Lower Back Pain

Low Back Pain:

Low back pain has surpassed the common cold as the number one leading cause of missed work. It is estimated that there are over two hundred (200) hundred causes of back pain. Back pain can range from a dull, annoying ache to absolute agony. Many cases of back pain are caused by stresses placed on the muscles, ligaments, tendons, fascia, joints and the nerves. Some examples of causes of back pain are: sedentary jobs, poor posture, obesity, lack of exercise, acute trauma, and repetitive motion injuries.

Sciatica vs. Disc Complaint:

LVPRC successfully treats patients with back pain that mimics a disc problem because often the symptoms are not caused by a nerve root entrapment at the intervertebral foramen or Disc; rather, the symptoms are caused by a peripheral nerve entrapment. It is not uncommon when ART® is used to free up the peripheral entrapments that significant improvements in Sciatica cases occur within only four to six (4-6) patient visits. In fact, there has been complete resolution of all symptoms in many of our previous patients that have been diagnosed with prior disc problems.

Common sites for peripheral entrapment of the Sciatic nerve that mimic a disc complaint:

® Entrapped Sciatic nerve between the hamstrings

® Entrapped Sciatic nerve in the Adductor Magnus and/or hamstrings muscles

® Entrapped Sciatic nerve in the Superior Gammelus muscle as the Sciatic nerve passes over it

® Entrapped Sciatic nerve in the Piriformis muscle as the Sciatic nerve passes under or through the Piriformis muscle

How ART® Resolves Sciatica:

Active Release Technique® (ART®) has revealed that Back Pain and Sciatica is more often caused by peripheral nerve entrapments than by nerve route entrapments at the Foramen and Disc. Significant improvement or resolution in Sciatica cases, within only two or three (2-3) patient visits, is not uncommon when ART® is used to free up the peripheral entrapment sites. In fact, many of our previous patients that had been diagnosed with disc problems have experienced complete resolution of all symptoms.

Some of the common sites for peripheral entrapment of the Sciatic nerve can be found:

• Between the hamstrings
• Attached to the Adductor Magnus and hamstrings muscles
• Attached to the Superior Gammelus muscle as the Sciatic nerve passes over this muscle
• Attached to the Piriformis muscle as the Sciatic Nerve passes under or through the Piriformis muscle

Active Release Technique® (ART®) has been shown to be very effective in the treatment of Sciatica. Rather than simply addressing just one area, ART® restores unimpeded motion and function to all the soft tissues.

Herniated Disc:

The bones (vertebrae) that form the spine in your back are cushioned by small, spongy discs. When these discs are healthy, they act as shock absorbers for the spine and keep the spine flexible, but, when a disc is damaged, it may bulge or break open. This is called a herniated disc. It may also be called a slipped or ruptured disc. See a picture of a herniated disc. You can have a herniated disc in any part of your spine, but most herniated discs affect the lower back (lumbar spine). Some herniated discs happen in the neck (cervical spine) and, more rarely, in the upper back (thoracic spine). This topic focuses mainly on the lower back.

Causes of a Herniated Disc:

A herniated disc may be caused by wear and tear of the disc. As you age, your discs dry out and aren't as flexible. Injuries to the spine may cause tiny tears or cracks in the hard outer layer of the disc. When this happens, the gel inside the disc can be forced out through the tears or cracks in the outer layer of the disc. This causes the disc to bulge, break open, or break into pieces.

Symptoms of a Herniated Disc:

When a herniated disc presses on nerve roots, it can cause pain, numbness, and weakness in the area of the body where the nerve travels. A herniated disc in the lower back can cause pain and numbness in the buttock and down the leg. This is called Sciatica (pronounced "sy-AT-ih-kuh"). Sciatica is the most common symptom of a herniated disc in the low back. If a herniated disc is not pressing on a nerve, you may have a backache or no pain at all. If you have weakness or numbness in both legs, along with loss of bladder or bowel control, contact your medial doctor immediately. This could be a sign of a rare but serious problem called Cauda Equina Syndrome.

Diagnosis of a Herniated Disc:

The picture below shows a herniation in the lower lumbar spine.

LVPRC doctors may diagnose a herniated disc by asking questions about your symptoms and by an examination. If your symptoms clearly point to a herniated disc, you may not need tests. However, your doctor may recomend tests such as an MRI or a CT scan to confirm a herniated disc or to rule out other health problems.

Causes of a Herniated Disc:

A herniated disc usually is caused by wear and tear of the disc (also called disc degeneration). As we age, our vertebral discs lose some of the fluid that helps them maintain flexibility. A herniated disc also may result from injuries to the spine which may cause tiny tears or cracks in the outer layer (annulus or capsule) of the disc. The jellylike material inside the disc (nucleus) may be forced out through the tears or cracks in the capsule which cause the disc to bulge, break open (rupture), or break into fragments. See an illustration of a herniated disc. Injury to the disc can occur from a sudden heavy strain or increased pressure to the lower back. Sometimes a sudden twisting movement or even a sneeze will force some of the nucleus (the material inside the disc) out through the disc's outer layer (annulus or capsule). Repetitive activities, including poor lifting habits, prolonged exposure to vibration, or sports-related injuries may stress the lower back.

Treatment of a Herniated Disc:

Symptoms from a herniated disc usually get better in a few weeks or months. The following are guidlines to help you recover. Rest if you have severe pain; otherwise, stay active. Walk and engage in other light activity. Use ice or a cold pack on the area for ten to fifteen (10-15) minutes, three (3) times a day. Put a thin cloth between the ice and your skin. Applied heat relieves pain for some people, but you should wait two or three (2-3) days after an injury to use it, and you should consult your doctor. Do the exercises that your doctor or physical therapist suggest. These recommendations will help keep your back muscles strong and prevent another injury.

LVPRC utilizes Active Release Techniques® (ART®) protocols in treating injuries to the muscles, tendons, fascia, nerves, and surrounding soft tissues associated with back pain. ART® has proven to be the mot effective treatment of back pain related to soft tissue injuries. Traditional treatments address only one area, but ART® restores unimpeded motion and function to all the soft tissues associated with back pain. ART® provides a means to diagnose and to treat the underlying causes of back pain and to correct the problem completely. Chiropractic is also frequently used for joint mobilization when a joint is restricted or subluxated and causing abnormal function.

Ask your doctor about medicine to treat your symptoms. Medicine won't cure a herniated disc, but it may help with pain and swelling. Usually a herniated disc will heal on its own over time. About half of the people with a herniated disc get better within one (1) month, and most are better after six (6) months. Only about one (1) person in ten (10) still has enough pain after six (6) weeks to think about surgery. Be patient, and stick with your treatment. If your symptoms don't get better in a few months, you may want to talk to your doctor about surgery.

Preventing a Herniated Disc:

After you have hurt your back, you are more likely to have back problems in the future. The following guidelines will help keep your back healthy. Protect your back when you lift. For example, lift with your legs, not your back. Don't bend forward at the waist when you lift; bend your knees and squat. Use good posture. When you stand or walk, keep your shoulders back and down, your chin back, and your belly in. This will help support your lower back. Get regular exercise. Stay at a healthy weight to reduce the load on your lower back. Don't smoke. Smoking increases the risk of a disc injury.

Lumbar Spinal Stenosis:

Lumbar spinal stenosis is a narrowing of the spinal canal in the lower back, known as the lumbar area. This narrowing occurs when the growth of bone or tissue (or both) reduces the size of the openings in the spinal bones. This narrowing can squeeze and irritate the nerves that branch out from the spinal cord. It can also squeeze and irritate the spinal cord itself. This may cause pain, numbness, or weakness, most often in the legs, feet, and buttocks.

Causes of Lumbar Spinal Stenosis:

Lumbar spinal stenosis is most often caused by changes in the shape and size of the spinal canal as people age. For example, connective tissues called ligaments get thicker and harder. Joint disease called Osteoarthritis leads to the growth of bony spurs that push on the spinal cord. These conditions can lead to problems that narrow the space in the spinal canal.

Symptoms of Spinal Stenosis:

If the spinal cord or nerves become squeezed, symptoms may include: numbness, weakness, cramping, or pain in the legs, feet, or buttocks. These symptoms get worse when you walk, stand straight, or lean backward. The pain gets better when you sit down or lean forward. Patients may feel stiffness in the legs and thighs. In severe cases, there may be loss of bladder and bowel control. Symptoms may be severe at times and less severe at other times. Most people will not be severely disabled. In fact, many people do not have symptoms at all.

Diagnosis of Spinal Stenosis:

Your doctor can determine if you have lumbar spinal stenosis by asking questions about your health history and by giving you a physical exam. You will probably need imaging tests such as an MRI, a CT scan, and sometimes X-rays.

Treatment of Spinal Stenosis:

LVPRC utilizes Active Release Techniques® (ART®) protocols in treating injuries to the muscles, tendons, fascia, nerves, and surrounding soft tissues associated with back pain. ART® has proven to be the mot effective treatment of back pain related to soft tissue injuries. Traditional treatments address only one area, but ART® restores unimpeded motion and function to all the soft tissues associated with back pain. ART® provides a means to diagnose and to treat the underlying causes of back pain and to completely correct the problem. Chiropractic is also frequently used for joint mobilization when a joint is restricted or subluxated and causing abnormal function.

LVPRC utilizes ART® to restore optimal tissue texture, motion, to improve the function of the soft tissue structures, and to release any entrapped nerves or blood vessels. This is accomplished through the direct removal of adhesions or fibrosis in the soft tissues via the application of very specific hands on protocols. Adhesions occur as a result of the natural healing process after the body suffers an injury: acute injury, repetitive motion injury (micro-tears), or constant pressure or tension injury.

ART® practitioners use very specific Long Nerve Tract protocols to treat more serious neurological complaints. You can most likely control mild to moderate symptoms with pain medicines, exercise, and physical therapy. Your doctor may also give you a corticosteroid shot, a medicine that reduces inflammation. ART® is considered to be the "Gold Standard" in eliminating the pain and dysfunction associated with these adhesions. ART® has been shown to be very effective in treating the neurologic symptoms associated with spinal stenosis.

You may need surgery if your symptoms worsen or if the synptoms limit your activities. In these cases, surgery to remove bone and tissue squeezing the spinal cord can help relieve leg pain and allow you to return to normal activity.

What to Expect from an ART® Treatment:

Every ART® session is actually a combination of examination and treatment. The ART® provider uses his or her hands to evaluate the texture, tension, movement and function of muscles, fascia, tendons, ligaments and nerves. Abnormal tissues are treated by combining precisely directed tension with very specific movements. These treatment protocols - over five hundred (500) of them - are unique to ART®. They allow providers to identify and to correct the specific problems that are affecting each individual patient. Treatments take about eight to fifteen (8-15) minutes for each area being treated.

A condition may require eight to ten (8-10) visits before full functionality is restored. Joint manipulations and physical therapy are frequently carried out in conjunction with ART® to increase treatment effectiveness.Whenever possible, patients perform active movements during the treatment process to ensure that the restrictions are found and corrected. Active motions stimulate neurological pathways in the spinal cord that help to reduce pain during treatment. Motion also helps to reproduce the stresses the patient will actually be under during normal active motion.

When Is Back Surgery a Good Idea:

Back pain is extremely common, and surgery often fails to relieve it. You should find out why your back hurts and whether surgery might help.

When, "Oh, my aching back," is not simply an ache, then this pain is serious. You likely may wonder, "Could back surgery end the discomfort once and for all?"

Trauma, aging, improper body mechanics and normal wear and tear can all injure your spine. Damage to any part of your back -- especially pressure on your nerves -- can cause pain and other symptoms.

Most back problems respond to nonsurgical treatments, such as anti-inflammatory medication, ice, heat, gentle massage, and physical therapy. When conservative treatments don't help, back surgery may offer relief; however, it doesn't help every type of back pain. In fact, back surgery is needed in only a small percentage of cases.

Do You Need Back Surgery:

Most people will have back pain sometime during their life. Ninety (90) percent of these people will get better without treatment or with conservative therapies within four to six (4-6) weeks. Only five (5) percent remain disabled longer than three months.

In most situations, an operation won't be considered unless conservative measures have failed, and, even then, it's not often indicated. Back surgery is usually reserved for times when a nerve is pinched, the spinal cord is compressed, or there is too much movement between the spinal bones.

Your doctor may recommend back surgery if you have neck or back pain accompanied by symptoms of nerve damage. Signs and symptoms include:

• Pain that radiates down your legs (sciatica) or arms
• Numbness, weakness or tingling in your arms or legs
• Loss of bladder or bowel control

Different types of back surgery include:

• Diskectomy: This surgery involves removal of the herniated portion of a disk to relieve pressure on a nerve. It is done as an open surgery, and surgery typically involves full or partial removal of the back portion of a vertebra (lamina) to access the ruptured disk.
• Laminectomy: This surgery involves the removal of the lamina that overlays the spinal canal. It enlarges the spinal canal and is performed to relieve nerve pressure caused by spinal stenosis.
• Fusion: Spinal fusion permanently connects two or more bones in your spine. This surgery can relieve pain by adding stability to a spinal fracture or by correcting excessive motion between vertebrae. This surgery may eliminate painful motion between vertebrae that can result from a degenerated or injured disk.
• Intradiscal electrothermal therapy (IDET): In this treatment, doctors insert a needle through a catheter into the disk. The needle is heated to a high temperature for up to twrnty (20) minutes. The heat thickens and seals the disk wall, reducing disk bulge and the related spinal nerve irritation.
• Vertebroplasty: During this procedure, your surgeon injects bone cement into compressed vertebrae. For fractured and compressed vertebrae, this procedure can help stabilize fractures and relieve pain. With a similar procedure (kyphoplasty) a balloon-like device is inserted to expand compressed vertebrae before bone cement is injected.
• Artificial disks: Implanted artificial disks are a treatment alternative to spinal fusion for painful movement between two vertebrae due to a degenerated or injured disk. These relatively new devices are still being studied, however, so it is not yet clear what role they might play as a back surgery option.

Consider All Options:

Before you agree to back surgery, consider seeking 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 to treat. To prevent recurrent back problems, use good body mechanics, keep your back muscles conditioned with regular exercise and stretching, and control your weight.