Posts Tagged ‘Back Pain’

The Magic and Mystery of Trigger Points

Sunday, April 15th, 2012

A physician well-known to this corner had a sudden onset of severe low back pain going down both legs. He had been engaged in a vigorous physical program for years, and was in excellent condition. There was no known injury. MRI showed a large disk herniation between the second and third lumbar vertebrae.

The pain persisted over four months, with some relief from chiropractic, but he was still in pain.

Then he went to see a myofascial practitioner. Extremely tender trigger points were identified on both sides, in the buttocks, thighs and even lower legs, which, when pressed, exactly mimicked the lower back pain. These trigger points were pressed deeply and massaged. Specific exercises were directed to apply pressure to these points at home, using a rubber ball and foam roller, after range of motion and heat. Changes were recommended in sitting and sleeping positions.

The pain started to improve immediately, and after six sessions was about 70% resolved, only showing up at the end of the day.

Another individual developed severe rectal pain the day following prostate surgery. He was unable to sit, had to position himself on his side, and walking was impaired. Over the next year he saw numerous urologic and orthopedic specialists, pain specialists, had x-rays and MRIs, multiple injections, physical therapy, even an injection into a nerve plexus deep in the rectum, all without relief.

He went to a myofascial therapist. Severe trigger points were identified in his buttocks and treated. After only the second treatment his pain had improved and he could sit down again. (more…)

Back Pain and Ruptured Discs

Thursday, November 17th, 2011

Herniated DiscLow back pain problems occur in 60-80% of people at some time in their lives.  Much of this relates to lumbar disc disease, either protrusion (bulge) or rupture.

The disc is a layer of cartilage and fiber, about a quarter inch thick, that acts as a cushion between two vertebrae.  It assists in twisting and bending movements, and prevents the deterioration of bone that would be caused by friction between bones.  The discs make up 25% of the height of the spine.  Their shrinkage causes most of the loss of height as people get older.

Discs are subject to injury and wear.  CT and MRI studies, but not x-rays, will visualize disc problems.  Ruptured discs, with entry of material into the spinal canal, are most common in people between 30 and 50 years of age.  They are very painful, due to pressure on spinal nerves and release of inflammatory molecules from the disc itself and from white blood cells trying to dispose of damaged tissue.  The pain may require narcotics for relief.  Non-steroidal drugs are often effective, and should be used first.

Risk factors for herniated discs include driving motor vehicles, sedentary activities, inactivity, vibration, smoking, history of pregnancy, obesity and tall height.  Extremes of lifting or pulling heavy weights also lead to low back injury.  Flexion of the spine is the motion most responsible for causing disc rupture.  Therefore, in all physical activities it is important to keep the spine straight, and especially NOT to bend the spine while lifting.

Surgery is often performed to remove part or all of the herniated disc, especially when lower lumbar disc rupture, usually the L4-5 disc, compresses a sciatic nerve root, causing debilitating pain to radiate down the leg.

The natural history of ruptured discs, however, reveals that they often heal themselves without the need for surgery.  Effective non-surgical treatments include epidural steroid injection, acupuncture, exercises, and physical therapy including ultrasound and electrical stimulation.  In a one-year trial, 90% of patients had satisfactory recovery without surgery.

Other studies reveal that low back pain is often related to abnormalities in the cervical spine, even in the absence of neck symptoms.  Treating the cervical spine will improve low back pain over half the time.  In my own experience, cervical chiropractic has been effective.
(more…)