Low Back Pain: Where Does The Pain Come From?
“Were does the pain come from?” is probably the most common question chiropractors hear, and frequently, the patient is not told the answer to this simple question. The problem is, the question is not so simple. This is because there are many structures in the low back that share a common nerve supply and hence, the pain arising from those structures is located in the same area of the back. For example, the back portion of the disk, the facet capsule and some of the deep muscles in the spine are all innervated by the same nerve and therefore hurt is a similar location. In all honesty, the only way to try to isolate the pain generator is to inject a local anesthetic to block the pain for a short while. This is like when you go to the dentist and they “numb” your tooth so you don’t feel the pain when they work on it. After a few hours, you start to feel some “life” coming back to your mouth and soon it regains its full feeling. Of course, no one would consider “numbing” the back just to figure out exactly where the pain is arising as really, it’s not that important. This is because the chiropractic treatment approach is similar regardless of the exact tissue that is involved. However, it DOES matter in cases where a nerve root is shooting pain down the leg caused by a herniated disk vs. a localized pain in the back that doesn’t radiate. Hence, doctors of chiropractic work hard to differentiate these two distinct types of conditions as the treatment is definitely different.
In 1995, the Quebec Task Force recognized the importance of this distinction and recommended all health care providers concentrate on differentiating the nerve root / herniated disk case from what is called “mechanical low back pain.” As noted in the model below, the arrow and pen point to the two most common structures that cause nerve root pain (the herniated disk) and mechanical low back pain (the facet joint).
The facet joint, when sprained / injured, hurts worse when bending backwards and feels good bending forwards. This is exactly the opposite for the herniated disk where bending backwards helps reduce pain and often reduces the shooting leg pain as well, while bending over even a little can create a sharp stabling pain in the back that may shoot down the leg. Of course, there are variations of this and, to make matters more complicated, BOTH the disk and the facet can generate pain at the same time, so it’s not always this cut and dry.
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Low Back Pain and Balance
What do low back pain and balance have to do with each other? Well, a lot! First (and most obvious), poor balance can lead to falling, which is the number one cause of injuries after the age of 70 (which includes low back pain). Unfortunately, as we age, we lose both balance AND bone density – a double whammy when it comes to falling, as this combination can result in fractures of low back vertebra. Below is a chart that shows what the “normal” length of time we should be able to stand on one foot (eyes open and eyes closed):
As this chart illustrates, over time, we rapidly lose our ability to balance, especially when we close our eyes. In fact, many of us cannot stand on one leg with our eyes closed for more than a few seconds well before the age of 59! Try it! Stand up in a corner of a room or in a doorway where you can grab onto the wall or door jams if you lose your balance. (We certainly do not want you to fall during this test!) Look at your watch or a clock with a second hand and count out loud in time with each second on the clock, “one thousand one, one thousand two, one thousand three, …..”– you get the idea. Once you have the rhythm down, try counting first with your eyes open for 30 seconds and then try it again with the eyes closed. Quite different, isn’t it? Now switch legs and try it again – eyes open first and then eye closed counting in time with the passing of each second. If you’re not pleased with you performance, try it over again a few times. If you’re like most of us, you may feel a little inadequate right now. Most of us need to start including some “balance exercises” into our daily routine.
So, why is it that we lose our balance so easily as we age? This is mostly because we become less active or, more sedentary as we advance in age, partially because we’re not interested in doing activities that require balance. Also, we get afraid of falling down. Remember, when we were young(er), we romped around and bounce off walls and fell all the time. It was “routine” to come home from school with grass stains on our knees and backyard sports always resulted in falling, sometimes pretty hard! Rolling down a hill to purposely getting dizzy was quite attractive to us as kids – but certainly not now! In fact, getting on the floor to play with the kids usually leaves us sore for at least a few days. Now, I’m not suggesting we all run out and start rolling down hills, jump up and down or purposely fall down. But, including active “balance” exercises into our daily routine should be THE LEAST we should do. So, go for a brisk walk or a slow jog, ride a bike, walk in the park on uneven ground.
YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE FOR LOW BACK PAIN! FOR MORE INFORMATION< LOG ON TO: www.newbackpainreliefinfo.com
Spondylolisthesis – What Is That?
Anna was competing in a gymnastics tournament last year and during one of her floor routines, noticed a sharp pain in her low back after performing a series of back hand springs. She said she landed crooked on the last of four back hand springs which resulted in immediate pain in the middle of the low back at the beltline. She has had pain in the low back before and initially, didn’t think this was any different from past episodes but when the pain didn’t improve after a week, she asked her parents if she could see their chiropractor for an adjustment. Her chiropractor took her history and was alerted by the mechanism of injury – the rapid onset of pain after bending backwards and landing crooked during her routine. The low back was carefully examined and during the range of motion testing, Anna’s backward bending test was very painful and limited in motion. When bending backwards at an angle with pressure applied in the low back, sharp pain stopped the test immediately. Her neurological tests were normal and she could bend over and touch her toes – in fact, that felt good. Her chiropractor had a strong suspicion of what had happened and ordered an x-ray to see if the preliminary diagnosis was accurate. The x-rays looked normal but with the history of extreme backward bending and immediate pain onset, a bone scan was ordered which was positive for a stress fracture in the back part of the vertebra. Unfortunately, this meant no gymnastics for 3 months and the use of a low back brace was recommended. The good news is that the back pain was gone within a month and follow-up x-rays 3 months later did not reveal a visible fracture line in the vertebra. Anna was able to resume gymnastics and competed with success and no low back pain.
So, what is spondylolisthesis? As depicted in the side view low back x-ray (left), it is the sliding forward of one vertebra over another (see arrow). It occurs in about 7% of the population and up to 30-50% in cultures that carry their young on their back (like a back pack). It is reported that most people who develop a spondylolisthesis acquire this between ages 6 and 16 due to a developmental weakness in that part of the spine, though more research is showing that the cause is due to trauma. It can also gradually occur over time (called “degenerative”), usually not found before age 50-60, where no single event can be recalled by the patient. There is also a type called a pending spondylolisthesis where a fracture occurs without slippage.
The good news is that “spondylos” are mostly stable and do not require surgery. In the more severe case, the nerves and/or spinal cord can get pinched, in which case surgery is necessary. The symptoms would then include leg pain, weakness, and/or numbness with or without significant low back pain. Most cases however, can be successfully managed without surgery and do not compromise the nerves or cord.
Chiropractic has been found to be very successful in managing patients with spondylolisthesis as the pain generator is often above or below the slipped vertebra. In fact, in one report, chiropractic was found to be more beneficial than medical care for this condition (Mierau D, et.al., J Manip Physiol Therap 1987;10:49-55). For more information on back pain log onto, www.newbackpainreliefinfo.com
IF YOU HAVE A SPONDYLOLISTHESIS YOU MAY BE A CANDIDATE FOR CHIROPRACTIC CARE ! FOR A FREE NO-OBLIGATION CONSULTATION CALL 262-251-8306
What Can I Do to Prevent Low Back Pain?
One important concept in spine care is making the patient an active participant in their rehabilitation. It’s important to change our sedentary lifestyles so that we not only get well, but also do things that prevent problems from occurring in the first place. But first, it is important to understand how back injuries occur. When we bend and twist and pick up things, tremendous forces are placed on the disks and ligaments of the spine. It’s important for muscles to be coordinated and flexible so you have maximum strength to resist.
Hopefully you’ve begun an exercise program. One of the more neglected areas of daily spinal hygiene is stretching. By stretching the muscles that move the bones and joints, we make them more flexible. This can make you more resilient at resisting heavy or awkward loads.
The important thing is to do stretches correctly. In general you want to be warm when you stretch. If you’re not too warm, then proceed slowly, gradually bringing more circulation to the area. After a long walk is a good time to stretch. You can also do stretches throughout the day, even in your office chair. Simple hand and shoulder stretches can be done at the computer, and can help to release tension in the shoulders and wrists.
It’s helpful to hold the stretch for at least 40 seconds so that the muscles have a chance to respond and elongate, and do not bounce, or move in a quick or rapid way.
If you have a back or other joint injury, it’s important that certain stretches are avoided, because they can further increase the stretch on ligaments. For example, you may not be able to touch your toes right now, but there are better ways to gain this flexibility than through toe-touching stretches. This is because bending forward can also aggravate a lower back condition. Instead you can bring the leg up to stretch the back of the thigh by placing the foot on a chair or table (acting as ballet bar). By keeping the low back in good upright posture, the back of the thigh is stretched while also lowering the stress on the spinal disks.
Our office can assist you with creating an individualized daily stretching program that fits your lifestyle, and minimizes the risk of injury. Paying attention to these simple preventive measures can be worth a pound of cure down the road.
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What Causes Low Back Pain From Degenerative Discs?
Back pain that is caused by degenerative discs is very common. But, its causes are poorly understood. For years, doctors observed that people with degenerative discs may have back pain and they may not.
On MRI, some people can have really bad looking degenerative discs and have no pain at all. Another person can have just a small disc problem and have excruciating pain. And, of course, there are all kinds of situations in between.
These findings led to many different theories about the origins of low back pain. And, of course, many different treatments.
A study done in 2005 has done quite a bit to answer the question; “What causes a painful degenerative disc ?”
The scientists dissected discs from patients who had degenerative painful discs, degenerative non-painful discs and healthy discs. They found that the painful degenerative discs had small tears in them and the tears were inflamed. Non-painful degenerative discs were not inflamed and didn’t have the tears.
The tears in the disc are slow to heal because the disc is under stress (tensile stress). The stress doesn’t allow the disc to heal. It’s the same as when you cut yourself badly. You need to have stitches in order for the ends of the wound to be held together with no stress. Then, the cut can heal. Like any damaged tissue, the disc needs to be stress-free in order to heal.
So, how do you get rid of the pain ? Controlling inflammation and taking stress off the disc are keys to getting rid of low back pain. This means, don’t use heating pads, don’t eat foods that increase inflammation and get your spine re-aligned to take pressure off the injured disc. If you do these things, the disc heals itself and the pain goes away.
To find out more about how I treat painful degenerative discs, log on to www.NewBackPainReliefInfo.com and get a copy of our free report. Or call Jennifer at 262-251-8306 and set up a free no obligation for treatment consultation.
References:
The Pathogenesis of discogenic low back pain., Journal of Bone and Joint Surgery-British Volume, January 2005, Vol. 87-B, Issue 1, 62-67.
Ice or Heat for Low Back Pain?
I am often asked whether to use ice or heat when you hurt your back. And, the answer is most definitely ice. Ice, Ice, ICE!
In 14 years of practice, I have only seen one patient that got into trouble using ice. This patient put an ice pack directly on his skin and he developed frostbite.
In contrast, I get two patients a month who sustain a mild back injury. They put a heating pad on it and in the morning they can’t stand up due to severe pain. The heat caused the 
injury to swell and it will take about twice as long to heal. The swelling must be brought down with ice, and then the chiropractic treatment can be allowed to work.
Be aware, emergency room doctors and nurses are notorious for telling patients to use heating pads on their backs and necks. I have no idea why. The scientific literature is pretty clear on this point and you should be too. Any new injury should be iced for the first 48 to 72 hours. After that, heat can be used, but in my experience I would only suggest it if the pain is significantly less. And, I would only use it under the advice of a professional.
When in doubt ice. 20 minutes every two hours and go to your chiropractor as soon as possible.
For more information on how I treat back pain, go to www.newbackpainreliefinfo.com or call Jennifer at 262-251-8306 to schedule an appointment for a free consultation to see if I can help.
