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Low Back Pain

Safe and natural chiropractic care can help with many forms of back pain.

Safe and natural chiropractic care can help with many forms of back pain.

Over 80% of Canadians will suffer back pain at some point in their lives, but despite plenty of diagnostic tools and treatment options available, it’s one of medicine’s most common and complex physical problems.

Low back pain is the second most common reasons for visits to the medical doctor.

Low back pain is a major reason for work time lost, affects income and can limit one’s ability to enjoy life. Most back pain will improve over time but who wants to live in pain? Symptoms are commonly one of the last things to appear due to cumulative trauma or body imbalances. Chiropractors can use a variety of functional assessments and treatments to find and fix these underlying imbalances that increases the risk of low back pain.

Chiropractors rank highly when it comes to patient satisfaction and cost effectiveness for treating low back pain

Best research suggests low back pain is a result of multifactoral causation. That is why the best treatments utilize multiple treatment options. Low back pain can be subcategorized into many more specific low back conditions such as:


Disc Bulge/Herniation

Disc degeneration is a natural part of aging and over time all people will exhibit changes in their discs consistent with a greater or lesser degree of degeneration. However, not all people will develop symptoms for this condition. In fact, degenerative disc disease is quite variable in its nature and severity. There is also no correlation between the severity of degeneration and symptoms that may result. This is why function is always more important then symptoms.

As we age the vertical height of the vertebral disc is decreased resulting in less shock absorption but can also narrow the distance between two adjacent vertebrae which may result in pinched nerves. The loss of disc space may make the spine less stable and the body in turns begins the construction of bony growth called bone spurs or osteophytes which can put pressure on nearby nerve roots or other adjacent tissue.

Those with prior history of back pain, a familial history or those overweight are at increased risk for DDD.

Spinal manipulation, mobilisation, and low back stability exercises can help improve motion and function and thereby limit symptoms of DDD. Surgery in some severe cases may be suggested.


Lumbar Facet Syndrome

Facets are located at every spinal level on both sides of the spine. Facets articulate with its neighbour above and below to form a joint, called your zygapophyseal joint, and provides stability for the spine. These facets in these various regions of the spine lie in different planes and at different angles, to give more or less motion in particular directions as is required for the area.

The zygapophyseal joints are covered by a capsule and full of a nourishing lubricant, synovial fluid. The joints do not have direct blood flow and thereby rely on the diffusion of nutrients and wastes to provide health. Stagnation or fixation of the joint can lead to decrease in synovial fluid movement and subsequent nutrition and joint health. These joints are richly innervated by nerves fibres which can provide a painful stimulus when the joints are injured or irritated.

Conservative treatments include spinal manipulation and/or mobilisation.

Chiropractic adjustments can be an effective way of introducing normal mechanics back into the joint. Although rarely required, if no relief is found intra-articular injections with pain-relieving medication may be the course of action.


Piriformis Syndrome

Is a condition caused by compression or irritation of the sciatic nerve by the piriformis muscle. Sciatic symptoms, tingling and numbness in the buttock and along the course of the sciatic nerve, are the result. The symptoms from piriformis syndrome are consistent with symptoms from a herniated disc so a diagnostic differentiation must take place.

Overuse or strain of the piriformis along with anatomical variations of the neuromuscular relationship increase one’s risk of developing this syndrome. Weak or inactive gluteal muscles, which are important hip extendors and rotators, can add strain on the piriformis creating hypertrophy of the muscle, or muscle strains which may compress or irritate the sciatic nerve passing beneath.

Treatment includes stretching of the piriformis and other overused hypertonic muscles as well as corrective postural exercises and chiropractic manipulation to create a balanced low back, pelvic and hip environment where all tissues have adequate stretch and muscle activation


Sacroiliac Joint Pain

The sacroiliac joint is formed between the bony tailbone (sacrum) and the ilium of the pelvis. The stability of this joint is created by strong ligaments and irregular joint surface areas which unite and interlock the bones. The pelvis has many functions being in the centre of our body. The sacroiliac joints are major shock absorbers and help us with weight and force transfer from leg to leg and vertically from the pelvis up the spine.

Sacroiliac joint pain is usually created from a sacroilitis or inflammation of one of the sacroiliac joints. Sacroiliac joint dysfunction, which is a disruption of the correlative movements between the sacroiliac joints, usually leads to increased stress on the surrounding tissue and resultant inflammation.

Sacroiliac joint pain can often be very sharp (like someone stabbing you) but can also be a variable intensity dull ache in the early stages of dysfunction. This condition commonly leads to secondary complaints such as sciatica and iliotibial band (ITB) syndrome if not treated early enough.

Early intervention is based on pain relief and utilizes ice, chiropractic manipulations and electrotherapy. Exercise and stretches are then required to help activate and co-ordinate muscle control of the sacroiliac joints. Finally, functional movement screening may show deficit movement patterns which may place one at risk for future episodes which can be corrected by further exercise prescription.

Hormonal changes during menstruation and pregnancy can affect the integrity of the sacroiliac joint ligaments. Hence pain can intensify in days leading up to menstruation. As well, relaxation of the sacroiliac joints is a necessary part of pregnancy in allowing the female pelvis to stretch enough to allow birth. More pregnancies lead to a greater risk of sacroiliac joint complications because of previous trauma to the area. Women are also at greater risk of complaints do to structural differences between the male and female pelvis.


Sciatica

Pain in the low back, back of the thigh and/or various parts of the leg caused by compression or irritation of the sciatic nerve. The sciatic nerve is comprised of five lumbar nerve roots. It begins in the lower back and courses through the buttock and down the leg. Pain at times can be fairly severe and can be accompanied by tingling or pins and needles in the thigh and/or leg, numbness and muscular weakness. Typically sciatica only affects one side of the body at a time. Pain can be exacerbated by vibration to the area and pressure to the low back or buttock or exposure to cold weather.

Some risk factors are sedentary lifestyle or occupation as sitting can put prolonged external pressure on the sciatic nerve. Some research highlights walkers and runners at an increase risk due to repetitive contracture of the hip musculature. Middle-aged adults are at increased risk due to age-related changes such as vertebral degeneration and loss of intervertebral disc height. Diabetics are at increased risk due to nerve damage and pregnancy increases risk due to hormonal changes, fetal position and weight gain.

Sciatica is a general term describing symptoms more than an accurate diagnosis so the treatment may vary depending upon the cause. Quite often sacroiliac joint dysfunction is a cause. But sciatica could also be caused by piriformis syndrome, disc herniation and spinal stenosis.


Spinal Stenosis

Spinal stenosis is an abnormal narrowing of the vertebral foramen (spinal canal). It is part of age-related changes, and predicting who will be affected is not possible. No clear correlation is noted between the symptoms of stenosis and race, occupation, sex, or body type.

Progressive narrowing of the spinal canal may occur alone or in combination with acute disc herniations. Congenital and acquired spinal stenosis places the patient at a greater risk for acute neurologic injury. Spinal stenosis is most common in the cervical and lumbar areas.

Depending on which nerves are affected, spinal stenosis can cause pain or numbness in your legs, back, neck, shoulders or arms; limb weakness and loss of coordination; loss of sensation in your extremities; and problems with bladder or bowel function.

The degenerative process can be managed, but it cannot be prevented by diet, exercise, or lifestyle. Treatment revolves around managing complaints and improving spinal stability and functional movement. This can include spinal stability exercises, activity modification and potentially surgery depending on severity of symptoms.


Spondylolisthesis

This condition describes a displacement of a vertebrae in either or anterior (forward) or posterior (backward) position with respect to the vertebrae below. They can occur anywhere in the spine but are most prevalent in the lumbar spine (low back).

Spondylolisthesis can be categorized as either: dysplastic, isthmic, degenerative, traumatic or pathological. Isthmic are the most common form but do not necessarily become symptomatic. The Myerding grading system is used to evaluate the severity of the slip.Diagnosis is made visually from a radiograph.

Conservative treatment is the best approach for stable, non-progressive types, especially if no neurological symptoms exist. Chiropractic treatments, and Active Release Techniques® combined with therapeutic exercise can evaluate and address postural and compensatory movement abnormalities such as a hyperlordotic lumbar spine and hip flexor, hamstring and lumbar paraspinal tightness as well as increase spinal stability. Acupuncture may also be beneficial.

Sound interesting? Please contact our Waterloo chiropractic office to make an appointment today.