Back Clinic Sciatica Chiropractic Team. Dr. Alex Jimenez organized a variety of article archives associated with sciatica, a common and frequently reported series of symptoms affecting a majority of the population. Sciatica pain can vary widely. It may feel like a mild tingling, dull ache, or burning sensation. In some cases, the pain is severe enough to make a person unable to move. The pain most often occurs on one side.
Sciatica occurs when there is pressure or damage to the sciatic nerve. This nerve starts in the lower back and runs down the back of each leg as it controls the muscles of the back of the knee and lower leg. It also provides sensation to the back of the thigh, part of the lower leg, and the sole of the foot. Dr. Jimenez explains how sciatica and its symptoms can be relieved through the use of chiropractic treatment. For more information, please feel free to contact us at (915) 850-0900 or text to call Dr. Jimenez personally at (915) 540-8444.
Consider the following, sciatica is a medical term used to describe a collective group of symptoms resulting from the irritation or compression of the sciatic nerve, generally due to an injury or aggravated condition. Sciatica is commonly characterized by radiating pain along the sciatic nerve, which runs down one or both legs from the lower back. The following case vignette discusses Mr. Winston’s medical condition, a 50-year-old bus driver who reported experiencing chronic, lower back and leg pain associated with sciatica during a 4-week time period. Ramya Ramaswami, M.B., B.S., M.P.H., Zoher Ghogawala, M.D., and James N. Weinstein, D.O., provide a comprehensive analysis of the various treatment options available to treat sciatica, including undergoing lumbar disk surgery and receiving nonsurgical therapy.
On a personal note, as a practicing doctor of chiropractic, choosing the correct treatment care for any type of injury or condition can be a personal and difficult decision. If the circumstances are favorable, the patient may determine what is the best form of treatment for their type of medical issue. While nonsurgical therapies, such as chiropractic care, can often be utilized to improve symptoms of sciatica, more severe cases of sciatica may require surgical interventions to treat the source of the issue. In most cases, nonsurgical therapies should be considered first, before turning to surgical therapies for sciatica.
Case Vignette
A Man with Sciatica Who is Considering Lumbar Disk Surgery
Ramya Ramaswami, M.B., B.S., M.P.H.
Mr. Winston, a 50-year-old bus driver, presented to your office with a 4-week history of pain in his left leg and lower back. He described a combination of severe sharp and dull pain that originated in his left buttock and radiated to the dorsolateral aspect of his left thigh, as well as vague aching over the lower lumbar spine. On examination, passive raising of his left leg off the table to 45 degrees caused severe pain that simulated his main symptom, and the pain was so severe that you could not lift his leg further. There was no leg or foot weakness. His body-mass index (the weight in kilograms divided by the square of the height in meters) was 35, and he had mild chronic obstructive pulmonary disease as a result of smoking one pack of cigarettes every day for 22 years. Mr. Winston had taken a leave of absence from his work because of his symptoms. You prescribed 150 mg of pregabalin per day, which was gradually increased to 600 mg daily because the symptoms had not abated.
Now, 10 weeks after the initial onset of his symptoms, he returns for an evaluation. The medication has provided minimal alleviation of his sciatic pain. He has to return to work and is concerned about his ability to complete his duties at his job. He undergoes magnetic resonance imaging, which shows a herniated disk on the left side at the L4�L5 root. You discuss options for the next steps in managing his sciatica. He is uncertain about invasive procedures such as lumbar disk surgery but feels limited by his symptoms of pain.
Treatment Options
Which of the following would you recommend for Mr. Winston?
Undergo lumbar disk surgery.
Receive nonsurgical therapy.
To aid in your decision making, each of these approaches is defended in a short essay by an expert in the field. Given your knowledge of the patient and the points made by the experts, which option would you choose?
Option 1: Undergo Lumbar Disk Surgery Option 2: Receive Nonsurgical Therapy
1. Undergo Lumbar Disk Surgery
Zoher Ghogawala, M.D.
Mr. Winston�s case represents a common scenario in the management of symptomatic lumbar disk herniation. In this particular case, the patient�s symptoms and the physical examination are consistent with nerve-root compression and inflammation directly from an L4�L5 herniated disk on his left side. The patient does not have weakness but has ongoing pain and has been unable to work for the past 10 weeks despite receiving pregabalin. Two questions emerge: first, does lumbar disk surgery (microdiskectomy) provide outcomes that are superior to those with continued nonoperative therapy in patients with more than 6 weeks of symptoms; and second, does lumbar microdiskectomy improve the likelihood of return to work in patients with these symptoms?
The highest quality data on the topic come from the Spine Patient Outcomes Research Trial (SPORT). The results of the randomized, controlled trial are difficult to interpret because adherence to the assigned treatment strategy was suboptimal. Only half the patients who were randomly assigned to the surgery group actually underwent surgery within 3 months after enrollment, and 30% of the patients assigned to nonoperative treatment chose to cross over to the surgical group. In this study, the patients who underwent surgery had greater improvements in validated patient-reported outcomes. The treatment effect of microdiskectomy was superior to that of nonoperative treatment at 3 months, 1 year, and 2 years. Moreover, in an as-treated analysis, the outcomes among patients who underwent surgery were superior to those among patients who received nonoperative therapy. Overall, the results of SPORT support the use of microdiskectomy in this case.
Results of clinical trials are based on a comparison of treatment options in study populations and may or may not apply to individual patients. SPORT did not specify what type of nonoperative therapy was to be used. Physical therapy was used in 73% of the patients, epidural injections in 50%, and medical therapies (e.g., nonsteroidal antiinflammatory drugs) in more than 50%. In the case of Mr. Winston, pregabalin has been tried, but physical therapy and epidural glucocorticoid injections have not been attempted. Despite widespread use of physical therapy for the treatment of lumbar disk herniation, the evidence supporting its effectiveness is inconclusive, according to published guidelines of the North American Spine Society. On the other hand, there is evidence that transforaminal epidural glucocorticoid injection provides short-term relief (30 days) in patients with nerve-root symptoms directly related to a herniated disk. Overall, there is evidence, from SPORT and from a randomized trial from the Netherlands published in the Journal, that early surgery between 6 and 12 weeks after the onset of symptoms provides greater alleviation of leg pain and better overall pain relief than prolonged conservative therapy.
The ability to return to work has not been formally studied in comparisons of operative with nonoperative treatments for lumbar disk herniation. Registry data from the NeuroPoint-SD study showed that more than 80% of the patients who were working before disk herniation returned to work after surgery. The ability to return to work may be dependent on the type of vocation, since patients who are manual laborers may need more time to recover to reduce the risk of reherniation.
It is well recognized that many patients who have a symptomatic lumbar disk herniation will have improvement spontaneously over several months. Surgery can alleviate symptoms more quickly by immediately removing the offending disk herniation from the affected nerve root. The risk�benefit equation will vary among individual patients. In the case of Mr. Winston, obesity and mild pulmonary disease might increase the risk of complications from surgery, although in SPORT, 95% of surgical patients did not have any operative or postoperative complication. For Mr. Winston, a patient with pain that has persisted for more than 6 weeks, microdiskectomy is a rational option that is supported by high-quality evidence.
2. Receive Nonsurgical Therapy
James N. Weinstein, D.O.
This case involves a common presentation of low back pain radiating to the buttock and posterolateral thigh that might represent either referred mechanical pain or radiculopathy. Classic radiculopathy resulting from compression of a lower lumbar nerve root (L4, L5, or S1) results in pain that radiates distal to the knee and is often accompanied by weakness or numbness in the respective myotome or dermatome. In this case, the pain is proximal to the knee and is not associated with weakness or numbness. In SPORT, surgery resulted in faster recovery and a greater degree of improvement than nonoperative treatment in patients with pain that radiated distal to the knee and was accompanied by neurologic signs or symptoms. However, since Mr. Winston would not have met the inclusion criteria for SPORT, the results of diskectomy in this case would be somewhat unpredictable. He does not have radiculopathy that radiates below the knee, and he does not have weakness or numbness; nonoperative treatment should be exhausted before any consideration of a surgical procedure that in most cases has not been shown to be effective in patients with this type of presentation. In this issue of the Journal, Mathieson and colleagues report the results of a randomized, controlled trial that showed that pregabalin did not significantly alleviate pain related to sciatica. Mr. Winston has been treated only with pregabalin; therefore, other conservative options should be explored.
Saal and Saal reported that more than 80% of patients with radiculopathy associated with a lumbar disk herniation had improvement in a matter of months with exercise-based physical therapy. In the nonoperative SPORT cohort, patients had significant improvement from baseline, and approximately 60% of those with classic radiculopathy who initially received nonoperative treatment avoided surgery. Mr. Winston has had minimal treatment and has had symptoms for only 10 weeks. He should undergo a course of exercise-based physical therapy and a trial of a nonsteroidal antiinflammatory medication and may consider a lumbar epidural glucocorticoid injection. Although there is little evidence of the effectiveness of these nonoperative options alone, the combination of these treatments and the benign natural history of the patient�s condition could result in alleviation or resolution of symptoms. If these interventions � and time � do not resolve his symptoms, surgery could be considered as a final option, but it may not have long-term effectiveness and could in and of itself cause the possibility of more harm than good. Mr. Winston has risk factors, such as obesity and a history of smoking, that have been shown to contribute to poor surgical outcomes of certain spinal procedures.
Mr. Winston has symptoms of back pain that interfere with his quality of life. He would need to understand, through shared decision making, that a nonsurgical approach is likely to be more effective than surgery over time.
Information referenced from the National Center for Biotechnology Information (NCBI) and the New England Journal of Medicine (NEJM). 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 .
Cited by Dr. Alex Jimenez
Additional Topics: Wellness
Overall health and wellness are essential towards maintaining the proper mental and physical balance in the body. From eating a balanced nutrition as well as exercising and participating in physical activities, to sleeping a healthy amount of time on a regular basis, following the best health and wellness tips can ultimately help maintain overall well-being. Eating plenty of fruits and vegetables can go a long way towards helping people become healthy.
1. Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT): a randomized trial. JAMA2006;296:2441–2450
2. Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT) observational cohort. JAMA2006;296:2451–2459
3. Kreiner DS, Hwang SW, Easa JE, et al. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J2014;14:180–191
4. Ghahreman A, Ferch R, Bogduk N. The efficacy of transforaminal injection of steroids for the treatment of lumbar radicular pain. Pain Med2010;11:1149–1168
6. Ghogawala Z, Shaffrey CI, Asher AL, et al. The efficacy of lumbar discectomy and single-level fusion for spondylolisthesis: results from the NeuroPoint-SD registry: clinical article. J Neurosurg Spine2013;19:555–563
8. Lurie JD, Tosteson TD, Tosteson AN, et al. Surgical versus nonoperative treatment for lumbar disc herniation: eight-year results for the spine patient outcomes research trial. Spine (Phila Pa 1976)2014;39:3–16
11. Pinto RZ, Maher CG, Ferreira ML, et al. Drugs for relief of pain in patients with sciatica: systematic review and meta-analysis. BMJ2012;344:e497–e497
12. Pearson A, Lurie J, Tosteson T, et al. Who should have surgery for an intervertebral disc herniation? Comparative effectiveness evidence from the Spine Patient Outcomes Research Trial. Spine2012;37:140–149
Suffer Sciatica: Are you experiencing pain along one side of your body from your lower back down through your hip and the back of your leg? If so, you could be suffering from a condition called sciatica.
According to the Mayo Clinic, sciatica can best be described as “most commonly occurring when a herniated disk or a bone spur on the spine compresses part of the nerve. This causes inflammation, pain and often some numbness in the affected leg.”
A variety of issues weigh in on an individual’s likelihood of ending up with sciatica. Most of them deal with increased pressure on the spine.
Suffer Sciatica: Causes
Obesity: carrying too much weight is instrumental in bringing on a number of health related issues. Extra pounds overload the spine, causing damage that results in sciatica.
Improper Lifting: Individuals who frequently twist the bodies and lift heavy loads are more likely to suffer from sciatica. Certain jobs that require these movements are a key cause of the condition.
Sedentary Lifestyle. A person’s job does not have to involve lifting to be responsible for this condition. Sitting for extended periods without stretching or standing puts excess pressure on the spine and can cause sciatica.
Too Many Birthdays. Getting older can affect all of our body’s joints and bones in a negative manner, especially if we never committed to an exercise routing. An individual’s back often deteriorates with age, causing bone spurs and herniated disks that sometimes result in sciatica.
Treatment options for sciatica are varied, and the choice depends on the severity of the condition.
Pain Medication: A common and easy way to treat sciatica is with drug therapy. Anti-inflammatory drugs are frequently used to reduce�the inflammation around the nerve, which is a big contributor of the pain. Over-the-counter pain medicines, as well as codeine, may also help with pain management.
Acupuncture. Alternative therapies like acupuncture have shown positive results in the treatment of sciatica. If a drug-free treatment option appeals to you, find an experienced acupuncturist in your area and talk to them about treatment options.
Strengthening Exercises. A consistent exercise program strengthens your muscles and helps the body function effectively. Ask your doctor which exercises assist the body with bouncing back from sciatica.
Supplements. Supplying the body with vital vitamins and minerals assists in overall health in general, including improvement from sciatica. Daily doses of supplements such as calcium, magnesium, St. John’s Wort, and Vitamin B12 have shown to treat sciatica effectively.
Chiropractic Care. Chiropractors understand all things spine-related, and work with the body as a whole to help it heal itself. Chiropractic treatment for sciatica works to align the spine and reduce the stress to the lower back. Treatment helps alleviate the underlying causes of the condition, and shows positive results in a short amount of time.
Cortisone Injections. Most of the time, sciatica can be treated by the less invasive measures mentioned above. However, severe bouts of sciatica may require a shot of cortisone directly into the inflamed area. Individuals generally choose this option when other treatments have garnered no relief.
Dealing with sciatica is painful and irritating, as the condition often sidelines the sufferer from daily activities. By knowing the treatment options that are effective in combating both the underlying causes and the pain of sciatica, sufferers can begin a regimen that will help them get back on their feet, pain-free in the shortest period of time possible and no longer have to suffer.
If you are suffering from sciatica and would like to talk to an experienced chiropractor about how to treat the condition, contact us today.
Sciatica
This article is copyrighted by Blogging Chiros LLC for its Doctor of Chiropractic members and may not be copied or duplicated in any manner including printed or electronic media, regardless of whether for a fee or gratis without the prior written permission of Blogging Chiros, LLC.
Relieve: A small muscle located deep in the buttocks, the piriformis muscle performs the essential function of rotating the leg outwards. Piriformis Syndrome is a painful condition that occurs when the piriformis muscle is tight and intrudes upon the sciatic nerve in the buttocks. Causing pain and tenderness and sometimes numbness in the buttocks, piriformis syndrome pain may also radiate down the sufferer’s leg, and in some cases, even into the calf.
There are two commonly identifiable potential causes for piriformis syndrome. One is sitting for prolonged periods of time, which can cause tightening of the muscle. The second cause is an injury to the buttocks, either by a fall, an accident, or a sports injury. Trauma causes the piriformis muscle to swell and irritate the sciatic nerve.
Spasms can also cause piriformis syndrome, however, the underlying cause of the spasms frequently remains unknown.
Unfortunately, once an individual has suffered from piriformis syndrome, the condition can recur periodically, usually brought on by too much exercise or sitting for a long time without stretching.
Whatever the initial cause, piriformis syndrome treatment options are vital in relieving the painful symptoms and healing the condition.
Relieve:
These Four Treatment Options Are Frequently Used To Treat Piriformis Syndrome.
Medication. Over-the-counter or prescribed pain medicines, anti-inflammatory drugs, or muscle relaxers frequently serve to reduce the pain from piriformis syndrome. A doctor may also inject medicine directly into the piriformis muscle to improve the condition.
Heat. A common way to relax tight muscles is to apply heat. Piriformis syndrome sufferers may find relief from painful symptoms by periodically applying heat directly to the tender area.
Heat therapy may relieve the tightness of the muscle and promote healing of the entire area. However, it’s important to avoid treating the muscle with heat if there is a chance the muscle may be torn.
Exercise. The overall cause of the condition is a tight piriformis muscle, so it stands to reason a proper exercise regimen will loosen the muscle and alleviate the symptoms associated with piriformis syndrome. A doctor can prescribe the correct exercises to stretch and subsequently strengthen the muscles and the body’s other muscles. A strong body will reduce the chances of the issue recurring down the road.
Hands on therapy. Used with other types of treatment or on their own, these types of therapies are popular because of their effectiveness, as well as the fact they are drug-free ways to gain relief from the pain. Massage is a commonly used therapy for piriformis syndrome, as it helps increase blood flow to the area. The massage therapist can manipulate the area to relieve the tightness of the muscle.
Another hands on therapy that produces positive results is chiropractic care.
Chiropractors view the body in its entirety, and will often treat other parts of the body, such as a foot or leg, in order to improve the condition of the piriformis muscle. They may also utilize a regimen of pelvic and spinal adjustments along with joint manipulation and stretching to loosen up the muscle and help heal the afflicted area.
As stated earlier, once the condition has been controlled and the area has healed, it’s vital to take precautions to avoid re-aggravating the area. Proper stretching before exercise, periodic breaks when sitting, and maintaining spinal and pelvic alignment will increase an individual’s chances of living free of the pain of piriformis syndrome in the future.
Treating Sciatica
If you have a question about how chiropractic care can help with the symptoms of piriformis syndrome, or other health conditions, contact us today.
This article is copyrighted by Blogging Chiros LLC for its Doctor of Chiropractic members and may not be copied or duplicated in any manner including printed or electronic media, regardless of whether for a fee or gratis without the prior written permission of Blogging Chiros, LLC.
Ever felt pain in your hip, the center of the buttocks, or pain down the back of the leg, you’re likely suffering, at least partly, with piriformis syndrome. The piriformis is a muscle which runs from the sacrum (mid-line base of spine) into the outer hip bone (trochanter). This muscle works overtime on runners.
The muscles in and about the gluteal area help with three areas
� rotation of the hip and leg;
� balance while one foot is off the ground
� stability of the pelvic region.
Needless to say, every one of these attributes are highly needed by runners and everyone else.
Piriformis Injuries
RMI or repetitive motion injury occurs when a muscle has to perform beyond the level of its capability, not given time to recover and doing it again and again. The normal response from a muscle in this situation is to tighten, which is a defensive response of the muscle. This stimulation, however, manifests itself several ways.
First Symptom�indicating piriformis syndrome could be pain in and about the outer hip bone. The tightness of the muscle generates increased pressure between the bone and the tendon which produces pain and either discomfort or an increased tension in the joint which produces a bursitis. A bursitis is an inflammation of the fluid filled sac in a joint caused by tension and strain within that joint.
Second Symptom suggesting piriformis syndrome would be pain right at the middle of the buttocks. Although this is not as common as the other two symptoms, this pain can be brought on within the fatty part of the buttocks region with direct compression. A tight muscle becomes a sore muscle upon compression because of reduced blood flow to that muscle.
Third Symptom indicating piriformis syndrome would be a sciatic neuralgia, or pain from the buttocks down the back of the leg and at times into different parts of the lower leg.
The sciatic nerve runs directly through the belly of the piriformis muscle and in the event the piriformis muscle contracts from being overused, the sciatic nerve now becomes strangled, producing pain, numbness and tingling.
Physiology
Any muscle constantly used has to have an opportunity to recover. This recovery can be natural with time, or could be facilitated and sped up with treatment. Continuing use will make it even worse since the muscle is tightening due to overuse. This injured muscle needs to relax and have blood flow encouraged into it for a rapid recovery. The tightness� lessens the normal blood flow going to the muscle. To encourage new blood into the muscle is the way of getting the muscle to begin to unwind and operate normally. Massages daily to this area is greatly supported.
The next step in this “recovery” process is to use a tennis ball under the butt and hip area. Roll out from the side of engagement while sitting down on the ground and set a tennis ball inside the outer hip bone under the buttocks area. Note areas of pain and soreness, as you start to allow your weight onto the tennis ball. Trigger points will have a tendency to collect in a repetitively used muscle, and till these toxins are manually broken up and removed, the muscle will have an artificial well being concerning flexibility potential and recovery potential. Consequently, if it’s sore while your sitting on it, you’re doing a good job. Let the ball operate under every spot for 15-20 seconds before transferring it to a different place. After 4-5 minutes place cross legs with the ankle of the affected leg over the knee of the non-affected leg. Then place the tennis ball just inside the outer hip bone and work the tendon of the muscle. Although this pain requires some time to reduce and is excruciating, the advantages are enormous. Be patient and good things will happen.
Treatments
Due to how the sciatic neuralgia and the hip bursitis or tendonitis are both inflammatory in character, ice therapy, or cryotherapy, within the involved region 15-20 minutes at a time will be beneficial. This should be performed multiple times each day.
Once the acute pain is gone then start with gentle stretching, like a cross-legged stretch while pulling up on the knee. The muscle should have improved flexibility.
Finally the use of pharmaceutical anti-inflammatories are not encouraged. One the intestines are greatly aggravated by them, but they also suggest an artificial wellbeing that can lead to larger problems. Proteolytic enzymes, such as bromelain, extremely beneficial without any side effects and are organic.
Chiropractic, Massages & Spinal Injections Are Your Papal Prescription For Low Back & Leg Pain.
Should you suffer from the low back and leg symptoms of sciatica, the pope feels your pain. Reports reveal that Pope Francis has spent part of his 2017 summer undergoing spinal shots and massage therapy to help manage his sciatica.
Sciatica is intense low back and leg pain which runs along the course of the sciatic nerve, that is the longest and largest nerve in the human system. The sciatic nerve extends from your low back all the way down to a foot. Several spinal ailments can irritate the sciatic nerve and cause sciatica, including a herniated disc, lumbar spinal stenosis, spondylolisthesis, and trauma (you can read more in common sciatica causes). The root reason for Pope Francis’ sciatica is unclear.
The 80-year-old pope has suffered from sciatica for many years, having first remarked on his struggle with it in a 2013 through a media conference when he said, “Sciatica is very painful, very painful! I don’t wish it on anyone!”
More recently, the pope has received epidural steroid shots and massages twice a week to handle his back pain pain, according to the Italian news magazine Famiglia Cristiana.
Sciatica PSA
How Spinal Injections & Massage Can Help Relieve Sciatica
Pope Francis’ routine of epidural steroid injections and massages underscores the fact that while the pain of sciatica can be extreme–almost indescribable–spine operation isn’t always the answer. The pope’s non-surgical approach to sciatica pain management is one that many individuals suffering from the illness adopt.
With epidural steroid shots, strong anti-inflammatory drugs known as corticosteroids are injected near the spinal nerve roots. The therapy works with varying success, but some people experience decreased pain for months following an injection.
With massage, a therapist can target the muscle tension that may be compressing the sciatic nerve or associated nerve roots. Deep tissue massage treatment may be type of massage used, since it utilizes direct pressure and friction to release the pressure in the soft tissues (ligaments, tendons, muscles) surrounding the sciatic nerve.
Several lumbar spine (lower back) disorders can cause sciatica. Sciatica is often described as moderate to intense pain at the left or right leg. Sciatica is caused by compression of at least one of the 5 places of nerve roots in the lower spine. Sometimes physicians call a radiculopathy sciatica. Radiculopathy is a term used to refer to pain, numbness, tingling, and weakness in the arms or legs brought on by a nerve root issue. If the nerve problem is in the neck, then it is called a cervical radiculopathy. However, because the low back is affected by sciatica, it is called a lumbar radiculopathy.
Pathways to Reduce Nerve Pain
Five sets of nerve roots at the lumbar spine combine to produce the sciatic nerve. Beginning at the back of the pelvis (sacrum), the sciatic nerve runs from the trunk, beneath the buttocks, and downward through the hip place into every leg. Nerve roots aren’t “solitary” structures but are a part of the body’s entire nervous system capable of transmitting pain and sensation to other areas of the human body. Radiculopathy occurs when compression of a nerve due to a disc rupture (herniated disc) or bone spur (osteophyte) occurs in the lumbar spine prior to it joining the sciatic nerve.
What Causes Sciatic Nerve Compression?
Several spinal disorders can lead to nerve compression or lumbar radiculopathy. The 5 are:
a bulging or herniated disc
lumbar spinal stenosis
spondylolisthesis
Injury
piriformis syndrome
Lumbar Bulging Disc or Herniated Disc
A bulging disc is also called a contained disc disorder. This usually means the gel-like center (nucleus pulposus) remains “contained” inside the tire-like outer wall (annulus fibrosus) of the disc.
A herniated disc occurs when the nucleus breaks throughout the annulus fibrosus. It’s known as a “non-contained” disc disease. Whether a disc herniates or bulges, disc material can press against an adjacent nerve root and compress lead to sciatica and nerve tissue.
A disc’s consequences are somewhat worse. Not only does the herniated disc cause direct compression of the nerve root from the interior of the bony spinal canal, but also the disc material itself also contains an acidic, chemical irritant (hyaluronic acid) which causes nerve inflammation. In both situations, nerve wracking and irritation cause pain and swelling, muscle weakness, tingling, and often leading to extremity numbness.
Lumbar Spinal Stenosis
Spinal stenosis is a neural compression disease. Leg pain may happen as a result of lumbar spinal stenosis. The pain is usually positional, frequently brought on by activities such as walking or standing and relieved by sitting down.
Spinal nerve roots branch out in the spinal cord called foramina comprised of bone and ligaments. Between each set of vertebral bodies, situated on the right and left sides, is a foramen. Nerve roots pass through these openings and extend outward beyond the spinal column to innervate different parts of the human body. Whenever these passageways become obstructed causing nerve compression or lean, the expression foraminal stenosis is utilized.
Spondylolisthesis
Spondylolisthesis is a disorder that most often affects the lumbar spinal column. It’s characterized by a single vertebra slipping forward over an adjacent vertebra. A vertebra slips and is displaced, when, spinal nerve root compression often triggers sciatic leg pain and happens. Spondylolisthesis is categorized as developmental (found at birth, develops during childhood) or acquired from spinal degeneration, injury or physical strain (eg, lifting weights).
Trauma and Injury
Sciatica can result from nerve compression brought on by external forces to the lumbar or sacral nerve roots. Examples include motor vehicle accidents. The impact may injure the nerves or, sometimes, the nerves may be compressed by fragments of bone.
Piriformis Syndrome
Piriformis syndrome is named after the muscle and the pain caused when the sciatic nerve irritates. The piriformis muscle and the thighbone is located in the lower portion of the spine, connect, and aids in cool rotation. The sciatic nerve runs beneath the piriformis muscle. When muscle aches grow in the muscle compressing the nerve, Piriformis syndrome develops. It may be difficult to diagnose and treat due to the deficiency of x ray or magnetic resonance imaging (MRI) findings.
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Sciatica
Lower back pain is one of the most commonly reported symptoms among the general population. Sciatica, is well-known group of symptoms, including lower back pain, numbness and tingling sensations, which often describe the source of an individual’s lumbar spine issues. Sciatica can be due to a variety of injuries and/or conditions, such as spinal misalignment, or subluxation, disc herniation and even spinal degeneration.
Herniated lumbar discs, although considered common, can be very debilitating and disabling. While it may be impossible to prevent disc herniations, understanding the mechanism of injury and implementing that knowledge can cut the odds of developing this unpleasant injury. A range of factors may promote lumbar disc damage or injury. The mechanism of injury for herniated discs often involves flexion, compression and twisting of the lumbar spine.
Mechanism of Injury: Herniated Discs
The lumbar spine’s discs are specialized connective tissue structures which function as shock absorbers between the spinal bones or vertebrae of the spine. Intervertebral discs are springy in nature due to a moist, jelly-like center portion known as the nucleus pulposus. The nucleus pulposus is contained and surrounded by a more layered, fibrous tissue that makes up what is known as the annulus fibrosis. Herniated discs or ruptured discs occur when harm to the annulus fibrosis causes the nucleus pulposus material to escape its boundaries and protrude outward in the disc.
Flexion
Where lumbar disc herniations occur regularly in a normal setting, these aren’t easily reproduced in a research setting. It is notable that in scientific research studies, where disc herniations were created in animal or human lumbar spine specimens, most demanded a small amount of spine flexion. Because of this, Stuart McGill, Ph.D., author of the book “Low Back Disorders,” concludes that repeated or prolonged spine flexion will be the primary mechanism leading to lumbar disc herniation. In a lab setting, McGill and other scientific doctors found that the way they could produce herniated disc injuries was to place weight, or a weight, onto the spine while bending into flexion. These circumstances are consistent with what could happen with repetitive lifting activities where the spine is flexed forward.
Compression
A research presented in 2001 in the journal “Clinical Biomechanics” demonstrated a link between compression of the spinal joints, technically known as vertical loading, and disc herniation. Even though the analysis used spinal sections taken from the necks of pigs, the researchers tried to replicate loading patterns common to the lumbar spines of humans. In the scientific study, severe and more frequent cases of herniated discs resulted when compression forces on the spinal bones had been increased. However, compression forces were essential to cause damage or injury such as disc herniations, that were subjected to repetitions of forward and backward bending. The authors reasoned that flexion and extension moves likely play a larger part than compression alone in inducing disc herniations. To put it differently, the spine can resist compression forces, such as lifting, when in a vertical position. Including a load whilst bending forward and backward though, may quickly spell difficulty for the individual.
Twisting
Another study published in 2010 in “Cinical Biomechanics” analyzed the role of axial torque, or twisting, in disc herniation. Using an animal model, the researchers discovered that disc herniation was not caused by twisting that was isolated. However, twisting did damage the annulus fibrosis. With damage to the annulus, the discs were more vulnerable to rupture or herniation when subjected to flexion movements. This implies that if the mechanism of injury of a disc herniation is flexion, these may be contributed to by damage brought on by twisting weakened discs.
Occupational Factors
A study published in 1987 in the “Journal of Chronic Diseases” examined the risk of lumbar herniated discs associated with occupation. The researchers noted that the risk for this condition is greater among men in blue-collar jobs in contrast to those in white collar jobs. This relates to increased lifting and bending activities among blue-collar workers when compared with white-collar employees. The writers noted less variation by occupational groups among women. The risk of lumbar disc herniations, however, was greater among women who described their work as strenuous. An additional finding that may relate to the spinal flexion mechanism of injury is that the risk of lumbar disc herniations is high among individuals whose work entails driving an automobile. Sitting while driving places the lumbar spine in a sustained posture of slight flexion.
Diagnosis for Herniated Discs
Lower back pain and symptoms associated with sciatica, are common manifestations resulting from lumbar spine disc herniation. Healthcare professionals, including chiropractors who specialize in sciatica, can help diagnose herniated discs as well as help determine the source of the individual’s symptoms. A spine specialist may provide the patient with or direct them to a clinic to have x-rays, MRI’s or CT scans to properly determine the presence of a herniated disc. Seeking immediate medical attention is essential towards the patient’s recovery.
MRI of a Lumbar Herniated Disc
The scope of our information is limited to chiropractic and spinal injuries and conditions. To discuss options on the subject matter, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .�
By Dr. Alex Jimenez
Additional Topics: Sciatica
Lower back pain is one of the most commonly reported symptoms among the general population. Sciatica, is well-known group of symptoms, including lower back pain, numbness and tingling sensations, which often describe the source of an individual’s lumbar spine issues. Sciatica can be due to a variety of injuries and/or conditions, such as spinal misalignment, or subluxation, disc herniation and even spinal degeneration.
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Any muscle constantly used has to have an opportunity to recover. This recovery can be natural with time, or could be facilitated and sped up with treatment. Continuing use will make it even worse since the muscle is tightening due to overuse. This injured muscle needs to relax and have blood flow encouraged into it for a rapid recovery. The tightness� lessens the normal blood flow going to the muscle. To encourage new blood into the muscle is the way of getting the muscle to begin to unwind and operate normally. Massages daily to this area is greatly supported.
