Back Pain

Dr. Lutz utilizes a patient-centered approach which incorporates his extensive training in chiropractic, rehabilitation and sports performance to quickly decrease pain associated with back pain, without the use of drugs or surgery.

Back pain is the most common complaint we treat. More than 80 percent of Americans experience lower back pain at some point in their lifetime. For many, the effects of low back pain are an everyday battle which immensely impacts the quality of life.

The pain we feel — whether in the back, the hips, or down the legs — is the body’s request for change. Back pain is not an indication something is broken or that it needs to be “fixed”.

At Motion ChiroTherapy, we take the time to understand the issue and how it behaves in order to apply the right tool for the job from our unique toolkit – only then can we achieve a solution.

What Causes Back Pain and How is it Treated?

Back pain is most commonly mechanical in nature, meaning the issue is based in movement, and how we’re using our body. If your back pain changes — becoming better or worse — with different positions and movements, you likely suffer from mechanical back pain.

Because the nerve supply to your legs stems from the spinal cord within the spine, poor spinal mechanics can alter the signals from your brain to the muscles. It is common to experience symptoms such as pain, muscle weakness, or numbness and tingling into the hip or groin, down your legs, with or without local back symptoms!

In quality non-surgical care, it’s important to minimize variables and rule out the spine as the pain generator. Many medical diagnoses need to be thoroughly examined so that we don’t “chase pain” and can understand WHY you’re dealing with discomfort.

In rare cases, back pain can indicate a serious medical problem requiring immediate attention. Our thorough history and exam will help guide us if we need to send you out immediately. Please be cautious if you’re dealing with signs like: bladder dysfunction, fever, direct trauma or unexplained weight loss accompanied by back pain.

Lower back Pain treatments - Greenville Chiropractor

Common Issues We Treat

  • Sprain/stain
  • Intervertebral disc degeneration
  • Disc herniation
  • Sciatica
  • Spondylolisthesis
  • Spinal stenosis

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What it isn’t

Let’s talk about pain science! Pain is a signal from the brain of a perceived threat. Pain is there to protect you! It’s a request from our brain telling us that it’s time to change something – whether that’s the way you move, positions you live in or what you’re eating. Mechanical back pain does not have to be debilitating and just because you have back pain does not mean you’re broken.

Just because you have pain doesn’t mean you need an MRI; just because your MRI shows “degenerative,” “disc bulges,” or “arthritis,” – doesn’t mean it’s causing your pain. Back pain is often unassociated with the aforementioned structural changes commonly found from imaging, e.g. X-ray, CT scan, MRI. There are countless studies that show arthritis, disc bulges, and hip pathology on individuals who don’t have any pain!

Common Causes for Back Pain

Mechanical back pain is most commonly caused by poor body mechanics and postural habits.

Humans are meant to move and move often — not sit in chairs and stare at electronic screens for hours on end. From infancy through the first year of life, we learn to how to move properly; setting us up for the rest of our lives.

Think about the average desk worker’s day: sit for breakfast, sit in the car on the way to work, sit at the desk, sit for lunch, back to sitting at the desk, sit in the car back home, sit in front of the T.V. — you get the point.

Mechanical back pain can occur suddenly from something as simple as bending over to put on your socks, but most commonly occurs for no apparent reason – likely from accumulated stress.

The accumulative postural stress of sitting as a daily habit is like bending your finger backward. It may not hurt at first, but the longer you hold it there, and the more pressure you apply over time, it will start to feel uncomfortable and aching. When you let go of the finger, you’ll have a residual ache, but you’ll notice the pain quickly subsides. This is mechanical pain and is similar to what the typical American with back pain experiences.

So, what happens after you poorly lift something heavy after sitting all day? It’s like cranking that finger back as far as it can go…and it’s probably going to hurt long after you let go of it!

Common Treatments for Back Pain

The most common treatments are rest, medication, physical therapy, sports therapy, chiropractic, acupuncture, massage, and other various conservative therapies.

While most acute bouts of back pain will resolve on their own within a few weeks, the risk of recurrence is very high. This sounds silly, but the greatest risk of lower back pain is previous low back pain — if you’ve had it once, it’s likely going to happen again. The goal is to learn proactive strategies so that if you deal with the pain in the future not only can you manage it, but attack and relieve it on your own.

Few individuals need surgery for back pain. Do you have a disc bulge? Even if it’s relevant, lumbar disc herniations have been shown to resolve on their own without surgery.

If you have intense and unrelenting pain down the leg, progressive muscle weakness, bladder or bowel symptoms, or specific structural problems not responding to conservative therapy, surgery may be warranted.

What You Can Do About Back Pain

Low Back pain is a $600 billion dollar industry in this country. That is outrageous! Musculoskeletal pain is unfortunately very mismanaged. Why make simple problems complex?

With all mechanical pain, there’s a ‘what’ and a ‘why’ — what the problem is and why it’s occurring in the first place. To achieve resolution it’s crucial to not only identify and correct the problem at hand but address the behaviors which lead to the issue!

Here are some self-help tips:
Keep moving!
Avoid sitting for longer than 30-minutes at a time.
Sit with upright posture with lumbar support.
Take micro-breaks: stretch, take a stroll, grab a snack, move around.
Take mental notes of what you are doing when your pain feels better or worse to identify any positional patterns.

Still Struggling With Back Pain? We Can Help!

Many traditional clinics focus on long-term treatments that require extensive in-office appointments costing patients both time and money. At Motion ChiroTherapy, we provide a cost-effective alternative. We quickly identify what’s causing your discomfort, get you out of pain, then teach you how to minimize any recurrence through specific exercises and principles.

To achieve rapid results, Dr. Robert Lutz takes his time to talk to you and learn about your problem, analyze your movements and uncover the root cause of each individual complaint. Once the source of discomfort is detected, we will use the most appropriate treatments from our unique toolbox to quickly resolve symptoms. We understand what patients want; fast pain relief, personal attention and the ability to get back in motion!

Sacroiliitis

The sacroiliac joint (SIJ) is the load-bearing, shock-absorbing union between the spine and pelvis. It is a mechanical link that connects the chain of locomotion to the rest of the body. This irregular, synovial and fibrocartilaginous joint is surrounded by a strong ligamentous-reinforced capsule and is minimally mobile (1,2).

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Approximately 13% of low back pain is attributable to the SIJ (3). Sacroiliac joint dysfunction (SIJD) can be divided into two general categories: mechanical and arthritic. “Mechanical” SIJD results from any process that alters normal joint mechanics. Common culprits include: leg length inequalities, gait abnormalities, lower extremity joint pain, pes planus, improper shoes, scoliosis, prior lumbar fusion, lumbopelvic myofascial dysfunction, repetitive strenuous activity and trauma – especially a fall onto the buttocks. Studies show that over half of mechanical SIJD results from an inciting injury (4). Pregnancy creates an array of sacroiliac joint issues with weight gain, gait changes and postural stressors occurring contemporaneously with hormone-induced ligamentous laxity. “Arthritic” SIJD results from either osteoarthritis or from an inflammatory arthropathy including; ankylosing spondylitis, psoriatic arthritis, enteropathic arthritis, and Reiter’s/reactive arthritis which produce sacroiliitis and resulting pain. Morning pain that resolves with exercise is characteristic of arthritic SIJD.
The clinical presentation of SIJD is quite variable and shares several common characteristics with other lumbar and hip problems.The patients’ lumbar spine must first be ruled out as the pain generator since it’s a common referral for low back discomfort. When asked to point specifically to the site of pain, the SIJD patient will often place their index finger over the posterior superior iliac spine (PSIS). Pain may or may not refer to the lower back, buttock, thigh or rarely into the lower leg via chemical radiculopathy of the neighboring L5 or S1 nerve roots (5). Symptoms may be exacerbated by bearing weight on the affected side and relieved by shifting weight to the unaffected leg. Pain may be provoked by arising from a seated position, long car rides, transferring in and out of a vehicle, rolling from side to side in bed or by flexing forward while standing. Pain is often worse while standing or walking and relieved by lying down.
References
1. Sturesson B, Selvik G, Uden A. Movements of the sacroiliac joints: A roentgnen stereophotogrammetric analysis. Spine. 1989;14:162–165.
2. Sturesson B, Uden A, Vleeming A. A radiostereometric analysis of the movements of the sacroiliac joints in the reciprocal straddle position. Spine. 2000;25:214–217.
3. Maigne JY, Aivaliklis A, Pfefer F. Results of sacroiliac joint double block and value of sacroiliac pain provocation tests in 54 patients with low back pain. Spine 1996;21: 1889–1892.
4. Bernard TN Jr, Kirkaldy-Willis WH. Recognizing specific characteristics of nonspecific low back pain. Clin Orthop Relat Res. Apr 1987;217:266-80.
5. Fortin JD, Washington WJ, Falco FJE. Three pathways between the sacro-iliac joint and neural structures. AJNR. 1999;20:1429–1434.

Piriformis Syndrome

Piriformis syndrome arises when a irritated piriformis muscle compresses the sciatic nerve (1). This pressure causes ischemia, congestion, local inflammation and radicular complaints (2). Researchers estimate that piriformis syndrome contributes to up to one third of all back pain (3,4).

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The piriformis muscle originates on the anterolateral surface of the mid-portion of the sacrum and inserts on the superior medial aspect of the greater trochanter. When the hip is extended, the piriformis functions primarily as an external rotator of the thigh, with secondary contributions toward flexion. The muscle assists in abduction when the hip is flexed to 90 degrees. (3) The sciatic nerve has a variable relationship to the piriformis muscle. In the majority of the population, the sciatic nerve travels deep to the muscle. Approximately one fourth of the population is anatomically predisposed to piriformis syndrome because their sciatic nerve passes through the muscle, splits the muscle or both. (5,6)

Symptoms of piriformis syndrome may begin abruptly as the result of a traumatic event, or may develop slowly in response to repeated irritation. Piriformis muscle irritation and hypertonicity can result from a strain, a fall onto the buttocks or catching oneself from a “near fall.” In other instances, the process may begin following repetitive microtrauma, like long distance walking, stair climbing or from chronic compression- i.e.sitting on the edge of a hard surface or a wallet. (8,9)

Presenting complaints for piriformis syndrome include pain, paresthesia or numbness beginning in the gluteal region and radiating along the course of the sciatic nerve. Additional symptoms may develop from local trigger point referral into the proximal thigh, sacroiliac and hip regions. (9) Symptoms are often provoked by holding any one position for longer than 15-20 minutes- particularly prolonged sitting or standing. Positional changes may provide transient relief. Patients may report increasing discomfort when walking, running, stair climbing, riding in a car or arising from a seated position. Activities that involve hip internal rotation, like sitting cross-legged, may exacerbate symptoms (10).

Piriformis syndrome shares several common characteristics and may even co-exist with other lumbopelvic problems. The differential diagnosis for piriformis syndrome includes; hip pathology, fracture, lumbar compression fracture, discitis, trochanteric bursitis, sacroiliitis, sacroiliac joint dysfunction, lumbar radiculopathy, spinal stenosis and viscerosomatic referred pain.


References
1. Yeoman W. The relation of arthritis of the sacroiliac joint to sciatica. Lancet. 1928;ii:1119-22.
2. Williams PL, Warwick R. Gray’s Anatomy. 36th ed. Philadelphia, Pa: WB Saunders Co; 1980.
3. Papadopoulos EC, Khan SN. Piriformis syndrome and low back pain: a new classification and review of the literature. Orthop Clin North Am. 2004;35:65-71.
4. Pace JB, Nagle D. Piriformis syndrome. West J Med. 1976;124:435-439.
5. Beason LE, Anson B.J. The relation of the sciatic nerve and its subdivisions to the piriformis muscle. Anat Record. 1937;70:1-5.
6. Pecina M. Contribution to the etiological explanation of the piriformis syndrome. Acta Anat (Basel). 1979;105:181-187.
7. http://physioplus.blogspot.com/2008/09/piriformis-syndrome.html, retrieved 10/13
8. Foster MR. Piriformis syndrome. Orthopedics. 2002;25:821-825
9. Travell J, Simons D. Myofascial Pain and Dysfunction, Vol 2. Williams and Wilkins 1992. pp 186-214
10. Magee DJ. Orthopedic Physical Assessment. 3rd ed. Philadelphia, Pa: WB Saunders Co; 1997.

Pinched Nerves

A pinched nerve is not a true medical diagnosis, but is commonly used when referring to numbness/tingling/pain running down the front or back of the leg or buttock region. A “pinched nerve” is one that has excessive pressure on it resulting in irritation.

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This is not diagnostic, however, because there are a variety of structures that could be applying this irritation to the nerve, such as: radiculopathy, bulging disc, degenerative disc disease,  spondylolisthesis, or spinal stenosis. It is also common for patients to experience symptoms that they may not recognize as a produce of an irritated nerve. The feeling of “tight” hamstrings that no matter how much you stretch, they never stay “loose” or numbness/pain perhaps just on the side of your foot can both be results of nerve irritation stemming from the low back.

Sciatica Treatment

Sciatica is not a true medical diagnosis but rather a symptom of an underlying medical condition. There are a few common lower back problems that can cause sciatica symptoms. These include a radiculopathy, bulging disc, degenerative disc disease, spondylolisthesis, or spinal stenosis

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Sciatica is often characterized by one or more of the following symptoms: constant pain in one side of the buttock or leg (rarely in both legs), pain that is worse when sitting, leg pain that is often described as burning or tingling, weakness or numbness, sharp pain that may make it difficult to stand up or walk, and pain that radiates down the leg and possibly into the foot and toes.

Our chiropractor in the FishHawk, Valrico and Riverview area typically finds that sciatica symptoms aren’t always as black and white as it’s drawn up in the books. The patient typically can’t draw a straight line with a pen from the back straight down the leg. Rather, the symptoms are variable and change based on positions and movements. The patient may sometimes have pain the glute, their hamstrings feel “different” and they have an odd sensation in the calf. Sciatic pain can vary from intermittent and irritating to constant and debilitating.

Symptoms are usually based on the location of the pinched nerve. The sciatic nerve is the largest single nerve in the body and is made up of individual nerve roots that start by branching out from the spine in the lower back and then combine to form the “sciatic nerve.” Sciatica symptoms occur when the large sciatic nerve is irritated or compressed at or near its point of origin. The sciatic nerve starts in the low back, typically at the third lumbar segment. At each level of the lower spine, a nerve root exits from the inside of the spinal canal, and each of these respective nerve roots then come together to form the large sciatic nerve.

The sciatic nerve runs from the lower back, through the buttock, and down the back of each leg. Portions of the sciatic nerve then branch out in each leg to innervate certain parts of the leg—the thigh, calf, foot, and toes. The specific sciatica symptoms—the leg pain, numbness, tingling, weakness, and possibly symptoms that radiate into the foot—largely depend on where the nerve is pinched.

Often, a particular event or injury does not cause sciatica— the most common cause of sciatica is “for no apparent reason” – it tends to develop over time. Our chiropractor in the FishHawk, Valrico and Riverview area helps you understand your sciatica symptoms and will quickly find you a solution or get you to the provider who can help.

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Muscle Strain

Muscles are another structure that are able to produce a significant amount of back pain. At times, they can be the primary cause of low back pain, where the individual may have “over did it” exercising or lifting, resulting in typical one-sided pain directly over the provoked muscle.

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Other times, muscles are merely a product of their environment. When your body senses instability, perhaps in the disc, the muscles around the structure tighten up and clench to try and add stability to this area. When muscles are neurologically “tight,” no amount of massages or soft tissue work will fix them. To get the muscles to calm down, the deeper problem at hand, the instability, needs to be addressed. Once the brain recognizes that the instability is gone, the muscles will have no reason to overcompensate.  A quick google search for a muscle stretch or the low back will produce a lot of options, but many of them are flexion-based (involve bending forward). While this may be palliative for a primary muscle “tightness,” it can be detrimental if there is an underlying irritated disc or instability and can actually make the condition worse. Additionally, if the muscle is a true strain where it has been acutely injured, stretching can also make it worse. This is why getting assessed by a professional is critical to fully understand your condition and get the most appropriate care possible! All of the aforementioned conditions are treated every day in our office by our chiropractic physicians.

Disc Herniation/Bulge

If you have had an MRI in the past, your doctor may have told you something like, “you have an L4-L5 disc herniation or bulge.” While these findings may startle you, there is no reason to be alarmed.

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Research has found that many disc bulges caught on MRI are actually asymptomatic, meaning that just as many people without back pain, can have similar looking spines as those with low back pain. While disc irritation is still quite common in the younger population, it is more-so based on how the brain perceives the threat to the disc, versus how big the herniation actually may appear on MRI. What does that mean? That even a large disc herniation may produce no pain to the patient at all, or a very small disc bulge may provide the patient significant discomfort. This also means that just because you have an MRI finding like a bulge or herniation, does NOT mean that you have to stay in pain. Discs are most appropriately treated with conservative measures first! Usually the “WHY” behind having an irritated disc, is purely mechanical in nature anyways, meaning that it is a result of our movement, or lack-thereof. And for a mechanical problem you need a mechanical solution!

Disc Degeneration/Bulge

If you have had an MRI in the past, your doctor may have told you something like, “you have arthritis in your spine” or “you have degeneration at L4-L5.” While these findings may startle you, there is no reason to be alarmed.

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A large portion of spinal degeneration is asymptomatic and a natural part of aging. It can actually be compared to growing older and getting grey hair. Spondylosis or mild degenerative changes in the spine, either at the joint or with loss of disc height, are a process that almost every person, with or without pain, goes through. That means that even though “arthritis in your spine” may sound irreversible and scary, it in no way means that you have to spend the rest of your life in pain. If there are no other conclusive MRI findings of significant foraminal or canal stenosis, most back pain in this scenario is mechanical in nature, meaning that it is a result of our movement, or lack-thereof. And for a mechanical problem you need a mechanical solution! This is most appropriately treated with conservative care measures first!