ClickCease
+1-915-850-0900 spinedoctors@gmail.com
Select Page

Back Pain

Back Clinic Back Pain Chiropractic Treatment Team. At the El Paso Back Clinic, we take back pain very seriously.

After diagnosing the root cause of your discomfort/pain, we’ll do everything within our power to cure the area and relieve your symptoms.

Common causes of back pain:
There is an infinite number of forms of back pain, and a variety of injuries and diseases may cause discomfort in this area of the body. One of the most Frequent ones we see one of our patients in East Side El Paso and surrounding areas comprise:

Disc Herniation
Inside the backbone are flexible discs that cushion your bones and absorb shock. Whenever these discs are broken, they may compress a nerve leading to lower extremity numbness. StressWhen a muscle at the trunk is overexerted or hurt, causing stiffness and pain, this type of injury is generally classified as a back strain. This can be the consequence of attempting to lift an item that can result in excruciating pain and impairment and is too heavy. Diagnosing the underlying cause of your pain.

Osteoarthritis
Osteoarthritis is characterized by the slow wearing down of protective cartilage. When the back is affected by this condition, it causes damage to the bones that results in chronic pain, stiffness, and limited mobility. SprainIf ligaments in your spine and back are stretched or torn, it’s called a spine sprain. Typically, this injury causes pain in the region. Spasms cause back muscles to overwork they may start to contract, and can even stay contracted– also called a muscle spasm. Muscle spasms can present with pain and stiffness until the strain resolves.

We want to accomplish the diagnosis straight away, integrating a background and exam along with state-of-the-art imaging, so we can provide you with the most efficient therapy choices. To begin, we will speak with you regarding your symptoms, which will provide us with critical information regarding your underlying condition. We’ll then perform a physical exam, during which we’ll check for posture issues, evaluate your spine and assess your backbone. If we guess injuries, like a disk or neurological injury, we’ll probably order imaging tests to obtain an analysis.

Regenerative remedies to your back pain. At the El Paso Back Clinic, you may be certain that you’re in the best possible hands with our Doctor of Chiropractic and Massage Therapist. Our purpose during your pain treatment isn’t only to relieve your symptoms — but also to avoid a recurrence and to treat your pain.


A Look Into Pilates For Back Pain

A Look Into Pilates For Back Pain

Introduction

Many people worldwide know that exercising has impressive benefits that help improve the body’s overall wellness. The body has different muscle groups that have a casual relationship with the vital organs inside the body. Organs like the heart, lungs, gut, and bladder correlate with the different muscles through the nerve roots that connect them. When the body suffers from various factors that affect it, it causes referred pain to the body where one pain is at one location but radiates from the other side. Exercising can help the body recover through physical rehabilitation by reducing inflammation and scarring on the muscle tissues. One of the many exercises that helps strengthen the muscles, increase flexibility, and even improve posture is Pilates. Today’s article looks at Pilates, its benefits, and how it can help alleviate back pain. We refer patients to certified providers specializing in musculoskeletal treatments to help many individuals with low back pain issues affecting their bodies. We also guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is the solution to asking our providers insightful questions. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer

Axiom-JapanStudy

What Is Pilates?

 

Have you been feeling sluggish or having low energy throughout the entire day? What about experiencing pain in your lower back? Have you experienced muscle stiffness in certain areas around your body? Many of these symptoms are associated with musculoskeletal issues that correlate with different factors that affect the body; why not try an exercise regime like Pilates? Pilates is a system of exercises that uses a particular machine or body to improve a person’s physical strength and posture while increasing the body’s flexibility and enhancing mental awareness. Joseph Pilates developed Pilates in the early 20th century as an exercise program to help World War I soldiers improve their physical fitness levels. Pilates was used as rehabilitation therapy for injured individuals by incorporating resistance, stretching, and target muscle strengthening. Pilates is now utilized for all individuals with different bodies and fitness levels and can provide tremendous benefits. 

 

What Are The Benefits?

Pilates, like any other form of exercise, has many beneficial properties that help improve a person’s health and wellness. Studies reveal that Pilates helps many individuals, including older adults, by improving their posture by decreasing thoracic flexion while increasing lumbar extension for pain relief. Some of the beneficial properties that Pilates offer to the body include:

  • Increasing core strength: The deep muscles in the abdomen, back, and pelvic regions become stronger and help stabilize the body more.
  • Strengthen muscle groups: Pilates helps make the muscles not only strong but also helps stretch them so that they can look long and lean. This makes the individual look toned.
  • It’s a whole body workout: As many exercises work on specific body parts, Pilates focuses on each muscle part of the body and helps muscle development.
  • Posture Improvement: Pilates help keep the spine aligned while strengthening the body and core. Over time a person’s posture will improve naturally, making them stand taller, stronger, and even more graceful.
  • Increases energy: Like all exercises, Pilates will give a person the energy boost they need. This is due to the focused breathing and increased blood circulation that stimulates the muscles and the spine.

 


Pilates Exercises For Back Pain-Video

Are you looking for a new exercise to tone your muscles? Have you been dealing with pain in your lower back? Do you have muscle weakness in some regions of your body? If you have been experiencing pain-related issues, why not try Pilates? The video above goes through a 10-minute Pilates workout for back pain. Studies reveal that non-specific low back pain is a highly prevalent condition many individuals associate with disability and work absence worldwide. Many environmental factors affect many individuals, causing them to suffer back issues. Pilates can help encourage many individuals to regain their health and wellness by incorporating core strength and stability while improving their posture.


Pilates Alleviate Back Pain

 

Many people don’t realize that some low back pain symptoms are related to poor posture. Poor posture can lead to associated symptoms of headaches, back pain, improper balance, and pelvic issues. What Pilates does is that it creates body awareness and helps improve the lower back muscles by strengthening them and relaxing the stiff muscles. Studies reveal that incorporating Pilates as physical therapy for individuals suffering from low back pain can help address the mental and physical pain aspects with core strengthening, flexibility, and relaxing the tense muscles. Many individuals should never put off exercising when it comes to back pain. Incorporating an exercise routine can benefit the body and prevent future injuries.

 

Conclusion

An exercise regime can provide many beneficial results for those looking for ways to be healthy, those suffering from injuries, or those who want to add something else to their workout routine. Pilates is one of those exercises that incorporates resistance, stretching, and muscle targeting as it is a full-body workout. Pilates is used in rehabilitation therapy for injured individuals and can provide tremendous benefits. Pilates can help many individuals with back issues associated with environmental factors like poor posture. Many individuals that utilize Pilates as part of their exercise regime will begin to feel stronger and healthier as their backs will thank them.

 

References

Baker, Sara. “Pilates Exercise for a Healthy Spine – Spineuniverse.” Spineuniverse, 28 Dec. 2019, www.spineuniverse.com/wellness/exercise/pilates-exercise-healthy-spine.

Kuo, Yi-Liang, et al. “Sagittal Spinal Posture after Pilates-Based Exercise in Healthy Older Adults.” Spine, U.S. National Library of Medicine, 1 May 2009, pubmed.ncbi.nlm.nih.gov/19404180/.

Sorosky, Susan, et al. “Yoga and Pilates in the Management of Low Back Pain.” Current Reviews in Musculoskeletal Medicine, Humana Press Inc, Mar. 2008, www.ncbi.nlm.nih.gov/pmc/articles/PMC2684152/.

Yamato, Tiê P, et al. “Pilates for Low Back Pain.” The Cochrane Database of Systematic Reviews, John Wiley & Sons, Ltd, 2 July 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC8078578/.

Disclaimer

Swimming Might Improve Your Musculoskeletal System

Swimming Might Improve Your Musculoskeletal System

Introduction

When the weather becomes hot, and everyone begins to plan fun activities to enjoy, one of the many activities that come to mind is hanging out in the pool. Swimming is an excellent way to combat the summer heat, but it can provide much more for the body. For athletes, it provides another form of cardio exercise to improve their quality performance when they are competing. While for individuals looking for an affordable exercise regime or just some fun activity to do, swimming can become a form of therapy and be beneficial for them if they were previously injured. Today’s article looks at how swimming causes an impact on the musculoskeletal system, its beneficial properties to the heart, and how aqua therapy combined with chiropractic care helps optimize full-body health. We refer patients to certified providers specializing in musculoskeletal treatments and hydrotherapy to help those with musculoskeletal disorders. We also guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is the solution to asking our providers insightful questions. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer

09 Sinatra CHF & Metabolic Cardiology

Swimming & Its Impact On The Musculoskeletal System

Water exercises or swimming can benefit those looking for different cardio exercises to build muscle endurance or have a clear sense of mind. Swimming is fantastic for all body sizes, and when it is done correctly, it can be highly recognized as a form of rehabilitation and injury recovery known as aquatic therapyResearch studies reveal that aquatic treatments and exercises can significantly reduce pain in individuals that suffer from low back pain while increasing physical function. Some of the impacts that swimming/aquatic therapy provides on the musculoskeletal system include:

  • Builds muscle strength
  • Improves endurance
  • Stabilizes joints
  • Improves poor posture

Swimming/ hydrotherapy is an excellent low-impact exercise that is easy on the back and spine, especially for individuals suffering from low back pain or spinal misalignments. Studies reveal that the efficacy of aquatic activities helps strengthen the abdominals and legs and stretch the back while managing musculoskeletal issues. 

 

When individuals suffer from back pain associated with chronic issues can become concerning for the vital organs that have a causal relationship with the muscle as they are affected as well. When spinal joints and muscles begin to suffer from abnormal weight increases, the muscles and ligaments become misaligned. Misalignment or subluxation is defined as spinal vertebrates that are out of place and cause pressure on the surrounding nerves exiting the spinal cord. These spinal issues then become a risk of developing musculoskeletal disorders in the body. Unlike many aerobic exercises like running or cycling that may be hard on the spine, swimming has little to no impact on the spinal structures. So when individuals begin to take up swimming, they realize that the water buoyancy helps support their body weight while relieving stress on all joints and decompressing the spine. This gives the individual a greater range of motion, while the water gives off a sense of purification as it helps the body relax. Hence, hydrotherapy helps relax people who suffer from obesity or muscle injuries associated with muscle and joint pain as the water provides gentle resistance while relaxing the muscles to promote longer exercise sessions.

 

The Benefits Of Swimming For The Heart

 

Swimming or any form of water aerobics is not only beneficial to the musculoskeletal system but can help improve cardiac function in the heart and even the lungs. Studies reveal that swimming is an effective option for maintaining and enhancing cardiovascular fitness. Some of the benefits swimming provides for the cardiovascular system include:

  • Lowers blood pressure
  • Improve circulation
  • Reduces heart rate

But how does swimming improve cardiovascular function in the body? Individuals submerge themselves underwater; they hold their breath until the air is needed. Being submerged underwater may help lung capacity while gaining control of how a person breathes. Breathing exercises associated with aqua therapy help promote stronger lungs and heart while increasing their capacity for blood and airflow to the heart and lungs. Say, for example, a person is having trouble breathing due to restrictive blood and air flow associated with cardiopulmonary issues, which potentially be involved in experiencing an asthma attack associated with obesity.


The Benefits Of Swimming-Video

Have you wanted to try a different form of cardio exercise? Have you been experiencing a limited range of motion in your arms, shoulders, back, and neck? Do you feel tightness across your chest? The video above gives an overview explanation of the health benefits of swimming. Swimming or aquatic therapy allows the individual experiencing chronic pain issues to do cardio activities without increasing or worsening pain, which is very therapeutic for the body. Many people are either training for an athletic event or finding a leisure activity that will benefit them in the long run. Swimming is considered an important factor in a person’s quality of life as it helps them become motivated to make small changes to better their health. Additionally, regular cardiovascular exercises/activities like swimming benefit pain reduction in a therapeutic sense. When individuals are trying to figure out and determine the proper training or therapy that can help alleviate their specific ailments, their goal is to see how those exercises should be done in a certain amount of time without causing fatigue or increased pain as the primary objective.


Aqua Therapy & Chiropractic Care

When looking for the proper exercise regime or treatment for pain issues, it can be challenging to see what works and doesn’t. For those with musculoskeletal disorders related to chronic issues, aqua therapy and chiropractic care go hand in hand in alleviating pain. Aqua therapy exercises can range from simple routines in shallow waters to high-tech equipment like underwater treadmills for muscle conditioning. Active water therapy exercises that are diverse in relieving musculoskeletal pain should be tailored to the person and the specific conditions that are ailing them.

 

But how does chiropractic care work hand in hand with aqua therapy? Well, chiropractic care and exercise have a casual relationship when it comes to treating musculoskeletal disorders. Many individuals do suffer from spinal misalignment, which becomes a risk of developing musculoskeletal issues that cause discomfort. Since many individuals associate chiropractic care with back issues, the reality shows that chiropractic care not only helps with back issues but various issues that affect the muscles, joints, and organs related to each other. An example would be an individual with low back problems who cannot do any activities for long periods while triggering gut issues. This is defined as somato-visceral pain where affected muscles associated with internal organs trigger pain. So for a chiropractor to adjust an individual dealing with back pain associated with gut or heart issues can slowly restore the person’s natural alignment by reducing the irritated nerve roots between the vertebrae and strengthening the surrounding muscles and tissues. Afterward, a chiropractor may recommend exercises like aquatic therapy to speed up the rehabilitation process, as studies reveal that physical activities are perceived to have a positive impact on health while being associated with perceived symptom reductions in musculoskeletal and injuries, as well as cardiovascular and blood conditions. Once a chiropractic regimen and exercise routine are in place, injury prevention kicks in, keeping the individual moving pain-free.

 

Conclusion

Whether it is having fun in the sun or finding a new exercise, swimming is not only for just playing but can be therapeutic for individuals dealing with chronic issues. Any aquatic exercise provides little to no impact on the body as it helps strengthen the musculoskeletal and cardiovascular systems with gentle force. Combined with chiropractic care, many individuals that are dealing with musculoskeletal issues associated with chronic organ issues will begin to become motivated to better themselves in the long run.

 

References

Ariyoshi, Mamoru, et al. “Efficacy of Aquatic Exercises for Patients with Low-Back Pain.” The Kurume Medical Journal, Kurume University School of Medicine, 11 Aug. 2009, www.jstage.jst.go.jp/article/kurumemedj1954/46/2/46_2_91/_article.

Lazar, Jason M, et al. “Swimming and the Heart.” International Journal of Cardiology, U.S. National Library of Medicine, 18 Apr. 2013, pubmed.ncbi.nlm.nih.gov/23602872/.

Massey, Heather, et al. “Perceived Impact of Outdoor Swimming on Health: Web-Based Survey.” Interactive Journal of Medical Research, JMIR Publications, 4 Jan. 2022, www.ncbi.nlm.nih.gov/pmc/articles/PMC8767464/.

Shi, Zhongju, et al. “Aquatic Exercises in the Treatment of Low Back Pain: A Systematic Review of the Literature and Meta-Analysis of Eight Studies.” American Journal of Physical Medicine & Rehabilitation, U.S. National Library of Medicine, Feb. 2018, pubmed.ncbi.nlm.nih.gov/28759476/.

Disclaimer

Ways To Improve Musculoskeletal System For Optimal Health

Ways To Improve Musculoskeletal System For Optimal Health

Introduction

Everyone wants to be healthier at some point in their lives. Some individuals train to be athletes and must follow procedures to maintain their health. In comparison, others want to get healthier by eating the right foodexercising for at least 30 minutes to an hour, meditating or doing yoga to relieve stress, and maintaining a healthy weight. However, many environmental factors do affect the human body. They can alter how a person looks, weight, levels of physical activity, and how different foods affect the body’s metabolism. When environmental factors start to take hold of a person’s health, it can trigger unwanted issues that affect not only the muscles in the body but the associated internal organs that help provide the functionality to the body. Today’s article focuses on the musculoskeletal system, how different issues affect the musculoskeletal system and associate with other problems in the body, and various treatments to improve musculoskeletal health. We refer patients to certified providers specializing in musculoskeletal therapies that help those with musculoskeletal disorders. We also guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is the solution to asking our providers insightful questions. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer

03 Minich Nutrition in CVD

The Musculoskeletal System & Its Function

How does the musculoskeletal system play its role in the human body? The body is considered a complex being that consists of various organs, muscles, tissues, ligaments, and joints that help move a person from one place to another, resting while needed, and doing multiple activities in a casual relationship. Studies reveal that the musculoskeletal system is controlled by the central nervous system that interconnects the motor-sensory function for the body’s ability to move and rest.

 

The three main muscle groups that make up the musculoskeletal system are:

  • Skeletal muscle- Muscle tendons that are connected to the bones
  • Cardiac muscle- Muscles associated with the heart
  • Smooth muscle- Muscles that line with blood vessels and specific organs (ex. intestines)

Each muscle group provides different functions that correlate to how the body moves. Skeletal muscles make the legs and arms move. Cardiac muscles help the heart pump blood to the various muscles, organs, and tissues. Smooth muscles help specific organs (intestines, stomach, and urinary tract) digest, collect nutrients, and eliminate toxins in the body.

 

Issues That Affect The Musculoskeletal System

These factors are related to different issues that can not only disrupt the musculoskeletal system but can be an overlap of profiles affecting the cardiovascular system, spinal health, and gut system. The different factors that are associated with the musculoskeletal system are:

  • Obesity
  • Lack of physical activity
  • Poor Posture
  • Inflammation
  • Unhealthy Diet

How would various factors implicate musculoskeletal issues while triggering different bodily problems? Well, let’s use obesity as an example. Obesity is associated with issues like back and joint pain as studies reveal that these musculoskeletal issues make up pain and disability as a dominant source. A poor diet of processed foods high in fats and sugars can be associated with the risk of developing obesity.

El Paso TX Health

 

Not only that, but obesity could potentially be involved in the thoracic spine and upper back pain due to the result of physical inactivity and poor dieting. The weight on the body can strain the muscles and ligaments in the back, causing the spinal vertebrae to become misaligned and pressure the nerves exiting the spinal cord. The misalignment of the vertebrae is called a subluxation. When a person is suffering from upper back pain, it can overlap with chest pain, which can be a concerning issue to vital organs like the heart, which potentially involved in the risk of cardiovascular disease. It is related to subluxation that may affect the heart contraction rate, rhythm, and power through the sympathetic efferent pathways originating from the thoracic region.


An Overview Of The Musculoskeletal System-Video

Are you experiencing pain in your upper back or chest? How about cardiac issues associated with shouldering and arming pain? Many of these issues are related to factors that affect the musculoskeletal system that might potentially be involved with chronic issues. The video above summarizes the musculoskeletal system’s role in the body. When environmental factors become a risk of developing musculoskeletal disorders that can potentially be involved in different bodily problems, studies reveal that musculoskeletal disorders associated with abnormal functions may cause a significant impact on regular performances. An example would be a person dealing with bad hip pain and cannot do any exercises triggering heart issues. This is defined as somato-visceral pain where the affected muscle is associated with an internal organ being a pain mediator. 


Treatments For Improving Musculoskeletal System

In most treatments, many individuals utilize the following to improve not only the musculoskeletal system but other issues that affect the body:

  • Exercise
  • Healthy Diet
  • Stress Management Treatments
  • Chiropractic Therapy

No matter what affliction or health problem a person is dealing with, having the best treatment solution possible is a start on a person’s health and wellness journey. The first step is to have a precise diagnosis to the doctor while giving as much information as possible is critical. Providing them with a complete health history is an essential first step. After a manual examination of the issues causing them pain, the primary physician could refer the individual for chiropractic care to relieve issues affecting their musculoskeletal system.

 

Many people usually only associate chiropractic care with back problems. Still, the reality is that chiropractic therapy can be helpful for the musculoskeletal system and various issues related to the muscles and organs. A chiropractor can provide therapeutic stretches and recommend exercises to individuals to help them avoid the same problems later on. Many chiropractors offer recommendations and nutrition that individuals can utilize to help improve their condition. For the musculoskeletal system, a healthy diet may help achieve and maintain a healthy body weight while reducing the risk of chronic disease. Eating the right amount of healthy greens, fruits, beneficial carbs, and healthy fats can help reduce the risk of developing chronic issues in the body like cardiovascular diseases. However, if primary cardiac problems affect the body, it is best to seek medical attention as soon as possible.

 

Conclusion

The body is considered a complex being that consists of various organs, muscles, tissues, ligaments, and joints that provide various activities to the host. The musculoskeletal system has three muscle groups: skeletal, cardiac, and smooth muscles provide different functions that correlate to how the body moves. When various factors begin to cause issues to the musculoskeletal system, they can potentially be involved with pain issues that affect more than the body. Treatments like chiropractic care, a healthy diet, exercise, and stress management may be the stepping stones to alleviating various issues that are affecting the musculoskeletal system and a great start in achieving health and wellness.

 

References

Kennel, Peter J, et al. “Skeletal Muscle Changes in Chronic Cardiac Disease and Failure.” Comprehensive Physiology, U.S. National Library of Medicine, 20 Sept. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC6752037/.

Malik, Khalid M, et al. “Musculoskeletal Disorders a Universal Source of Pain and Disability Misunderstood and Mismanaged: A Critical Analysis Based on the U.S. Model of Care.” Anesthesiology and Pain Medicine, Kowsar, 15 Dec. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC6348332/.

Murphy, Andrew C, et al. “Structure, Function, and Control of the Human Musculoskeletal Network.” PLoS Biology, Public Library of Science, 18 Jan. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC5773011/.

Stochkendahl, Mette J, et al. “Diagnosis and Treatment of Musculoskeletal Chest Pain: Design of a Multi-Purpose Trial.” BMC Musculoskeletal Disorders, BioMed Central, 31 Mar. 2008, www.ncbi.nlm.nih.gov/pmc/articles/PMC2315652/.

Disclaimer

The Gallbladder & The Parasympathetic Nervous System Function

The Gallbladder & The Parasympathetic Nervous System Function

Introduction

The digestive system in the body helps with the process of digesting food that the host consumes. The food being digested goes through a bio-transformation where it turns into nutrients and is stored in the intestinesliver, and gallbladder, where it turns into bile to be excreted out of the system to ensure a healthy functional gut system and body. But when disruptive factors like poor eating habits or gut issues start to affect the body and gallbladder, this causes many problems that can make an individual miserable. This affects their quality of life since they are dealing with painful issues in their bodies that overlap the primary source risk profiles. Today’s article looks at the gallbladder, how it functions with the body and parasympathetic nervous system, and how referred shoulder pain and gallbladder dysfunction are connected. We refer patients to certified providers specializing in gastroenterology and chiropractic treatments that help those with issues that affect their shoulders and gallbladder. We also guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is the solution to asking our providers insightful questions. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer

03 - Brown Fatty liver disease ETOH and NAFLD

What Is The Gallbladder?

The digestive system comprises the mouth, the internal organs from the GI tract, the liver, the gallbladder, and the anus, where food is consumed, digested, and excreted out of the body to keep it healthy. The gallbladder is a small organ that store and releases bile at the appropriate time into the intestines to be mixed with the digested foods to be excreted out of the body. This pear-shaped organ inflates and deflates like a balloon when it stores and releases bile while having a casual relationship with the nerves and hormones that help regulate the gallbladder functioning properly. Studies reveal that the ganglia become the target of causing the hormone cholecystokinin and the parasympathetic nerve to up or downregulate the neurotransmission to the gallbladder. This causes the gallbladder to be functional in the body.

 

What Are Its Functions In The Parasympathetic Nervous System?

So what are the functions that the gallbladder provides to the body? For starters, the parasympathetic nervous system allows the body to rest and digest the consumed food to be turned into nutrients. The parasympathetic nervous system also provides gallbladder stimulation as studies reveal that the gallbladder receives innervation from the parasympathetic nervous system connected to the vagus nerve that transmits information to the spine and the brain. Keeping and releasing bile from this pear-shaped organ helps regulate the gastrointestinal tract. This causal relationship between the gallbladder and the parasympathetic nerve is essential because the body needs to know when to store and release bile from the gallbladder, or it might trigger some issues that can do more harm to the body and even affect the gallbladder itself.


Do You Have Shoulder Pain?- Video

Have you been experiencing gut issues causing a sharp or dull ache in your back or sides? How about questionable shoulder pain that seems to come out of nowhere? Or are your experiencing inflammation in your digestive system? Many of these symptoms are signs of visceral-somatic pain affecting the gallbladder. Visceral-somatic pain is defined when there is damage to the organ, and it starts to affect the muscles in a different location in the body. The video above gives an excellent example of visceral-somatic pain in the gallbladder and the shoulder. Now many people wonder how shoulder pain is the mediator of the gallbladder? Well, inflammation in the liver and gallbladder causes the nerve roots to be hypersensitive and compressed. This leads to overlapping profiles, triggering pain in the shoulder muscles and associated with upper mid-back pain.


Referred Shoulder Pain & Gallbladder Dysfunction

 

Now say the individual is experiencing shoulder pain; however, when they rotate their shoulder, there is no pain? Where is the source of shoulder pain localized, and what is causing the issue? And why is it correlating to the gallbladder? This is known as referred pain, where the source of pain is poorly localized when it is located elsewhere. Studies reveal that gallbladder dysfunctions like cholecystitis might be associated with acute thoracolumbar shoulder pain. So what does this mean? It means that any referred pain that is the causation of shoulder pain gives the impression that something is wrong with the gallbladder. This would provide much-needed information when individuals are being examined by their physicians.

 

Conclusion

The body needs the digestive system to help process food the host consumes and excretes for a healthy functioning system. The gallbladder stores and releases bile to the digested food. This ensures that the nutrients and bile are transported and passed out of the body. When disruptive factors cause gut issues and affect the gallbladder, it can correlate to different problems impacting the body. An example would be gallbladder issues associated with shoulder pain. This is referred to as pain, which is from an affected organ and associated with the muscle in a different location. This can make the individual feel miserable and wonder what is going on with their shoulders when it might be something associated with their gallbladder. Available treatments can provide better knowledge to determine the problem and how to alleviate the issues.

 

References

Carter, Chris T. “Acute Thoracolumbar Pain Due to Cholecystitis: A Case Study.” Chiropractic & Manual Therapies, BioMed Central, 18 Dec. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4683782/.

Jones, Mark W, et al. “Anatomy, Abdomen and Pelvis, Gallbladder.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 8 Nov. 2021, www.ncbi.nlm.nih.gov/books/NBK459288/.

Mawe, Gary M., et al. “Nerves and Hormones Interact to Control Gallbladder Function.” Physiology, 1 Apr. 1998, journals.physiology.org/doi/full/10.1152/physiologyonline.1998.13.2.84.

Medical Professional, Cleveland Clinic. “Gallbladder: What Is It, Function, Location & Anatomy.” Cleveland Clinic, 28 July 2021, my.clevelandclinic.org/health/body/21690-gallbladder.

Disclaimer

Low Back Pain Issues Masking Different Issues In The Body

Low Back Pain Issues Masking Different Issues In The Body

Introduction

Everyone around the world has dealt with pain that makes them feel uncomfortable and has them place their hands on the location where the pain is originating in their bodies. Many factors can become issues in the body, like a poor, unhealthy lifestyle that causes problems in the gut system and develop painful symptoms that affect the intestines. Stressful events that cause headaches that affect the neck and upper back muscles or gut issues that cause discomfort in the abdominal and back region. All these issues are known as referred pain, where a person feels pain in one part of their body, but it is caused by a different source of pain in a different location. An example would be an individual with back pain, but the pain is originating in their abdominal organs. Today’s article looks at various issues that mask low back pain in the body, how organ issues mimic low back pain, and how to alleviate these issues affecting the body. We refer patients to certified providers specializing in gastroenterology and chiropractic treatments that help those with issues that affect their back and gut system. We also guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is the solution to asking our providers insightful questions. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer

10 - Mullin SIBO SIFO

Different Issues Masking Low Back Pain

Have you experienced discomfort in your abdominal region causing pain in your lower back? How about pelvic issues that are causing bowel discomfort? Or constipation issues that are compressing the nerves in your lower back? These signs and symptoms correlate to visceral-somatic pain, defined as poorly localized pain characterized by irritated internal organs that cause muscle hypersensitivity from the same nerve. So what does this mean for a person experiencing back issues affecting their quality of life? Well, this might be an indication of the individual that might be suffering from gastrointestinal problems that are correlating to low back pain. Studies reveal any disturbances causing musculoskeletal or gastrointestinal complaints that could induce referred pain through the sympathetic nervous system. An example will be if the body suffers from infections from the kidneys that are associated with low back pain.

So how would the kidneys be associated with low back pain? What is the correlation? For example, a person is constantly eating foods with either a high salt content or a high protein in their system. These high food contents begin to form kidney stones in one or both organs, thus causing a sharp pain that triggers low back pain. As the kidney stones pass through the urinary tract, it administrates radiating pain to the body’s lower abdominal and pelvic region. Another example of issues that can mask low back is constipation in the abdominal area associated with pelvic dysfunction. How does this correlate to the lower back? Think of your abdominal organs overlapped by risk profiles associated with gut disorders. Signs like hypothyroidism, SIBO, celiac disease, or IBS can increase the risk associated with pelvic floor dysfunction, which causes bloating and constipation to the abdominal organs. These issues are co-morbidities to IBS as studies reveal that the pelvic floor and abdominal muscles are co-activated to increase spine stability and intra-abdominal pressure. Now it may seem not a bad thing to the body unless the individual is constantly standing for an extended period or is obese, thus becoming a mediator for the host to suffer from low back pain while being associated with pelvic dysfunction.


Organ Issues Mimicking Low Back Pain- Video

Have you been feeling muscle tenderness in the lower extremities of your body? How about gut issues that are associated with low back pain? Or are you feeling bowel dysfunction in your pelvic region? All these issues correlate to viscerosomatic pain, where the infected organ is causing issues to the muscle in a different location. The video above explains how various organ issues can mimic spinal and back pain in the body. One of the examples that the video explains is how kidney infections are associated with back pain. Studies reveal that visceral pain originating from the upper urinary tract coincidently correlates with the characteristics of referred pain and changes in the somatic tissues of the body.


Alleviating Issues Affecting The Body

Say an individual is suffering from low back pain issues; as they get their mandatory examination, they explain to their physician about their low back pain and what is happening. Once the suffering individual is situated, the physician begins to look over the body where the pain is located, either by physical examination or through the intake form they are looking over. So what does this implicates in the body? Well, studies have revealed that systemic pathologies of the visceral organs can mimic or mask musculoskeletal pain. An example would be someone who is experiencing gastrointestinal issues in their gut, and it’s triggering muscle spasms in the back. This causes the nerve roots to be hypersensitive to the visceral organs and increases the risk associated with low back pain.

 

Conclusion

Dealing with pain is no joke, primarily when the pain is located in a different body region. Sometimes the pain can be an organ issue that mimics muscle pain in the back. This is known as viscero-somatic pain, defined where infected organs are either mimicking or triggering muscle issues in different body locations. This causation is usually due to various factors like unhealthy lifestyle habits affecting the visceral organs and affecting the muscles that correspond to the organs, like IBS issues affecting the lower back. Available treatments are there to figure out what problems affect the body and provide a better understanding to alleviate them.

 

References

Basso, Francesca Lo, et al. “Manual Treatment for Kidney Mobility and Symptoms in Women with Nonspecific Low Back Pain and Urinary Infections.” De Gruyter, De Gruyter, 1 May 2021, www.degruyter.com/document/doi/10.1515/jom-2020-0288/html.

Bussey, Melanie Dawn, et al. “Is Pelvic Floor Dysfunction Associated with Development of Transient Low Back Pain during Prolonged Standing? A Protocol.” Clinical Medicine Insights. Women’s Health, SAGE Publications, 27 May 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6537301/.

J;, Stowell T;Cioffredi W;Greiner A;Cleland. “Abdominal Differential Diagnosis in a Patient Referred to a Physical Therapy Clinic for Low Back Pain.” The Journal of Orthopaedic and Sports Physical Therapy, U.S. National Library of Medicine, Nov. 2005, pubmed.ncbi.nlm.nih.gov/16355918/.

Lacy, Brian E, et al. “Management of Chronic Abdominal Distension and Bloating.” Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, 1 Apr. 2020, www.cghjournal.org/article/S1542-3565(20)30433-X/fulltext.

PJ;, Pedersen KV;Drewes AM;Frimodt-Møller PC;Osther. “Visceral Pain Originating from the Upper Urinary Tract.” Urological Research, U.S. National Library of Medicine, 16 May 2010, pubmed.ncbi.nlm.nih.gov/20473661/.

Disclaimer

Viscerosomatic Pain Affecting Thoracic Spine

Viscerosomatic Pain Affecting Thoracic Spine

Introduction

The spine has three areas: cervical, thoracic, and lumbar in the back, encased with muscles, tissues, ligaments, and joints that help protect the spinal cord from injuries. With the spinal cord being part of the central nervous system, this long cord has many nerve roots that are spread all over the body and help function each section of the body. When the back muscles become damaged or injured in the thoracic region of the spine, it can cause painful symptoms and other issues that correspond with the thoracic spine. Today’s article will look at the thoracic spine, how back pain in the upper-mid section of the back, and how visceral referred pain affects the thoracic region in the body. We refer patients to certified, skilled providers specializing in osteopathic and chiropractic treatments that help those suffering from chest pains and thoracic back pain. We also guide our patients by referring to our associated medical providers based on their examination when it’s appropriate. We find that education is critical for asking insightful questions to our providers. Dr. Alex Jimenez DC provides this information as an educational service only. Disclaimer

 

Can my insurance cover it? Yes, it may. If you are uncertain, here is the link to all the insurance providers we cover. If you have any questions or concerns, please call Dr. Jimenez at 915-850-0900.

6_Houston_Hypertension

The Thoracic Spine

 

Have you been experiencing herniation in the upper-mid section of your back? Have you felt chest pain occur frequently? Do your back muscles feel stiff or constantly ache even after you stretch? All these symptoms are signs that affect the thoracic region of the spine. Research studies have defined the three spinal areas: the cervical, thoracic, and lumbar help keep the upper half of the body upright. The thoracic area of the spine has added support from the rib cage and allows the body to rotate and flex the upper body. The thoracic region of the spine is also the first curvature that is tight enough to protect the vital organs and loose enough to allow respiratory movement in the body. Additional research studies have also mentioned that the thoracic segments in the spine are susceptible to injuries that can affect the back entirely. The thoracic segments can succumb to structural alterations, disc herniation, and even trauma in the spine from environmental factors like lifting or carrying heavy objects, muscle strain, and forceful impact. 

 

How Thoracic Pain Affect The Body

When the thoracic region of the spine begins to suffer from environmental factors or traumatic events, it can affect the body and aggravate the nerves that encase the spinal column. Research studies have found that when the thoracic spine has succumbed to injuries, it can affect the upper half of the body. Structural changes in the thoracic T 1 through 3 regions of the spine can cause the cervical area to develop neck pain. This causes restricted segmental mobility in the cervical and thoracic regions of the spine. Another research study has mentioned that individuals suffering from thoracic pain will often complain about paravertebral pain aggravated by prolonged standing, hyperextension, and even hyper rotation in the thoracic spinal column. When this happens, it can cause discomfort to the individual and limit their range of motion since their muscles are stiff. Thoracic pain can even affect the corresponding muscles connected to the body’s internal organs.


Referred Pain Affect The Thoracic Spine-Video

Have you felt muscle stiffness in your upper-middle back? Have you been dealing with neck or chest pain? Have inflammatory issues affecting your esophagus? Many of these are signs and symptoms of visceral referred pain affecting the thoracic region of the spine. The video above explains how visceral referred pain can affect the thoracic spine and the corresponding muscle and organs in the area. Research studies have defined pain as damaged nociceptive sensory nerves that affect the peripheral tissues in the face. The broken nerve roots can affect one portion of the body but also a different section of the body. Additional research studies have also found that visceral pain affecting the thoracic regions of the spine can impact the cardiovascular system. This is due to hypertension caused by chronic stress from environmental factors.


Visceral Referred Pain Affecting The Thoracic Region

 

Research studies have noticed that thoracic spinal pain can become a common site for inflammation, degenerative discs, and other issues contributing to pain and disability in the spine. Visceral pain is a complex disorder that can cause the surrounding muscles and organs in the thoracic region to be compromised. When the body is suffering from visceral referred pain, the thoracic region of the spine will also begin to suffer. Additional research studies have found that visceral referred pain that affects the thoracic neurons will also affect the esophageal and cardiac input to the cardiovascular and gut systems. When the affected thoracic neurons begin to cause heart and esophageal problems, these two organs become hypersensitive due to noxious stimulation.

 

Conclusion

The spine has three areas: the cervical, thoracic, and lumbar, which help keep the body upright and is encased with muscles, tissues, and ligaments that protect the spinal cord from injuries. Injuries that affect the thoracic regions of the back can cause problems to the corresponding muscles and the internal organs, especially in the gut and cardiovascular systems. These organs become hyper-sensitive and can make the body develop hypertension and other issues that can make the body dysfunctional. When individuals realize that their upper-middle back pain in the thoracic region can affect their cardiovascular system, they can find ways to treat their back pain and prevent cardiovascular issues from forming.

 

References

Briggs, Andrew M, et al. “Thoracic Spine Pain in the General Population: Prevalence, Incidence and Associated Factors in Children, Adolescents and Adults. A Systematic Review.” BMC Musculoskeletal Disorders, BioMed Central, 29 June 2009, www.ncbi.nlm.nih.gov/pmc/articles/PMC2720379/.

Brumovsky, P R, and G F Gebhart. “Visceral Organ Cross-Sensitization – an Integrated Perspective.” Autonomic Neuroscience: Basic & Clinical, U.S. National Library of Medicine, 16 Feb. 2010, www.ncbi.nlm.nih.gov/pmc/articles/PMC2818077/.

Gkasdaris, Grigorios, et al. “Clinical Anatomy and Significance of the Thoracic Intervertebral Foramen: A Cadaveric Study and Review of the Literature.” Journal of Craniovertebral Junction & Spine, Medknow Publications & Media Pvt Ltd, 2016, www.ncbi.nlm.nih.gov/pmc/articles/PMC5111324/.

Joshi, Shriya, et al. “Thoracic Posture and Mobility in Mechanical Neck Pain Population: A Review of the Literature.” Asian Spine Journal, Korean Society of Spine Surgery, 3 June 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6773982/.

Murray, Greg M. “Guest Editorial: Referred Pain.” Journal of Applied Oral Science : Revista FOB, Faculdade De Odontologia De Bauru Da Universidade De São Paulo, 2009, www.ncbi.nlm.nih.gov/pmc/articles/PMC4327510/.

van Kleef , Maarten, et al. “10. Thoracic Pain.” Pain Practice : the Official Journal of World Institute of Pain, U.S. National Library of Medicine, 2010, pubmed.ncbi.nlm.nih.gov/20492577/.

Ward, John, et al. “Immediate Effects of Upper Thoracic Spine Manipulation on Hypertensive Individuals.” The Journal of Manual & Manipulative Therapy, Maney Publishing, Feb. 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4459143/.

Waxenbaum, Joshua A, et al. “Anatomy, Back, Thoracic Vertebrae – Statpearls – NCBI Bookshelf.” In: StatPearls [Internet]. Treasure Island (FL), StatPearls Publishing, 12 Aug. 2021, www.ncbi.nlm.nih.gov/books/NBK459153/.

Disclaimer

No Reason Back Pain Symptoms

No Reason Back Pain Symptoms

Back pain for no reason that is non-specific is also known as idiopathic, meaning there is no definitive cause like a herniated disc, vehicle accident/crash, falling accident, work, school, or sports injury. An aching sore back that came out of nowhere can be baffling. However, there are reasons for pain, including age, unhealthy posture, work occupation, muscle spasms, lifestyle habits, family medical history, and viscerosomatic reflexes.

Back Pain For No Reason

Back Pain No Reason

Individuals will trace back their steps and often find that there was no heavy lifting of packages, overdoing it working out, or bending, twisting awkwardly, but the pain is present.

Age

  • Age is a primary cause of back pain. After the age of 20, the discs in the spine begin to dehydrate, shrink, and compress/flatten out. This can cause everyday activities to generate back strain and pain as the discs begin to slip, slide, and rub against each other. This is known as degenerative disc disease and is a process that continues as the body gets older.

Back Muscle Spasms

  • Muscle spasms are a common manifestation of back pain and occur when the muscles involuntarily contract. Spasms often happen from bending, heavy lifting, or other physical activities.

Lifestyle Factors

Lifestyle factors can be a causation factor for back pain that comes out of nowhere.

  • Smoking increases the risk as nicotine increases the wear and tear on the discs as well as other organs.
  • The smoke/nicotine causes the discs to age faster because it breaks down the collagen, an essential part of the discs.
  • Individuals that are out of shape, overweight, and/or obese are more likely to have back pain from the added weight.

Unhealthy Posture/Mechanics

  • Practicing unhealthy postures will no doubt begin to cause back or some type of pain from the strain and awkward positioning placed on the muscles being used. Strains, twists, pulls, or tears can occur if repeating the same motion.

Viscerosomatic Reflex

  • Viscera means organ, and somatic refers to the body or musculoskeletal system. A viscerosomatic reaction happens when a pain signal from an organ is transmitted via the spinal cord, where neurons and motor structures like the muscles, blood vessels, and skin are interconnected. The body’s organs can become distressed or suffer an infection/disease that causes signals to be sent that there is something wrong. However, the signal could be pain that materializes in the spine/back muscles but is not a spinal injury or condition.

Diagnosis and Treatment

The first step to successfully treating back pain is scheduling an appointment with a spine specialist or chiropractor. A series of specific questions will be asked to gain insight into the underlying cause of the pain. These include:

  • Location of the pain
  • Intensity of the pain
  • Frequency of the pain
  • Medical history
  • Diet habits

A careful examination is necessary for the doctor to identify the reasons in any individual patient. Once the physician has learned about the symptoms and history, they can determine a possible cause and create a personalized treatment/rehabilitation plan to get the body back to optimal health.


Decompression Patient Testimonials


References

Koes, B W et al. “Diagnosis and treatment of low back pain.” BMJ (Clinical research ed.) vol. 332,7555 (2006): 1430-4. doi:10.1136/bmj.332.7555.1430

Lankhorst, G J et al. “The natural history of idiopathic low back pain. A three-year follow-up study of spinal motion, pain and functional capacity.” Scandinavian journal of rehabilitation medicine vol. 17,1 (1985): 1-4.

www.niams.nih.gov/health-topics/sports-injuries

Walker, Bruce F et al. “Combined chiropractic interventions for low-back pain.” The Cochrane database of systematic reviews vol. 2010,4 CD005427. 14 Apr. 2010, doi:10.1002/14651858.CD005427.pub2

Asthma Coughing Back Pain Clinic

Asthma Coughing Back Pain Clinic

Asthma, coughing, and heavy breathing can contribute to back muscle strain, soreness, and pain. An asthma attack can cause the body to heave during intense gasping, leaving the back muscles physically exhausted. Chiropractic adjustments and decompression can bring back pain relief, strengthen and stretch the spine and spinal muscles, and prevent it from returning, along with asthma management.

Asthma Coughing Back Pain

Asthma

The bronchial tubes divide into smaller passages called bronchi and then into bronchioles. The bronchioles have tiny air sacs called alveoli, where inhaled oxygen is delivered to the blood. After absorbing the oxygen, the blood leaves the lungs and travels to the heart. Asthma is a lung condition that can affect anyone at any age. Asthma narrows the lungs’ airways causing inflammation in response to respiratory triggers, making it harder for air to travel out of the airways when exhaling. Symptoms include:

  • Wheezing
  • Difficulty breathing
  • Gasping to get air
  • Coughing
  • Tightness in the chest

Triggers can include:

  • Hot and/or humid weather
  • Exercise
  • Cold air
  • Pollen
  • Pets
  • Viral infections
  • Respiratory infections

Asthma Coughing and Back Strain

Asthma symptoms can take a toll on the back muscles and spine. Asthma attacks that cause gasping and heavy breathing cause the primary muscle (diaphragm) that supports breathing to weaken and strain. The diaphragm helps the spine but cannot do so effectively when under constant strain.

Constant Coughing and Spinal Health

Coughing is the body’s way of expelling unwanted foreign bodies. Chronic coughing stresses, strains, and overexerts the spinal support muscles and impacts posture. Individuals unconsciously take on a tense, forward-leaning posture/position that can cause:

  • Neck and shoulder stiffness, upper/lower back tightness, disc herniation, and pain.
  • Vertebrae subluxations/spinal misalignments can interfere with circulation and nerve function.
  • For short-term back pain following an asthma attack or coughing episode, it is recommended to rest, apply heat or ice, and take over-the-counter pain medication.
  • Massage therapy and myofascial release can stretch and relax the muscles.
  • Chiropractic manipulation relieves the stress on the nerves and muscles and stimulates the spinal cord and nerves to regain proper functioning.

Breathing Exercises and Yoga

Strengthened and conditioned core muscles can help to breathe more efficientlyWhen breathing normally it is usually a shallow inhale/exhale that does not fill the lungs to the total capacity. Diaphragmatic breathing is a technique to fully engage the diaphragm and abdominal muscles to fill the lungs with air more efficiently. Using the diaphragm correctly will:

  • Strengthen the diaphragm.
  • Use less energy to breathe.
  • Slow down the breathing rate.
  • Decrease the work of breathing hard.
  • Decrease the demand for continuous oxygen.

Yoga is another core-strengthening technique that encourages focused breathing that can help improve asthma control.


Decompression Neurosurgeon


References

American Lung Association. Breathing Exercises. (www.lung.org/lung-health-diseases/wellness/breathing-exercises) Accessed 3/29/2022.

Cleveland Clinic. (n.d.) “Diaphragmatic breathing.” my.clevelandclinic.org/health/articles/9445-diaphragmatic-breathing

Lunardi, Adriana Claudia, et al. “Musculoskeletal dysfunction and pain in adults with asthma.” The Journal of asthma: Official Journal of the Association for the Care of Asthma vol. 48,1 (2011): 105-10. doi:10.3109/02770903.2010.520229

Rasmussen-Barr, E. et al. “Are respiratory disorders risk factors for troublesome low-back pain? A study of a general population cohort in Sweden.” The European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society vol. 28,11 (2019): 2502-2509. doi:10.1007/s00586-019-06071-5

Solakoğlu, Özge, et al. “The effects of forward head posture on expiratory muscle strength in chronic neck pain patients: A cross-sectional study.” Turkish Journal of physical medicine and rehabilitation vol. 66,2 161-168. 18 May. 2020, doi:10.5606/tftrd.2020.3153

Disc Bulge & Herniation Chiropractic Care Overview

Disc Bulge & Herniation Chiropractic Care Overview

Disc bulge and disc herniation are some of the most common conditions affecting the spine of both young and middle-aged patients. It is estimated that approximately 2.6% of the US population annually visits a clinician to treat spinal disorders. Roughly $ 7.1 billion alone is lost due to the time away from work.

Disc herniation is when the whole or part of the nucleus pulposus is protruded through the torn or weakened outer annulus fibrosus of the intervertebral disc. This is also known as the slipped disc and frequently occurs in the lower back, sometimes also affecting the cervical region. Herniation of the intervertebral disc is defined as a localized displacement of disc material with 25% or less of the disc circumference on an MRI scan, according to the North American Spine Society 2014. The herniation may consist of nucleus pulposus, annulus fibrosus, apophyseal bone or osteophytes, and the vertebral endplate cartilage in contrast to disc bulge.

There are also mainly two types of disc herniation. Disc protrusion is when a focal or symmetrical extension of the disc comes out of its confines in the intervertebral space. It is situated at the intervertebral disc level, and its outer annular fibers are intact. A disc extrusion is when the intervertebral disc extends above or below the adjacent vertebrae or endplates with a complete annular tear. In this type of disc extrusion, a neck or base is narrower than the dome or the herniation.

A disc bulge is when the outer fibers of the annulus fibrosus are displaced from the margins of the adjacent vertebral bodies. Here, the displacement is more than 25% of the circumference of the intervertebral disc. It also does not extend below or above the margins of the disc because the annulus fibrosus attachment limits it. It differs from disc herniation because it involves less than 25% of the disc’s circumference. Usually, the disc bulge is a gradual process and is broad. The disc bulge can be divided into two types. In a circumferential bulge, the whole disc circumference is involved. More than 90 degrees of the rim is involved asymmetrically in asymmetrical bulging.

Normal Intervertebral Disc Anatomy

Before going into detail about the definition of disc herniation and disc bulge, we need to look at the standard intervertebral disc. According to spine guidelines in 2014, a standard disc is something that has a classic shape without any evidence of degenerative disc changes. Intervertebral discs are responsible for one-third to one-fourth of the height of the spinal column.

One intervertebral disc is about 7 -10 mm thick and measures 4 cm in anterior-posterior diameter in the lumbar region of the spine. These spinal discs are located between two adjacent vertebral bodies. However, no discs can be found between the atlas and axis and the coccyx. About 23 discs are found in the spine, with six in the cervical spine, 12 in the thoracic spine, and only five in the lumbar spine.

Intervertebral discs are made of fibro cartilages, forming a fibrocartilaginous joint. The outer ring of the intervertebral disc is known as the annulus fibrosus, while the inner gel-like structure in the center is known as the nucleus pulposus. The cartilage endplates sandwich the nucleus pulposus superiorly and inferiorly. The annulus fibrosus comprises concentric collagen fiber sheets arranged in a radial tire-like structure into lamellae. The fibers are attached to the vertebral endplates and oriented at different angles. With their cartilaginous part, the endplates anchor the discs in their proper place.

The nucleus pulposus is composed of water, collagen, and proteoglycans. Proteoglycans attract and retain moisture, giving the nucleus pulposus a hydrated gel-like consistency. Interestingly, throughout the day, the amount of water found in the nucleus pulposus varies according to the person’s level of activity. This feature in the intervertebral disc serves as a cushion or a spinal shock-absorbing system to protect the adjacent vertebra, spinal nerves, spinal cord, brain, and other structures against various forces. Although the individual movement of the intervertebral discs is limited, some form of vertebral motion like flexion and extension is still possible due to the features of the intervertebral disc.

Effect of Intervertebral Disc Morphology on Structure and Function

The type of components present in the intervertebral disc and how it is arranged determine the morphology of the intervertebral disc. This is important in how effectively the disc does its function. As the disc is the most important element which bears the load and allows movement in the otherwise rigid spine, the constituents it is made up of have a significant bearing.

The complexity of the lamellae increases with advancing age as a result of the synthetic response of the intervertebral disc cells to the variations in the mechanical load. These changes in lamellae with more bifurcations, interdigitation and irregular size and number of lamellar bands will lead to the altered bearing of weight. This in turn establishes a self-perpetuated disruption cycle leading to the destruction of the intervertebral discs. Once this process is started it is irreversible. As there is an increased number of cells, the amount of nutrition the disc requires is also increasingly changing the normal concentration gradient of both metabolites and nutrients. Due to this increased demand, the cells may also die increasingly by necrosis or apoptosis.

Human intervertebral discs are avascular and hence the nutrients are diffused from the nearby blood vessels in the margin of the disc. The main nutrients; oxygen and glucose reach the cells in the disc through diffusion according to the gradient determined by the rate of transport to the cells through the tissues and the rate of demand. Cells also increasingly produce lactic acid as a metabolic end product. This is also removed via the capillaries and venules back to the circulation.

Since diffusion depends on the distance, the cells lying far from the blood capillaries can have a reduced concentration of nutrients because of the reduced supply. With disease processes, the normally avascular intervertebral disc can become vascular and innervated in degeneration and in disease processes. Although this may increase the oxygen and nutrient supply to the cells in the disc, this can also give rise to many other types of cells that are normally not found in the disc with the introduction of cytokines and growth factors.

The morphology of the intervertebral disc in different parts of the spine also varies although many clinicians base the clinical theories based on the assumption that both cervical and lumbar intervertebral discs have the same structure. The height of the disc was the minimum in the T4-5 level of the thoracic column probably due to the fact that thoracic intervertebral discs are less wedge-shaped than those of cervical and lumbar spinal regions.

From the cranial to caudal direction, the cross-sectional area of the spine increased. Therefore, by the L5-S1 level, the nucleus pulposus was occupying a higher proportion of the intervertebral disc area. The cervical discs have an elliptical shape on cross-section while the thoracic discs had a more circular shape. The lumbar discs also have an elliptical shape though it is more flattened or re-entrant posteriorly.

What is a Disc Bulge?

The bulging disc is when the disc simply bulges outside the intervertebral disc space it normally occupies without the rupture of the outer annulus fibrosus. The bulging area is quite large when compared to a herniated disc. Moreover, in a herniated disc, the annulus fibrosus ruptures or cracks. Although disc bulging is more common than disc herniation, it causes little or no pain to the patient. In contrast, the herniated disc causes a lot of pain.

Causes for Disc Bulging

A bulging disc can be due to several causes. It can occur due to normal age-related changes such as those seen in degenerative disc disease. The aging process can lead to structural and biochemical changes in the intervertebral discs and lead to reduced water content in the nucleus pulposus. These changes can make the patient vulnerable to disc bulges with only minor trauma. Some unhealthy lifestyle habits such as a sedentary lifestyle and smoking can potentiate this process and give rise to more severe changes with the weakening of the disc.

General wear and tear due to repeated microtrauma can also weaken the disc and give rise to disc bulging. This is because when the discs are strained, the normal distribution of weight loading changes. Accumulated micro-trauma over a long period of time can occur in bad posture. Bad posture when sitting, standing, sleeping, and working can increase the pressure in the intervertebral discs.

When a person maintains a forward bending posture, it can lead to overstretching and eventually weakness of the posterior part of the annulus fibrosus. Over time, the intervertebral disc can bulge posteriorly. In occupations that require frequent and repetitive lifting, standing, driving, or bending, the bulging disc may be an occupational hazard. Improper lifting up of items, and improper carrying of heavy objects can also increase the pressure on the spine and lead to disc bulges eventually.

The bulging intervertebral discs usually occur over a long period of time. However, the discs can bulge due to acute trauma too. The unexpected sudden mechanical load can damage the disc resulting in micro-tears. After an accident, the disc can become weakened causing long-term microdamage ultimately leading to bulging of the disc. There may also be a genetic component to the disc bulging. The individual may have a reduced density of elastin in the annulus fibrosus with increased susceptibility to disc diseases. Other environmental facts may also play a part in this disease process.

Symptoms of Disc Bulging

As mentioned previously, bulging discs do not cause pain and even if they do the severity is mild. In the cervical region, the disease will cause pain running down the neck, deep pain in the shoulder region, pain radiating along the upper arm, and forearm up to the fingers.

This may give rise to a diagnostic dilemma as to whether the patient is suffering from a myocardial infarction as the site of referred pain and the radiation is similar. Tingling feeling on the neck may also occur due to the bulging disc.

In the thoracic region, there may be pain in the upper back that radiates to the chest or the upper abdominal region. This may also suggest upper gastrointestinal, lung, or cardiac pathology and hence need to be careful when analyzing these symptoms.

The bulging discs of the lumbar region may present as lower back pain and tingling feeling in the lower back region of the spine. This is the most common site for disc bulges since this area holds the weight of the upper body. The pain or the discomfort can spread through the gluteal area, thighs, and to the feet. There may also be muscle weakness, numbness or tingling sensation. When the disc presses on the spinal cord, the reflexes of both legs can increase leading to spasticity.

Some patients may even have paralysis from the waist down. When the bulging disc compresses on the cauda equine, the bladder and bowel functions can also change. The bulging disc can press on the sciatic nerve leading to sciatica where the pain radiates in one leg from the back down to the feet.

The pain from the bulging disc can get worse during some activities as the bulge can then compress on some of the nerves. Depending on what nerve is affected, the clinical features can also vary.

Diagnosis of Disc Bulging

The diagnosis may not be apparent from clinical history due to similar presentations in more serious problems. But the chronic nature of the disease may give some clues. Complete history and a physical examination need to be done to rule out myocardial infarction, gastritis, gastro-oesophageal reflux disease, and chronic lung pathology.

MRI of Disc Bulge

Investigations are necessary for the diagnosis. X-ray spine is performed to look for gross pathology although it may not show the bulging disc directly. There may be indirect findings of disk degeneration such as osteophytes in the endplates, gas in the disc due to the vacuum phenomenon, and the loss of height of the intervertebral disc. In the case of moderate bulges, it may sometimes appear as non-focal intervertebral disc material that is protruded beyond the borders of the vertebra which is broad-based, circumferential, and symmetrical.

Magnetic resonance imaging or MRI can exquisitely define the anatomy of the intervertebral discs especially the nucleus pulposus and its relationships. The early findings seen on MRI in disc bulging include the loss of normal concavity of the posterior disc. The bulges can be seen as broad-based, circumferential, and symmetrical areas. In moderate bulging, the disc material will protrude beyond the borders of the vertebrae in a non-focal manner. Ct myelogram may also give detailed disc anatomy and may be useful in the diagnosis.

Treatment of Disc Bulging

The treatment for the bulging disc can be conservative, but sometimes surgery is required.

Conservative Treatment

When the disc bulging is asymptomatic, the patient does not need any treatment since it does not pose an increased risk. However, if the patient is symptomatic, the management can be directed at relieving the symptoms. The pain is usually resolved with time. Till then, potent pain killers such as non-steroidal anti-inflammatory drugs like ibuprofen should be prescribed. In unresolved pain, steroid injections can also be given to the affected area and if it still does not work, the lumbar sympathetic block can be tried in most severe cases.

The patient can also be given the option of choosing alternative therapies such as professional massage, physical therapy, ice packs, and heating pads which may alleviate symptoms. Maintaining correct posture, tapes, or braces to support the spine are used with the aid of a physiotherapist. This may fasten the recovery process by avoiding further damage and keeping the damaged or torn fibers in the intervertebral disc without leakage of the fluid portion of the disc. This helps maintain the normal structure of the annulus and may increase the recovery rate. Usually, the painful symptoms which present initially get resolved over time and lead to no pain. However, if the symptoms get worse steadily, the patient may need surgery

If the symptoms are resolved, physiotherapy can be used to strengthen the muscles of the back with the use of exercises. Gradual exercises can be used for the return of function and for preventing recurrences.

Surgical Treatment

When conservative therapy does not work with a few months of treatment, surgical treatment can be considered. Most would prefer minimally invasive surgery which uses advanced technology to correct the intervertebral disc without having to grossly dissect the back. These procedures such as microdiscectomy have a lower recovery period and reduced risk of scar formation, major blood loss, and trauma to adjacent structures when compared to open surgery.

Previously, laminectomy and discectomy have been a mainstay of treatment. However, due to the invasiveness of the procedure and due to increased damage to the nerves these procedures are currently abandoned by many clinicians for disc bulging.

Disc bulging in the thoracic spine is being treated surgically with costotransversectomy where a section of the transverse process is resected to allow access to the intervertebral disc. The spinal cord and spinal nerves are decompressed by using thoracic decompression by removing a part of the vertebral body and making a small opening. The patient may also need a spinal fusion later on if the removed spinal body was significant.

Video-assisted thoracoscopic surgery can also be used where only a small incision is made and the surgeon can perform the surgery with the assistance of the camera. If the surgical procedure involved removing a large portion of the spinal bone and disc material, it may lead to spinal instability. This may need bone grafting to replace the lost portion with plates and screws to hold them in place.

What is a Disc Herniation?

As mentioned in the first section of this article, disc herniation occurs when there is disc material displaces beyond the limits of the intervertebral disc focally. The disc space consists of endplates of the vertebral bodies superiorly and inferiorly while the outer edges of the vertebral apophyses consist of the peripheral margin. The osteophytes are not considered a disc margin. There may be irritation or compression of the nerve roots and dural sac due to the volume of the herniated material leading to pain. When this occurs in the lumbar region, this is classically known as sciatica. This condition has been mentioned since ancient times although a connection between disc herniation and sciatica was made only in the 20th century. Disc herniation is one of the commonest diagnoses seen in the spine due to degenerative changes and is the commonest cause of spinal surgery.

Classifications of Disc Herniation

There are many classifications regarding intervertebral disc herniation. In focal disc herniation, there is a localized displacement of the disc material in the horizontal or axial plane. In this type, only less than 25% of the circumference of the disc is involved. In broad-based disc herniation, about 25 – 50 % of the disc circumference is herniated. The disc bulge is when 50 – 100 % of the disc material is extended beyond the normal confines of the intervertebral space. This is not considered a form of disc herniation. Furthermore, the intervertebral disc deformities associated with severe cases of scoliosis and spondylolisthesis are not classified as a herniation but rather adaptive changes of the contour of the disc due to the adjacent deformity.

Depending on the contour of the displaced material, the herniated discs can be further classified as protrusions and extrusions. In disc protrusion, the distance measured in any plane involving the edges of the disc material beyond intervertebral disc space (the highest measure is taken) is lower than the distance measured in the same plane between the edges of the base.

Imaging can show the disc displacement as a protrusion on the horizontal section and as an extrusion on the sagittal section due to the fact that the posterior longitudinal ligament contains the disc material that is displaced posteriorly. Then the herniation should be considered an extrusion. Sometimes the intervertebral disc herniation can occur in the craniocaudal or vertical direction through a defect in the vertebral body endplates. This type of herniation is known as intravertebral herniation.

The disc protrusion can also be divided into two focal protrusion and broad-based protrusion. In focal protrusion, the herniation is less than 25% of the circumference of the disc whereas, in broad-based protrusion, the herniated disc consists of 25 – 50 % of the circumference of the disc.

In disc extrusion, it is diagnosed if any of the two following criteria are satisfied. The first one is; that the distance measured between the edges of the disc material that is beyond the intervertebral disc space is greater than the distance measured in the same plane between the edges of the base. The second one is; that the material in the intervertebral disc space and material beyond the intervertebral disc space is having a lack continuity.

This can be further characterized as sequestrated which is a subtype of the extruded disc. It is called disc migration when disk material is pushed away from the site of extrusion without considering whether there is continuity of disc or not. This term is useful in interpreting imaging modalities as it is often difficult to show continuity in imaging.

The intervertebral disc herniation can be further classified as contained discs and discs that are unconfined. The term contained disc is used to refer to the integrity of the peripheral annulus fibrosus which is covering the intervertebral disc herniation. When fluid is injected into the intervertebral disc, the fluid does not leak into the vertebral canal in herniations that are contained.

Sometimes there are displaced disc fragments that are characterized as free. However, there should be no continuity between disc material and the fragment and the original intervertebral disc for it to be called a free fragment or a sequestered one. In a migrated disc and in a migrated fragment, there is an extrusion of disc material through the opening in the annulus fibrosus with a displacement of the disc material away from the annulus.

Even though some fragments that are migrated can be sequestered the term migrated means just to the position and it is not referred to the continuity of the disc. The displaced intervertebral disc material can be further described with regard to the posterior longitudinal ligament as submembranous, subcapsular, subligamentous, extra ligamentous, transligamentous, subcapsular, and perforated.

The spinal canal can also get affected by an intervertebral disc herniation. This compromise of the canal can also be classified as mild, moderate, and severe depending on the area that is compromised. If the canal at that section is compromised only less than one third, it is called mild whereas if it is only compromised less than two-thirds and more than one third it is considered moderate. In a severe compromise, more than two-thirds of the spinal canal is affected. For the foraminal involvement, this same grading system can be applied.

The displaced material can be named according to the position that they are in the axial plane from the center to the right lateral region. They are termed as central, right central, right subarticular, right foraminal, and right extraforaminal. The displaced intervertebral disc material’s composition can be further classified as gaseous, liquefied, desiccated, scarred, calcified, ossified, bony, nuclear, and cartilaginous.

Before going into detail on how to diagnose and treat intervertebral disc herniation, let us differentiate how cervical disc herniation differs from lumbar herniation since they are the most common regions to undergo herniation.

Cervical Disc Herniation vs. Thoracic Disc Herniation vs Lumbar Disc Herniation

Lumbar disc herniation is the most commonest type of herniation found in the spine which is approximately 90% of the total. However, cervical disc herniation can also occur in about one-tenth of patients. This difference is mainly due to the fact that the lumbar spine has more pressure due to the increased load. Moreover, it has comparatively large intervertebral disc material. The most common sites of intervertebral disc herniation in the lumbar region are L 5 – 6, in the Cervical region between C7, and in the thoracic region T12.

Cervical disc herniation can occur relatively commonly because the cervical spine acts as a pivoting point for the head and it is a vulnerable area for trauma and therefore prone to damage in the disc. Thoracic disc herniation occurs more infrequently than any of the two. This is due to the fact that thoracic vertebrae are attached to the ribs and the thoracic cage which limits the range of movement in the thoracic spine when compared to the cervical and lumbar spinal discs. However, thoracic intervertebral disc herniation can still occur.

Cervical disc herniation gives rise to neck pain, shoulder pain, pain radiating from the neck to the arm, tingling, etc. Lumbar disc herniation can similarly cause lower back pain as well as pain, tingling, numbness, and muscle weakness seen in the lower limbs. Thoracic disc herniation can give rise to pain in the upper back radiating to the torso.

Epidemiology

Although disc herniation can occur in all age groups, it predominantly occurs between the fourth and fifth decade of life with the mean age of 37 years. There have been reports that estimate the prevalence of intervertebral disc herniation to be 2 – 3 % of the general population. It is more commonly seen in men over 35 years with a prevalence of 4.8% and while in women this figure is around 2.5%. Due to its high prevalence, it is considered a worldwide problem as it is also associated with significant disability.

Risk Factors

In most instances, a herniated disc occurs due to the natural aging process in the intervertebral disc. Due to the disc degeneration, the amount of water that was previously seen in the intervertebral disc gets dried out leading to the shrinking of the disc with the narrowing of the intervertebral space. These changes are markedly seen in degenerative disc disease. In addition to these gradual changes due to normal wear and tear, other factors may also contribute to increasing the risk of intervertebral disc herniation.

Being overweight can increase the load on the spine and increase the risk of herniation. A sedentary life can also increase the risk and therefore an active lifestyle is recommended in preventing this condition. Improper posture with prolonged standing, sitting, and especially driving can put a strain on the intervertebral discs due to the additional vibration from the vehicle engine leading to microtrauma and cracks in the disc. The occupations which require constant bending, twisting, pulling and lifting can put a strain on the back. Improper weight lifting techniques are one of the major reasons.

When back muscles are used in lifting heavy objects instead of lifting with the legs and twisting while lifting can make the lumbar discs more vulnerable to herniation. Therefore patients should always be advised to lift weights with their legs and not the back. Smoking has been thought to increase disc herniation by reducing the blood supply to the intervertebral disc leading to degenerative changes of the disc.

Although the above factors are frequently assumed to be the causes for disc herniation, some studies have shown that the difference in risk is very small when this particular population was compared with the control groups of the normal population.

There have been several types of research done on genetic predisposition and intervertebral disc herniation. Some of the genes that are implicated in this disease include vitamin D receptor (VDR) which is a gene that codes for the polypeptides of important collagen called collagen IX (COL9A2).

Another gene called the human aggrecan gene (AGC) is also implicated as it codes for proteoglycans which is the most important structural protein found in the cartilage. It supports the biochemical and mechanical function of the cartilage tissue and hence when this gene is defective, it can predispose an individual to intervertebral disc herniation.

Apart from these, there are many other genes that are being researched due to the association between disc herniation such as matrix metalloproteinase (MMP) cartilage intermediate layer protein, thrombospondin (THBS2), collagen 11A1, carbohydrate sulfotransferase, and asporin (ASPN). They may also be regarded as potential gene markers for lumbar disc disease.

Pathogenesis of Sciatica and Disc Herniation

The sciatic pain originated from the extruded nucleus pulposus inducing various phenomena. It can directly compress the nerve roots leading to ischemia or without it, mechanically stimulate the nerve endings of the outer portion of the fibrous ring and release inflammatory substances suggesting its multifactorial origin. When the disc herniation causes mechanical compression of the nerve roots, the nerve membrane is sensitized to pain and other stimuli due to ischemia. It has been shown that in sensitized and compromised nerve roots, the threshold for neuronal sensitization is around half of that of a normal and non-compromised nerve root.

The inflammatory cell infiltration is different in extruded discs and non-extruded discs. Usually, in non-extruded discs, the inflammation is less. The extruded disc herniation causes the posterior longitudinal ligament to rupture which exposes the herniated part to the vascular bed of the epidural space. It is believed that inflammatory cells are originating from these blood vessels situated in the outermost part of the intervertebral disc.

These cells may help secrete substances that cause inflammation and irritation of the nerve roots causing sciatic pain. Therefore, extruded herniations are more likely to cause pain and clinical impairment than those that are contained. In contained herniations, the mechanical effect is predominant while in the unconfined or the extruded discs the inflammatory effect is predominant.

Clinical Disc Herniation and What to Look for in the History

The symptoms of the disc herniation can vary a great deal depending on the location of the pain, the type of herniation, and the individual. Therefore, history should focus on the analysis of the main complaint among the many other symptoms.

The chief complaint can be neck pain in cervical disc herniation and there can be referred pain in the arms, shoulders, neck, head, face, and even the lower back region. However, it is most commonly referred to as the interscapular region. The radiation of pain can occur according to the level at the herniation is taking place. When the nerve roots of the cervical region are affected and compressed, there can be sensory, and motor changes with changes in the reflexes.

The pain that occurs due to nerve root compression is called radicular pain and it can be described as deep, aching, burning, dull, achy, and electric depending on whether there is mainly motor dysfunction or sensory dysfunction. In the upper limb, the radicular pain can follow a dermatomal or myotomal pattern. Radiculopathy usually does not accompany neck pain. There can be unilateral as well as bilateral symptoms. These symptoms can be aggravated by activities that increase the pressure inside the intervertebral discs such as the Valsalva maneuver and lifting.

Driving can also exacerbate pain due to disc herniation due to stress because of vibration. Some studies have shown that shock loading and stress from vibration can cause a mechanical force to exacerbate small herniations but flexed posture had no influence. Similarly, activities that decrease intradiscal pressure can reduce the symptoms such as lying down.

The main complaint in lumbar disc herniation is lower back pain. Other associated symptoms can be a pain in the thigh, buttocks, and anogenital region which can radiate to the foot and toe. The main nerve affected in this region is the sciatic nerve causing sciatica and its associated symptoms such as intense pain in the buttocks, leg pain, muscle weakness, numbness, impairment of sensation, hot and burning or tingling sensation in the legs, dysfunction of gait, impairment of reflexes, edema, dysesthesia or paresthesia in the lower limbs. However, sciatica can be caused by causes other than herniation such as tumors, infection, or instability which need to be ruled out before arriving at a diagnosis.

The herniated disc can also compress on the femoral nerve and can give rise to symptoms such as numbness, tingling sensation in one or both legs, and a burning sensation in the legs and hips. Usually, the nerve roots that are affected in herniation in the lumbar region are the ones exiting below the intervertebral disc. It is thought that the level of the nerve root irritation determines the distribution of leg pain. In herniations at the third and fourth lumbar vertebral levels, the pain may radiate to the anterior thigh or the groin. In radiculopathy at the level of the fifth lumbar vertebra, the pain may occur in the lateral and anterior thigh region. In herniations at the level of the first sacrum, the pain may occur in the bottom of the foot and the calf. There can also be numbness and tingling sensation occurring in the same area of distribution. The weakness in the muscles may not be able to be recognized if the pain is very severe.

When changing positions the patient is often relieved from pain. Maintaining a supine position with the legs raised can improve the pain. Short pain relief can be brought by having short walks while long walks, standing for prolonged periods, and sitting for extended periods of time such as in driving can worsen the pain.

The lateral disc herniation is seen in foraminal and extraforaminal herniations and they have different clinical features to that of medial disc herniation seen in subarticular and central herniations. The lateral intervertebral disc herniations can when compared to medial herniations more directly irritate and mechanically compress the nerve roots that are exiting and the dorsal root ganglions situated inside the narrowed spinal canal.

Therefore, lateral herniation is seen more frequently in older age with more radicular pain and neurological deficits. There is also more radiating leg pain and intervertebral disc herniations in multiple levels in the lateral groups when compared to medial disc herniations.

The herniated disc in the thoracic region may not present with back pain at all. Instead, there are predominant symptoms due to referred pain in the thorax due to irritation of nerves. There can also be predominant pain in the body that travels to the legs, tingling sensation and numbness in one or both legs, muscle weakness, and spasticity of one or both legs due to exaggerated reflexes.

The clinician should look out for atypical presentations as there could be other differential diagnoses. The onset of symptoms should be inquired about to determine whether the disease is acute, sub-acute, or chronic in onset. Past medical history has to be inquired about in detail to exclude red flag symptoms such as pain that occurs at night without activity which can be seen in pelvic vein compression, and non-mechanical pain which may be seen in tumors or infections.

If there is a progressive neurological deficit, with bowel and bladder involvement is there, it is considered a neurological emergency and urgently investigated because cauda equine syndrome may occur which if untreated, can lead to permanent neurological deficit.

Getting a detailed history is important including the occupation of the patient as some activities in the job may be exacerbating the patient’s symptoms. The patient should be assessed regarding which activities he can and cannot do.

Differential Diagnosis

  • Degenerative disc disease
  • Mechanical pain
  • Myofascial pain leading to sensory disturbances and local or referred pain
  • Hematoma
  • Cyst leading to occasional motor deficits and sensory disturbances
  • Spondylosis or spondylolisthesis
  • Discitis or osteomyelitis
  • Malignancy, neurinoma or mass lesion causing atrophy of thigh muscles, glutei
  • Spinal stenosis is seen mainly in the lumbar region with mild low back pain, motor deficits, and pain in one or both legs.
  • An epidural  abscess can cause symptoms similar to radicular pain involving spinal disc herniation
  • Aortic aneurysm which can cause low back pain and leg pain due to compression can also rupture and lead to hemorrhagic shock.
  • Hodgkin’s lymphoma in advanced stages can lead to space-occupying lesions in the spinal column leading to symptoms like that of intervertebral disc herniation
  • Tumors
  • Pelvic endometriosis
  • Facet hypertrophy
  • Lumbar nerve root schwannoma
  • Herpes zoster infection results in inflammation along with the sciatic or lumbosacral nerve roots

Examination in Disc Herniation

Complete physical examination is necessary to diagnose intervertebral disc herniation and exclude other important differential diagnoses. The range of motion has to be tested but may have a poor correlation with disc herniation as it is mainly reduced in elderly patients with a degenerative disease and due to disease of the joints.

A complete neurological examination is often necessary. This should test muscle weakness and sensory weakness. In order to detect muscle weakness in small toe muscles, the patient can be asked to walk on tiptoe. The strength of muscle can also be tested by comparing the strength to that of the clinician. There may be dermatomal sensory loss suggesting the respective nerve root involvement. The reflexes may be exaggerated or sometimes maybe even absent.

There are many neurologic examination maneuvers described in relation to intervertebral disc herniation such as the Braggart sign, flip the sign, Lasegue rebound sign, Lasegue differential sign, Mendel Bechterew sign, Deyerle sign both legs or Milgram test, and well leg or Fajersztajin test. However, all these are based on testing the sciatic nerve root tension by using the same principles in the straight leg raising test. These tests are used for specific situations to detect subtle differences.

Nearly almost all of them depend on the pain radiating down the leg and if it occurs above the knee it is assumed to be due to a neuronal compressive lesion and if the pain goes below the knee, it is considered to be due to the compression of the sciatic nerve root. For lumbar disc herniation detection, the most sensitive test is considered to be radiating pain occurring down the leg due to provocation.

In the straight leg raising test also called the Lasegue’s sign, the patient stays on his or her back and keeps the legs straight. The clinician then lifts the legs by flexing the hip while keeping the knee straight. The angle at which the patient feels pain going down the leg below the knee is noted. In a normal healthy individual, the patient can flex the hip to 80- 90? without having any pain or difficulty.

However, if the angle is just 30 -70? degrees, it is suggestive of lumbar intervertebral disc herniation at the L4 to S1 nerve root levels. If the angle of hip flexion without pain is less than 30 degrees, it usually indicates some other causes such as tumor of the gluteal region, gluteal abscess, spondylolisthesis, disc extrusion, and protrusion, malingering patient, and acute inflammation of the dura mater. If pain with hip flexion occurs at more than 70 degrees, it may be due to tightness of the muscles such as gluteus maximus and hamstrings, tightness of the capsule of the hip joint, or pathology of sacroiliac or hip joints.

The reverse straight leg raising test or hip extension test can be used to test higher lumbar lesions by stretching the nerve roots of the femoral nerve which is similar to the straight leg raising test. In the cervical spine, in order to detect stenosis of the foramina, the Spurling test is done and is not specific to cervical intervertebral disc herniation or tension of the nerve roots. The Kemp test is the analogous test in the lumbar region to detect foraminal stenosis. Complications due to the disc herniation include careful examination of the hip region, digital rectal examination, and urogenital examination is needed.

Investigation of Disc Herniation

For the diagnosis of intervertebral disc herniation, diagnostic tests such as Magnetic resonance imaging (MRI), Computed tomography (CT), myelography, and plain radiography can be used either alone or in combination with other imaging modalities. Objective detection of disc herniation is important because only after such a finding the surgical intervention is even considered. Serum biochemical tests such as prostate-specific antigen (PSA) level, Alkaline phosphatize value, erythrocyte sedimentation rate (ESR), urine analysis for Bence Jones protein, serum glucose level, and serum protein electrophoresis may also be needed in specific circumstances guided by history.

Magnetic Resonance Imaging (MRI)

MRI is considered the best imaging modality in patients with history and physical examination findings suggestive of lumbar disc herniation associated with radiculopathy according to North American Spinal Society guidelines in 2014. The anatomy of the herniated nucleus pulposus and its associated relationships with soft tissue in the adjacent areas can be delineated exquisitely by MRI in cervical, thoracic, and lumbosacral areas. Beyond the confines of the annulus, the herniated nucleus can be seen as a focal, asymmetric disc material protrusion on MRI.

On sagittal T2 weighted images, the posterior annulus is usually seen as a high signal intensity area due to radial annular tear associated with the herniation of the disc although the herniated nucleus is itself hypointense. The relationship between the herniated nucleus and degenerated facets with the nerve roots which are exiting through the neural foramina are well-demarcated on sagittal images of MRI. Free fragments of the intervertebral disc can also be distinguished from MRI images.

There may be associated signs of intervertebral disc herniation on MRI such as radial tears on the annulus fibrosus which is also a sign of degenerative disc disease. There may be other telling signs such as loss of disc height, bulging annulus, and changes in the endplates. Atypical signs may also be seen with MRI such as abnormal disc locations, and lesions located completely outside the intervertebral disc space.

MRI can detect abnormalities in the intervertebral discs superiorly to other modalities although its bone imaging is a little less inferior. However, there are limitations with MRI in patients with metal implant devices such as pacemakers because the electromagnetic field can lead to abnormal functioning of the pacemakers. In patients with claustrophobia, it may become a problem to go to the narrow canal to be scanned by the MRI machine. Although some units contain open MRI, it has less magnetic power and hence delineates less superior quality imaging.

This is also a problem in children and anxious patients undergoing MRI because good image quality depends on the patient staying still. They may require sedation. The contrast used in MRI which is gadolinium can induce nephrogenic systemic fibrosis in patients who had pre-existing renal disease. MRI is also generally avoided in pregnancy especially during the first 12 weeks although it has not been clinically proven to be hazardous to the fetus. MRI is not very useful when a tumor contains calcium and in distinguishing edema fluid from tumor tissue.

Computed Tomography (CT)

CT scanning is also considered another good method to assess spinal disc herniation when MRI is not available. It is also recommended as a first-line investigation in unstable patients with severe bleeding. CT scanning is superior to myelography although when the two are combined, it is superior both of them. CT scans can show calcification more clearly and sometimes even gas in images. In order to achieve a superior imaging quality, the imaging should be focused on the site of pathology and thin sections taken to better determine the extent of the herniation.

However, a CT scan is difficult to be used in patients who have already undergone laminectomy surgical procedures because the presence of scar tissue and fibrosis causes the identification of the structures difficult although bony changes and deformity in nerve sheath are helpful in making a diagnosis.

The herniated intervertebral discs in the cervical disc can be identified by studying the uncinate process. It is usually projected posteriorly and laterally to the intervertebral discs and superiorly to the vertebral bodies. The uncinate process undergoes sclerosis, and hypertrophy when there is an abnormal relationship between the uncinate process and adjacent structures as seen in degenerative disc disease, intervertebral disc space narrowing, and general wear and tear.

Myelopathy can occur when the spinal canal is affected due to disc disease. Similarly, when neural foramina are involved, radiculopathy occurs. Even small herniated discs and protrusions can cause impingement of the dural sac because the cervical epidural space is narrowed naturally. The intervertebral discs have attenuation a little bit greater than the sac characterized in the CT scan.

In the thoracic region, a CT scan can diagnose an intervertebral disc herniation with ease due to the fact that there is an increased amount of calcium found in the thoracic discs. Lateral to the dural sac, the herniated disc material can be seen on CT as a clearly defined mass that is surrounded by epidural fat. When there is a lack of epidural fat, the disc appears as a higher attenuated mass compared to the surrounding.

Radiography

Plain radiography is not needed in diagnosing herniation of the intervertebral discs, because plain radiographs cannot detect the disc and therefore are used to exclude other conditions such as tumors, infections, and fractures.

In myelography, there may be deformity or displacement of the extradural contrast-filled thecal sac seen in herniation of the disc. There may also be features in the affected nerve such as edema, elevation, deviation, and amputation of the nerve root seen in the myelography image.

Diskography

In this imaging modality, the contrast medium is injected into the disc in order to assess the disc morphology. If pain occurs following injection that is similar to the discogenic pain, it suggests that that disc is the source of the pain. When a CT scan is also performed immediately after discography, it is helpful to differentiate the anatomy and pathological changes. However, since it is an invasive procedure, it is indicated only in special circumstances when MRI and CT have failed to reveal the etiology of back pain. It has several side effects such as headache, meningitis, damage to the disc, discitis, intrathecal hemorrhage, and increased pain.

Treatment of Herniated Disc

The treatment should be individualized according to the patient-guided through history, physical examination, and diagnostic investigation findings. In most cases, the patient gradually improves without needing further intervention in about 3 – 4 months. Therefore, the patient only needs conservative therapy during this time period. Because of this reason, there are many ineffective therapies that have emerged by attributing the natural resolution of symptoms to that therapy. Therefore, conservative therapy needs to be evidence-based.

Conservative Therapy

Since the herniation of the disc has a benign course, the aim of treatment is to stimulate the recovery of neurological function, reduce pain, and facilitate early return to work and activities of daily living. The most benefits of the conservative treatment are for younger patients with hernias that are sequestered and in patients with mild neurological deficits due to small disc hernias.

Bed rest has long been considered a treatment option in herniation of the disc. However, it has been shown that bed rest has no effect beyond the first 1 or 2 days. The bed rest is regarded as counterproductive after this period of time.

In order to reduce the pain, oral non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen can be used. This can relieve the pain by reducing inflammation associated with the inflamed nerve. Analgesics such as acetaminophen can also be used although they lack the anti-inflammatory effect seen in NSAIDs. The doses and the drugs should be appropriate for the age and severity of the pain in the patient. If pain is not controlled by the current medication, the clinician has to go one step up on the WHO analgesics ladder. However, the long-term use of NSAIDs and analgesics can lead to gastric ulcers, liver, and kidney problems.

In order to reduce the inflammation, other alternative methods such as applying ice in the initial period and then switching to using heat, gels, and rubs may help with the pain as well as muscle spasms. Oral muscle relaxants can also be used in relieving muscle spasms. Some of the drugs include methocarbamol, carisoprodol, and cyclobenzaprine.

However, they act centrally and cause drowsiness and sedation in patients and it does not act directly to reduce muscle spasm. A short course of oral steroids such as prednisolone for a period of 5 days in a tapering regime can be given to reduce the swelling and inflammation in the nerves. It can provide immediate pain relief within a period of 24 hours.

When the pain is not resolved adequately with maximum effective doses, the patient can be considered for giving steroid injections into the epidural space. The major indication for the steroid injection into periradicular space is discal compression causing radicular pain that is resistant to conventional medical treatment. A careful evaluation with CT or MRI scanning is required to carefully exclude extra discal causes for pain. The contraindications for this therapy include patients with diabetes, pregnancy, and gastric ulcers. Epidural puncture is contraindicated in patients with coagulation disorders and therefore the foraminal approach is used carefully if needed.

This procedure is performed under the guidance of fluoroscopy and involves injecting steroids and an analgesic into the epidural space adjacent to the affected intervertebral disc to reduce the swelling and inflammation of the nerves directly in an outpatient setting. As much as 50% of the patients experience relief after the injection although it is temporary and they might need repeat injections at 2 weekly intervals to achieve the best results. If this treatment modality becomes successful, up to 3 epidural steroidal injections can be given per year.

Physical therapy can help the patient return to his previous life easily although it does not improve the herniated disc. The physical therapist can instruct the patient on how to maintain the correct posture, walking, and lifting techniques depending on the patient’s ability to work, mobility, and flexibility.

Stretching exercises can improve the flexibility of the spine while strengthening exercises can increase the strength of the back muscles. The activities which can aggravate the condition of the herniated disc are instructed to be avoided. Physical therapy makes the transition from intervertebral disc herniation to an active lifestyle smooth. The exercise regimes can be maintained for life to improve general well-being.

The most effective conservative treatment option that is evidence-based is observation and epidural steroid injection for the relief of pain in the short-term duration. However, if the patients so desire they can use holistic therapies of their choice with acupuncture, acupressure, nutritional supplements, and biofeedback although they are not evidence-based. There is also no evidence to justify the use of trans electrical nerve stimulation (TENS) as a pain relief method.

If there is no improvement in the pain after a few months, surgery can be contemplated and the patient must be selected carefully for the best possible outcome.

Surgical Therapy

The aim of surgical therapy is to decompress the nerve roots and relieve the tension. There are several indications for surgical treatment which are as follows.

Absolute indications include cauda equina syndrome or significant paresis. Other relative indications include motor deficits that are greater than grade 3, sciatica that is not responding to at least six months of conservative treatment, sciatica for more than six weeks, or nerve root pain due to foraminal bone stenosis.

There have been many discussions over the past few years regarding whether to treat herniation of intervertebral disc disease with prolonged conservative treatment or early surgical treatment. Much research has been conducted in this regard and most of them show that the final clinical outcome after 2 years is the same although the recovery is faster with early surgery. Therefore, it is suggested that early surgery may be appropriate as it enables the patient to return to work early and thereby is economically feasible.

Some surgeons may still use traditional discectomy although many are using minimally invasive surgical techniques over recent years. Microdiscectomy is considered to be the halfway between the two ends. There are two surgical approaches that are being used. Minimally invasive surgery and percutaneous procedures are the ones that are being used due to their relative advantage. There is no place for the traditional surgical procedure known as a laminectomy.

However, there are some studies suggesting microdiscectomy is more favorable because of its both short-term and long-term advantages. In the short term, there is a reduced length of operation, reduced bleeding, relief of symptoms, and reduced complication rate. This technique has been effective even after 10 years of follow-up and therefore is the most preferred technique even now. The studies that have been performed to compare the minimally invasive technique and microdiscectomy have resulted in different results. Some have failed to establish a significant difference while one randomized control study was able to determine that microdiscectomy was more favorable.

In microdiscectomy, only a small incision is made aided by an operating microscope and the part of the herniated intervertebral disc fragment which is impinging on the nerve is removed by hemilaminectomy. Some part of the bone is also removed to facilitate access to the nerve root and the intervertebral disc. The duration of the hospital stay is minimal with only an overnight stay and observation because the patient can be discharged with minimal soreness and complete relief of the symptoms.

However, some unstable patients may need more prolonged admission and sometimes they may need fusion and arthroplasty. It is estimated that about 80 – 85 % of the patients who undergo microdiscectomy recover successfully and many of them are able to return to their normal occupation in about 6 weeks.

There is a discussion on whether to remove a large portion of the disc fragment and curetting the disc space or to remove only the herniated fragment with minimal invasion of the intervertebral disc space. Many studies have suggested that the aggressive removal of large chunks of the disc could lead to more pain than when conservative therapy is used with 28% versus 11.5 %. It may lead to degenerative disc disease in the long term. However, with conservative therapy, there is a greater risk of recurrence of around 7 % in herniation of the disc. This may require additional surgery such as arthrodesis and arthroplasty to be performed in the future leading to significant distress and economic burden.

In the minimally invasive surgery, the surgeon usually makes a tiny incision in the back to put the dilators with increasing diameter to enlarge the tunnel until it reaches the vertebra. This technique causes lesser trauma to the muscles than when seen in traditional microdiscectomy. Only a small portion of the disc is removed in order to expose the nerve root and the intervertebral disc. Then the surgeon can remove the herniated disc by the use of an endoscope or a microscope.

These minimally invasive surgical techniques have a higher advantage of lower surgical site infections and shorter hospital stays. The disc is centrally decompressed either chemically or enzymatically with the use of chymopapain, laser, or plasma (ionized gas) ablation and vaporization. It can also be decompressed mechanically by using percutaneous lateral decompression or by aspirating and sucking with a shaver such as a nucleosome. Chemopapin was shown to have adverse effects and was eventually withdrawn. Most of the above techniques have shown to be less effective than a placebo. Directed segmentectomy is the one that has shown some promise in being effective similar to microdiscectomy.

In the cervical spine, the herniated intervertebral discs are treated anteriorly. This is because the herniation occurs anteriorly and the manipulation of the cervical cord is not tolerated by the patient. The disc herniation that is due to foraminal stenosis and that is confined to the foramen are the only instances where a posterior approach is contemplated.

The minimal disc excision is an alternative to the anterior cervical spine approach. However, the intervertebral disc stability after the procedure is dependent on the residual disc. The neck pain can be significantly reduced following the procedure due to the removal of neuronal compression although significant impairment can occur with residual axial neck pain. Another intervention for cervical disc herniation includes anterior cervical interbody fusion. It is more suitable for patients with severe myelopathy with degenerative disc disease.

Complications of the Surgery

Although the risk of surgery is very low, complications can still occur. Post-operative infection is one of the commonest complications and therefore needs more vigorous infection control procedures in the theatre and in the ward. During the surgery, due to poor surgical technique, nerve damage can occur. A dural leak may occur when an opening in the lining of the nerve root causes leakage of cerebrospinal fluid which is bathing the nerve roots. The lining can be repaired during the surgery. However, headache can occur due to loss of cerebrospinal fluid but it usually improves with time without any residual damage. If blood around the nerve roots clots after the surgery, that blood clot may lead to compression of the nerve root leading to radicular pain which was experienced by the patient previously. Recurrent herniation of the intervertebral disc due to herniation of disc material at the same site is a devastating complication that can occur long term. This can be managed conservatively but surgery may be necessary ultimately.

Outcomes of the Surgery

There has been extensive research done regarding the outcome of lumbar disc herniation surgery. Generally, the results from the microdiscectomy surgery are good. There is more improvement of leg pain than back pain and therefore this surgery is not recommended for those who have only back pain. Many patients improve clinically over the first week but they may improve over the following several months. Typically, the pain disappears in the initial recovery period and it is followed by an improvement in the strength of the leg. Finally, the improvement of the sensation occurs. However, patients may complain of feeling numbness although there is no pain. The normal activities and work can be resumed over a few weeks after the surgery.

Novel Therapies

Although conservative therapy is the most appropriate therapy in treating patients, the current standard of care does not address the underlying pathology of herniation of the intervertebral discs. There are various pathways that are involved in the pathogenesis such as inflammatory, immune-mediated, and proteolytic pathways.

The role of inflammatory mediators is currently under research and it has led to the development of new therapies that are directed at these inflammatory mediators causing damage to the nerve roots. The cytokines such as TNF ? are mainly involved in regulating these processes. The pain sensitivity is mediated by serotonin receptor antagonists and ?2 adrenergic receptor antagonists.

Therefore, pharmacological therapies that target these receptors and mediators may influence the disease process and lead to a reduction in symptoms. Currently, cytokine antagonists against TNF ? and IL 1? have been tested. Neuronal receptor blockers such as sarpogrelate hydrochloride etc have been tested in both animal models and in clinical studies for the treatment of sciatica. Cell cycle modifiers that target the microglia that are thought to initiate the inflammatory cascade have been tested with the neuroprotective antibiotic minocycline.

There is also research on inhibiting the NF- kB or protein kinase pathway recently. In the future, the treatment of herniation of the intervertebral disc will be much more improved thanks to the ongoing research. (Haro, Hirotaka)

 

El Paso Chiropractor Near Me

Dr. Alex Jimenez DC, MSACP, RN, CCST

 

A disc bulge and/or a herniated disc is a health issue that affects the intervertebral discs found in between each vertebra of the spine. Although these can occur as a natural part of degeneration with age, trauma or injury as well as repetitive overuse can also cause a disc bulge or a herniated disc. According to healthcare professionals, a disc bulge and/or a herniated disc is one of the most common health issues affecting the spine. A disc bulge is when the outer fibers of the annulus fibrosus are displaced from the margins of the adjacent vertebral bodies. A herniated disc is when a part of or the whole nucleus pulposus is protruded through the torn or weakened outer annulus fibrosus of the intervertebral disc. Treatment of these health issues focuses on reducing symptoms. Alternative treatment options, such as chiropractic care and/or physical therapy, can help relieve symptoms. Surgery may be utilized in cases of severe symptoms. – Dr. Alex Jimenez D.C., C.C.S.T. Insight

Curated by Dr. Alex Jimenez D.C., C.C.S.T.

 

References

  • Anderson, Paul A. et al. Randomized Controlled Trials Of The Treatment Of Lumbar Disk Herniation: 1983-2007. Journal Of The American Academy Of Orthopaedic Surgeons, vol 16, no. 10, 2008, pp. 566-573. American Academy Of Orthopaedic Surgeons, doi:10.5435/00124635-200810000-00002.
  • Fraser I (2009) Statistics on hospital-based care in the United States. Agency for Healthcare Research and Quality, Rockville
  • Ricci, Judith A. et al. Back Pain Exacerbations And Lost Productive Time Costs In United States Workers. Spine, vol 31, no. 26, 2006, pp. 3052-3060. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/01.brs.0000249521.61813.aa.
  • Fardon, D.F., et al., Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology,  and the American Society of Neuroradiology. Spine J, 2014. 14(11): p. 2525-45.
  • Costello RF, Beall DP. Nomenclature and standard reporting terminology of intervertebral disk herniation. Magn Reson Imaging Clin N Am. 2007;15 (2): 167-74, v-vi.
  • Roberts, S. Disc Morphology In Health And Disease. Biochemical Society Transactions, vol 30, no. 5, 2002, pp. A112.4-A112. Portland Press Ltd., doi:10.1042/bst030a112c.
  • Johnson, W. E. B., and S. Roberts. Human Intervertebral Disc Cell Morphology And Cytoskeletal Composition: A Preliminary Study Of Regional Variations In Health And Disease. Journal Of Anatomy, vol 203, no. 6, 2003, pp. 605-612. Wiley-Blackwell, doi:10.1046/j.1469-7580.2003.00249.x.
  • Gruenhagen, Thijs. Nutrient Supply And Intervertebral Disc Metabolism. The Journal Of Bone And Joint Surgery (American), vol 88, no. suppl_2, 2006, p. 30. Ovid Technologies (Wolters Kluwer Health), doi:10.2106/jbjs.e.01290.
  • Mercer, S.R., and G.A. Jull. Morphology Of The Cervical Intervertebral Disc: Implications For Mckenzies Model Of The Disc Derangement Syndrome. Manual Therapy, vol 1, no. 2, 1996, pp. 76-81. Elsevier BV, doi:10.1054/math.1996.0253.
  • KOELLER, W et al. Biomechanical Properties Of Human Intervertebral Discs Subjected To Axial Dynamic Compression. Spine, vol 9, no. 7, 1984, pp. 725-733. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/00007632-198410000-00013.
  • Lieberman, Isador H. Disc Bulge Bubble: Spine Economics 101. The Spine Journal, vol 4, no. 6, 2004, pp. 609-613. Elsevier BV, doi:10.1016/j.spinee.2004.09.001.
  • Lappalainen, Anu K et al. Intervertebral Disc Disease In Dachshunds Radiographically Screened For Intervertebral Disc Calcifications. Acta Veterinaria Scandinavica, vol 56, no. 1, 2014, Springer Nature, doi:10.1186/s13028-014-0089-4.
  • Moazzaz, Payam et al. 80. Positional MRI: A Valuable Tool In The Assessment Of Cervical Disc Bulge. The Spine Journal, vol 7, no. 5, 2007, p. 39S. Elsevier BV, doi:10.1016/j.spinee.2007.07.097.
  • Lumbar Disc Disease: Background, History Of The Procedure, Problem. Emedicine.Medscape.Com, 2017, emedicine.medscape.com/article/249113-overview.
  • Vialle, Luis Roberto et al. LUMBAR DISC HERNIATION. Revista Brasileira de Ortopedia 45.1 (2010): 1722. PMC. Web. 1 Oct. 2017.
  • Herniated Nucleus Pulposus: Background, Anatomy, Pathophysiology. emedicine.medscape.com/article/1263961-overview.
  • Vialle, Luis Roberto et al. LUMBAR DISC HERNIATION. Revista Brasileira De Ortopedia (English Edition), vol 45, no. 1, 2010, pp. 17-22. Elsevier BV, doi:10.1016/s2255-4971(15)30211-1.
  • Mullen, Denis et al. Pathophysiology Of Disk-Related Sciatica. I. Evidence Supporting A Chemical Component. Joint Bone Spine, vol 73, no. 2, 2006, pp. 151-158. Elsevier BV, doi:10.1016/j.jbspin.2005.03.003.
  • Jacobs, Wilco C. H. et al. Surgical Techniques For Sciatica Due To Herniated Disc, A Systematic Review. European Spine Journal, vol 21, no. 11, 2012, pp. 2232-2251. Springer Nature, doi:10.1007/s00586-012-2422-9.
  • Rutkowski, B. Combined Practice Of Electrical Stimulation For Lumbar Intervertebral Disc Herniation.Pain, vol 11, 1981, p. S226. Ovid Technologies (Wolters Kluwer Health), doi:10.1016/0304-3959(81)90487-5.
  • Weber, Henrik. Spine Update The Natural History Of Disc Herniation And The Influence Of Intervention.Spine, vol 19, no. 19, 1994, pp. 2234-2238. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/00007632-199410000-00022.
  • Disk Herniation Imaging: Overview, Radiography, Computed Tomography.Emedicine.Medscape.Com, 2017,
  • Carvalho, Lilian Braighi et al. Hrnia De Disco Lombar: Tratamento. Acta Fisitrica, vol 20, no. 2, 2013, pp. 75-82. GN1 Genesis Network, doi:10.5935/0104-7795.20130013.
  • Kerr, Dana et al. What Are Long-Term Predictors Of Outcomes For Lumbar Disc Herniation? A Randomized And Observational Study. Clinical Orthopaedics And Related Research, vol 473, no. 6, 2014, pp. 1920-1930. Springer Nature, doi:10.1007/s11999-014-3803-7.
  • Buy, Xavier, and Afshin Gangi. Percutaneous Treatment Of Intervertebral Disc Herniation. Seminars In Interventional Radiology, vol 27, no. 02, 2010, pp. 148-159. Thieme Publishing Group, doi:10.1055/s-0030-1253513.
  • Haro, Hirotaka. Translational Research Of Herniated Discs: Current Status Of Diagnosis And Treatment. Journal Of Orthopaedic Science, vol 19, no. 4, 2014, pp. 515-520. Elsevier BV, doi:10.1007/s00776-014-0571-x.

 

 

Cancer Back Pain

Cancer Back Pain

Back pain and soreness are widespread conditions that affect all genders, races, and lifestyles. The causes for back pain are varied from injury, poor posture, arthritis, age, overuse, etc. If back pain is frequent, perhaps the last assumption is that the pain could be caused by cancer. While it’s far from the most common causes, cancer back pain is possible, which makes consulting a doctor that will figure out the root cause, especially if there are other non-related symptoms, and treat the back pain very important.

Cancer Back Pain

Cancer Back Pain

Back pain that could be caused by cancer usually occurs with other symptoms and include:

  • Back pain that is not related to movement.
  • Pain does not get worse with activity.
  • Back pain usually presents at night or early in the morning and fades away or improves as the day progresses.
  • Back pain persists even after physical therapy or other treatments.
  • Changes in bowel movements or blood in urine or stool.
  • Unexplained, sudden weight loss.
  • Unexplained fatigue/exhaustion.
  • Weakness, tingling, or numbness in the arms or legs.
  • Back pain does not have to be severe to be cancer, as it can range in severity.
  • Having a family history of cancer and these symptoms can increase the risk.

Types of Cancer That Can Contribute To Back Pain

Types of cancer that can form around, in, and near the spine can cause back pain. These include:

Spinal Tumor

  • A spinal tumor can grow in the spinal bone or the membranes around the spinal cord.
  • The spine is a common source for bone metastasis, where cancer starts in one location and spreads to others.
  • 30 to 70 percent of individuals with cancer spreads to the spine, according to the American Association of Neurological Surgeons – AANS.

Lung

  • Lung cancer is one of the most common cancers that can spread to the spine.
  • A lung tumor can press on the spine, affecting nerve transmissions.
  • An individual with lung cancer may notice becoming tired/fatigued more easily, shortness of breath, coughing up blood, and back pain.

Breast

  • Rare but possible breast cancer symptom.
  • Breast cancers can metastasize to the back.
  • Like lung cancers, some breast cancer tumors can press on nerves connected to the spine, causing discomfort and pain.

Gastrointestinal

  • Cancers of the stomach, colon, and rectum can cause back pain.
  • The pain radiates from where the cancer is to the back.

Tissue and Blood Cancers

Blood and tissue cancers like:

  • Multiple myeloma
  • Lymphoma
  • Melanoma
  • Can cause back pain.

Diagnosing Cancer and Back Pain

Medical treatments for back pain-related cancer depend on its type and how advanced it is. A doctor will consider symptoms and medical history when diagnosing possible back pain causes. Because cancer is a rare cause of back pain, a doctor may recommend various treatments before a full cancer work-up. The doctor may order imaging studies and blood testing if the pain persists after chiropractic, physical therapy, or anti-inflammatory medications. These tests will help identify potential cancer markers causing back pain.

  • Treatments usually include chemotherapy and radiation to shrink a tumor.
  • A doctor will recommend surgery to remove a tumor.

Chiropractic

Cancer patients have found chiropractic treatment to be effective for:

  • Pain management.
  • Flexibility improvement.
  • Mobility improvement.
  • Strengthening muscles.
  • Helping to reduce stress.
  • Helping the body function more efficiently.

Chiropractic physiotherapy benefits patients undergoing chemotherapy, as it helps the body withstand the debilitating effects of the treatment based on the whole-body approach.


Body Composition


Don’t Hate Dieting

Individuals hate dieting, usually because they go about it the wrong way. Individuals do not need to starve themselves and live at the gym. Reaching quick weight loss goals might sound appealing; however, going through it for an extended time can make individuals feel:

  • Tired
  • Depressed
  • Unmotivated

Individuals can find a nutrition plan/exercise balance that works for them and their lifestyle. For some individuals, dieting alone is effective, but more than likely, they have increased metabolisms. Trying to lose fat by only cutting calories can be difficult for individuals with smaller metabolisms. The goal is to find a balance between diet and exercise. This does not mean having to go on an extreme diet, skip meals, or cut out entire macronutrient groups like fat or carbs, as the body needs both of these nutrients. Finding a sustainable long-term nutrition plan takes planning and support. A dietician, nutritionist, or health coach can offer a variety of nutrition and exercise plans customized to the individual.

References

Downie, Aron et al. “Red flags to screen for malignancy and fracture in patients with low back pain: a systematic review.” BMJ (Clinical research ed.) vol. 347 f7095. 11 Dec. 2013, doi:10.1136/bmj.f7095

Mabry, Lance M et al. “Metastatic cancer mimicking mechanical low back pain: a case report.” The Journal of manual & manipulative therapy vol. 22,3 (2014): 162-9. doi:10.1179/2042618613Y.0000000056

Vasser, Melinda, and Matthew Koroscil. “When Back Pain Turns Deadly: An Unusual Presentation of Lung Cancer.” Respiratory medicine case reports vol. 29 101009. 28 Jan. 2020, doi:10.1016/j.rmcr.2020.101009

Verhagen, Arianne P et al. “Red flags presented in current low back pain guidelines: a review.” The European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society vol. 25,9 (2016): 2788-802. doi:10.1007/s00586-016-4684-0

Planks For Spine Support and Back Pain Prevention

Planks For Spine Support and Back Pain Prevention

Regularly doing planks can support/strengthen the spine and prevent back pain no matter the fitness level. It’s estimated that 70% of adults will experience back problems and pain. One of the best ways to keep the spine healthy is by strengthening the core muscles. The more these muscles are built up, the healthier the body will become. The plank position activates the entire core taking the pressure off of the spine.

Planks For Spine Support and Back Pain Prevention

Core Anatomy

The core is the center of the body. It contains all the muscles surrounding the torso. These muscles work together to:

  • Stabilize the body during movement.
  • Prevent injury when engaged in physical activity/exercise.
  • Provide spinal support.

The core is split into two groups of muscles: The inner core and the outer core.

Inner Core

The inner core consists of:

Multifidus Muscles

Quadratus Lumborum

  • The deep abdominal muscle in the lower back sits on either side of the lumbar region of the spine.

Transversus Abdominis

  • Located between the lower ribs and the top of the pelvis.

Pelvic Floor

  • This base group of muscles stretches from the tailbone to the pubic bone.

Diaphragm

  • A dome-shaped muscle that rests below the lungs.

Outer Core

Rectus Abdominis

  • These are more commonly known as the abs.

External Obliques

  • These muscles are located on either side of the rectus abdominis.

Internal Obliques

  • These muscles are located below the external obliques, inside the hip bones.

Erector Spinae

  • These muscles surround the spine and extend up both sides of the vertebral column.

Planks and Back Pain Prevention

When the core is not strong enough, the spine and back muscles overcompensate to keep the body standing correctly. Studies have shown how planks effectively activate the muscles responsible for spinal stabilization. The exercise targets the entirety of the core and strengthens the shoulders and glutes. Strengthening these muscles improves posture, helping to alleviate back problems and pain. However, it’s recommended to talk to a doctor before beginning a plank regimen if back pain is present. If done incorrectly, they could aggravate the back muscles.

Proper Form

Choose an area clear of furniture where the whole body can stretch out. Follow these steps:

  • Begin with hands and knees on the floor.
  • Extend the legs back while keeping the elbows directly below the shoulders and the wrists below the elbows.
  • Keep the head down, looking at the space just above the hands.
  • Engage the abs and keep the body rigid.
  • Imagine a perfectly straight line from the neck to the toes.
  • Hold the position for 10 to 60 seconds, depending on fitness level.
  • Lower the body gently to the floor.
  • Make sure not to curve the back as curving means that the abdominal muscles are being engaged, and tilting the head up can strain the neck.
  • Both can lead to injury, which is why maintaining proper form is essential.

Plank Variations

There are variations of this exercise for different levels of physical fitness. Once the modified and full plank has been mastered, various planks can target other areas of the body. These include:

Side Plank

  • These involve shifting the weight to one forearm while extending the other arm into the air.

One-arm Plank

  • These involve lifting one hand off the ground, then alternating.

Single-leg Plank

Walking Plank

Reverse Plank

Anybody can work up to a plank at any age at any fitness level; it just takes time. Once achieved, it is a great way to keep the body’s core strong, healthy and helps prevent back problems.


Body Composition


Band Lateral Raise

The lateral band raise is an excellent workout for the shoulders. It works out the lateral deltoid, anterior deltoid, and serratus anterior.

  • Grasp one band in one hand.
  • Step on the free end with the opposite foot.
  • Right hand and left foot and vice versa.
  • Slowly extend and raise the arm until they are parallel to the floor.
  • Lower the arms in the same manner.
  • If the shoulders are healthy and strong enough, try adding dumbbells or kettlebells to increase the resistance.
References

Calatayud, Joaquín et al. “Tolerability and Muscle Activity of Core Muscle Exercises in Chronic Low-back Pain.” International journal of environmental research and public health vol. 16,19 3509. 20 Sep. 2019, doi:10.3390/ijerph16193509

World Health Organization. (2013) “Low back pain.” www.who.int/medicines/areas/priority_medicines/Ch6_24LBP.pdf

Youdas, James W et al. “Magnitudes of muscle activation of spine stabilizers in healthy adults during prone on elbow planking exercises with and without a fitness ball.” Physiotherapy Theory and practice vol. 34,3 (2018): 212-222. doi:10.1080/09593985.2017.1377792

Fever and Back Pain

Fever and Back Pain

It is one thing to wake up with back pain, but another when the pain is combined with a fever, body aches, and chills. It could be the flu or another infection. However, after checking the body’s temperature and fever is present with no other symptoms than back pain unless it is the flu; the fever could be another issue that may or may not be related as there are a variety of causes for back pain like:

  • Inflamed muscles
  • Muscle or ligament strain – If in poor physical condition, repeated and constant tension on the back can cause muscle spasms. Repeated heavy lifting or a sudden awkward movement can strain the back muscles and spinal ligaments.
  • Bulging or ruptured discs – Discs act as cushions between the bones/vertebrae in the spine. The soft material inside a disc can bulge or rupture and press on a nerve. However, a bulging or ruptured disc can present without back pain. Disc disease is often found by accident when spine X-rays are performed for another reason.
  • Arthritis – Osteoarthritis can affect the lower back. In some cases, arthritis in the spine can narrow the space around the spinal cord, a condition called spinal stenosis.
  • Osteoporosis – The spine’s vertebrae can develop painful fractures if the bones become porous and brittle.

Back pain without a fever is usually an indication of a misaligned spine.

Fever and Back Pain

Fever A Sign of Something Else

A fever is the body’s way of trying to raise its core temperature in an attempt to kill off a virus or a bacterial infection. Possible causes of back pain with fever include:

Kidney Infection

  • This type of infection often presents with low back pain and fever.

Spinal Epidural Abscess

  • This is an infection of the lower region of the spine, causing fever and lower back pain.

Vertebral Osteomyelitis

  • This is an infection of the lower spine that causes pain in the arms, lower back, and legs, along with a fever.

Meningitis

  • This causes swelling and inflammation of the brain and spine and needs to be addressed immediately.

Spinal Cord Abscess

  • This is an infection of the internal part of the spine. It is rare but can happen, causing low back pain and fever.

Symptoms

This is when seeing a chiropractor can help. A few signs that should not be ignored include:

  • Recently involved in an automobile accident.
  • Suffered a serious fall.
  • Feeling a tingling in the legs.
  • Having balance issues.
  • Having abdominal pain.
  • Pain is not going away, or it goes away for a while, then comes back.
  • Have weakness in the arms or legs.
  • Having bowel or urinary problems that were not present previously.
  • The pain is worse when sitting or standing up after sitting.
  • Have upper back pain after alcohol consumption.

A chiropractor will take a complete medical history, X-rays, an MRI if necessary, and a thorough physical examination will be performed to determine the cause. After a diagnosis is reached, the chiropractor will perform adjustments to relieve the pain and open the nerve pathways to increase circulation to the area. A chiropractic massage will help reduce stress, relieve back pain, and reduce depression, which can also help reduce the fever unless it is from another issue.


Body Composition


Influenza

Influenza or the flu is a contagious respiratory illness caused by viruses that infect the nose, throat, and lungs. It can cause mild to severe illness and, in extreme cases, can lead to death. Like a common cold, the flu is spread primarily through tiny droplets that get expelled from an infected person when they sneeze, cough, or talk. Approximately 8% of the population gets the flu each season. Flu symptoms are sudden, causing the following:

  • Fever
  • Chills
  • Muscle or body aches
  • Headaches
  • Sore throat
  • Runny or stuffy nose
  • Cough
  • Fatigue
  • Vomiting and diarrhea which is more common in children.

Most individuals with healthy immune systems will recover around seven days. However, the elderly, pregnant women, individuals of any age with certain chronic medical conditions like asthma, diabetes, or heart disease, and children under the age of five have an increased risk of developing complications. Flu vaccination is currently recommended for anyone older than six months in the U.S. and effectively prevents infection in 50 – 80% of the population. The primary treatment method for the flu is to support the immune system with plenty of rest, proper nutrition, and hydration.

References

Ameer MA, Knorr TL, Mesfin FB. Spinal Epidural Abscess. [Updated 2021 Feb 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK441890/

Kehrer, Michala et al. “Increased short- and long-term mortality among patients with infectious spondylodiscitis compared with a reference population.” The spine journal: official journal of the North American Spine Society vol. 15,6 (2015): 1233-40. doi:10.1016/j.spinee.2015.02.021

Rubin, Devon I. “Epidemiology and risk factors for spine pain.” Neurologic clinics vol. 25,2 (2007): 353-71. doi:10.1016/j.ncl.2007.01.004

Tsantes, Andreas G et al. “Spinal Infections: An Update.” Microorganisms vol. 8,4 476. 27 Mar. 2020, doi:10.3390/microorganisms8040476

Thoracic Upper Back Pain

Thoracic Upper Back Pain

The thoracic upper back or middle back is designed for stability to anchor the rib cage and protect the organs within the chest. Compared to the neck and lower back, the upper back is highly resistant to injury and pain. When thoracic upper back pain does present, it is usually brought on from long-term poor posture or an injury that overwhelms the sturdiness. It is less common than lower back and neck pain, but it does affect around 20% of the population and primarily women. It can occur for a variety of reasons, and chiropractic treatment can bring long-term relief.

Thoracic Upper Back Pain

Thoracic Upper Back Pain

The thoracic upper back is crucial for various functions related to:

  • Neural tissue health
  • Organ protection
  • Arm function
  • Breathing mechanics
  • Trunk support

The delicate balance and function can create potential issues and imbalances, causing soreness, strain, and pain. Underlying causes for thoracic upper back pain include:

  • Direct impact on the area.
  • Injury from a fall, sports, or automobile accident.
  • Unhealthy posturing/positions that place added strain on the spine, causing misalignment.
  • Repetitive motions and overuse like pulling, pushing, reaching, and twisting.
  • Repetitive/Improper shoulder mechanics can lead to muscle imbalance and poor movement.
  • Poor core mechanics.
  • Nerve dysfunction.

Muscular irritation

  • Muscular irritation usually comes from unconditioned muscles and a lack of strength.
  • The shoulder attaches large muscles to the shoulder blade and the back of the rib cage.
  • These are large muscles and are prone to developing strains or tightness.

Joint dysfunction

  • Caused by a sudden injury.
  • Natural spinal degeneration from aging.
  • Facet joint cartilage and/or joint capsule tearing.

Chiropractic

Chiropractic can realign the spine and body if experiencing any of the following:

  • Symptoms that keep returning even with the use of medication.
  • Home remedies do not bring adequate relief.
  • Unable to prevent symptoms from presenting.
  • Chronic pain.

Injury Medical Chiropractic and Functional Medicine Clinic will develop a personalized/customized treatment plan specific to the individual’s needs. Treatment will include:

  • Spinal adjustments to improve alignment and nerve integrity.
  • Therapeutic massage.
  • Posture training to increase spinal alignment.
  • Exercise training to restore muscular balance.
  • Health coaching.
  • Anti-Inflammatory Diet.

Body Composition


Sitting For Prolonged Periods

Weakened Muscles

Metabolism is linked with body composition, meaning that increased muscle increases metabolism helping to burn more calories.

  • When sitting, the gluteal muscles, abdominal muscles, and legs become inactive.
  • Sitting for extended periods day after day can cause these muscles to degenerate.
  • Consistent muscle loss from the lower body can hurt the body’s functional strength and, with age, increase the risk of injury.
  • Any muscle loss, especially from the lower body, and is the largest muscle group, can lead to consistent fat gain.

Circulation Slows Down

Sitting for too long also slows down blood flow to the brain and the legs, causing them to become sluggish.

  • Sitting without standing can increase the risk of developing blood clots.
  • Blood clots can break off and cause blockages throughout the body.
  • One study showed a significant reduction in the vascular flow after sitting for just three hours.
  • But individuals who took breaks and got up to walk around for two minutes every hour showed improved circulation.
References

Beddhu, Srinivasan et al. “Light-intensity physical activities and mortality in the United States general population and CKD subpopulation.” Clinical journal of the American Society of Nephrology: CJASN vol. 10,7 (2015): 1145-53. doi:10.2215/CJN.08410814

Briggs AM, Smith AJ, Straker LM, Bragge P. Thoracic spine pain in the general population: Prevalence, incidence and associated factors in children, adolescents and adults. A systematic review. BMC Musculoskelet Disord. 2009;10:77.

Fouquet N, Bodin J, Descatha A, et al. Prevalence of thoracic spine pain in a surveillance network. Occup Med (Lond). 2015;65(2):122-5.

McManus, Ali M et al. “Impact of prolonged sitting on vascular function in young girls.” Experimental physiology vol. 100,11 (2015): 1379-87. doi:10.1113/EP085355

Kinesiology, Kinesio, KT, Elastic Tape For Back Pain

Kinesiology, Kinesio, KT, Elastic Tape For Back Pain

We see it on all types of athletes nowadays. They are wearing tape that looks like it’s for an injury. It is for injuries, but it can also be used as a preventative measure to avoid injuries. It is known as Kinesiology, Kinesio, KT, and elastic tape. It reduces swelling, increases mobility, and expedites recovery. It can be beneficial with back soreness/pain.

Kinesiology, Kinesio, KT, Elastic Tape For Back Pain

Tape

When it comes to Kinesio tape for back pain, medical professionals reported the tape is most effective when incorporated with other pain treatments. A study found that taping various areas of the body safely relieved knee pain and reduced the need for pharmacological treatment for knee osteoarthritis. It is applied to the body to support a joint, improve circulation, or provide proprioception feedback to the brain. The tape can help increase awareness of a specific painful area, reminding the individual to maintain proper posture and not move in a way that causes pain. Online videos can teach how to tape a particular area of the body. Examples include:

Each joint and muscle requires various tapings or different patterns and directions. Applying the tape to body areas that an individual can reach and access, like the knee and ankle, can be simple. But it can be a challenge to apply it to the shoulder or back. This is when a physical therapist, chiropractor, medical clinician, partner, family member, or friend can help with the application. Kinesiology tape is designed to adhere for an average of three to four days, even when bathing.

Benefits

Kinesio taping for low back pain with help should be done in a shortened muscle position, meaning the person helping should apply the tape while the person experiencing back pain stands up straight. The taping can be two stripes going up and down, or it can be done with strips fanning out towards the buttocks. This gives support to the spine/back muscles and decreases pain.

Recovery and Prevention

Recovery from a spine condition or injury prevention, kinesiology tape can be used without any risk. It can help reduce pain, improve circulation, and provide muscle support. For a minor sprain or strain, the tape could help on its own. But for an individual experiencing severe back pain, it is recommended to seek professional medical care along with a stretching and strengthening regimen. The tape is recommended to be used as part of a complete treatment plan.


Body Composition


Five-Day Training Plan

The idea of training five times a week can be pretty intimidating. This is not about pushing yourself to your breaking point Monday through Friday. The objective of working out this frequently is about exercising normally, not like a professional athlete. That’s why many individuals divide up the areas they work out each day. Particular attention is given to one muscle group or system, letting the others rest and recover. This workout strategy is called a split and is favored by the bodybuilding community. Five-day splits are utilized to target different major muscle group/s every day. A standard training plan includes:

Monday

  • Back
  • Biceps

Tuesday

  • Chest
  • Triceps

Wednesday

Thursday

  • Legs
  • Lower Back

Friday

  • Biceps
  • Triceps

This is just one of the many programs that trainers, athletes, and fitness individuals have developed. Some individuals replace shoulders day with cardio; some do abs every day; it depends on what fitness goal the individual is going for.

References

Journal of Bodywork and Movement Therapies. (April 2016) “Kinesio taping for chronic low back pain: A systematic review” pubmed.ncbi.nlm.nih.gov/27634093/

Therapeutic Advances in Musculoskeletal Disease. (August 2019) “The effectiveness of Kinesio Taping® for pain management in knee osteoarthritis: a randomized, double-blind, controlled clinical trial” journals.sagepub.com/doi/full/10.1177/1759720X19869135

What are the potential benefits for back pain?: Asian Journal of Sports Medicine. (June 2015) “Low Back Pain in Athletes” www.ncbi.nlm.nih.gov/pmc/articles/PMC4592766/

Camping With Back Pain, Modifications and Adjustments

Camping With Back Pain, Modifications and Adjustments

Going camping for an extended weekend can be exciting and fearful for individuals with back pain. Being in nature is exhilarating, setting up tents with the family, fishing, and hitting the backpacking trails. For those that struggle with back and/or neck pain or conditions that cause pain, the objective is to be prepared for the worst. The weather, steep hills, physical activities, sitting in chairs that are not spine supportive, and sleeping on hard ground can contribute to all kinds of back issues. There are adjustments and modifications, as well as, tools to help the experience remain pain-free and be highly enjoyable.

Camping With Back Pain, Modifications and Adjustments

Camping Back Pain

Not everyone with back pain or conditions that cause pain will struggle with camping out. There are individuals that prefer an ultra-firm sleeping surface like the ground as it provides their spine with the necessary support. Research has found that medium to fully firm mattresses and surfaces are the least to cause back pain. Many individuals go mattress-free a few nights a week and report that it helps reduce their pain.

  • Mattresses that are too soft sink in too much, provide no support to the spine that leads to spinal problems and more aches, and pains.
  • Sciatica from pinched nerves can become irritated or flare up when sleeping on the ground.
  • Individuals with arthritis in the spinal joints can present with stiffness and more pain.
  • Carrying and moving heavy equipment
  • Hiking
  • Backpacking with heavy bags
  • Setting up tents
  • Repeatedly bending over
  • Using traditional camping chairs can position the spine at unnatural angles and can aggravate certain spinal conditions.

Modifications and Adjustments

As with most physical activities for individuals with back pain, it’s all about preparation and modification. Here are a few ways to adjust the camping trip to prevent and avoid back pain:

  • Don’t sit for too long.
  • Move around throughout the day.
  • Stretch out
  • Don’t take long hiking or biking trips.
  • Use the pockets in cargo pants/shorts or a jacket for essential items.
  • Rent a camper with a bed.
  • Get a cabin if necessary.

Equipment

Individuals with spinal conditions and pain will benefit from using proper and advanced gear to provide back support.

Do a little research and see what options are available. Overall, aim for equipment that is sturdy and supportive. Listen to your body, follow a doctor or chiropractor’s advice, and enjoy nature.


Body Composition


Food Journaling

Individuals can keep track of their food choices by logging their food intake into a personal food journal. This is where food choices and calorie intake can be examined, analyzed, and learned from. A study showed that individuals who diligently track their food and calorie intake had a greater amount of weight loss. For those that want to lose body fat, the body needs to be in a caloric deficit. After a week of logging meals, snacks, and drinks, an individual is in a better position to correct and adjust a weight loss plan. For example, journaling helps with:

References

Most comfortable sleeping: Sleep Health. (December 2015) “Effect of different mattress designs on promoting sleep quality, pain reduction, and spinal alignment in adults with or without back pain; a systematic review of controlled trials.” www.sciencedirect.com/science/article/abs/pii/S2352721815001400