Back Pain & Sciatica Relief

Back Pain

Upper back pain (also known as mid-back pain)

Lower back pain is one of the main reasons Americans visit their doctor. For adults over 40, it’s the 3rd cause for doctor visits after heart disease and arthritis. 80% of people will have lower back pain at some point in their lives. Nearly everyone suffering from lower back pain once will have it again. Americans spend at least $100 billion each year on lower back pain treatment. Back pain is a complex issue because there is no single way to treat it. It takes depth of understanding and skill to treat back pain successfully.

ANATOMY

The spine is made of 24 small bones (vertebrae) that are stacked on top of each other to create the spinal column. Between each vertebra is a soft, gel-like, cushion called a disc that helps absorb pressure and keeps the bones from rubbing against each other. Each vertebra is held to the others by groups of ligaments. Ligaments connect bones to bones; tendons connect muscles to bones. There are also tendons that fasten muscles to the vertebrae. The spinal column also has real joints (just like the knee or elbow or any other joints) called facet joints. The facet joints link the vertebrae together and give them the flexibility to move against each other.

Each vertebra has a hole in the center, so when they stack on top of each other they form a hollow tube that holds and protects the entire spinal cord and its nerve roots. The spinal cord itself is a large collection of nerve tissue that carries messages from your brain to the rest of your body. In order for your body to function, you need your nerves. The spine branches off into thirty-one pairs of nerve roots. These roots exit the spine on both sides through spaces (neural foramina) between each vertebra.

The spine itself has three main segments: the cervical spine, the thoracic spine, and the lumbar spine. There is another important part of the spine whish has tremendous influence but often ignored is Sacrum and pelvis. The cervical and lumbar spine are the most mobile segments and most problems are often seen there. The spine is a highly complex, mobile structure, which gets most of its stability from the muscles surrounding it.

Back pain can be:

• .Acute: lasting less than 3 months. Most people gain relief after 4 to 6 weeks of home treatment.
• Recurrent: a repeat episode of acute symptoms. Most people have at least one episode of recurrent lower back pain.
• Chronic: lasting longer than 3 months.

Symptoms of Back pain:

Back pain can present in a variety of ways, Pain can be constant or intermittent. Intensity can vary from a dull ache to searing agony. The onset may be sudden, with or without apparent reason, or gradual. Depending on cause it may start as dull ache turning in to a stabbing pain.

Pain in the back can be referred from other internal organs or structures. Most of the back pain coming from the musculoskeletal system (from muscle and skeleton) is mechanical in origin. Pain can come from a single source/structure or a combination of sources/structures.

Some conditions and structures that cause back pain:

Cervical spine: Neck pain, Headache, Bulging disc, spinal stenosis
Thoracic spine: Upper back pain
Lumbar spine: Bulging disc, sciatica, spinal degeneration, Spinal stenosis, piriformis syndrome
Sacroiliac joint dysfunction

Most back problems will get better without any intervention. The key is to know when you need to seek medical help and when self-care measures alone will allow you to get better. When medical help is necessary, the decision of which treatment option to use can be difficult since there are so many to choose from. We are here to clear up some myths from the truth and give you some facts based on evidence and research which will empower you to make the right decision.

10 Myths about Lower Back Pain

Myth 1: If your back hurts, you should take it easy until the pain goes away.

Fact: People who remain active despite acute back pain do better, experience less future chronic pain (more then three months) and use fewer healthcare services than those who rest and wait for the pain to diminish. Modify your activities when needed, but stay active.

Myth 2: Bed rest is the best for back pain.

Fact: Patients who treat with bed rest miss more work due to back pain. After three weeks or three months, there is no difference in pain relief, days of limited activity, daily functioning or satisfaction with care. Continuing with regular daily activity has proven to give the fastest recovery when experiencing acute lower back pain. Modifying activities is appropriate, but keep moving! Only if really needed, one or two days of bed rest can be appropriate.

Myth 3: Injuries or heavy lifting causes most back pain.

Fact: Heavy lifting or injuries are risk factors, but do not account for most episodes. Many patients do not seem to remember a specific incident that brought on the pain, “it just seemed to happen.” With spontaneous recovery being the rule, pinpointing an exact cause may not even be necessary in most cases.

Myth 4: Back pain is usually disabling.

Fact: Fear that activity will make the situation worse and delay recovery is unfounded. Actually, patients with acute back or neck pain who continue routine activities as normal as possible do better than those who try either bed rest or immediate exercise.

Myth 5: Tests (X-ray, CT-Scan and MRI) can always identify the cause of a person’s pain.

Fact: Large numbers of pain-free people show spine abnormalities on X-rays, MRI and CT-Scans. People who have never experienced back pain or sciatica (leg pain from a back pain condition) demonstrate in 20-30% of the cases a herniated/bulging disk on a MRI. Spinal stenosis, which is rare in younger adults, occurs in about one fifth of the over-60, pain-free group. Detecting an abnormality on an imaging test only proves one thing: the patient has a spinal abnormality! (The relationship between abnormality and pain always needs to be established).

Myth 6: Everyone with back pain should have some form of imaging (X-ray, MRI, and CT-Scan) before starting any kind of treatment.

Fact: Most patients with acute back pain simply will get better on their own (about 90 percent). Many physicians now advocate imaging tests (after serious conditions are ruled out) only for those patients that fail to recover naturally and after conservative management. The imaging should always support the physical examination findings in order to consider further intervention. An example of conservative management is specialized physical therapy like we provide at Synergy Therapeutic Group. Don’t forget, at STG we treat the impairment, not the imaging.

Myth 7: If you have a herniated/ruptured disk, you must have surgery.

Fact: According to a new study that questions the need to operate on disk injuries, people with herniated disks in their lower backs usually recovered eventually without surgery. Therefore, in most cases, there is no harm in waiting and choosing non-operative approaches.

This study appears in the November 22-29 issue of the Journal of the American Medical Association (JAMA) and is the only large and well-designed trial to compare surgery for Back Pain and Sciatica relief with non-surgical, non-invasive options such as physical therapy methods, waiting, and anti-inflammatory drug use.

Patients are often told that if they delay back surgery they may risk permanent nerve damage, perhaps a weakened leg or even risk losing bowel or bladder control. But nothing like that occurred in this two-year study comparing surgery with preferring to wait and choose non-invasive techniques, in nearly 2,000 patients who suffer from back and leg pain due to herniated disks and sciatica.

The study involved 13 spine clinics in 11 states. The treatment was decided at random. Patients who did not have surgery generally received different non-invasive treatments.
Most specialists agree that surgery is only appropriate when there is a combination of:

• definite disk herniation on an imaging test
• corresponding physical examination findings, e.g. signs of nerve root irritation ( sciatica, pinched nerve in neck/back)
• failure to respond to non-surgical treatment (at least eight weeks) (e.g. specialized Physical Therapy, as we provide at (‘Synergy Therapeutic Group’)

Studies show that the disk shrinks naturally over time: about 90% of patients will experience gradual improvement over six weeks, leaving only ten percent of patients with a symptomatic disk herniation who might require surgery.

Consider all options

Before you agree to back surgery, consider getting a second opinion from a qualified spine specialist. Back and leg pain can be a complex issue that may require a team of health professionals to diagnose and treat. To prevent recurrent back problems, use good body mechanics, keep your back muscles conditioned with regular exercise and stretching and control your weight.

Myth 8: Managing lower back pain with drugs is both an effective and inexpensive alternative to surgery.

FACT: Pain relief drugs have a lot of negative side effects, including new injuries, while the pain is artificially disguised.

MYTH 9: I have to go back to the chiropractor regularly to stay pain free.

FACT: After initial treatments are over you should be able to self manage your condition and symptoms. If you have to go back again and again to get some relief then the treatment was not right for you.

MYTH 10: Physical therapy didn’t work before, why will it work now?

FACT: Back pain is a complex issue. Though somebody has back pain it may not be from the spine. Source and structure causing back pain must be identified to produce great result. When you go to a traditional physical therapist, the chance of having immediate results are slim. Since 90% will get better no matter what type of therapy they get, we are talking about the last 10%. Here at STG we treat the cause, not the symptoms and in the process we produce the best technology and best techniques available.

Research has shown that most back pain that does not go away after traditional, conservative treatment. Relief usually comes from one of three structures in the back: the facet joints, the discs or the sacroiliac joint and its surrounding soft tissues (internal as well as external). The above structures are inter-related. Affecting one may affect the others but often bulging discs are thought to be a more valid consideration as a source of pain as we are able to see them in imaging such as MRI’s. We are expert in treating back conditions which did not get better with traditional physical therapy, shots or previous surgeries.

My pain was about an 8 or 9 on a scale of 10. After 16 treatments when I left the office the last time it was a 0. This is after about 20 years of back pain. (John, DuQuoin, IL)

The materials on this Web site are for your general educational information only. Information you read on this Web site cannot replace the valuable opinion of your health care professional. You should always talk to your licensed health care professional for diagnosis and treatment.

Sciatica

Is sciatica a disorder or a symptom? The term sciatica is commonly used to describe pain that travels along the distribution of the sciatic nerve. Sciatica is a symptom caused by one or a series of disorders occurring in the lumbar spine or surrounding area. The sciatic nerve is the largest nerve in the human body. About the diameter of a finger, it affects more females than males at a 6:1 ratio. There are certain theories that exist to explain why it affects more females than males. Sciatic nerve fibers begin at the 4th and 5th lumbar vertebra (L4, L5) and the first few segments of the sacrum in front of the SI joint. The nerve passes through the sciatic foramen just below the Piriformis muscle (rotates the thigh laterally) (there are other anatomical anomalies of the nerve in relation to the Piriformis muscle) to the back of the extension of the hip and to the lower part of the Gluteus Maximus (muscle in the buttock, thigh extension). The sciatic nerve then runs vertically downward into the back of the thigh, behind the knee, branching into the hamstring muscles (calf) and further down to the feet.

Sciatica Symptoms

Usually, sciatica affects one side of the body. The pain may be dull, sharp, burning or accompanied by intermittent shocks of shooting pain beginning in the buttock traveling downward into the back or side of the thigh and/or leg. Sciatica then extends below the knee and may be felt in the feet. Sometimes symptoms include tingling and numbness. Sitting and trying to stand up may be painful and difficult. Coughing and sneezing can intensify the pain. Sciatica symptoms are a classical example of where we can have 20 patients exhibiting the same symptom, but have 20 different reasons or combination of reasons producing the same symptoms. Sciatica symptom can be caused by:

1) Piriformis Syndrome

This is the most common cause of sciatic pain and is created when pressure is placed on the sciatic nerve by the Piriformis muscle. Muscle imbalances, especially in the lumbo-pelvic area, pulls the hip joints and pelvis out of place. This change of position typically shortens and tightens the Piriformis muscle/ lengthens and weakens, which then places pressure on the sciatic nerve.

2) Lumbar herniated disk

Although this is the end result, this could be due to muscle imbalance. According to a presentation to the American Academy of Orthopedic Surgeons on March 10, 2001, by Dr. Ahn of the Johns Hopkins University, smoking, high blood pressure, and high cholesterol are important risk factors for lower back pain. These are the same risk factors for heart attacks and strokes. He theorizes that smoking, high blood pressure, and high cholesterol damage the inner linings of arteries to form plaques that shut off the blood supply to disks resulting in disk herniation.

3) Sacroiliac joint dysfunction

Irritation of the sacroiliac joint at the bottom of the spine can also irritate the L5 nerve, which lies on top of it, and cause sciatica type pain. This is not a true radiculopathy, but the pain can feel the same as sciatica caused by a nerve irritation. Many times a dysfunctional pelvis secondary to an unstable sacroiliac joint can put undue stress on the sciatic nerve. Sometimes it is associated with suprapubic tenderness.

4) Isthmic Spondylolisthesis

This condition occurs when a small stress fracture allows one vertebral body to slip forward on another vertebral body (e.g. the L5 vertebra slips over the S1 vertebra). With a combination of disk space collapse, the fracture, and the vertebral body slipping forward, the L5 nerve can get pinched as it exits the spine and cause sciatica. The common spinal segment in which this occurs is the L4-5 secondary to this being the most mobile segment. A dysfunctional segment above or an unstable sacroiliac join can put undue strain on the segment.

5) Lumbar spinal stenosis

This condition commonly causes sciatica due to a narrowing of the spinal canal. It is more common in men over age 60 and typically results from a combination of one or more of the following: enlarged facet joints, overgrowth of soft tissue or a bulging disc placing pressure on the nerve roots as they exit the spine. (In the past, surgery was the only option; now with traction assisted manual therapy techniques we are able to reduce symptoms).

6) Pain in MS or some other types of peripheral neuropathy

This pain is related to the demyelinating process (nerve get strip of off insulation) itself. This neuropathic pain is often characterized as having a burning, gnawing or shooting quality. As this is the largest nerve in the body, it can be affected by diabetic neuropathy. (Research and in clinic, we have seen that low level laser helps with this type of pain to some extent but we are uncertain as to how)

As we discussed earlier, sciatic pain affects more females than males by a 6:1 ratio. Research is starting to link together the anatomical, physiological, biochemical and hormonal factors responsible for gender-based differences in pain perception and response to treatments. Anatomically, women are built differently. Since pelvic organs play a big role in maintaining pelvic integrity, the strengthening or retraining of pelvic muscles becomes a key factor for a better outcome in the presence of certain weaknesses.

At Synergy Therapeutic Group we don’t use a “one-size fits all” approach to treating lower back pain or sciatic pain. We develop a system to match certain characteristics of back pain with specific treatment options while keeping gender specificity in mind.

People want the fastest way to get better and that’s what we do!

When we use our method of treatment and everything aligns well, you can see a 50 percent improvement of pain in a couple of visits. We know that patients responded differently to treatments. Some patients had good results from manual manipulations, such as the high-velocity thrust procedures often performed by chiropractors. Other patients had good results from either McKenzie exercises or core-stabilization exercises. Some people responded well to muscle energy techniques. Sometimes treating the shoulder relieved back pain.

Our challenge is to figure out what type of patient responds best to which treatment. For example, if we found a tight Piriformis muscle and immediately started to stretch we have found this may not be the best option. It can increase pain. There are well-documented studies regarding patients’ treatment responses. These studies determined that patients who had certain characteristics of pain responded well to the procedure. For instance, people who had been experiencing pain for less than 15 days had no pain below the knee and had a hypo-mobile or stiff spine, a benefit from certain manual techniques.

Our back pain program has been referred to as a miracle!

We say this is neither a wishlist nor a miracle. It’s a matter of matching a patient’s back pain characteristics with the appropriate and specific treatments in a logical and intuitive fashion with the highest amount of skill producing GREAT RESULTS.

For more information, contact us at our  Du Quoin and Carbondale, IL office at 618-529-4360.

When I started I was in a lot of pain, couldn’t even walk, couldn’t work, or even do things I enjoyed. 6 weeks later I am feeling great and back to work. I would recommend this facility to friends and family in the future… (Shannon, DuQuoin, IL)