Low Back Pain
Low back pain is one of the most common conditions we see in Inver Grove Heights, MN. Not only is it common in Inver Grove Height, it is one of the most common conditions in the United States. Research shows that over 80% of Americans will have some sort of low back pain in their lifetime. This extremely high rate cost the country more than $100 Billion annually according to a study done and UNC. This puts Low back pain as the 6th most costly condition that the country sees.
Not only is low back pain quite common and expensive, it can be chronic as well. It is estimated that 16 million Americans, that is 8% of the population, suffer from chronic low back pain. This pain affects peoples every day lives and can prevent people from doing their jobs, household chores, playing with their kids, sleep, leisure activities, and even messes with people’s social lives.
With low back pain being so common in this country, you could imagine it is one of, if not the most common symptom patients have when they come into our office. The symptoms and causes of low back pain can be diverse in type and intensity. Low back pain can present itself in many ways and here are some of the most common ones we see. Dull, aching pain which tends to be mild to severe pain. Pain that travels from the low back into the buttock, lets, and feet. Sometimes this type of pain that moves is very intense and can affect all different areas of one’s leg. The leg symptoms can be weakness, tingling, or loss of sensation to name a few. A common term used for pain traveling down one’s leg is sciatica. At times low back pain can be worse with sitting or lying down, especially when transition from a seated position to standing, or rolling over in bed. This can make things such as driving exceedingly difficult. Another common type of low back is one which is worse in the morning and tends to loosen up as one moves around.
Now these are many examples of ways people experience low back pain. However, this is not a comprehensive list by any means. Low back pain varies on an individual level, and many factors influence the pain experience, including mental and emotional health, financial stress, or exercise and activity level.
X-rays and Examination
One of the most important aspects of treating low back pain is the initial examination. Taking a good, detailed history is where we start. This allows us to get a good picture of the original cause of the low back pain. Sometimes we find that a patient’s low back pain has been brewing for years because of certain events or microevents that have happened such as a significant car accident or sports injury or sitting at a desk 8 hours a day for 10 years. Our examination can include a lot of things, here are a few aspects that are common at our clinic; palpation of the spine, checking of muscle tone, range of motion, orthopedic tests, neurological tests(sensation, reflexes, muscle testing), functional movements, posture assessment, and x-rays.
One of the more advanced tools that we have at our disposal is the digital x-rays. Digital x-rays are a great tool that are safe and use a very low dose of radiation. X-rays can help us evaluate the cause of one’s low back pain. It can show many things but here are a few: arthritis, the spacing between the vertebrae (disc degeneration), fracture, and other more rare conditions such as cancer. Taking a good history and evaluation will allow us to know if x-rays are necessary. A few reasons that x-rays are recommended are if one had recent trauma, neurological symptoms (pain or sensations going down ones leg), intense symptoms that have been present for a longer period of time, history of spinal surgery, or suspected deformities such as scoliosis.
The use and convenience of having digital x-rays on site helps us evaluate and treat a patient. It allows us to be as specific as possible in the diagnosis and treatment of each individual. Having the x-rays on site allows us to be more efficient with diagnosis and treatment if they are needed. This can help speed up the start of treatment or if need, a referral to another provider.
How does chiropractic help with low back pain?
Chiropractic care is highly effective for the treatment of lower back pain because it looks at the big picture of how the low back is moving and then addresses each individual piece of the puzzle to ensure proper mobility. Chiropractors find where there is dysfunction and puts in a small but effective force to reintroduce motion into a joint. When each segment of the lower back is moving appropriately it allows for not only an increase in mobility, but it also eases discomfort in the area due to proper body mechanics.
There are times when lower back pain is stemming from a different location in the body. If the feet, ankles, knees, or hips are not moving properly that can lead to lower back pain. Chiropractic care can look to ensure that these joints are level and are functioning how they are supposed to. If there is immobility in any joint, the surrounding structures must work overtime to allow normal motion to still take place which over time can lead to pain. Once the joints that are not properly moving are identified they can be adjusted to allow normal motion to occur. After normal mobility is achieved in the lower extremity and lower back it is only a matter of time before the pain starts to diminish.
Physical Therapy and Low Back Pain
Physical therapy can help with low back pain through addressing individual’s pain and inflammation by assessing posture, mobility, range of motion, strength, and neurological function to optimize an individual’s movement. The physical therapist will address impairments and problematic structures causing low back pain. The rehabilitation process with include but not limited to manual therapy, therapeutic exercises, and through movement analysis.
Manual therapy techniques including soft tissue massage, prolonged stretch, and joint mobilizations will be used to address and help structures speed up recovery through the body’s natural inflammatory process. Manual therapies are utilized to increase blood flow and lymphatic return; decreasing adhesions in muscle fibers, and to return muscle fibers to optimal length.
Therapeutic exercises are used alongside manual therapy to correct muscle weakness and improve muscle length for adequate muscle length tension relationship. If a muscle is either too tight or too stretched this causes decreased ability for the muscle to contract at optimal force. Therapeutic exercises will target muscle groups through stretches and strengthening exercises to improve mobility.
Through movement system analysis physical therapists can identify abnormal posture and faulty movement faults to distinguish tissue impairments and contributing factors that will help provide treatment directed towards improving movement patterns and muscle imbalances. The way that humans move is dependent on one’s posture/alignment, muscle force/length, and physical activities. Correcting these impairments will decrease the chance of future injuries.
How Does Massage Therapy help with low back pain?
According to the American Massage Therapy Association, Research shows massage therapy provides several important health benefits, including: Improves blood circulation, which aids in recovery of muscle soreness from physical activity. Massage relaxes muscles for improved range of motion and mobility. Massage leads to increased endorphin levels. Endorphins are a hormone released from the brain and nervous system. They activate the body’s opiate receptors, causing a natural pain-relieving effect. These are all important for the management of acute and chronic low back pain. It is also researched that massage therapy produces the best results when combined with other medical treatments such as chiropractic and physical therapy.
A study on massage and back pain conducted at the Touch Research Institute at the University of Miami in 2001 found that: “Massage lessened lower back pain, depression and anxiety, and improved sleep. The massage therapy group also showed improved range of motion and their serotonin and dopamine levels were higher.” (International Journal od Neuroscience, 106, 131-145)
How does muscle stim, intersegmental traction and inversion traction help with low back pain?
Interferential current therapy is an effective therapy option used by many physiotherapy clinics to relieve pain and accelerate the self-healing process, getting your body back to a healthy, pain free state. The high frequency signals of an IFC penetrate through the skin into the deeper lying muscle tissues. Electrodes are placed on your skin around the injured part. The interferential current device then transmits electrical impulses in minute quantities trough your skin. Underlying tissue and nerves are stimulated which begins the healing properties. These impulses are not painful in the least. In fact, patients describe them sensation as a minor prickle on their skin. Frequencies produced b the IFC have been proven to stimulate endorphins, the body’s natural pain killers. This can help to create a self-healing process without the need for medications. This form of therapy is also extremely useful in reducing pain, inflammation, curing edema, and spasms.
Intersegmental traction tables gently help reestablish the normal ranges of the body’s spine. Intersegmental traction tables also help facilitate muscle relaxation and reduce muscle spasms. It has been shown that use of an intersegmental traction table greatly accelerates recovery progress from a back injury.
The intersegmental table operates by a dual roller moving up and down the muscles on either side of the spine. The rolling contact is constant and works electronically. Intersegmental traction tables are very relaxing and make for a great healing tool.
Inversion therapy is a technique where you are suspended upside down to stretch the spine and relieve back pain. The theory is that by shifting the body’s gravity, pressure eases off the back while also providing traction for the spine. In theory, inversion therapy can improve the space between your spinal discs and relieve pressure. Activities such as sitting, running, and bending can put pressure on these discs. The pressure increases the risk for back pain, a collapsed vertebra, and other complications.
For these reasons, inversion therapy may be beneficial for people with: Chronic Lower back pain, poor circulation, sciatic, and scoliosis.
Sciatica
Sciatica is when the sciatic nerve is irritated, inflamed, or compressed causing pain or other symptoms in the low back and certain parts of one’s leg. The sciatic nerve originates in the low back from the nerve roots L4-S3. It can be caused by a handful of different issues such as a herniated disc, disc degeneration, arthritis, stenosis, inflammation, compression, and piriformis syndrome. Usually the symptoms are located on one side of the body. Here is are a few things that can increase your risk for having sciatica: age, diabetes, being overweight or obese, not exercising regularly, wearing high heels, sleeping on a poor mattress, smoking, and certain types of jobs that involve excessive sitting or lifting.
The most common symptoms are in the thigh, calf or foot which can be accompanied by low back pain. It is common with sciatica to have numbness or weakness along the sciatic nerve which runs from the low back into the buttock, down the back of the leg into the foot. The symptoms can range from throbbing, electric shock, numbness, tingling, weakness, and constant dull ache. In some cases, sciatic can cause intense debilitating pain. At times, sciatica can cause l lack of feeling in certain parts of one’s leg, leg weakness, or decreased reflexes. These are all things a doctor will check during an examination.
Disc Bulges
A disc bulge is a common term that is used when the disc between two vertebrae in your spine has a small outpouching that can put pressure on nerve roots, and they most commonly occur in the lumbar spine. Disc bulges commonly occur with either continued repetitive movements or with an injury. The most common location for a disc to bulge is posterolaterally due to most of our movements are bending forward and because there is not structural support in the back of the disc compared to the front. Disc bulges are “… more likely to occur posterolaterally, where the annulus fibrosus is thinner and lacks the structural support from the anterior or posterior longitudinal ligaments” (Dydyk, 2020). This pressure can cause a variety of sensations from pain to numbness. If the disc bulge gets big enough and has enough pressure it can progress further to a disc herniation which can put even more pressure on the nerve root.
There are many sensations that can occur when a bulge presses against a nerve root, but some of the most common are burning, stinging, or sharp shooting pains. The pain can either remain local or can radiate down the leg in varying lengths. This radiating pain occurs due to the compression of the nerve by the disc bulge. The burning/stinging pain is due to the nerve not being able to communicate constantly with the brain due to the slight compression by the disc bulge. The response from the brain is the numbing sensation that is commonly felt by those with nerve compression from a bulging disc.
Dydyk AM, Ngnitewe Massa R, Mesfin FB. Disc Herniation. [Updated 2020 Aug 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441822/
Low Back Muscle Sprain/Strain
Low back pain can be caused a variety of differing reasons with one of the most common being lumbar muscle strain or ligament sprain. Acute low back pain is most likely associated with improper lifting, bending, and repetitive movements putting increased demand on the low back musculature.
Common symptoms of muscle sprains are pain with flexion, extension, and torsion movements. Through these movements the muscles are either being overly stretched or contracted resulting in pain signals being sent to the brain as our bodies natural protective mechanism.
Physical therapy can help with acute and chronic low back pain through educating individuals to move in a neutral posture during the acute phases to decrease the demand for tissue healing. Through the rehabilitation process, abdominal bracing and activation will be implemented to improve trunk control to reduce the risk of future back injuries due to muscle imbalances.
How does disc degeneration cause low back pain?
This is a condition of the discs between vertebrae with loss of cushioning, fragmentation and herniation related to aging. There may be no symptoms. Our discs act as shock absorbers in the spine and take compression force off the bones. When those discs start to shrink and dry out they don’t absorb as much compression and the bones start to get affected. When the discs start to shrink they also get weaker in material, which makes us more prone to herniations or disc bulges. This can affect the nerves exiting in the lower back causing pain and other symptoms. Some common symptoms people experience are sharp/shooting pain, sciatica or radiating nerve pain, pain with certain movements like bending, lifting and twisting.
Some conservative treatments that can help slow the disc degeneration process are chiropractic, physical therapy, weight loss and massage therapy.BMC- restoration of disc height through non-surgical spinal decompression. Study was for people with discogenic low back pain. 39% of low back pain is discogenic. They found a significant correlation between the increase in disc height and reduction of pain. 1mm of disc increase change and a 2 point decrease in pain scale. Takes stress and pressure off facets joints and nervous system. This can serve a clinically important difference.
Frequently Asked Questions
Why is my Low Back pain worse in the morning?
Low back pain that is worse in the morning and is something that is quite common. Usually people with low back pain in the morning slowly start to loosen up as the get out of bed and start moving around. It can be caused by many different things. Here are a few of them. One cause can be sleeping positions. People who sleep on their stomachs put extra stress on their spine which can cause pain when they wake up. Also, when it comes to sleep, it could be the mattress. Having a good, firmer mattress can go a long way with helping decrease low back pain in the morning. Another cause of morning low back pain can be disc degeneration or arthritis in the lumbar spine. These can cause pain without a major triggering or event. These two conditions are something that happens with age and can start at different times depending on genetics or lifestyle. Getting evaluated by chiropractor will help uncover the specific cause and they can recommend the best form of treatment.
Do I have a muscle strain or a herniated disc?
Many patients come asking or stating that they have either a muscle strain or a herniated disc. How do we know which one it is though? Muscle strains tend to hurt worse when using the muscle. For example, it may hurt less when bending over as compared to getting back up from a bent over position. Disc herniations however can be just as painful in both directions. Disc herniations often cause pain or symptoms that travel down one’s leg. This can come in a few forms such as pain, tingling, loss of sensation, and weakness. In severe cases it can cause bowl or bladder problems which needs medical attention immediately. The good news however is that most low back muscle strains and disc herniations can be handled with conservative treatment and not surgery. Finding the right health care practitioner is especially important!
How can I tell if my low back px is kidney related?
What can I do at home to relieve my low back px?
Some things that you can do to help your back pain at home are stretches and being active regularly. When muscles are too tight, our body makes up the loss of range from a different joint in the body. Being active regularly helps keep our muscles and heart strong as well as keeps our joints moving well.
How do I know my low back pain is serious?
How should I sleep if I have low back pain?
There are many different positions that help lower back pain while sleeping, but the most common one is sleeping on your side with a pillow between your knees. This relieves pressure on your lower back and hips by having your legs in a neutral position. Another position is sleeping on your back with your legs slightly propped up with your upper body propped up as well. If done properly this can relieve pressure on your lower back and feel like sleeping in a “zero-gravity” position. If it is difficult having your upper and lower body propped then try just your knees propped up while laying on your back. Lastly, some find relief by sleeping on your side in the fetal position. This can relieve discomfort as keeps the spine in a neutral position.