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What are Back Mice? Understanding Painful Lumps in the Back

What are Back Mice? Understanding Painful Lumps in the Back

Individuals may discover a lump, bump, or nodule under the skin around their lower back, hips, and sacrum that can cause pain by compressing nerves and damaging the fascia. Can knowing the conditions linked to them and their symptoms help healthcare providers determine a correct diagnosis and develop an effective treatment plan for them?

What are Back Mice? Understanding Painful Lumps in the Back

Painful Bumps, Nodules Around Low Back, Hips, and Sacrum

Painful masses in and around the hips, the sacrum, and the lower back are lumps of fat or lipomas, fibrous tissue, or other types of nodules that move when pressed on. Some healthcare providers and chiropractors, in particular, use the non-medical term back mice (In 1937, the term was used to describe lumps associated with episacroiliac lipoma) to describe the bumps. Some healthcare professionals argue against calling the masses mice because it is not specific and could lead to misdiagnoses or incorrect treatment.

  • Most show up in the lower back and hip area.
  • In some cases, they protrude or herniate through the lumbodorsal fascia or the network of connective tissue that covers the deep muscles of the lower and middle back.
  • Other lumps can develop in the tissue under the skin.

Today, many conditions are associated with back mice lumps, including:

  • Iliac crest pain syndrome
  • Multifidus triangle syndrome
  • Lumbar fascial fat herniation
  • Lumbosacral (sacrum) fat herniation
  • Episacral lipoma

Related Conditions

Iliac Crest Pain Syndrome

  • Also known as iliolumbar syndrome, iliac crest pain syndrome develops when a tear in the ligament occurs.
  • The ligament band connects the fourth and fifth lumbar vertebrae with the ilium on the same side. (Dąbrowski, K. Ciszek, B. 2023)
  • Causes include:
  • Tearing the ligament from repeated bending and twisting.
  • Trauma or fracture of the ilium bone caused by a fall or vehicle collision accident.

Multifidus Triangle Syndrome

  • Multifidus triangle syndrome develops when the multifidus muscles along the spine weaken and diminish function or ability.
  • These muscles can atrophy, and intramuscular fatty tissue can replace the muscle.
  • Atrophied muscles decrease the spine’s stability and can cause lower back pain. (Seyedhoseinpoor, T. et al., 2022)

Lumbar Facial Fat Herniation

  • The lumbodorsal fascia is a thin fibrous membrane covering the back’s deep muscles.
  • Lumbar fascial fat herniation is a painful mass of fat that protrudes or herniates through the membrane, gets trapped and inflamed, and causes pain.
  • The causes of this type of herniation are currently unknown.

Lumbosacral (Sacrum) Fat Herniation

  • Lumbosacral describes where the lumbar spine meets the sacrum.
  • Lumbosacral fat herniation is a painful mass like lumbar facial herniation in a different location around the sacrum.
  • The causes of this type of herniation are currently unknown.

Episacral Lipoma

Episacral lipoma is a small painful nodule under the skin that primarily develops over the top outer edges of the pelvic bone. These lumps occur when a portion of the dorsal fat pad protrudes through a tear in the thoracodorsal fascia, the connective tissue that helps hold the back muscles in place. (Erdem, H. R. et al., 2013) A healthcare provider may refer an individual to an orthopedist or orthopedic surgeon for this lipoma. An individual may also find pain relief from a massage therapist familiar with the condition. (Erdem, H. R. et al., 2013)

Symptoms

Back lumps can often be seen under the skin. They are typically tender to the touch and can make sitting in a chair or lying on the back difficult, as they often appear on the hip bones and sacroiliac region. (Bicket, M. C. et al., 2016) The nodules may:

  • Be firm or tight.
  • Have an elastic feel.
  • Move under the skin when pressed.
  • Cause intense, severe pain.
  • The pain results from pressure on the lump, which compresses the nerves.
  • Damage to the underlying fascia can also cause pain symptoms.

Diagnosis

Some individuals do not realize they have nodules or lumps until pressure is applied. Chiropractors and massage therapists often find them during treatments but do not diagnose the abnormal fatty growth. The chiropractor or massage therapist will refer the patient to a qualified dermatologist or medical professional who can perform imaging studies and a biopsy. Determining what the lumps are can be challenging because they are non-specific. Healthcare providers sometimes diagnose the nodules by injecting them with a local anesthetic. (Bicket, M. C. et al., 2016)

Differential Diagnosis

The fatty deposits can be any number of things, and the same applies to the sources of nerve pain. A healthcare provider may further diagnose by ruling out other causes, which can include:

Sebaceous Cysts

  • A benign, fluid-filled capsule between the layers of skin.

Subcutaneous Abscess

  • A collection of pus beneath the skin.
  • Usually painful.
  • It can become inflamed.

Sciatica

  • Radiating nerve pain down one or both legs that is caused by a herniated disc, bone spur, or spasming muscles in the lower back.

Liposarcoma

  • Malignant tumors can sometimes appear as fatty growths in the muscles.
  • Liposarcoma is typically diagnosed by biopsy, where some tissue is removed from the nodule and examined for cancer cells. (Johns Hopkins Medicine. 2024)
  • An MRI or CT scan may also be performed to determine the exact location of the nodule.
  • Painful lipomas are also associated with fibromyalgia.

Treatment

Back nodules are usually benign, so there’s no reason to remove them unless they’re causing pain or mobility problems (American Academy of Orthopedic Surgeons: OrthoInfo. 2023). However, they should be examined to make sure they are not cancerous. Treatment usually involves injected anesthetics, such as lidocaine or corticosteroids, as well as over-the-counter pain relievers like NSAIDs.

Surgery

If pain is severe, surgical removal may be recommended. This involves cutting out the mass and repairing the fascia for lasting relief. However, removal may not be recommended if there are many nodules, as some individuals can have hundreds. Liposuction may be effective if the lumps are smaller, more extensive, and comprise more fluid. (American Family Physician. 2002) Complications of surgical removal can include:

  • Scarring
  • Bruising
  • Uneven skin texture
  • Infection

Complementary and Alternative Treatment

Complimentary and Alternative Medicine treatments like acupuncture, dry needling, and spinal manipulation can help. Many chiropractors believe back nodules can be successfully treated with complementary and alternative therapies. A common approach uses acupuncture and spinal manipulation in combination. A case study reported that anesthetic injections followed by dry needling, which is similar to acupuncture, improved pain relief. (Bicket, M. C. et al., 2016)

Injury Medical Chiropractic and Functional Medicine Clinic specializes in progressive therapies and functional rehabilitation procedures focused on restoring normal body functions after trauma and soft tissue injuries and the complete recovery process. Our areas of practice include Wellness & Nutrition, Chronic Pain, Personal Injury, Auto Accident Care, Work Injuries, Back Injury, Low Back Pain, Neck Pain, Migraine Headaches, Sports Injuries, Severe Sciatica, Scoliosis, Complex Herniated Discs, Fibromyalgia, Chronic Pain, Complex Injuries, Stress Management, Functional Medicine Treatments, and in-scope care protocols. If the individual requires other treatment, they will be referred to a clinic or physician best suited for their condition, as Dr. Jimenez has teamed with the top surgeons, clinical specialists, medical researchers, therapists, trainers, and premiere rehabilitation providers.


Beyond the Surface


References

Dąbrowski, K., & Ciszek, B. (2023). Anatomy and morphology of iliolumbar ligament. Surgical and radiologic anatomy : SRA, 45(2), 169–173. doi.org/10.1007/s00276-022-03070-y

Seyedhoseinpoor, T., Taghipour, M., Dadgoo, M., Sanjari, M. A., Takamjani, I. E., Kazemnejad, A., Khoshamooz, Y., & Hides, J. (2022). Alteration of lumbar muscle morphology and composition in relation to low back pain: a systematic review and meta-analysis. The spine journal : official journal of the North American Spine Society, 22(4), 660–676. doi.org/10.1016/j.spinee.2021.10.018

Erdem, H. R., Nacır, B., Özeri, Z., & Karagöz, A. (2013). Episakral lipoma: Bel ağrısının tedavi edilebilir bir nedeni [Episacral lipoma: a treatable cause of low back pain]. Agri : Agri (Algoloji) Dernegi’nin Yayin organidir = The journal of the Turkish Society of Algology, 25(2), 83–86. doi.org/10.5505/agri.2013.63626

Bicket, M. C., Simmons, C., & Zheng, Y. (2016). The Best-Laid Plans of “Back Mice” and Men: A Case Report and Literature Review of Episacroiliac Lipoma. Pain physician, 19(3), 181–188.

Johns Hopkins Medicine. (2024). Liposarcoma. www.hopkinsmedicine.org/health/conditions-and-diseases/sarcoma/liposarcoma

American Academy of Orthopedic Surgeons: OrthoInfo. (2023). Lipoma. orthoinfo.aaos.org/en/diseases–conditions/lipoma

American Family Physician. (2002). Lipoma excision. American Family Physician, 65(5), 901-905. www.aafp.org/pubs/afp/issues/2002/0301/p901.html

Relief from Neurogenic Claudication: Treatment Options

Relief from Neurogenic Claudication: Treatment Options

Individuals experiencing shooting, aching pain in the lower extremities, and intermittent leg pain could be suffering from neurogenic claudication. Can knowing the symptoms help healthcare providers develop an effective treatment plan?

Relief from Neurogenic Claudication: Treatment Options

Neurogenic Claudication

Neurogenic claudication occurs when spinal nerves become compressed in the lumbar or lower spine, causing intermittent leg pain. Compressed nerves in the lumbar spine can cause leg pain and cramps. The pain usually worsens with specific movements or activities like sitting, standing, or bending backward.  It is also known as pseudo-claudication when the space within the lumbar spine narrows. A condition known as lumbar spinal stenosis. However, neurogenic claudication is a syndrome or group of symptoms caused by a pinched spinal nerve, while spinal stenosis describes the narrowing of the spinal passages.

Symptoms

Neurogenic claudication symptoms can include:

  • Leg cramping.
  • Numbness, tingling, or burning sensations.
  • Leg fatigue and weakness.
  • A sensation of heaviness in the leg/s.
  • Sharp, shooting, or aching pain extending into the lower extremities, often in both legs.
  • There may also be pain in the lower back or buttocks.

Neurogenic claudication is different from other types of leg pain, as the pain alternates – ceasing and beginning randomly and worsens with specific movements or activities. Standing, walking, descending stairs, or flexing backward can trigger pain, while sitting, climbing stairs, or leaning forward tends to relieve pain. However, every case is different. Over time, neurogenic claudication can affect mobility as individuals try to avoid activities that cause pain, including exercise, lifting objects, and prolonged walking. In severe cases, neurogenic claudication can make sleeping difficult.

Neurogenic claudication and sciatica are not the same. Neurogenic claudication involves nerve compression in the central canal of the lumbar spine, causing pain in both legs. Sciatica involves compression of nerve roots exiting from the sides of the lumbar spine, causing pain in one leg. (Carlo Ammendolia, 2014)

Causes

With neurogenic claudication, compressed spinal nerves are the underlying cause of the leg pain. In many cases, lumber spinal stenosis – LSS is the cause of pinched nerve. There are two types of lumbar spinal stenosis.

  • Central stenosis is the main cause of neurogenic claudication. With this type, the central canal of the lumbar spine, which houses the spinal cord, narrows, causing pain in both legs.
  • Lumbar spinal stenosis can be acquired and develop later in life due to spine deterioration.
  • Congenital means the individual is born with the condition.
  • Both can lead to neurogenic claudication in different ways.
  • Foramen stenosis is another type of lumbar spinal stenosis that causes the narrowing of spaces on either side of the lumbar spine where nerve roots branch off the spinal cord. The associated pain is different in that it is either in the right or left leg.
  • The pain corresponds to the side of the spinal cord where the nerves are being pinched.

Acquired Lumbar Spinal Stenosis

Lumbar spinal stenosis is usually acquired due to the degeneration of the lumbar spine and tends to affect older adults. The causes of the narrowing can include:

  • Spinal trauma, such as from a vehicle collision, work, or sports injury.
  • Disc herniation.
  • Spinal osteoporosis – wear-and-tear arthritis.
  • Ankylosing spondylitis – a type of inflammatory arthritis that affects the spine.
  • Osteophytes – bone spurs.
  • Spinal tumors – non-cancerous and cancerous tumors.

Congenital Lumbar Spinal Stenosis

Congenital lumbar spinal stenosis means an individual is born with abnormalities of the spine that may not be apparent at birth. Because the space within the spinal canal is already narrow, the spinal cord is vulnerable to any changes as the individual ages. Even individuals with mild arthritis can experience symptoms of neurogenic claudication early on and develop symptoms in their 30s and 40s instead of their 60s and 70s.

Diagnosis

Diagnosis of neurogenic claudication is largely based on the individual’s medical history, physical examination, and imaging. The physical examination and review identify where the pain is presenting and when. The healthcare provider may ask:

  • Is there a history of lower back pain?
  • Is the pain in one leg or both?
  • Is the pain constant?
  • Does the pain come and go?
  • Does the pain get better or worse when standing or sitting?
  • Do movements or activities cause pain symptoms and sensations?
  • Are there any usual sensations while walking?

Treatment

Treatments can consist of physical therapy, spinal steroid injections, and pain meds. Surgery is a last resort when all other therapies are unable to provide effective relief.

Physical Therapy

A treatment plan will involve physical therapy that includes:

  • Daily stretching
  • Strengthening
  • Aerobic exercises
  • This will help improve and stabilize the lower back muscles and correct posture problems.
  • Occupational therapy will recommend activity modifications that cause pain symptoms.
  • This includes proper body mechanics, energy conservation, and recognizing pain signals.
  • Back braces or belts may also be recommended.

Spinal Steroid Injections

Healthcare providers may recommend epidural steroid injections.

  • This delivers a cortisone steroid to the outermost section of the spinal column or the epidural space.
  • Injections can provide pain relief for three months to three years. (Sunil Munakomi et al., 2024)

Pain Meds

Pain medications are used to treat intermittent neurogenic claudication. These include:

  • Over-the-counter analgesics like acetaminophen.
  • Nonsteroidal anti-inflammatory drugs or NSAIDs like ibuprofen or naproxen.
  • Prescription NSAIDs may be prescribed if needed.
  • NSAIDs are used with chronic neurogenic pain and should only be used when required.
  • The long-term use of NSAIDs can increase the risk of stomach ulcers, and the overuse of acetaminophen can lead to liver toxicity and liver failure.

Surgery

If conservative treatments are unable to provide effective relief and mobility and/or quality of life are affected, surgery known as a laminectomy may be recommended to decompress the lumbar spine. The procedure may be performed:

  • Laparoscopically – with small incisions, scopes, and surgical instrumentation.
  • Open surgery – with a scalpel and sutures.
  • During the procedure, facets of the vertebra are partially or completely removed.
  • To provide stability, the bones are sometimes fused with screws, plates, or rods.
  • Success rates for both are more or less the same.
  • Between 85% and 90% of individuals undergoing the surgery achieve long-lasting and/or permanent pain relief. (Xin-Long Ma et al., 2017)

Movement Medicine: Chiropractic Care


References

Ammendolia C. (2014). Degenerative lumbar spinal stenosis and its imposters: three case studies. The Journal of the Canadian Chiropractic Association, 58(3), 312–319.

Munakomi S, Foris LA, Varacallo M. (2024). Spinal Stenosis and Neurogenic Claudication. [Updated 2023 Aug 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK430872/

Ma, X. L., Zhao, X. W., Ma, J. X., Li, F., Wang, Y., & Lu, B. (2017). Effectiveness of surgery versus conservative treatment for lumbar spinal stenosis: A system review and meta-analysis of randomized controlled trials. International journal of surgery (London, England), 44, 329–338. doi.org/10.1016/j.ijsu.2017.07.032

The Ultimate Guide To Strengthening Multifidus Muscles

The Ultimate Guide To Strengthening Multifidus Muscles

For individuals experiencing lower back pain can understanding the anatomy and function of the multifidus muscle help in injury prevention and in the development of a highly effective treatment plan?

The Ultimate Guide To Strengthening Multifidus Muscles

Multifidus Muscle

The multifidus muscles are long and narrow on either side of the spinal column, which helps stabilize the lower region of the spine or lumbar spine. (Maryse Fortin, Luciana Gazzi Macedo 2013) Sitting too much, practicing unhealthy postures, and lack of movement can progress to the multifidus muscle weakening or atrophy, which can lead to spinal instability, vertebral compression, and back pain. (Paul W. Hodges, Lieven Danneels 2019)

Anatomy

Known as the deep layer, it is the innermost layer of the three muscle layers of the back and controls the movement of the spine. The other two layers, known as the intrinsic and superficial, are responsible for the thoracic cage/rib cage and shoulder movement. (Anouk Agten et al., 2020) The multifidus has attachment points at:

  • The thoracic spine of the middle back.
  • The lumbar spine of the lower back.
  • The iliac spine – the base of the wing-shaped iliac bone of the pelvis.
  • Sacrum – series of bones at the base of the spine connected to the tailbone.
  • When standing or moving, the multifidus muscle works with the transversus abdominus and pelvic floor muscles to stabilize the lumbar spine. (Christine Lynders 2019)

Muscle Function

The main function is to stabilize the lower back, but it also helps extend the lower spine whenever reaching or stretching. (Jennifer Padwal et al., 2020) Because the muscle has numerous attachment points and is serviced by a specific branch of nerves known as the posterior rami, it allows each vertebra to work individually and more efficiently.

  • This protects against spinal deterioration and the development of arthritis. (Jeffrey J Hebert et al., 2015)
  • The multifidus muscle works with two other deep muscle groups to stabilize and move the spine. (Jeffrey J Hebert et al., 2015)
  • The rotatores muscle enables unilateral rotation, turning from side to side, and bilateral extension or bending backward and forward.
  • The semispinalis muscle above the multifidus allows extension and rotation of the head, neck, and upper back.
  • The multifidus muscle ensures spinal strength because it has more attachment points to the spine than the other layers, which reduces spinal flexibility and rotation but increases strength and stability. (Anouk Agten et al., 2020)

Lower Back Pain

A weak multifidus muscle destabilizes the spine and provides less support to the vertebra. This adds pressure on muscles and connective tissues between and adjacent to the spinal column, increasing the risk of lower back pain symptoms. (Paul W. Hodges, Lieven Danneels 2019) The loss of muscle strength and stability can cause atrophy or wasting away. This can cause compression and other back problems. (Paul W. Hodges et al., 2015) Back problems associated with multifidus muscle deterioration include (Paul W. Hodges, Lieven Danneels 2019)

  • Herniated discs – also bulging or slipped discs.
  • Nerve entrapment or compression pinched nerve.
  • Sciatica
  • Referred pain – nerve pain originating from the spine felt in other areas.
  • Osteoarthritis – wear-and-tear arthritis
  • Spinal osteophytes – bone spurs
  • Weak abdominal or pelvic floor muscles can compromise the core, increasing the risk of chronic lower back pain and injury.

Individuals are recommended to consult a physical therapist and chiropractor who can help develop the appropriate treatment, rehabilitation, and strengthening plan based on age, injury, underlying conditions, and physical abilities.


Can Core Exercises Help with Back Pain?


References

Fortin, M., & Macedo, L. G. (2013). Multifidus and paraspinal muscle group cross-sectional areas of patients with low back pain and control patients: a systematic review with a focus on blinding. Physical therapy, 93(7), 873–888. doi.org/10.2522/ptj.20120457

Hodges, P. W., & Danneels, L. (2019). Changes in Structure and Function of the Back Muscles in Low Back Pain: Different Time Points, Observations, and Mechanisms. The Journal of orthopaedic and sports physical therapy, 49(6), 464–476. doi.org/10.2519/jospt.2019.8827

Agten, A., Stevens, S., Verbrugghe, J., Eijnde, B. O., Timmermans, A., & Vandenabeele, F. (2020). The lumbar multifidus is characterised by larger type I muscle fibres compared to the erector spinae. Anatomy & cell biology, 53(2), 143–150. doi.org/10.5115/acb.20.009

Lynders C. (2019). The Critical Role of Development of the Transversus Abdominis in the Prevention and Treatment of Low Back Pain. HSS journal : the musculoskeletal journal of Hospital for Special Surgery, 15(3), 214–220. doi.org/10.1007/s11420-019-09717-8

Padwal, J., Berry, D. B., Hubbard, J. C., Zlomislic, V., Allen, R. T., Garfin, S. R., Ward, S. R., & Shahidi, B. (2020). Regional differences between superficial and deep lumbar multifidus in patients with chronic lumbar spine pathology. BMC musculoskeletal disorders, 21(1), 764. doi.org/10.1186/s12891-020-03791-4

Hebert, J. J., Koppenhaver, S. L., Teyhen, D. S., Walker, B. F., & Fritz, J. M. (2015). The evaluation of lumbar multifidus muscle function via palpation: reliability and validity of a new clinical test. The spine journal : official journal of the North American Spine Society, 15(6), 1196–1202. doi.org/10.1016/j.spinee.2013.08.056

Hodges, P. W., James, G., Blomster, L., Hall, L., Schmid, A., Shu, C., Little, C., & Melrose, J. (2015). Multifidus Muscle Changes After Back Injury Are Characterized by Structural Remodeling of Muscle, Adipose and Connective Tissue, but Not Muscle Atrophy: Molecular and Morphological Evidence. Spine, 40(14), 1057–1071. doi.org/10.1097/BRS.0000000000000972

Understanding Quadriceps Tightness and Back Alignment Issues

Understanding Quadriceps Tightness and Back Alignment Issues

For individuals dealing with lower back pain, it could be quadricep muscle tightness causing the symptoms and posture problems. Can knowing the signs of quadricep tightness help prevent pain and avoid injury?

Understanding Quadriceps Tightness and Back Alignment Issues

Quadriceps Tightness

Quadriceps muscles are in the front of the thigh. Forces that could be creating chronic pain and posture problems could be happening at the same time are:

  • Quadricep tightness causes lower back pain as the pelvis gets pulled down.
  • Tight quadriceps lead to weakened hamstring muscles.
  • These are the opposing muscles behind the thigh.
  • Stress and pressure on the hamstrings can cause back pain and problems.
  • Pelvic alignment becomes affected, causing posture problems and increased pain symptoms. (Sai Kripa, Harmanpreet Kaur, 2021)

Quadriceps Tightness Pulls the Pelvis Down

One of the four muscles in the quadriceps group:

  • The rectus femoris attaches to the pelvis at the anterior superior iliac spine, which is the front part of the hip bone.
  • The rectus femoris is the only muscle in the group that crosses over the hip joint, which also affects movement.
  • When the quadriceps, especially the rectus femoris, become tight, they pull down on the hips.
  • The pelvis tilts downward or forward, technically referred to as the anterior tilt of the pelvis. (Anita Król et al., 2017)
  • The spine is between the pelvis, and if the pelvis tilts forward, the lumbar spine compensates by arching.
  • A larger arch in the lower back is referred to as excessive lordosis and often causes tightness and pain in the back muscles. (Sean G. Sadler et al., 2017)

Hamstring Compensation

  • When the quadriceps tighten and the pelvis gets pulled down, the back has an abnormal lift. This puts the hamstring on a consistent stretch that can cause pain symptoms.
  • Healthy posture and hamstring muscle tone help maintain correct pelvic positioning in the back.
  • This is correct because it helps maintain a comfortable position.
  • Quadricep tightness can set off a reaction as the pelvis tilts down in front and up in the back while overly stretching the hamstrings.
  • Pain and soreness are the usual result
  • Lack of hamstring strength and quadriceps stretching can cause the hamstrings to lose their ability to support correct pelvic and spinal positions. (American Council on Exercise. 2015)

Knowing When Quads Are Tightening

  • Individuals often don’t realize their quadriceps are tight, especially those who spend most of the day sitting.
  • The more time spent in a chair can cause the quadriceps and lower back muscles to tighten steadily.

Individuals can try a few tests at home:

Standing Up

  • Push the hips forward.
  • Push from the sitting bones so you’re at the correct level.
  • How far forward do the hips go?
  • What is felt?
  • Pain could indicate tight quadriceps.

In A Lunge Position

  • With one leg forward and bent in front of the other.
  • The back leg is straight.
  • How far forward does the leg go?
  • What is felt?
  • How does the front of the hip on the back leg feel?

Standing Bent Leg

  • Stand with the front leg bent and the back leg straight.
  • Discomfort in the back leg could mean tight quadriceps.

In A Kneeling Position

  • Arch the back
  • Grab the ankles
  • Modify the position to adjust for any pain or joint issues.
  • If you have to prop yourself up or modify the pose to reduce pain, it could be tight quadriceps.
  1. Helping to understand the condition can help in communication with a healthcare provider.
  2. A healthcare provider and/or physical therapist can conduct a posture evaluation examination to test the quadriceps.

Understanding Academic Low Back Pain: Impact and Chiropractic Solutions


References

Kripa, S., Kaur, H. (2021). Identifying relations between posture and pain in lower back pain patients: a narrative review. Bulletin of Faculty of Physical Therapy, 26(34). doi.org/doi: 10.1186/s43161-021-00052-w

Król, A., Polak, M., Szczygieł, E., Wójcik, P., & Gleb, K. (2017). Relationship between mechanical factors and pelvic tilt in adults with and without low back pain. Journal of back and musculoskeletal rehabilitation, 30(4), 699–705. doi.org/10.3233/BMR-140177

Sadler, S. G., Spink, M. J., Ho, A., De Jonge, X. J., & Chuter, V. H. (2017). Restriction in lateral bending range of motion, lumbar lordosis, and hamstring flexibility predicts the development of low back pain: a systematic review of prospective cohort studies. BMC musculoskeletal disorders, 18(1), 179. doi.org/10.1186/s12891-017-1534-0

American Council on Exercise. (2015). 3 Stretches for Opening Up Tight Hips (Fitness, Issue. www.acefitness.org/resources/everyone/blog/5681/3-stretches-for-opening-up-tight-hips/

Gain Flexibility, Improve Posture: The Sit and Reach Test

Gain Flexibility, Improve Posture: The Sit and Reach Test

For individuals experiencing tightness in the lower back and hamstrings, can utilizing the sit and reach test help determine an individual’s risk for future pain and injury?

Gain Flexibility, Improve Posture: The Sit and Reach Test

Sit and Reach Test

Lower back and hamstring tightness and pain symptoms are usually brought on by muscle stiffness. The sit-and-reach test is one of the most common ways to measure lower back and hamstring flexibility. Exercise physiologists, physical therapists, chiropractors, and fitness trainers use the sit-and-reach test to measure lower back and hamstring flexibility to assess baseline flexibility. The test has been around since 1952 (Katharine F. Wells & Evelyn K. Dillon 2013) and has an extensive database of results across all age groups and genders.

  • Individuals can use the sit-and-reach test to compare flexibility to the average result for individuals of the same gender and age.
  • For healthcare providers, the test may be repeated after several weeks to determine flexibility progress.

Measurement

The test can be a valuable measurement of functional flexibility to sit with the legs straight in front and reach the toes. Jobs, sports, and everyday tasks regularly require bending over, reaching, and lifting objects. These are real-life examples of how having a healthy back and hamstring flexibility is vital in preventing pain symptoms and injuries. New flexibility assessments are currently being developed, and many trainers and therapists use their own versions with patients and clients. But even with more advanced specialized flexibility tests, the sit and reach test can be a functional testing tool for tracking general flexibility changes over time. (Daniel Mayorga-Vega et al., 2014)

Performing The Test

A special sit-and-reach testing box is used; however, individuals can make their own testing box by finding a heavy-duty box around 30cm or 11.811 inches tall. Set a measurement ruler/stick on top of the box so that 26 cm or 10.2362 inches of the ruler extends over the front edge toward the individual being tested. The 26cm mark should be at the edge of the box.

  1. Get into position – Remove shoes and sit on the floor with legs stretched out in front with the knees straight and feet flat against the front end of the test box.
  2. Start the movement – In a slow, steady motion, lean forward, keeping the knees straight, and slide the hands up the ruler as far as possible.
  3. Stretch and repeat – Extend as far as possible, record the results, rest, and repeat three times.
  4. Calculate the results – Average the results.

Results

Results compare flexibility over time to norms, or averages, for gender and age. Adequate flexibility is reaching the toes – the 26-cm mark on the ruler while keeping the legs straight.

Adult Women

  • 37cm or 14.5669 inches or above: Excellent
  • 33 to 36cm or 12.9921 inches: Above average
  • 29 to 32cm or 11.4173 inches:  Average
  • 23 to 28cm or 9.05512 inches: Below average
  • Below 23cm or 8.66142 inches: Poor

Adult Men

  • 34cm or 13.3858 inches or above: Excellent
  • 28 to 33cm or 11.0236 inches:  Above average
  • 23 to 27cm or 9.05512 inches:  Average
  • 16 to 22cm or 6.29921 inches: Below average
  • Below 16cm or 5.90551 inches: Poor

Alternatives

Individuals can test their own hamstring and lower back flexibility with some easy at-home tests. Use these methods while working on flexibility, and keep a record to see improvements. (Brittany L. Hansberger et al., 2019) One alternative is the V-sit reach test.

  • To perform this, make a line on the floor with tape, then place a measuring tape perpendicular to the tape, making a cross.
  • Sit with the feet in a V shape, touching the tape, feet about a foot apart, with the measuring tape between the legs; the 0 end starts where the legs part.
  • Overlap hands with arms outstretched in front.
  • Repeat three times, leaning forward and reaching with hands out.
  • Then, repeat and take note of how far the hands could reach.

Another alternative is the fingertip-to-floor-distance test.

  • Individuals will need someone to measure the distance between their fingertips and the floor.
  • Warm up with a few practice stretches of standing and bending toward the floor.
  • Then, measure how far from the floor the fingertips are.
  • The ability to touch the floor is a good sign.

Improving Flexibility

Individuals with less than adequate flexibility are recommended to work on stretching the major muscle groups in both the upper and lower body on a regular basis to improve and maintain body flexibility.

  • Individuals can incorporate dynamic stretching, which consists of active movements utilizing a full range of motion as part of warming up for workouts, sports, or other activities.
  • Static stretching is recommended when cooling down after the muscles are warmed up and joints are lubricated.
  • The American College of Sports Medicine recommends 2 to 3 sessions a week of flexibility training and learning to stretch daily.
  • Stretches should be held for 15 to 30 seconds, then released and repeated 2 to 4 times. (Phil Page 2012)

This will take time and dedication, but with the help of trained specialists, regaining flexibility and full range of motion can be accomplished.


Benefits of Stretching


References

Katharine F. Wells & Evelyn K. Dillon (1952) The Sit and Reach—A Test of Back and Leg Flexibility, Research Quarterly. American Association for Health, Physical Education and Recreation, 23:1, 115-118, DOI: 10.1080/10671188.1952.10761965

Mayorga-Vega, D., Merino-Marban, R., & Viciana, J. (2014). Criterion-Related Validity of Sit-and-Reach Tests for Estimating Hamstring and Lumbar Extensibility: a Meta-Analysis. Journal of sports science & medicine, 13(1), 1–14.

Hansberger, B. L., Loutsch, R., Hancock, C., Bonser, R., Zeigel, A., & Baker, R. T. (2019). EVALUATING THE RELATIONSHIP BETWEEN CLINICAL ASSESSMENTS OF APPARENT HAMSTRING TIGHTNESS: A CORRELATIONAL ANALYSIS. International journal of sports physical therapy, 14(2), 253–263.

Page P. (2012). Current concepts in muscle stretching for exercise and rehabilitation. International journal of sports physical therapy, 7(1), 109–119.

Understanding Spinal Synovial Cysts: An Overview

Understanding Spinal Synovial Cysts: An Overview

Individuals that have gone through a back injury may develop a synovial spinal cyst as a way to protect the spine that could cause pain symptoms and sensations. Can knowing the signs help healthcare providers develop a thorough treatment plan to relieve pain, prevent worsening of the condition and other spinal conditions?

Understanding Spinal Synovial Cysts: An Overview

Spinal Synovial Cysts

Spinal synovial cysts are benign fluid-filled sacs that develop in the spine’s joints. They form because of spinal degeneration or injury. The cysts can form anywhere in the spine, but most occur in the lumbar region/lower back. They typically develop in the facet joints or junctions that keep the vertebrae/spinal bones interlocked.

Symptoms

In most cases, synovial cysts don’t cause symptoms. However, the doctor or specialist will want to monitor for signs of degenerative disc disease, spinal stenosis, or cauda equina syndrome. When symptoms do present, they typically cause radiculopathy or nerve compression, which can cause back pain, weakness, numbness, and radiating pain caused by the irritation. The severity of symptoms depends on the size and location of the cyst. Synovial cysts can affect one side of the spine or both and can form at one spinal segment or at multiple levels.

Effects Can Include

  • Radiculopathy symptoms can develop if the cyst or inflammation caused by the cyst comes into contact with a spinal nerve root. This can cause sciatica, weakness, numbness, or difficulty controlling certain muscles.
  • Neurogenic claudication/impingement and inflammation of spinal nerves can cause cramping, pain, and/or tingling in the lower back, legs, hips, and buttocks. (Martin J. Wilby et al., 2009)
  • If the spinal cord is involved, it may cause myelopathy/severe spinal cord compression that can cause numbness, weakness, and balance problems. (Dong Shin Kim et al., 2014)
  • Symptoms related to cauda equina, including bowel and/or bladder problems, leg weakness, and saddle anesthesia/loss of sensation in the thighs, buttocks, and perineum, can present but are rare, as are synovial cysts in the middle back and neck. If thoracic and cervical synovial cysts develop, they can cause symptoms like numbness, tingling, pain, or weakness in the affected area.

Causes

Spinal synovial cysts are generally caused by degenerative changes like osteoarthritis that develop in a joint over time. With regular wear and tear, facet joint cartilage/the material in a joint that provides protection, a smooth surface, friction reduction, and shock absorption begins to waste away. As the process continues, the synovium can form a cyst.

  • Traumas, large and small, have inflammatory and degenerative effects on joints that can result in the formation of a cyst.
  • Around a third of individuals who have a spinal synovial cyst also have spondylolisthesis.
  • This condition is when a vertebrae slips out of place or out of alignment onto the vertebra underneath.
  • It is a sign of spinal instability.
  • Instability can occur in any spine area, but L4-5 are the most common levels.
  • This segment of the spine takes most of the upper body weight.
  • If instability occurs, a cyst can develop.
  • However, cysts can form without instability.

Diagnosis

Treatment

Some cysts remain small and cause few to no symptoms. Cysts only need treatment if they are causing symptoms. (Nancy E, Epstein, Jamie Baisden. 2012)

Lifestyle Adjustments

  • A healthcare professional will recommend avoiding certain activities that worsen symptoms.
  • Individuals might be advised to begin stretching and targeted exercises.
  • Physical therapy or occupational therapy may also be recommended.
  • Intermittent use of over-the-counter nonsteroidal anti-inflammatories/NSAIDs like ibuprofen and naproxen can help relieve occasional pain.

Outpatient Procedures

  • For cysts that cause intense pain, numbness, weakness, and other issues, a procedure to drain fluid/aspiration from the cyst may be recommended.
  • One study found that the success rate ranges from 0 percent to 50 percent.
  • Individuals who go through aspiration usually need repeat procedures if fluid build-up returns. (Nancy E, Epstein, Jamie Baisden. 2012)
  • Epidural corticosteroid injections can reduce inflammation and could be an option to relieve pain.
  • Patients are recommended to receive no more than three injections per year.

Surgical Options

For severe or persistent cases, a doctor may recommend decompression surgery to remove the cyst and surrounding bone to relieve pressure on the nerve root. Surgical options range from minimally invasive endoscopic procedures to larger, open surgeries. The best surgical option varies based on the severity of the situation and whether associated disorders are present. Surgical options include:

  • Laminectomy – Removal of the bony structure that protects and covers the spinal canal/lamina.
  • Hemilaminectomy – A modified laminectomy where a smaller portion of the lamina is removed.
  • Facetectomy – The removal of part of the affected facet joint where the synovial cyst is located, usually following a laminectomy or hemilaminectomy.
  • Fusion of the facet joints and vertebra – Decreases vertebral mobility in the injured area.
  1. Most individuals experience immediate pain relief following a laminectomy or hemilaminectomy.
  2. Fusion can take six to nine months to heal completely.
  3. If surgery is performed without fusion where the cyst originated, the pain could return, and another cyst could form within two years.
  4. Surgery Complications include infection, bleeding, and injury to the spinal cord or nerve root.

How I Gained My Mobility Back With Chiropractic


References

Wilby, M. J., Fraser, R. D., Vernon-Roberts, B., & Moore, R. J. (2009). The prevalence and pathogenesis of synovial cysts within the ligamentum flavum in patients with lumbar spinal stenosis and radiculopathy. Spine, 34(23), 2518–2524. doi.org/10.1097/BRS.0b013e3181b22bd0

Kim, D. S., Yang, J. S., Cho, Y. J., & Kang, S. H. (2014). Acute myelopathy caused by a cervical synovial cyst. Journal of Korean Neurosurgical Society, 56(1), 55–57. doi.org/10.3340/jkns.2014.56.1.55

Epstein, N. E., & Baisden, J. (2012). The diagnosis and management of synovial cysts: Efficacy of surgery versus cyst aspiration. Surgical neurology international, 3(Suppl 3), S157–S166. doi.org/10.4103/2152-7806.98576

Gaining Posture Awareness Through Low Back Curve Exercises

Gaining Posture Awareness Through Low Back Curve Exercises

For individuals trying to achieve healthy posture, could using posture awareness training be effective in treatment and prevention?

Gaining Posture Awareness Through Low Back Curve Exercises

Posture Awareness

Spinal curves help support the body’s weight, movement, and balance. Five areas include the neck, upper back, lower back, sacrum, and coccyx. The bottom of the spine or sacrum rests between the two hip bones that comprise the pelvis. Because of this location, the movements made with the pelvis significantly affect the spine. (Ibrahim Alkatout, et al., 2021) When the pelvis moves, the spine moves.

  • Posture-related back pain and associated symptoms are often caused by a weakened strength and flexibility ratio between the opposing muscle groups that hold the body upright.
  • Achieving healthy posture requires technique and consistent practice for maintaining a healthy pelvis and low back curve. (DeokJu Kim, et al., 2015)
  • Finding the low back curve and exploring how it responds when moving the pelvis is important to effective posture awareness training.

Lower Back Curve Awareness Exercise

One important thing to do to increase postural awareness is to become aware of the low back curve. (Arkadiusz Łukaz Żurawski, et al., 2020)

Sit On a Firm Chair or Stool

  • So that the weight is planted into the seat in a balanced way.

Hold Onto the Arms of the Chair

  • If the chair doesn’t have arms, hold onto the edge of a desk/workstation or the sides of the chair seat.
  • This will support the back when moving the pelvis.
  • Maintaining core abdominal strength is key to preventing back injury. (Erika Zemková, Ludmila Zapletalová. 2021)

Movement

  • Tilt the pelvis forward.
  • In this position, notice the slightly exaggerated arch in the lower back and the increase in lower back muscle tension.
  • A moderate amount of this increase and exaggeration is normal.

Relax Back to the Start Position

Sitting upright with the hip bones/top of the pelvis directly above the bottom.

  • Next, tilt the pelvis back.
  • The abs may have to work hard to support this position
  • Use your hands against the chair for support.
  • Check the lumbar curve area, noticing if it has flattened out.
  • Notice the tension in the back muscles.
  • Is it a little looser? This is normal.

Relax Back to the Start Position

  • Sitting upright.
  • Repeat the sequence again.
  • This time, when in the forward position, pause briefly and slide a hand between the lower back and the back of the chair or the wall.
  • When in the backward position, there will be little to no space between the lower back and the seatback or wall.

Problems

  • If there are problems moving the pelvis back and forth, imagine a basket or bowl of fruit.
  • The pelvis has a round shape and is open at the top, like a bowl or basket.
  • Imagine the fruit is placed toward the front of the bowl, and the weight brings the bowl/pelvis forward.
  • To go back, imagine the fruits are placed toward the back.
  • The weight causes the bowl to roll backward.
  • This may help to get the rhythm of the movement.

This posture awareness exercise can be used as a posture muscle builder by doing it with the back against the wall.

  • A more challenging position for this exercise is standing against a wall.
  • Keep the heels against the baseboard to really work the abs.
  • Start with sitting and gradually to standing.

Foot Motion and Posture


References

Kim, D., Cho, M., Park, Y., & Yang, Y. (2015). Effect of an exercise program for posture correction on musculoskeletal pain. Journal of physical therapy science, 27(6), 1791–1794. doi.org/10.1589/jpts.27.1791

Alkatout, I., Wedel, T., Pape, J., Possover, M., & Dhanawat, J. (2021). Review: Pelvic nerves - from anatomy and physiology to clinical applications. Translational neuroscience, 12(1), 362–378. doi.org/10.1515/tnsci-2020-0184

Żurawski, A. Ł., Kiebzak, W. P., Kowalski, I. M., Śliwiński, G., & Śliwiński, Z. (2020). Evaluation of the association between postural control and sagittal curvature of the spine. PloS one, 15(10), e0241228. doi.org/10.1371/journal.pone.0241228

Zemková, E., & Zapletalová, L. (2021). Back Problems: Pros and Cons of Core Strengthening Exercises as a Part of Athlete Training. International journal of environmental research and public health, 18(10), 5400. doi.org/10.3390/ijerph18105400