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.
Sciatica is medically defined as a series of symptoms, particularly pain, which often extend along the sciatic nerve. The symptoms generally begin in the lower back, radiating down the buttocks and legs, through the back of the thighs and into the calf and foot.
The characteristic symptom of pain associated with sciatica can manifest abruptly or may develop gradually over time. Individuals diagnosed with sciatica describe the pain as a sharp, shooting or electric shock-like in nature. Movement of the lower extremities can aggravate the pain and it may be evenly distributed along the leg, although there can be specific spots where the pain may be more intense. Other symptoms reported by sciatica sufferers include tingling sensations and numbness in the distribution of the sciatic nerve.
Sciatica is commonly caused after an injury or condition results in the irritation and inflammation of the structures surrounding the lumbar region of the spine, which may in turn lead to the compression or impingement of the sciatic nerve and/or the surrounding nerve roots. The added pressure can be due to a variety of common injuries and conditions, including: ruptured intervertebral discs, spinal stenosis or the narrowing of the spinal canal.
Anatomy of the Sciatic Nerve
The sciatic nerve is the longest and widest nerve in the body, measuring approximately three-quarters of an inch in diameter. It originates in the sacral plexus; a network of nerves found in the lower back, along the lumbosacral region of the spine. The lumbosacral spine refers to the area where the lumbar spine and the sacrum come together. The sciatic nerve and it’s nerve root branches’ primary function is to allow movement and provide feeling in the thigh, knee, calf, ankle, foot and toes.
The sciatic nerve itself can be found running through the low back or the lumbar region of the spine. The nerve roots in this area are found along the L4 and L5 vertebrae. The sciatic nerve also travels through the pelvic region or sacrum.
In most individuals, the sciatic nerve runs under the piriformis muscle, the important muscle which is in charge of moving the thighs from side to side. The sciatic nerve then descends from the piriformis muscle, through the buttocks and the back of the thighs. By the area behind the knee, the sciatic nerve branches out into smaller nerve roots which continue traveling down and into the feet.
The sciatic nerve is part of the body’s nervous system, a complex network of nerves responsible for transmitting signals of sensation along with sensations of pain to other areas of the body. With sciatica, an injury or condition, such as a herniated disc, which causes irritation and inflammation along the tissues and other structures surrounding the sciatic nerve, can compress and apply unnecessary pressure to the nerve roots, radiating pain down the legs.
The sciatic nerve exits the sacrum in the pelvic area through a nerve passageway known as the sciatic foramen. At the upper part of the sciatic nerve, two branches form: the articular branches; and the muscular branches. The articular branch goes to the hip joint while the muscular branch serves the leg flexor muscles to enable movement. Other complex nerve structures are also involved: the peroneal nerves; and the tibial nerves. The peroneal nerves originate from the nerve roots along the L4 and L5 vertebrae of the spine and in the S1 and S2 vertebrae of the sacrum. After the peroneal nerves exit the pelvis, they travel down the front and side of the leg into the outer side of the knee and foot. The tibial nerves originate from the nerve roots at the L4 and L5 as well as the S1 through S3 vertebrae of the spine. The tibial nerves travel in front of the knee and down into the foot. When the sciatic nerve becomes compressed or impinged, it can cause painful symptoms along these pathways, characteristic of sciatica.
Should Sciatica be Treated with Surgery?
Most patients diagnosed with symptoms of sciatica can experience relief from non-surgical treatments, such as chiropractic care, and surgical interventions are generally not required to treat it. However, when the compression or impingement of the sciatic nerve manifests more serious symptoms, it may be necessary to receive further advice from a healthcare professional on the best form of treatment you should follow.
Severe symptoms such as: bowel or bladder dysfunction; advanced stages of spinal stenosis; neurological dysfunction including severe leg weakness; and intense symptoms where non-surgical treatments are no long effective; could indicate the need for surgery to treat sciatica.
The two common spinal surgeries for sciatica are:
Discectomy and microdiscectomy. With both of these procedures, the surgeon removes all or part of a herniated disc which may have been applying pressure against the sciatic nerve, causing your symptoms. The difference between the procedures is that a microdiscectomy is a minimally invasive surgery. The surgeon uses microscopic magnification to work through a very small incision using very small instruments. Because the surgery is minimally invasive, many patients recover quicker from this type of surgical procedure.
Laminectomy or laminotomy: These procedures both involve a part of the spine called the lamina, or the bony plate which functions to protect the spinal canal and spinal cord. A laminectomy involves the removal of the entire lamina; a laminotomy involves the removal of only a part of the lamina. These procedures can create more space for the nerves, reducing the risk of the nerves being compressed or impinged.
Over-the-counter medication, such as non-steroidal anti-inflammatory drugs or NSAIDs, can help reduce the irritation and inflammation of the body which may relieve the symptoms of pain. These however are only considered temporary treatments and the source of the individual’s sciatica should be addressed to promote overall health and wellness. Be sure to consult your healthcare provider on the best treatment option for your sciatica.
For more information, please feel free to ask Dr. Jimenez or contact us at 915-850-0900 .
By Dr. Alex Jimenez
Additional Topics: What is Chiropractic?
Chiropractic care is an well-known, alternative treatment option utilized to prevent, diagnose and treat a variety of injuries and conditions associated with the spine, primarily subluxations or spinal misalignments. Chiropractic focuses on restoring and maintaining the overall health and wellness of the musculoskeletal and nervous systems. Through the use of spinal adjustments and manual manipulations, a chiropractor, or doctor of chiropractic, can carefully re-align the spine, improving a patient�s strength, mobility and flexibility.
Sciatica is a disabling condition characterised by pain in the leg along the distribution of the sciatic nerve. It can be accompanied by back pain, tingling, numbness, reduced strength and reflex changes in the leg.
Sciatica is most commonly caused by irritation of the nerve roots emerging from the lower spine. For this reason it is often considered a type of nerve pain.
It is estimated that around 5 to 10% of people with low back pain have sciatica, equating to around 200,000 to 400,000 Australians. It is notoriously difficult to treat sciatica with over-the-counter medications and complementary therapies.
Our study released today examines the commonly prescribed nerve pain treatment pregabalin for acute and chronic sciatica. The results show that pregabalin does not improve pain symptoms or function, but is associated with unwanted side effects such as dizziness when compared to a placebo.
Huge Uptake Of New Drug
Medicines that have shown to be effective for treating nerve pain were considered to be an exciting new treatment option for sciatica.
Pregabalin became subsidised by the Australian government for nerve pain in 2013 and quickly became widely prescribed for conditions such as sciatica. In its first year of listing, nearly 1.4 million prescriptions were written and in its second year, this figure increased to 2.4 million. This was 32% more than the government predicted.
Since its first approval in 2004 pregabalin has become the most widely prescribed medicine for nerve pain globally, with worldwide sales of between US$3-5 billion annually. The astonishing growth is likely to be a consequence of many factors but may partly be a reflection of the lack of effective treatments for sciatica.
But while pregabalin has been shown to be effective for other types of nerve pain, there was little evidence it helped patients with sciatica. There were also emerging concerns of increased harmful effects, including risk of suicidality and misuse.
We designed our study to examine whether pregabalin is effective and has tolerable side effects in patients with sciatica.
Pregabalin Does Not Work For Sciatica
The research compared the effects of pregabalin against placebo (identical inactive capsules) in 207 patients with sciatica.
Patients were randomly assigned to take up to eight weeks of pregabalin or placebo, prescribed and monitored by a general practitioner or a medical specialist. To keep the results as unbiased as possible, patients, doctors and study staff were kept blinded to who was treated with pregabalin and who received placebo capsules.
This study found after eight weeks there was no difference in the severity of leg pain between those who took pregabalin and those who took placebo capsules. The same result was seen at one year. There were also no differences in other relevant outcomes, such as back pain severity and function, at either eight weeks or one year.
However, people who took pregabalin reported more adverse effects. The most common adverse effect reported in the trial was dizziness.
The study shows that taking pregabalin does not improve your sciatic symptoms when compared with placebo, but you are more likely to have adverse effects when taking pregabalin.
Treatment Options For Sciatica
Few alternative treatment options exist for people suffering from sciatica.
There is limited data describing the effects of nonsurgical treatments such as exercise, spinal manipulation or acupuncture on sciatica.
There is also no convincing evidence to show medicines such as anti-inflammatory drugs, oral corticosteroids or opioid analgesic medicines are effective. Epidural corticosteroid injections have been shown to have a small benefit in the short-term only.
Surgery confers a short-term effect in selected patients with sciatica, but after a year people with sciatica who have not had surgery do just as well as people who�ve had the procedure.
The good news is that sciatica does get better with time. It�s important to stay as active as possible and to avoid prolonged bed rest (as this can delay recovery).
If you�re currently taking pregabalin, speak to a doctor about your condition, and mention any improvement or adverse effects you�ve experienced since starting pregabalin. It�s important not to stop pregabalin abruptly � usually doses should be reduced slowly over a few weeks. Abruptly stopping pregabalin can have some ill effects and should be done with care, close monitoring and advice from a doctor.
It�s unfortunate, but we do not currently have a lot of effective treatment options for people with sciatica. Speak to your doctor or treating clinician (such as a physiotherapist) about what may be appropriate for you, including specific advice on how you can stay as active as possible.
Sciatica specifically refers to pain, weakness, numbness, or tingling in the leg, along the distribution of the the sciatic nerve down the back of the leg. Most commonly however, people will refer to any condition that causes back pain in association with leg symptoms as sciatica.
Common Causes:
True sciatica occurs when there is pressure on, or damage to, the sciatic nerve. This nerve starts in the lower spine and runs down the back of each leg. This nerve controls the muscles of the back of the knee and lower leg and provides senation to the back of the thigh, part of the lower leg and the sole of the foot.
As previously mentioned, the term “sciatica” is often used by patients to describe any condition where there is back pain together with associated leg symptoms. This being the case, there are a number of other conditions that will actually mimic sciatic nerve pain. Sacroiliac joint irritation (sacroiliac joint syndrome), lumbar facet joint irritation (lumbar facet joint syndrome), and piriformis syndrome all frequently produce leg symptoms, and are therefore commonly mistaken for sciatica.
Common Symptoms:
Sciatica pain can vary widely. It may feel like a mild tingling, a dull ache, or even a burning sensation, while in other cases, the pain can be servere enough to make movement practically impossible. Most commonly, sciatica effects only one leg.
Treatment:
Treatment begins with first determining whether a patient is suffering from true sciatic nerve involvement, or if they are actually suffering from one of the other conditions that frequently mimics sciatica. From there treatment is directed towards reducing inflammation, pain, and spasm, while restoring movement and function to the effected spinal levels. Once normal spinal mechanics are restored, patients are given a simple home exercise program in order to help maintain normal function and to help prevent re-occurances.
What is sciatic nerve pain? Sciatic nerve pain is one of the most tough [ www.youtube.com/watch?v=FUcGA-BvmIQ dolore sciatica] problems for physicians, also those experienced in treating back pain as well as sciatica patients, to determine as well as treat. Sciatica usually presents itself as a prickling and/or numbness, like the sensation one may experience with a pulled hamstring muscle mass, the biceps femoris at the back of the leg. The experience could be plain, almost an ache, with durations of prickling and/or tingling happening throughout specific activities. The prickling and/or numbness experienced, if not dealt with, may develop into a full-on constantly [ www.youtube.com/watch?v=SrFQWAtJtZU click resources] severe phase with discomfort capturing throughout the butts and also radiating down the leg. Sciatic nerve pain might influence one or both legs, typically one, starting as a pain radiating from some point in the lower back, the lumbar spine, after that throughout the gluteal muscle mass (the buttocks), as well as ultimately down the rear of the leg. In innovative instances, sciatic nerve pain gets to right right into the feet as well as toes, triggering discomfort as well as an eventual loss of feeling.
Remarkably, sciatica is not a details condition, it is just a catch-all clinical term put on a constellation of symptoms in order to explain a state the back pain victim remains in. In this instance, sciatic nerve pain is utilized to define a patient’s complaint of pain radiating across the butts, down the leg, and also right into the feet and toes … along with the connected tingling and/or feeling numb. Sciatica could be brought on by a variety of conditions, from stress and anxiety and trauma at a particular area on the spinal column, the reduced back or back curvature, to a much more general condition such as obesity or pregnancy. There are a number of other problems associated with sciatica, all needing varying degrees of clinical intervention and also treatment. A few of the conditions likely to present with sciatica are:
1. Osteomyelitis: An infection of the bone or bone marrow. Osteomyelitis might be debilitating and also in severe cases may also create death. It is tough to identify as well as might go undetected for a long period of time unless appropriate blood examinations are purchased and also the doctor is well trained in contagious diseases influencing the bones.
2. Growths on or near the spine: Lumps, particularly tumors or abnormal growth (e.g., scar tissue) affecting the nerves or nerve roots as they exit the spinal canal and intervertebral foramen, will certainly sciatic nerve pain or sciatic nerve pain.
3. Degenerative Disc Disease: Again, degenerative disc condition is not an illness anymore than sciatic nerve pain, called sciatica, is a specific problem. Degenerative disc condition is a break down of the IVDs, the intervertebral discs, and also is generally an effect old combined with the any or every one of the 5 primary elements influencing the spine as we age.
o Excess weight and/or obesity
o Muscle weakness
o Muscle Imbalance
o Poor nourishment and also diet plan
o Poor hydration or dehydration
4. Herniated (i.e., burst) or protruding disc: This problem might be particularly bothersome if the herniated disc or bulging disc is extending posteriorly (to the back) and right into the spine canal, or impinging on the nerve origin at the intervertebral foramen, hence putting pressure on the spine and/or nerve root; and, sciatica is the result in lots of instances.
Chiropractor, Dr. Alexander Jimenez looks at how sciatica can affect what you do and where you go.
Popular songstress hears her “Body Talk” and finds “Let’s Get Physical” challenging due to low back and leg pain.
In the event you suffer from sciatica, you may have to take time off work due to debilitating leg pain and low back. That�s just what occurred to Olivia Newton-John, who postponed her May 2017 performances because of sciatica flare up.
A statement posted on the star�s official Facebook page said, �We are so sorry to announce the Olivia concerts scheduled for May will be postponed due to a issue that is negative with Olivia’s sciatica.�
In a Facebook post that was separate, Newton John expressed disappointment at having to postpone the shows, but that the symptoms wouldn’t allow her to perform. �I have had a long running issue with sciatica, � she wrote. �I need to take this time with this very debilitating condition.�
Sciatica�s hallmark symptoms of intense low back and leg pain make it among the most well known spinal issues. Individuals who have sciatica frequently describe their pain as electrical-like as it runs in the buttock down and down the trunk of the thigh to the foot. Moving your legs often makes the pain worse performing all night as Newton-John her pain would have during her concerts may have greatly intensified.
Newton-John�s choice to take time to handle her sciatica is an excellent example for anyone who lives with acute low back and leg pain. Avoiding activities that aggravate your sciatica and focusing on mild activities and other treatments go a long way to lower your pain.
Keep Sciatica Pain From Increasing
By Staying Informed
Does one have problems with sciatica? SpineUniverse has many resources that will help you understand this sciatic nerve-associated pain and also the treatments that may assist you to will find relief:
Lower back pain is a common symptoms frequently reported among a majority of the population in the United States. While low back pain generally resolves on its own, constant discomfort could signal the presence of a more serious injury or condition. A variety of factors can lead to spinal damage or injury, manifesting as low back pain, however, when the pain and discomfort includes tingling sensations, numbness and even burning sensations along the lower extremities, damage or injury to the sciatic nerve may have occurred.
Over-exercising, lifting, bending, or twisting abruptly into awkward positions, and even driving for extended periods of time, can strain the sciatic nerve, leading to lower back pain which radiates into the back of the legs as well as other numerous symptoms, known as sciatica.
What is Sciatica?
Approximately 5 to 10 percent of individuals experience some form of low back pain from sciatic nerve pain. Most commonly seen in people ranging from 18 to 35 years of age, the prevalence of sciatic symptoms varies tremendously from 1.6 percent throughout the general population to 43 percent in a selected working population. Unfortunately, only 30 percent of individuals suffering from sciatica seek medical attention only after experiencing these painful symptoms for a year or more. In a majority of cases, sciatica is caused by a herniated disc involving nerve root compression.
Not all individuals with lower back pain have sciatica. Lower back pain could result from a variety of factors, most frequently seen in sedentary workers who sit behind a desk for an extended period of time with improper posture while not following ergonomics.
Causes for Sciatica
Several causes of sciatica include trauma from an injury, spondylolisthesis, piriformis syndrome, spinal tumors and obesity. �Sciatica can be debilitating at times when the episode is acute. At that time, it is very difficult to carry out day-to-day activities. Some patients are advised bed rest for three to four weeks so that their condition improves. Majority of the symptoms settle down with non-operative management, which involves extensive rest,� Dr. Sunil Dachepalli, senior orthopedic and joint replacement surgeon and sports medicine expert at Yashoda Hospitals quoted.
For long-distance drivers, they are at a higher risk of developing sciatica because of the constant jolts on bumpy roads which have been known to weaken the discs of the spine. Smooth roads can prevent this though. The individual�s height can also be a component towards the development of sciatica as most discs rupture backwards when the person bends forward. Taller people tend to slouch forward more often and also, when they bend, their center of gravity moves further away from the spine. The pressure on the spine is multiplied by the distance of the force, resulting in more pressure on discs of taller people when they bend forward.
It�s essential to properly diagnose the presence of sciatica and determine the source of the pain and other symptoms. Sciatica caused by a common back complication, such as a spinal misalignment, may require a combination of treatments to relieve an individual�s symptoms as well as treat the underlying cause of the sciatica. Dr. N. Somasekhar Reddy, senior consultant orthopedic surgeon stated, �In 80 percent of the cases where people treat their sciatica on time, it is found that these simple methods can help them get better with time.�
Symptoms of Sciatica
Sciatica is characterized by a sharp pain along with numbness on the leg. The affected leg may also feel weak and appear thinner than the other leg. Additionally, many individuals experience a mild tingling, dull ache, or burning sensation that can also be felt on the back of the calf or on the sole of the foot. The pain and discomfort usually worsens when one lies down and can often make getting enough rest difficult. Occasionally, redness and swelling may appear on the back. An episode of back pain that has lasted continuously for more than four weeks could suggest the presence of sciatica.
Home Remedies for Sciatica
If you�ve been diagnosed with sciatica, there are a several remedies that can help ease the pain. Foremost, ice therapy can be used on the affected are of the back to reduce the swelling. Participating on regular physical activity and exercise can help strengthen the muscles and improve flexibility to prevent degenerative wear and tear changes associated with age. In addition, avoid sitting or standing for prolonged periods of time by taking several breaks to stand, stretch, and walk around. If you must be on your feet, rest one foot on a small stool or footrest and then switch feet throughout the day. Individuals with sciatica symptoms should also avoid wearing high heels. This type of footwear alters the body�s natural posture, adding pressure to the spine which could aggravate your sciatica. And finally, take pressure off your back by sleeping on your side or on your back with a pillow under your knees.
While these remedies can relieve symptoms of sciatica, their effects may only be temporary and it�s still crucial to receive immediate medical attention to diagnose any possible underlying conditions or injuries that could have developed your complications and follow with proper treatment. Chiropractic care focuses on realigning the spine through the use of spinal adjustments and manual manipulation to decrease the stress on the spine as well as strengthen the structures around the vertebra and restore the body�s natural health.
Back pain is a common symptom affecting a wide range of individuals. Various factors can cause back complications but when a person’s lower back pain begins to radiate down into the back of the legs, it could be another issue. Approximately 5 to 10 percent of individuals experience low back pain due to sciatica. Characterized as a group of symptoms rather than a single condition, sciatica can often make an individual’s lifestyle more difficult than a simple low back problem.
When the constant symptoms of low back pain are attributed to sciatica, the radiating pain and discomfort can greatly restrict an individual’s everyday lifestyle, altering their daily activities. After identifying the collection of symptoms associated with sciatica, it’s important for the individual’s to seek a professional medical diagnosis to determine the source of their symptoms. Once diagnosed, following treatment with a qualified healthcare specialist can help them recover from their symptoms and improve their overall health and wellness.
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.
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.
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