1) Disc and Joint Degeneration

Your spine is made up of 24 individual vertebra stacked on top of each other.  To allow for flexibility and movement, there is a ‘disc’ between each pair of vertebrae.  As we age, these discs can wear, becoming progressively thinner over time.  This leads to a cycle of arthritic changes, including bone spurring and narrowing of the opening where our nerves exit the spine.   Sometimes the nerves can become ‘pinched’ in these narrowed openings. This causes ‘sciatica’ or sciatic nerve pain.

Disc and joint degeneration can affect people as young as 20, and becomes exceptionally common by age 70.  Degeneration can be accompanied by an overgrowth of bone, narrowing of the joint space and deformity of the joint. There are many factors that affect the progression of this condition. This risk factors include a history of trauma, smoking, continually operating motorized vehicles, being overweight and repetitive movements.

Symptoms

How the symptoms present depends on the areas affected.  In general, the symptoms of low back pain due to degeneration include:   

·         Pain, discomfort or stiffness lasting longer than 30 minutes first thing in the morning

·         Radiating pain into your legs

·         Swelling and tenderness to touch in the low back and hips

·         Warmth/heat may be felt in the area

·         Joint stiffness following activity

·         Pain increase after activity or with weight-bearing

·         Decreased range of motion

·         Crepitus (i.e.; creaking or cracking)

 

Most researchers believe that symptoms of this condition are not the direct result of disc and joint degeneration.  It has been referred to as a natural aging process and considered the ‘grey hair’ of the spine.  Rather, research suggests it is more likely the symptoms are due to another cause.  These other causes include joint restrictions and muscular tightness. These problems can occur before and after disc and joint degeneration develops.

Stenosis

In some individuals, by no fault of their own, the degenerative process occurring in the spine creates excessive bone growth.  This causes a narrowing to occur where the nerves exit the spinal column.  This process takes place over years, and can lead to worsening symptoms.

 

Individuals with symptomatic spinal stenosis typically have the following signs and symptoms:

·         Progressively worsening symptoms with time

·         Over 60 years of age

·         Sciatica in one or both legs

·         Leg numbness

·         Leg Weakness

·         Improvement in symptoms with rest or sitting

·         Symptoms diminish with forward bending or sitting

 

It is challenging, if not impossible, to stop the normal aging of the spine.  Yet, there are several things that can help reduce spinal stenosis symptoms.

·         Maintain mobility of the spinal joints and muscles

·         Proper lifting and bending techniques lessen the strain on the spine

·         Improve the endurance and capacity of the muscles also lessens the strain on the spine.

·         Limiting sugar, grains, saturated fats and processed food helps to lower chronic low grade inflammation.

Disc Injury

Disc lesions start when the outer fibers of the disc become strained or frayed.  If enough fibers become frayed, this can create weakness in the disc.  When the disc is compressed, the outer fibers may ‘bulge’ or ‘protrude’ like a weak spot on an inner tube.  If more fibers are damaged, the jelly within the disc may ‘herniate’ out.  Most low back disc problems occur at one of the two lowest discs - L4 or L5.  The spinal cord and nerve roots lay directly behind the disc. This causes inflammation or direct compression of the disc on the nerves to create radiating pain.

 

Symptoms of a disc injury vary depending on the type and location of the disc injury.  Also on the level of inflammation present.  Symptoms may include:

 

·         Lower back pain

·         Radiating pain into one buttock or one entire leg

·         Decrease of lower limb reflexes, and

·         Motor reflex weakness

 

Disc injuries can occur gradually over time, or from trauma.  If there is nerve compression or inflammation around the nerve, you will experience sciatic nerve pain.  Depending on the severity of nerve compromise, it may radiate into the buttocks, or all the way down your leg into the foot.  Symptoms from a disc herniation typically can resolve within a few weeks. But if the disc isn’t allowed to heal, symptoms often will remain or return.

This is the classic history of someone suffering from a disc injury. Back pain is on and off for months or years. The pain may be getting worse each episode. The pain then starts to radiate into the buttocks, down the leg, and into your foot.  This can take place over months or years. There will often be a decrease in strength in the foot and leg, accompanied by numbness and/or tingling.  Depending on the type and location of disc herniation, symptoms may be in one, or both legs.  Typically, if a disc herniation is worsening, the back pain improves, but leg pain becomes worse.

Treatment

If you have a disc injury, conservative care should be the first line of treatment.  The therapies provided first strive to reduce the nerve compression and to stop injury progression. Next our goal is to reduce your leg pain, and decrease the inflammation to get you out of pain as quickly as possible.  Once pain has subsided, we then focus on developing strategies to lessen pressure on the disc. This will allow the disc to heal and to stop symptoms from re-occurring.  

We also help you develop stability within the spine. This causes disc herniations to become less likely to become symptomatic. We give you the strategies and tools you need to keep your back strong and resilient.

4) Strain / Sprain

Your lower back is made up of five vertebrae stacked on top of the other with the discs between them.  Along the spine we have muscles and ligaments to provide support.  “Sprains’ and “strains” are a result of these muscles and ligaments being stretched too hard or too far. This is like when a rope frays after it is stretched beyond its normal capacity.  “Sprain” refers to when the tough and durable ligaments holding your bones together have been damaged.  “Strain” means the muscles or tendons that move your spine have been injured.

 

What causes them

Sprains and strains may result from sudden or forceful movements.  Falls, twisting, lifting, pushing, pulling, direct blows or quick movements for example.  Most commonly, sprains and strains are the result of repeated overloading, rather than a single event.  The spine is strong and robust.  Yet, with repetitive movements and challenges, the same structures become fatigued. They are not given time to recover, which leads to injury.  This occurs in much the same way that constantly bending a piece of copper wire will cause it to break.  Risk factors include: Poor postures, sedentary lifestyles, poor workstation ergonomics, repetitive movements and poor lifting mechanics.

Symptoms

Pain may begin suddenly, although more commonly it develops gradually.  Pain can range from a dull discomforting ache to a debilitating stabbing pain.  Rest may help, but will often lead to stiffness.  Pain is typically in the middle of your low back, but can spread to the hips.

Sprains and strains injure your normal healthy elastic tissues.  They are then replaced with less elastic ‘scar tissue’.  This process can sometimes lead to ongoing pain. It can predispose you to developing arthritis.  People sometimes elect to forego treatment and "just deal with it". People with strain/sprain injuries to their lower back develop chronic low back pain more than 60% of the time.  Seeking early and appropriate treatment like the type provided in our office, is critical.

What To Avoid

Some activities may need to be limited for a while. Bending, twisting, lifting or painful movements for example.  However, bed rest is not in your best interest. “Motion is lotion”, and it is important that you remain active and return to your normal activities as much as your symptoms allow. Be sure to take ‘micro breaks’ every 20 minutes, if possible.  This means, it is best for you to stand every 20 minutes to move around and change position.

Avoiding Sprains and strains

“An ounce of prevention is worth a pound of cure”.  There are many steps that can be taken to reduce the risk of a low back sprain/strain injury.  Remember, it’s not the load that injures, it’s the load you are not ready for.

By increasing your physical conditioning and the tissue tolerance in your back, you are less likely to suffer an injury.  Deconditioning is extremely common.  Sitting all day and repetitive movements can lead to muscle weakness.  This weakness leads to less and less support to the vertebrae and discs.  Your muscles begin to atrophy, and may develop fatty infiltrate.  This can lead to a further decrease in spinal stability.

There are many strategies to reduce the risk of developing a back strain or sprain. Having an active lifestyle and improving your spinal stability will help. Improving spinal strength and endurance is also important. Using ideal lifting technique, you will reduce your risk of developing a back sprain or strain.

5) Joint Dysfunction / Facet Syndrome

The five vertebrae and the discs between them make up the lower back.  The front of the vertebra is called the ‘body’.  The back of each vertebra is formed by two smaller bony columns. One on each side, capped with smooth joints called ‘facets’.  Each vertebra rests on the one below in a ‘tripod’ fashion. The disc in front between the two bodies, and the facet joints in the back.  In a normal and healthy spine, each of these joints will move freely and independently.

Facet syndrome is a problem that can arise from sprains or strains, or joints that are not moving properly.  When the ‘facet joints’ are not moving properly, they can become irritated or inflamed.  To visualize this, imagine the spine as a big spring moving freely in every direction.  When one of those joints is not moving, it is like having a section of that spring welded together.  While the spring may still move as a whole, a part of it is no longer functioning.

Restricted joints give rise to a self-perpetuating cycle of discomfort.  Joint restriction causes swelling and inflammation. This triggers muscular guarding, leading to more restriction.  The spine functions as a unit, rather than in isolated pieces. Joint restriction in one area of your spine can often cause ‘compensatory’ problems in another area.  Think of this as a rowboat with multiple oarsman on each side.  When one rower quits, the others are placed under extra stress. This causes them to become overworked.

Risk factors for facet syndrome include:

·         an injury to the lower back

·         overuse of the back muscles

·         arthritis or degeneration

·         being overweight

·         smoking

·         prolonged whole body vibration (i.e. operating a motor vehicle)

·         stress, and anxiety

Symptoms of a facet syndrome

You will likely notice pain on one side of your back.  Pain may radiate into your flank, hip and thigh, but not typically below the knee.  Often the pain comes and goes.  The pain will typically increase when you arch backwards, or return to an upright position after bending forward.  Lying down typically gives relief.

It is thought that if the facet joints are not moving properly for a long period of time, it could contribute to causing arthritis. Much like the way a misaligned wheel on your car can cause premature wearing on your tire.

Treatment

These problems are common and treatable.  Chiropractic care is safe and effective for treatment of joint restriction and facet syndrome.  Our office offers several tools to help ease your symptoms and speed your recovery.

To aid in your healing, be sure to take frequent breaks from sedentary activities. Also, wear comfortable and supportive footwear, and avoid painful activities.  Exercise such as yoga can also help back pain suffers.