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.
I go back to normal after seeing him (Dr. Alex Jimenez) and I know I can go back to doing whatever I can. But I’m now more careful. I would recommend him. It’s hard to find someone that knows their job and has a love for their job. That’s why I always come back. If I’ve got pain, I’m gonna look for him. – Mike Melgoza
Low back pain is one of the most prevalent reasons why people visit the doctor’s office and miss days from work. Approximately 80 percent of people will experience back pain at some point throughout their lifetime. Low back pain can range from moderate to severe and it can be acute, short-term, or chronic, long-term.�Because back pain can be caused by a variety of factors, the symptoms may also vary from one person to the other.
Most of the time, low back pain is more of an annoyance than anything else.�If an individual’s low back pain becomes intense and persistent, it can be tremendously debilitating and it can ultimately make it a challenge to participate as well as engage in many everyday activities. It’s essential to seek immediate medical attention to receive a proper diagnosis and continue with the best treatment option for each patient’s specific health issue.
Causes of Low Back Pain
Many potential causes can result in low back pain. In our modern world, spinal misalignments, or subluxations, caused by poor posture, have become one of the most common causes for low back pain, probably due to the simple fact that more and more people work in sedentary desk jobs than ever before. Without the appropriate back support from an ergonomic desk chair, low back pain can easily occur as a result of poor posture and due to the limited mobility of the spine throughout the day.
Even people who are up on their feet the vast majority of the day might suffer from low back pain due to a lack of spinal and abdominal support as well as a lack of proper coordination of the back muscles. While lower back pain can’t always be prevented, it’s possible to reduce the risk of suffering from lower back pain by practicing proper posture throughout the day to support the spine.
For individual’s who sit behind a computer screen for extended periods of time, this might mean investing in an ergonomic desk chair. For the more active individuals, it may mean purchasing a good pair of athletic shoes which can provide them with the right level of back and foot support throughout the day. Low back pain can also develop due to a variety of injuries and/or conditions. Fortunately, many treatment options are available to help treat low back pain, including chiropractic care and physical therapeutics.
Dr. Alex Jimenez’s Insight
The spine is made up of small bones, known as vertebrae, intervertebral discs, muscles, ligaments and nerves. With several factors, however, including poor posture, trauma from an injury, or an aggravated condition, the spine can become misaligned, ultimately affecting the complex structures surrounding the spine and resulting in back pain. Low back pain is among the most common types of back pain, particularly due to its increased role in supporting the weight of the human body.
Chiropractic Care for Low Back Pain
Chiropractic care is an alternative treatment option which focuses on the diagnosis, treatment and prevention of a variety of injuries and conditions associated with the musculoskeletal and nervous system, including back pain. Seeking chiropractic care as treatment for lower back pain is always recommended before you opt to start taking any prescription drugs and/or medications.
Pain and anti-inflammatory drugs and/or medications can relieve your low back pain, however, the results are usually temporary and these may also bring about undesirable side effects. Chiropractic care is a non-invasive and drug-free strategy for low back pain relief. It’s recommended to seek alternative treatment options, including chiropractic care and physical therapeutics, before turning to the use of drugs and/or medications as well as surgical interventions.
A doctor of chiropractic, or chiropractor, will commonly use spinal adjustments and manual manipulations to carefully correct any spinal misalignments, or subluxations, which may be causing the patient’s low back pain. Moreover, a chiropractor may utilize�passive and active treatments for low back pain and they often vary considerably in their techniques and methods. Passive and active treatments for low back pain are described as follows:
Passive treatments depend upon techniques and methods to be performed on the person. This may include anything from applying ice or heat packs to the affected area to stimulating the affected region with controlled electricity. Other treatment modalities used here may comprise of ultrasonography, TENS units, and iontophoresis.
Active treatments, on the other hand, describes measures that the patient will take, as instructed by a healthcare professional, to manage their low back pain. Typically, this comes from the type of stretches and exercises that are meant to reduce low back pain and minimize potential flare-ups too. Active treatments could include low-impact aerobic conditioning and back strengthening exercises. These may vary based upon the healthcare professional’s requirements.
Chiropractic care and physical therapeutics might be a wonderful solution for treating nearly any level of low back pain. Through the utilization of spinal adjustments and manual manipulations, as well as a combination of active and passive physical therapeutics, you’re in a position to work towards reducing your stress and increasing your body’s natural capability to prevent future health issues.
Contact a healthcare professional today to find out more about how you can manage your low back pain.The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.
Curated by Dr. Alex Jimenez
Additional Topics: Acute Back Pain
Back pain is one of the most prevalent causes for disability and missed days at work worldwide. As a matter of fact, back pain has been attributed as the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience some type of back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through the use of spinal adjustments and manual manipulations, ultimately improving pain relief.
Once I started treatment with Dr. Jimenez, I started noticing I was able to go back to the gym, I was able to sit longer periods of time, and ever since I’ve been a lot better. – Denise A.
Pain is a fundamental response of the nervous system which functions to help keep the body aware to possible injury. When an injury occurs, pain signals are transmitted from the injured site up through the spinal cord ant into the brain, where the messages are processed accordingly.
As the injury heals, however, the pain will typically become less severe. While it’s normal for everyone to experience occasional aches and pains, chronic pain can become a real health issue which can severely restrict an individual from completing their daily tasks, ultimately affecting their quality of life. Below, we will describe chronic pain and discuss treatment options to help manage chronic pain symptoms.
What is Chronic Pain Syndrome?
Chronic pain is quite different when compared to general types of pain. With chronic pain syndrome, the body will continue to send pain signals to the brain, where symptoms can last for several weeks, months, even years after the initial injury has healed.
Chronic pain is defined as pain which lasts 12 weeks or more. The type of pain is often felt as sharp or dull, causing an aching or burning sensation around the affected regions and it may be steady or intermittent. Chronic pain can develop in almost any section of the human body. Because chronic pain can tremendously restrict an individual’s strength, mobility, flexibility and endurance, these symptoms can make it challenging for anyone to get through their regular tasks and physical activities.
Chronic pain syndrome is usually caused by an initial injury but it’s also believed that symptoms can manifest after nerve damage has occurred.�There are several different types of chronic pain. Also, chronic pain might have a mental and emotional toll in some people in addition to draining your energy and motivation. It’s important to address your chronic pain with a healthcare professional as soon as possible.
Types of Chronic Pain
According to the American Academy of Pain Medicine, more than 1.5 billion people around the world have some type of chronic pain. As a matter of fact, chronic pain syndrome is the most prevalent cause of long-term disability in the United States, affecting approximately 100 million Americans. Chronic pain is generally caused by an initial injury, such as a back sprain or pulled muscle. Sometimes, it can be caused by automobile accident injuries or a different sort of injury. Other times, chronic pain can be caused by previous underlying health issues like medical conditions or even a disease. Chronic pain is usually divided into these categories.
Nociceptive Pain: Nociceptive pain is a medical term used to describe when the pain is located in the muscles and soft tissues. This is also sometimes referred to as somatic pain. Back pain, hip pain, knee pain arthritis, and headaches, can all be considered to be nociceptive pain. Chiropractic care and physical therapeutics can help reduce and eliminate pain and discomfort associated with these health issues.
Neuropathic Pain: This type of pain is associated with actual nerve damage and it is often more intense and may be described as a sharp or stabbing sensation. Phantom limb pain, pain associated with post mastectomy, and diabetic neuropathy, are examples of neuropathic pain. A combination of chiropractic care, physical therapeutics and electrotherapy, is occasionally used in the treatment of neuropathic pain.
Chronic Pain Treatment Options
While pain drugs and/or medications can help ease symptoms associated with chronic pain syndrome, the effects are often only temporary. Fortunately, you can find better treatment options for your chronic pain. Chiropractic care and physical therapy utilize several treatment approaches and techniques to provide pain relief. The objective of these is to increase strength, mobility flexibility and endurance, while reducing overall pain. Several treatment alternatives which may also be used include:
Deep Tissue Massage: A healthcare professional can alleviate tension from the muscles, ligaments, and tendons by applying direct pressure to the affected sites.
Hot and Cold Treatments:�Hot therapies can bring more oxygen and blood to the affected areas whereas cold therapies can decrease muscle spasms and inflammation.
Transcutaneous Electric Nerve Stimulation (TENS): TENS raises the release of natural endorphins to reduce pain throughout the entire body. This therapy may be used to decrease pain associated to several health issues.
Ultrasound: Ultrasound increases blood flow and provides heat deep in joints and muscles. This can facilitate muscle stretching while reducing chronic pain.
Dr. Alex Jimenez’s Insight
Pain is the body’s natural reaction to a possible injury or condition, a warning that something is wrong. Once your body heals, the pain will stop and all bodily functions return to normal, at least, that’s the way it’s supposed to be. For many people, pain can continue long after its cause is gone. Pain that lasts for 3 months or more is medically referred to as chronic pain. Approximately 25 percent of people with chronic pain will develop a condition known as chronic pain syndrome, or CPS. When pain is present day after day, it can take a toll on your physical as well as on your mental and emotional health, where people with CPS will often develop symptoms of anxiety and depression, which can also interfere with their daily lives.
Chiropractic Care and Chronic Pain
Chiropractic care can play an essential role in alleviating and eliminating different kinds of chronic pain symptoms. Among the most fundamental aspects of providing a successful treatment plan for chronic pain is for the chiropractor to develop a specialized treatment plan for each patient. A chiropractor will perform a comprehensive exam to assess the principal cause of the patient’s chronic pain. Using that information, the chiropractor will then customize an individualized treatment plan.
Chiropractic care focuses on the diagnosis, treatment and prevention of a variety of injuries and/or conditions associated with the musculoskeletal and nervous system, including chronic pain. A chiropractor will commonly utilize spinal adjustments and manual manipulations to carefully correct any spinal misalignments, or subluxations, along the length of the spine. By realigning the spine, a chiropractor can restore essential connections between the brain, spinal cord and the rest of the body, which may be responsible for chronic pain symptoms.
Furthermore, a chiropractor can recommend a series of exercises and physical activities, as well as offer nutritional advice, to help promote a speedy recovery. A chiropractor can also teach the patient how they can incorporate ergonomic principles into their everyday life. The healthcare professional will likely assemble a personalized home exercise plan that’ll be a part of the patient’s whole pain management program.
A chiropractor may work closely together with you to establish goals and manage your own personal treatment program. Your chiropractor may also let you work through any challenges you may be experiencing and adapt your treatment as needed. The journey to overcome chronic pain in order to recover maximum freedom. A qualified and experienced chiropractor can allow you to address problems and supply support while providing the best treatment available.�The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.
Curated by Dr. Alex Jimenez
Additional Topics: Acute Back Pain
Back pain is one of the most prevalent causes for disability and missed days at work worldwide. As a matter of fact, back pain has been attributed as the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience some type of back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through the use of spinal adjustments and manual manipulations, ultimately improving pain relief.
Chiropractic care is a drug-free, nonsurgical treatment for many types of conditions and to help manage pain. As more and more medical professionals are recognizing its effectiveness and viability for treating many issues in the body, chiropractic is gaining popularity and becoming the treatment of choice for many patients with chronic pain, back problems and other issues. In particular, it has been found to be a very effective treatment for spondylolisthesis. It can not only relieve the pain, but often return the patient�s mobility as well.
What Is Spondylolisthesis?
Spondylolisthesis is a condition in which one vertebra slides forward over the vertebra that is below it. It is typically confined to the lumbosacral, or lower back area. It can become painful, causing lower back pain and weakness or numbness in one or both legs, when it causes the nerve roots or spinal cord to be squeezed. In severe cases, a patient can lose control of their bowel or bladder function, but this is fairly rare. However, any patient who begins to lose bowel or bladder control should contact their doctor immediately.
In some cases, a person�s vertebra can slip out of place without any symptoms being present. Sometimes the symptoms don�t show up until months or even years later. Symptoms of spondylolisthesis may include:
Low back pain
Pain in the buttock area
Pain that radiates from the lower back down one or both legs
Spondylolisthesis is diagnosed by a doctor or chiropractor who may conduct several diagnostic tests. Typically, the doctor will take X-rays of the patient�s back to rule out certain conditions, especially if they suspect spondylolisthesis.
The X-ray will allow the doctor to see if any of the patient�s vertebrae have slipped out of place, or are cracked or fractured. An MRI or CT scan may also be ordered to better view the spine and see the extent of the damage.
What Are The Treatments For Spondylolisthesis?
The treatment for spondylolisthesis is based on the actual damage identified by the doctor, the pain and mobility problems that the patient is experiencing, and the overall severity of the condition. Rest is the first course of treatment as well as ceasing the physical activities that may have caused the damage in the first place.
Pain may be managed by non-steroidal anti-inflammatory drugs such as naproxen and ibuprofen. Acetaminophen may also be administered for pain.
Other treatments for spondylolisthesis include:
Bracing
Weight loss (if the person is obese or overweight)
Physical therapy to strengthen the core
Epidural steroid injections
Surgery (in severe cases such as damage to the spinal cord or nerve root)
There are several types of surgery that may be used to treat spondylolisthesis. The surgeon may remove tissue or bone in order to relieve pressure on the nerves or spinal cord. Sometimes the doctor may opt for fusing the damaged bones into place so they can no longer slip. In some cases, both procedures are done. This type of treatment is usually a last resort because recovery can be lengthy and the patient will have to wear a back brace or cast while their back is healing.
Is Chiropractic Effective For Treating Spondylolisthesis?
Chiropractic is a drug-free, noninvasive treatment for spondylolisthesis. It is often a preferred treatment because the patient does not have to undergo painful surgery or take medication that could have undesirable side effects. There are three primary spinal manipulation techniques that may be used by the chiropractor:
Spinal manipulation specific to the restricted or impaired joints
Flexion-distraction technique which is a slow, gentle pumping action
Instrument assisted manipulation uses an instrument to apply gentle force to the spine
Chiropractic care has been found to be very effective in treating this condition, but prevention is always the best course of action. Regular exercise, healthy weight management, and regular chiropractic visits can help ward off many spine related conditions including spondylolisthesis.
One of my friends recommended me, over and over, and just extended how good he�(Dr. Alex Jimenez, D.C.) was. So I gave it a shot. I had really bad sciatica and it was killing me, I couldn’t walk, but he has been helping me out, I can walk now… I couldn’t walk more than 25 yards, it (sciatica) was really affecting me. I had to get some help. I can’t say enough about Dr. Jimenez, he’s been helping me out, I can walk.
Edgar M. Reyes
According to the American Association of Neurological Surgeons, approximately 75 to 85 percent of individuals in the United States alone will experience some form of back pain throughout their lifetime, where 50 percent will suffer more than one episode within a year. Back pain is one of the most common complaints frequently reported among the general population and it is often a symptom which could indicate the presence of another underlying condition. Back pain can be caused by a variety of factors, some due to bad habits, such as improper posture, and others due to injuries from accidents. Other health issues, such as degenerative disc disease, or DDD, and arthritis can also result in back pain.�While the causes can vary, they share the same symptoms.
Bak pain can include upper back pain, middle back pain and lower back pain, often connected to sciatica, or sciatic nerve pain, a condition characterized by the compression or impingement of the sciatic nerve found in the low back. Back pain and sciatica have been closely associated with several common health issues. Often times, sciatica, or sciatic nerve pain, is caused by an underlying health issue along the lumbar spine. The sciatic nerve is the longest nerve in the human body, which connects to nerve roots in the region of the lower back and runs through the buttocks, down along the hips and into the back of each leg. Further sections of this nerve then branch out from the calf to the foot and into the toes. Sciatica can be identified by the following symptoms.
Low back pain which radiates down one or both legs
Leg and/or foot pain along with tingling and burning sensations
Numbness in the leg, feet and/or toes
Persistent pain and discomfort on one or both sides of the buttocks
Intense painful symptoms in the lower extremities
Having difficulties when sitting and while getting up
It’s essential to understand that back pain and sciatica are not generally considered to be a specific health issue themselves but rather, they are usually only considered to be a collection of several symptoms associated with an underlying injury and/or condition. A proper diagnosis of the root cause of your symptoms is additionally important in order to safely and effectively treat back pain and sciatica. As mentioned above, numerous factors can cause back pain and sciatica symptoms. Below, we will discuss some of the most common spine health issues which can cause back pain and sciatica, including degenerative disc disease, lumbar spinal stenosis, lumbar herniated disc and spondylolisthesis. Approximately 90 percent of sciatica cases are due to disc herniations.
Degenerative Disc Disease
The degeneration of the intervertebral discs, found between each vertebrae of the spine, is a natural process which often occurs with age, while for some individuals, however, it can begin to develop earlier than usual. In a healthy spine, the intervertebral discs function as shock absorbers between the bones of the spine, which ultimately provide height and allow the back to remain flexible while resisting forces. As we begin to get older, these rubbery discs begin to shrink and lose integrity. Almost everyone will demonstrate signs of wear-and-tear along their spinal discs over time, but not everyone will experience degenerative disc disease, or DDD. Although not actually a disease, DDD refers to a condition in which pain with the degeneration of the intervertebral discs.
One or more degenerated discs along the length of the spine may irritate a nerve root and cause sciatica. This condition is commonly characterized when a reduced disc becomes exposed. Bone spurs can also develop with disc degeneration and can lead to sciatica. Symptoms of degenerative disc disease, or DDD, frequently occur along the lower back, however, they can also develop in the neck, depending on the location of the degenerated discs. Common symptoms of DDD include, pain and discomfort, particularly when sitting, bending, lifting or twisting, tingling sensations and/or numbness in the extremities, and lessened symptoms when walking and moving, as in with changing positions or lying down. Weakness in the leg muscles or foot drop may be a sign that there is damage to the nerve root.
Lumbar Spinal Stenosis
Another common cause of back pain and sciatica is lumbar spinal stenosis. The natural degeneration of the spine which occurs with age can cause a variety of changes to the spine. Lumbar spinal stenosis is brought on by a gradual narrowing of the spinal canal that is common in the aging process and it generally affects people over the age of 50. When the space around the spinal cord narrows, it can place unnecessary amounts of pressure on the spinal cord and nerve roots. Additionally, it can be the result of a bulging disk, enlarged aspect joints, or an overgrowth of tissue. Only a small number of individuals are born with spine health issues which can develop into lumbar spinal stenosis. This is known as congenital spinal stenosis and it is frequently diagnosed in men.
Arthritis, or the degeneration of any joint in the body, has been attributed to be the most common cause of spinal stenosis. As the intervertebral discs begin to wear-and-tear naturally begin, they can lose water content and eventually dry out, ultimately losing height and even collapsing. This can place pressure on the facet joints, the joints which provide flexibility and movement to the spine, resulting in arthritis. As a result, the ligaments around the structures of the spine can increase in size, lessening the space for the nerves. Also, the human body may respond by growing new bone, additionally narrowing the space for the nerves to pass through. Symptoms of lumbar spinal stenosis may include, pain, tingling or burning sensations, numbness and weakness, as well as less painful symptoms when leaning forward or sitting.
Lumbar Herniated Disc
A herniated disc is a condition which can occur anywhere along the length of the spine, however, it most commonly affects the lower back or lumbar spine. It may also be referred to as a bulging, protruding or ruptured disc. A lumbar herniated disc is considered to be one of the most common causes of back pain in the lower back, as well as sciatica. An intervertebral disc begins to herniate when the soft, jelly-like nucleus, known as the nucleus pulposus, pushes against its outer ring, known as the annulus fibrosus, due to wear-and-tear or a sudden injury. With persistent pressure, the jelly-like nucleus may push through the disc’s outer ring or it may cause the ring to bulge, putting additional pressure on the spinal chord and its surrounding nerve roots.
Moreover, the intervertebral disc material can release chemicals and/or substances which may ultimately irritate the surrounding structures of the spine, contributing to nerve inflammation. When a nerve root becomes irritated, it can potentially lead to symptoms of pain and discomfort, numbness and weakness in one or both legs, otherwise referred to as sciatica, or sciatic nerve pain. An individual may also develop a herniated disc without ever experiencing any symptoms. A lumbar herniated disc is generally caused by the natural degeneration of the spine and discs, however, trauma and/or injury may also result in lumbar disc herniations. Symptoms of a lumbar herniated disc includes sciatica, tingling sensations, numbness, weakness, and loss of bladder or bowel control in severe cases. This last symptoms will require immediate medical attention.
Spondylolisthesis
Spondylolisthesis is another common cause of back pain and sciatica, particularly in young athletes. Repeated stress on the lower back, or lumbar spine, can create a crack or stress fracture in one of the vertebrae. In these cases, however, the stress fracture can often weaken the bone so much, to the point where it is unable to maintain its proper position in the spine, ultimately causing the vertebra to begin to shift or slip out of place. This condition is what is commonly known as spondylolisthesis. In children and adolescents, spondylolisthesis can occur through periods of rapid growth, by way of instance, during an adolescent growth spurt. This condition frequently occurs as a result of overuse, overstretching, or hyperextension, and even due to genetics.
Many healthcare professionals characterize spondylolisthesis as either low grade or high grade, depending on how much the vertebrae have shifted or slipped out of place. A high grade slip is generally identified when more than 50 percent of the width of the fractured vertebra slips forwards onto the vertebra beneath it. Individuals with high grade cases of spondylolisthesis will commonly describe experiencing significant levels of pain and discomfort as well as nerve injury. In the majority of instances, however, individuals with spondylolisthesis will not experience any obvious symptoms, as a matter of fact, most are unaware of the condition till an x-ray is taken for an unrelated injury and/or condition. Individuals with spondylolisthesis may experience back pain and sciatica, including muscle spasms, back stiffness and tight hamstrings.
Dr. Alex Jimenez’s Insight
Back pain is one of the most common reasons why individuals often miss days from work or go to the doctor, as it has also become one of the leading causes of disability worldwide. As a matter of fact, it has been statistically determined that approximately 80 percent of people will or have experienced back pain at least once throughout their life. Fortunately, a variety of treatments are available which can help ease the symptoms of back pain. It’s essential to understand back pain and sciatica, a collection of symptoms commonly associated with spine health issues along the lower back, in order to seek proper diagnosis and continue with an appropriate treatment plan in order to relieve your symptoms of back pain and sciatica.
Treatment for Back Pain and Sciatica
Chiropractic care is a well-known, alternative treatment option commonly utilized to help diagnose, treat and prevent back pain and sciatica. Since there are many factors which can contribute to symptoms of back pain and sciatic nerve pain, a doctor of chiropractic’s, or chiropractor’s, initial step would be to determine the root cause of the patient’s symptoms. Determining a diagnosis involves a thoughtful review of the patient’s health history, and a physical and neurological examination. Diagnostic testing may involve an x-ray, MRI, CT scan and/or electrodiagnostic tests, such as a nerve conduction speed evaluation or an electromyography. These examinations and tests help determine possible contraindications to treatment.
The aim of chiropractic care is to help promote the human body’s potential to heal itself. It is based on the scientific principle that limited spinal motion results in pain and reduced function and performance. Chiropractic care is non-invasive, or non-surgical, and drug-free. The type of chiropractic treatment provided is dependent upon the cause of the individual’s back pain and sciatica. A treatment program may include many distinct treatments and therapies, like ice/cold therapies, ultrasound, TENS, and spinal adjustments or manual manipulations. If the doctor of chiropractic decides that the patient’s spinal health issue requires treatment by a different kind of physician, then the individual may be referred to another healthcare professional.
Physical therapeutics for these conditions is also effective and generally has two components: active and passive. Passive physical therapeutics consist of ultrasound, electric stimulation, heat and ice packs as well as iontophoresis. Active physical therapeutics modalities include stretching exercises, back exercises and low-impact aerobic conditioning. Manual physical therapeutics, such as spinal adjustments and/or manual manipulations, might be integrated in part by a chiropractor. Physical therapists normally recommend 20 minutes of dynamic lumbar stabilization exercises every day. Core muscle strengthening is also important in treating back pain. Low-impact aerobics are also important and include water therapy, biking, and walking.
Physical therapeutics are an important element of treating spinal health issues. If you meet with a physical therapist, there will be a full assessment. Tests will be performed and an individualized treatment plan will be developed based on the patient’s goals. If you’re experiencing back pain or sciatica, don’t wait any longer for relief. Contact a healthcare professional to establish a one-on-one consultation and complete evaluation. Many chiropractors and physical therapists are certified, experienced and dedicated to helping you feel better. They have helped many others recover from spinal health issues and can help you too. The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.
Curated by Dr. Alex Jimenez
Additional Topics: Back Pain
Back pain is one of the most prevalent causes for disability and missed days at work worldwide. As a matter of fact, back pain has been attributed as the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience some type of back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through the use of spinal adjustments and manual manipulations, ultimately improving pain relief.
Did you know that inflammation and low back pain can by caused by a low pH balance? Inflammation is believed to be caused by a variety of factors, including injury and/or an underlying condition, however, recent research studies have found a connection between inflammation, chronic back pain and pH balance. The lower your pH balance is, the more acidic your body is. When the human body is acidic, a condition referred to as acidosis, it can cause inflammation and other symptoms throughout the body, even in the lower back. Whether your pH balance or another health issue is causing your low back pain, it’s important to understand how acidity and low pH levels can affect the structure and function of the human body.
Metabolic acidosis is a condition used to describe when there is too much acid in your body fluids. When there is too much acid in your body, your pH balance reading will be low. In other words, your body will be considered acidic. When the human body is acidic, it neutralizes the acid by leaching calcium, magnesium, potassium and sodium from the bones. Over time, the excess acidity of the body can begin to gradually eat away at the bones, causing the progressive degeneration of the bones and eventually even leading to fractures. While a fracture may seem like a severe cause for back pain, the degeneration of the vertebrae of the spine can also cause disc degeneration disease, or DDD, leading to back pain and low back pain. The purpose of the article below is to demonstrate as well as discuss the relationship between low pH balance in intervertebral discs and low back pain.
The Relationship Between Low PH in Intervertebral Discs and Low Back Pain: a Systematic Review
Abstract
Introduction: To systematically review the relationship between low pH in intervertebral discs and low back pain.
Material and methods: Electronic database (PubMed, ISI Web of Science, Cochrane Library, CINAHL, AMED, and China National Knowledge Infrastructure) searches and hand searching of conference proceedings were conducted. Two authors independently evaluated the methodological quality and abstracted relevant data according to standard criteria. Then the experimental methods and samples employed in the finally retrieved articles were assessed.
Results: We first retrieved 136 articles regarding pain and pH, and only 16 of them were mainly about low back pain and pH. Finally, 7 articles met our expectation to focus on the pathogenesis of low back pain caused by pH. In these 7 studies the authors held three opinions to explain the pathogenesis of low back pain in relation to low pH. First, low pH caused by lactate stimulates the muscle and increases the muscle tension, which causes low back pain. Second, low pH stimulates the nerve roots and produces the feeling of pain. Third, low pH changes the matrix metabolism, leading to neuronal death and low back pain.
Conclusions: In this systematic review we propose a new hypothesis that low back pain may be caused by low pH based on the previous literature. Further experimental studies are necessary to verify our hypothesis. This hypothesis will promote our understanding of the pathogenesis of low back pain and the development of novel diagnostic and therapeutic approaches for low back pain.
Keywords:low back pain, pH, acidity, intervertebral disc, systematic review
Introduction
Low back pain is one of the most frequent causes of morbidity and disability. Low back pain affects up to 50% to 80% of the population in developed countries and its recurrence rate amounts to 85%, resulting in an economic loss of approximately 50 to 100 billion dollars per year in the US [1, 2].
Currently, effective treatment of low back pain is severely hampered due to the fact that its pathogenesis remains elusive [3, 4]. In recent years, several hypotheses have been proposed to explain the pathogenesis of low back pain and most of them focus on the dysfunction of the spinal column and its components, such as injury and clinical instability [5�7], spinal column degeneration [8], inferior facet-tip impingement on the lamina [9], and Schmorl’s nodes [10] and facet joint injury [11]. Other hypotheses focus on subfailure injury of the spinal muscles and ligaments and propose that spinal ligaments, disc annulus, facet capsules and thoracolumbar fascia may cause chronic back pain due to muscle control dysfunction [12�16]. In addition, the pain adaptation and pain-spasm-pain hypotheses have been proposed [17�19]. However, these hypotheses are largely speculative and need further experimental investigations.
The intervertebral disc (IVD) is composed of the nucleus pulposus (NP), the annulus fibrosus (AF), and the endplates (EP). The corpora vertebrae lie above and below the discs. The healthy disc is avascular, and its nutrition depends on diffusion via the AF and EP [20, 21]. The discs mainly produce ATP via anaerobic glycolysis; consequently lactate is produced and the pH is lower than other tissues. Low back pain is known to be related to intervertebral disc degeneration, and the pH would decrease in degenerated intervertebral discs [22, 23]. Therefore, low pH in the discs may be related to low back pain. Indeed, Hambly and Mooney [24] reported a close relationship between low back pain and low intradiscal pH in rabbits, while Krapf et al. [25] found that low pH could cause muscle spasm which was related to low back pain.
Based on the previous literature we propose a new hypothesis that low pH may cause low back pain. In this systematic review, we have collected and analysed the relevant literature regarding the relationship between low pH and low back pain to address the following questions: (1) What role does low pH play in low back pain? (2) Is the relationship obvious between low pH and low back pain? And (3), why are low pH and low back pain so relevant?
Material and Methods
Electronic databases (PubMed, ISI Web of Science, Cochrane Library, CINAHL, AMED, and China National Knowledge Infrastructure), which were last updated on 26 Nov. 2011, were searched without limit by two independent investigators. The search used terms and Boolean operators as follows: (low back pain OR lower back pain OR low back ache OR low backaches OR lumbago OR recurrent low back pain OR postural low back pain or mechanical low back pain) AND (low pH OR lactate OR lactate OR hydrogen ion concentration). Reference lists of all the selected articles were hand-searched for any additional trials. Conference abstracts of key pain and orthopaedic journals were hand-searched to identify unpublished data. If necessary, we contacted the authors to get additional information.
In total 136 articles were initially identified by literature search, and 113 articles were excluded after checking the titles and abstracts, which did not reach our expectation. Next we reviewed the full texts of the remaining articles and excluded the following articles: (1) articles not in English; (2) reviews, systematic reviews or letters; (3) pain in other tissues; (4) not related to pH, acidity or protons. As a result, 16 articles were retrieved and the references of these 16 articles were checked to ensure that other pertinent publications would not be missed. Finally, seven articles met our expectation to focus on the pathogenesis of low back pain caused by pH (Figure 1). The literature search was performed by two of the authors (CZL and HL) independently, and any disagreement was resolved by discussion.
We scrutinized the seven articles with the focus on �the mechanisms by which pH causes low back pain�, and then assessed the experimental methods and samples employed in the seven articles.
Results
Seven articles met our expectation [26�32]. Then we evaluated the level of evidence for each article, according to the standard listed in Table I [33]. Five of them were level II, and two were level III. The characteristics of the seven studies are listed in Table II.
Nerve Roots
Three studies involving 32 patients [26, 27, 29] suggested that low pH would stimulate the nerve roots and cause low back pain.
Diamant et al. analysed the correlation between lactate level and pH in discs of patients with lumbar rhizopathy and found that low pH was caused by the increased lactate level due to the enhanced anaerobic glycolysis within the NP, which counteracts the decreased nutritional diffusion. The reaction of nerve roots in cases with low pH is related to increased production and leakage of acid metabolism. Sensitive structures such as the nerve roots could be irritated by the leakage of acid metabolites and it was shown that pain will arise in tissues with low pH [26, 34].
Keshari et al. used HR-MAS NMR spectroscopy to analyse snap frozen samples taken from 9 patients who underwent discectomy for painful disc degeneration [27, 35, 36]. They found that proteoglycan, collagen, and lactate may serve as metabolism markers of discogenic back pain. Therefore, they speculated that low pH was caused by increased lactate and increased lactate stimulated nerve fibres in granulation tissue associated with disc healing, which was correlated with discogenic pain [27, 35, 36].
Baumann et al. examined the responses of cultured adult human dorsal root ganglion (hDRG) neurons to low pH [29]. They found that low pH evoked, sustained depolarizations were due to more than one mechanism, and the inhibition of resting membrane conductance contributes to the responses to low pH in some hDRG neurons, which was related to low back pain [29].
Muscle Tension and Swelling of Connective Tissue
A previous study suggested that low pH would increase muscle tension, which could cause low back pain [30]. The authors examined 20 patients with chronic palpable tension of the erector muscles of the spine, and found that the pH decreased because of the enhanced anaerobic glycolysis in NP. The low pH was caused by the accumulation of lactate. Lactate would stimulate the multifidus muscle and increase the muscle tension. Simultaneously, myogelosis is induced, leading to low back pain [30]. Vormann et al. [31] showed that the simple and safe addition of an alkaline multimineral preparate was able to reduce the pain symptoms in these patients with chronic low back pain. These results suggest that a disturbed acid-base balance may contribute to the symptoms of low back pain.
Metabolism
Bartels et al. measured the oxygen and lactate concentrations in 11 patients with back pain and 13 patients with scoliosis, and found that in each case, the oxygen and lactate concentrations were the highest in the interior of the disc and fell toward the outer annulus [28]. Therefore, they speculated that the microcirculation through the endplate and the rate of cellular metabolism would influence the oxygen and lactate concentrations in the disc. For instance, the oxygen concentration would fall as cellular demand increases; consequently the lactate concentration would increase and the pH would decrease. It was observed that in some discs the concentration of oxygen was less than 40 mm Hg and that of lactate was more than 5 mmol/l, which would lead to cell death.
Another study also indicated that decreased pH, decreased PO2 and increased PCO2 may be related to the mechanisms of pain production in patients with back pain [32]. These abnormalities can be identified by magnetic resonance imaging. Further investigation is needed to determine whether therapeutic manipulation of these variables can be effective in relieving axial spinal pain.
Low pH would lead to a change in the matrix metabolism, which could strongly influence the cell activity and even cause cell death. It is well known that acid-sensing ion channels (ASICs) on the cell surface could be stimulated by protons. After cells die, the protons would increase and activate ASICs, which in turn mediate ischaemic neuronal death [37], and eventually cause low back pain [28, 38�40].
Dr. Alex Jimenez’s Insight
When an individual’s bodily fluids contain too much acid, or they’re too acidic,�a common concern known as acidosis, it can lead to a variety of health issues if not properly addressed. Your lungs and kidneys can generally compensate for slight pH imbalances, however, problems with any of these organs or even an improper nutrition consisting of processed foods high in sugar, can result in excess acid accumulating in the human body. Other risk factors which can contribute to an increased chance of developing acidosis include: a high-fat diet that’s low in carbohydrates, kidney failure, obesity, dehydration, aspirin or methanol poisoning, and diabetes. Furthermore, as mentioned in the article, acidosis has also been associated as a cause of inflammation which may lead to chronic back pain and low back pain. Therefore, maintaining pH balance is believed to be able to help treat low back pain, alongside other alternative treatment options, such as chiropractic care.
Discussion
After careful review of the seven articles we retrieved, we obtained a systematic view with regard to the relationship between low pH and low back pain, although the authors of the individual studies had proposed three different opinions.
If low pH directly stimulates the nerve roots, the pH is very important to the healing of low back pain. Lactate would cause low pH, stimulate the nerve roots, cause depolarization at the surface of the nerves, and modulate the nociceptors to let the patients feel pain. However, in order to establish a relationship between discogenic back pain and lactate, a much larger number of patients need to be studied and the changes in proteoglycans (PG)/collagen (col), PG/lactate peak (Lac), and Lac/col ratios should be correlated with visual pain scores or other pain indexes [27, 29].
The second opinion holds that low pH would act on the muscle but not nerve roots. If the oxygen tension falls below 5 mm Hg, the muscle tension would increase, and even result in myogelosis. Muscle contraction depends solely on the chemical energy of ATP. If the oxygen tension decreased, the cells would undergo anaerobic glycolysis and produce much lactate, leading to decreased pH. However, it remains elusive what level of pH would cause pain [30].
The third opinion claims that disc energy and matrix metabolism are crucially involved in low back pain [38�40]. This provides a valuable insight into the pathogenesis of low back pain. Nevertheless, the detailed cellular and molecular mechanisms by which disc energy and matrix metabolism disruption lead to neuronal death and eventually pain development are not completely understood.
This systematic review had several limitations. First, the heterogeneity between individual studies was substantial. Second, there are only small number patients in several prospective cohort studies of selected articles. Third, there may be some selection bias because the retrieved articles were confined to limited databases.
In conclusion, in this systematic review we propose a new hypothesis that low back pain may be caused by low pH based on previous literature, in which three opinions have been proposed by the authors to explain the pathogenesis of low back pain in relation to low pH. First, low pH caused by lactate stimulates the muscle and increases the muscle tension, which would cause low back pain. Second, low pH stimulates the nerve roots and produces the feeling of pain. Third, low pH changes the matrix metabolism, leading to neuronal death and low back pain. These different opinions are not exclusive but may be complementary. Further experimental studies are necessary to verify our hypothesis that low pH causes low back pain. This hypothesis will promote our understanding of the pathogenesis of low back pain and the development of novel diagnostic and therapeutic approaches for low back pain.
Acknowledgments
This study was partly supported by a grant from the National Nature Science Foundation of China (81171756) and the Science and Technology Planning Project of Zhejiang Province (2012C13G2010083).
In conclusion,�a lower pH balance can mean that your blood is more acidic, while a higher pH balance means that your blood is closer to the levels it should be at. While these numbers may only appear to differentiate slightly, these numerical differences can be serious and may ultimately affect your overall health and wellness. In the article above, researchers proposed that low back pain may be caused by low pH levels. Furthermore, the outcome measures of the systematic review will help support the understanding of the pathogenesis of low back pain, promoting more treatment options for chronic back pain. Information referenced from the National Center for Biotechnology Information (NCBI).�The scope of our information is limited to chiropractic as well as to spinal injuries and conditions. To discuss the subject matter, please feel free to ask Dr. Jimenez or contact us at�915-850-0900�.
Curated by Dr. Alex Jimenez
Additional Topics: Back Pain
Back pain is one of the most prevalent causes for disability and missed days at work worldwide. As a matter of fact, back pain has been attributed as the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience some type of back pain at least once throughout their life. The spine is a complex structure made up of bones, joints, ligaments and muscles, among other soft tissues. Because of this, injuries and/or aggravated conditions, such as herniated discs, can eventually lead to symptoms of back pain. Sports injuries or automobile accident injuries are often the most frequent cause of back pain, however, sometimes the simplest of movements can have painful results. Fortunately, alternative treatment options, such as chiropractic care, can help ease back pain through the use of spinal adjustments and manual manipulations, ultimately improving pain relief.
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The spine is made of bones called vertebrae, with the spinal cord running through the spinal canal in the center. The cord is made up of nerves. These nerve roots split from the cord and travel between the vertebrae into various areas of the body. When these nerve roots become pinched or damaged, the symptoms that follow are known as, radiculopathy. El Paso, TX. Chiropractor, Dr. Alexander Jimenez breaks down�radiculopathies,�along with their causes, symptoms and treatment.
The entire length of the spine, at each level, nerves exit through holes in the bone of the spine (foramen) on each side of the spinal column. These nerves are called nerve roots, or radicular nerves and�branch out from the spine and supply different parts of the body.
Nerves exiting the cervical spine travel down through the arms, hands, and fingers. This is where neck problems affecting a cervical nerve root can cause pain, as well as, other symptoms through the arms and hands, one form of (radiculopathy). Another is low back problems that affect a lumbar nerve root. This can radiate through the leg and into the foot, another form of (radiculopathy, or sciatica), which creates leg pain and/or foot pain.
The spinal cord does not go into the lumbar spine and because the spinal canal has space in the lower back, problems in the lumbosacral region often cause nerve root problems and not a spinal cord injury. Serious conditions i.e. disc herniation or fracture in the lower back are also not likely to cause permanent loss of motor function in the legs.
Cervical Spine – This nerve root is named according to the Lower spinal segment that the nerve root runs between.�
Example – The nerve at C5-C6 level is called the C6 nerve root.
It’s named like this because as it exits the spine, it passes Over the C6 pedicle (a piece of bone part of the spinal segment).
Lumbar Spine – These nerve roots are named according to the Upper spinal segment that the nerve runs between.
Example – The nerve at L4-L5 level is called the L4 nerve root.
The nerve root is named this way because as it exits the spine it passes Under the L4 pedicle.
Two Nerve Roots
Two nerves cross each disc level
Only one exits�the spine (through the foramen) at that level.
Exiting Nerve Root –�This is the nerve root exiting the spine at a certain level.
Example: L4 nerve root exits the spine at L4-L5 level.
Traversing Nerve Root –�This nerve root goes across the disc and exits the spine at the level below.
Example: L5 nerve is the traversing nerve root at L4-L5 level, and is the exiting nerve root at L5-S1 level.
There is some confusion when a nerve root is compressed by disc herniation or other cause to refer both to the intervertebral level (where the disc is) and to the nerve root that is affected. This depends on where the disc herniation or protrusion is happening. It could impinge upon either the exiting nerve�or the traversing nerve.
If The Traversing Nerve Is Affected
Lumbar Radiculopathy
In the lumbar spine, there is a weak area in the disc space right in front of the traversing nerve root, so lumbar discs tend to herniate or leak out and impinge on the traversing nerve.
If The Exiting Nerve Is Affected
Cervical Radiculopathy
The opposite is true in the neck. In the cervical spine, the disc tends to herniate to the side, rather than toward the back and the side. If the disc material herniates to the side, it will compress or impinge the exiting nerve root.
Radiculopathy & Sciatica
Nerve root goes by another name Radicular Nerve, and when a herniated or prolapsed disc presses on a radicular nerve, this is referred to as a radiculopathy. A medical physician might say there is herniated disc at L4-L5, which creates an L5 radiculopathy or an L4 radiculopathy. It all depends on where the disc herniation occurs (the side or the back of the disc) and which nerve is affected. And the term for radiculopathy in the low back is the ever famous Sciatica.
Radiculopathy
A pinched nerve can occur at different areas of the spine (cervical, thoracic or lumbar).
Common causes are narrowing of the hole where the� nerve roots exit, which can result from stenosis, bone spurs, disc herniation and other conditions.
Symptoms vary but often include pain, weakness, numbness and tingling.
Symptoms can be managed with nonsurgical treatment, but minimal surgery can also help.
Prevalence & Pathogenesis
A herniated disc can be defined as herniation of the nucleus pulposus through the fibers of the annulus fibrosus.
Most disc ruptures occur during the third and fourth decades of life while the nucleus pulposus is still gelatinous.
The most likely time of day associated with increased force on the disc is the morning.
In the lumbar region, perforations usually arise through a defect just lateral to the posterior midline, where the posterior longitudinal ligament is weakest.
Epidemology
Lumbar Spine:
Symptomatic lumbar disc herniation occurs during the lifetime of approximately 2% of the general population.
Approximately 80% of the population will experience significant back pain during the course of a herniated disc.
The groups at greatest risk for herniation of intervertebral discs are younger individuals (mean age of 35 years)
True sciatica actually develops in only 35% of patients with disc herniation.
Not infrequently, sciatica develops 6 to 10 years after the onset of low back pain.
The period of localized back pain may correspond to repeated damage to annular fibers that irritates the sinuvertebral nerve but does not result in disc herniation.
Epidemology
Cervical Spine:
The average annual incidence of cervical radiculopathies is less than 0.1 per 1000 individuals.
Pure soft disc herniations are less common than hard disc abnormalities (spondylosis) as a cause of radicular arm pain.
In a study of 395 patients with nerve root abnormalities, radiculopathies occurred in the cervical and lumbar spine in 93 (24%) and 302 (76%), respectively.
Pathogenesis
Alterations in intervertebral disc biomechanics and biochemistry over time have a detrimental effect on disc function.
The disc is less able to work as a spacer between vertebral bodies or as a universal joint.
Pathogenesis – LUMBAR SPINE
The two most common levels for disc herniation are L4-L5 and L5-S1, which account for 98% of lesions; pathology can occur at L2-L3 and L3-L4 but is relatively uncommon.
Overall, 90% of disc herniations are at the L4-L5 and L5-S1 levels.
Disc herniations at L5-S1 will usually compromise the first sacral nerve root, a lesion at the L4-L5 level will most often compress the fifth lumbar root, and herniation at L3-L4 more frequently involves the fourth lumbar root.
Disc herniation may also develop in older patients.
Disc tissue that causes compression in elderly patients is composed of the annulus fibrosus and and portions of the cartilaginous endplate (hard disc.)
The cartilage is avulsed from the vertebral body.
Resolution of some of the compressive effects on neural structures requires resorption of the nucleus pulposus.
Disc resorption is part of the natural healing process associated with disc herniation.
The enhanced ability to resorb discs has the potential for resolving clinical symptoms more rapidly.
Resorption of herniated disc material is associated with a marked increase in infiltrating macrophages and the production of matrix metalloproteinases (MMPs) 3 and 7.
Nerlich and associates identified the origins of phagocytic cells in degenerated intervertebral discs.
The investigation identified cells that are transformed local cells rather than invaded macrophages.
Degenerative discs contain the cells that add to their continued dissolution.
Pathogenesis – CERVICAL SPINE
In the early 1940s, a number of reports appeared in which cervical intervertebral disc herniation with radiculopathies was described.
There is a direct correlation between the anatomy of the cervical spine and the location and pathophysiology of disc lesion.
The eight cervical nerve roots exit via intervertebral foramina that are bordered anteromedially by the intervertebral disc and posterolaterally by the zygapophyseal joint.
The foramina are largest at C2-C3 and decrease in size until C6-C7.
The nerve root occupies 25% to 33% of the volume of the foramen.
The C1 root exits between the occiput and the atlas (C1)
All lower roots exit above their corresponding cervical vertebrae (the C6 root at the C5-C6 interspace), except C8, which exits between C7 and T1.
A differential growth rate affects the relationship of the spinal cord and nerve roots and the cervical spine.
Most acute disc herniations occur posterolaterally and in patients around the forth decade of life, when the nucleus is still gelatinous.
The most common areas of disc herniations are C6-C7 and C5-C6.
C7-T1 and C3-C4 disc herniations are infrequent ( less than 15 %).
Disc herniation of C2-C3 is rare.
Patients with upper cervical disc protrusions in the C2-C3 region have symptoms that include suboccipital pain, loss of hand dexterity, and paresthesias over the face and unilateral arm.
Unlike lumbar herniated discs, cervical herniated discs may cause myelopathy in addition to radicular pain because of the anatomy of the spinal cord in the cervical region.
The uncovertebral prominences play a role in the location of ruptured discs material.
The uncovertebral joint tends to guide extruded disc material medially, where cord compression may also occur.
Disc herniations usually affect the nerve root numbered most caudally for the given disc level; for example, the C3 � C4 disc affects the fourth cervical nerve root; C4- C5, the fifth cervical nerve root; C5 � C6, the sixth cervical nerve root; C6 � C7, the seventh cervical nerve root; and C7 � T1, the eighth cervical nerve root.
Not every herniated disc is symptomatic.
The development of symptoms depends on the reserve capacity of the spinal canal, the presence of inflammation, the size of the herniation, and the presence of concomitant disease such as osteophyte formation.
In disc rupture, protrusion of nuclear material results in tension on the annular fibers and compress?on of the dura or nerve root causing pain.
Also important is the smaller size of the sagittal diameter, the bony cervical spinal canal.
Individuals in whom a cervical herniated disc causes motor dysfunction have a complication of cervical disc herniation if the spinal canal is stenotic.
Clinical History – LUMBAR SPINE
Clinically, the patient�s major complaint is a sharp, lancinating pain.
In many cases there may be a previous history of intermittent episodes of localized low back pain.
The pain not only in the back but also radiates down the leg in the anatomic distribution of the affected nerve root.
It will usually be described as deep and sharp and progressing from above downward in the involved leg.
Its onset may be insidious or sudden and associated with a tearing or snapping sensations of the spine.
Occasionally, when sciatica develops, the back pain may resolve because once the annulus has ruptured, it may no longer be under tension.
Disc herniation occurs with sudden physical effort when the trunk is flexed or rotated.
On occasion, patients with L4-L5 disc herniation have groin pain. In a study of 512 lumbar disc patients, 4.1% had groin pain.
Finally, the sciatica may vary in intensity; it may be so severe that patients will be unable to ambulate and they will feel that their back is “locked”.
On the other hand, the pain may be limited to a dull ache that increases in intensity with ambulation.
Pain is worsened in the flexed position and relieved by extension of the lumbar spine.
Characteristically, patients with herniated discs have increased pain with sitting, driving, walking, couching, sneezing, or straining.
Clinical History – CERVICAL SPINE
Arm pain, not neck pain, is the patient� s major complaint.
The pain is often perceived as starting in the neck area and then radiating from this point down to shoulder, arm and forearm and usually into the hand.
The onset of the radicular pain is often gradual, although it can be sudden and occur in association with a tearing or snapping sensation.
As time passes, the magnitude of the arm pain clearly exceeds that of the neck or shoulder pain.
The arm pain may also be variable in intensity and preclude any use of the arm; it may range from severe pain to a dull, cramping ache in the arm muscles.
The pain is usually severe enough to awaken the patient at night.
Additionally, a patient may complain of associated headaches as well as muscle spasm, which can radiate from the cervical spine to below the scapulae.
The pain may also radiate to the chest and mimic angina (pseudoangina) or to the breast.
Symptoms such as back pain, leg pain, leg weakness, gait disturbance, or incontinence suggest compression of the spinal cord (Myelopathy).
Physical Examination – LUMBAR SPINE
Physical examination will demonstrated a decrease in range of motion of the lumbosacral spine, and patients may list to one side as they try to bend forward.
The side of the disc herniation typically corresponds to the location of the scoliotic list.
However, the specific level or degree of herniation does not correlate with the degree of list.
On ambulation, patients walk with an antalgic gait in which they hold the involved leg flexed so that they put as little weight as possible on the extremity.
Neurologic Examination:
The neurologic examination is very important and may yield objective evidence of nerve root compression (We should evaluate of reflex testing, muscle power, and sensation examination of the patient).
In addition, a nerve deficit may have little temporal relevance because it may be related to a previous attack at a different level.
Compression of individual spinal nerve roots results in alterations in motor, sensory, and reflex function.
When the first sacral root is compressed, the patient may have gastrocnemius-soleus weakness and be unable to repeatedly raise up on the toes of that foot.
Atrophy of the calf may be apperent, and the ankle (Achilles) reflex is often diminished or absent.
Sensory loss, if present, is usually confined to the posterior aspect of the calf and the lateral side of the foot.
Involvement of the fifth lumbar nerve root can lead to weakness in extension of the great toe and, in a few cases, weakness of the everters and dorsiflexors of the foot.
A sensory deficit can appear over the anterior of the leg and the dorsomedial aspect of the foot down to the big toe
With compression of the fourth lumbar nerve root, the quadriceps muscle is affected; the patient may note weakness in knee extension, which is often associated with instability.
Atrophy of the thigh musculature can be marked. Sensory loss may be apparent over the anteromedial aspect of the thigh, and the patellar tendon reflex can be diminished.
Nerve root sensitivity can be elicited by any method that creates tension.
The straight leg-raising (SLR)test is the one most commonly used.
This test is performed with the patient supine.
Physical Examination – CERVICAL SPINE
Neurologic Examination:
A neurologic examination that shows abnormalities is the most helpful aspect of the diagnostic work-up, although the examination may remain normal despite a chronic radicular pattern.
The presence of atrophy helps document the location of the lesion, as well as its chronicity.
The presence of subjective sensory changes is often difficult to interpret and requires a coherent and cooperative patient to be of clinical value.
When the third cervical root is compressed, no reflex change and motor weakness can be identified.
The pain radiates to the back of the neck and toward the mastoid process and pinna of the ear.
Involvement of the fourth cervical nerve root leads to no readily detectable reflex changes or motor weakness.
The pain radiates to the back of the neck and superior aspect of the scapula.
Occasionally, the pain radiates to the anterior chest wall.
The pain is often exacerbated by neck extension.
Unlike the third and the fourth cervical nerve roots, the fifth through eighth cervical nerve roots have motor functions.
Compression of the fifth cervical nerve root is characterized by weakness of shoulder abduction, usually above 90 degree, and weakness of shoulder extension.
The biceps reflexes are often depressed and the pain radiates from the side of the neck to the top of the shoulder.
Decreased sensation is often noted in the lateral aspect of the deltoid, which represents the autonomous area of the axillary nerve.
Involvement of the sixth cervical nerve root produces biceps muscles weakness as well as diminished brachioradial reflex.
The pain again radiates from the neck down the lateral aspect of the arm and forearm to the radial side of hand (index finger, long finger, and thumb).
Numbness occurs occasionally in the tip of the index finger, the autonomous area of the sixth cervical nerve root.
Compression of the seventh cervical nerve root produces reflex changes in the triceps jerk test with associated loss of strength in the triceps muscles, which extend the elbow.
The pain from this lesion radiates from the lateral aspect of the neck down the middle of the area to the middle finger.
Sensory changes occur often in the tip of the middle finger, the autonomous area for the seventh nerve.
Patients should also be tested for scapular winging, which may occur with C6 or C7 radiculopathies.
Finally, involvement of the eighth cervical nerve root by a herniated C7-T1 disc produces significant weakness of the intrinsic musculature of the hand.
Such involvement can lead to rapid atrophy of the interosseous muscles because of the small size of these muscles.
Loss of the interossei leads to significant loss of fine hand motion.
No reflexes are easily found, although the flexor carpi ulnaris reflex may be decreased.
The radicular pain from the eighth cervical nerve root radiates to the ulnar border the hand and the ring and little fingers.
The tip of the little finger often demonstrates diminished sensation.
Radicular pain secondary to a herniated cervical disc may be relieved by abduction of the affected arm.
Although these signs are helpful when present, their absence alone does not rule out a nerve root lesion.
Laboratory Data
Medical screening laboratory test (blood counts, chemistry panels erythrocyte sedimentation rate [ESR]) are normal in patients with a herniated disc.
Electro diagnostic Testing
Electromyography(EMG)is an electronic extension of the physical examination.
The primary use of EMG is to diagnose radiculopathies in cases of questionable neurologic origin.
EMG findings may be positive in patients with nerve root impingement.
Radiographic Evaluation – LUMBAR SPINE
Plain x-rays may be entirely normal in a patient with signs and symptoms of nerve root impingement.
Computed Tomography
Radigraphic evaluation by CT scan may demonstrate disc bulging but may not correlate with the level of nerve damage.
Magnetic Resonance Imaging
MR imaging also allows visualization of soft tissues, including discs in the lumbar spine.
Herniated discs are easily detected with MR evaluation.
MR imaging is a sensitive technique for the detection of far lateral and anterior disc herniations.
Radiographic Evaluation – CERVICAL SPINE
X-rays
Plain x-rays may be entirely normal in patients wit han acute herniated cervical disc.
Conversely,�70% of asymptomatic women and 95% of asymptomatic men between the ages of 60 and 65 years have evidence of degenerative disc disease on plain roentgenograms.
Views to be obtained include anteroposterior, lateral, flexion, and extension.
Computed Tomography
CT permits direct visualization of compression of neural structures and is therefore more precise than myelography.
Advantages of CT over myelography include better visualization of lateral abnormalities such as foraminal stenosis and abnormalities caudal to the myelographic block, less radiation exposure, and no hospitalization.
Magnetic Resonance
MRI allows excellent visualization of soft tissues, including herniated discs in the cervical spine.
The test is noninvasive.
In a study of 34 patients with cervical lesions, MRI predicted 88% of the surgically proven lesions versus 81% for myelography-CT, 58% for myelography, and 50% for CT alone.
Differential Diagnosis – LUMBAR SPINE
The initial diagnosis of a herniated disc is ordinarily made on the basis of the history and physical examination.
Plain radiographs of the lumbosacral spine will rarely add to the diagnosis but should be obtained to help rule out other causes of pain such as infection or tumor.
Other tests such as MR, CT, and myelography are confirmatory by nature and can be misleading when used as screening tests.
Spinal Stenosis
Patient with spinal stenosis may also suffer from back pain that radiates to the lower extremities.
Patients with spinal stenosis tend to be older than those in whom herniated discs develop.
Characteristically, patients with spinal stenosis experience lower extremity pain (pseudoclaudication=neurogenic claudication) after walking for an unspecified distance.
They also complain of pain that is exacerbated by standing or extending the spine.
Radiographic evaluation is usually helpful in differentiating individuals with disc herniation from those with bony hypertrophy associated with spinal stenosis.
In a study of 1,293 patients, lateral spinal stenosis and herniated intervertebral discs coexisted in 17.7% of individuals.
Radicular pain may be caused by more than one pathologic process in an individual.
Facet Syndrome
Facet syndrome is another cause of low back pain that may be associated with radiation of pain to structures outside the confines of the lumbosacral spine.
Degeneration of articular structures in the facet joint causes pain to develop.
In most circumstances, the pain is localized over the area of the affected joint and is aggravated by extension of the spine (standing).
A deep , ill-defined, aching discomfort may also be noted in the sacroiliac joint, the buttocks, and the legs.
The areas of sclerotome affected show the same embryonic origin as the degenerated facet joint.
Patients with pain secondary to facet joint disease may have relief of symptoms with apophyseal injection of a long-acting local anesthetic.
The true role of facet joint disease in the production of back and leg pain remains to be determined.
Other mechanical causes of sciatica include congentenial abnormalites of the lumbar nerve roots, external compression of the sciatic nerve (wallet in a back pants pocket), and muscular compression of the nerve (piriformis syndrome).
In rare circumstances, cervical or thoracic lesion should be considered if the lumbar spine is clear of abnormalities.
Medical causes of sciatica (neural tumors or infections, for example) are usually associated with systemic symptoms in addition to nerve pain in a sciatic distribution.
Differential Diagnosis – CERVICAL SPINE
No diagnostic criteria exist for the clinical diagnosis of a herniated cervical disc.
The provisional diagnosis of a herniated cervical disc is made by the history and physical examination.
The plain x-ray is usually nondiagnostic, although occasionally disc space narrowing at the suspected interspace or foraminal narrowing on oblique films is seen.
The value of x-rays is to exclude other causes of neck and arm pain, such as infection and tumor.
MR imaging and CT-myelography are the best confirmatory examinations for disc herniation.
Cervical disc herniations may affect structures other than nerve roots.
Disc herniation may cause vessel compression (vertebral artery) associated with vertebrobasilar artery insufficiency and be manifested as blurred vision and dizziness.
Other mechanical causes of arm pain should be excluded.
The most common is some form of compression on a peripheral nerve.
Such compression can occur at the elbow, forearm, or wrist. An example is compression of the median nerve by the carpal ligament leading to carpal tunnel syndrome.
The best diagnostic test to rule out these peripheral neuropathies is EMG.
Excessive traction on the arm secondary to heavy weights may cause radicular pain without disc compression of nerve roots.
Spinal cord abnormalities must be considered if signs of myelopathy are present in conjunction with radiculopathies.
Spinal cord lesions such as syringomyelia are identified by MRI, and motor neuron disease is identified by EMG.
Multiple sclerosis should be considered in a patient with radiculopathies if the physical signs indicate lesions above the foramen magnum (optic neuritis).
In very rare circumstances, lesions of the parietal lobe corresponding to the arm can mimic the findings of cervical radiculopathies.
You try to stand up from a seated position and feel a stab of pain in your lower back. It may even shoot through your hip, buttock, or down the back of your thigh. The pain may even get worse then you walk uphill or sit for a long period of time. While these symptoms could mean a pinched nerve, lumbar disc herniation, hip bursitis, or degenerative hip disease, it could also be sacroiliac joint dysfunction.
What Is Sacroiliac Joint Dysfunction?
The sacroiliac (SI) joint is located in the pelvis. It is very strong as it is a weight bearing joint connecting the pelvis to the sacrum. It is surrounded by tough ligaments that reinforce it, providing added support.
There is an SI joint located on each side of the sacrum and they work together, moving as a single unit to act as a shock absorber for the spine and for transmitting force of the upper body. Just like any other joint in the body, the SI joint can be injured or diseased, causing it to become unstable and inflamed, causing pain and limited mobility.
What Causes SI Joint Inflammation?
While doctors have not established how the pain is generated, it is believed that it is due to a change in the normal motion of the joint. This could occur due to:
Hypermobility (Instability or Too Much Movement) � This can cause the pain to reside in the lower back. It can also be felt in the hip or both the hip and lower back and may even radiate into the groin.
Hypomobility (Fixation or Too Little Movement) � This can cause the pain to reside in the lower back or buttocks and may radiate down one leg, usually in the back of the thigh. It usually doesn�t reach the knee, but sometimes can even reach the ankle and foot. In this way, the condition mimics sciatica.
Sacroiliac joint dysfunction typically affects women who are young or middle aged. Older women and men are rarely affected although it does happen.
What Are Treatment Options For Sacroiliac Joint Pain?
When SI joint pain is initially diagnosed the treatment is usually fairly conservative. Medication, physical therapy, and injections are used by doctors for pain management.
NSAIDs and other similar medications decrease inflammation and reduce pain, while physical therapy can readjust the SI joint in cases where it is dislocated or immobilized. It also includes exercises that stabilize the joint for pain management over the long term.
Steroid injections directly into the sacroiliac joint can help with the reduction of inflammation and pain while making physical therapy more effective. When steroid injections are effective but the effects are temporary there is another non-surgical treatment that is sometimes used called RFA, or radiofrequency ablation.
In cases where the conservative methods do not achieve the desired results there are surgical options that provide pain reduction and stabilization on a more permanent scale. SI fusion involves fusing the joint, providing relief.
However, there is a treatment option that is non-invasive, doesn�t involve steroids or medications that could have harmful side effects � chiropractic.
Spinal manipulation � This is the traditional chiropractic adjustment that is also known as high-velocity, low-amplitude (HVLA) thrust.
Spinal mobilization � This is a less forceful, gentle chiropractic adjustment also known as low-velocity, low-amplitude thrust.
Chiropractic is proven to be an effective, non-invasive, gentle method for relieving the pain and inflammation of SI joint dysfunction. No medication, no surgery, just relief.
So if you�ve been suffering from sacroiliac joint dysfunction, give us a call! Our Doctor of Chiropractic is here to help!
Injury Medical Clinic: Sciatica Treatments & Recoveries
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