Thelumbosacral joint is the first place chiropractors start their investigation with individuals presenting with low back pain and possible sciatica. Because of the importance of the sciatic nerve, almost any lumbar condition has the potential to disturb the nerve that can lead to chronic nerve pain. For many low back conditions, the best way to start is from the bottom and work up.
Starting at the lumbosacral joint L5-S1, the chiropractor will palpate and massage the area. This is because the lumbosacral joint is a central nerve center with all kinds of possible sciatic nerve interference because of the proximity to the various nerve bundles and vertebral discs.
When sciatic nerve issues begin to develop, often the problem will be in this region of the spine. Beginning at the lumbosacral joint can generate vast insight into the root cause of radiating pain in the lower back and legs.
The Lumbosacral Joint
This pain typically presents when the nerve is inflamed, compressed, or irritated. Numbness or chronic weakness can also happen in the lower extremities and can cause unbearable discomfort. Some of the reasons that make the joint a prime suspect for sciatic pain include:
The L5 vertebrae are vulnerable to slipping forward over the connecting S1 vertebrae. The sciatic nerve goes through this area, leaving it open to compression.
A disc herniation and/or inflammation can also stress the sciatic nerves.
Deterioration of the lumbosacral facet joints is common with older individuals. This can lead to nerve compression and sciatic nerve irritation.
Piriformis syndrome can affect the area around the lumbosacral joint, causing nerve compression and inflammation.
The lumbosacral joint is frequently used making it a consistently stressed joint. Overuse, poor posture, and improper body mechanics affect this region of the lumbar spine. And, because of the closeness to the sciatic nerve, it is commonly affected.
Other Spinal Conditions
The lumbosacral joint also experiences problems that stem from chronic conditions, which can involve some form of sciatic pain as a symptom. They include:
Degenerative disc disease
Lumbar stenosis
Sacroiliac joint dysfunction
Spondylolisthesis
Sciatica is a condition that represents a series of symptoms. But it is often a symptom of other condition/s that affect the sciatic nerve. If spinal conditions progress, it can bring undue stress and strain to the lumbosacral joint and the sciatic nerve.
Knowing Where To Begin
The key to a proper and successful treatment plan is an accurate diagnosis. Knowing and understanding the symptoms, spinal conditions, and having an idea of the origin of these types of pain promotes a rapid diagnosis. Our chiropractic and physical therapy team thoroughly investigate the pain source using imaging, palpation, observation, and other diagnostic tools to help get individuals back on track and healthy.
Facet Syndrome Chiropractic Treatment
Dr. Alex Jimenez�s Blog Post Disclaimer
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*
Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
References
Grgi?, Vjekoslav. �Lumbosakralni fasetni sindrom: funkcijski i organski poreme?aji lumbosakralnih fasetnih zglobova� [Lumbosacral facet syndrome: functional and organic disorders of lumbosacral facet joints].�Lijecnicki vjesnik�vol. 133,9-10 (2011): 330-6.
Underlying causes for an abdominal aortic aneurysm can be challenging to diagnose and identify. Combined with sciatica symptoms, doctors could misdiagnose the ailment and prescribe the wrong treatment protocol. Then an individual has to deal with two conditions that were not properly diagnosed, continue to develop, and worsen. This is why finding the right sciatica specialist that can also identify an abdominal aneurysm is so crucial to developing the right treatment plan. There can be a variety of factors that can lead to the development of an abdominal aneurysm. They include:
Health conditions associated with an increased risk for an abdominal aneurysm include:
Atherosclerosis
This condition occurs when there is a buildup of fats, cholesterol, and other substances that create plaque buildup in the bloodstream. This causes vessels to harden and narrow. Atherosclerosis can develop during the young adult stage and becomes an issue later in life.
High Cholesterol
Cholesterol is a waxy, fat-type substance that is found in all the cells in the body. The body needs some cholesterol for the production of hormones, vitamin D, and substances to help digest foods. The body makes all the cholesterol it needs. Too much can build up in the blood vessels, which narrows the bloodstream and hardens the arterial walls.
High Blood Pressure
High blood pressure or hypertension refers to a sustained increased force of blood moving through the aorta that can weaken artery walls. It is a common condition that is widespread among individuals that are older, those that smoke, and those that are overweight. There is an estimated 60-70% of individuals over 60 that are diagnosed with high blood pressure.
Inflamed Arteries
When the arteries become inflamed, it can cause blood flow constriction and cause the arterial walls to weaken. This increases the risk of an aneurysm. Arteries can get inflamed through:
There are hereditary conditions that can weaken the body�s connective tissues. This can lead to degeneration of the aortic walls and raise an individual�s risk for an aneurysm. Two of the most common connective tissue disorders are Ehlers-Danlos syndrome, which affects collagen production, and Marfan Syndrome. This condition increases the production of fibrillin, which is a protein that helps to build the elastic fibers in connective tissue.
Other Risk Factors
Additional health factors can strain the cardiovascular system. This increases the risk of weakening or damaging blood vessels. This significantly raises the chances of developing an abdominal aortic aneurysm. Risk factors include:
Smoking and Tobacco
All types of tobacco use can contribute to diminished cardiovascular health. Individuals that smoke or use some tobacco product pose a significantly higher risk of developing an abdominal aneurysm.
Age
Aneurysms occur most often in older adults. This is because they are more likely to have cardiovascular issues and are more likely to have higher levels of plaque buildup.
Genetics and Family History
Immediate relatives of an individual with an abdominal aneurysm often have a 12-19% chance of developing the condition.
Lack of Physical Activity
Not getting adequate physical activity puts an individual at a higher risk for heart and cardiovascular disease. Aerobic activity done on a regular basis increases the heart rate and blood flow through the body. This keeps the tissues and blood vessels strong and flowing properly.
Gender
Both men and women can develop an abdominal aortic aneurysm. However, the majority of those that do develop the condition are men. This is because men are more likely to go through the heart and cardiovascular issues.
Diagnosis
Underlying conditions that can cause sciatic pain can vary or be a combination of several conditions. The most important action to take is to consult a doctor or chiropractic sciatica specialist for a clinical diagnosis. While rare, sciatica-type pain could be caused by medical conditions like:
Spinal tumor
Spinal infection
Cauda equina syndrome
These factors can contribute to an increased chance of developing an abdominal aortic aneurysm. However, individuals can have unknown risk factors and still develop the condition. Treatments may range from regular monitoring, lifestyle changes, and physical therapy/chiropractic to urgent or emergency surgery. If you feel symptoms of pain in the buttocks, leg, numbness, tingling, or other neurological symptoms in the back and/or leg, it is very important to see a doctor or chiropractor for clinical diagnosis that identifies the cause of the symptoms.
Sciatic Nerve Treatment
Dr. Alex Jimenez�s Blog Post Disclaimer
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*
Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
The sacrum and coccyx are part of the vertebral spinal column and could contribute to low back pain. They are not like the other bones in the spinal column. The sacrum, also known as the sacral vertebra, sacral spine, and S1 is a large, flat triangular-shaped bone that is between the hip bones and below the last lumbar vertebra known as L5. The coccyx, known as the tailbone, is positioned below the sacrum.
The sacrum and coccyx are made up of smaller bones that fuse and grow into a solid bone mass by the age of 30. The sacrum is composed of 5 fused vertebrae known as S1-S5 and 3 to 5 smaller bones that fuse creating the coccyx. Both are weight-bearing bones and are integral to walking, standing, and sitting functions.
Sacrum and the Lumbosacral Spine
The sacrum forms the back of the pelvis. Along with the coccyx and the two sacroiliac joints make up the pelvic girdle. S1 is at the top of the sacrum and connects to the last lumbar vertebrae L5. Together they create the lumbosacral spine. Where they join forms the lumbosacral curves known as lumbar lordosis and lumbar kyphosis.
The curvature works to support the upper body, weight/force distribution maintains spinal balance and flexibility. Lordosis is the inward curve of the spine, but too much can cause swayback that can be associated with spondylolisthesis. Loss of this curve can cause spinal imbalance and can lead to Flatback syndrome.
Kyphosis is the outward curve of the spine. The location of the sacrum at the intersection of the spine and pelvis means it has an important role in the movement of the low back and hips. The sacrum�s joints help to bear weight and help stabilize the spinal column along with the ligaments, tendons, and muscles help support/stabilize joint movement.
Lumbosacral joint
Joint L5 and S1connect the lumbar spine to the sacrum. The pressure at this meeting point can be massive as the curve of the spine shifts from the lordotic forward curve to a kyphotic backward curve. The L5-S1 region bears weight, absorbs, and distributes the upper body�s weight when moving and resting. Disc herniation and spondylolisthesis are more common at L5-S1 for this reason.
Sacroiliac joints
The sacroiliac joints connect the sacrum to the left and right sides of the pelvis. The range of movement of the sacroiliac joints is minimal compared to other joints like the knees. However, the joints are essential for walking, standing, and stabilization of the hips. Sacroiliitis and sacroiliac joint dysfunction are two spinal disorders related to the joints. Other spinal disorders related to the sacral spine include:
The coccyx commonly known as the tailbone is just below the sacrum. It is smaller than the sacrum and has an important weight-bearing function. It helps supports weight while sitting.An example is leaning back while sitting. This motion and position increase the pressure/weight on the coccyx. An injury in this area can cause tailbone pain. Inflammation of the coccyx�s connective tissue that results in tailbone pain that gets worse when sitting is a common symptom. A traumatic event like a fall or auto accident that causes a tailbone fracture can also cause this pain.
Sacral and Coccygeal Nerves
The spinal cord ends at L1-L2, which branches out into the cauda equina, which is a bundle of nerves that looks like a horse’s tail. In the sacrum, there are sacral nerves known as the sacral plexus. Plexus means a network of nerve structures. The sacral and lumbar plexus compose the lumbosacral plexus. This is where the sciatic nerve, which is the largest nerve in the sacral plexusconverges into the band. Sciatic nerve compression causes a combination of symptoms known as sciatica. It is very well known for causing low back and leg pain.
The coccygeal nerve serves the tailbone. There are five sacral nerves numbered S1 through S5 and are part of the spinal cord.
S1 supports groin and hip function
S2 the back of the thighs
S3 the middle of the buttock area
S4 and S5 the anus and vagina
Injury or trauma to the sacral spine can cause mild stress fractures to severe bone fractures. These fractures can cause sacral nerve compression and intense pain. Symptoms include:
A doctor or chiropractor, physical therapist are excellent sources for information to help prevent sacrum and coccyx pain. These medical professionals will utilize a patient’s medical history, recommend lifestyle changes and injury prevention guidelines.
If at risk of developing osteoporosis then a bone mineral density test could be recommended.
Proper posture must be maintained. Avoid slouching as this places added pressure on the lumbosacral spine and the sacroiliac joints.
Proper body mechanics when engaging in any activity needs to be observed.
Use legstrength to lift objects.
Avoid twisting while lifting or holding heavy objects, as this can cause sprain, strain, or serious injury of the lower spine.
Put on the seat belt. Auto accidents are a major cause of spine trauma. Exercise restraint when driving or riding in any vehicle even a golf cart.
Sciatica Pain Relief
Dr. Alex Jimenez�s Blog Post Disclaimer
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*
Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
Women experiencing low back pain will find there are a variety of possible causes. Lower back pain can stem from the reproductive system or the spine itself. Finding the possible cause of low back pain can be difficult to diagnose. As well as, pinpointing the pain can be a very challenging task. Women wonder how it’s possible to mistake menstrual cramps for back pain and then it happens to them. There are certain conditions that make the low back and core region a central location of continual pain. And unfortunately, women could be more susceptible.
Most individuals will experience low back pain at some point during their life. However, there is a slight prevalence and is more common in females than males across all ages. Low back pain in women increases with age. A research comparison studying middle-aged individuals reported an increase of low back pain in females versus males post-menopause. Some possible low back pain causes include.
Menopause and Hormone Issues
Chronic lower back pain is one of the most reported musculoskeletal issues women face during menopause. About sixty-seventy percent of perimenopausal women present symptoms associated with estrogen deficiency. And over half in perimenopause report chronic musculoskeletal pain. Many of these studies show increasing menopausal symptoms and the correlation to chronic low back pain symptoms.
Menstruation and Uterine Dysfunction
Dysmenorrhea is a uterine dysfunction that involves frequent and severe cramping during menstruation, which often leads to low back pain. The condition is classified as primary or secondary. Both types include low back pain as a common symptom.Primary dysmenorrhea starts when a woman begins menstruation and continues throughout their life. Intense contractions can cause continual and severe menstrual cramping. Secondary dysmenorrhea usually starts later and is caused by another condition like endometriosis or pelvic inflammatory disease.
Endometriosis
Endometriosis is a condition that can contribute to back pain in women. Tissue that behaves like endometrial tissue begins to grow outside of the uterus, in the pelvic cavity or other areas. The new tissue responds to the body’s hormonal changes and can cause swelling, pain, spotting, and bleeding. Endometriosis growths bleed monthly as well. Without a place for the blood to go, the excess irritates and inflames the surrounding tissue.
The condition can cause heavy periods, chronic pain, and scar tissue build-up. Symptoms can present at any menstrual cycle stage. Pelvic pain that runs down the legs is common. Some women have also reported throbbing, shooting pain that can be mild to severe. Symptoms include:
Abdominal pain
Low back pain
Pain when walking or standing
Pain during ovulation
Pain when urinating
Urinary urgency
Pelvic inflammation
Constipation
Pain during intercourse
Bowel movement pain
Rectal pain that radiates
Pain caused by scar tissue build-up within the bladder, fallopian tubes, bowels, and ovaries
Chronic fatigue
Endometriosis can be diagnosed by a doctor during an initial pelvic exam. Further imaging tests to assist in the identification could be requested.
Spinal Issues
The reproductive organs can sometimes contribute to back pain. However, women can also be susceptible to degenerative conditions that affect the spine’s structure. Low back pain is common with an average patient experiencing one to two episodes a year. Low back pain can start in early adulthood and become a chronic problem that can be triggered by various events or activities. Most back pain issues are resolved within six weeks. This is known as acute low back pain. When the pain doesn’t stop for more than 12 weeks it is considered chronic lower back pain.
Postmenopausal Compression Fractures
Around twenty-five percent of women will go through a vertebral compression fracture of the middle or lower spine. The risks increase with age, with around a 40 percent chance at 80 years of age. Small cracks in the vertebrae can cause severe disability and limit function. Osteoporosis is the most common cause of vertebral compression fracture/s. Postmenopausal women are at an increase of developing osteoporosis. This comes from hormonal changes that decrease bone mineral density, leaving the bones open to fracture.
Spondylolisthesis
This is when one vertebral body, or the thick oval bone segment in front of the vertebra, slips against an adjacent body. The result is pain or mechanical symptoms. The pain can spread throughout the spine to the hip, buttocks, into the legs, and possibly the foot. The condition can be congenital, from an unknown cause, or acquired. There is some research on childbirth and hysterectomies putting women at risk for spondylolisthesis.
It is common in the lumbar spine/lower back, but can also present in the cervical spine/neck region. The thoracic/middle spine is extremely rare except in trauma cases. The thoracic spine is the longest region of the spine. It is between the cervical and lumbar regions. One cause of the increased pain is longer times spent sitting in chairs that are not ergonomic. A second is being confined to smaller workspaces. The key is to get up and move around or use a sit-stand desk to alternate sitting and standing. Irregular and localized low back pain is typical for low back spondylolisthesis. The pain usually worsens when the area/region is flexed or directly touched.
Piriformis Syndrome
Back pain sometimes isn�t back pain, but piriformis syndrome. The piriformis muscle is a small muscle that extends from the lower spine to the top of the femur. It can involuntarily contract and compress or irritate the sciatic nerve. The muscle helps rotate and turn the leg and foot outward. Symptoms are consistent with sciatica. It typically presents with buttock pain that shoots, aches, or throbs along the leg�s backside, thigh, calf, and foot. Tingling along the nerve along with numbness is common. Causes include:
Buttock injury
Hip injury
Weight training specifically the gluteal/buttock, hips, and hamstrings
Sitting for a long time – Examples include truck drivers, desk job workers, etc.
Damage to the piriformis muscle
Sciatic nerve wraps around the piriformis muscle
Sacroiliac Joint Dysfunction
Sacroiliac joint dysfunction involves inflammation of the joints, located at the connection of the pelvis and lower spine. It can present as low back or buttock pain that radiates down the leg/s. The pain worsens when climbing stairs or standing for an extended amount of time. Sacroiliac joint dysfunction can be tough to diagnose, as it is often mistaken for other low back pain causes.
SI joint dysfunction causes:
Pregnancy – the increased weight and altered movement/s can cause additional stress and wear.
Joint infection – in rare cases, the joints can be subject to infection.
Arthritis – the joints can develop arthritis from normal wear and tear.
Traumatic Injury – the joints can be injured from a forceful impact from a fall or auto accident.
Most cases do not end up requiring medication or surgery. It is when the pain lasts more than six weeks that there could be something more taking place like neurologic symptoms or other conditions, spinal or otherwise.
Personalized Chiropractic Spine Treatment
Dr. Alex Jimenez�s Blog Post Disclaimer
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*
Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
An overview of chiropractic treatment for lower lumbar back pain, how it works, how safe it is, and how often treatment is necessary. Along with the principles of chiropractic for the relief of lower/lumbar back pain, whether acute or chronic. Seeing a doctor ofchiropractic/DC, a chiropractor�or a chiropractic physician can be highly beneficial towards effectively treating low back pain. �
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Practice
Chiropractic medicine utilizes a variety of treatments/therapies that are designed to manipulate/adjust the:
Spine
Joints
Tissues
These treatments focus on the entire body to relieve pain and improve functional ability. This is referred to as spinal manipulative therapy or SMT, but there are many other treatment methods and techniques.
Every chiropractor has a personal treatment approach based on the patient’s condition/s, medical history, and personalized treatment plan. A chiropractor will begin traditionally starting off with soft, natural, less-invasive treatments. If these do not generate positive results they will move on to more aggressive techniques.
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Consent Form
At every stage of the chiropractic process, there is a strict emphasis maintained on proactively discussingwith the patient exactly what is taking place and what is going to happen. A chiropractor makes sure that the patient understands everything that occurs during:
Diagnosis
Examination
Procedure/s
This is all done in order to educate the patient and receive direct permission to start the treatment. The emphasis on informed consent is essential. This is because some chiropractic techniques could carry material risk. This means that a certain technique or particular procedure could possibly cause injury.
A chiropractor also informs the patient of the possible risks of not being treated. It is not meant to scare a patient. It is to eliminate any misunderstandings and make sure that the patient has full control over their body, so they can make an informed decision, as to which way they want to go. �
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Examination
A chiropractor will thoroughly examine a patient before making any sort of diagnosis or treatment plan. The assessment can include:
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Medical history
The characteristics of the pain, any red flag symptoms that require further diagnostic testing will be conducted to remove any potentially serious medical issues that can be associated with neck or lower lumbar back pain-like:
Neurological disorders
Fractures
Infections
Tumors
There can be many reasons as to why low lumbar back pain happens. A chiropractor will investigate and develop a personally customized treatment plan. Next, a physical exam will be performed. This includes an orthopedic and neurological exam. These will test the:
Reflexes
Sensory nerves
Joints
Muscles
Other areas of the body
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Advanced Diagnostic Testing
Imaging and laboratory tests are not always used for non-specificlower lumbar back pain, but they could be necessary if there are signs/symptoms of an underlying condition.
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Severity/Duration of Condition
Chiropractic medicine looks at the symptoms and conditions of an injury or ailment and classifies them on how severe they are, and how long they last. Symptoms can be divided into degrees of severity: They are:
Mild
Moderate
Severe
For the duration period, pain and other symptoms are referred to as:
Acute pain – lasts for less than 6 weeks
Subacute – lasts between 6 and 12 weeks
Chronic – lasts for at least 12 weeks
Flare-ups – the same symptoms happen irregularly or from an exacerbation of the original injury
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Treatment Trial
If an individual is dealing with acute or subacute lower lumbar back pain, then a chiropractic trial could be an option. This could be two to three weekly sessions over the course of two to four weeks adding up to twelve total sessions. This can be a sufficient treatment to completely alleviate the pain. However, when the pain does not go away then additional treatments could be necessary, especially if an individual has other issues/conditions.
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Measured Outcomes
Outcome measurements are a valuable tool because they help determine whether or not the treatment is producing significant results. Some outcome measurements of treatments include:
Numeric Pain Scale for patients to rate the pain
Pain diagram so patients can describe the location and character of the pain
Increases and decreases in normal daily practices, like work, exercise, and sleep
Testing functions
Lifting ability
Strength
Flexibility
Endurance
For some low lumbar back pain could last and go over the 12-week mark making it a chronic pain condition. A chiropractor will look for signs/symptoms to see if there is a risk of developing chronic pain. �
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Chiropractic How Often
When the pain is acute lower lumbar back pain, a standard treatment plan can be six to ten sessions over the course of two to four weeks. These treatments emphasize the passive non-exercise approach of manual therapy for relieving pain and improving function.
If the non-exercise method doesn’t deliver positive results then a more active exercise-based treatment can be utilized to increase function and return an individual back to normal life.
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Back Pain That Doesn’t Go Away
Often acute symptoms are resolved within the first 4-weeks. But it is possible that the pain can become chronic, meaning that it lasts longer than 12 weeks. Some individuals can hit a plateau during the recovery process.
This is referred to as MTB or that the patient has met the therapeutic benefits. A chiropractor will want to see if pausing/stopping chiropractic treatment will have a residual effect, exacerbate the pain, or reduce function and activity.
Example: If mild to severe chronic lower lumbar back pain has worsened, a patient could need one to six more visits with each pain episode. And this would be two to three weekly treatments for two to four weeks. However, patients rarely need continuing or ongoing care of one to four visits per month.
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Re-Evaluation
Chiropractors will not continue treatment/s if they are not helping the patient. Therefore, every 2 to 4 weeks there is a re-evaluation of the patient to see if the treatment is still having a positive and beneficial effect. Here are some of the criteria for continuing treatment:
Individual still responds positively to the treatment
The individual has met the therapeutic benefits and worsens when they are not treated
Proof shows that self-care alone will not be sufficient to maintain the therapeutic benefits
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Continuing Treatment
Living with chronic lower lumbar back pain can be a challenge, but chiropractors want to emphasize to individuals that self-care is an essential component for pain management. This includes physical rehabilitation combined with range-of-motion exercises. A chiropractic physician may encourage a variety of treatment options, like:
Chiropractic treatment and the benefits are different for everybody. This is why it is important to communicate with your chiropractor every step of the way and to be open-minded about the different treatment options they offer.
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Lower Back Pain Chiropractic Treatment
Dr. Alex Jimenez�s Blog Post Disclaimer
The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*
Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas*& New Mexico*�
Bertolotti syndrome is something has not been heard of when it comes to lower back pain, but diagnostic work has uncovered a common congenital condition. Back pain is experienced at some point by all of us. Around two-thirds of the population will develop low back pain in their life, and more than half will develop chronic low back pain or pain that has lasted more than six months. Low back pain can be challenging in finding the root cause. Diagnostic work is required through� X-rays and MRIs. These tests can identify a lesser-known cause of mechanical low back pain called Bertolotti syndrome.
Bertolotti Syndrome
This congenital condition’s name comes from Italian physician Mario Bertolotti. It is in 10 to 20 percent of the population, �with or with no lower back pain. Bertolotti syndrome happens when the last lumbar vertebra, known as the lumbosacral transitional vertebra/LSTV. This vertebra and the sacrum become fused together or create a false joint due to an enlarged transverse process.
This can be bony bumps on the vertebrae where muscles and ligaments attach to the lumbosacral transitional vertebra. When the LSTV and sacrum fuse together, known as sacralization or pseudo-joint, it does not generate pain. It�s just the way that an individual’s anatomy has been since birth. Only when it causes lower back pain that it is called Bertolotti syndrome.
Causes
Low back pain that leads to inflammation and reactive muscle spasms brought on from Bertolotti syndrome can be caused by:
Asymmetrical structures of the lumbar vertebrae. If the LSTV is fused to the sacrum and iliac bone, these are the wings of the pelvis, which can place unwanted stress on the sacroiliac joint, which can cause pain that is felt above the buttocks.
A�pseudo-joint does not have the cushion or lubrication between the bones like real joints to absorb shock. This causes bone-on-bone grinding, which can be quite painful and can lead to osteoarthritis. This can also generate added stress on the discs of the pseudo-joint.
Sacralization fusion can decrease the spine�s mobility. This can speed up the wear and tear of the vertebrae and shock-absorbers of the intravertebral discs.
Added non-equal force/s on the muscle tissues that surround the lower back. This can be caused by the spine not being properly�aligned causing muscle imbalance/s and fatigue. Both sides of the back can be affected, but when tightness and muscle spasms in the low back and pelvis present, it’s usually only on one side.
Symptoms
Most individuals usually never know they have a sacralization or pseudo-joint. These are often found accidentally from an X-ray for something unrelated. But when symptoms present they can vary from person to person and usually appear in adulthood�in the 20s or 30s.
These include:
Low back pain that is localized and does not spread/radiate down the legs
Pain or discomfort in or around the sacroiliac joint
Stiffness that comes out of nowhere or difficulty moving a certain way with pain present
Symptoms improve once the individual sits or lays down
Diagnosis
Bertolotti syndrome can be diagnosed based on medical history, physical exam, and X-rays. A physical exam can include a recreation of the movement/s that triggered the pain/discomfort. An X-ray of the low back and pelvis will reveal any bony abnormalities.
Treatment
Bertolotti syndrome can be effectively managed with non-invasive treatments. These� include:
Improperly and overdoing repetitive rotation/s and extension/s through work or just movements that have become second nature are injuries just waiting to happen. Lifestyle changes and re-learning how to move properly will ease the strain on the affected area.
Over the counter pain medication/s like�Advil, Aleve, or Tylenol.
Chiropractic/Physical therapy can help build low back areas and increase mobility.
Local anesthetic and spaced out intervals of corticosteroid injections to the affected nerve/s to reduce inflammation.
Platelet-rich plasma (PRP) uses the body�s platelets to reduce pain, inflammation, and healing the damaged joints through an injection.
Prolotherapy treatment uses concentrated local anesthetic and dextrose injected into the low back area to enhance the body�s natural healing.
Radiofrequency ablation uses heat to numb the affected nerves around a pseudo-joint so that pain reduces.
Surgery is the last resort and is usually done to eliminate a pseudo-joint. It can also consist of reducing or removing an elongated transverse process�and can be performed as a same-day or outpatient procedure.
If you or someone you know is dealing with some form of idiopathic low back pain and doctors can’t seem to pinpoint the cause. Bertolotti syndrome could be a suspect, therefore it’s best to seek a spine specialist near you that can help.
Research has found that vertebrogenic chronic low back pain could be caused by a lumbar vertebral endplatechange that involves the basivertebral nerveand is not disc-related. The underlying cause of chronic low back pain can be very difficult to diagnose. The intervertebral discs are a common suspect, but when disc-related treatments don�t ease the pain, the root problem could be something else. Researchers are exploring an overlooked area with the vertebral endplates being the cause of vertebrogenic low back pain.
Research has found that there are more nerves in the vertebral endplates than in the spinal discs. More nerves can mean higher potential/increase in pain. And like the other areas of the spine such as the discs and joints, vertebral endplates can also degenerate, also increasing the risk for pain.
Vertebral Endplates and Basivertebral Nerve
The vertebral endplates line the top and bottom of each vertebral body. These are the round, thick, weight-bearing bones in the spine. The vertebral endplates are made of cancellous or spongy bone and function as the barrier between each disc and the vertebrae.
The low back/lumbar spine takes the most weight. That can be a significant amount of pressure on the structures in the low back. The endplates are situated between a cushioned disc/s and the hard, bony vertebral body making them vulnerable to degeneration and nerve damage contributing to chronic low back pain. The endplates and vertebral bodies consist of a network of intraosseous nerves.
Intraosseous nerves live within the bone.
The basivertebral nerve� BVN is an intraosseous nerve that winds through the vertebral bodies. This nerve feeds into each spinal bone through the back of the vertebral body and then branches out with nerves going towards the top and bottom vertebral endplates. Research has shown that although these nerves are inside the bone they can send pain signals from a damaged vertebral endplate that could result in vertebrogenic low back pain. This is why it has been�recently linked it as a possible cause of chronic low back pain.
Nerve pain in the spine has been linked with discs that have degenerated. A doctor, chiropractor/spine specialist refers to this as discogenic pain. But with new research, an understanding of the function the vertebral endplates and BVN play in the sensation of pain has been realized and this is where the term vertebrogenic pain comes from. If a doctor discovers that the endplates could be the source of your chronic low back pain, they might use this term.
Vertebral Endplate Pain Diagnosis
Like most back pain conditions diagnosing vertebral endplate pain can be just as challenging. This is because diagnostic imaging scans typically don�t pick up mild to moderate endplate damage. A classification scale known as Modic changes helps doctors identify vertebrogenic pain.
Modic changes or MC are areas that show up on an MRI showing bone marrow damage that has been linked to low back pain. The name comes from the doctor that classified them in 1988, Dr. Michael Modic. Modic changes help doctors and spine specialists see and understand the connection between endplate damage and chronic low back pain.
2 types were identified that show a connection between vertebral endplate damage and chronic low back pain:
Type 1
This type shows a�development� in the vessels of the vertebral body, that includes:
Inflammation
Edema, which is a collection of excess fluid
Endplate changes like a split or crack/s in the endplate
Type 2
This type reveals changes in the bone marrow like fatty deposits that have taken the place of bone marrow.
If the lumbar MRI shows Type 1 or Type 2 MC, a doctor could recommend a conservative treatment plan that could include:
These could be utilized in conjunction with spine specialist care in addressing symptoms and pain. However, if the pain does not ease or reduce with conservative treatment, a doctor could suggest an outpatient procedure.
Candidates for this procedure usually qualify meeting the following:
The individual has struggled with chronic low back pain for at least 6 months
The pain has not reduced/eased up with at least 6 months of conservative care
MRI shows Type 1 or Type 2 Modic changes�that correlate symptoms of vertebrogenic low back pain
The procedure uses fluoroscopy or an x-ray video. A thin tube called a cannula is inserted into a vertebral pedicle. A pedicle is a structure that sticks out from the back of the vertebra. The cannula tunnels its way to the basivertebral nerve. The doctor then runs the Intracept Radiofrequency generator into the path of the nerve and ablates destroys/removes any obstructions in the nerve with the help of the frequency generator. Since it�s a minimally invasive procedure, it can be performed in an outpatient clinic, allowing the patient to go home the same day.
The device/tool used in the procedure is not implanted in the spine. It is removed once the procedure is done.
Expectations as to how long the pain relief will last depends on:
The severity of the condition
Post-physical therapy
Type of work
Diet
Exercise
One study showed the benefits to last up to two years.
If�nonsurgical treatment has not worked for at least six months talk to your doctor about basivertebral nerve ablation for vertebrogenic chronic low back pain. There are risks and benefits both of which should be discussed in depth.
Endplate or Disc and the Root Cause
The intervertebral discs are often the more common cause of low back pain. But they might not be the root cause of spine pain. More research is going on with the role the vertebral endplates play in spine health. As more patients are being diagnosed earlier then better long-term outcomes will follow.
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