LOWER BACK - LUMBAR SPINE & PELVIS
LOWER BACK / SCIATICA / PELVIC PAIN
SIGNS & SYMPTOMS
Sciatica occurs when there is pressure or damage to the sciatic nerve. This nerve starts in the lower spine and runs down the back of the leg. There are two nerves that comprise the sciatic nerve, known as the Tibial and Peroneal nerves. They are made up of the L4-S3 nerve roots. Thus, an injury to any of those levels could contribute to dysfunction. Sciatic nerve controls the muscles of the back of the knee and lower leg and provides sensation to the back of the thigh, part of the lower leg, the sole of the foot and along the outer edge.
Often, biomechanical shifting of the sacrum, pelvis, coxofemoral and lumbar spine causes added pressure on the sciatic nerve as it travels between the Piriformis muscle and Superior Gemellus muscle. Due to the attachment of those muscles, any shifting of the aforementioned bone, muscle and joint structures will cause further compression of the sciatic nerve.
(1) "Back pain fact sheet", NINDS, Publication date March 2020. (2) Herbert-Blouin et al. Hilton's Law Revisited. Clin Anat. 2014 May (27)4: 548-455(3) Howell et al. Neuromuscular Control Deficits and the Risk of Subsequent Injury after a Concussion: A scoping review.
- Pain in the lower back
- Buttock pain on one side
- Hip pain on one side
- Pain down one leg and into the foot
- Tingling/numbness/burning down one leg and into the foot
- Worsens when straightening leg
- Decreased ROM when flexing forward, bending to the side, or extending backwards
- Stiffness in foot or leg
- Increased pain when sitting for longer periods of time
- Acute, or short term back pain that lasts a few days to a few weeks
- Chronic back pain, or pain that continues for 12 weeks or longer. About 20 percent of people affected by acute low back pain develop chronic low back pain with persistent symptoms at one year (1).
- Congenital issues (meaning from birth)
- Scoliosis (curvature of spine),
- Lordosis (exaggerated arch in lower back)
- Kyphosis (excessive outward arch of spine)
- Spina bifida (incomplete development of spinal cord and/or its protective covering can cause problems involving malformation of vertebrae and abnormal sensations and even paralysis).
- Injuries Sprains (overstretched or torn ligaments); strains (tears in tendons or muscle); spasms (sudden contraction of a muscle or group of muscles); traumatic injury (sports, car accidents, or fall)
- Degenerative problems Intervertebral disc degeneration (occurs when the rubbery disc wears down); Spondylosis (the general degeneration of the spine associated with wear and tear that occurs in joints, discs and bones); Arthritis or other inflammatory disease (occurs in the spine, including osteoarthritis and rheumatoid arthritis as well as spondylitis, an inflammation of the vertebrae)
- Nerve and spinal cord problems- Spinal nerve compression, inflammation and/or injury; Sciatica (pressing on the sciatic nerve that travels through the buttocks and extends down the back of the leg); Spinal stenosis (narrowing of the spinal column that puts pressure on the spinal cord and nerves); Spondylolisthesis (vertebrae of the lower spine slips out of place, pinching the nerves exiting the spinal column); Herniated or ruptured discs (occur when the disc becomes compressed and bulges outward); Infections (involving the vertebrae, a condition called osteomyelitis, in the discs it's known as discitis and the in the sacroiliac joints connected the lower spine to pelvic, it's called sacroiliitis; Cauda Equina Syndrome (occurs when a ruptured disc pushes into the spinal canal and presses on the bundle of lumbar and sacral nerve roots; Osteoporosis (progressive decrease in bone density and strength that can lead to painful fractures of vertebrae)
- Non-spine sources- Kidney stones (can cause sharp pain in lower back, usually on one side); Endometriosis (buildup of uterine tissue in places outside the uterus); Fibromyalgia (a chronic pain syndrome involving the widespread muscle pain and fatigue); Tumors (press on or destroy the bony spine or spinal cord and nerves); Pregnancy (back symptoms almost always completely go away after giving birth) (1).
- Influencing factors in low back pain can include age, fitness level, weight gain, genetics (ankylosing spondylitis), job-related factors, mental health, smoking, heavy backpacks in children, psychological factors, previous concussions (3). Most acute low back pain is mechanical in nature, meaning there is disruption in the way the components of the back (the spine, muscle, discs, and nerves) fit together and move (1).
Sciatica occurs when there is pressure or damage to the sciatic nerve. This nerve starts in the lower spine and runs down the back of the leg. There are two nerves that comprise the sciatic nerve, known as the Tibial and Peroneal nerves. They are made up of the L4-S3 nerve roots. Thus, an injury to any of those levels could contribute to dysfunction. Sciatic nerve controls the muscles of the back of the knee and lower leg and provides sensation to the back of the thigh, part of the lower leg, the sole of the foot and along the outer edge.
Often, biomechanical shifting of the sacrum, pelvis, coxofemoral and lumbar spine causes added pressure on the sciatic nerve as it travels between the Piriformis muscle and Superior Gemellus muscle. Due to the attachment of those muscles, any shifting of the aforementioned bone, muscle and joint structures will cause further compression of the sciatic nerve.
(1) "Back pain fact sheet", NINDS, Publication date March 2020. (2) Herbert-Blouin et al. Hilton's Law Revisited. Clin Anat. 2014 May (27)4: 548-455(3) Howell et al. Neuromuscular Control Deficits and the Risk of Subsequent Injury after a Concussion: A scoping review.
HIP PAIN
SIGNS & SYMPTOMS
Hip pain is a common complaint at our office. It is similar to the shoulder joint as it is a ball in socket joint that has a tremendous Range of Motion with more force application, held in place by muscles, tendons and ligaments. It has a direct association with pelvic tilt and rotation and therefore it often becomes dysfunctional whenever the lumbar or pelvic regions of the spine become aberrant in their function.
There are a significant number of muscles that contribute to normal hip (coxofemoral joint) function. Of which, the iliopsoas, piriformis and gluteal muscles are some of the most important. Treatment is most successful when you evaluate and treat the lumbar, pelvic and hip joints in association with the soft tissue, or muscles that control hip function.
We have the most success with internal and/or external rotational hip adjustments performed with a drop-table, applying force along the appropriate vector. This, in association with Active Release to the iliopsoas, percussor and stretching to the gluteal, piriformis, lumbar paraspinals and often chiropractic treatment of the rotated/fixated sacrum, pelvic and lumbar regions are all included. Lumbar decompression is often utilized to treat chronic lumbar joint/disc dysfunction that causes compensatory response from the pelvic and hip joints is often considered.
What causes hip pain?
It's a combination of injury to joint, muscle, inflammation, neurological pathway disruption and sensory misperception in the brain. You can't affect one without affecting them all as described through Hilton's Law. Hilton's law is a powerful springboard to understand articular anatomy and pathophysiology (2). Through diagnostic testing, we're able to determine the source of your back pain and treat it appropriately using a multi-modal approach.
There are two types of back pain:
- Sharp hip pain
- Referral groin pain
- Achy stiffness into the side of leg
Hip pain is a common complaint at our office. It is similar to the shoulder joint as it is a ball in socket joint that has a tremendous Range of Motion with more force application, held in place by muscles, tendons and ligaments. It has a direct association with pelvic tilt and rotation and therefore it often becomes dysfunctional whenever the lumbar or pelvic regions of the spine become aberrant in their function.
There are a significant number of muscles that contribute to normal hip (coxofemoral joint) function. Of which, the iliopsoas, piriformis and gluteal muscles are some of the most important. Treatment is most successful when you evaluate and treat the lumbar, pelvic and hip joints in association with the soft tissue, or muscles that control hip function.
We have the most success with internal and/or external rotational hip adjustments performed with a drop-table, applying force along the appropriate vector. This, in association with Active Release to the iliopsoas, percussor and stretching to the gluteal, piriformis, lumbar paraspinals and often chiropractic treatment of the rotated/fixated sacrum, pelvic and lumbar regions are all included. Lumbar decompression is often utilized to treat chronic lumbar joint/disc dysfunction that causes compensatory response from the pelvic and hip joints is often considered.
What causes hip pain?
It's a combination of injury to joint, muscle, inflammation, neurological pathway disruption and sensory misperception in the brain. You can't affect one without affecting them all as described through Hilton's Law. Hilton's law is a powerful springboard to understand articular anatomy and pathophysiology (2). Through diagnostic testing, we're able to determine the source of your back pain and treat it appropriately using a multi-modal approach.
There are two types of back pain:
- Acute, or short term back pain that lasts a few days to a few weeks
- Chronic back pain, or pain that continues for 12 weeks or longer. About 20% of people affected by acute low back pain develop chronic low back pain with persistent symptoms at one year (1).
ILIOPSOAS STRAIN
SIGNS & SYMPTOMS
The Iliopsoas muscle is often known as the "great masquerade," due to its connectivity within many regions of the body and proximity to important organs and structures. It is an important muscle for appropriate control of the pelvis and trunk, as it attaches between the lumbar spine, pelvis and hip joint. It is often an injury seen during athletics as it is a dynamic mover during sprinting, jumping and overall movement. Its primary job is to flex the hip and during bending of the trunk. It is comprised of the Psoas minor (attached at T12 and L1), Psoas Major (attaches to the vertebrae and discs of T12-L5) and the Iliacus (starts at the top portion of the pelvic rim). These three muscles coalesce to form the Iliopsoas, which traverse the anterior portions of the hip region and specifically into the femur (lesser trochanter attachment)
- Pain in the groin
- Pain in the hip
- Reduced range of motion in the hip, pelvis or lumbar spine
- Pain in the lower back or pelvis region
- Tightness in the lower abdomen and groin during walking or running
- Palpable pain at the lower, outer abdomen and front of the hip
- Inability to raise hip/leg without tightness and/or pain
The Iliopsoas muscle is often known as the "great masquerade," due to its connectivity within many regions of the body and proximity to important organs and structures. It is an important muscle for appropriate control of the pelvis and trunk, as it attaches between the lumbar spine, pelvis and hip joint. It is often an injury seen during athletics as it is a dynamic mover during sprinting, jumping and overall movement. Its primary job is to flex the hip and during bending of the trunk. It is comprised of the Psoas minor (attached at T12 and L1), Psoas Major (attaches to the vertebrae and discs of T12-L5) and the Iliacus (starts at the top portion of the pelvic rim). These three muscles coalesce to form the Iliopsoas, which traverse the anterior portions of the hip region and specifically into the femur (lesser trochanter attachment)
LUMBAR DISC BULGE & HERNIATION
SIGNS & SYMPTOMS
Disc injuries are a common, yet painful occurrence. Patients often complain of shooting pain, numbness/tingling and extreme localized discomfort in the lower back and buttock regions. Many people are driven toward conventional treatments like drugs or surgery to alleviate their pain, but there are other options. Conservative care through Chiropractic Neurology is a great option for many patients that wish to avoid surgery. If that fails, surgery is then warranted.
HOW DOES A DISC BULGE OR HERNIATE?
First, it is important to understand the physiology of a disc herniation. A disc can herniate if a tremendous amount of compression, or rotational pressure occurs, literally tearing the outer fibers of the disc, the annulus fibrosus, and allowing the nucleus pulposus, or inner contents, to herniate, or protrude. However, this acute, traumatic injury is less common as discs are incredibly resilient structures. It is more common for a disc herniation to be preceded by a chronic rotational or linear restriction of the spinal segments. This causes a bulge to form slowly over time, due to the multiple microtraumas that occur causing a weakening of the outer fibers, eventually leading to complete tearing of the disc. This doesn't always happen, and can often maintain itself as a only a slight bulge, often creating pain and discomfort as well. Think of an ice cream sandwich, squeeze down on one side of it and watch as the other side bulges out. The cookie parts are the restricted vertebrae of your spine and the ice cream part is the disc that bulges or may herniate.
HOW DOES A DISC HEAL?
In order for a herniation or bulge to heal, we need to improve disc motion. The inner contents of the disc do not receive blood supply in the same way as other parts of the body do, so it must get its nutrients through diffusion, or motion, as in a vacuum effect, known as imbibition. Through motion, the disc is able to imbibe, or drink in nutrients from the blood vessels, which are located in the outer ring of the disc, by creating a pressurized pumping action. However, as stated earlier, if the vertebrae are restricted, or not moving, the disc is not able acquire nutrients and cannot heal appropriately. A disc herniation is similar to a cut in your skin. It is a fissure that has occurred, leaking contents. The major difference is in how they heal.
The cut in your skin has blood flow to carry nutrients, but the disc must have motion to imbibe its healing contents.
- Sciatic Pain (pain down the leg)
- Pain in the buttock region
- Lower back pain
- Tingling/Numbness or weakness in a leg or both legs
- Increased pain during sitting
- Increased pain going from a sit to stand position
- Increased pain when standing for prolonged periods of time
- Increased pain in the morning
- Pain when sneezing or coughing
Disc injuries are a common, yet painful occurrence. Patients often complain of shooting pain, numbness/tingling and extreme localized discomfort in the lower back and buttock regions. Many people are driven toward conventional treatments like drugs or surgery to alleviate their pain, but there are other options. Conservative care through Chiropractic Neurology is a great option for many patients that wish to avoid surgery. If that fails, surgery is then warranted.
HOW DOES A DISC BULGE OR HERNIATE?
First, it is important to understand the physiology of a disc herniation. A disc can herniate if a tremendous amount of compression, or rotational pressure occurs, literally tearing the outer fibers of the disc, the annulus fibrosus, and allowing the nucleus pulposus, or inner contents, to herniate, or protrude. However, this acute, traumatic injury is less common as discs are incredibly resilient structures. It is more common for a disc herniation to be preceded by a chronic rotational or linear restriction of the spinal segments. This causes a bulge to form slowly over time, due to the multiple microtraumas that occur causing a weakening of the outer fibers, eventually leading to complete tearing of the disc. This doesn't always happen, and can often maintain itself as a only a slight bulge, often creating pain and discomfort as well. Think of an ice cream sandwich, squeeze down on one side of it and watch as the other side bulges out. The cookie parts are the restricted vertebrae of your spine and the ice cream part is the disc that bulges or may herniate.
HOW DOES A DISC HEAL?
In order for a herniation or bulge to heal, we need to improve disc motion. The inner contents of the disc do not receive blood supply in the same way as other parts of the body do, so it must get its nutrients through diffusion, or motion, as in a vacuum effect, known as imbibition. Through motion, the disc is able to imbibe, or drink in nutrients from the blood vessels, which are located in the outer ring of the disc, by creating a pressurized pumping action. However, as stated earlier, if the vertebrae are restricted, or not moving, the disc is not able acquire nutrients and cannot heal appropriately. A disc herniation is similar to a cut in your skin. It is a fissure that has occurred, leaking contents. The major difference is in how they heal.
The cut in your skin has blood flow to carry nutrients, but the disc must have motion to imbibe its healing contents.
LUMBAR SEGMENTAL RESTRICTION
SIGNS & SYMPTOMS
Pain in our lower back/spine is experienced when there is a lack of joint motion between the lumbar vertebrae and/or in the sacro-iliac joint (pelvis), combined with changes in muscle tone and nerve and blood vessel supply. This leads to inflammation in the area, which activates and over-stimulates particular nerve fibers (type-C) and their endings, called nociceptors, whose sole purpose is to detect pain. The combination of joint restrictions, muscle tone changes, and alterations in nerve and blood vessel signaling cause a reduction in feedback to our brain from the environment and body, which drives the pain pattern. In addition, these changes in joint motion over time can place inappropriate pressure on certain areas of the lower back, leading to disc bulges, disc herniations, and arthritis.
By improving motion in the joints and muscles, we are able to inhibit the type-C nerve fibers and the over-activation of nociceptors that are sending our brain messages of pain. This is known as the Pain-Gate Theory, and is widely accepted as the cause of pain. It simply states that proper motion in joints, ligaments and muscles activate 1A nerve fibers that send our brain messages of motion, and at the same time, they send inhibitory messages to the pain fibers, which reduce their firing and decrease the sensation of pain. In summary, when your spine moves well, pain is inhibited and you no longer feel it.
- Reduced ROM
- Pain, numbness or tingling down the front or back of the leg
- Pain across the lower back in a band-like distribution
- Pain when standing for long periods, or climbing stairs
- Pain when seated (in the tailbone region, lower back, buttock), or pain when getting up from a seated position
- Pain when sneezing or coughing
- Foot, knee or hip pain
Pain in our lower back/spine is experienced when there is a lack of joint motion between the lumbar vertebrae and/or in the sacro-iliac joint (pelvis), combined with changes in muscle tone and nerve and blood vessel supply. This leads to inflammation in the area, which activates and over-stimulates particular nerve fibers (type-C) and their endings, called nociceptors, whose sole purpose is to detect pain. The combination of joint restrictions, muscle tone changes, and alterations in nerve and blood vessel signaling cause a reduction in feedback to our brain from the environment and body, which drives the pain pattern. In addition, these changes in joint motion over time can place inappropriate pressure on certain areas of the lower back, leading to disc bulges, disc herniations, and arthritis.
By improving motion in the joints and muscles, we are able to inhibit the type-C nerve fibers and the over-activation of nociceptors that are sending our brain messages of pain. This is known as the Pain-Gate Theory, and is widely accepted as the cause of pain. It simply states that proper motion in joints, ligaments and muscles activate 1A nerve fibers that send our brain messages of motion, and at the same time, they send inhibitory messages to the pain fibers, which reduce their firing and decrease the sensation of pain. In summary, when your spine moves well, pain is inhibited and you no longer feel it.
PELVIC PAIN / SACROILIAC SPRAIN OR STRAIN / TAILBONE COCCYX PAIN
SIGNS & SYMPTOMS
Back pain is one of the most common reasons people see a doctor or miss days at work. Even school-age children can have back pain. It can range from a dull, constant ache to a sudden, sharp or shooting pain. It can begin suddenly as a result of an accident or by lifting something heavy, or it can develop slowly and occur at random. Getting too little exercise followed by a strenuous workout also can cause back pain (1).
Sacro-Iliac or pelvic pain is often a major contributor to an individual's lower back complaint and is felt along the belt-line and buttock region, near the bony protrusions that you can feel if you rub your fingers along your lower back at the top of your buttock region. The sacroiliac joint connects the spine to the pelvis/hip and injury or damage here can mimic other conditions such as herniated disc or hip problems. Accurate diagnosis is important to determine the source of pain. In our office, this seems to be the most common cause of most patient's lower back pain as it affects multiple surrounding areas. When functioning well, it allows for the lumbar and hip regions to function appropriately. This region is often the primary source, or at least contributor to sciatic pain that is felt in the buttock and down your leg at times.
- Pain that feels like it's near, above or on either side of your tailbone
- Pain when sitting
- Pain when standing or walking
- It can wrap around into the groin
- Pain along crest of pelvic girdle
- Pain traveling up your spine on either side or both
- Pain centrally, above tailbone (tailbone pain)
- Pelvic misalignment
Back pain is one of the most common reasons people see a doctor or miss days at work. Even school-age children can have back pain. It can range from a dull, constant ache to a sudden, sharp or shooting pain. It can begin suddenly as a result of an accident or by lifting something heavy, or it can develop slowly and occur at random. Getting too little exercise followed by a strenuous workout also can cause back pain (1).
Sacro-Iliac or pelvic pain is often a major contributor to an individual's lower back complaint and is felt along the belt-line and buttock region, near the bony protrusions that you can feel if you rub your fingers along your lower back at the top of your buttock region. The sacroiliac joint connects the spine to the pelvis/hip and injury or damage here can mimic other conditions such as herniated disc or hip problems. Accurate diagnosis is important to determine the source of pain. In our office, this seems to be the most common cause of most patient's lower back pain as it affects multiple surrounding areas. When functioning well, it allows for the lumbar and hip regions to function appropriately. This region is often the primary source, or at least contributor to sciatic pain that is felt in the buttock and down your leg at times.
