Common Diagnosis

Low Back Pain

low-back

One of the most common ailments/discomforts we treat at the clinic is low back pain. Low back pain is the most common reason people visit any doctor. This is probably because we walk upright. The upright posture puts all the pressure where the spine meets the tailbone. This is where the last vertebrae of the spine (L5) compresses the disc into the sacrum (the tailbone or S1). Because of the biomechanics of this area, it is common around the age of forty to see a population that has disc problems, mainly herniated, slipped, ruptured, bulged and compressed discs. I explain this to my patients by asking “How many years do you have your car before it starts having problems?”  Most will say five to six years. With your spine it’s forty years. Think of all the stresses you have put on your spine in forty years. All the lifting, bending, twisting and sitting (sitting being the most pressure you can put on your L5 S1 disc).

Sacroiliac Joint Problems

One of the main types of low back pain is sacroiliac joint problems – caused by bending at the waist and turning the shoulders. This movement is commonly seen in golf, bowling, gardening and vacuuming. (As shown in picture above). This problem mainly occurs because our legs tie or fix our pelvis bones to the ground. When we twist our shoulders, it torques our tailbone (which is connected to our spine) out of position. You will mainly feel pain to the right or left of the belt line in the low back. Sacroiliac joint problems literally put chiropractors on the map because manipulation of the pelvis is the treatment of choice for this problem.

disc    disc

Notice the Disc Bulge at the tip of the pen in red, compressing the light brown nerve root as shown in both photos above.

Disc Ruptures, Herniations and Bulges.

The L5 S1 Joint (joint between the last vertebrae) gets a tremendous amount of torque and compression throughout our lives. Because the disc is like a jelly doughnut, it eventually can lose its jelly, or nucleolus pulposus, through tears in the disc because of the pressure on it. When this occurs, one will commonly feel leg pain, weakness and numbness. This pain can increase with increased sitting on a toilet or lying on your back and lifting your leg so the bottom of your foot faces toward the ceiling. With a disc problem, you will most likely notice increased back and leg pain when your leg gets to approximately 60 degrees to the horizon.

Most patients understandably do not want back surgery when they find they have this problem. At our clinic we offer flexion decompression which decreases disc pressure, reduces the disc bulge, and decreases nerve root pressure.  When patients refrain from activities that hurt their disc and receive treatment for one to three months, they can commonly return to a normal life without surgery. When treating this problem, I coach patients through an extensive ergonomic understanding of the spine throughout recovery, which helps the healing and avoids re-injury.

Stenosis

stenosis

Stenosis is one of the most common back problems affecting retirees. This condition is caused when the holes in the spine (most commonly at the L5 S1 / C5 C6 or low back and lower neck area) are compromised. These holes are called the intervertebral foramen and the spinal canal. Anything that decreases the size and compresses the spinal cord or the nerve coming out of the spine will begin to create leg pains, aches or numbness. It is especially important not to lift or sit too much because both these activities will compress the area of the stenosis and increase leg and back pain. This includes sitting for long drives or going to the movies or sporting events without getting up to stretch. Our approach to this condition is extensive counseling. This is explained through models and ergonomic education on the spine along with decompression of the lower spine. Have I seen this work – yes! I am presently treating an eighty-five year old man with severe stenosis who likes to garden. He entered my office with a pain level of eight (ten being the worst). His primary care physician set him up with a neurosurgeon to have an MRI.  We discovered he had stenosis and within six to eight weeks of treatment, using decompression to his lower spine, his pain level was a one and he was back to gardening. Each patient level of stenosis is different, but if you can obtain these results without surgery, what a home run! By the way, the neurosurgeon sent me a letter and said to continue the decompression treatment.

Spondylolisthesis

When this condition is severe enough, you will find it causes patients to have extremely flexible hamstrings. This is because it relieves their leg symptoms. Once thought to be a disorder of the spine that you are born with, a leading authority in radiology now believes it can only be acquired. Many offensive football linemen have this problem. It is thought to occur because they come from a low position and push up. This causes pressure on the pars interarticularis (boney part of the lower spine) which pulls apart and allows the spine to lose alignment with the tailbone. This in turn causes the spinal cord to get pinched between the last vertebrae and the tailbone which compromises the spinal cord and causes leg pain. Treatment of spondylolisthesis (even with up to 75% slippage or grade 3) can be greatly benefited by decompression done on a cox flexion table. I have a number of patients over the years that have tried a multitude of treatments who swear by cox decompression for their spondylolisthesis symptoms.

Scoliosis

Scoliosis is a common disorder that may affect up to 5% of the population. This is the condition that I have and it started me in chiropractic. While many think the goal of chiropractors is to straighten the spine, the goal is actually to make the spine more flexible (primarily at the apex) where the curve or where the mid-back curve meets the low back curve. This is around the lower shoulder blades and where you may feel most of the pain. Pain is also common to the left or right of the lower spine and along the rib cage. Most commonly, scoliosis will curve to the right between the shoulder blades and to the left in the lower back. Therefore, the right of your upper back and to the left of your lower back may be where you feel the pain and discomfort. It is very important that children during their growth spurts are checked often for curve progression. This should be done every six months between the ages of twelve and eighteen. The check should be visual, to look for a high shoulder, and also an Adams test, which is looking at the spine while the child is touching his or her toes. You are looking to see if the ribs are higher on one side. X-Rays should also be taken and the curve degree should be figured out. If surgery is not necessary, the treatment of choice is manipulation and flexion decompression. It is also important to stay flexible, strong and at a proper weight. Bracing is important during the teenage years if the curve is large enough and/or progressing.

Degenerative Disc Disease

degenerative-disc

The most common ailment the retired population enters a chiropractor’s office for are degenerative disc disease and osteoarthritis. Many wonder if chiropractic can help this condition.  Remember, the conditions’ goal is to stiffen and cause a loss of mobility, which are the very two things chiropractic helps most. Many of my patients with this condition continue to receive treatment because they feel it improves the quality of their life.

X-Ray showing post surgical fusion at L5, S1 with surgical hardware.

Post Back Surgical Patients

I have treated many patients after back surgery with great success! Surgery is commonly successful at relieving arm and leg pain/numbness but patients sometimes feel the same tightness, restriction and ache after back surgery. This is especially true with patients who have had fusion of their neck or low back. Once having an adjustment, the patient commonly will not feel the aggravation of restriction of motion and misalignment that they tolerated prior to treatment.

Back and Leg Pain Before and After Pregnancy

back-pain

I have treated pregnant woman for eighteen years both before and after they deliver. The excess weight and expanding abdominal area takes its toll on the pregnant women’s pelvis and spine area. Take this into account with holding a baby on your hips for the next three years and it is a receipe for disaster to the lower spine. Correcting the mechanics of these areas into proper alignment, learning the proper ergonomics of lifting, taking care of the baby, and strengthening on the back muscles is what solves it.

The model is demonstrating the Piriformis stretch, which should be held for a count of 15, 4 times a day.

Piriformis Syndrome

This is literally a pain in the butt. The piriformis muscle is a muscle that sits right where your back jean pocket is.   When this muscle gets tight, it chokes off the sciatic nerve and creates sciatica. The treatment for this problem is learning proper ergonomics, correction of the sacroiliac joints, and stretching the muscle. A heel lift may also be of benefit.

Headache Prevention and Treatment

Head, neck, and shoulder pain causing tension headaches that induce the migraine headache.
I like to group head, neck, and shoulder pain in with tension headaches and migraines because that is what they often lead to. The biggest culprit of this disorder is sitting forty hours a week looking into a computer screen or driving all week with your neck bent forward. I know this is true because, when I was in chiropractic school and I sat in lectures from 7:30 am to 5:30 pm, then ate and went to the library until 12:00pm, all the sitting gave me tremendous tension headaches and neck pain. I had to have my colleagues work on my neck and shoulders constantly. The head is a fourteen to sixteen pound ball that sits on the neck, like a golf ball sits on a tee. All this pressure downward creates tremendous pressure on the neck joints and its nerves. This in turn causes contracture of the muscles and creates the tension headache. You can usually tell if your headaches are neck related because your shoulders will be tight and you will have pain or stiffness where your neck meets the back of your skull (the sub occipital area.) Correction of the joints in your neck so the vertebrae sits in the right position has a high likelihood of solving the tension headaches and neck pain. Massage and lying flat with a heating pad and towel roll under your neck is also of great benefit.

Headaches & Chiropractic

If you have a headache, you’re not alone. Nine out of ten Americans suffer from headaches. Some are occasional, some frequent, some are dull and throbbing, and some cause debilitating pain and nausea.
 
What do you do when you suffer from a pounding headache? Do you grit your teeth and carry on? Lie down? Pop a pill and hope the pain goes away? There is a better alternative.
 
Research shows that spinal manipulation – the primary form of care provided by doctors of chiropractic – may be an effective treatment option for tension headaches and headaches that originate in the neck.
 
A report released in 2001 by researchers at the Duke University Evidence-Based Practice Center in Durham, NC, found that spinal manipulation resulted in almost immediate improvement for those headaches that originate in the neck, and had significantly fewer side effects and longer-lasting relief of tension-type headache than a commonly prescribed medication.
 
Also, a 1995 study in the Journal of Manipulative and Physiological Therapeutics found that spinal manipulative therapy is an effective treatment for tension headaches and that those who ceased chiropractic treatment after four weeks experienced a sustained therapeutic benefit in contrast with those patients who received a commonly prescribed medication.

Headache Triggers

Headaches have many causes, or “triggers.” These may include foods, environmental stimuli (noises, lights, stress, etc.) and/or behaviors (insomnia, excessive exercise, blood sugar changes, etc.). About 5 percent of all headaches are warning signals caused by physical problems.
 
Ninety-five percent of headaches are primary headaches, such as tension, migraine, or cluster headaches. These types of headaches are not caused by disease. The headache itself is the primary concern.
 
“The greatest majority of primary headaches are associated with muscle tension in the neck,” says Dr. George B. McClelland, a doctor of chiropractic from Christiansburg, VA. “Today, Americans engage in more sedentary activities than they used to, and more hours are spent in one fixed position or posture. This can increase joint irritation and muscle tension in the neck, upper back and scalp, causing your head to ache.”

What Can You Do?

The ACA suggests the following:

  • If you spend a large amount of time in one fixed position, such as in front of a computer, on a sewing machine, typing or reading, take a break and stretch every 30 minutes to one hour. The stretches should take your head and neck through a comfortable range of motion.
  • Low-impact exercise may help relieve the pain associated with primary headaches. However, if you are prone to dull, throbbing headaches, avoid heavy exercise. Engage in such activities as walking and low-impact aerobics.
  • Avoid teeth clenching. The upper teeth should never touch the lowers, except when swallowing. This results in stress at the temporomandibular joints (TMJ) – the two joints that connect your jaw to your skull – leading to TMJ irritation and a form of tension headaches.
  • Drink at least eight 8-ounce glasses of water a day to help avoid dehydration, which can lead to headaches.

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