Common Low Back Problems

Low back pain is one of the most common conditions that physicians see. The causes are varied; car accident, slip & fall, lifting injury or just poor posture. It is important to understand the pathology of the condition to be treated and how these treatments affects the lower back (by reducing pain through reducing muscles spasm, breaking adhesions to restore normal motion, as well as to aid the healing process, thereby reducing the chance for future injury).

Facet syndrome affects the facet joints, primarily, but other tissues can feel the effect. The pain is due to the facet joint riding up on another. This shrinks the IVF by reducing the amount of room the nerve root has to move, not to mention the blood vessels and pain fibers that are found there. Symptoms of facet syndrome are low back and buttock pain, pain into the posterior portion of the legs above the knee, stiffness especially in the morning, increased pain with extension, and absence of numbness. Palpatory signs include local paralumbar tenderness, point tenderness over the spinous processes of L5-S1, pain on hyperextension of the lumbar spine, absence of neurological deficit, hip, buttock and back pain with straight leg raise, as well as positive x-ray findings, such as increased sacral base angle, increased lordosis of the lumbar spine and facet tropism. If the facet joint is locked, then chiropractic care is a viable options since it will be able to open the IVF.

SI dysfunction is another common chiropractic condition. The cause is hard to discern, a problem with the SI joint. There are strong, thick ligaments that attach here as well as muscles. With every step we take the sacrum is supposed to rotate in between the illiums. If this is not allowed to occur, then irritation can develop in the joint as well as in the surrounding tissues. Symptoms include; ipsilateral buttock, dull in character, and made worse with sitting. Occasionally it may extend down the lateral and posterior calf, occasionally as far as the ankle, foot, and toes. Sensory changes rarely occur but occasionally take the form of paresthesis in the ipsilateral lower extremity. Pain referred from the SI joint is experienced in the posterior dermatomal areas of L5, S1, and S2 radiating over the sacrum and into the buttocks. Pain referral from the anterior ligaments radiates into the anterior dermatomal areas of L2 and L3, particularly into the thigh region immediately below the groin. Palpation over the SI joint as well as FABRE test, SLR (with SI pain at 70-90 degrees) and Yeoman’s test can lead to this diagnosis. The longer this condition is allowed to progress the more adhesions can be allowed to develop, further locking the joint and irritating the soft tissue structures.

Sciatica is also a common condition chiropractors treat. Sciatica stems from a pinching of a nerve in the lumbar spine as it makes its way to form the sciatic nerve (may also pinch the sciatic nerve directly). The reason the nerve is irritated must be discerned before treatment can begin. If it is due to a herniated disc, (MRI is the definitive test with certain orthopedic tests lending input), a surgical consult must be initiated. If it is due to a mis-aligned vertebra, then an adjustment may be performed. Also, if due to stenosis of the lateral recess, then the clinician needs to determine if there is mal position in concurrence, or if it is alone. If alone, then a surgical consult must be initiated. Low back pain is not the primary complaint of patients with true sciatica (that caused by a herniated disc). In fact, they may not even complain of any back pain at all. If there is mis-alignment, then a trial of manipulation could be done. Other conditions can radiate pain into the extremities so a thorough history and exam must be done as well as the appropriate imaging.

Piriformis syndrome also produces sciatica-type symptoms. As the sciatic nerve heads towards the feet, it passes near the piriformis muscle. It may pass above, below, or in some cases through. If the muscle becomes spasmed it can pinch the nerve, producing symptoms into the leg. Localized symptoms can be produced due to the hypertonicty of the piriformis. The piriformis can become spasmed from trauma or a mal-position/dysfunction of the sacrum, which it is attached to.

These are only a few of the common problems facing people with back pain, but all of them can be treated safely and effectively with chiropractic care.