LOW BACK, HIP & LEG PAIN
60% - 80% of the population will experience Low Back Pain at some time in their life. At any given point in time it is estimated that 33% are suffering with it. 70% will have pain sufficient for them to see a doctor. The symptoms can range anywhere from being a nuisance to being severe and debilitating. Many with mild symptoms will self treat with over the counter remedies and ice or heat. When symptoms recur or become severe, the key to successful management is to identify what exactly is causing the symptoms so that the wide range of treatments available can be applied successfully and quickly, then implement a plan to strengthen and stabilize any weaknesses that contributed to its onset.
Causes of Low Back Pain
While there are numerous conditions that result in pain in the neck and upper back, the most common causes are…..
Lumbar Disc Disease: Sandwiched in between the 24 moveable bones of our spine are cushions called intervertebral discs. They are somewhat like jelly donuts with fibrous pastry on the outside called annulus fibrosus and a center filled with a jelly like substance called nucleus pulposus. As we go through life, bending lifting, twisting our backs, stopping short in our cars, playing sports, etc., the annulus acquires small tears. This is painful and in most cases produces some discomfort that is often self limiting. This is the common mild low back pain many people have that self resolves with home care. Over time the process tends to repeat itself, becoming more painful and lasting longer. As the condition recurs the nucleus can leak into the tears in the annulus. The nucleus is an irritant and causes inflammation, so this hurts even more and tends to last longer. If the leakage becomes big enough to distort the outer margin of the disc, the disc will begin to protrude toward the nerves that run down the leg and cause leg pain, tingling, numbness, or sometimes weakness. Generally these bouts can resolve but more often need treatment from a professional. If the nucleus protrudes outside the annulus (disc herniation) and into the spinal canal where the spinal sensitive nerves are, this is more serious and should always be examined and treated by a professional with experience in treating disc disease.
Degenerative Disc Disease: The process described above, over time, results in the disc itself becoming less of an effective shock absorber. It becomes narrower from top to bottom and the spinal bones (vertebra) get closer together. When this occurs the small joints behind the disc, called facet joints squeeze and this hurts. Additionally, the central tunnel the spinal cord runs through as well as the tunnels in between the vertebra through which the nerve roots travel become narrowed. When this happens we refer to it as Spinal Stenosis.
Spinal Stenosis: As the disc disease process described above progresses, the central tunnel through which the spinal cord passes and the smaller openings in between the vertebra get narrower. This can result in gradual squeezing of the descending and or exiting nerve roots causing pain and achiness in the legs. This eventually can cause difficulty walking. Interestingly, many patients with spinal stenosis who can only walk a few steps without pain, will report they are able to walk around the supermarket for hours while holding onto a shopping cart. This is because the act of leaning forward opens the spinal canal and nerve passages, taking pressure off the sensitive nerves.
Lumbar Facet Syndrome: One of the more common causes of low back pain is the lumbar facet syndrome. Behind each disc are 2 small joints called facets. While the disc is designed to bear weight and absorb shock, the purpose of the facets is to guide movement….forward – backward, tilt right and left, turn the torso right and left. Day to day activities, especially those that include extension of the spine (bending backward) like painting a ceiling, cause these joints to compress and this results in low back pain that can radiate to the buttocks, hips, and groin.
Somatic Dysfunction/Vertebral Subluxation Complex: The spinal column is designed to accomplish 2 major functions; protect the spinal cord and allow for movement of the head, neck, and torso in multiple directions. Over the course of the day, our spines accumulate the stresses and strains of daily activities and sometimes a spinal bone, called a vertebra can lock in an abnormal position, creating misalignment. This condition, called Somatic Dysfunction or Vertebral Subluxation Complex can put pressure on the spinal joints or the exiting spinal nerves and produce Low back pain, hip pain, buttocks pain and groin pain. It often contributes to the initiation of disc disease and facet syndrome as described above.
Myofascial Pain/Trigger Points: Tender and sore areas in muscles that hurt when pressure is applied are called tender points. When they persist and pain seems to refer outward from the sore area, we refer to them as trigger points. If trigger points persist we call the condition myofascial pain syndrome. Most people have experienced tender points form muscle strain. These often go away by themselves. Trigger points on the other hand are more painful and persistent. Many people unfortunately suffer with chronic myofascial pain syndrome. Symptoms typically occur after a muscle has been contracted repetitively. This can be caused by repetitive motions used in jobs or hobbies or by stress-related muscle tension.
Making Pain Go AWAY
Treatment to resolve pain successfully is dependent upon an accurate diagnosis. This is accomplished by taking a thorough history, doing a complete examination, and utilizing any of a variety of diagnostic tools we have at our disposal. Once completed , the spectrum of treatment modalities available include medication, Osteopathic/Chiropractic manipulation, Physical Therapy, Injections, Computerized Non-Surgical Spinal Decompression, and Surgery. For herniated and degenerative discs with or without spinal stenosis in particular we are happy to be able to offer both Cox type manual decompressive flexion distraction and computerized non-surgical spinal decompression.