Low Back Pain and Sciatica: Chiropractic or Surgery?

Many people who suffer from low back pain also experience pain and numbness radiating into the leg. Some people even have muscle weakness in their leg or foot. This is called sciatica or sciatic nerve pain, and it is one of the most painful conditions one can experience. It can be debilitating, and causes many people to be disabled from their jobs and unable to enjoy spending time with family and friends.

If a person goes to their primary care physician they may first be given medication for the condition. If the medication is not effective they next may have an MRI of the lower back taken. If the MRI shows a lumbar disc herniation causing pressure on the sciatic nerve a referral to a surgeon may lead to a recommendation for back surgery called a "micro-diskectomy". But this is not the only treatment option to be considered.

Researchers have recently found that spinal manipulation of the lumbar spine is just as effective as micro-diskectomy for patients struggling with sciatica from a lumbar disc herniation. Overall patients who received spinal manipulation benefited to the same degree as those who underwent surgery. In United States, most spinal manipulation is performed by doctors of chiropractic. The research paper titled, "Manipulation or Micro-diskectomy for Sciatica? published October 2010, in the Journal of Manipulative and Physiological Therapeutics noted that "after a year, no significant complications were seen in either treatment group, and the 60% of patients who benefited from spinal manipulation improved to the same degree as their surgical counterparts". The patient population, in the research study, included people experiencing chronic sciatica (symptoms greater than six months) that had failed traditional, medical management.

Another benefit from conservative treatment such as spinal manipulation is that it is less costly than surgery. One study noted that micro-diskectomy surgery in the United States averages $25,000 per procedure. The cost of chiropractic care for sciatica is usually much less than a 10th of the surgical amount. If chiropractic care for sciatic nerve pain was performed before surgery it could save the United States billions of health care dollars annually.

The research supports spinal manipulation performed by a doctor of chiropractic as a valuable and safe treatment option for those experiencing lumbar disc herniations and sciatic nerve pain. Those individuals experiencing sciatic nerve pain should consider spinal manipulation as the treatment to be tried first, only to be followed by surgery if unsuccessful.

How the Psoas Muscle Causes Back and Hip Pain

The biggest factor in back and hip pain is the psoas muscle. The number of problems caused by the psoas is quite astonishing. These include: low back pain, sacroiliac pain, sciatica, disc problems, spondylolysis, scoliosis, hip degeneration, knee pain, menstruation pain, infertility, and digestive problems. The list can also include biomechanical problems like pelvic tilt, leg length discrepancies, kyphosis, and lumbar lordosis.

What is the psoas?

The psoas (pronounced "so - oz") primarily flexes the hip and the spinal column. The psoas is a key core muscle. At about 16 inches long on the average, it is one of the largest and thickest muscles of the body (in animals it's known as the tenderloin). This powerful muscle runs down the lower mid spine beginning at the 12th thoracic vertebrae connecting to all the vertebral bodies, discs and transverse processes of all the lumbar vertebrae down across the pelvis to attach on the inside of the top of the leg at the lesser trochanter. The lower portion combines with fibers from the iliacus muscle, which sits inside the surface of the pelvis and sacrum, to become the Iliopsoas muscle as it curves over the pubic bone and inserts on the lesser trochanter.

What is the function of the psoas?

This has a number of diverse functions making it a key factor in health. The psoas as a hip and thigh flexor is the major walking muscle. If the legs are stationary the action of it is a bend the spine forward; if sitting it stabilizes and balances the trunk. The lower psoas brings the lumbar vertebrae forward and downward to create pelvic tilt.

When we think of smooth, elegant and graceful movement in dancers and athletes we are looking at the psoas functioning at it optimum. It requires that the psoas maintain the pelvis in a dynamically neutral orientation that can move easily and retain structural integrity. This creates positions of the spine that require the least muscular effort.

What are the common pain symptoms of the psoas?

When the muscle becomes contracted due to injuries, poor posture, prolonged sitting, or stress, it can alter the biomechanics of the pelvis and the lumbar, thoracic and even cervical vertebrae. Typically a dysfunctional is responsible for referred pain down the front of the thigh and vertically along the lower to mid spinal column. Trigger points are found above the path of the psoas on the abdomen. Frequently the quadratus lumborum muscles develop trigger point, as well as the piriformis, gluteals, hamstrings, and erector spinae.

It can torque your spine to the right or left, pull it forward and twist the pelvis into various distortions. Frequently one psoas will shorten and pull the spine and/or pelvis to our dominant side. The distortions of the spine and pelvis can also show up as a short or long leg. This all results in scoliosis, kyphosis, lordosis, trigger points, and spasms in back muscles trying to resist the pulling of the psoas.

It can pull the spine downward, compressing the facet joints and the intervertebral discs of the lumbar spine. The pressure can cause the discs to degenerate, becoming thinner and less flexible. This degeneration makes the discs more susceptible to bulging or tearing, especially with twisting and bending movements.

What keeps the psoas in contraction?

The psoas will stay contracted because of postural habits and trauma. The way we stand, walk and sit can distort the psoas. If we walk or stand with our chin in an overly forward position the muscle will tighten. Sitting through much of the day it shortens to keep us bio mechanically balanced in our chairs. Over time we develop a "normal" way of holding the psoas that is dysfunctional.

Unresolved trauma can keep the psoas short and reactive. This is a primary muscle in flight, fight, freeze or defensive responses to danger. When survival is at stake, it propels the body to hit the ground running. When startled, it ignites preparation of the extensor muscles to reach out (grab hold) or run. Until the psoas is released the muscle may stay contracted and go into further shortening and spasm very easily.

Overly challenging exercises, stretches or release techniques for the psoas can sometimes do more harm than good. When the psoas is capable of contracting and relaxing normally it can be strengthened and lengthened.

Abdominal Exercise: How Does It Help In Reducing Lower Back Pain?

There are many causes for lower back pain, like retracted muscle, disc issues/problems, arthritis, or sacroiliac joint dysfunction. If you want to tackle lower back pain successfully, the important areas you need to address are beneficial abdominal workout routines.

A person's core stability depends mainly on abdominal strength. Thus, it prevents a swayed back as well as compacted nerves. Nevertheless, not all abdominal exercises are the same. So to prevent making your pain worse, you will have to select the correct abdominal exercises from the start.

To get it done effectively, you ought to know the main cause before doing any exercise.

Back Pain Causes

Low back pain is caused by these two reasons:

• Injury to the back or abdominal region


• Uneven muscle strength or muscle group imbalances

Muscle imbalances lead to postural dysfunction. It consist of spine's abnormal curvature and pelvis' abnormal alignment. Thus, abnormal alignment will cause wearing out of the joints, muscles, ligaments and discs.

Everyone should know that this pain doesn't happen in just one night. Ok, you may become symptomatic rapidly, but this happens over a long time period, it takes time where your back reaches the point of finally caving in, leading to pain in the lower back.

Back Muscle Imbalance

Muscle imbalance takes place when the muscles are overdeveloped in one part wherein the other side are being pulled out. These imbalances can also occur on any body part which may be due to your activities. There are actually several things that may give rise to this pain.

Once the muscle groups are unbalanced, misalignment will almost certainly take place. Postural dysfunction can take place following spinal shifts and muscle imbalances.

Abdominals and Their Role

The abdominal region is the place where pain starts. It is generally caused by short or tight muscles in the lumbar region. Either one of these will cause abnormal pressure on the spinal column and nerve irritation. Discs can become compressed resulting in tighter muscles and additional soreness.

Your abdominal muscles are those that tilt your hips under and return your spine to a neutral position. Your abdominals need to be used just enough to return the spine to a neutral position to prevent it from over-arching. Your abdominals aid your back to transfer from a bad postural position into a neutral position.

But conditioning your abdominal muscles doesn't instantly make them supportive of your spine or alleviate postural dysfunction. It is dependent on where the muscle imbalance is occurring, thus the postural dysfunction, performing an incorrect abdominal exercise might not have any benefit to you at all, or you could actually make the condition more painful.

Lower Back Pain Exercises - Heal Yourself at Home

Have you thrown your back out? Here are some lower back pain exercises that will quickly help you heal.

A few months ago, I was pretty busy out in the yard. I had to shovel and spread quite a bit of mulch. Unfortunately for my back, I wasn't paying that much attention to my posture. I let my lower back get round again and again as I lifted. Day after day this went on, until finally I reached down to pick some weeds and BAM! My back seized up.

Here are some lower back pain exercises that I used to get better in just a week or two.

First, I should note that these exercises are specifically designed to address injuries like disc herniation and bulging disks that can happen when you bend forward and/or sit with a rounded lower back, over and over again. This is a really common cause of lower back pain, but there ARE others. So, if the following situations apply to you, skip these exercises as they may do more harm than good.

Skip these exercises if you:

• Had your back give out while under a heavy load and think that there is probably some major tissue damage.


• Have a disorder called spondylolisthesis (if you have this you would most likely already know)


• Injured yourself while bending back (spinal extension injury)

And, as always, these exercises are provided for educational purposes only. Consult your physician before beginning any new rehabilitation routine.

First, Why Do I Have Lower Back Pain?

The brain causes the muscles in the lower back muscles to lock up and spasm to protect the vulnerable spine and discs. When we bend forward with a rounded lower back, day after day, we put excess stress on the discs. The vertebrae compress along the front of the spine and squeeze the discs toward the back of the spine, much like toothpaste is squeezed from the bottom of a tube towards the opening.

Eventually the discs will become injured and bulge out, pressing onto surrounding nerves. When your brain senses that this is happening, it triggers a back spasm to lock up and protect the spine, preventing any further damage.

These exercises help alleviate lower back pain by accomplishing two things. First they put the disc back into place. Then these movements activate the spine's supporting muscles, which let the brain know that everything is functioning as it should. Since these muscles are supporting the spine, there is no need for emergency support and the brain can relax the back spasms.

The Routine

1. MacKenzie Pressups - 10 repetitions


2. Hip extensions - 8 repetitions x 5 sec hold


3. Birddogs - 4 repetitions x 10 sec hold


4. Side bridges - 5 repetitions x 10 sec hold on each side

Afterwards, walk around and let your body feel how your spine's support muscles and structures are now properly aligned and activated. There will be less need for the brain to trigger the back spasms that cause you pain and stiffness.

MacKenzie Pressups

This exercise squeezes your discs from the back of the spine to the front, alleviating discs that are bulging towards the rear.

Lying down on your stomach with your hands beneath your shoulders, keeping your shoulder blades down and back, slowly arch your back, pushing your chest up while you breathe out. Keep your hips on the floor.

Lower yourself down slowly on your inhale.

Begin gently and only slowly increase your range of motion. This exercise may hurt a little on the first few repetitions. If it doesn't feel better after 3 or 4 reps, abandon this exercise.

Hip Extension

This exercise lets your brain know that your glutes are working to stabilize your spine.

Lie on the ground with your feet flat on the ground around shoulder width apart, your knees bent at about 90 degrees.

Raise your hips up towards the sky by pushing through your heels and flexing your glutes (butt muscles). Allow all other muscles to remain relaxed.

Keep your hips up with your glutes flexed for 5 seconds, then lower back down steadily. Do 8 reps.

Bird Dogs

This exercise activates the important spinal stabilizers called the multifidus and transverse abdominus, which help with fine stabilization between individual vertebrae.

Down on all fours, keep your hands and knees aligned with each other, as if they were sharing a plank.

Maintaining neutral spine position (flat back, essentially), slowly lift up one leg, straightening it as your heel moves away from your body. Next, keeping your shoulders packed down, raise the opposite arm out at a 45 degree angle (half of 90!). This will activate the often-dormant lower trapezius. Keep your hips stable while you do this exercise, don't let them shift as you raise your limbs.

Side Bridge / Side Plank

Lying on your side with your feet stacked on top of each other or with one foot placed in front of the other, place your elbow beneath your shoulder. Keep your other hand on your hip or leg.

Flexing your obliques and quadratus lomborum (side abdominal muscles), raise your hips up.

Don't bend at the waist. In fact, it is a good idea to do this exercise against a wall for the first few times, to allow you to get a feel for proper alignment. You want to be pretty straight, from your head to your feet.

Hold for 10 seconds, then repeat 5 times on right and left sides.

Walk Around

After you complete this circuit, stand up and stroll around, maintaining excellent posture. With any luck, your body should sense that everything is functioning as it should, and that back spasms aren't needed any longer.

How Often Should I Do This Routine?

Do these lower back pain exercises 2 to 3 times/day when you have just thrown your back out. After you heal, continue to perform this circuit for injury prevention.

Why Warm Up Is Necessary Prior To Exercise For Chronic Lower Back-Pain?

Most people do not do any warm up exercise before embarking on an exercise program as they feel that it is not necessary. They fail to understand that warm up exercises are very necessary because our body muscle-temperature is not sufficiently warm before warm ups. A cold muscle contracts and relaxes slowly leaving one vulnerable to sprains and injury. When you start doing warm-ups, blood circulation increases in muscles and in turn make the muscles warm.

Most sport-related or ailment-related exercises regimen start with elaborate warm up exercises. They are structured in such a way so as to increase the intensity of the warm ups very gradually. This ensures loosening of muscles. Muscle rigidity is slowly removed. Muscles are prepared to face stiffer exercises that follow the warm ups. Heart as well as lungs is prepared for the ensuing exercise regimen. It obviates post exercise pain in joints and muscles.

What type of warm-ups to do to reduce lower back pain?

The recommended warm ups for reducing lower back pain are:

(1) Walking,

(2) Static-cycling,

(3) Circling the arms, while in a standing position,

(4) Mad-cat warm-up, a very effective one for the lower back and,

(5) Leg cycling (Lie down on your back, do cycling motion with both legs.)

The benefits of warm ups for lower back pain are manifold. Temperature increases in muscles. Oxygen reaches muscles faster. Muscle viscosity is reduced on account of warming of the body. This enables muscles to (1) have better mobility, increase joint range of movement and sustained supply of blood, glucose and oxygen as per the demand of muscles at that moment. There is an increased secretion of synovial fluid. This lubricates joints making joint movement easy and effective avoiding friction. Musculo-skeletal structures face no injury threats.

Warm up prepares both the body and mind for the exercises. A heated body naturally releases sweat, which automatically cools the body.

Muscular contraction and relaxation are largely temperature dependent. Before the muscles cool down completely, the main exercise regimen should start. It is better to start the main exercise after a small time gap after warm up. To know more about warm ups for lower back pain and also gain an in depth understanding of self help rehabilitation and treat the root cause of back pain visit http://www.badbacknomore.com and sign up to receive free part one of the four part course.

Lower Back Pain Treatment, Symptoms and Major Causes

Lower back pain or lumbago affects more than 80% of the people at some stage of life and can be very bothering. No specific reason can be assigned for this disease and the pain can be chronic, moderate and acute. This musculoskeletal disorder impedes free movement of an individual and the serious cases often demand total bed rest. The symptoms sometimes persist for a week and subside and may relapse after a gap of few weeks or months.

Symptoms

The following symptoms are the indications of Lower back pain -

1. Pain in back while bending, moving and walking.
2. The pain is felt in the buttocks and pains that can last for 48 to 72 hours.
3. Often the pain may extend below the knee to the foot and ankle.
4. Pain felt while sneezing and coughing.
5. Stiffness in the back and the hip muscles.

Causes

Though back pains don't have any specific cause but some underlying reasons can be:

1. Any injury to the back muscles, spine and back bone that can result in this problem.
2. Abnormal functioning of the abdominal organs.
3. Pressure on the nerve roots or Sciatica is another factor.
4. Degeneration of the spinal discs.
5. Spondylosis, Fibromylagia and Osteomyelitis are other causes of lower backache.
6. Even smoking can cause lower backache.

Treatment

In case of moderate and sub acute back pains some self care treatments and medications are enough to cure the disorder but in chronic cases regular exercises with due precautions must be carried to keep the pain in check.

1. Sleeping with pillows in between the knees or sleeping lying on the back with knees resting on the pillow gives some comfort and so are often recommended by doctors.

2. Exercises are beneficial for chronic back pain as it improves the blood circulation in the muscles.

3. Some backache may require long bed rest depending upon the severity of the pain.

4. Painkillers like ibuprofen and acetaminophen are prescribed to relieve the back pain.

5. Application of heat and ice packs are also found to be beneficial in some cases.

Herbs can also play a vital role in treating lower backache.

1. Drinking few cups of tea from the herb Chamomile smooths the muscles and reduces the pain.

2. The extract of the Horsetail helps in building the connective tissue and alleviates the pain.

3. Fresh juice from yarrow gives excellent results by strengthening back muscles

4. Application of a pack of black mustard seeds produces intense heat that lowers the back pain.

The 10 Most Common Causes of Lower Back Pain

"What is the cause of lower back pain?" has got to be the most common question I have heard as a treating physician over the past 20+ years. Simple enough question, problem is there is no easy answer.

The cause of lower back pain, or LBP cannot be confined to one condition. There are multiple causes of lower back pain. Some are simple and self-limited back strains, while others are serious conditions like disc herniations involving neurologic damage that require immediate, specialized treatment. Here is a brief overview of the 10 most common causes of lower back and leg pain.

1. Subluxation

Vertebral misalignment, or subluxations, occurs when the lower back has been subjected to chronic postural stress or a strain that results in the joints between the vertebrae locking up. After a period of malfunction, the surrounding muscles may tighten and nerves become irritated. Subluxations are the key malfunction that doctors of chiropractic treat. They may cause pain or may be asymptomatic for long periods of time until they deteriorate into degenerative arthritis. Various physical examinations, x-rays and computerized diagnostic equipment is often used to locate subluxations.

2. Back strain/sprain

Strains and sprains of the lower back are caused by over stressing the muscles (strain) or ligaments (sprain) by either a physical activity or imbalanced posture. Slight strains will usually result in pain and/or stiffness within the muscles of the back. Contracting the affected muscles aggravates strains.

Mild strains may resolve within a few days with rest. More severe strains/sprains as the result of strenuous activity such as sports, work, gardening, automobile accidents and such involve more extensive damage. When ligaments have been sprained they will usually become very painful with movement of the affected area. Healing times may be much longer in these cases, as much as a few months. Mild strains can be easily treated at home while more serious strains and sprains should be evaluated by a competent physician that specializes in spinal health. If enough inflammation builds up, the nerves of the lower back can be affected causing sciatica or leg pain, which can be mistaken for a disc injury. A physical examination will usually be sufficient for an accurate diagnosis. X-rays should be performed in cases of physical trauma.

3. Facet syndrome

The small joints in the back of the spine that allow movement are called facet joints. Due to chronic poor posture, past trauma or over exertion, the facet joints may develop arthritis. The resulting inflammation in the joint causes a deep aching sensation in the lower back that is intensified by sitting, arching the back and exertion. The diagnosis is made with a physical examination and confirmed on x-ray.

4. Degenerative Disc Disease

This is a very common cause of lower back pain. With repeated bending, twisting, lifting and past trauma such as lifting injuries or accidents, the discs or cushions between the spinal bones begin to lose water and deteriorate. As the disc deteriorates, it shrinks creating tension within the joints of the back and sometimes around the nerves causing back and leg pain. Diagnosis is by x-ray and MRI if the leg pains persist despite 30 days of treatment.

5. Osteoarthritis

Arthritis is inflammation of a joint. There are many varieties of arthritis that affect the spine. By far the most common is osteoarthritis or OA. OA involves the breakdown of the cartilage surfaces of a joint causing the joint to lose it's normal motion. As the cartilage wears thinner, bone spurs grow around the area in an attempt to fuse the joint shut. OA is known as wear and tear arthritis because it is caused by long standing postural stresses, past trauma and repetitive use. Sometimes genetic weakness of the cartilage causes it to wear out prematurely. OA is diagnosed off of physical exam and confirmed on x-ray.

6. Herniated/bulging disc

The cushions between the spinal bones may become weakened due to physical injury or because of degenerative disc disease. The weakened outer disc layers allow the disc to bulge outward sometimes contacting nearby spinal nerves causing leg pain or sciatica. If the outer layers suffer enough damage the inner gel-like substance of the disc, called the nucleus, may protrude outward and irritate nerves. A presumptive diagnosis can be made off of physical examination, but an accurate diagnosis as to this cause of lower back pain can only be obtained through an MRI or CT scan.

7. Sciatica

Pain that travels down the buttocks, posterior thigh, lower leg and into the foot is called sciatica. It is named after the large Sciatic nerve that originates from branches in the lower back to supply the lower extremity. Sciatica is graded by how far down the leg the pain travels. Sciatica can be caused by many conditions such as subluxation, tight buttocks muscles, strains, disc disease, bulging or herniation, stenosis or tumors. An accurate diagnosis is made from a physical examination and an MRI or CT scan of the lumbar spine.

8. Stenosis

The main opening running the length of the spine that the spinal cord is housed in is called the central or spinal canal. Normally, there is plenty of room for the spinal cord and other structures to fit inside this opening. Arthritis of the spinal joints can cause the joints to enlarge and push inward reducing the size of the canal. Similarly, a bulging disc may also crowd the space causing stenosis or narrowing. Pressure on the cord and nerves results in back and/or leg pain often aggravated by standing and walking and relieved by sitting. This is a common cause of lower back pain among the elderly.

9. Cauda Equina Syndrome

Pressure on the lowest nerves of the lower back and tailbone area results in loss of bowel and/or bladder control. Symptoms may also cause loss of sensation around the anus. If you experience any of these symptoms, it is urgent that you have an examination and MRI immediately at a hospital. These symptoms are beyond the scope of a chiropractor, family medical doctor or orthopedist. A neurosurgical evaluation is recommended. This condition can be caused by a severe disc herniation, stenosis or a tumor.

10. Tumors

Both benign and malignant tumors occur in the spine and can cause lower back and leg pain. They may present themselves as pain in the back or may cause pain to radiate down the leg (sciatica) because of its proximity to a nerve. Most tumors can be seen on x-ray and other imaging such as MRI and CT scan. The initial diagnosis may come from complaints of back pain that cannot be reproduced on physical exam by your doctor. Mechanical pain due to strains, disc problems and so forth can be mechanically irritated or provoked. Back pain from organic disease such as a tumor often times cannot be provoked or worsened by mechanical procedures. A history of unexpected weight loss, fatigue, anemia or pain that awakens you at night in conjunction with a normal psychical exam is very suspicious.

As you can see there are many causes of lower back pain ranging from simple non-threatening conditions to very serious and lethal diseases. Once the proper diagnosis is made, appropriate lower back pain treatment can be rendered.

For more detailed information on lower back pain treatment visit Dr Marks online.