individual to suffer and find some relief to alleviate the pain. Today’s article will focus on what causes lumbar stenosis, how it is associated with low back pain, and how traction therapy can help alleviate lumbar stenosis for many people. Patients are referred to qualified, skilled providers who specialize in spinal decompression and traction therapy. We go hand in hand with our patients by referring them to our associated medical providers based on their examination when it’s appropriate. We find that education is valuable for asking critical questions to our providers. Dr. Jimenez DC provides this information as an educational service only. Disclaimer

 

Can my insurance cover it? Yes, it may. If you are uncertain, here is the link to all the insurance providers we cover. If you have any questions or concerns, please call Dr. Jimenez at 915-850-0900.

Pain Practice

What Causes Lumbar Stenosis?

 

Experiencing mild to chronic pain in your lower back? Do you feel unstable when walking or running to your destination? Or have you experienced symptoms of muscle weakness or tenderness around your lower back? Many of these symptoms are caused by lumbar spinal stenosis. Research studies have defined lumbar stenosis as intervertebral spinal discs in the lumbar regions starting to degenerate naturally, causing the lower extremities to become hypermobile around the facet joints. When this happens to the spinal joint over time, it causes a reduction in the spinal canal, making the nerve roots that surround the spine irritated. Lumbar stenosis will gradually worsen as the pain symptoms range from mild to severe. Other research studies have shown that lumbar stenosis is caused due to natural aging in the spine that causes the degeneration process, thus leading to pain symptoms associated with stenosis.

 

How Low Back Pain Is Associated With Stenosis?

Research studies have found that lumbar stenosis is associated with leg and back pain when a person has lumbar stenosis, a common source in the lower back. Other back issues and symptoms are also playing an effect on the development of lumbar stenosis. Degenerative spondylosis causes an increased load on the posterior portions of the spine where the hips are located at. Additional research studies have shown that many suffering individuals will exhibit various symptoms associated with lumbar stenosis. Some of the signs that lumbar spinal stenosis does include:

  • Neurogenic claudication
  • Radiating pain in the lower limbs (buttock, legs, and feet)
  • Decrease sensory functions 
  • Severe pain in posture stance
  • Increase chances of falling down

An Overview On Lumbar Traction-Video

Feeling radiating pain in your lower limbs? Do you feel muscle stiffness or tenderness in certain parts of your lower back? Have you experienced severe pain from standing or sitting for too long? Having lumbar spinal stenosis is no laughing matter for your lower back. The pain can become excruciating if it isn’t being taken care of, and that is where lumbar traction can help. The video above explains why lumbar traction is terrific when dealing with low back pain and lumbar stenosis. Lumbar traction helps loosen the tense muscles and resets the spinal discs that aggravate the nerve roots. Lumbar traction also provides relief to individuals suffering from sciatic nerve pain and can help rehydrate the dry intervertebral discs in the body. This link will explain what lumbar traction therapy offers and the impressive results for many individuals who suffer from lumbar spinal stenosis or other low back pain issues


How Traction Therapy Helps Alleviate Lumbar Stenosis

 

Many individuals looking for treatments that can help alleviate lumbar stenosis and low back can try lumbar traction therapy. Research studies have shown that traction therapy can help many suffering patients dealing with low back pain or lumbar stenosis will have a decrease in radicular pain in their lower back and legs. Lumbar traction helps relieve the surrounding nerves’ aggravated pressure, and radiculopathy symptoms are decreased in the lower back. Other research studies have mentioned that lumbar traction can help widen the spinal disc space in the spine while reducing low back pain and causing the sensory-motor functions to return to the legs. Lumbar traction therapy has many beneficial results for lower back pain relief for individuals.

 

Conclusion

Living with low back pain or lumbar stenosis is not a laughing matter for a person’s health. Overall, experiencing low back pain is no joke when associated with other symptoms like lumbar spinal stenosis. Lumbar stenosis causes the spinal canal to become narrow, and it can press on the surrounding nerve roots in the lumbar region. Many individuals who suffer from lumbar stenosis will have a wide range of pain in their lower extremities while feeling unstable when they are moving. When this happens, therapies like lumbar traction can help decompress the affected nerve roots and help widen the spinal canal and discs back to their original state. Incorporating traction and decompression therapy to alleviate low back pain can do many wonders for the individual.

 

References

Bjerke, Benjamin. “Lumbar Spinal Stenosis.” Spine, Spine-Health, 8 June 2020, www.spine-health.com/conditions/spinal-stenosis/lumbar-spinal-stenosis.

Harte, Annette A, et al. “The Effectiveness of Motorised Lumbar Traction in the Management of LBP with Lumbo Sacral Nerve Root Involvement: A Feasibility Study.” BMC Musculoskeletal Disorders, BioMed Central, 29 Nov. 2007, www.ncbi.nlm.nih.gov/pmc/articles/PMC2217540/.

Lee, Byung Ho, et al. “Lumbar Spinal Stenosis: Pathophysiology and Treatment Principle: A Narrative Review.” Asian Spine Journal, Korean Society of Spine Surgery, Oct. 2020, www.ncbi.nlm.nih.gov/pmc/articles/PMC7595829/.

Lee, Seung Yeop, et al. “Lumbar Stenosis: A Recent Update by Review of Literature.” Asian Spine Journal, Korean Society of Spine Surgery, Oct. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4591458/.

Vanti, Carla, et al. “Vertical Traction for Lumbar Radiculopathy: A Systematic Review.” Archives of Physiotherapy, BioMed Central, 15 Mar. 2021, www.ncbi.nlm.nih.gov/pmc/articles/PMC7958699/.

Wu, Lite, and Ricardo Cruz. “Lumbar Spinal Stenosis – Statpearls – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 25 Aug. 2021, www.ncbi.nlm.nih.gov/books/NBK531493/.

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Disc Bulge & Herniation Chiropractic Care Overview

Disc Bulge & Herniation Chiropractic Care Overview

Disc bulge and disc herniation are some of the most common conditions affecting the spine of both young and middle-aged patients. It is estimated that approximately 2.6% of the US population annually visits a clinician to treat spinal disorders. Roughly $ 7.1 billion alone is lost due to the time away from work.

Disc herniation is when the whole or part of the nucleus pulposus is protruded through the torn or weakened outer annulus fibrosus of the intervertebral disc. This is also known as the slipped disc and frequently occurs in the lower back, sometimes also affecting the cervical region. Herniation of the intervertebral disc is defined as a localized displacement of disc material with 25% or less of the disc circumference on an MRI scan, according to the North American Spine Society 2014. The herniation may consist of nucleus pulposus, annulus fibrosus, apophyseal bone or osteophytes, and the vertebral endplate cartilage in contrast to disc bulge.

There are also mainly two types of disc herniation. Disc protrusion is when a focal or symmetrical extension of the disc comes out of its confines in the intervertebral space. It is situated at the intervertebral disc level, and its outer annular fibers are intact. A disc extrusion is when the intervertebral disc extends above or below the adjacent vertebrae or endplates with a complete annular tear. In this type of disc extrusion, a neck or base is narrower than the dome or the herniation.

A disc bulge is when the outer fibers of the annulus fibrosus are displaced from the margins of the adjacent vertebral bodies. Here, the displacement is more than 25% of the circumference of the intervertebral disc. It also does not extend below or above the margins of the disc because the annulus fibrosus attachment limits it. It differs from disc herniation because it involves less than 25% of the disc’s circumference. Usually, the disc bulge is a gradual process and is broad. The disc bulge can be divided into two types. In a circumferential bulge, the whole disc circumference is involved. More than 90 degrees of the rim is involved asymmetrically in asymmetrical bulging.

Normal Intervertebral Disc Anatomy

Before going into detail about the definition of disc herniation and disc bulge, we need to look at the standard intervertebral disc. According to spine guidelines in 2014, a standard disc is something that has a classic shape without any evidence of degenerative disc changes. Intervertebral discs are responsible for one-third to one-fourth of the height of the spinal column.

One intervertebral disc is about 7 -10 mm thick and measures 4 cm in anterior-posterior diameter in the lumbar region of the spine. These spinal discs are located between two adjacent vertebral bodies. However, no discs can be found between the atlas and axis and the coccyx. About 23 discs are found in the spine, with six in the cervical spine, 12 in the thoracic spine, and only five in the lumbar spine.

Intervertebral discs are made of fibro cartilages, forming a fibrocartilaginous joint. The outer ring of the intervertebral disc is known as the annulus fibrosus, while the inner gel-like structure in the center is known as the nucleus pulposus. The cartilage endplates sandwich the nucleus pulposus superiorly and inferiorly. The annulus fibrosus comprises concentric collagen fiber sheets arranged in a radial tire-like structure into lamellae. The fibers are attached to the vertebral endplates and oriented at different angles. With their cartilaginous part, the endplates anchor the discs in their proper place.

The nucleus pulposus is composed of water, collagen, and proteoglycans. Proteoglycans attract and retain moisture, giving the nucleus pulposus a hydrated gel-like consistency. Interestingly, throughout the day, the amount of water found in the nucleus pulposus varies according to the person’s level of activity. This feature in the intervertebral disc serves as a cushion or a spinal shock-absorbing system to protect the adjacent vertebra, spinal nerves, spinal cord, brain, and other structures against various forces. Although the individual movement of the intervertebral discs is limited, some form of vertebral motion like flexion and extension is still possible due to the features of the intervertebral disc.

Effect of Intervertebral Disc Morphology on Structure and Function

The type of components present in the intervertebral disc and how it is arranged determine the morphology of the intervertebral disc. This is important in how effectively the disc does its function. As the disc is the most important element which bears the load and allows movement in the otherwise rigid spine, the constituents it is made up of have a significant bearing.

The complexity of the lamellae increases with advancing age as a result of the synthetic response of the intervertebral disc cells to the variations in the mechanical load. These changes in lamellae with more bifurcations, interdigitation and irregular size and number of lamellar bands will lead to the altered bearing of weight. This in turn establishes a self-perpetuated disruption cycle leading to the destruction of the intervertebral discs. Once this process is started it is irreversible. As there is an increased number of cells, the amount of nutrition the disc requires is also increasingly changing the normal concentration gradient of both metabolites and nutrients. Due to this increased demand, the cells may also die increasingly by necrosis or apoptosis.

Human intervertebral discs are avascular and hence the nutrients are diffused from the nearby blood vessels in the margin of the disc. The main nutrients; oxygen and glucose reach the cells in the disc through diffusion according to the gradient determined by the rate of transport to the cells through the tissues and the rate of demand. Cells also increasingly produce lactic acid as a metabolic end product. This is also removed via the capillaries and venules back to the circulation.

Since diffusion depends on the distance, the cells lying far from the blood capillaries can have a reduced concentration of nutrients because of the reduced supply. With disease processes, the normally avascular intervertebral disc can become vascular and innervated in degeneration and in disease processes. Although this may increase the oxygen and nutrient supply to the cells in the disc, this can also give rise to many other types of cells that are normally not found in the disc with the introduction of cytokines and growth factors.

The morphology of the intervertebral disc in different parts of the spine also varies although many clinicians base the clinical theories based on the assumption that both cervical and lumbar intervertebral discs have the same structure. The height of the disc was the minimum in the T4-5 level of the thoracic column probably due to the fact that thoracic intervertebral discs are less wedge-shaped than those of cervical and lumbar spinal regions.

From the cranial to caudal direction, the cross-sectional area of the spine increased. Therefore, by the L5-S1 level, the nucleus pulposus was occupying a higher proportion of the intervertebral disc area. The cervical discs have an elliptical shape on cross-section while the thoracic discs had a more circular shape. The lumbar discs also have an elliptical shape though it is more flattened or re-entrant posteriorly.

What is a Disc Bulge?

The bulging disc is when the disc simply bulges outside the intervertebral disc space it normally occupies without the rupture of the outer annulus fibrosus. The bulging area is quite large when compared to a herniated disc. Moreover, in a herniated disc, the annulus fibrosus ruptures or cracks. Although disc bulging is more common than disc herniation, it causes little or no pain to the patient. In contrast, the herniated disc causes a lot of pain.

Causes for Disc Bulging

A bulging disc can be due to several causes. It can occur due to normal age-related changes such as those seen in degenerative disc disease. The aging process can lead to structural and biochemical changes in the intervertebral discs and lead to reduced water content in the nucleus pulposus. These changes can make the patient vulnerable to disc bulges with only minor trauma. Some unhealthy lifestyle habits such as a sedentary lifestyle and smoking can potentiate this process and give rise to more severe changes with the weakening of the disc.

General wear and tear due to repeated microtrauma can also weaken the disc and give rise to disc bulging. This is because when the discs are strained, the normal distribution of weight loading changes. Accumulated micro-trauma over a long period of time can occur in bad posture. Bad posture when sitting, standing, sleeping, and working can increase the pressure in the intervertebral discs.

When a person maintains a forward bending posture, it can lead to overstretching and eventually weakness of the posterior part of the annulus fibrosus. Over time, the intervertebral disc can bulge posteriorly. In occupations that require frequent and repetitive lifting, standing, driving, or bending, the bulging disc may be an occupational hazard. Improper lifting up of items, and improper carrying of heavy objects can also increase the pressure on the spine and lead to disc bulges eventually.

The bulging intervertebral discs usually occur over a long period of time. However, the discs can bulge due to acute trauma too. The unexpected sudden mechanical load can damage the disc resulting in micro-tears. After an accident, the disc can become weakened causing long-term microdamage ultimately leading to bulging of the disc. There may also be a genetic component to the disc bulging. The individual may have a reduced density of elastin in the annulus fibrosus with increased susceptibility to disc diseases. Other environmental facts may also play a part in this disease process.

Symptoms of Disc Bulging

As mentioned previously, bulging discs do not cause pain and even if they do the severity is mild. In the cervical region, the disease will cause pain running down the neck, deep pain in the shoulder region, pain radiating along the upper arm, and forearm up to the fingers.

This may give rise to a diagnostic dilemma as to whether the patient is suffering from a myocardial infarction as the site of referred pain and the radiation is similar. Tingling feeling on the neck may also occur due to the bulging disc.

In the thoracic region, there may be pain in the upper back that radiates to the chest or the upper abdominal region. This may also suggest upper gastrointestinal, lung, or cardiac pathology and hence need to be careful when analyzing these symptoms.

The bulging discs of the lumbar region may present as lower back pain and tingling feeling in the lower back region of the spine. This is the most common site for disc bulges since this area holds the weight of the upper body. The pain or the discomfort can spread through the gluteal area, thighs, and to the feet. There may also be muscle weakness, numbness or tingling sensation. When the disc presses on the spinal cord, the reflexes of both legs can increase leading to spasticity.

Some patients may even have paralysis from the waist down. When the bulging disc compresses on the cauda equine, the bladder and bowel functions can also change. The bulging disc can press on the sciatic nerve leading to sciatica where the pain radiates in one leg from the back down to the feet.

The pain from the bulging disc can get worse during some activities as the bulge can then compress on some of the nerves. Depending on what nerve is affected, the clinical features can also vary.

Diagnosis of Disc Bulging

The diagnosis may not be apparent from clinical history due to similar presentations in more serious problems. But the chronic nature of the disease may give some clues. Complete history and a physical examination need to be done to rule out myocardial infarction, gastritis, gastro-oesophageal reflux disease, and chronic lung pathology.

MRI of Disc Bulge

Investigations are necessary for the diagnosis. X-ray spine is performed to look for gross pathology although it may not show the bulging disc directly. There may be indirect findings of disk degeneration such as osteophytes in the endplates, gas in the disc due to the vacuum phenomenon, and the loss of height of the intervertebral disc. In the case of moderate bulges, it may sometimes appear as non-focal intervertebral disc material that is protruded beyond the borders of the vertebra which is broad-based, circumferential, and symmetrical.

Magnetic resonance imaging or MRI can exquisitely define the anatomy of the intervertebral discs especially the nucleus pulposus and its relationships. The early findings seen on MRI in disc bulging include the loss of normal concavity of the posterior disc. The bulges can be seen as broad-based, circumferential, and symmetrical areas. In moderate bulging, the disc material will protrude beyond the borders of the vertebrae in a non-focal manner. Ct myelogram may also give detailed disc anatomy and may be useful in the diagnosis.

Treatment of Disc Bulging

The treatment for the bulging disc can be conservative, but sometimes surgery is required.

Conservative Treatment

When the disc bulging is asymptomatic, the patient does not need any treatment since it does not pose an increased risk. However, if the patient is symptomatic, the management can be directed at relieving the symptoms. The pain is usually resolved with time. Till then, potent pain killers such as non-steroidal anti-inflammatory drugs like ibuprofen should be prescribed. In unresolved pain, steroid injections can also be given to the affected area and if it still does not work, the lumbar sympathetic block can be tried in most severe cases.

The patient can also be given the option of choosing alternative therapies such as professional massage, physical therapy, ice packs, and heating pads which may alleviate symptoms. Maintaining correct posture, tapes, or braces to support the spine are used with the aid of a physiotherapist. This may fasten the recovery process by avoiding further damage and keeping the damaged or torn fibers in the intervertebral disc without leakage of the fluid portion of the disc. This helps maintain the normal structure of the annulus and may increase the recovery rate. Usually, the painful symptoms which present initially get resolved over time and lead to no pain. However, if the symptoms get worse steadily, the patient may need surgery

If the symptoms are resolved, physiotherapy can be used to strengthen the muscles of the back with the use of exercises. Gradual exercises can be used for the return of function and for preventing recurrences.

Surgical Treatment

When conservative therapy does not work with a few months of treatment, surgical treatment can be considered. Most would prefer minimally invasive surgery which uses advanced technology to correct the intervertebral disc without having to grossly dissect the back. These procedures such as microdiscectomy have a lower recovery period and reduced risk of scar formation, major blood loss, and trauma to adjacent structures when compared to open surgery.

Previously, laminectomy and discectomy have been a mainstay of treatment. However, due to the invasiveness of the procedure and due to increased damage to the nerves these procedures are currently abandoned by many clinicians for disc bulging.

Disc bulging in the thoracic spine is being treated surgically with costotransversectomy where a section of the transverse process is resected to allow access to the intervertebral disc. The spinal cord and spinal nerves are decompressed by using thoracic decompression by removing a part of the vertebral body and making a small opening. The patient may also need a spinal fusion later on if the removed spinal body was significant.

Video-assisted thoracoscopic surgery can also be used where only a small incision is made and the surgeon can perform the surgery with the assistance of the camera. If the surgical procedure involved removing a large portion of the spinal bone and disc material, it may lead to spinal instability. This may need bone grafting to replace the lost portion with plates and screws to hold them in place.

What is a Disc Herniation?

As mentioned in the first section of this article, disc herniation occurs when there is disc material displaces beyond the limits of the intervertebral disc focally. The disc space consists of endplates of the vertebral bodies superiorly and inferiorly while the outer edges of the vertebral apophyses consist of the peripheral margin. The osteophytes are not considered a disc margin. There may be irritation or compression of the nerve roots and dural sac due to the volume of the herniated material leading to pain. When this occurs in the lumbar region, this is classically known as sciatica. This condition has been mentioned since ancient times although a connection between disc herniation and sciatica was made only in the 20th century. Disc herniation is one of the commonest diagnoses seen in the spine due to degenerative changes and is the commonest cause of spinal surgery.

Classifications of Disc Herniation

There are many classifications regarding intervertebral disc herniation. In focal disc herniation, there is a localized displacement of the disc material in the horizontal or axial plane. In this type, only less than 25% of the circumference of the disc is involved. In broad-based disc herniation, about 25 – 50 % of the disc circumference is herniated. The disc bulge is when 50 – 100 % of the disc material is extended beyond the normal confines of the intervertebral space. This is not considered a form of disc herniation. Furthermore, the intervertebral disc deformities associated with severe cases of scoliosis and spondylolisthesis are not classified as a herniation but rather adaptive changes of the contour of the disc due to the adjacent deformity.

Depending on the contour of the displaced material, the herniated discs can be further classified as protrusions and extrusions. In disc protrusion, the distance measured in any plane involving the edges of the disc material beyond intervertebral disc space (the highest measure is taken) is lower than the distance measured in the same plane between the edges of the base.

Imaging can show the disc displacement as a protrusion on the horizontal section and as an extrusion on the sagittal section due to the fact that the posterior longitudinal ligament contains the disc material that is displaced posteriorly. Then the herniation should be considered an extrusion. Sometimes the intervertebral disc herniation can occur in the craniocaudal or vertical direction through a defect in the vertebral body endplates. This type of herniation is known as intravertebral herniation.

The disc protrusion can also be divided into two focal protrusion and broad-based protrusion. In focal protrusion, the herniation is less than 25% of the circumference of the disc whereas, in broad-based protrusion, the herniated disc consists of 25 – 50 % of the circumference of the disc.

In disc extrusion, it is diagnosed if any of the two following criteria are satisfied. The first one is; that the distance measured between the edges of the disc material that is beyond the intervertebral disc space is greater than the distance measured in the same plane between the edges of the base. The second one is; that the material in the intervertebral disc space and material beyond the intervertebral disc space is having a lack continuity.

This can be further characterized as sequestrated which is a subtype of the extruded disc. It is called disc migration when disk material is pushed away from the site of extrusion without considering whether there is continuity of disc or not. This term is useful in interpreting imaging modalities as it is often difficult to show continuity in imaging.

The intervertebral disc herniation can be further classified as contained discs and discs that are unconfined. The term contained disc is used to refer to the integrity of the peripheral annulus fibrosus which is covering the intervertebral disc herniation. When fluid is injected into the intervertebral disc, the fluid does not leak into the vertebral canal in herniations that are contained.

Sometimes there are displaced disc fragments that are characterized as free. However, there should be no continuity between disc material and the fragment and the original intervertebral disc for it to be called a free fragment or a sequestered one. In a migrated disc and in a migrated fragment, there is an extrusion of disc material through the opening in the annulus fibrosus with a displacement of the disc material away from the annulus.

Even though some fragments that are migrated can be sequestered the term migrated means just to the position and it is not referred to the continuity of the disc. The displaced intervertebral disc material can be further described with regard to the posterior longitudinal ligament as submembranous, subcapsular, subligamentous, extra ligamentous, transligamentous, subcapsular, and perforated.

The spinal canal can also get affected by an intervertebral disc herniation. This compromise of the canal can also be classified as mild, moderate, and severe depending on the area that is compromised. If the canal at that section is compromised only less than one third, it is called mild whereas if it is only compromised less than two-thirds and more than one third it is considered moderate. In a severe compromise, more than two-thirds of the spinal canal is affected. For the foraminal involvement, this same grading system can be applied.

The displaced material can be named according to the position that they are in the axial plane from the center to the right lateral region. They are termed as central, right central, right subarticular, right foraminal, and right extraforaminal. The displaced intervertebral disc material’s composition can be further classified as gaseous, liquefied, desiccated, scarred, calcified, ossified, bony, nuclear, and cartilaginous.

Before going into detail on how to diagnose and treat intervertebral disc herniation, let us differentiate how cervical disc herniation differs from lumbar herniation since they are the most common regions to undergo herniation.

Cervical Disc Herniation vs. Thoracic Disc Herniation vs Lumbar Disc Herniation

Lumbar disc herniation is the most commonest type of herniation found in the spine which is approximately 90% of the total. However, cervical disc herniation can also occur in about one-tenth of patients. This difference is mainly due to the fact that the lumbar spine has more pressure due to the increased load. Moreover, it has comparatively large intervertebral disc material. The most common sites of intervertebral disc herniation in the lumbar region are L 5 – 6, in the Cervical region between C7, and in the thoracic region T12.

Cervical disc herniation can occur relatively commonly because the cervical spine acts as a pivoting point for the head and it is a vulnerable area for trauma and therefore prone to damage in the disc. Thoracic disc herniation occurs more infrequently than any of the two. This is due to the fact that thoracic vertebrae are attached to the ribs and the thoracic cage which limits the range of movement in the thoracic spine when compared to the cervical and lumbar spinal discs. However, thoracic intervertebral disc herniation can still occur.

Cervical disc herniation gives rise to neck pain, shoulder pain, pain radiating from the neck to the arm, tingling, etc. Lumbar disc herniation can similarly cause lower back pain as well as pain, tingling, numbness, and muscle weakness seen in the lower limbs. Thoracic disc herniation can give rise to pain in the upper back radiating to the torso.

Epidemiology

Although disc herniation can occur in all age groups, it predominantly occurs between the fourth and fifth decade of life with the mean age of 37 years. There have been reports that estimate the prevalence of intervertebral disc herniation to be 2 – 3 % of the general population. It is more commonly seen in men over 35 years with a prevalence of 4.8% and while in women this figure is around 2.5%. Due to its high prevalence, it is considered a worldwide problem as it is also associated with significant disability.

Risk Factors

In most instances, a herniated disc occurs due to the natural aging process in the intervertebral disc. Due to the disc degeneration, the amount of water that was previously seen in the intervertebral disc gets dried out leading to the shrinking of the disc with the narrowing of the intervertebral space. These changes are markedly seen in degenerative disc disease. In addition to these gradual changes due to normal wear and tear, other factors may also contribute to increasing the risk of intervertebral disc herniation.

Being overweight can increase the load on the spine and increase the risk of herniation. A sedentary life can also increase the risk and therefore an active lifestyle is recommended in preventing this condition. Improper posture with prolonged standing, sitting, and especially driving can put a strain on the intervertebral discs due to the additional vibration from the vehicle engine leading to microtrauma and cracks in the disc. The occupations which require constant bending, twisting, pulling and lifting can put a strain on the back. Improper weight lifting techniques are one of the major reasons.

When back muscles are used in lifting heavy objects instead of lifting with the legs and twisting while lifting can make the lumbar discs more vulnerable to herniation. Therefore patients should always be advised to lift weights with their legs and not the back. Smoking has been thought to increase disc herniation by reducing the blood supply to the intervertebral disc leading to degenerative changes of the disc.

Although the above factors are frequently assumed to be the causes for disc herniation, some studies have shown that the difference in risk is very small when this particular population was compared with the control groups of the normal population.

There have been several types of research done on genetic predisposition and intervertebral disc herniation. Some of the genes that are implicated in this disease include vitamin D receptor (VDR) which is a gene that codes for the polypeptides of important collagen called collagen IX (COL9A2).

Another gene called the human aggrecan gene (AGC) is also implicated as it codes for proteoglycans which is the most important structural protein found in the cartilage. It supports the biochemical and mechanical function of the cartilage tissue and hence when this gene is defective, it can predispose an individual to intervertebral disc herniation.

Apart from these, there are many other genes that are being researched due to the association between disc herniation such as matrix metalloproteinase (MMP) cartilage intermediate layer protein, thrombospondin (THBS2), collagen 11A1, carbohydrate sulfotransferase, and asporin (ASPN). They may also be regarded as potential gene markers for lumbar disc disease.

Pathogenesis of Sciatica and Disc Herniation

The sciatic pain originated from the extruded nucleus pulposus inducing various phenomena. It can directly compress the nerve roots leading to ischemia or without it, mechanically stimulate the nerve endings of the outer portion of the fibrous ring and release inflammatory substances suggesting its multifactorial origin. When the disc herniation causes mechanical compression of the nerve roots, the nerve membrane is sensitized to pain and other stimuli due to ischemia. It has been shown that in sensitized and compromised nerve roots, the threshold for neuronal sensitization is around half of that of a normal and non-compromised nerve root.

The inflammatory cell infiltration is different in extruded discs and non-extruded discs. Usually, in non-extruded discs, the inflammation is less. The extruded disc herniation causes the posterior longitudinal ligament to rupture which exposes the herniated part to the vascular bed of the epidural space. It is believed that inflammatory cells are originating from these blood vessels situated in the outermost part of the intervertebral disc.

These cells may help secrete substances that cause inflammation and irritation of the nerve roots causing sciatic pain. Therefore, extruded herniations are more likely to cause pain and clinical impairment than those that are contained. In contained herniations, the mechanical effect is predominant while in the unconfined or the extruded discs the inflammatory effect is predominant.

Clinical Disc Herniation and What to Look for in the History

The symptoms of the disc herniation can vary a great deal depending on the location of the pain, the type of herniation, and the individual. Therefore, history should focus on the analysis of the main complaint among the many other symptoms.

The chief complaint can be neck pain in cervical disc herniation and there can be referred pain in the arms, shoulders, neck, head, face, and even the lower back region. However, it is most commonly referred to as the interscapular region. The radiation of pain can occur according to the level at the herniation is taking place. When the nerve roots of the cervical region are affected and compressed, there can be sensory, and motor changes with changes in the reflexes.

The pain that occurs due to nerve root compression is called radicular pain and it can be described as deep, aching, burning, dull, achy, and electric depending on whether there is mainly motor dysfunction or sensory dysfunction. In the upper limb, the radicular pain can follow a dermatomal or myotomal pattern. Radiculopathy usually does not accompany neck pain. There can be unilateral as well as bilateral symptoms. These symptoms can be aggravated by activities that increase the pressure inside the intervertebral discs such as the Valsalva maneuver and lifting.

Driving can also exacerbate pain due to disc herniation due to stress because of vibration. Some studies have shown that shock loading and stress from vibration can cause a mechanical force to exacerbate small herniations but flexed posture had no influence. Similarly, activities that decrease intradiscal pressure can reduce the symptoms such as lying down.

The main complaint in lumbar disc herniation is lower back pain. Other associated symptoms can be a pain in the thigh, buttocks, and anogenital region which can radiate to the foot and toe. The main nerve affected in this region is the sciatic nerve causing sciatica and its associated symptoms such as intense pain in the buttocks, leg pain, muscle weakness, numbness, impairment of sensation, hot and burning or tingling sensation in the legs, dysfunction of gait, impairment of reflexes, edema, dysesthesia or paresthesia in the lower limbs. However, sciatica can be caused by causes other than herniation such as tumors, infection, or instability which need to be ruled out before arriving at a diagnosis.

The herniated disc can also compress on the femoral nerve and can give rise to symptoms such as numbness, tingling sensation in one or both legs, and a burning sensation in the legs and hips. Usually, the nerve roots that are affected in herniation in the lumbar region are the ones exiting below the intervertebral disc. It is thought that the level of the nerve root irritation determines the distribution of leg pain. In herniations at the third and fourth lumbar vertebral levels, the pain may radiate to the anterior thigh or the groin. In radiculopathy at the level of the fifth lumbar vertebra, the pain may occur in the lateral and anterior thigh region. In herniations at the level of the first sacrum, the pain may occur in the bottom of the foot and the calf. There can also be numbness and tingling sensation occurring in the same area of distribution. The weakness in the muscles may not be able to be recognized if the pain is very severe.

When changing positions the patient is often relieved from pain. Maintaining a supine position with the legs raised can improve the pain. Short pain relief can be brought by having short walks while long walks, standing for prolonged periods, and sitting for extended periods of time such as in driving can worsen the pain.

The lateral disc herniation is seen in foraminal and extraforaminal herniations and they have different clinical features to that of medial disc herniation seen in subarticular and central herniations. The lateral intervertebral disc herniations can when compared to medial herniations more directly irritate and mechanically compress the nerve roots that are exiting and the dorsal root ganglions situated inside the narrowed spinal canal.

Therefore, lateral herniation is seen more frequently in older age with more radicular pain and neurological deficits. There is also more radiating leg pain and intervertebral disc herniations in multiple levels in the lateral groups when compared to medial disc herniations.

The herniated disc in the thoracic region may not present with back pain at all. Instead, there are predominant symptoms due to referred pain in the thorax due to irritation of nerves. There can also be predominant pain in the body that travels to the legs, tingling sensation and numbness in one or both legs, muscle weakness, and spasticity of one or both legs due to exaggerated reflexes.

The clinician should look out for atypical presentations as there could be other differential diagnoses. The onset of symptoms should be inquired about to determine whether the disease is acute, sub-acute, or chronic in onset. Past medical history has to be inquired about in detail to exclude red flag symptoms such as pain that occurs at night without activity which can be seen in pelvic vein compression, and non-mechanical pain which may be seen in tumors or infections.

If there is a progressive neurological deficit, with bowel and bladder involvement is there, it is considered a neurological emergency and urgently investigated because cauda equine syndrome may occur which if untreated, can lead to permanent neurological deficit.

Getting a detailed history is important including the occupation of the patient as some activities in the job may be exacerbating the patient’s symptoms. The patient should be assessed regarding which activities he can and cannot do.

Differential Diagnosis

  • Degenerative disc disease
  • Mechanical pain
  • Myofascial pain leading to sensory disturbances and local or referred pain
  • Hematoma
  • Cyst leading to occasional motor deficits and sensory disturbances
  • Spondylosis or spondylolisthesis
  • Discitis or osteomyelitis
  • Malignancy, neurinoma or mass lesion causing atrophy of thigh muscles, glutei
  • Spinal stenosis is seen mainly in the lumbar region with mild low back pain, motor deficits, and pain in one or both legs.
  • An epidural  abscess can cause symptoms similar to radicular pain involving spinal disc herniation
  • Aortic aneurysm which can cause low back pain and leg pain due to compression can also rupture and lead to hemorrhagic shock.
  • Hodgkin’s lymphoma in advanced stages can lead to space-occupying lesions in the spinal column leading to symptoms like that of intervertebral disc herniation
  • Tumors
  • Pelvic endometriosis
  • Facet hypertrophy
  • Lumbar nerve root schwannoma
  • Herpes zoster infection results in inflammation along with the sciatic or lumbosacral nerve roots

Examination in Disc Herniation

Complete physical examination is necessary to diagnose intervertebral disc herniation and exclude other important differential diagnoses. The range of motion has to be tested but may have a poor correlation with disc herniation as it is mainly reduced in elderly patients with a degenerative disease and due to disease of the joints.

A complete neurological examination is often necessary. This should test muscle weakness and sensory weakness. In order to detect muscle weakness in small toe muscles, the patient can be asked to walk on tiptoe. The strength of muscle can also be tested by comparing the strength to that of the clinician. There may be dermatomal sensory loss suggesting the respective nerve root involvement. The reflexes may be exaggerated or sometimes maybe even absent.

There are many neurologic examination maneuvers described in relation to intervertebral disc herniation such as the Braggart sign, flip the sign, Lasegue rebound sign, Lasegue differential sign, Mendel Bechterew sign, Deyerle sign both legs or Milgram test, and well leg or Fajersztajin test. However, all these are based on testing the sciatic nerve root tension by using the same principles in the straight leg raising test. These tests are used for specific situations to detect subtle differences.

Nearly almost all of them depend on the pain radiating down the leg and if it occurs above the knee it is assumed to be due to a neuronal compressive lesion and if the pain goes below the knee, it is considered to be due to the compression of the sciatic nerve root. For lumbar disc herniation detection, the most sensitive test is considered to be radiating pain occurring down the leg due to provocation.

In the straight leg raising test also called the Lasegue’s sign, the patient stays on his or her back and keeps the legs straight. The clinician then lifts the legs by flexing the hip while keeping the knee straight. The angle at which the patient feels pain going down the leg below the knee is noted. In a normal healthy individual, the patient can flex the hip to 80- 90? without having any pain or difficulty.

However, if the angle is just 30 -70? degrees, it is suggestive of lumbar intervertebral disc herniation at the L4 to S1 nerve root levels. If the angle of hip flexion without pain is less than 30 degrees, it usually indicates some other causes such as tumor of the gluteal region, gluteal abscess, spondylolisthesis, disc extrusion, and protrusion, malingering patient, and acute inflammation of the dura mater. If pain with hip flexion occurs at more than 70 degrees, it may be due to tightness of the muscles such as gluteus maximus and hamstrings, tightness of the capsule of the hip joint, or pathology of sacroiliac or hip joints.

The reverse straight leg raising test or hip extension test can be used to test higher lumbar lesions by stretching the nerve roots of the femoral nerve which is similar to the straight leg raising test. In the cervical spine, in order to detect stenosis of the foramina, the Spurling test is done and is not specific to cervical intervertebral disc herniation or tension of the nerve roots. The Kemp test is the analogous test in the lumbar region to detect foraminal stenosis. Complications due to the disc herniation include careful examination of the hip region, digital rectal examination, and urogenital examination is needed.

Investigation of Disc Herniation

For the diagnosis of intervertebral disc herniation, diagnostic tests such as Magnetic resonance imaging (MRI), Computed tomography (CT), myelography, and plain radiography can be used either alone or in combination with other imaging modalities. Objective detection of disc herniation is important because only after such a finding the surgical intervention is even considered. Serum biochemical tests such as prostate-specific antigen (PSA) level, Alkaline phosphatize value, erythrocyte sedimentation rate (ESR), urine analysis for Bence Jones protein, serum glucose level, and serum protein electrophoresis may also be needed in specific circumstances guided by history.

Magnetic Resonance Imaging (MRI)

MRI is considered the best imaging modality in patients with history and physical examination findings suggestive of lumbar disc herniation associated with radiculopathy according to North American Spinal Society guidelines in 2014. The anatomy of the herniated nucleus pulposus and its associated relationships with soft tissue in the adjacent areas can be delineated exquisitely by MRI in cervical, thoracic, and lumbosacral areas. Beyond the confines of the annulus, the herniated nucleus can be seen as a focal, asymmetric disc material protrusion on MRI.

On sagittal T2 weighted images, the posterior annulus is usually seen as a high signal intensity area due to radial annular tear associated with the herniation of the disc although the herniated nucleus is itself hypointense. The relationship between the herniated nucleus and degenerated facets with the nerve roots which are exiting through the neural foramina are well-demarcated on sagittal images of MRI. Free fragments of the intervertebral disc can also be distinguished from MRI images.

There may be associated signs of intervertebral disc herniation on MRI such as radial tears on the annulus fibrosus which is also a sign of degenerative disc disease. There may be other telling signs such as loss of disc height, bulging annulus, and changes in the endplates. Atypical signs may also be seen with MRI such as abnormal disc locations, and lesions located completely outside the intervertebral disc space.

MRI can detect abnormalities in the intervertebral discs superiorly to other modalities although its bone imaging is a little less inferior. However, there are limitations with MRI in patients with metal implant devices such as pacemakers because the electromagnetic field can lead to abnormal functioning of the pacemakers. In patients with claustrophobia, it may become a problem to go to the narrow canal to be scanned by the MRI machine. Although some units contain open MRI, it has less magnetic power and hence delineates less superior quality imaging.

This is also a problem in children and anxious patients undergoing MRI because good image quality depends on the patient staying still. They may require sedation. The contrast used in MRI which is gadolinium can induce nephrogenic systemic fibrosis in patients who had pre-existing renal disease. MRI is also generally avoided in pregnancy especially during the first 12 weeks although it has not been clinically proven to be hazardous to the fetus. MRI is not very useful when a tumor contains calcium and in distinguishing edema fluid from tumor tissue.

Computed Tomography (CT)

CT scanning is also considered another good method to assess spinal disc herniation when MRI is not available. It is also recommended as a first-line investigation in unstable patients with severe bleeding. CT scanning is superior to myelography although when the two are combined, it is superior both of them. CT scans can show calcification more clearly and sometimes even gas in images. In order to achieve a superior imaging quality, the imaging should be focused on the site of pathology and thin sections taken to better determine the extent of the herniation.

However, a CT scan is difficult to be used in patients who have already undergone laminectomy surgical procedures because the presence of scar tissue and fibrosis causes the identification of the structures difficult although bony changes and deformity in nerve sheath are helpful in making a diagnosis.

The herniated intervertebral discs in the cervical disc can be identified by studying the uncinate process. It is usually projected posteriorly and laterally to the intervertebral discs and superiorly to the vertebral bodies. The uncinate process undergoes sclerosis, and hypertrophy when there is an abnormal relationship between the uncinate process and adjacent structures as seen in degenerative disc disease, intervertebral disc space narrowing, and general wear and tear.

Myelopathy can occur when the spinal canal is affected due to disc disease. Similarly, when neural foramina are involved, radiculopathy occurs. Even small herniated discs and protrusions can cause impingement of the dural sac because the cervical epidural space is narrowed naturally. The intervertebral discs have attenuation a little bit greater than the sac characterized in the CT scan.

In the thoracic region, a CT scan can diagnose an intervertebral disc herniation with ease due to the fact that there is an increased amount of calcium found in the thoracic discs. Lateral to the dural sac, the herniated disc material can be seen on CT as a clearly defined mass that is surrounded by epidural fat. When there is a lack of epidural fat, the disc appears as a higher attenuated mass compared to the surrounding.

Radiography

Plain radiography is not needed in diagnosing herniation of the intervertebral discs, because plain radiographs cannot detect the disc and therefore are used to exclude other conditions such as tumors, infections, and fractures.

In myelography, there may be deformity or displacement of the extradural contrast-filled thecal sac seen in herniation of the disc. There may also be features in the affected nerve such as edema, elevation, deviation, and amputation of the nerve root seen in the myelography image.

Diskography

In this imaging modality, the contrast medium is injected into the disc in order to assess the disc morphology. If pain occurs following injection that is similar to the discogenic pain, it suggests that that disc is the source of the pain. When a CT scan is also performed immediately after discography, it is helpful to differentiate the anatomy and pathological changes. However, since it is an invasive procedure, it is indicated only in special circumstances when MRI and CT have failed to reveal the etiology of back pain. It has several side effects such as headache, meningitis, damage to the disc, discitis, intrathecal hemorrhage, and increased pain.

Treatment of Herniated Disc

The treatment should be individualized according to the patient-guided through history, physical examination, and diagnostic investigation findings. In most cases, the patient gradually improves without needing further intervention in about 3 – 4 months. Therefore, the patient only needs conservative therapy during this time period. Because of this reason, there are many ineffective therapies that have emerged by attributing the natural resolution of symptoms to that therapy. Therefore, conservative therapy needs to be evidence-based.

Conservative Therapy

Since the herniation of the disc has a benign course, the aim of treatment is to stimulate the recovery of neurological function, reduce pain, and facilitate early return to work and activities of daily living. The most benefits of the conservative treatment are for younger patients with hernias that are sequestered and in patients with mild neurological deficits due to small disc hernias.

Bed rest has long been considered a treatment option in herniation of the disc. However, it has been shown that bed rest has no effect beyond the first 1 or 2 days. The bed rest is regarded as counterproductive after this period of time.

In order to reduce the pain, oral non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen can be used. This can relieve the pain by reducing inflammation associated with the inflamed nerve. Analgesics such as acetaminophen can also be used although they lack the anti-inflammatory effect seen in NSAIDs. The doses and the drugs should be appropriate for the age and severity of the pain in the patient. If pain is not controlled by the current medication, the clinician has to go one step up on the WHO analgesics ladder. However, the long-term use of NSAIDs and analgesics can lead to gastric ulcers, liver, and kidney problems.

In order to reduce the inflammation, other alternative methods such as applying ice in the initial period and then switching to using heat, gels, and rubs may help with the pain as well as muscle spasms. Oral muscle relaxants can also be used in relieving muscle spasms. Some of the drugs include methocarbamol, carisoprodol, and cyclobenzaprine.

However, they act centrally and cause drowsiness and sedation in patients and it does not act directly to reduce muscle spasm. A short course of oral steroids such as prednisolone for a period of 5 days in a tapering regime can be given to reduce the swelling and inflammation in the nerves. It can provide immediate pain relief within a period of 24 hours.

When the pain is not resolved adequately with maximum effective doses, the patient can be considered for giving steroid injections into the epidural space. The major indication for the steroid injection into periradicular space is discal compression causing radicular pain that is resistant to conventional medical treatment. A careful evaluation with CT or MRI scanning is required to carefully exclude extra discal causes for pain. The contraindications for this therapy include patients with diabetes, pregnancy, and gastric ulcers. Epidural puncture is contraindicated in patients with coagulation disorders and therefore the foraminal approach is used carefully if needed.

This procedure is performed under the guidance of fluoroscopy and involves injecting steroids and an analgesic into the epidural space adjacent to the affected intervertebral disc to reduce the swelling and inflammation of the nerves directly in an outpatient setting. As much as 50% of the patients experience relief after the injection although it is temporary and they might need repeat injections at 2 weekly intervals to achieve the best results. If this treatment modality becomes successful, up to 3 epidural steroidal injections can be given per year.

Physical therapy can help the patient return to his previous life easily although it does not improve the herniated disc. The physical therapist can instruct the patient on how to maintain the correct posture, walking, and lifting techniques depending on the patient’s ability to work, mobility, and flexibility.

Stretching exercises can improve the flexibility of the spine while strengthening exercises can increase the strength of the back muscles. The activities which can aggravate the condition of the herniated disc are instructed to be avoided. Physical therapy makes the transition from intervertebral disc herniation to an active lifestyle smooth. The exercise regimes can be maintained for life to improve general well-being.

The most effective conservative treatment option that is evidence-based is observation and epidural steroid injection for the relief of pain in the short-term duration. However, if the patients so desire they can use holistic therapies of their choice with acupuncture, acupressure, nutritional supplements, and biofeedback although they are not evidence-based. There is also no evidence to justify the use of trans electrical nerve stimulation (TENS) as a pain relief method.

If there is no improvement in the pain after a few months, surgery can be contemplated and the patient must be selected carefully for the best possible outcome.

Surgical Therapy

The aim of surgical therapy is to decompress the nerve roots and relieve the tension. There are several indications for surgical treatment which are as follows.

Absolute indications include cauda equina syndrome or significant paresis. Other relative indications include motor deficits that are greater than grade 3, sciatica that is not responding to at least six months of conservative treatment, sciatica for more than six weeks, or nerve root pain due to foraminal bone stenosis.

There have been many discussions over the past few years regarding whether to treat herniation of intervertebral disc disease with prolonged conservative treatment or early surgical treatment. Much research has been conducted in this regard and most of them show that the final clinical outcome after 2 years is the same although the recovery is faster with early surgery. Therefore, it is suggested that early surgery may be appropriate as it enables the patient to return to work early and thereby is economically feasible.

Some surgeons may still use traditional discectomy although many are using minimally invasive surgical techniques over recent years. Microdiscectomy is considered to be the halfway between the two ends. There are two surgical approaches that are being used. Minimally invasive surgery and percutaneous procedures are the ones that are being used due to their relative advantage. There is no place for the traditional surgical procedure known as a laminectomy.

However, there are some studies suggesting microdiscectomy is more favorable because of its both short-term and long-term advantages. In the short term, there is a reduced length of operation, reduced bleeding, relief of symptoms, and reduced complication rate. This technique has been effective even after 10 years of follow-up and therefore is the most preferred technique even now. The studies that have been performed to compare the minimally invasive technique and microdiscectomy have resulted in different results. Some have failed to establish a significant difference while one randomized control study was able to determine that microdiscectomy was more favorable.

In microdiscectomy, only a small incision is made aided by an operating microscope and the part of the herniated intervertebral disc fragment which is impinging on the nerve is removed by hemilaminectomy. Some part of the bone is also removed to facilitate access to the nerve root and the intervertebral disc. The duration of the hospital stay is minimal with only an overnight stay and observation because the patient can be discharged with minimal soreness and complete relief of the symptoms.

However, some unstable patients may need more prolonged admission and sometimes they may need fusion and arthroplasty. It is estimated that about 80 – 85 % of the patients who undergo microdiscectomy recover successfully and many of them are able to return to their normal occupation in about 6 weeks.

There is a discussion on whether to remove a large portion of the disc fragment and curetting the disc space or to remove only the herniated fragment with minimal invasion of the intervertebral disc space. Many studies have suggested that the aggressive removal of large chunks of the disc could lead to more pain than when conservative therapy is used with 28% versus 11.5 %. It may lead to degenerative disc disease in the long term. However, with conservative therapy, there is a greater risk of recurrence of around 7 % in herniation of the disc. This may require additional surgery such as arthrodesis and arthroplasty to be performed in the future leading to significant distress and economic burden.

In the minimally invasive surgery, the surgeon usually makes a tiny incision in the back to put the dilators with increasing diameter to enlarge the tunnel until it reaches the vertebra. This technique causes lesser trauma to the muscles than when seen in traditional microdiscectomy. Only a small portion of the disc is removed in order to expose the nerve root and the intervertebral disc. Then the surgeon can remove the herniated disc by the use of an endoscope or a microscope.

These minimally invasive surgical techniques have a higher advantage of lower surgical site infections and shorter hospital stays. The disc is centrally decompressed either chemically or enzymatically with the use of chymopapain, laser, or plasma (ionized gas) ablation and vaporization. It can also be decompressed mechanically by using percutaneous lateral decompression or by aspirating and sucking with a shaver such as a nucleosome. Chemopapin was shown to have adverse effects and was eventually withdrawn. Most of the above techniques have shown to be less effective than a placebo. Directed segmentectomy is the one that has shown some promise in being effective similar to microdiscectomy.

In the cervical spine, the herniated intervertebral discs are treated anteriorly. This is because the herniation occurs anteriorly and the manipulation of the cervical cord is not tolerated by the patient. The disc herniation that is due to foraminal stenosis and that is confined to the foramen are the only instances where a posterior approach is contemplated.

The minimal disc excision is an alternative to the anterior cervical spine approach. However, the intervertebral disc stability after the procedure is dependent on the residual disc. The neck pain can be significantly reduced following the procedure due to the removal of neuronal compression although significant impairment can occur with residual axial neck pain. Another intervention for cervical disc herniation includes anterior cervical interbody fusion. It is more suitable for patients with severe myelopathy with degenerative disc disease.

Complications of the Surgery

Although the risk of surgery is very low, complications can still occur. Post-operative infection is one of the commonest complications and therefore needs more vigorous infection control procedures in the theatre and in the ward. During the surgery, due to poor surgical technique, nerve damage can occur. A dural leak may occur when an opening in the lining of the nerve root causes leakage of cerebrospinal fluid which is bathing the nerve roots. The lining can be repaired during the surgery. However, headache can occur due to loss of cerebrospinal fluid but it usually improves with time without any residual damage. If blood around the nerve roots clots after the surgery, that blood clot may lead to compression of the nerve root leading to radicular pain which was experienced by the patient previously. Recurrent herniation of the intervertebral disc due to herniation of disc material at the same site is a devastating complication that can occur long term. This can be managed conservatively but surgery may be necessary ultimately.

Outcomes of the Surgery

There has been extensive research done regarding the outcome of lumbar disc herniation surgery. Generally, the results from the microdiscectomy surgery are good. There is more improvement of leg pain than back pain and therefore this surgery is not recommended for those who have only back pain. Many patients improve clinically over the first week but they may improve over the following several months. Typically, the pain disappears in the initial recovery period and it is followed by an improvement in the strength of the leg. Finally, the improvement of the sensation occurs. However, patients may complain of feeling numbness although there is no pain. The normal activities and work can be resumed over a few weeks after the surgery.

Novel Therapies

Although conservative therapy is the most appropriate therapy in treating patients, the current standard of care does not address the underlying pathology of herniation of the intervertebral discs. There are various pathways that are involved in the pathogenesis such as inflammatory, immune-mediated, and proteolytic pathways.

The role of inflammatory mediators is currently under research and it has led to the development of new therapies that are directed at these inflammatory mediators causing damage to the nerve roots. The cytokines such as TNF ? are mainly involved in regulating these processes. The pain sensitivity is mediated by serotonin receptor antagonists and ?2 adrenergic receptor antagonists.

Therefore, pharmacological therapies that target these receptors and mediators may influence the disease process and lead to a reduction in symptoms. Currently, cytokine antagonists against TNF ? and IL 1? have been tested. Neuronal receptor blockers such as sarpogrelate hydrochloride etc have been tested in both animal models and in clinical studies for the treatment of sciatica. Cell cycle modifiers that target the microglia that are thought to initiate the inflammatory cascade have been tested with the neuroprotective antibiotic minocycline.

There is also research on inhibiting the NF- kB or protein kinase pathway recently. In the future, the treatment of herniation of the intervertebral disc will be much more improved thanks to the ongoing research. (Haro, Hirotaka)

 

El Paso Chiropractor Near Me

Dr. Alex Jimenez DC, MSACP, RN, CCST

 

A disc bulge and/or a herniated disc is a health issue that affects the intervertebral discs found in between each vertebra of the spine. Although these can occur as a natural part of degeneration with age, trauma or injury as well as repetitive overuse can also cause a disc bulge or a herniated disc. According to healthcare professionals, a disc bulge and/or a herniated disc is one of the most common health issues affecting the spine. A disc bulge is when the outer fibers of the annulus fibrosus are displaced from the margins of the adjacent vertebral bodies. A herniated disc is when a part of or the whole nucleus pulposus is protruded through the torn or weakened outer annulus fibrosus of the intervertebral disc. Treatment of these health issues focuses on reducing symptoms. Alternative treatment options, such as chiropractic care and/or physical therapy, can help relieve symptoms. Surgery may be utilized in cases of severe symptoms. – Dr. Alex Jimenez D.C., C.C.S.T. Insight

Curated by Dr. Alex Jimenez D.C., C.C.S.T.

 

References

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  • Fardon, D.F., et al., Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology,  and the American Society of Neuroradiology. Spine J, 2014. 14(11): p. 2525-45.
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  • Roberts, S. Disc Morphology In Health And Disease. Biochemical Society Transactions, vol 30, no. 5, 2002, pp. A112.4-A112. Portland Press Ltd., doi:10.1042/bst030a112c.
  • Johnson, W. E. B., and S. Roberts. Human Intervertebral Disc Cell Morphology And Cytoskeletal Composition: A Preliminary Study Of Regional Variations In Health And Disease. Journal Of Anatomy, vol 203, no. 6, 2003, pp. 605-612. Wiley-Blackwell, doi:10.1046/j.1469-7580.2003.00249.x.
  • Gruenhagen, Thijs. Nutrient Supply And Intervertebral Disc Metabolism. The Journal Of Bone And Joint Surgery (American), vol 88, no. suppl_2, 2006, p. 30. Ovid Technologies (Wolters Kluwer Health), doi:10.2106/jbjs.e.01290.
  • Mercer, S.R., and G.A. Jull. Morphology Of The Cervical Intervertebral Disc: Implications For Mckenzies Model Of The Disc Derangement Syndrome. Manual Therapy, vol 1, no. 2, 1996, pp. 76-81. Elsevier BV, doi:10.1054/math.1996.0253.
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  • Lappalainen, Anu K et al. Intervertebral Disc Disease In Dachshunds Radiographically Screened For Intervertebral Disc Calcifications. Acta Veterinaria Scandinavica, vol 56, no. 1, 2014, Springer Nature, doi:10.1186/s13028-014-0089-4.
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  • Mullen, Denis et al. Pathophysiology Of Disk-Related Sciatica. I. Evidence Supporting A Chemical Component. Joint Bone Spine, vol 73, no. 2, 2006, pp. 151-158. Elsevier BV, doi:10.1016/j.jbspin.2005.03.003.
  • Jacobs, Wilco C. H. et al. Surgical Techniques For Sciatica Due To Herniated Disc, A Systematic Review. European Spine Journal, vol 21, no. 11, 2012, pp. 2232-2251. Springer Nature, doi:10.1007/s00586-012-2422-9.
  • Rutkowski, B. Combined Practice Of Electrical Stimulation For Lumbar Intervertebral Disc Herniation.Pain, vol 11, 1981, p. S226. Ovid Technologies (Wolters Kluwer Health), doi:10.1016/0304-3959(81)90487-5.
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  • Carvalho, Lilian Braighi et al. Hrnia De Disco Lombar: Tratamento. Acta Fisitrica, vol 20, no. 2, 2013, pp. 75-82. GN1 Genesis Network, doi:10.5935/0104-7795.20130013.
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Kinesthesia: Body Sense Positioning

Kinesthesia: Body Sense Positioning

Kinesthesia is the body’s ability to sense movement, position, action, and location, also known as proprioception. An example is when moving the arm, the brain and body are aware that the arm has moved. When dealing with chronic back pain, individuals are unable to function normally with regular everyday movements causing discomfort.

Chronic back pain can make an individual feel like a stranger in their body, altering their perception. Tension develops throughout the body due to the pain, causing tightness and positional adaptations that are unfamiliar, awkward, and unhealthy for the musculoskeletal system. These body positioning changes continue while the individual is unaware of what they are doing, causing further strain and injury.

Kinesthesia: Body Sense Positioning

Kinesthesia

Kinesthesia is essential for overall coordination, balance, and posture as long as the movements are done correctly with proper form. Chronic back pain can affect kinesthesia differently. Individuals can misjudge and estimate that their bodies’ ability to lift, carry, or open something is more complicated or easier than it is. This can exceed the body’s tolerances, causing:

  • Strains
  • Sprains
  • Severe injuries

Once the back starts to hurt, this causes the individual’s sense of kinesthesia to compensate for the pain. As a result, individuals may knowingly or unknowingly attempt to carry out uncoordinated, awkward movements and positions, making things worse.

Motor Control

Motor control is the ability to control movement. When experiencing back pain, individuals adjust their motor control to avoid specific movements that cause back pain. Motor control adaptations and kinesthesia involve body positioning and heightened responsiveness to stimuli, like muscle spasms. Even moderate back pain can cause awkward and dangerous responses causing individuals to overcompensate or become too cautious, worsening or creating new injuries in the process. The body is performing movements that do not follow proper form, even though an individual thinks they are protecting themselves.

Building Healthy Proprioception

A recommended strategy for building kinesthesia to benefit the back and the rest of the body is yoga. Yoga helps build bodily sensory awareness. It trains the body when sending significant signals from the muscles, joints, and tendons back to the proprioceptive centers in the brain. This happens immediately and increases over time.

Yoga Poses

Creating positive awareness of the body’s movements will help relieve back pain as the body learns to feel, understand, and control the muscles. Here are a few poses to help, along with video links.

Reclining Hand-to-Big-Toe Pose

  • Lie with the back flat on the floor.
  • Grasp the big toe, foot, or ankle in both hands, or use a yoga strap or towel if you cannot reach the toes.
  • Hold the pose as long as possible while comfortable.
  • Repeat steps two and three on the other side.
  • Perform twice a day.
  • This pose stretches the lower back muscles, prevents spasms, and alleviates pain.
  • Avoid this pose if you have a herniated disc or retrolisthesis.

Bridge Pose

  • Lie flat on the floor with knees bent.
  • Arms bent on the floor.
  • Press down on the elbows and feet to raise the torso off the floor.
  • Hold and Repeat 4 to 5 times
  • Perform daily to relieve herniated disc, retrolisthesis, and vertebral fracture pain.
  • Avoid this pose if dealing with spinal stenosis, anterolisthesis, facet syndrome, or quadratus lumborum spasm.

Lord of the Fishes Pose

Body awareness is critical, but if an individual moves in a way that’s not natural to the body, it can cause injury. Kinesthesia and healthy posture can help avoid back pain and other health issues. A professional chiropractor can alleviate back pain, educate on proper form and recommend specific stretches and exercises to strengthen the body to prevent injury.


Body Composition


Magnesium

Magnesium supports a healthy immune system. It helps maintain:

  • Healthy bone structure
  • Muscle function
  • Insulin levels

Magnesium assists the body with ATP energy metabolism and acts as a calcium blocker. This reduces cramping and aids in muscle relaxation after physical activity/exercise. Magnesium is essential in biochemical reactions in the body. A slight deficiency can lead to an increased risk of cardiovascular disease and a higher risk of insulin resistance. Many magnesium-rich foods are high in fiber, like:

  • Dark leafy greens
  • Nuts
  • Legumes
  • Whole grains

Studies have shown that consuming a diet rich in Magnesium also provides a higher intake of dietary fiber. Dietary fiber aids in:

  • Digestion
  • Helps control weight
  • Reduces cholesterol
  • Stabilizes blood sugar

The best sources of Magnesium include:

  • Spinach, swiss chard, and turnip greens
  • Almonds and cashews
  • Flax, pumpkin, and chia seeds
  • Cocoa

References

Meier, Michael Lukas et al. “Low Back Pain: The Potential Contribution of Supraspinal Motor Control and Proprioception.” The Neuroscientist: a review journal bringing neurobiology, neurology and psychiatry vol. 25,6 (2019): 583-596. doi:10.1177/1073858418809074

Tong, Matthew Hoyan et al. “Is There a Relationship Between Lumbar Proprioception and Low Back Pain? A Systematic Review With Meta-Analysis.” Archives of physical medicine and rehabilitation vol. 98,1 (2017): 120-136.e2. doi:10.1016/j.apmr.2016.05.016

Wang, Jinsong, et al. “Dietary magnesium intake improves insulin resistance among non-diabetic individuals with metabolic syndrome participating in a dietary trial.” Nutrients vol. 5,10 3910-9. 27 Sep. 2013, doi:10.3390/nu5103910

Classes For Chronic Back Pain Management

Classes For Chronic Back Pain Management

Medical experts have seen how pain education and cognitive behavioral therapy or CBT classes effectively manage chronic back pain; even a one-time pain management class can help. Individuals experiencing back pain often try a variety of remedies to find relief. These include:

  • Eliminating activities
  • Over-the-counter medications
  • Prescription pain medications
  • Support devices and braces
  • Pain specialists
  • Surgery

All treatment options can help alleviate discomfort and pain, but sometimes taking a pain management class and getting educated on what is happening in the body has been shown to help individuals gain a better understanding helping them to find relief. A recent study suggests that a one-time class may be all that is needed. These quick classes can give more individuals immediate access to information and skill sets that can help reduce the pain and everything that comes with it.

Classes For Chronic Back Pain Management

Cognitive Behavioral Therapy Classes

Cognitive Behavioral Therapy for chronic pain provides individuals with information and pain management skills. Cognitive-behavioral therapy is handled by a therapist and can take multiple individual or group sessions that last one or two hours. A session can include:

  • Education on pain and how it works.
  • How thoughts and emotions influence pain.
  • How pain affects mood.
  • Sleep and pain.
  • Activity and action plan development.

Chronic lower back pain or CLBP is considered a physical ailment; cognitive behavioral therapy can provide mental health strategies to manage symptoms better. For example, individuals with chronic pain begin to fear doing activities that could increase their pain level and begin to constantly worry about worsening the injury or creating a new injury. This can lead to severe stress that exacerbates the chronic symptoms and can lead to other health issues.

Single Session Vs. Multiple

Doctors and medical experts are trying to make pain education and relief skills more accessible. They do not require multiple sessions and instead consist of single-session, two-hour management classes. A randomized clinical trial of adults with chronic low back pain was compared to:

  • 2-hour pain relief skills class known as Empowered Relief.
  • 2-hour back pain health education class with no skill set training.
  • 16-hour, 8-session cognitive behavioral therapy group class.

The study found that three months after treatment, the Empowered Relief group showed positive results. In the randomized trial, a single-session pain relief class was found to be non-inferior to an eight-session cognitive behavioral therapy class to:

  • Reduce pain-related distress
  • Pain intensity
  • Pain interference

Benefits

The individuals that completed the one-time 2-hour class reported positive results after three months. They found that the course had significantly reduced:

  • Pain intensity
  • Pain interference
  • Sleep disturbance
  • Anxiety
  • Fatigue
  • Depression

However, doctors caution that the two-hour class does not replace comprehensive cognitive-behavioral therapy. This is to get individuals on a positive path of pain management that can further develop into a healthy lifestyle. The objective is to create a range of options that meets an individual’s needs. The most significant advantage of a two-hour class is the convenience. Individuals can participate in these classes in person or online.


Body Composition


Supplements That Can Help Improve Lean Body Mass

A few dietary supplements that directly support body composition improvement.

Protein Powders

Protein powders are common nutritional/dietary supplements. Protein powders come in a variety of sources:

  • Milk-based – whey and casein
  • Egg-based
  • Plant-based – rice, hemp, pea, pumpkin seed, and soy.

Rice Protein

Rice protein is a plant-based protein powder used by vegans, vegetarians, and individuals who can’t tolerate dairy products. Research has found that rice protein has similar effects on body composition as whey. Scientists found that individuals who took rice protein and individuals that took whey protein both experienced positive body composition changes.

References

Cochrane Database of Systematic Reviews. (Oct 2015) “Psychological therapies for the management of chronic neuropathic pain in adults.” www.ncbi.nlm.nih.gov/pmc/articles/PMC6485637/

Darnall BD, Roy A, Chen AL, et al. Comparison of a Single-Session Pain Management Skills Intervention With a Single-Session Health Education Intervention and 8 Sessions of Cognitive Behavioral Therapy in Adults With Chronic Low Back Pain: A Randomized Clinical Trial. JAMA Netw Open. 2021;4(8):e2113401. doi:10.1001/jamanetworkopen.2021.13401

Future Neurology. (Nov 2014) “Neuroimaging chronic pain: what have we learned and where are we going?” www.ncbi.nlm.nih.gov/pmc/articles/PMC5289824/

HRB Open Research. (Aug 2020) “The relative effectiveness of psychotherapeutic techniques and delivery modalities for chronic pain: a protocol for a systematic review and network meta-analysis” www.ncbi.nlm.nih.gov/pmc/articles/PMC7459872/

Journal of Psychosomatic Research. (Jan 2010) “Mindfulness-based stress reduction for chronic pain conditions: variation in treatment outcomes and role of home meditation practice.”

National Institutes of Health. (March 2016) “Meditation and cognitive-behavioral therapy ease low back pain.” www.nih.gov/news-events/nih-research-matters/meditation-cognitive-behavioral-therapy-ease-low-back-pain

Pain. (Feb 2008). “Mindfulness meditation for the treatment of chronic low back pain in older adults: A randomized controlled pilot study. www.ncbi.nlm.nih.gov/pmc/articles/PMC2254507/

Pain and Therapy. (Jun 2020) “Rehabilitation for Low Back Pain: A Narrative Review for Managing Pain and Improving Function in Acute and Chronic Conditions.” www.ncbi.nlm.nih.gov/pmc/articles/PMC7203283/

When Chronic Back Pain Is Actually A Medical Condition

When Chronic Back Pain Is Actually A Medical Condition

Back pain usually comes from lifting an object the wrong way or awkwardly moving the body, injuring the spinal structures or muscles. However, sometimes it could be signs/symptoms of a more serious medical condition. The back pain could be caused by:

How to know when the root cause of back pain is from something else in the body? There are two types of pain that pain specialists look at. These are visceral pain and somatic pain. Visceral pain comes from damage or injury to the organs or organ tissues. This internal pain can radiate to the spine from conditions like:

  • Pancreatitis
  • Ulcerative colitis
  • Crohn’s disease
  • Gall stones
  • Cancers
  • Kidney pain
  • Urinary tract infections

Somatic pain is injury or damage to the muscles, skin, and soft tissues. It can be caused by:

  • Regular wear and tear
  • Aging
  • Injury
  • Sedentary lifestyle

However, visceral pain can cause somatic/bodily pain to flare up. The stress the body is going through because of the medical condition can cause inflammation.

When Chronic Back Pain Is Actually A Medical Condition

Kidney Infections and Stones

The kidneys are located in the rear of the body toward the middle of the back. The kidneys:

  • Filter waste products from the body
  • Regulate bodily fluids
  • Perform other vital functions.

Kidney infections and kidney stones can easily mimic a sprain or strain in the back. Infections or stones can also present with other symptoms like:

  • Fever
  • Nausea
  • Malaise
  • Burning sensation when urinating.
  • The pain feels like it’s higher and deeper in the back compared to musculoskeletal low back pain.
  • Side and groin pain could accompany the back pain.
  • The pain does not go away after shifting positions or lying down.

Urinary Tract Infection UTI

Upper urinary tract infections in the kidneys or ureters can cause back pain. Upper UTIs happen when a lower UTI in the bladder or urethra goes unnoticed or does not respond to antibiotic treatment. Infections can occur at any age, with women and older men being more susceptible. The pain usually presents in the lower back and groin area. Other possible symptoms include:

  • Pain in the back, sides of the lower abdomen between the lower ribs and hips.
  • Fever
  • Vomiting
  • Frequent urination in small amounts
  • Burning during urination
  • Strong urge to urinate
  • Foul-smelling urine
  • Cloudy urine
  • Fatigue.

The pain can feel like:

  • Cramping pain
  • Pressure
  • Soreness

Pancreatitis

Pancreatitis is inflammation of the pancreas, the long flat organ located in the upper abdomen behind the stomach. It assists digestion and sugar management. The American Pancreatic Association reports acute pancreatitis can make individuals feel sick with moderate to severe abdominal pain that can radiate to the back and often worsens after eating. The pain is felt in the upper to middle back. Other possible symptoms include:

  • Abdominal pain that radiates to the back
  • Abdominal pain after eating
  • Fever
  • Nausea
  • Vomiting
  • Tenderness in the abdomen

The pain can feel like ​a pulled muscle or joint pain that increases and decreases at first and then strengthens after eating or lying down.

Inflammatory Bowel Diseases IBD

Ulcerative colitis and Crohn’s disease are inflammatory bowel diseases not to be confused with irritable bowel syndrome.

  • Ulcerative colitis affects the colon.
  • Inflamed intestinal areas characterize Crohn’s disease.
  • Both can cause spreading back pain.

A study found 25% of individuals with IBD have chronic back pain. Other possible symptoms include:

The pain can feel mild or severe, like a cramp in the lower abdomen around the low back. It can present in cycles as a flare-up, then goes away. It’s essential to read the body’s warning signs and not push through the pain or ignore it. If any back pain goes on for more than a week, consult a doctor or chiropractor for a thorough examination. A pain specialist could be recommended if there is chronic back pain from a severe medical condition. A primary doctor or specialist helps keep the medical condition in check, while a pain specialist and/or chiropractor can alleviate chronic musculoskeletal pain from inflammation, irritation, and overstimulated nerves.


Body Composition


Personalized Lifestyle Medicine

Personalized lifestyle medicine develops customized treatment/health plans to fit the individual. It includes:

  • Research on how the body works as an integrated system.
  • Combines new technology approaches in medicine.
  • The relationship between nutrients and gene expression.
  • Life and behavioral sciences.

Nutrigenomics testing helps individuals understand the influence of dietary components on their genes, which can help prevent the development of certain chronic diseases.

References

American Pancreatic Association (Pancreapedia). (2015). Pathogenesis and Treatment of Pain in Chronic Pancreatitis. pancreapedia.org/reviews/pathogenesis-and-treatment-of-pain-in-chronic-pancreatitis

American College of Rheumatology. (2019). The U.S. Prevalence of Inflammatory Bowel Disease and Associated Axial Pain: Data from the National Health & Nutrition Examination Survey (NHANES). acrabstracts.org/abstract/the-us-prevalence-of-inflammatory-bowel-disease-and-associated-axial-pain-data-from-the-national-health-nutrition-examination-survey-nhanes/

Back Pain: Inflammatory or Mechanical and Chiropractic Care

Back Pain: Inflammatory or Mechanical and Chiropractic Care

It is estimated that every adult will experience some form of back pain at least once in their lives. There’s a difference between mechanical and inflammatory back pain. With inflammatory back pain, movement tends to help it, while resting worsens the pain. For some individuals, relief from inflammatory back pain is something they could have to manage for some time. Fortunately, there are effective management and relief options available.

Back Pain: Inflammatory or Mechanical and Chiropractic Care

Inflammatory vs. Mechanical Pain

Chronic back pain has two major causes. These are Mechanical and Inflammatory. They have slightly different characteristics when presenting. Chiropractors know what to look for to tell the difference between the two. Then a decision can be made on how to proceed with treatment or management.

Inflammatory

Pain caused by inflammation can be described as:

  • Not having a known definite cause.
  • Characterized by stiffness, especially after waking up.
  • Pain reduces with movement, activity, stretching, exercise.
  • Is worst during the early hours of the morning.
  • Is often accompanied by pain in the buttocks/sciatica symptoms.

Mechanical

Mechanical pain can be described as:

  • Pain that becomes worse with activity, stretching, or exercise.
  • Pain reduces with rest.
  • There is no stiffness after sleeping.
  • This pain is not constant but can become intense/severe for short periods.
  • Pain in the buttocks/sciatica symptoms do not present.

Inflammatory and Non-Inflammatory

Non-inflammatory is the same as mechanical pain. Mechanical/non-inflammatory back pain has causation related to the mechanics of the back and can result from injury or trauma. The cause of non-inflammatory pain does not necessarily present right away. For example, poor posture that leads to back pain is a mechanical/non-inflammatory cause. However, non-inflammatory back pain can be accompanied by inflammation as a natural reaction to injury. But this inflammation is not the cause of the pain. Non-inflammatory back pain can be treated effectively with conservative treatments. This includes:

  • Chiropractic adjusting
  • Physical therapy
  • Spinal decompression

Contributing Autoimmune Diseases

When inflammation is the cause of pain, it is considered inflammatory pain. Autoimmune disease/s can cause the body to attack different areas of the body mistakenly. Chronic pain can be caused by autoimmune diseases that include:

  • Rheumatoid Arthritis

Arthritis causes the immune system to attack the joints throughout the body.

  • Ankylosing Spondylitis

This is a rare type of arthritis that affects the spine. It is found more in men and usually begins in early adulthood.

  • Multiple Sclerosis

This is a disease where the immune system attacks nerve fibers and can lead to back pain.

  • Psoriatic Arthritis

This type of arthritis is characterized by patches of psoriasis along with joint pain and inflammation.

Inflammatory Pain Treatment

Individuals that think they might have inflammatory back pain should consult a doctor, spine specialist, and/or chiropractor. A general practitioner can misdiagnose inflammatory back pain as mechanical back pain. Many find relief from taking non-steroidal anti-inflammatory drugs or NSAIDs and following an exercise/physical activity regimen. However, sometimes this is not enough. This is where chiropractic treatment and physical therapy comes in.

Chiropractic and Physical Therapy

These medical professions complement each other well and can be beneficial as a part of an overall treatment plan. A chiropractor, with the help of a physical therapist, can bring significant relief. Management techniques involve:

  • Chiropractic adjustments
  • Flexion-distraction
  • Posture correction
  • Personalized exercises

Inflammation Night Pain

Inflammatory back pain tends to worsen at night. What happens is the inflammatory markers settle down when the body is not moving. A few simple practices can help you get better sleep.

  • Stretch Before Bed and When Waking

Performing stretches before going to bed and after waking up helps keep the body limber.

  • Inspect Pillows and Mattress

Sleeping with the spine out of alignment could exacerbate the problem. Using a too-soft mattress or a too-large pillow could be contributing to the pain. Sleeping on the side is recommended to use a pillow between the legs to keep the low back straight.

Exercises

Some exercises should be discussed with your doctor. Individuals have found that exercise and stretching are essential for relief.

Cardio

These exercises increase heart rate, boost mood, and release natural pain killers. Low-impact cardio exercises:

  • Swimming
  • Walking
  • Cycling

Strength-Building

Strengthening the core muscles will help maintain posture and spine support. Some of these include yoga poses:


Body Composition


Mediterranean Lifestyle

Sustainable and easy to follow three basic elements: following the diet, physical activity, and high levels of socializing. For individuals that want to change their diet and lifestyle to the Mediterranean, try the following:

  • Add more vegetables to meals. This can be salads, stews, and pizzas. Kidney beans, lentils, and peas are common Mediterranean staples.
  • Switch to whole grains as well as products made from whole grain flour. The high fiber content can improve heart health and can help lower blood pressure. Minimize refined carbohydrates like white bread and breakfast cereals.
  • Balance rich desserts with fresh fruits like oranges and bananas that can include antioxidant fruits like blueberries and pomegranates.
  • Treat meat as a side dish instead of the main course. Adding strips of chicken or beef into a vegetable saute/soup.
  • Balance meat dishes with fish and seafood. This includes sardines, salmon, clams, and oysters.
  • Go vegetarian for one day a week.
  • Cut out processed meats with high levels of preservatives.
  • Add healthy fats like avocados, sunflower seeds, nuts, and peanuts to meals.
  • Add dairy like cheese and Greek or plain yogurt.
  • Increase physical activity into a routine.
  • Talk to friends and family.
References

Cornelson, Stacey M et al. “Chiropractic Care in the Management of Inactive Ankylosing Spondylitis: A Case Series.” Journal of chiropractic medicine vol. 16,4 (2017): 300-307. doi:10.1016/j.jcm.2017.10.002

Dahlhamer, James et al. “Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults – the United States, 2016.” MMWR. Morbidity and mortality weekly report vol. 67,36 1001-1006. 14 Sep. 2018, doi:10.15585/mmwr.mm6736a2

Riksman, Janine S et al. “Delineating inflammatory and mechanical sub-types of low back pain: a pilot survey of fifty low back pain patients in a chiropractic setting.” Chiropractic & manual therapies vol. 19,1 5. 7 Feb. 2011, doi:10.1186/2045-709X-19-5

Santilli, Valter et al. “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.” The spine journal: official journal of the North American Spine Society vol. 6,2 (2006): 131-7. doi:10.1016/j.spinee.2005.08.001

Teodorczyk-Injeyan, Julita A et al. “Nonspecific Low Back Pain: Inflammatory Profiles of Patients With Acute and Chronic Pain.” The Clinical journal of pain vol. 35,10 (2019): 818-825. doi:10.1097/AJP.0000000000000745

Drinking Tea For Inflammation and Back Pain

Drinking Tea For Inflammation and Back Pain

Individuals and doctors have praised the anti-inflammatory, pain-relieving properties of drinking tea. Inflammation is the body’s natural immune response when injury and infection present. This is good. However, it’s meant to be a temporary response that deactivates when there is no longer any danger. When the body is exposed to various irritants like industrial chemicals, inflammatory foods like sugar, refined carbohydrates, and autoimmune disorders can cause the immune system to go into overdrive. Chronic inflammation can develop, circulating powerful hormones and chemicals through the body, causing damage to the cells. One consequence of chronic inflammation is back pain. Besides standard backaches, some chronic conditions are directly tied to inflammation. These include forms of arthritis:

  • Ankylosing spondylitis
  • Rheumatoid arthritis
  • Transverse myelitis
  • Multiple sclerosis
  • These conditions involve inflammation of the central nervous system.
  • Drinking tea can help with back pain and pain in general.

 

Drinking Tea For Inflammation and Back Pain

Teas With Anti-Inflammatory Properties

Certain teas contain anti-inflammatory compounds. These compounds are called polyphenols and work to decrease the chemicals in the body responsible for pain and inflammation. There are varieties of teas that contain anti-inflammatory properties.

Certain Teas Reduce Inflammation

Drinking specific teas with more polyphenols can better decrease inflammation. For example, green tea is higher in polyphenols than black tea. Recent studies centered on individuals with rheumatoid arthritis over six months found significant improvement in symptoms in those who drank green tea. Green tea works best when part of an anti-inflammatory and nutritional lifestyle adjustment. This supports combating inflammation. Other teas that are believed to reduce inflammation include:

  • Turmeric
  • Holy basil
  • Ginger

Three Cups a Day

The amount of tea depends on the quality of the tea and how it is prepared. Doctors recommend around three cups a day for individuals with rheumatoid arthritis. However, these could contain caffeine. If this is an issue, there are decaffeinated versions with the same anti-inflammatory properties.

Drinking Tea Works Best When Combined with Other Treatments

If experiencing back pain or looking to combat a specific condition, it’s recommended to utilize various treatment approaches combined with drinking tea. This includes:

  • Chiropractic care
  • Physical therapy
  • Acupuncture
  • Mindfulness meditation
  • Yoga
  • Dietary supplements
  • Anti-inflammatory diet

Tea Is Not For All Types Of Pain

Certain back conditions benefit from drinking tea regularly; however, spine structural issues or fractures will not benefit from tea’s mild anti-inflammatory properties. It is vital for individuals with back pain that a spine specialist or chiropractor perform a proper and thorough examination, especially for Individuals that take medication that could directly interact with anti-inflammatory teas.

Drinking Tea for Back Pain

For most individuals, drinking tea is safe to help treat back pain conditions and added health benefits. For example, studies have found that green tea has mild anti-cancer, anti-diabetic properties and can help in maintaining a healthy weight. If tea helps reduce pain, it’s worth trying. Remember, pain is the body’s way to alert the individual that something is wrong.


Body Composition


Alcohol and Heart Health

According to the Mayo Clinic, consuming more than three alcoholic drinks in one sitting causes a temporary blood pressure elevation. Foods often served with alcohol are usually high in salt, which can also raise blood pressure. A few alcoholic beverages on a night out is fine, but heavy or binge drinking can lead to short-term spikes in blood pressure that could cause cardiac health problems. These are the short-term effects of alcohol on blood pressure. Heavy alcohol consumption can lead to long term health risks like:

  • Hypertension
  • Heart disease
  • Digestive issues
  • Liver disease
  • Stroke

It’s recommended that individuals incorporate regular exercise/physical activity and healthy diet changes and watch alcohol intake to improve heart health.

References

The Clinical Journal of Pain. (October 2019) “Nonspecific Low Back Pain:

Inflammatory Profiles of Patients With Acute and Chronic Pain” journals.lww.com/clinicalpain/fulltext/2019/10000/nonspecific_low_back_pain__inflammatory_profiles.2.aspx

Certain Teas Bring Down Inflammation More Than Others: Journal of Physical Therapy Science. (October 2016) “Green tea and exercise interventions as nondrug remedies in geriatric patients with rheumatoid arthritis” www.ncbi.nlm.nih.gov/pmc/articles/PMC5088134/

The Bottom Line: Proceeding of the Japan Academy, Series B Physical and Biological Sciences. (March 2012) “Health-promoting effects of green tea” www.ncbi.nlm.nih.gov/pmc/articles/PMC3365247/

Cardio Exercise Equipment That Won’t Worsen Back Pain

Cardio Exercise Equipment That Won’t Worsen Back Pain

At home or a gym, working out with cardio exercise equipment can be a highly beneficial treatment for back discomfort, soreness, and pain. However, when checking out all the cardio machines it is recommended to use those that will help with back pain and not worsen or cause further injury. The same goes for purchasing cardio equipment to use at home. Research has found that exercise training could be highly effective in the treatment of back pain. A study on pain found that the endorphins generated from aerobic exercise help to lessen low back pain. The North American Spine Society announced evidence-based recommendations for the treatment of back pain, and one of the top recommendations was aerobic exercise. Individuals can always go outside to:

  • Walk
  • Hike
  • Run
  • Bike ride

But mixing it up with cardio equipment can have its own benefits for different reasons. It could be too hot, raining, sometimes individuals prefer a set workout program to reach calorie or distance goals, and it could be easier on the spine. Working out at home or at a gym, cardiovascular machines can help bring relief for back pain.11860 Vista Del Sol, Ste. 128 Cardio Exercise Equipment That Won't Cause Back Pain

Cardiovascular Exercise Back Pain Treatment

Cardiovascular exercise is highly recommended for everyone. For individuals dealing with back pain, exercise combined with conservative therapy is usually part of a treatment plan. This  includes:

  • Physical therapy
  • Chiropractic care
  • Health coaching
  • Diet
  • Aerobic exercise regimen

With an exercise program, experts recommend starting with moderate-intensity aerobic exercise. Moderate intensity workouts are meant to get an individual’s heart and blood pumping, sweating a little, and slightly deep breathing. These types of exercise include:

  • Power walking outside
  • Power walking on a treadmill
  • Stationary biking

As long as the physical activity gets the heart rate up, these exercises have been shown to decrease back pain, relieve stress, and elevate mood. 20 minutes of moderate-intensity exercise three to five times a week for six weeks is what is recommended. This will help the back become healthier, feel better, and is recommended by the American Heart Association.

Exercise Not For All Spine Conditions

However, not all spinal conditions benefit from regular exercising. Getting an evaluation from a doctor, spine specialist, or chiropractor is recommended for injuries, severe and/or persistent back pain before starting a cardiovascular exercise program. This could be a spinal fracture, or spinal condition that requires bracing, or intense physical therapy/rehabilitation. Individuals that do not exercise regularly or have a medical or heart condition/s definitely need to get a doctor’s clearance before beginning a cardiovascular workout regimen.

Top Cardiovascular Exercises and Equipment

Once a doctor clears the individual for aerobic exercise there is no cardio equipment that is off-limits. Elliptical machines and stationary bikes are the most well-tolerated by individuals with back problems/conditions. Because they are low impact. However, if it is tolerable using a jogging treadmill is beneficial as well. Listen to the body. If a workout on a treadmill causes back pain that is not just workout soreness,  stop with that machine and try different cardiovascular equipment that is more low impact. Do not ignore back pain. If pain is continuous and exercising is not helping, stop and see a doctor, or chiropractor to evaluate and analyze the situation. Then they can adjust the exercise part of the treatment plan according to the presenting symptoms.


Body Composition


Concurrent Training

Concurrent training is the combination of aerobic and resistance exercises during the same workout session. Aerobic and resistance exercise impacts the body in different ways. The type of aerobic training determines how it interacts with resistance exercise. The order of the types of exercises like aerobic and resistance workouts can make a difference. Having an understanding of a few specifics about concurrent training will help to make decisions about an exercise program.

  • Aerobic/interval and resistance training does not seem to interfere with the others’ adaptations
  • However, gaining strength could be lowered by adding running to a resistance program
  • Whereas bicycling does not have the same effect.

Cycling and the ergonomics that go with it are similar to traditional lower-body resistance exercises. The muscle contractions that come with running result in muscle damage, while the contractions in cycling also cause muscle damage, it is not to the same extent. Pairing the exercise programs correctly is key, such as a running program in combination with an upper-body lifting exercise can be beneficial. While running and doing leg presses every day could interfere with each other and could cause injuries. Or if doing both aerobic and resistance exercises in the same session, or on the same day, consider the order of the exercises, depending on what the goal is.

Disclaimer

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, CTG*
email: coach@elpasofunctionalmedicine.com
phone: 915-850-0900
Licensed in Texas & New Mexico

References

British Journal of Sports Medicine. (November 2020) “Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis” https://bjsm.bmj.com/content/54/21/1279

Pain. (December 2020) “Are endogenous opioid mechanisms involved in the effects of aerobic exercise training on chronic low back pain? A randomized controlled trial” https://journals.lww.com/pain/Citation/2020/12000/Are_endogenous_opioid_mechanisms_involved_in_the.23.aspx

North American Spine Society. (2020) “Evidence-Based Clinical Guidelines for Multidisciplinary Spine Care” https://www.spine.org/Portals/0/assets/downloads/ResearchClinicalCare/Guidelines/LowBackPain.pdf

Diabetic Back Pain: Ways To Bring Relief

Diabetic Back Pain: Ways To Bring Relief

The diabetic disease processes can be a contributor to chronic back pain. Diabetes can damage the human body from the eyes to the feet if left untreated, and the spine/back is a prime target. Data from 11 studies consisted of individuals over 18 years of age diagnosed with type 1 or type 2 diabetes. The results showed individuals with diabetes had a 35% increased risk of experiencing lower back pain. According to the Centers for Disease Control and Prevention, around 34 million people were found to have diabetes in 2021. Diabetes primarily impacts blood sugar/glucose levels. However, the disease can affect several of the body’s systems. It is a state of chronic inflammation.

Diabetic Back Pain Connection

The connection between diabetes and back pain include:

Neuropathy

Diabetic neuropathy happens when constant high glucose levels damage/injure the nerves. The result is symptoms like pain, tingling, and numbness. It affects up to 50% of individuals with diabetes and can lead to severe chronic back pain. High sugar levels damage various organ systems including the nervous system that results in neuropathy that causes pain/discomfort.

Bone Health

A complication that diabetes can cause is compromised bone health. High glucose levels can damage the collagen that makes up bone. This creates an increased risk of vertebral and other types of fractures. The high-risk compounds fractures that do not heal properly or correctly. Diabetics have an increased risk of fracture because of the accumulation increase of advanced glycation products. This substance forms when proteins or lipids combine with sugar. With time these products can cause damage to various tissues that include bone.

11860 Vista Del Sol, Ste. 128 Diabetic Back Pain: Ways To Bring Relief

Obesity

Obesity contributes to the development of type 2 diabetes and is also a complication that results from incorrect glucose level management. Regardless of which came first, the added weight is a major contributor to back pain because of the added pressure/load on the spine. Excess weight and physical inactivity can result in serious issues of the musculoskeletal system.

Additional Factors

Poorly controlled diabetes also reduces muscle blood flow and increases cartilage inflammation. Other types of tissue damage can occur like degeneration of intervertebral discs and spinal canal stenosis. Disc degeneration and spinal stenosis are common causes of back and neck pain. Diabetics are prone to infection/s. This can cause back pain if it is in the bone known as osteomyelitis.

Diabetic Back Pain Management

There are steps that can help ease pain and discomfort.

Getting Involved In Physical Activity

Exercising/physical activity is a must. The body needs to move to get all the systems flowing improving diabetes and back pain. A sedentary lifestyle can take back pain to new levels with time. Even though when pain presents the first instinct is to stop and rest. Simple ways to get moving include:

  • Walks
  • Stretches
  • Gentle laps in a pool
  • All can help with:
  • Improved blood flow
  • Aids in weight loss
  • Recommended for both conditions
  • Exercising releases endorphins, which are the pain relief chemicals that the body produces naturally.

Reducing Stress

Reducing stress will help manage back pain. A few ways to decompress and reduce stress include:

11860 Vista Del Sol, Ste. 128 Diabetic Back Pain: Ways To Bring Relief

Quitting Bad Habits

Smokers have a significantly higher risk for low back pain compared to non-smokers. Nicotine can alleviate pain short term, but over time the nerves become more sensitive and can increase the pain. Alcohol use can help numb the pain short term, but it can cause muscle spasms and dehydration intensifying the pain. Complications can arise if taking pain medication. The most important thing is managing diabetes effectively. Injury Medical Chiropractic and Functional Medicine Clinic will help the individual feel better, move better, and keep back pain away.

Body Composition

Vitamin D and Healthy Blood Sugar Levels

Vitamin D benefits muscle health, muscle mass, and blood sugar. Insulin is the hormone that lets blood sugar into the muscles. Individuals with adequate blood vitamin D levels significantly lower the risk of hyperglycemia than those with below-recommended levels. Research shows daily vitamin D supplements used in combination with calcium decelerate the gradual rise in blood sugar in those with prediabetes. Adequate vitamin D levels can prevent the progression of hyperglycemia. Supplementation is beneficial for individuals going through a deficiency. Adults should aim for a dietary intake of 600 – 800 IU per day. However, supplements are never a substitute for a healthy and diverse diet.

Disclaimer

The information herein is not intended to replace a one-on-one relationship with a qualified health care professional, licensed physician, and is not medical advice. We encourage you to make your own health care decisions based on your research and partnership with a qualified health care professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from a wide array of disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the musculoskeletal system’s injuries or disorders. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and support, directly or indirectly, our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request. We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP, CIFM, CTG*
email: coach@elpasofunctionalmedicine.com
phone: 915-850-0900
Licensed in Texas & New Mexico

References

Pozzobon, Daniel, et al. “Is There an Association between Diabetes and Neck and Back Pain? A Systematic Review with Meta-Analyses.” PLOS ONE, vol. 14, no. 2, 2019, doi:10.1371/journal.pone .0212030.

“Diabetic Neuropathy.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 3 Mar. 2020, www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/symptoms-causes/syc-20371580 .

Murray, Cliodhna E, and Cynthia M Coleman. “Impact of Diabetes Mellitus on Bone Health.” International Journal of Molecular Sciences, MDPI, 30 Sept. 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6801685/

Groen BBL, Hamer HM, Snijders T, van Kranenburg J, Frijns D, Vink H, et al. Skeletal muscle capillary density and microvascular function are compromised with aging and type 2 diabetes. Journal of Applied Physiology. 2014;116(8):998–1005. pmid:24577061

Eivazi M, Abadi L. Low Back Pain in Diabetes Mellitus and Importance of Preventive Approach. Health Promotion Perspectives. 2012;2(1):80–8. pmid:24688921

Chiropractic Manipulation Under Anesthesia

Chiropractic Manipulation Under Anesthesia

Chiropractic manipulation under anesthesia, also known as M.U.A is a non-invasive stretching and musculoskeletal manipulation technique. This type of chiropractic treatment can offer relief from chronic and constant back pain and other types of pain that have not responded well or at all to conservative non-surgical care. Chiropractic manipulation under anesthesia breaks up adhesions/internal scar tissue that could result from an injury or previous surgery, helping restore the normal range of motion and reduce pain. This technique is utilized to treat:

Adhesions can grow around:

  • Spinal joints
  • Nerve roots
  • Inside the surrounding muscles

This can result in restricted:

  • Movement
  • Limited flexibility
  • Pain
 

Undergoing chiropractic manipulation under anesthesia while sedated means the body is in a highly relaxed state. This sedation allows the chiropractor to adjust the bones, joints into proper alignment and stretch the muscles without the individual�s voluntary/reflexive resistance. And the sedation allows the chiropractor to use less force, making the procedure painless.  

Manipulation Under Anesthesia Specialists

This type of manipulation is a specialty procedure. Trained and certified physicians only perform it in the fields of:

  • Chiropractic medicine
  • Orthopedics
  • Physical therapy and rehabilitation
  • Osteopathy

 

Advantages to MUA treatment

There are individuals with pain that respond well to regular chiropractic manipulation, physical therapy, or exercise. However, depending on their condition, relief might only last for a few days or weeks. This is where manipulation under anesthesia could improve the range of motion and relieve pain. Manipulation under anesthesia has been performed for more than sixty years. It can be cost-effective and safer than invasive treatment like spine surgery. It is recognized and covered by most insurance and workers’� compensation plans.  

11860 Vista Del Sol, Ste. 128 Chiropractic Manipulation Under Anesthesia
 

Determining if MUA is right for the individual and their condition

Manipulation under anesthesia is not for all individuals with back pain. MUA is only recommended for patients that meet the procedure’s criteria. Like any other type of recommended treatment, a doctor will carefully consider the individual’s medical history, symptoms, previous treatments, and effectiveness. A doctor will also perform a physical and neurological examination with an individual’s complete medical history. Test results will confirm the patient�s diagnosis and determine if anesthetic manipulation can help relieve pain and other symptoms. Tests can include:

  • X-ray
  • MRI
  • CT scan
  • A musculoskeletal sonogram uses sound waves to produce images of muscles, tendons, ligaments, and joints.
  • EKG – electrocardiogram is a test that checks for problems with the heart�s electrical activity
  • Nerve conduction velocity test sees how fast electrical signals move through the nerve/s
  • Pregnancy test

 

Consideration for individuals with:

  • Pinched or entrapped nerve
  • Chronic/Persistent neck or back pain
  • Painful, restricted range of motion
  • Failed back surgery syndrome
  • Chronic sprains and strains
  • Acute muscle spasms
  • Fibromyalgia
  • Chronic spinal disc conditions
  • Fibrous adhesion/s
 

Not an appropriate treatment for individuals with:

  • Uncontrolled diabetic neuropathy
  • Spinal cord compression
  • Morbid obesity
  • Any cancer
  • Acute or healing bone fracture/s
  • Osteomyelitis vertebral bone infection
  • Acute inflammatory arthritis
  • Metastatic bone disease
  • Severe osteoporosis
  • Acute inflammatory gout
  • Tuberculosis of the bone
  • Co-existing medical problems could mean an individual may not be able to undergo any procedure that requires sedation.
  • Another reason why a patient’s complete medical history is vital

 

Procedure

This procedure is usually performed in an ambulatory surgery center that is a modern healthcare facility focused on providing same-day surgical care for diagnostic and preventive procedures or at a hospital. An anesthesiologist administers the medicine/s. The patient could be sedated but not unconscious or general anesthesia meaning complete unconsciousness. The choice of sedation depends on various factors, like the patient’s diagnosis and how severe the condition is. The anesthesiologist can recommend a specific type of medicine or a cocktail of medications for the patient’s comfort during and after.

Once sedated, the chiropractor utilizes specialized techniques to stretch, adjust and mobilize the affected areas of the spine and body. The manipulations free up fibrous adhesions or scar tissue in one or more areas of the spine and surrounding tissues. The procedure usually takes 15 to 30 minutes. The individual will be awakened and then is carefully monitored in a recovery area. Many report an immediate reduction in pain and a broader range of motion after the procedure. There is usually temporary muscle soreness, similar to the soreness after an intense workout.  

11860 Vista Del Sol, Ste. 128 Chiropractic Manipulation Under Anesthesia
 

Before being discharged, the patient is provided instructions about aftercare therapy. Instructions may include:

  • At-home warm-up movements
  • Physical therapy rehabilitation
  • Passive stretching
  • Electrical stimulation
  • Cryotherapy or cold therapy to reduce inflammation and pain

Physical therapy, exercise, and stretching

Three to six weeks after the procedure, individuals continue with physical therapy to help prevent back pain from returning and any fibrous adhesions/scar tissue broken up from reforming. Exercise and stretching will help strengthen and stabilize the abdominal and spinal muscles and prevent pain from returning.


InBody

 

Malnutrition

Malnutrition is defined as a lack of uptake or intake of nutrition that can negatively affect body composition. An important nutrient that elderly individuals might not get enough of is protein. Trouble chewing, food cost, and trouble cooking are all factors that limit elderly individuals’ access to protein, which can lead to sarcopenia. These complications can affect how the body responds to diet and exercise.

That is because protein requirements for the elderly are usually higher than for younger individuals. This comes from age-related changes in the metabolism that includes a decreased response to protein intake. This means that an older individual needs to consume more protein to achieve the same anabolic effect. Micronutrient deficiency is a lack of nutrients like minerals and vitamins. These support important bodily processes like cell regeneration, immune system function, and vision. A common example is iron and calcium deficiencies. This type of deficiency has the greatest impact on normal physiological functions in conjunction with protein-energy deficiency, as most micronutrients are acquired from food.  

Dr. Alex Jimenezs Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that directly or indirectly support our clinical scope of practice.*

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. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*  

References

pubmed.ncbi.nlm.nih.gov/24490957/

Spinal Misalignments Pain And Discomfort Root

Spinal Misalignments Pain And Discomfort Root

When spinal misalignments happen the body experiences soreness, inability to rotate the neck, or after sitting/standing in one position for too long hip and leg discomfort/pain. This is why spinal alignment is so crucial to healthy living. These examples help to illustrate the delicate balance required in the spine to maintain optimal health, stay pain-free, prevent injury, and the ability to conduct everyday chores/responsibilities without the fear and anxiety of setting off pain symptoms.
11860 Vista Del Sol, Ste. 128 Spinal Misalignments The Root Of Pain And Discomfort

Understanding how pain is processed

Pain is a complex sensation. Neural pain receptors, also known as nociceptors detect harmful stimulation/s in the form of:
  • Body Temperature changes
  • Mechanical forces and pressure on the body
  • Chemical changes in the body brought on by inflammation or cell damage
How the signal transmits from the stimulated nerve and how it is perceived depends on the upper levels of neural activity in the body. Specifically, the spinal cord, brainstem, and the brain. Examples of pain perceptions:
  • Beliefs
  • Mood levels
  • Stress levels
  • General health
  • Other sensations the body could be experiencing
  • Previous pain generating experiences – auto accident, work injury, etc.

Spinal Misalignments and Balance

Pain is essential for alerting the body when engaged in activities, and body positions that can cause damage to the tissues like poor postures, work/sports/personal injuries, inflammatory foods, etc. The nerves’ pain pathways can experience overstimulation when the system is overloaded.
Excessive stimulation can be brought on by chronic inflammation, mood disorders, and poor health. One overlooked issue with the perception of pain is the health/effectiveness of the actual neural pathways. The nerve’s energy is affected by spinal misalignments. Proper nerve health and circulation are crucial for the body to transmit proper pain signals. Spinal misalignments can be brought on by:
  • Chronic poor posture
  • Injury
  • Other imbalances in the body
  • Can lead to major dysfunction of the nerves pathways
The longer the pain and discomfort go on the more intense/severe the issues can become. This is when pain and discomfort become chronic leaving individuals feeling hopeless, frustrated.

Symptoms

The spine does more than provide stability. Any type of spinal misalignments will affect the rest of the body as well. Possible symptoms that the spine is out of alignment includes:
  • Chronic headaches
  • Frequent illnesses
  • Fatigue
  • Lower back pain
  • Neck pain
  • Hip pain
  • Knee pain
  • Numbness/tingling in the hands or feet
  • Walking gait abnormalities causing one shoe to wear out quicker than the other
11860 Vista Del Sol, Ste. 128 Spinal Misalignments The Root Of Pain And Discomfort

Chiropractic Management

Many treatments focus on masking the pain rather than addressing the underlying root cause. This can lead to a chronic pain cycle and dependence on pain medications and invasive treatment. Chiropractic is a science-based approach that focuses on getting to the root issue. Chiropractic utilizes gentle and effective techniques like:
  • Manipulation
  • Exercise regimen
  • Stretching regimen
  • Body mechanics training
  • Health nutritional education
When the body is aligned and the spinal nerves are healthy, an individual’s pain perception will be changed for optimal functionality.

InBody Composition


Body composition goals

The first step is to reduce caloric intake by changing/adjusting dietary nutritional habits. Individuals can experiment with various types of diets and regular exercise regimens, and getting into the habit of getting the proper amount of sleep. Depending on an individual’s existing muscle mass, gaining Lean Body Mass first could be an option. An individual may be able to lose fat and gain muscle because:
  • Increased muscle mass will increase the Basal Metabolic Rate/metabolism, and if no extra calories are added body fat can be shed while building muscle.
  • Lifting weights can increase Total Daily Energy Expenditure, causing the body to burn more calories.
Circuit training is one option for improving changes in body composition while not affecting changes in overall body weight. This means muscle gain and fat loss is happening at the same time.

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* 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. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
References
Dubinsky RM, Miyasaki J.Assessment: Efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review). Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.�Neurology. 2010;74:173-176. Shrier I. Does stretching help prevent injuries?�Evidence-based Sports Medicine. Williston, VT: BMJ Books; 2002.