What is the difference between a herniated disc, bulging disc, and sciatica?
The disc is a shock absorbing cushion that separates two vertebrae. Inside the disc is a jelly like substance that is normally contained within the fibers of the disc. However, postural stress, accidents and falls can misalign vertebrae and tear these fibers allowing the jelly in the center of the disc to bulge out and put pressure on the nerves. This is referred to as Sciatica or pain down along the course of the sciatic nerve into the buttocks and to the leg. Sciatica can also cause weakness, tingling and numbness along the path of the nerve from your low back
to your foot. A herniated or extruded disc is when the jelly is no longer contained within the confines of the disc.
What are some of the orthopedic tests and why are they important?
A positive straight leg raise test is about 80 percent sensitive for a L4-L5 or a L5-S1 herniated disc. Each leg is raised to 70 degrees slowly. The leg is then lowered and the foot flexed to see if pain is increased. Pain radiating below the knee or a reproduction of the patients sciatica pain is a positive finding
If I have a herniated disc do I need surgery?
Not always! “Reduced odds of surgery were observed for... those whose first provider was a chiropractor. 42.7 percent of workers with back pain who first saw a back surgeon had surgery in contrast to 1.5 % of those who saw a chiropractor: - Keeney et al (2012) Spine
FAQ on Back Pain
What Causes Back Pain?
There are a multitude of causes of Low Back pain. Sometimes it is a recent accident or injury, other times is simply bending or twisting wrong. It can be an injury from years ago which contributed to your current pain. Old joint injuries can create a cascade of joint dysfunction in the back years after the initial injury. These Joint dysfunctions cause some muscles to become tight and other muscles to become weak resulting in poor stabilization and accelerated degeneration of the spine resulting in recurrent low back pain. Discovering the true cause of back pain is like putting together the pieces of a puzzle. A thorough history and exam leaves clues in finding the weak link causing continued pain.
Will Back Pain Go Away on Its Own?
Until recently, researchers believed that back pain will “heal” on its own. Clinical practice and recent studies show this is not true. In fact, left untreated the symptoms may temporarily resolve but will most likely return. The study also showed that only 9 percent of patients having low back pain for 30 days were pain free 5 years later.
What is the incidence of Low Back Pain?
Low back pain affects up to 90 percent of the population at some point in their lives. It is the second most common reason for visits to the doctor’s office, outnumbered only by respiratory infections. Some studies show as many as 40 percent of people will experience sciatica at some point in their lives.
How do you treat low back pain?
I have been very successful in treating low back pain. I frequently combine several techniques In order to achieve faster results. I choose the technique based on the patient condition and comfort. I often start patients on The McKenzie and acute low back pain protocol home exercises. Combining McKenzie with chiropractic adjustments reduces healing time significantly. I educate patients on proper posture and movement to facilitate healing. My goal is to reduce the patient’s pain by 40-60 percent within the first week. The spinal adjustment removes pressure from the nervous system. Giving patients exercises act as retainers (like braces on the teeth) to further speed healing.
What are the red flags of low back pain?
Red flags can indicate a serious underlying cause of low back pain. “Red Flags “ include-fever, the presence of a severe or rapidly progressing neurological deficit, urinary and/or fecal incontinence, a history of malignancy, pain lasting more than 6 weeks, pain in persons younger than 18 or older than 50, a history of major trauma, pain radiating below the knee, night pain and pain non-relieved by position change.
What are some tips to avoid low back pain?
- Exercise regularly
- Avoid prolonged bending or stooping
- Maintain a healthy diet and weight
- Avoid prolonged inactivity or bed rest
- Practice good posture
- Change positions with prolonged sitting
- Stretch and warm up prior to physical activity.
- Lift with your knees and keep the object close, avoid twisting or bending when lifting
- Maintain good core stability
- Sleep on a firm mattress
- Quit Smoking
- Work with your Doctor of Chiropractic to assure your workstation is ergonomically correct
Studies also show the highest numbers of surgeries are done in the areas where there are highest numbers of orthopedic surgeons.
Do Chiropractors prescribe drugs?
No, it is important to remember that prescription drugs are responsible for the 4th cause of death in our country. For example Celebrex a commonly prescribed drug for back pain was responsible for 159,000 deaths. Studies have shown that prolonged use of over the counter nsaids lead to accelerated joint degeneration.
Is there research supporting Chiropractic manipulation?
Patients with chronic low- back pain treated by chiropractors showed greater improvement and satisfaction at one month than patients treated by family physicians. Satisfaction scores were higher for Chiropractic patients. A higher proportion of chiropractic patients (56 percent vs 13 percent) reported that their low-back pain was better or much better, whereas nearly one-third of medical patients reported their low-back pain was worse or much worse”
-Nyiendo et al (2000) Journal of Manipulative and Physiological Therapeutics
What about Patient Satisfaction around Chiropractic?
“Chiropractic patients were found to be more satisfied with their back care providers after four weeks of treatment than were medical patients. Results from observational studies suggested that back pain patients are more satisfied with chiropractic care than with medical care. Additionally, studies conclude that patients are more satisfied with chiropractic care than they were with physical therapy after six weeks”
-Hertzman-Miller et al (2002). American Journal of Public Health
Popularity of Chiropractic
The Annals of Internal Medicine (2002) reported that chiropractic is the largest, most regulated, and best recognized of the complementary and alternative medicine (CAM) professions. The use of Chiropractic is increasing and has tripled in the past two decades. Patient satisfaction with chiropractic is very high