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You Tube Video: 5 Stretches For Low Back Pain

Stretches For Low Back Pain

I recommend 5 stretches for low back pain to all of my patients presenting with low back issues.  These stretches are advised for any low back condition I treat.  If tolerated I recommend doing these stretches every morning for 10-15 minutes preferably before going on a morning walk.  The purpose of these stretches are to loosen the tight muscles in our spine, hips, and legs.  These stretches will also put the lumbar spine into the 2 functional movements of flexion and extension.  These stretches are based on yoga poses which I find to be the most effective method of stretching.  I highly encourage all my patients to eventually add a yoga class to their wellbeing strategy.

5 Yoga Stretches

  1. Childs Pose
  2. Upward Dog Pose
  3. Downward Dog Pose
  4. Pigeon Pose
  5. Leg Up Wall Pose

The following video we will demonstrate these poses.



Bulging Disc Vs Herniated Disc

Bulging Disc vs Herniated Disc on MRI

To many people even some doctors, the difference in term bulging disc vs herniated disc is minimal but it is 2 different terms which can be misunderstood in the diagnosis process. Many people are very upset when they are in bad pain and get an MRI and results come back with bulging or herniated disc.  Most doctors are quick to judge a patients condition based the findings on an MRI.  MRI technology is amazing and reveals incredible anatomy with a non invasive test but it has many limitations.  Studies have been done comparing groups of people suffering from spinal conditions as compared to people with no known spinal condition.  The results of the studies show that MRI will show negative findings in both groups, cautioning Doctors to make clinical judgments about MRI results.  It is important to match the patients symptoms to what is found on the MRI.  A perfect example I see in practice is when an MRI shows nerve compression at a level of the spine that correlates with symptoms except the bulge is on the other side of the spine from the nerve pain the patient has.  This tells me that what I see on the MRI is not the problem the patient is suffering from.  Common MRI findings of the spine are Disc Bulge, Disc Herniation, and Disk Degeneration. Understanding the difference of a bulging disc vs herniated disc on MRI puts many patients ate ease once they fully understand.

Disc Bulge

Disc bulging is very common to find at levels of the spine with no symptoms.  Our disc is a cushion that over time starts to wear out.  As the disc wears out it compresses and we start to see minor bulging of borders.  A great analogy is like a car tire that is losing air.  Rarely do these create serious issues and are noted on an MRI just to observe the area.

Disc Herniation

Disc herniation is a more serious issue with the disc structure.  Our discs are basically made of a jelly like center with an outer ring of ligamentous material.  A disc herniation is when the outer layers start to tear and the jelly center starts to protrude out.  This is much more likely to affect the nerves because they are usually larger than a bulge and will also cause inflammation in the area of the injury.  These can be caused by a traumatic event or by excessive wear and tear, the bulge may have been the precursor to a herniation.  Herniation’s can cause pain in the area they occur or not even be felt.  Herniation’s can cause nerve compression if they are in proximity to a nerve or the spinal cord.  If nerve compression is caused the patient will exhibit pain, numbness, and even weakness in the extremity innervated by the nerve.  If spinal cord compression occurs it can be very serious and cause many parts of the body below the herniation to be affected.  Herniation’s affecting a nerve only can be treated with conservative care such as physical therapy or chiropractic.  Spinal cord compressions are very serious and usually require surgical intervention before permanent impairment occurs. Again note that a bulging disc vs herniated disc on MRI reports is not the only factor in assessing urgency for surgical intervention.  Location of the disc herniation is very important.  If the herniation is not hitting the spinal cord or a spinal nerve it is less likely to cause nerve damage.

Degenerative Disc Disease

Degenerative spinal joint disease and degenerative disc disease are a process that begins in the middle 30’s.  It is very common to find on Xray or MRI.  The good news it is rarely serious enough to be affecting the spine. Degeneration of the spine is a process of breakdown and fusion.  As the spine ages it becomes less mobile if we do not stretch it regularly the vertebra get closer together as the disc spaces narrow.  As the vertebra get closer together they begin to fuse.  During this process the openings called canals also start to become more narrow due to loss of disc height and joint surfaces enlarging as part of the degenerative changes.  When the canals get to narrow the nerves may become compressed and create symptoms in the extremities.  As the joints become arthritic they get inflamed causing local pain and stiffness.  The good news is most of these changes have to be advanced to cause symptoms, usually not creating problems until we are in our 60’s.  In some cases due to genetic issues people may have degenerative complaints at a younger ages but this is uncommon.

Regular Chiropractic Care along with healthy lifestyle changes can slow the process of degenerative spinal disease.  Regular spinal manipulations keep the spine mobile and maintains proper alignment on the discs reducing uneven wearing.  Lifestyle plays a role also, keeping a healthy weight reduces stress on the joints.  Regular exercise strengthens the spinal muscles and also reinforces mobility to the spine.  Stretching keeps the spine mobile and lengthens the muscles decreasing stress on the spine.

 


Low Back Pain

What causes Low Back Pain?

Low back pain has many anatomic structure it can originating from.  Each issue has its own corresponding symptoms with much overlap in between them.  The most common issue relates to pelvic misalignments at the sacroiliac joint.  This pain can be on both sides of the low back just above the gluteal region but it is usually located on one side.  Above the pelvis are the different lumbar vertebra and any of these bones can have irritation of their joints.  This type of pain is usually midline in the low back.  In between each vertebra are discs which act as cushions absorbing shock to the spine.  Discs are susceptible from injury due to trauma or wear and tear overtime to either bulging or herniating. Injured discs can cause a range of symptoms ranging from low back pain to pain radiating down the leg.  Muscle spasms in the low back are a nonspecific symptom because they can be caused by any of the above issues.  They can also be the result of straining the low back while doing strenuous activity.

Is My Low Back Pain a Herniated Disc?

This is a common concern for a new patient who is in a lot of pain.  Many people know someone who had back surgery due to a disc problem.  Although it is common to find disc disease, when an MRI is performed it does not always define the cause of pain.  Having disc disease is a common part of aging which starts in the early 30’s.  Normal wear and tear of the spine results in degeneration of the the discs and the vertebral joints.  In most cases these issues do not result in problems until later in life when the spine is greatly degenerated. Stenosis or narrowing of canals that nerves and the spinal column travel through can cause nerve compression and damage.  I have seen many severely degenerated spines with no symptoms of stenosis, we can have quite a bit of stenosis with no problems.

When someone is unlucky enough to have a disc herniating and hitting a nerve it is a miserable condition.  The low back pain associated with the herniation isn’t always present.  The herniated disc is only a problem is it is hitting a nerve or the spinal cord. When this happens you have pain in the down the leg.  If it is a bad enough, nerve compression it can affect strength in the leg depending on location of the herniation.  During an exam we can usually determine if the problem is related to a herniated or degenerative disc causing nerve compression.  Herniated discs many times will respond to conservative Chiropractic care and Decompression therapy.  Other conditions such as Facet Syndrome, Piriformis Syndrome, and IT Band Syndrome with or without Sacroiliac joint dysfunction can resemble disc herniation.  When treated properly all of these conditions usually resolve with Chiropractic Care with no need for a surgical intervention.

Facet Syndrome

The facets are the joints of the spine and are located on the backside of the vertebra.  These joints can be injured and become swollen like any other joint in the body.  The result is usually low back pain in the area of the injured joint.  In some cases the swelling may be great enough to cause nerve compression resulting in similar symptoms as a herniated disc.  When this condition is the cause it is very fast to respond to Chiropractic Care as we manipulate the spinal joints in the area to resolve the joint dysfunction causing the swelling.

Piriformis Syndrome

The piriformis muscle is a deep muscle under the Gluteal Muscles.  This muscle can get very tight and cause compression of the sciatic nerve as it travels from the low back down the leg. This is very common in runners from overuse and also is seen in people who have jobs requiring them to sit a lot.  The usual symptoms are low back pain and aching in the gluteal area with leg pain. Chiropractic care and home stretching programs work very well to resolve this condition.

IT Band Syndrome

The IT band is a very long tendon that runs from the side of the pelvis down the outside of the leg to the knee.  Multiple hip muscles attach to the IT band as stabilizers of the hip and knee.  The IT band is very susceptible to problems when patients have misalignments of the pelvis at the sacroiliac joints.  If the pelvis is not in the correct position it changes the line of pull of the muscles and we lose hip stability.  This lack of stability causes radiating pain down the leg resembling a nerve entrapment. The pelvic misalignment will also cause low back pain. Chiropractic care and Massage Therapy work very well in resolving IT Band Syndrome.


Stages of Low Back Pain

Low Back Pain

Low back problems are progressive in nature. Most low back problems are unrelated to any major injury. The majority of low back pain I have seen in my clinic is either caused by long-term postural strains or minor injuries from the past that never healed properly and have progressed into muscular imbalances. On occasion I do see patients who have major injuries that caused an acute problem but for the most part low back pain is the result of minor daily events resulting in pain.

Our low back is constructed of more than just five lumbar vertebrae we also have a pelvis which contains three large bones and two major joints. This joint of the pelvis called the sacroiliac joint is commonly a problematic area overlooked by most physicians. Many people with lower back pain suffer from strain of the sacroiliac joint of the pelvis. In my view this is the first stage in the progression of low back pain, which I call the sacroiliac stage.

When a person has had minor injuries to the spine or long term postural imbalances they are suffering from muscle imbalances as a result of neurologic changes in muscular postural reflexes. These neurologic changes are described in great detail in the new chiropractic theories section, which I suggest reading to understand the muscle imbalances I am going to describe, and how chiropractic care corrects them.

In the lower body the tendency is for the muscles of the low back and hamstrings to increase in tone and the muscles abdominal region and front of the thigh to decrease in tone. Since these muscle insert into the pelvis change in there tones will allow the pelvic bones to shift out of alignment causing strain on the ligaments of the sacroiliac joint. This strain of the sacroiliac ligaments is usually the most common cause of early low back pain. People describe this pain at or below the beltline, worse in the morning, worse after sitting, and it feels better once they have been up and moving. Chiropractic care is driven towards correcting the pelvic misalignment by proper manipulation techniques that target the muscle imbalance that created the imbalance.

The second stage of progression I call the disc stage. This stage results from long term pelvic misalignments. When the pelvis is out of alignment the spine, which rests on it, starts to compensate with minor a scoliosis or a lumbar lean.

When the disc herniates it is painful and causes just low back pain, but if it herniates in just the wrong place it can put pressure on the spinal nerves or the spinal cord. When the disc is pushing on a neurologic structure it results in pain/numbness/burning down the leg and if left untreated even results in weakness of the muscles of the leg.

At this stage of treatment the recovery time is much longer than sacroiliac phase. The therapy is driven toward taking away pelvic misalignments to relieve uneven pressure on the disc and physical therapy modalities (hot packs, acupuncture, and electrical stimulation) to relieve inflammation of the disc.

Many people get through this stage with the use of medication or cortisone injection by a medical doctor. The problem still exists and progresses to the last stage, which can never be completely corrected with any care. This stage is called stenosis of the spine. Stenosis is defined as narrowing of the canals where nerves or the spinal cord travel by extreme arthritis of the facet joints and complete loss of the disc. When someone is at this stage it is usually later in life and is very debilitating. Chiropractic care, physical therapy modalities, and spinal rehabilitation via exercise may take away pain but the pain will usually return again and again. Symptoms of stenosis are wide and never consistent but usually the person has low back pain with leg pain/numbness and weakness in the legs.

When a person has suffered a major back injury any structure within the spinal unit or the pelvis can be involved. In these cases a wide variety of diagnostic tests most be run to pin point the site of injury for recovery to be timely and full. If properly treated with the aid of medical professionals and chiropractic care to stop the progression of postural imbalances as a result of the injuries a person can return to a highly functional state again. When left unresolved these injuries have a tendency to progress rapidly through the stages just described.