Back Clinic Lower Back Pain Chiropractic Team. More than 80% of the population suffers from back pain at some point in their lives. Most cases can be linked to the most common causes: muscle strain, injury, or overuse. But it can also be attributed to a specific condition of the spine: Herniated Disc, Degenerative Disc Disease, Spondylolisthesis, Spinal Stenosis, and Osteoarthritis. Less common conditions are sacroiliac joint dysfunction, spinal tumors, fibromyalgia, and piriformis syndrome.
Pain is caused by damage or injury to the muscles and ligaments of the back. Dr. Alex Jimenez compiled articles outline the importance of understanding the causes and effects of this uncomfortable symptom. Chiropractic focuses on restoring a person’s strength and flexibility to help improve symptoms of lower back pain.
What is a Herniated Disc?
Herniation of the nucleus pulposus (HNP) occurs when the nucleus pulposus (gel-like substance) breaks through the anulus fibrosus (tire-like structure) of an intervertebral disc (spinal shock absorber).
A herniated disc occurs most often in the lumbar region of the spine especially at the L4-L5 and L5-S1 levels (L = Lumbar, S = Sacral). This is because the lumbar spine carries most of the body’s weight. People between the ages of 30 and 50 appear to be vulnerable because the elasticity and water content of the nucleus decreases with age.
The progression to an actual HNP varies from slow to sudden onset of symptoms. There are four stages: (1) disc protrusion (2) prolapsed disc (3) disc extrusion (4) sequestered disc. Stages 1 and 2 are referred to as incomplete, where 3 and 4 are complete herniations. Pain resulting from herniation may be combined with a radiculopathy, which means neurological deficit. The deficit may include sensory changes (i.e. tingling, numbness) and/or motor changes (i.e. weakness, reflex loss). These changes are caused by nerve compression created by pressure from interior disc material.
Progression of Herniated Disc
The extremities affected are dependent upon the vertebral level at which the HNP occurred. Consider the following examples:
Cervical – Pain in the neck, shoulders, and arms Thoracic – Pain radiates into the chest Lumbar – Pain extends into the buttocks, thighs, legs
Cauda Equina Syndrome occurs from a central disc herniation and is serious requiring immediate surgical intervention. The symptoms include bilateral leg pain, loss of perianal sensation (anus), paralysis of the bladder, and weakness of the anal sphincter.
Diagnosis of a Herniated Disc
The spine is examined with the patient laying down and standing. Due to muscle spasm, a loss of normal spinal curvature may be noted. Radicular pain (inflammation of a spinal nerve) may increase when pressure is applied to the affected spinal level.
A Lasegue test, also known as Straight-leg Raising Test, is performed. The patient lies down, the knee is extended, and the hip is flexed. If pain is aggravated or produced, it is an indication the lower lumbosacral nerve roots are inflamed.
Other neurological tests are performed to determine loss of sensation and/or motor function. Abnormal reflexes are noted as these changes may indicate the location of the herniation.
Radiographs are helpful, but Computed Axial Tomography (CAT) or Magnetic Resonance Imaging (MRI) provides more detail. The MRI is the best method enabling the physician to see the soft spinal tissues unseen in a conventional x-ray.
Radiographic Evidence of HNP
The findings from the examination and tests are compared to make a proper diagnosis. This includes determining the location of the herniation so treatment options can be reviewed with the patient.
Chiropractor, Dr. Alexander Jimenez examines being able to have sex despite having back pain.
The results of SpineUniverse’s national survey on Sexual Satisfaction and Back Pain (read the article Back Pain and Its Impact on Sexual Satisfaction for survey results) indicate that back pain is ruining the sex lives of many people.
It is vital to consider that behind the numbers are real individuals, while the statistical results of the survey are very important. People who care about their partner’s and about their sexual gratification satisfaction. People who are now frustrated and even depressed regarding the impact of back pain on their sex lives.
What exactly can they do to better their situation?
Most specialists agree that three tips can allow you to have better sex� even with back pain:
Tip # 1: Talk It Out
For many people, talking about sex comes for others, their faces turn red even thinking about possibly referring to sex.
Nonetheless, you as well as your partner have to locate a method to discuss your back malady, and the way that it will impact-� or already does change�your relationship.
Take the time to talk through the five dilemmas below:
Back pain: How intense is the pain? Where does it hurt? What moves or increase or positions alleviate the pain?
Sex drive: Is your back pain killing your sex drive? Then you’ve got to discuss this, if it is. If you do not clarify why and simply begin avoiding having sex, you�re your relationship with your partner can be damaged. It’s more straightforward to identify that it is a problem, and never simply theirs �and then find a solution together.
Emotional Impact: What does back pain do to your emotions? Do you feel less appealing to your own partner? Depressed?
Physical Limitations: Living with back pain means living with physical constraints in multiple facets of your daily life. What physical constraints would you now need to work about during sex?
Intimacy: What physical and nonphysical steps can enhance familiarity? (Yes, familiarity means more than sex.) Within the limits caused by back pain, what else can you do to feel close and connected?
Tip # 2: Practical Changes
Here we go, the nitty gritty details of what to do (or not do). (It is ok in case you skipped ahead to this part, but make sure to return and browse the remaining post.)
Position Matters
It may not be the sexiest thing to think about, but you have to remember your diagnosis. Have you got spinal stenosis? A herniated disc? Degenerative changes in your spine? Because what is causing your pain affects how your body reacts to different positions, your analysis is vitally important during sex. For example:
If you have spinal stenosis, your back pain will probably get worse if you arch your back during sex.
Your pain will probably improve should you bend forward during sex when you have a disc herniation or degenerative disk disorder.
So if you’re able to identify which positions naturally lessen your back pain, you can then accommodate your position during sex to help make the experience less painful, given your specific state. For example:
Men that have degenerative disk disease may locate their back pain is decreased by lying with a pillow placed under their low back, while their partner straddles them.
Change The Place
As we’ve learned from Hollywood films, sex does not occur merely in a bed. And perhaps being out of bed will actuality help lower your back pain. For example:
In case you like lying in your back during sex, a solid surface, such as a rug on the floor, may be more comfy for you.
But remember, back pain is individual, if you are on a soft mattress, and perhaps your pain is less during sex. You are required to figure out what’s best for you and your partner.
Rest Your Back
Back pain is frequently made worse by your muscles becoming tense as well as knotted around the region that was painful. Going in a hot tub before sex, having a soothing massage, and sometimes even just using heat or ice packs on the affected region can all ease away muscle pains just before sex.
For more practical tips about sex and back pain and more details on sexual positions go to Sex & Back Pain.
Tip # 3: Speak To A Medical Specialist
We know, talking about sex together with your doctor isn’t the most appealing notion (unless your doctor is Dr. Ruth). But think of this: When Viagra first became available, many men were too embarrassed to talk about erectile dysfunction using their doctor. Subsequently Bob Dole appeared in among their advertisements, and that made it more easy to talk to your physician about sex. (Maybe the thinking was�’If Bob Dole, a politician, can declare he has a problem, maybe I can, too!’)
Besides, physicians have heard it all and they’re prepared to help. Your physicians care about all facets of your physical and emotional well-being; they won’t pity, judge or mock you. So take a deep breath, push past the potential embarrassment, and confer with your physician about how back pain is affecting your sex life. Often, physicians can give advice that is really useful. By way of example, even just a modest change in a medication can make a major difference to your pain.
Because Sex Is More Than�
Sex is more than just the sum of its own physical parts�it’s more than a formula of physical steps that lead to the “perfect” experience. Lots of that which we see in films and on TV these days makes sex the pinnacle of a relationship, the one thing that clearly defines you as a couple (think Grey’s Anatomy).
However, for the vast bulk of people, sexual satisfaction depends on numerous variables, not just physical performance. Factors for example emotional connectedness, a bouquet of flowers sent for no reason, attentive listening, saying thank you for the small things, or sending the kids to Grandma can add to sexual gratification.
And your back pain limits none of those things. You can still have a satisfying, intimate relationship�back pain or not.
Let�s chat about chiropractic and pregnancy. For those of you that didn�t read my last post, What I Wish I Would�ve Known the First Time Around, I am the daughter of a chiropractor. My dad, Dr. Robert J. Natusch, Jr, DC, recently retired after near 40 years with offices in Northern New Jersey. My brother and sister-in-law are both licensed chiropractors at their family owned and operated practice, Upper Valley Chiropractic in Lebanon, New Hampshire (you can find them on Facebook).
Chiropractic � a Lifestyle of Health
My two siblings and I grew up vaccine-free, drug-free, and antibiotic-free. We never took over-the-counter pain meds or pills, even for headaches. If we had an issue, my dad would give us an adjustment and my mom gave us an herbal or holistic remedy and sent us on our way. To me, that was normal!
I was born at home. Those in attendance for my birth aside from my mom and dad? My older brother (21 months older) and my aunt, to tend to my brother while my mom and dad labored with me. I was mere minutes old when I received my first adjustment. It was our way of life and continues to be for my husband, our two sons, and I. It is our weekly preventative healthcare maintenance. Dr. John Tenpenny is our �primary� care doctor and if you�re in Florida, I highly recommend him.
Why the Two Go Together
Since you�re reading this, I�m guessing you�re curious how chiropractic care and pregnancy can be in the same sentence. Some feel those two are taboo and many were shocked when I told them I�d continue to see my chiropractor weekly through my 9 months of pregnancy. The gasps came when I told them my chiropractor adjusted me while I was in labor with my childrenand he came to my house again after my children were born to give them their first adjustments, too! I�m sure I�m a smidge biased, but thankfully, this has become much more mainstream. And personally, I feel moms and babes are all the better for it!
I don�t have many official references for this post, except what I�ve heard my dad repeat in his lectures my entire life.
�It is vital for moms to get adjusted through their pregnancy and beyond. Since you�re gradually adding weight to your abdomen, that causes lower back stress. Your whole posture and skeletal structure slowly alters for the duration of the pregnancy. This can amplify current misalignments.�
But, let�s get a little more in depth as to why this is important while you�re growing another human being inside you.
(Please remember, I am not a licensed chiropractor. This post is not intended to diagnose, cure, or treat any disease or health concern. This information is for educational purposes only.)
This image shows a few vertebrae within your spine. The vertebrae are your bones. The blue and red slivers are your sponge-like discs that cushion your vertebrae so your bones don�t rub on each other and cause pain. The yellow parts are the nerves nestled safely in between your vertebrae which send and receive signals to and from your brain to your organs. When that perfect structure is altered by things like bad posture, carrying your baby on your hip, sleeping on a pillow, crossing your legs, tripping, falling, carrying a purse on one shoulder, car accidents, sports, etc., etc. those messages are not able to be sent or received properly. It�s like a garden hose with the water on full blast, but there�s a kink in the line. The water won�t be at its fullest potential because there is a blockage.�
That�s the red nerve and disc within this picture. The organs which are connected to that nerve are not sending and receiving the complete message to and from the brain because the vertebra is putting pressure (a kink) in that nerve. That causes pain which may even be felt elsewhere in the body and not felt within the spine. You may treat the symptom of pain unsuccessfully until you get to the source which lies within the spine.
Just think for a moment, does that nerve have anything to do with the organ that helps grow your baby? Maybe it�s the one that represents your uterus. If left unadjusted, your body is not able to operate to its fullest potential and ability when growing your little one. Messages are not being sent or received fully. The consequences of not rectifying the issue may not reveal itself until delivery!
A simple adjustment (or series of adjustments depending on the severity and years of your life without chiropractic care) can aid in rectifying the issue and allowing your body to operate at its fullest potential and health while growing your baby.
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How The Pelvis Benefits From Chiropractic
Let�s take a moment to look at how God designed our birthing pelvis.
Our pelvis is designed with a cartilage substance to connect our pubic (pubis) bone. During pregnancy, labor, and birth, the body sends signals to control that cartilage. When it softens, it�s time for the baby to soon make his arrival! If there is a communication kink somewhere within the spine, those signals would not be clearly communicated. You�d be so much better off addressing the misalignment (know as a subluxation) now � well before delivery day � so your body can relax in its designed location.
When people ask me if it�s safe to be adjusted during pregnancy, the analogy of the kinked water hose comes to mind. Our female bodies are created and designed to grow and carry a baby. A chiropractor�s job is to keep my spine in the correct alignment so my body can function to its fullest potential. During the most spine-altering 9 months in my life, I would never think to neglect my weekly chiropractic adjustments! That�s like deciding to stay home from the grocery store when you need food.
Every parent can say they only want the best, optimal health for their child once they are born. Being under a chiropractor�s care allows you the ability to give your child the best, optimal health while they are in your womb.
Though the most visible kinesiology tape users might be professional athletes, Olympians, or weekend warriors � a much smaller clientele is also proving the advantages of this unique treatment. With a special line designed for sensitive skin and playful prints and colors that will speak to the sticker and Band-Aid loving child, it�s not surprising that kinesiology tape is quickly becoming more than an athlete�s aid.
While the uses and applications of kinesiology tape for pediatric treatment are growing daily, here is a quick run down of how kinesiology tape is being used in pediatric care today:
Pain &�Swelling Relief
� When kinesiology tape is applied to an injured or inflamed area, children can enjoy some relief without having to take pain medication or sit through icing and therapy treatments.
Orthopedic Treatment
� Children often don�t understand the purpose behind rehabilitation exercises, so kinesiology tape provides an additional or alternative treatment for children with orthopedic injuries, weak or underdeveloped muscles, gait abnormalities, paralysis � even poor posture.
Neuromuscular Disorders
� Kinesiology tape has proven effective to activate weak muscles and inhibit overactive muscles.� With a simple and safe taping application, children suffering from neuromuscular conditions like cerebral palsy, or muscular dystrophy could see improvements in symptoms and movement ability. It has also been shown to improve muscle tone in genetic disorders like Downs Syndrome and other conditions causing either spasticity, atrophy or poor muscle tone.
For children dealing with serious medical conditions, a colorful and painless treatment that can be worn for several days, even while playing and bathing, can make a big difference in their comfort level.
Interested in learning more about pediatric kinesiology taping? Dr. Kenzo Kaze, the creator of Kinesio Tape, provides step by step guidelines for taping infants and children in his manual, Kinesio Taping in Pediatrics available at Theratape.com.
For a list of successful case studies where kinesiology tape has provided improvement for children, check out Theratape�s research compilation as well as this case report (pdf) from Novel Physiotherapies. Hopefully, as more and more case studies document positive results, the use of kinesiology tape in pediatric care will continue to expand and increase.
Perhaps you bent the wrong way while lifting something heavy. Or you�re dealing with a degenerative condition like arthritis. Whatever the cause, once you have low back pain, it can be hard to shake. About one in four Americans say they�ve had a recent bout of low back pain. And almost everyone can expect to experience back pain at some point in their lives.
Sometimes, it�s clearly serious: You were injured, or you feel numbness, weakness, or tingling in the legs. Call the doctor, of course. But for routine and mild low back pain, here are a few simple tips to try at home.
Chill It
Ice is best in the first 24 to 48 hours after an injury because it reduces inflammation, says E. Anne Reicherter, PhD, PT, DPT, associate professor of Physical Therapy at the University of Maryland School of Medicine. �Even though the warmth feels good because it helps cover up the pain and it does help relax the muscles, the heat actually inflames the inflammatory processes,� she says. After 48 hours, you can switch to heat if you prefer. Whether you use heat or ice � take it off after about 20 minutes to give your skin a rest. If pain persists, talk with a doctor.
Keep Moving
�Our spines are like the rest of our body � they�re meant to move,� says Reicherter. Keep doing your daily activities. Make the beds, go to work, walk the dog. Once you�re feeling better, regular aerobic exercises like swimming, bicycling, and walking can keep you � and your back � more mobile. Just don�t overdo it. There�s no need to run a marathon when your back is sore.
Stay Strong
Once your low back pain has receded, you can help avert future episodes of back pain by working the muscles that support your lower back, including the back extensor muscles. �They help you maintain the proper posture and alignment of your spine,� Reicherter says. Having strong hip, pelvic, and abdominal muscles also gives you more back support. Avoid abdominal crunches, because they can actually put more strain on your back.
Stretch
Don�t sit slumped in your desk chair all day. Get up every 20 minutes or so and stretch the other way. �Because most of us spend a lot of time bending forward in our jobs, it�s important to stand up and stretch backward throughout the day,� Reicherter says. Don�t forget to also stretch your legs. Some people find relief from their back pain by doing a regular stretching routine, like yoga.
Think Ergonomically
Design your workspace so you don�t have to hunch forward to see your computer monitor or reach way out for your mouse. Use a desk chair that supports your lower back and allows you to keep your feet planted firmly on the floor.
Watch Your Posture
Slumping makes it harder for your back to support your weight. Be especially careful of your posture when lifting heavy objects. Never bend over from the waist. Instead, bend and straighten from the knees.
Wear Low Heels
Exchange your four-inch pumps for flats or low heels (less than 1 inch). High heels may create a more unstable posture, and increase pressure on your lower spine.
These could be signs that you have a nerve problem or another underlying medical condition that needs to be treated.
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Are Functional Orthotics Part of Your Wellness Protocol?
Most Chiropractors advertise pain relief without drugs and care for injuries. Recently, some doctors and practices have begun labeling and promoting themselves as Wellness Centers. A wellness practice is focused on both maintaining a pre-existing level of musculoskeletal balance and postural health and preventing conditions that might alter this state of health. The challenge is, how can healthy patients be protected from problems that might arise in the future? The answer is simple: custom-made orthotics. Custom orthotics may be traditionally seen as a preventative measure, but so are most treatments of old. They are the perfect, foundational support your patients will never want to go without.
Wellness is a great concept�one of those �win-win� situations for doctor and patient. Orthotics are the perfect way to implement this concept and help establish a �preventative� approach, in addition to the traditional reactive ones, if need be. Let�s take at a look at the foundation of the body, and see just how useful they can be.
Look To The Feet
The feet are the foundation of the body. By age 40, nearly everyone has a foot condition of�some sort, many of which eventually contributing to health concerns farther up the Kinetic Chain (Figure 1). Therefore, it�s in the best interest of healthy patients to be offered a wellness program which stresses preventative care for normal, healthy feet, in order to prevent foot problems from occurring later in life.
�Pictured above, patient with severe bunions, or Hallux Valgus.
Figure 1. While 99% of all feet are normal at birth, 8% develop troubles by the first year of age, 41% at age 5, and 80% by age 20 (Fig. 1).�By age 40, nearly everyone has a foot condition of some sort.
How Can Orthotics Help?
Patients who participate in Chiropractic wellness programs can benefit from custom-made orthotics nearly as much as patients who seek Chiropractic care for musculoskeletal injuries and conditions. Foot Levelers� custom orthotics have been shown to effectively support the pedal foundation for both categories of patients, and can prevent problems well into the future with static and dynamic support.
Static support.Static support. A 1999 study using radiographic measurements found that custom-made, flexible orthotics can significantly improve the alignment of the arches when standing.2 In the wellness-practice concept of orthotic use, custom-made, flexible orthotics can be used to maintain a properly functioning arch alignment.
Dynamic support. During gait, the foot undergoes substantial changes and must permit a smooth transfer of the body�s center of mass over the leg in order to conserve energy and keep the work expenditure to a minimum.3 This requires a flexible, yet supportive orthotic that accommodates varying weights and forces and allows proper movement and function of the foot, while supporting all three arches�in order to prevent eventual arch collapse.
Postural benefits. Since the entire body structure is balanced on one foot at a time when walking and running, improving foot alignment can help maintain knee, hip, pelvic and even spinal postural alignment,4 and prevent joint degeneration (of the hip, knee, or spinal joints). A pelvic or spinal tilt or recurrent subluxations will often respond rapidly to orthotic support of the arches in the feet.
Orthotics For Everyone
Custom-made, flexible orthotics have long been recognized as a valid adjunct to Chiropractic care for many musculoskeletal conditions. In the wellness model of Chiropractic care, Foot Levelers� custom-made, flexible orthotics (Fig. 2) can be utilized as a preventative modality for the preservation of optimal arch support and the postponement or prevention of joint imbalances in later years. Therefore, orthotics are appropriate for virtually all Chiropractic patients.
Chronic low back pain as well as radiating discomfort down one or both legs could indicate the presence of an injury or condition, such as lumbar stenosis. Spinal stenosis in the lumbar spine commonly develops with age, characterized as the narrowing of the spinal canal in the lower back. When this reduction in the vertebrae occurs, extra pressure is placed on the nerves as well as the spinal cord. Because these nerves run from the lower back to the legs, symptoms of leg pain, heaviness and/or cramping may also develop.
Anatomy of the Spinal Canal
The spinal canal located in the region of the lumbar spine is the most frequent section affected by spinal stenosis. The lumbar spine is made up of five vertebrae extending between the ribcage and pelvis, medically labelled from top to bottom as L1 through L5. Each of these vertebrae are properly separated by intervertebral discs which function as shock absorbers, cushioning and distributing the pressure being exerted onto the spine.
Each vertebrae of the spine contain what is identified as vertebral arches, protruding arch-shaped bones which create the necessary space within the spinal bones for the spinal cord. That space is referred to as the spinal canal. When the structure of the spine is healthy and it functions effectively, the spinal canal should properly be capable of protecting the spinal cord, providing the necessary and safest space required to maintain overall wellness.
Symptoms of Lumbar Spinal Stenosis
Individuals suffering from spinal stenosis in the lumbar spine commonly describe experiencing symptoms of pain and discomfort along the lower back, hips, buttocks and/or legs. Other prevalent symptoms of the condition include: lower back pain that radiated down one or both buttocks, legs, and/or feet; worsening pain in the lower extremities when walking; tingling sensations or numbness in one or both legs or feet; weakness in one or both legs or feet; restricted mobility or difficulty walking; and issues controlling bladder or bowel movements, a complication which may require immediate medical care.
Sciatica, best known as a set of symptoms rather than a single condition or disorder, can be a common diagnosis for determining the presence of an issue affecting the lower spine. Symptoms of sciatica include a collection of pain and discomfort, tingling sensations and numbness, burning sensations, and muscle weakness. Symptoms of sciatica can indicate a serious complication along the lumbar spine.
For individuals experiencing spinal stenosis in the upper back, referred to as cervical stenosis, the symptoms will be similar along the neck, shoulders, arms and/or hands.
Causes of Lumbar Spinal Stenosis
The gradual degeneration of the spine caused by the natural changes that come with age are the most common cause for the narrowing of the spinal canal, mostly due to the repetitive stress and pressure of the surrounding tissues over the course of several years. As the spinal canal becomes narrower over time, a number of conditions and disorders can develop, causing the compression or impingement of the spinal cord and leading to the irritation and inflammation of the nerve roots. This process will ultimately cause symptoms to manifest along the lower back, buttocks, and/or legs.
Lumbar spinal stenosis can also be caused by the degeneration of the intervertebral discs found between each vertebrae of the spine. Spinal disc shrinkage can impede the disc�s ability to properly separate the individual bones of the spine. This problem can generally lead to a much more severe condition referred to as a lumbar disc herniation. Also, if the spinal cord ligaments have expanded due to the natural wear and tear alteration of the structures of the body, lumbar stenosis can develop. Consequently, the degeneration of the vertebrae in the spine is the most common cause for lumbar spinal stenosis.
Diagnosing Lumbar Stenosis
When visiting a healthcare professional, such as a chiropractor, for the diagnosis of lumbar spinal stenosis, the doctor will primarily conduct a thorough physical examination of the patient to determine the source of the issue. The doctor of chiropractic, or other healthcare specialist, may also extensively review the individual�s medical history, referring them to receive other necessary or additional X-rays or MRI scans. By examining the patient�s symptoms as well as analyzing the test results, a chiropractor will be able to diagnose the individual�s injury or condition to discuss the best possible treatment options for you, including the thorough discussion of the benefits and risks of each option. Finally, the healthcare professional and patient can decide together on the preferred treatment procedure to follow to begin the rehabilitation process and restore their original health and wellness.
Treating Lumbar Spinal Stenosis
Chiropractic focuses on the diagnosis, treatment and prevention of injuries and/or conditions of the musculoskeletal and nervous system. A chiropractor may commonly utilize spinal adjustments and manual manipulations to carefully correct any misalignments in the spine that may be causing the impingement or compression of the spinal nerves. The chiropractic adjustments can help decrease the stress and pressure being placed against the structures and other tissues of the spine, reducing the symptoms of pain and discomfort associated with spinal stenosis along the different regions of the spine. Furthermore, the chiropractor may recommend a series of stretches and exercises according to the individual�s complications to speed up the rehabilitation process and help them regain their original strength, flexibility and mobility.
In the case that other forms of treatment are required to treat the individual�s injuries and/or conditions, the healthcare specialist will refer the patient to other professionals for treatment. A modification of the patient�s physical activities may be recommended as well. Other healthcare providers may provide the use of medications and other treatment methods or techniques, including physical therapy, to help improve the symptoms. While many individuals may try a number of conservative treatments to solve the issue, if the individual�s condition is severe enough to require spinal surgery, a healthcare provider may refer the patient to the appropriate doctor for treatment.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
Additional Topics: Low Back Pain After Auto Injury
After being involved in an automobile accident, the sheer force of the impact can cause damage or injury to the body, primarily to the structures surrounding the spine. An auto collision can ultimately affect the bones, muscles, tendons, ligaments and other tissues surrounding the spine, commonly the lumbar region of the spine, causing symptoms such as low back pain. Sciatica is a common set of symptoms after an automobile accident, which may require immediate medical attention to determine its source and follow through with treatment.
Athletes are specially trained to exercise and compete vigorously without experiencing injury or aggravating a previously existing condition. However, accidents and direct trauma during their specific sport or physical activity can inevitably result in damage or injury to the individual. Muscle or tissue damage are common in sports and can be dealt with accordingly but when a bone fracture occurs, these may be more delicate and may require additional diagnosis and care in order to properly help an athlete recover.
Among the general population of athletes, stress fractures can be a rare cause of pain, accounting for only 2 percent of all reported sports injuries. However, a considerably higher number of stress fractures are diagnosed in long distance runners and triathletes.
Stress fractures occurring around the pelvis are significantly uncommon although, a majority of them are often considered a differential diagnosis when athletes, specifically long distance runners and triathletes, report hip, groin or buttock pain during and after running. Because stress fractures around the pelvic/hip region, including the sacral, pubic rami and femoral neck region, are rarely diagnosed, understanding and discussing the anatomy of the injury, their clinical presentation, diagnosis and treatment for each of these types of stress fractures is important for an athlete in order to find a solution for those who do encounter it.
How Stress Fractures Occur
Stress fractures occur over a determined period of time when the bone is no longer capable of withstanding submaximal, repetitive forces. They frequently result when normal stresses cause bone fracture with decreased bone density, such as in an elderly osteoporotic individual, or as a result of an abnormal stress being placed against a normal bone and causing a fracture, such as in a long distance runner.
When the bones are exposed to loading, the introductory physiological response is a respective increase in osteoclastic activity, or bone resorption, leading to temporary structural weakening before new bone formation. If these stresses continue to occur without having the bone properly adjust to this additional, ongoing osteoclastic activity, the pressure may exceed bone regeneration, causing microfractures to occur.
The first characteristic of a stress reaction observed through the use of MRI is bone oedema as well as increased activity on bone scan. Bone scan in the acute phase has high sensitivity but an increased uptake may also be due to infection, bone infarction or neoplastic activity. Researchers from previous studies stated that 60 to 70 percent of X-rays in the acute phase of stress fractures, approximately less than 2 weeks after the injury, have a negative result. Due to its high sensitivity as well as a lack of radiation and high specificity, even despite its elevated cost, MRI is often the preferred procedure to identify stress fractures in their early phases.
Various distinct intrinsic and extrinsic elements have been determined as risk factors for stress fractures. These include but are not limited to: biomechanics, strength and flexibility, nutrition, hormonal and menstrual disturbances, and footwear. These must all be considered prior to assessing an individual with a suspected stress fracture. During an analysis of 8 female athletes with sacral stress fractures, the most significant risk factor for these types of fractures was the rapid increase in impact activity during more intense exercise programs. An increase in workload should thus be considered a significant risk factor for stress fractures.
Anatomy of Sacral Stress Fractures
The sacrum consists of 5 fused vertebrae, S1 to S5, and is triangular in shape. It connects with the ilium at the sacroiliac joint and, due to its shape and function to distribute forces, it�s often described as the foundation to the arch of the pelvis. The sacrum, much like an inverted arch, supports the entire weight of the upper body and transfers force to the pelvis.
Sacral stress fractures most commonly occur in the lateral portion of the sacrum and are more frequently diagnosed in women. It�s been hypothesized that the shape of the female pelvis can lead create difficulty when distributing weight through the sacrum than the average male pelvis. However, it�s also been reported that several male elite Australian triathletes have experienced sacral stress fractures in recent years.
Symptoms
An athlete with a sacral stress fracture will often manifest acute onset back, buttock or hip pain which is generally described to occur suddenly during a run, making them incapable of continuing at the time. The individual may also experience limited mobility and they could or could not suffer pain on the palpation of the sacrum. Additionally, they may not experience any neurological symptoms but symptoms of sciatica may be common during this type of stress fracture. Sciatica can include pain, weakness or numbness and burning or tingling sensations along the lower back, buttock or hip, often radiating down the thigh. The individual may suffer pain or tightness when walking and they will experience symptoms when hopping on the affected side. Athletes with sacral stress fractures also frequently report pain during single leg loading tasks, for example, when putting pants on.
Diagnosis
Due to the extreme overlying soft tissue and complex bone anatomy, simple radiographs can rarely conclude the presence of a sacral stress fracture. Bone scan, MRI or CT can be utilized to effectively diagnose a sacral stress fracture. CT and MRI findings suggest that sacral stress fractures occur as a result of constant compressive forces which lead to microfractures of the trabecular bone. These fractures infrequently develop a visible callus on plain radiograph, therefore, MRI or CT scans should be utilized as a follow up imaging if poor healing is detected.
Treatment
The progression of treatment for an athlete with a sacral stress fracture broadly depends on the athlete�s symptoms as these are generally stable fractures. Rehabilitation procedures will progress from non-weight bearing to weight bearing to progressive return to running activities as the symptoms decrease. In most cases, a period of 6 weeks with no running followed by a 6 to 8-week period of a return to running progression may be required. A majority of published works indicate athletes may have a full return to activity by 4 months with rare cases taking up to 14 months.
Repeated CT scans approximately 4 and 8 months after the individual�s original diagnosis can often display no signs of previous fractures which demonstrate a quicker and fuller healing of the well-vascularized trabeculae microfractures when compared to fractures involving the less well-vascularized cancellous bone. Researchers concluded that women with sacral stress fractures who had the best diets and fewer prior stress injuries or menstrual irregularities, healed the fastest.
Anatomy of Pubic Rami Stress Fractures
The inferior pubic ramus slopes downward and medial from the superior ramus, narrowing as it goes down and it is the region where the adductor magnus, brevis and gracilis connect, including the obturator internus and externus. Pubic Rami stress fractures have been diagnosed among runners, triathletes and military service members. These generally occur in the inferior pubic rami next to the pubic symphysis. Researchers proposed that these fractures are a result of repetitive forces being applied to and transmitted to the bone through muscle contraction or fatigue. In a study on female military service members, it was suggested that over-striding during marching procedures was a potential factor contributing to pubic rami stress fractures.
Symptoms
Pubic rami stress fractures are generally detected either in competitive races or during intensive training sessions. These frequently occur at the insertion of the adductors and/or external rotators of the hip. Athletes with pubic rami stress fractures commonly suffer from pain in the hip, buttock, inguinal or adductor region which increases with activity and decreases with rest. It�s important to remember that pain caused by irritation and swelling along these regions may also cause symptoms similar to sciatica. It�s important to receive a proper diagnosis to rule out a compression of the sciatic nerve which could be causing neurological symptoms. Athletes with this type of injury often limp and on clinical testing, they may experience symptoms with passive hip abduction, resisted hip adduction and resisted hip external rotation. Stress fractures of the pelvis can be determined even without radiographic evidence if the following criteria are met by an individual. First, running will be impossible for the athlete as a result of severe discomfort in the groin area. Then, the individual will experience discomfort in the groin with an unsupported stance on the affected leg. And last, an athlete may suffer symptoms of pain and tenderness after deep palpation procedures.
Diagnosis
Simple radiographs may demonstrate displaced fracture lines but a lack of radiographic evidence in the early phases of injury is not uncommon. Bone scan, CT or MRI may be used to determine the presence of fracture and bone oedema may be evident on MRI.
Treatment
These fractures tend to have a high rate for healing following 6 to 10 weeks of rest, however, they have a small risk of non-union and re-fracture if the appropriate amount of rest is not followed. Fractures that display delayed union will likely demonstrate full recovery when further conservative procedures are followed. Progression of treatment should be guided by pain and at first, the individual may require the utilization of crutches as walking may be painful.
Anatomy of Femoral Neck Stress Fractures
The femoral neck is the flattened, pyramid shaped piece of bone which connects the femoral head to the femoral shaft.
Athletes with femoral neck stress fractures generally report hip or groin pain when running. This pain usually has an insidious onset and the symptoms may become significantly worse depending on the intensity or duration of a run. At first, symptoms may occur at the end of a run but as the stress reaction worsens, the pain may begin showing earlier in the run where gradually more time may be required to relieve the pain and discomfort. Athletes with femoral neck stress fractures may experience hip and/or groin pain while resting and may suffer restless nights of sleep due to the symptoms. Often, individuals will also report pain while rolling in bed, single leg stance and during active straight leg raise.
Femoral neck stress fractures are described as either tension or compression stress fractures. Fracture displacement determines the outcome of an injury and tension stress fractures generally have a higher rate of displacement as a result of non-union, malunion or osteonecrosis. Due to this fact, tension stress fractures are considered more serious than compression fractures and may require surgical fixation.
Diagnosis
Conventional radiographs are often negative in the acute setting but may shown signs during instances where symptoms have been present for 2 weeks or more. MRI is the favored standard for diagnosis and should be ordered when a stress fracture of the femoral neck is suspected.
Treatment
Tension side stress fractures require diagnosis from a healthcare professional immediately after its occurred due to their risk of displacement. Compression side fractures are often managed conservatively with protected weight bearing and ongoing monitoring to keep track of the individual�s healing process. Initial phases of management should include non-weight bearing on crutches until there are no symptoms at rest, then progress to partial weight bearing to full weight bearing over a period of 4-6 weeks. A gradual return to run program can be started at 8 to 12-weeks of treatment, once the individual is able to properly walk without experiencing pain and other symptoms.
Return to Activity Plan
With all stress fractures located around the pelvis, a careful, gradual return to activity plan can be an essential element of the rehabilitation process. To make sure the athlete receives progressive loading without sudden increases in workload, the return to activity plan should be at least as long as the time off the individual�s specific activity. For instance, if the athlete had a sacral stress fracture which required 6 weeks of no running, then that athlete needs at least a 6-week gradual return to running plan before they can return to their previous running load.
Hip Strengthening Exercises
A strengthening program of the lower extremities can additionally be implemented early in the rehabilitation process, first beginning with non-weight bearing exercises, which can gradually change as the individual becomes able to weight bear without pain. Early strengthening can also help decrease muscle loss and address any biomechanical complications the athlete might be facing. As the stress fractures heal and the tolerance for load improves, these exercises can be progressed to other higher-load exercises to provide the athlete�s body for the return of their specific sports activity.
Proper stretching and exercising techniques are effective methods and techniques that can help increase an athlete’s strength, mobility and flexibility to prevent experiencing an injury or aggravating a condition. Bone fractures, in this case, pelvic stress fractures, can be challenging to heal but with proper treatment, an athlete will be able to return-to-play in no time.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
Additional Topics: Low Back Pain After Auto Injury
After being involved in an automobile accident, the sheer force of the impact can cause damage or injury to the body, primarily to the structures surrounding the spine. An auto collision can ultimately affect the bones, muscles, tendons, ligaments and other tissues surrounding the spine, commonly the lumbar region of the spine, causing symptoms such as low back pain. Sciatica is a common set of symptoms after an automobile accident, which may require immediate medical attention to determine its source and follow through with treatment.
Low back pain is one of the most prevalent symptoms that lead people to seek diagnosis and treatment with a healthcare professional. When the individual�s low back pain is accompanied with pain in one or both legs or buttocks, resulting in symptoms similar to sciatica, it may be an indicator that the patient may have a lumbar disc herniation, also referred to as a herniated disc, ruptured disc, or slipped disc.
Anatomy of the Lumbar Spine
The lumbar spine consists of five vertebrae that extend through the length of the ribcage and pelvis. From top to bottom, these vertebrae are medically labeled L1 through L5 and they�re each separated by intervertebral discs. The discs are made up of a fibrous tissue known as the annulus with a soft nucleus found at the center of each disc. These discs are fundamental towards the proper function of the spine, performing the important roles of shock absorption and distribution of pressure.
In the instance the annulus becomes ruptured or torn, the nucleus can become separated from the disc. This complication can decrease the disc�s ability to properly separate the vertebrae, an issue which often leads to increased pressure due to the compression or impingement of the spinal nerves found between each vertebrae of the spine. Individuals with a lumbar disc herniation and symptoms of sciatica commonly experience pain and discomfort related to the pinching of the nerves, which can in turn radiate down the legs.
Generally, a herniated disc is caused by the natural degeneration of the body�s structures as we age. If not diagnosed or treated in time, however, this simple wear and tear complication can develop into a more serious injury or condition. In addition, intervertebral discs can also tear due to trauma from heavy lifting or as a result of a sudden injury, such as an automobile accident or a work injury.
Diagnosing a Lumbar Disc Herniation
A chiropractor can properly diagnose a variety of injuries or conditions relating to the musculoskeletal and nervous system, including a lumbar disc herniation. During the first consultation, the chiropractor will conduct a thorough physical exam, including a comprehensive review of your medical history and test results. Using this, the healthcare professional will be able to determine the source of the symptoms. In many cases, the specialist may require additional tests to confirm the presence of a specific injury and/or condition. Most chiropractic offices will provide you with up to date information about your diagnosis, as well as the risks and benefits of each treatment option. Chiropractors will work with the individual personally to decide on the best treatment option for their complication.
Treating a Lumbar Disc Herniation
Chiropractic adjustments and manual manipulations are the most common forms of treatment provided by a doctor of chiropractic, or DC. Using this gentle techniques, the healthcare specialist will carefully realign the spine, correcting the subluxations in order to decrease and eliminate the symptoms caused by nerve compression or impingement. Chiropractors may also redirect a patient to receive other types of treatment depending on the severity of their issue. Chiropractic care can help restore an individual�s strength, mobility and flexibility, offering a wide variety of benefits. Chiropractic treatment is well-known for its natural benefits, including the enhancement of many functions of the body.
Chiropractic Can Improve Sex Life
Many people visit the chiropractor with back pain, but after several sessions of treatment, they often return reporting that their sex life has improved. Jason Helfrich, co-founder and CEO of 100% Chiropractic, stated that the body can positively respond in many aspects when the unnecessary pressure on the nervous system is decreased or removed.
Every function of the body is controlled by the nervous system, however, when the spine is misaligned, known as a subluxation, the nerves traveling between the brain and the rest of the body, these can become blocked, compromising the body�s ability to function properly. A chiropractor�s goal is to remove these subluxations, since they can both cause pain and impede feeling. But treatment can help more than just improve symptoms of back pain. The lumbar region of the spine is where the nerves that extend into your reproductive regions are found. Correcting misalignments in the lower spine can improve nerve flow to your sexual organs, increasing things like blood flow to your clitoris or the penis.
�Correcting a spinal subluxation also allows the organs to send messages to the brain more easily. This means that not only do you become physically aroused faster, but your brain also registers that ready-for-action, heightened sense of pleasure more quickly, so you move past the mental obstacles that may be keeping you from orgasming�, quoted Helfrich.
Other Adjustments for an Improved Sex Life
Libido and fertility need a proper balance of estrogen, progesterone, and other hormones, many of which are released in the upper cervical and neck area of the body. If there are any misalignments or subluxations in the upper region of the spine, the nerve transmissions exiting the brain can be interrupted due to the compression or impingement of these tissues, which will ultimately have an effect all the way down to the reproductive organs, among others.
Including fertility is affected by the nerves and hormones coming out of the spine, as they control the reproductive cycle.
Beyond all of the physiological benefits of spinal adjustments and manual manipulations, chiropractic treatment can also simply give the muscles more range of motion. This means you can try previously difficult positions under the sheets, enhancing an individual�s sex life further.
�We want to improve people�s health, and health is about living life as its intended. Having a great sex life is huge part of that�, Jason Helfrich concluded.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
Additional Topics: Low Back Pain After Auto Injury
After being involved in an automobile accident, the sheer force of the impact can cause damage or injury to the body, primarily to the structures surrounding the spine. An auto collision can ultimately affect the bones, muscles, tendons, ligaments and other tissues surrounding the spine, commonly the lumbar region of the spine, causing symptoms such as low back pain. Sciatica is a common set of symptoms after an automobile accident, which may require immediate medical attention to determine its source and follow through with treatment.
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