For individuals experiencing back pain, can lying in the supine position help bring relief?
Supine Position
The supine position describes the body’s position when lying on your back with your face up. The individual is flat on their back with no incline, arms at their sides or bent at a 90-degree angle. It’s commonly used in medical settings for examinations, surgeries, and procedures, particularly when access to the anterior/front of the body is needed. It can benefit certain conditions, like helping relieve pain, but exacerbate others, like acid reflux. The term is also used as a modifier for exercises and stretches that begin with the individual on their back. (ScienceDirect Topics, 2009)
Medical Uses
Examinations
Healthcare providers often use the supine position for physical examinations, including vital signs, palpation of the abdomen, and chest inspection. (Nurse.com, 2024)
Procedures
It’s also used for various procedures, such as lumbar punctures and injections. (Steris Healthcare, 2025)
Surgery
Due to its accessibility to the front of the body, the supine position is frequently used for surgeries such as cardiac, abdominal, thoracic, and cranial procedures.
It allows for easy access to the airway, facilitates anesthesia choices, and can be readily converted to an open procedure if necessary. ScienceDirect Topics, 2009)
Overall Health
Natural Position
Many individuals naturally fall asleep in the supine position, finding it comfortable and conducive to spinal alignment.
Back Pain Relief
Sometimes, lying supine with proper support can relieve back pain, particularly in individuals with lumbar spinal issues. (MedicalNewsToday, 2022)
Acid Reflux
However, the supine position can exacerbate acid reflux, as gravity allows stomach acid to travel up the esophagus. (MedicalNewsToday, 2022)
Sleep Apnea
The supine position can worsen sleep apnea in some individuals.
Clinical Uses
A physical therapist, trainer, or clinician may use supine to describe positions used for manual therapy or when having the patient do stretching and back exercises as part of a home exercise program.
If the therapist or personal trainer is training the individual on core stabilization exercises for the first time, the individual will most likely start in the supine position.
This is because when the body is supine, the muscles have the least work to do to maintain correct posture and position against the force of gravity.
Many bed exercises begin in this position for rehabilitation.
Back Care
Here are a few recommendations to relieve low back pain using the supine position.
First, individuals can release the tension in the back by assuming the hook-lying position, a modification of the supine position in which the knees are bent and the feet are resting flat on the floor (Aurora BayCare Medical Center, N.D.).
Start breathing and relaxing, allowing the tension to drain out of the muscles.
In a hook-lying position with the fingertips on the lower belly, inhale deeply, then exhale naturally and puff out the remaining air.
At that point, the fingertips should feel the transverse abdominal muscle engage.
Release and repeat 10 times.
After the body is warmed up, move on to actual exercise. For example, beginners may be given hip stretches to help relieve back pain. These might be done to maintain or prevent back pain. Individuals can do yoga for their back while in the supine position. As with any exercise program, not all yoga poses involve lying on the back, but many beginners and restorative ones do.
For example, the supine spinal twist involves lying on the back, bending the knees, and gently placing them to one side. The idea is to stay in that position for a few moments—and breathe—to allow the oblique abdominal and back muscles to release.
Variations
Lawn Chair Position
This variation involves slightly bending the hips and knees and elevating them above the heart, which can help relieve lower back pain.
Frog-Leg Position
The frog-leg position involves lying on the back with bent knees pushed out to the sides, providing access to the groin and perineum. (Steris Healthcare, 2025)
Injury Medical Chiropractic & Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
For individuals with lower back pain when walking, could they have injured a muscle or have an underlying condition affecting the joints, ligaments, or nerves?
Back Pain When Walking
Lower back pain when walking can occur for a variety of reasons. It can result from poor posture, injuries, muscle fatigue, or an underlying condition. Specific injuries, like muscle strains, can affect the ligaments in the spine and cause pain. Muscles that have not been used often can result in fatigue and pain. Specific health conditions, such as degenerative disc disease, spinal stenosis, herniated discs, sciatica, or even sacroiliac joint dysfunction, can cause lower back pain. Factors like overexertion or improper gait can exacerbate it.
Muscle Issues
Muscle strains, ligament sprains, or fatigue can cause lower back pain when walking. Pain can occur after walking or come on gradually from wear and tear without an apparent cause, as follows (American Association of Neurological Surgeons, 2024)
Strains
Occur when the fibers in the back are overstretched or torn.
Pain from muscle strains is usually worse during activity and better when resting.
Sprains
It occurs when the ligaments that connect bone to bone become detached.
If the muscles do not adequately support the spine, the spinal joints absorb more pressure, which can lead to injury to the spinal ligaments.
Fatigue
It can happen from overexertion and lead to lower back pain when walking.
It could occur when walking longer than the body is used to, on uneven surfaces that make the muscles work harder to help maintain balance, or climbing hills that cause you to lean forward while walking.
Degenerative Disc Disease
Between each vertebra is a disc that provides cushioning between the bones.
As the disc wears down, surrounding muscles, ligaments, joints, and nerves in the spine absorb more pressure, causing damage.
Degenerative disc disease is a wear-and-tear condition that becomes more common as individuals age and is a common cause of lower back pain.
Healthcare providers recommend walking as a low-impact activity for individuals with the disease. However, if the condition is more severe, individuals could experience pain from this exercise, especially when walking on hard surfaces. (Hospital for Special Surgery, 2024)
Sciatica
Sciatica pain occurs when a nerve exiting the spine in the lower back becomes compressed or pinched. It is a common symptom of a herniated disc, in which a disc moves out of place and puts pressure on nearby nerves. In addition to lower back pain, sciatica can cause pain in the hip, the back of the thigh, and down the leg. Sciatica can also cause: (American Academy of Orthopaedic Surgeons, 2021)
Numbness
Tingling
Muscle cramps
Leg muscle weakness
Healthcare providers often recommend walking as a safe form of physical activity for individuals with sciatica. However, individuals should avoid twisting or bending forward. (American Academy of Orthopaedic Surgeons, 2021) To decrease pain, avoid walking on uneven surfaces or uphill.
Lumbar Spinal Stenosis
Spinal stenosis is a wear-and-tear condition that often affects the lumbar spine/five vertebrae in the lower back.
It causes the space surrounding the spinal cord to narrow.
Lumbar spinal stenosis typically causes pain when standing upright, including when walking.
Many with this condition find that leaning slightly forward helps to reduce the pain by opening up the compressed areas.
Hyperlordosis
Lordosis describes the normal curve in the spine in the lower back. However, when this curve is exaggerated, it causes hyperlordosis or swayback. (American Academy of Orthopaedic Surgeons, 2020) Hyperlordosis affects the range of motion, putting abnormal pressure on the muscles, ligaments, and joints. It also reduces the spine’s ability to absorb shock correctly when walking, leading to pain. (Cedars-Sinai, 2025)
Prevention Strategies
Individuals can take steps to reduce their risk of lower back pain when walking, even if they’ve been diagnosed with a condition that can potentially cause this symptom. Walking can decrease chronic low back pain for some. (Suh J. H. et al., 2019) As with any new exercise program, check with a healthcare provider to ensure that walking for exercise is appropriate for the injury, condition, or disease and is safe. Recommended tips: (Harvard Health Publishing, 2015)
Wear shoes made for walking.
Perform gentle lower back stretches before walking.
Start slowly by walking for a few minutes, then gradually increase the time.
Walk on a smooth surface, such as a sidewalk or athletic track, or indoors, such as in a shopping center or mall.
Warm up and cool down by walking slowly at the beginning and end of the walk.
This allows the back and leg muscles to warm up before exercise and recover afterward.
Walk at a slow to moderate pace/speed that allows one to converse.
Standing up straight while walking or standing upright reduces pressure on the lower back.
Alternative Exercise
If there is still back pain when walking, it might not be an appropriate exercise for the individual and/or how their condition presents symptoms. Alternate activities can include: (Hospital for Special Surgery, 2023)
Elliptical Trainer
This exercise keeps the feet in contact with the pedals, putting less shock-absorbing pressure on the spine than walking.
Recumbent Biking
will keep the back upright, which is recommended if there is more pain when bending forward.
Upright Stationary Biking
This is recommended if the back pain improves when bending forward.
Walking In A Pool
This activity provides benefits while reducing pressure on the spine.
To target different muscles, try walking laps in waist-deep water in multiple directions (forward, backward, and side to side).
Water Aerobics
This activity provides cardiovascular health benefits with decreased pressure on the back.
Injury Medical Chiropractic & Functional Medicine Clinic
See a physical therapist for a personalized exercise program to reduce back pain and appropriate for your condition. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Beyond Adjustments: Chiropractic and Integrative Healthcare
Suh, J. H., Kim, H., Jung, G. P., Ko, J. Y., & Ryu, J. S. (2019). The effect of lumbar stabilization and walking exercises on chronic low back pain: A randomized controlled trial. Medicine, 98(26), e16173. doi.org/10.1097/MD.0000000000016173
For individuals experiencing lower back pain and sciatica symptoms, can using a lidocaine patch help?
Lidocaine Patch
Lidocaine patches are in a drug class called local anesthetics (MedlinePlus, 2025) (Food and Drug Administration, 2022). They relieve pain in small body areas by blocking the nerves from sending pain signals. The Food and Drug Administration approved lidocaine 5% or 1.8% patches for relieving postherpetic neuralgia (PHN) pain. These lidocaine patches are prescription-only (Food and Drug Administration, 2022). They are available either by prescription or over the counter and are commonly used for back pain and other areas. Over-the-counter lidocaine, 4% patches, can be used to relieve minor aches and pains, including back pain. However, further research is needed to recommend the use of lidocaine patches as an effective method of pain relief. (Department of Veterans Affairs/Department of Defense, 2022) (North American Spine Society, 2020)
The Patch
They are available in prescription and over-the-counter forms. Over-the-counter forms come as a 4% patch in various brands, such as (MedlinePlus, 2025)
Aspercreme
Lidocare
Salonpas
Prescription-only patches come in 5% or 1.8% patches and are approved to relieve long-term nerve pain from shingles in adults. Zlido is a brand name for a 1.8% lidocaine patch. Five percent lidocaine patches are available generically. (DailyMed, 2018) (Food and Drug Administration, 2021) The safety and effectiveness in children are unknown. (Food and Drug Administration, 2022)
Other Lidocaine Forms
As a local anesthetic, it is available in several other forms, including:
Spray
Topical cream
Lotion
Liquid
Ear drops
Eye gel
Injection
It is also available as a short-term intravenous infusion for abnormal heart rhythm. (DailyMed, 2025)
Effectiveness
Clinical trials have shown that the patches effectively relieve chronic low back pain. However, these studies were nonrandomized and did not include a control group to compare against the treatment group. (Santana J. A., Klass S., & Felix E. R. 2020) The results may be subject to potential biases. For this reason, further evidence is needed to support lidocaine patches’ effectiveness in reducing low back pain. (North American Spine Society, 2020) High-quality randomized and controlled clinical trials are necessary to study the effectiveness. (North American Spine Society, 2020) (Santana J. A., Klass S., & Felix E. R. 2020)
Clean and dry the affected area before placing the patch.
Apply to the affected body area as directed.
Wash your hands after touching the patch.
Remove the patch after what is usually recommended after eight hours.
How Quickly Does It Work?
The amount of medication absorbed into the blood depends on how long the patch is placed on the body and how much is covered with the patch. In a study, healthy participants wore three lidocaine patches on their backs for 12 hours on and 12 hours off during 24 hours. Lidocaine levels were highest at 11 hours. At the end of the 24 hours, there was still some lidocaine left in the bloodstream. (Food and Drug Administration, 2022)
Individuals with PHN may notice a difference in pain intensity after four hours of using the patch. (Rowbotham, M. C. et al., 1996) (Food and Drug Administration, 2022) Experts may suggest using patches for four weeks for those who experience pain after their shingles rash disappears. However, if there is still pain after these four weeks, it is recommended to see a pain specialist. (Gross, G. E. et al., 2020)
Side Effects
Common side effects are typically mild skin reactions where the patch is. These reactions are usually temporary and will disappear within a few minutes or hours. Examples include: (Food and Drug Administration, 2022)
Severe allergic reactions are rare, but it is possible.
Symptoms include breathing problems, itchiness, and rash.
Methemoglobinemia
Methemoglobinemia is a condition that makes it hard for red blood cells to carry oxygen.
Individuals may experience symptoms of blue-looking skin, headache, lightheadedness, shortness of breath, abnormal heart rhythm, or seizures.
Using too many lidocaine patches to cover large parts of the body or using the patches longer than 12 hours within 24 hours may cause side effects that may include heart-related effects, such as a slow heart rate and low blood pressure. Individuals may also experience the following side effects (Food and Drug Administration, 2022)
Hot or cold sensation
Numbness
Dizziness
Ringing ears
Lightheadedness
Mood changes
Drowsiness to unconsciousness
Vision changes
Seizures
Tremors
Vomiting
Injury Medical Chiropractic & Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Santana, J. A., Klass, S., & Felix, E. R. (2020). The Efficacy, Effectiveness and Safety of 5% Transdermal Lidocaine Patch for Chronic Low Back Pain: A Narrative Review. PM & R: the journal of injury, function, and rehabilitation, 12(12), 1260–1267. doi.org/10.1002/pmrj.12366
Rowbotham, M. C., Davies, P. S., Verkempinck, C., & Galer, B. S. (1996). Lidocaine patch: double-blind controlled study of a new treatment method for post-herpetic neuralgia. Pain, 65(1), 39–44. doi.org/10.1016/0304-3959(95)00146-8
Gross, G. E., Eisert, L., Doerr, H. W., Fickenscher, H., Knuf, M., Maier, P., Maschke, M., Müller, R., Pleyer, U., Schäfer, M., Sunderkötter, C., Werner, R. N., Wutzler, P., & Nast, A. (2020). S2k guidelines for the diagnosis and treatment of herpes zoster and postherpetic neuralgia. Journal der Deutschen Dermatologischen Gesellschaft = Journal of the German Society of Dermatology: JDDG, 18(1), 55–78. doi.org/10.1111/ddg.14013
Are there benefits to back cracking, risks, and how can it be done safely?
Back Cracking
Back cracking is intentionally applying pressure or twisting movements, producing a popping or cracking sound in the spine. Back cracking involves stretching or extending the spine. In most cases, it is considered safe when done gently as it can provide temporary relief from back pain and stiffness by:
Stretching the ligaments and muscles around the spine
Releasing gas bubbles that may be causing pressure
Improving joint mobility
Mechanism of Action
Cracking your back creates small gas bubbles in the synovial fluid (the lubricating fluid in the joints).
These bubbles form when the pressure in the joints is suddenly released, causing a popping or cracking sound.
It is generally safe, but there are certain conditions under which individuals should avoid cracking their backs.
Popping Sound
Research has used a new type of magnetic resonance imaging (MRI), cine MRI, to study the noise source. Cine MRI produces moving images.
This study using this MRI found that the formation of bubbles makes a popping sound.
The popping sound does not come from the popping of bubbles in the synovial fluid, as previously believed. (Kawchuk G. N. et al., 2015)
When someone cracks their back, the force pulls the bones of the joint apart, causing the pressure within the joint to drop and form a bubble, which eventually dissipates. (Kawchuk G. N. et al., 2015)
Crepitus
Crepitus is the medical term for cracking or popping noise from joints.
It is not a condition or disease but can be a symptom of one.
Other terms include clicking or crunching.
Is It Safe To Perform Daily?
Back cracking once a day is generally considered safe. But if it causes pain or swelling, then stop and contact a healthcare provider. If someone feels the need to crack their back more throughout the day, it could be a sign that they need to see a professional chiropractic healthcare provider. (AICA Orthopedics, 2022) Individuals may crack their backs to address certain conditions or to relieve various discomfort symptoms that can include: (National Center for Complementary and Integrative Health, 2025)
Headache
Neck pain
Lower back pain
Sciatica
Individuals may often experience mild side effects like headache, stiffness, or pain. These side effects tend to resolve within a day. Though back cracking can provide temporary relief for some conditions, some serious side effects like neurological problems or strokes have been reported. (National Center for Complementary and Integrative Health, 2025)
Rotate the upper body to the right side and press against the right knee with the left elbow.
Hold the stretch for 30 seconds and come back to the center.
Repeat on the other side.
Knee to Chest
Lie flat on the ground.
Lift one leg and bring the knee to the chest, pulling the knee in with your hands.
Hold for five seconds.
Repeat with the other leg.
Several back-cracking assistive devices, such as poles and wheels, are available. Talk to a healthcare provider to determine the right type and ensure it is safe for you and your condition or injury.
Individuals Who Should Avoid Back Cracking
Back cracking can cause additional stress or damage to the joints in those with back injuries or other conditions. Individuals with these conditions should avoid back cracking (AICA Orthopedics, 2022)
Numbness or tingling of the arms or legs.
Osteoporosis
Spinal cancer
Spinal abnormalities
Individuals who have a high stroke risk.
A Professional Back Adjustment
A chiropractor is a healthcare provider who specializes in spine and spinal adjustments. They adjust the spine and other areas of the body to correct misalignment problems, reduce and relieve pain, and allow the body to recover independently. (National Library of Medicine. MedlinePlus, 2023) The chiropractor will take a health history to learn about previous injuries and conditions. Then, they will evaluate the patient and determine the best course of action. Although a chiropractor performs spinal adjustments, they may also incorporate other treatments, including: (National Library of Medicine. MedlinePlus, 2023)
Injury Medical Chiropractic & Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to develop an optimal health and wellness solution. We focus on what works for you to relieve pain, restore function, and prevent injury. Regarding musculoskeletal pain, specialists like chiropractors, acupuncturists, and massage therapists can help mitigate the pain through spinal adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal issues.
Chiropractic Secrets
References
Kawchuk, G. N., Fryer, J., Jaremko, J. L., Zeng, H., Rowe, L., & Thompson, R. (2015). Real-time visualization of joint cavitation. PloS one, 10(4), e0119470. doi.org/10.1371/journal.pone.0119470
Learn about kyphosis, its causes and symptoms, and treatment approaches to alleviate discomfort and improve posture.
What Is Kyphosis?
How frequently have you seen that after spending too much time sitting down, your posture has become more hunched? Do you have neck and shoulder strains that are momentarily relieved by stretching? Or do you experience shoulder and back discomfort and tension as a result of bad posture? Frequently, people have experienced musculoskeletal problems that may impact the neck, shoulders, and back—the three most frequent parts of the body. A spinal disorder called kyphosis may result from prolonged hunching. An increase in the forward curve of the spine that affects the thoracic location is known as kyphosis, and it may be brought on by degenerative alterations in the intervertebral discs. (Lam & Mukhdomi, 2025) The development of a hunchback or rounded upper back is a symptom of kyphosis that may impact posture and general musculoskeletal health. Depending on how severe the kyphosis is, the symptoms might vary from severe stiffness and pain to trouble breathing. Finding different treatment choices for this spinal ailment may also be made easier for many people by having a better grasp of the environmental variables that contribute to its development and the symptoms that are connected with it.
Environmental Factors Contributing to Kyphosis
Kyphosis may occur as a result of many environmental factors. This is because a lot of individuals engage in physically demanding activities that put a lot of strain on the spine. On the other hand, kyphosis may occur as a result of the spine’s gradual aging process. Among the environmental elements that cause kyphosis are:
Bad Posture
Living a Sedentary Lifestyle
Overweight Items & Inappropriate Lifting
Osteoporosis
Conditions & Injuries of the Spine
Kyphosis Symptoms & Its Effects on the Musculoskeletal System
Because it may impact both the cervical and thoracic regions of the spine, kyphosis can result in a number of musculoskeletal issues.When kyphosis begins to damage the cervical region, it may result in referred neck pain, which puts more pressure on the soft tissues in the back. This forces the head to cope with a mechanical imbalance, which puts strain on the muscles and creates weariness. (Ogura and others, 2021) At the same time, when kyphosis begins to impact the thoracic spine, other risk factors include poor bone density and dysfunction in the lower extremities in older persons, which may restrict movement. (Lorbergs and others, 2017). Other musculoskeletal problems linked to kyphosis include:
Stiffness & Pain in the Upper Back
Minimal Flexibility & Mobility
Referred pain
Weakness and Muscle Fatigue
Digestive & Breathing Problems
Understanding Long-Lasting Injuries- Video
Treatment Approaches For Kyphosis
If the spinal curvature has become much worse, many people have chosen to undergo surgery to manage the symptoms of kyphosis. Nonetheless, a lot of individuals have chosen nonsurgical treatments since they are less expensive and noninvasive. In order to improve a person’s posture and lessen the difficulties associated with kyphosis, nonsurgical therapies may take many different forms. (Jenkins et al., 2021) When individuals begin using nonsurgical methods to lessen cervical kyphosis, their mobility and postural control will significantly improve. (Oakley and others, 2024)
Chiropractic Care & More
For those with kyphosis, chiropractic adjustments are a non-invasive treatment option that may help reduce pain and realign the spine. The goal of chiropractic therapy is to stretch and strengthen weak, tense muscles while realigning the spine to its natural position. By increasing the range of motion in the neck, chiropractic therapy may alleviate overlapping risk profiles, such as headaches and kyphotic neck discomfort. (Norton and others, 2022) Additionally, in order to avoid a slouched posture, chiropractors may create a personalized treatment plan for those with kyphosis that offers substantial relief from the neck to the back. (Fortner and others, 2017). For those with kyphosis, chiropractic adjustments may provide the following advantages:
Adjustments to the spine may help realign the vertebrae, improve posture, and lessen excessive curvature.
Postural Training: To improve support, chiropractors may provide workouts that build stronger core and back muscles.
Pain management: Spinal decompression methods and manual treatment may ease tense muscles and lessen transferred pain.
Increased Flexibility and Mobility: Mobility exercises and stretching help increase range of motion and avoid stiffness.
Additional Treatments For Kyphosis
In addition to chiropractic treatment, alternative kyphosis management techniques may enhance spinal stability and stop the progression of spine curvature. Among these extra treatments are;
Physical Therapy.
Supporting Postural Ergonomics
Final Thoughts
Although kyphosis may cause pain and suffering, quality of life can be greatly improved with early diagnosis and appropriate therapy. Proactively treating kyphosis may result in improved posture, less discomfort, and more mobility, whether via physical therapy, chiropractic adjustments, or lifestyle changes.
Injury Medical Chiropractic & Functional Medicine Clinic
We associate with certified medical providers who implement the importance of the causes and symptoms of kyphosis. While asking important questions to our associated medical providers, we advise patients to integrate small changes into their daily routine to reduce the effects of kyphosis from affecting the cervical and thoracic areas. Dr. Alex Jimenez, D.C., envisions this information as an academic service. Disclaimer.
References
Fortner, M. O., Oakley, P. A., & Harrison, D. E. (2017). Treating ‘slouchy’ (hyperkyphosis) posture with chiropractic biophysics((R)): a case report utilizing a multimodal mirror image((R)) rehabilitation program. Journal of Physical Therapy Science, 29(8), 1475-1480. doi.org/10.1589/jpts.29.1475
Jenkins, H. J., Downie, A. S., Fernandez, M., & Hancock, M. J. (2021). Decreasing thoracic hyperkyphosis – Which treatments are most effective? A systematic literature review and meta-analysis. Musculoskelet Sci Pract, 56, 102438. doi.org/10.1016/j.msksp.2021.102438
Lorbergs, A. L., Murabito, J. M., Jarraya, M., Guermazi, A., Allaire, B. T., Yang, L., Kiel, D. P., Cupples, L. A., Bouxsein, M. L., Travison, T. G., & Samelson, E. J. (2017). Thoracic Kyphosis and Physical Function: The Framingham Study. J Am Geriatr Soc, 65(10), 2257-2264. doi.org/10.1111/jgs.15038
Norton, T. C., Oakley, P. A., & Harrison, D. E. (2022). Improving the cervical lordosis relieves neck pain and chronic headaches in a pediatric: a Chiropractic Biophysics((R)) (CBP((R))) case report with a 17-month follow-up. Journal of Physical Therapy Science, 34(1), 71-75. doi.org/10.1589/jpts.34.71
Oakley, P. A., Gage, W. H., Harrison, D. E., & Mochizuki, G. (2024). Non-surgical reduction in thoracolumbar kyphosis and sagittal vertical axis corresponding with improved sensorimotor control in an older adult with spinal deformity: a Chiropractic Biophysics((R)) case report. Journal of Physical Therapy Science, 36(11), 756-764. doi.org/10.1589/jpts.36.756
Ogura, Y., Dimar, J. R., Djurasovic, M., & Carreon, L. Y. (2021). Etiology and treatment of cervical kyphosis: state of the art review-a narrative review. J Spine Surg, 7(3), 422-433. doi.org/10.21037/jss-21-54
Can the straight leg test help find the cause of back or hamstring pain in individuals experiencing it?
Straight Leg Test
The straight leg raise test is often used to diagnose sciatica/radiculopathy, herniated discs, and other spinal problems. The healthcare provider giving the test performs most of the movement as they assess what’s causing the leg and/or back pain. The patient lies on their back with the legs straight. The provider will have the patient perform specific movements and inform them of how it feels. Then, they’ll raise the leg to see if and at what point symptoms begin to show. Providers often use this test alongside imaging studies.
Some studies suggest the straight leg test helps diagnose sciatica and other causes. (Pesonen J. et al., 2021)
Purpose
The straight leg raise is one of the most common manual tests done during physical exams. The straight leg raise test seeks to reproduce the pain or other symptoms in a controlled fashion to provide clues to what’s happening. It is a manual exam, and the healthcare provider will:
Position the patient
Moves the patient
Create pressure to see how well the patient can resist it
This is often used alongside imaging tests, such as an X-ray or CT scan. (Allegri M. et al., 2016) Its goal is to check for nerve movement and sensitivity of nerve tissue to compression. The straight leg lift test is neurodynamic because it uses movement to diagnose nerve problems. (Baselgia L.T. et al., 2017)
During the Test
Expect to feel some pain during the test, as the whole point is to see what aggravates the symptoms. They may be caused by:
Most of the tests are passive, with the provider doing the lifting. The patient can help achieve the most accurate result by staying as relaxed as possible and being clear about what is felt. (Pande K. 2015) The procedure:
The patient lies on their back with their legs straight.
The provider will ask the patient to turn one of the legs in.
This tells them what hip position affects the lower back symptoms.
They’ll then ask you to bring the leg toward the body’s center.
Then, they’ll lift the straight leg until the patient experiences symptoms.
Pain suggests a herniated disc.
If there is no pain, this also provides valuable information.
The procedure is repeated with the other leg.
Modifications
It’s important to let the examiner know about any limitations. The straight leg raise test has modifications if the patient cannot lift their leg while it’s straight or if they have difficulty lying on their back, which can also help avoid an injury during the test.
Variations
The healthcare provider may repeat the test with the ankle in a dorsiflexed position/raising the foot. Then, they’ll have the patient do it with their chin tucked into their chest. (Young R. et al., 2013) These variations can help check for nerve involvement in specific locations, such as the spinal cord or the dura mater, the membrane covering the brain and spinal cord. (Venne G. et al., 2017) The spinal cord nerves are likely involved and affected if the usual pain is in the back or leg but not the chin, neck, or foot. (Camino Willhuber GO, Piuzzi NS. 2023)
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and mitigate issues through adjustments that help the body realign itself. The clinic can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.
Pesonen, J., Shacklock, M., Suomalainen, J. S., Karttunen, L., Mäki, J., Airaksinen, O., & Rade, M. (2021). Extending the straight leg raise test for improved clinical evaluation of sciatica: validity and diagnostic performance with reference to the magnetic resonance imaging. BMC musculoskeletal disorders, 22(1), 808. doi.org/10.1186/s12891-021-04649-z
Allegri, M., Montella, S., Salici, F., Valente, A., Marchesini, M., Compagnone, C., Baciarello, M., Manferdini, M. E., & Fanelli, G. (2016). Mechanisms of low back pain: a guide for diagnosis and therapy. F1000Research, 5, F1000 Faculty Rev-1530. doi.org/10.12688/f1000research.8105.2
Baselgia, L. T., Bennett, D. L., Silbiger, R. M., & Schmid, A. B. (2017). Negative Neurodynamic Tests Do Not Exclude Neural Dysfunction in Patients With Entrapment Neuropathies. Archives of physical medicine and rehabilitation, 98(3), 480–486. doi.org/10.1016/j.apmr.2016.06.019
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Can individuals managing facet arthropathy treat the condition with over-the-counter pain relievers, prescription muscle relaxers, exercise, and chiropractic spinal manipulation?
Facet Arthropathy
Facet arthropathy, or facet osteoarthritis, is arthritis that affects the facet joints in the spine. It causes pain and stiffness due to cartilage degeneration within these joints, often resulting from wear and tear associated with aging. Essentially, it occurs when the small joints in the back of the spine become arthritic and rub against each other painfully.
It affects the bony protrusions, called facet joints, that connect the spine’s bones.
Symptoms include neck and back pain that can worsen with standing, bending, or twisting.
Facet arthropathy is diagnosed using X-rays and other imaging studies.
Severe cases may require surgery.
Facet Joints
Twenty-four vertebrae form the spine, with two facet joints between each. Facet joints are small joints located at the back of each vertebra in the spine. They allow movement and stability, help maintain the alignment of the spinal bones/vertebrae, and limit excessive motion. The joints and the cushioning intervertebral disc form a three-joint complex between each vertebra.
The three-joint complex allows the spine to move, including bending, rotating, and extending.
Synovial fluid lubricates the joints so they can move.
The intervertebral disc provides flexibility and dissipates compressive loads.
The facet joints stabilize the spine by constraining rotation and bending.
Symptoms
Arthropathy refers to any disease affecting a joint, including arthritis. Osteoarthritis, also known as arthrosis, is a specific type of arthropathy. It is a non-inflammatory, degenerative arthritis. Pain is the main symptom that is typically worse in the morning when awakening, and in the evening, the pain can also get worse when twisting or bending backward. The symptoms can vary based on the part of the affected spine. Low back pain is the most common, a condition referred to as lumbar facet arthropathy because it affects the lumbar spine of the lower back. (Perolat R. et al., 2018) Common Symptoms include:
Muscle spasms or cramps.
Pain that may come in periodic flare-ups
Pain that worsens with standing or inactivity.
Dull pain on both sides of the spine.
Aching pain on both sides of the spine.
Pain in the lower back, buttocks, shoulders, or back of the skull
Radiating pain to the buttocks and legs.
Pain that improves with sitting, leaning forward, or changing positions.
Pins-and-needles sensations in the hands or feet.
Clicking sounds when moving the spine.
Catching sensations when moving the spine.
Muscle weakness.
Causes
Facet arthropathy causes progressive damage to the spine. Spinal osteoarthritis, aka spondylosis, is the most common cause, but it can also occur with a severe form of spinal arthritis known as ankylosing spondylitis. It is primarily due to age-related wear and tear, but injuries or repetitive stress on the spine can also cause it. Arthritis in the facet joints can develop due to:
Aging-related wear and tear
Disc problems
A previous back injury
Torn ligaments
Spinal fractures
Deterioration of facet joints can also cause bony overgrowths called osteophytes or bone spurs, which can cause radiating pain and restrict the spine’s range of motion.
Degeneration
The facet joints and intervertebral discs degenerate due to age-related wear and tear.
The cartilage in the facet joints can dry out, crack, and wear down.
The joint capsule and synovial membrane can inflame or tear, affecting synovial fluid production.
The loss of cartilage can lead to hypermobility, and the joint can stiffen over time.
Diagnosis
Imaging studies are important to the diagnosis. Several types confirm the diagnosis and also characterize the nature and severity of the condition:
X-rays provide a plain, black-and-white image of the spinal column.
CT scan composites multiple X-rays to create a three-dimensional image of the spinal column.
MRI uses magnetic and radio waves to generate images of soft tissues like ligaments and cartilage.
To confirm the diagnosis, a diagnostic block, which is a small amount of local anesthetic, is injected into a facet joint. The needle placement is directed either with an ultrasound or a CT scan. Facet arthroplasty is confirmed if the injection provides immediate relief (American Academy of Orthopaedic Surgeons, 2022). The healthcare provider will want to exclude other possible causes as part of the differential diagnosis. Conditions that mimic facet arthropathy include:
Herniated disc
Psoriatic arthritis
Reactive arthritis
Spinal gout
Spinal compression fracture
Treatment
The treatment varies depending on the location and severity of the condition. Generally, conservative treatments are used before more invasive procedures are considered.
Lifestyle Changes
Initially, a healthcare provider may recommend rest and avoiding aggravating movements, including any activity that involves bending or twisting.
Activities that take the weight off the facet joint, such as sitting, leaning forward, or changing positions, may help ease the pain.
Patients may also be advised to adjust their sleep positions to take the pressure off facet joints.
Options included curling up on your side or lying on your back with the knees supported with pillows.
Medications
If a diagnostic block is used, a patient may not need medications immediately. However, as the anesthetic starts to wear off, the patient may be prescribed over-the-counter or prescription pain relievers based on the severity of the pain. These can include:
Analgesics like Tylenol
Nonsteroidal anti-inflammatory drugs like Advil or Aleve
Muscle relaxants like Lloresal for acute back pain
Antidepressants like Cymbalta for chronic back pain
Physical Therapy
Physical therapy is a major part of the treatment of lower back pain. The treatment plan will include personalized exercises to strengthen the core muscles and avoid stress on the spine. Examples include:
Knee-to-chest stretches, hugging your knees for 30 to 60 seconds.
Walking 10 to 20 minutes per day.
Aquatic therapy to alleviate pressure on the spine.
Surgery
If conservative measures don’t work or provide sufficient relief, a healthcare provider may recommend specialist procedures or surgeries that include:
Lumbar intra-articular injections deliver an anesthetic or corticosteroid into the spine for longer-lasting pain relief.
Sinuvertebral nerve ablation destroys spinal nerves with a strong electrical current.
Extracorporeal shockwave therapy ESWT delivers low- or high-energy electrical pulses to help ease pain.
Spinal fusion surgery involves fusing two or more vertebrae to eliminate movement and pain in the facet joints.
Facet rhizotomy is a surgical procedure used to sever one of the nerves supplying the facet joint.
Stem cell regeneration is an experimental procedure in which stem cells are harvested and injected into damaged joints to restore function.
Injury Medical Chiropractic and Functional Medicine Clinic
Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and help mitigate issues through adjustments that help the body realign itself. They can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.
Facet Syndrome Pain Treatment
References
Perolat, R., Kastler, A., Nicot, B., Pellat, J. M., Tahon, F., Attye, A., Heck, O., Boubagra, K., Grand, S., & Krainik, A. (2018). Facet joint syndrome: from diagnosis to interventional management. Insights into imaging, 9(5), 773–789. doi.org/10.1007/s13244-018-0638-x
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