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 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
Truide Torres primero fue a ver al Dr.. Alex Jim�nez cuando comenz� a experimentar dolor de espalda durante su embarazo. A medida que progres� su embarazo, sus s�ntomas empeoraron y su calidad de vida se volvi� tremendamente limitada. Truide Torres estaba involucrada en muchas actividades f�sicas, sin embargo, debido a su dolor de espalda, tuvo que dejar de hacer ejercicio por completo. Fue entonces cuando decidi� buscar atenci�n quiropr�ctica con el Dr. Alex Jim�nez por su dolor de espalda. Aunque no estaba segura de que si deber�a recibir este tipo de tratamiento durante el embarazo, Truide Torres supo r�pidamente por el Dr. Alex Jim�nez que la atenci�n quiropr�ctica es un enfoque de tratamiento natural, seguro y eficaz que puede utilizarse para ayudar a tratar el dolor de espalda durante el embarazo. Truide Torres recomienda altamente el cuidado quiropr�ctico para cualquier persona que experimente dolor de espalda.
El Paso, TX Quiropr�ctico
La atenci�n quiropr�ctica es un enfoque de tratamiento alternativo de la columna vertebral y los discos, as� como la geometr�a �sea y nerviosa relacionada sin el uso de o cirug�a. Implica la ciencia y el arte de reparar las articulaciones desalineadas del cuerpo, particularmente de la columna vertebral, lo que reduce el estr�s del nervio espinal y, por lo tanto, promueve la salud y el bienestar en todo el cuerpo. No se conocen contraindicaciones para el cuidado quiropr�ctico que se usa durante el embarazo. Todos los quiropr�cticos est�n capacitados para utilizar ajustes espinales y manipulaciones manuales en mujeres embarazadas. Invertir en la fertilidad y la salud del embarazo de las mujeres que est�n embarazadas es un cuidado de rutina para la mayor�a de los quiropr�cticos. La atenci�n quiropr�ctica tambi�n se puede usar para otros problemas de salud en cualquier persona.
Tenemos la bendici�n de presentarle la Cl�nica Premier de bienestar y lesiones de El Paso.
Nuestros servicios est�n especializados y enfocados en lesiones y el proceso de recuperaci�n completo. Nuestras �reas de pr�ctica incluyen: bienestar y nutrici�n, dolor cr�nico, lesiones personales, cuidado de accidentes automovil�sticos, lesiones laborales, lesiones de espalda, dolor lumbar, dolor de cuello, dolores de cabeza por migra�a, lesiones deportivas, ci�tica grave, escoliosis, discos complejos herniados, fibromialgia, Dolor cr�nico, manejo del estr�s y lesiones complejas.
Como Cl�nica de Rehabilitaci�n Quiropr�ctica y Centro de Medicina Integrada de El Paso, nos enfocamos apasionadamente en tratar pacientes despu�s de lesiones frustrantes y s�ndromes de dolor cr�nico. Nos enfocamos en mejorar su capacidad a trav�s de programas de flexibilidad, movilidad y agilidad dise�ados para todos los grupos de edad y discapacidades.
Recomi�ndanos: Si ha disfrutado este video y / o le hemos ayudado de alguna manera, no dude en recomendarnos. Gracias, Dios te bendiga.
Facet syndrome, also called facet joint sprain or facet joint syndrome is a common cause of back pain. There are many treatments that are used, but most mainstream medical treatments involve pain medication which can have undesirable side effects and may even lead to addiction.
Chiropractic is a proven, reliable treatment for relieving the pain and discomfort of facet syndrome. It helps restore mobility and flexibility while providing pain relief. Some patient notice significant relief from the pain and inflammation of this condition with chiropractic treatment and it is often recommended to facet syndrome patients.
What Is Facet Syndrome?
Facet syndrome is the result of an injury to the facet joints. Zygapophyseal joints, or facet joints reside at the posterior of the spine. At each level there are two joints, one on each side of the spine.
The facet joints are enclosed in a joint capsule. They are synovial joints so the capsule contains synovial fluid. The surface of the joints is covered with hyaline cartilage.
Other joints, such as the ankle, contain this type of cartilage covering. These joints are constructed in this way due to their role in the body � to control excessive or extensive movement. This would include hyper extension and rotation. By doing so they help to stabilize the spine.
Facet syndrome occurs when there is an injury to the facet joints. There are numerous causes, but basically, it is a sprain that is brought about by excessive movement.
This damages the joint capsule and the result is inflammation, swelling, and pain. The pain triggers a protective mechanism in the spine called a reactive muscle spasm which causes great difficulty in moving comfortable and severe, sudden pain.
It is difficult to rest the back because of its integral function in supporting the entire body. A severe sprain can take weeks to heal, typically 2 to 6 weeks. This means that the pain and lack of mobility is impacting you on a daily basis. It can be very difficult to pursue day to day activities and enjoy your typical lifestyle.
Chiropractic For Facet Syndrome
Chiropractic care is a proven, effective treatment for facet syndrome. When you visit your chiropractor, he or she will conduct a physical exam, discuss your medical history, and may send you for diagnostic tests like x-rays and MRIs. Once they have a clear picture of your condition and a facet syndrome diagnosis has been confirmed, they will discuss with you a recommended course of treatment that may include:
Exercise � they will recommend specific exercises to help relieve the pain and strengthen the muscles in the back so that they can better support the spine.
Posture � posture is extremely important in spinal health and overall wellness. Your chiropractor will help you achieve good, healthy posture and give you exercises to do at home to help you maintain good posture and retrain your body to have better posture.
Heat or cold therapy � heat wraps and hot showers or ice packs and cold pad applications may be recommended to help control pain.
Changes in activities � you may be advised to take frequent breaks if you sit at a desk all day or to shorten your commute. There may be some activities that you won�t be able to do for a while � or won�t be able to do for long periods of time until your back heals.
Chiropractic treatment � spinal manipulation is the most common chiropractic treatment for facet syndrome. Your chiropractor may include other types of treatments though, depending on your specific condition and lifestyle.
Chiropractic is a safe, effective, non-invasive, and drug free way to treat facet syndrome, relieve back pain, and help you regain your mobility. Talk to your chiropractor about your treatment options for facet syndrome.
Injury Medical Clinic: Back Pain Care & Treatments
Back pain sometimes strikes without warning. One minute you’re bending or lifting something heavy; the next minute you’re unable to move. Sudden onset of muscle spasm from the back is common. Roughly 8 out of 10 adults will experience back pain at some point in their lives. Generally, the origin of back pain and muscle spasm can be credited to overuse, an accident or a sports injury. But more often than not, the origin of muscle spasm is the effect of damage to a structure within the lumbar spine.
One matter is clear: if you have had one or more episodes of muscular strain in the back, chances are it’ll happen again. The muscles in the back function together. Without all the muscles of the back working together, no lateral and extension motion of the spine would be impossible. Stability is also added by the muscles of the back in order to keep the spine erect and maintain equilibrium. When the muscles are in spasm due to a spinal health issue, that balance can be compromised.
What are Muscle Spasms?
Muscle spams are involuntary contractions of a muscle. Although “back attacks” seem to happen out of nowhere, the motion that triggers the episode is generally preceded by a collection of health issues to the structures of the spine that develops gradually, over time. Inflammation sets in once injured. This, in turn, sensitizes the nerves, causing the muscle/s to contract and spasm.
Disc Disorders and Muscle Spasms
Conditions, such as degenerative disc disease or a herniated disc, may cause an acute episode of low back pain. A disc bulge or disc herniation may also compress a spinal nerve root causing irritation and inflammation. The body tries to immobilize the affected area by tightening the musculature to stop pain and as a result, debilitating muscle spasms occur.
Muscles can get too tight due to insufficient exercise, a lot of exercise, structural imbalances, dehydration and electrolyte loss, or any mix thereof. By comparison, some muscle bands are weak. When muscle imbalances become persistent, aberrant forces are transmitted into the spine. Consequently, an accident can be triggered by one movement out of the norm to a joint, ligament, or disk resulting in spasm and back pain. As these structures are already “primed,” the event that activates the spasm is nothing more than an effect of an underlying health issue. Muscle spams in the back are frequently painful. Here are several remedies which can help you get moving.
Remedies for Back Spasms
Initial 48 to 72 hours: Apply ice for 20 minutes every 2 hours while lying on your back. Constantly use an ice pack, never apply ice directly to skin.
After 72 hours: Apply moist warmth. A heating pad is ideal. You might find relief by soaking in a bathtub of warm water.
Whereas ice reduces redness, warmth relaxes muscles and increases blood flow to the area and nerves that are irritated.
By elevating your legs, pressure is taken off the spine and may help relieve pain.
Aspirin or ibuprofen can help reduce inflammation and alleviate pain. Consult with your doctor or healthcare provider regarding the dosing and drug regimen most acceptable for your problem. With reduced back muscle spasms, combination remedies (ie, remainder, ice/heat and drugs) generally yield much better outcomes than one therapy alone.
Back Spasm Prevention
When the back spasm episode has passed, and you’ve allowed enough time for the inflammation to subside, begin focusing on what you can do to keep it from happening again.
Start stretching: Incorporate stretching exercises in your daily routine. Muscle fibers gain from stretching and so will you. Consider taking yoga courses or Pilates; always stretch before exercise.
Get in shape:�Now’s the time to get started in case you do not take part in routine physical activity. Exercise confers advantages too important to ignore and too numerous to mention. Join a fitness center. Start playing a sport. The key to any exercise routine is that it be done consistently.
Strength training: A�significant part of any exercise regimen, strength training not only builds muscle, it can reduce imbalances. Remember: muscles operate with one another, so be sure to balance your strengthening regularly.
Make preventing another incident of muscular spasms your priority. It’s never too late to start increasing your strength, flexibility and mobility. Choose activities that you enjoy and commit to performing them. In addition, several healthcare professionals can help decrease muscles spasms. Chiropractic care is a well-known alternative treatment option which utilizes a variety of treatment methods to help ease muscle spasms caused by spinal health issues.
How a Chiropractor Can Help
Muscle spasms both disrupt your life and can be painful. There are several ways in which a chiropractor can help you find relief for your muscle spasms. Here’s how chiropractic care can help to decrease the severity and frequency of your muscle spasms.
Chiropractic care, can go a long way toward assisting you to avoid tightness in your muscles that result in constantly painful symptoms, when you get regular spinal adjustments and manual manipulations. Chiropractic treatment includes spinal adjustments and manual manipulations which help align your body to take pressure off of soft tissues within the body and nerves, reducing the nerve signals your brain might be receiving that cause an involuntary contraction. Manual manipulations and spinal adjustments also allows your spine and joints to restore normal motion, which in turn contributes to a decrease in muscle spasms and pain.
Your chiropractor may also utilize massage treatment to help relax the muscles in your body which are prone to spasm. These kinds of treatments help to decrease fluid, reduce scar tissue and supply relief. Massage may also help to reduce any inflammation that communicates with the cramps and spasms your own muscles. Your chiropractor can also provide nutritional advice to help put an end to chronic spasms. If you are dehydrated you could have an electrolyte imbalance which may be causing your cramping and muscle spasms. Making certain modifications to your diet and drinking more water can help restore balance and decrease the number or spasms you’re experiencing as well.
Moreover, the chiropractor may use associated therapies for the treatment of muscle spasms. This can include hot and cold treatments, ultrasound and electric stimulation of the muscle. These therapies help greatly to increase flow and also prevent swelling or scarring of the muscle. Associated treatments are a means for prevention of further damage and injury recurrences as well as to reduce pain. What’s more, a doctor of chiropractic may suggest a series of appropriate stretches and exercises to speed up the recovery process. Certainly, the ultimate objective is to alleviate the muscle spasms.
Dr. Alex Jimenez’s Insight
Muscle spasms are common symptoms caused by a variety of injuries and/or aggravated conditions which can result in back pain. Regardless of the cause of your back pain, muscle spasms can often become a constant and debilitating health issue that can affect your overall quality of life. Chiropractic care is a common treatment option utilized to help ease soft tissue injuries caused by accident and/or sports injuries. Through the use of spinal adjustments and manual manipulations, a chiropractor can restore the original alignment of the spine, helping to reduce stress and tension build up in the soft tissues surrounding the spine, ultimately improving muscle spams.
Remember, it’s not normal to experience muscle spasms. If you do, then it is likely you have an underlying problem that has to be diagnosed and treated. You don’t have to suffer from the pain and discomfort of muscle spasms, your chiropractor can be your partner.�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
According to statistics, approximately 80% of people will experience symptoms of back pain at least once throughout their lifetimes. Back pain is a common complaint which can result due to a variety of injuries and/or conditions. Often times, the natural degeneration of the spine with age can cause back pain. Herniated discs occur when the soft, gel-like center of an intervertebral disc pushes through a tear in its surrounding, outer ring of cartilage, compressing and irritating the nerve roots. Disc herniations most commonly occur along the lower back, or lumbar spine, but they may also occur along the cervical spine, or neck. The impingement of the nerves found in the low back due to injury and/or an aggravated condition can lead to symptoms of sciatica.
Back pain can affect 8 out of 10 people throughout their lifetime. Because it’s become such a common complaint over many generations, it’s not uncommon for the average person to turn to self-care remedies in order to find immediate relief for their symptoms without the need to seek medical attention. As a result, many myths about back pain and its treatments have developed over the years. Neel Anand, MD discusses several of the most common myths regarding the symptoms, causes and treatments of back pain. Dr. Anand is the Director of Orthopedic Spine Surgery at the Cedars-Sinai Institute for Spinal Disorders in Los Angeles. Below are seven of the most prevalent myths which have been debunked by healthcare professional Neel Anand, MD. We will then discuss debunked chiropractic care myths regarding back pain.
Sitting Up Straight
Every time your mother told you to sit up straight, she wasn’t wrong about how hunching over could be bad for your back, however, sitting up straight can certainly have its own health issues. Sitting up straight for an extended period of time, with no break and in a position which doesn’t feel quite natural for your body, can alternatively cause strain on your spine. An improper posture can eventually lead to spinal misalignment, or subluxation, which may then cause back pain. If you work in an office for 8 hours each day, maintaining a proper posture can be difficult. To provide your body with the proper support it needs in an office work setting, make sure to keep your feet resting flat on the ground while maintaining your chair at a height where your knees are at a 9-degree angle. Also, make sure that you stand up and stretch several times a day or simply take some time to go for a walk several times a day in order to keep your muscles from becoming stiff and/or shortened. Proper posture is important for managing back pain, especially if you have a sedentary lifestyle.
Utilizing the Firmest Mattress
People who suffer from back pain may experience worsening pain and discomfort if they switch their current mattress for one of the firmer choices. A mattress that is too firm can place unnecessary amounts of stress on an individual’s shoulders and hips. Conversely, a mattress that is too soft can lack the support necessary to allow proper movement.�In both circumstances, the individual can suffer a misalignment in their spine from improper sleeping posture. Improper sleeping posture caused by an improper mattress can cause back pain. Research studies have also demonstrated that a good mattress can be just as helpful to prevent further health issues.
Exercise and the Spine
A poll from the North American Spine Society revealed that one of the biggest misconceptions regarding back pain involves exercise. Of course, if you have a sedentary lifestyle and decide to participate in strenuous physical activity, you’re bound to experience some type of injury which could result in back pain, however, an individual who properly engages in the appropriate amount of exercise their body can sustain will experience countless benefits towards their spinal health. You can prevent symptoms of bak pain by preparing your body for the shock of everyday movements with stretching and warm-up exercises in order to help wake up your muscles. Take a cue from professional athletes that engage in stretching and warm up routines during their daily routine to avoid injury on the field. Strengthening your core and back muscles can also help you avoid injuries which could cause back pain. Exercises focused on cardio as well as strengthening your stomach and back muscles can help improve overall health and wellness.
Degeneration Associated with Age
Back pain is not an unavoidable side-effect that comes with age and certainly, getting older does not mean life has to become debilitating. While the degeneration of the structures of the body is a natural and even a normal process that comes with age, remaining physically active by participating in regular exercise and physical activity can help keep our bodies strong, flexible and mobile.��There are many fitness alternatives, including yoga, Pilates and T�ai Chi as well as other treatment options ranging from acupuncture to physical therapy, which can help improve symptoms of back pain which may be caused by the wear-and-tear of the body. Just because you’re getting older doesn’t mean that you simply have to live with aches and pains.
Back Pain without a Cause
You’ll often hear back pain sufferers claim that their symptoms started without a cause or that they simply began on their own. In almost all cases, however, individuals who suffer back pain may have caused their own symptoms without them even realizing it. From improperly lifting a heavy object and twisting your back incorrectly to overdoing a workout, poor posture and even weight gain, back pain can be the result of many different factors. All of these circumstances can place too much pressure on the spine, leading to these seemingly “out of nowhere” symptoms of back pain. While most cases of back pain may improve on their own, a persistent case of back pain that is left untreated for an extended period of time may lead to some very serious health issues. Therefore, if you experience back pain without an apparent cause, make sure to seek immediate medical attention to properly diagnose the source of your symptoms and begin the proper treatment for it.
Heat and its Effects
There aren’t many things as relaxing as sinking yourself into a wonderful hot bath, however, after injuring your back, doing so may make your situation worse. While heat therapy might be beneficial for some types of injuries and/or conditions to help relax and loosen the tissues as well as to stimulate blood flow to the affected area, applying heat to some of these can increase inflammation, worsening your symptoms of back pain. Instead, many healthcare professionals recommend the use of ice therapy for back pain because it can help decrease pain, swelling, inflammation and muscle spasms or cramping. Doctors recommend applying ice to the affected area for 20 minutes at a time to reduce painful symptoms. Play it safe and check with a healthcare professionals for the best recommended treatment for your specific source of back pain.
Back Pain Treatment Methods
Many individuals who suffer from back pain will avoid seeing a doctor entirely out of fear of surgery. But, as a matter of fact, although most people experience back pain at some point throughout their lifetimes, the majority of them are able to find relief from their symptoms without the need for invasive treatment procedures. Commonly utilized treatment methods for back pain include over-the-counter drugs and/or medications or lifestyle modifications like exercise and physical activity. Other alternative treatment options, such as chiropractic care and physical therapy, are common treatment options for many individuals with back pain. Only when a healthcare professional has determined that no other treatment method has been effective towards the improvement of your symptoms is it when surgery may be recommended for you and even then, many patients will often seek a second opinion from another healthcare professional. Furthermore, patients who may require surgery to relieve their back pain generally suffer from more severe injuries and/or conditions. Whether you understand the source of your back pain or not, fear of surgery should never keep you from seeking medical attention. But if you prefer a much more natural approach, chiropractic care may be the best treatment option for you.
Chiropractic Care Myths Debunked
Just as there’s many myths regarding what works and what doesn’t when it comes to back pain, there’s also several myths regarding the use of alternative treatment options for your symptoms. As with any other medical procedure, there are many misconceptions out there about what chiropractic care can do for your health issues, when in fact, chiropractic care can be tremendously beneficial for your back pain. However, it is best to have these misunderstandings cleared up once and for all. If you’re considering chiropractic care for your back pain, below we will discuss several of the most common chiropractic care misconceptions and myths which have been debunked through various research studies.
If you suffer from back pain and have considered visiting a chiropractor, you might have heard the myth that chiropractors are not real healthcare providers and that they do not have any medical training. As the Council on Chiropractic Education (CCE) and the American Chiropractic Association (ACA) have made it clear before, a doctor of chiropractic, or chiropractor, receives graduate degrees from Doctor of Chiropractic programs plus they also complete residency programs afterwards to complete their studies. In total, chiropractors spend a minimum of eight years in higher education, including four years as part of their chiropractic college education.
Given that chiropractic care commonly utilizes spinal adjustments and manual manipulations for the treatment of various spinal health issues, a common myth is that this type of treatment isn’t safe. The truth is that chiropractic care is a safe and effective, alternative treatment option for neck and back pain. A qualified and experienced chiropractor utilizes careful precision when using chiropractic treatment methods on a patient. Moreover, a doctor of chiropractic will first make sure to properly diagnose the source of a patient’s back pain symptoms in order to determine which type of treatment method will be best for them. In addition, you may have heard that chiropractic care is only effective for back pain. Research studies have demonstrated that chiropractic care can be helpful for a variety of health issues, including neck pain, headaches and even migraines. Also, individuals who suffer from fibromyalgia and osteoarthritis can also find pain relief with chiropractic care.� Approximately 35 percent of people who receive chiropractic care are seeking back pain relief, whereas the remaining 65 percent visit a chiropractor to seek relief from neck pain, arm pain, leg pain and head pain.
Dr. Alex Jimenez’s Insight
When it comes to back pain, chiropractic care is one of the most popular alternative treatment options people will turn to for relief of their symptoms. Several myths and misconceptions about chiropractic care often turn people away from receiving the proper treatment they deserve, when in fact, chiropractic care can help treat a variety of injuries and/or conditions, including back pain. As a chiropractor in practice, I have helped restore the original health and wellness of many of my patients, giving them back their quality of life. Research studies have debunked these myth, demonstrating that chiropractic care is a safe and effective alternative treatment option because it allows the human body to naturally heal itself through the proper alignment of the spine.
In conclusion,�if you are suffering from back pain, or any other spinal health issue for that matter, chiropractic care can safely and effectively help improve your symptoms. Chiropractic care is a well-known alternative treatment option which focuses on the diagnosis, treatment and prevention of a variety of injuries and/or conditions associated with the musculoskeletal and nervous system. Through the use of spinal adjustments and manual manipulations, among other treatment methods, a chiropractor, or doctor of chiropractic, can help tremendously reduce your symptoms, however, it is essential for you to choose a qualified and experienced chiropractor. Dr. Alex Jimenez is a chiropractor dedicated to enhancing the overall health and wellness of his patients by restoring the original integrity of their spine as well as providing them with the pain relief they deserve. 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
According to statistics, approximately 80% of people will experience symptoms of back pain at least once throughout their lifetimes. Back pain is a common complaint which can result due to a variety of injuries and/or conditions. Often times, the natural degeneration of the spine with age can cause back pain. Herniated discs occur when the soft, gel-like center of an intervertebral disc pushes through a tear in its surrounding, outer ring of cartilage, compressing and irritating the nerve roots. Disc herniations most commonly occur along the lower back, or lumbar spine, but they may also occur along the cervical spine, or neck. The impingement of the nerves found in the low back due to injury and/or an aggravated condition can lead to symptoms of sciatica.
Back Pain Treatment: Carlos Hermosillo is a small contractor in El Paso, Tx, who’s known Dr. Alex Jimenez for several years. As a result of the physical demands of his job, Mr. Hermosillo often experiences lower back pain and back pain symptoms which tremendously limit his ability to perform his normal physical activities, fortunately, Dr. Alex Jimenez provides him with the chiropractic care he regularly needs to return to work as soon as possible. After being involved in an accident, Carlos Hermosillo once again turned to chiropractic care for relief of his symptoms. Mr. Hermosillo highly recommends Dr. Alex Jimenez as the non surgical choice for back pain treatment.
Back pain can originate from the muscles, nerves, bones, joints or other structures in the spine. Internal structures such as the gallbladder, pancreas, aorta, and kidneys may also cause referred pain in the back. The management goals when treating back pain are to achieve maximal reduction in pain intensity as rapidly as possible, to restore the individual’s ability to function in everyday activities, to help the patient cope with residual pain, to assess for side-effects of therapy, and to facilitate the patient’s passage through the legal and socioeconomic impediments to recovery. For many, the goal is to keep the pain to a manageable level to progress with rehabilitation, which then can lead to long-term pain relief.
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