Did you know that most Back Pain and Sciatica can be attributed to 4 types of conditions?
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Herniated Disc
Although it is not uncommon for a disc to herniate, this is less likely to be the main source of pain than the other 3 conditions.
This usually affects people 35 years of age and under. The reason for this is that after age 35, the disc becomes a lot firmer and less likely to bulge out acutely.
The interesting thing is that on MRIs, 80% of people without back pain show a disc bulge. That means that even though it may be tempting to diagnose a disc herniation quickly, other diagnoses need to be ruled out first.
Contrary to what many people believe, disc herniations CAN be healed. However, it takes the correct approach and it does take time.
This can be a very painful condition. The most common level affected is between the 4th and 5th Lumbar vertebrae. It is so painful because as the disc bulges, it can press directly on the nerve root at that level. This can cause pain down that leg, as well as numbness, tingling and weakness.
People with a disc herniation will usually have increased pain with bending and lifting.
Degenerative Changes
There are 3 main types of degenerative changes that we see:
- Degenerative Disc Disease (DDD)
- Stenosis
- Arthritis
DDD is a normal part of aging. As we age, the disc begins to dry out and loses height. You can see that beginning to happen as a "Degenerative Disc" to the right.
That in itself is not painful, but it allows less space for the nerves and so they can become compressed and irritated. That is a very painful situation.
When the space for the nerves is compromised, that is called "Stenosis".
To make matters worse, with age we also often experience arthritis. Arthritis causes bone spurs, called Osteophytes. You can see Osteophyte formation to the right. These Osteophytes can form in the nerve space, further pressing on the nerve roots and spinal cord.
In addition, arthritis causes the joints in the spine to not work optimally and this can also be painful.
People with back pain and sciatica from Degenerative Changes are usually 50 years and older. Often the pain is worse when standing or walking for a while. It is usually eased by sitting or leaning forward on something like a shopping cart.
This position helps because it opens up the nerve spaces, taking off the pressure.
The good news is that there is so much that can be done for these type of problems. Often medication, surgery and injections aren't required for relief.
SIJ Dysfunction
This is a very interesting condition because it is so often missed. Many people suffer from SIJ pain, but it can be overlooked because it doesn't usually show up on a scan. It is relatively easy to diagnose with a clinical examination, but it does require special, hands-on tests to be administered.
SIJ stands for Sacro-Iliac Joint. This is the joint between the pelvis bone and the sacrum. You can see on the left that we have two Sacro-Iliac Joints. You can also see where the pain is often felt with SIJ problems.
It is also possible for the pain to extend partway down the leg.
SIJ dysfunction can affect people of all ages. It is more often seen in women than men. The pain is often more present when sitting, changing positions, or leaning forward.
This condition usually causes pain when the joint is slightly out of normal alignment. This can happen because of an injury or a fall, a car accident, a strain or even just tight or weak muscles.
Usually the first approach for SIJ problems is to do a hands-on assessment to determine if this is the problem. Then a combination of stretching, strengthening and hands-on techniques usually achieves complete healing. For some people, a brace can be utilized to help hold the joint in place while the ligaments that support the joint tighten up.
Muscle Involvement
Muscle pain may be the most intense type of back pain. There are two dominant reasons for this:
- The nerve supply to the back muscles is rich.
- Almost every position and motion requires contraction of the back muscles.
Even slight movement of an injured back muscle can cause debilitating pain. Many people experience muscle pain and, because it is so severe, assume that something more serious must be going on.
Muscle pain can be due to muscle injury (eg strain) or muscle spasm. Both are relatively benign conditions, but can cause an extreme amount of pain.
It is also possible for certain muscles to become so tight that they compress and irritate nerves, causing pain in the legs. One example of this is Pyriformis Syndrome, in which the Pyriformis muscle presses on the sciatica nerve. This is an example of a condition that can mimic the feelings of a disc herniation, but is usually very easy to treat.
Back problems often begin with a muscle injury. If left untreated, the condition can progress to disc injury and ultimately require a more invasive approach. Therefore it is best to address muscle injuries as quickly as possible.
Muscle problems can affect people at any age, although they are more common after 20, when many people start to lose core strength and flexibility through inactivity. An important first approach is to spend a lot of time gently stretching the postural muscles around the low back and pelvis. Later, strengthening should be done to return core strength to normal. It is important to note that the core and low back muscles supply up to 80% of the stability to the spine. It is therefore very important to achieve normal levels of strength and endurance in the core muscles.
When someone has low back muscle pain, it can be painful almost all the time. Usually side-lying in a slightly fetal position is the most comfortable position.However, bed rest is not the best approach for lasting relief.
Treatment Options for Herniated Disc
Herniated discs can vary greatly in severity. The correct treatment varies from Physical Therapy to Injections to Medication to Surgery.
Usually Physical Therapy is the first approach that offers the best likelihood for long term relief of symptoms. However, it must be the right kind of Phyical Therapy conducted by someone with expertise in treating Herniated Discs. Not all Physical Therapists practice with the same level of skill and experience.
We have found that experience makes all the difference. We have partnered with excellent Physical Therapy groups with a proven track record of success.
It is also important to note that some types of Disc problems should not be treated by a Physical Therapist before further studies are conducted. To determine the right approach for your specific symptoms, and to see which type of specialist may be right for you, click below.
Treatment for Degenerative Changes
We are happy to tell you that most back pain from Degenerative Changes can be overcome. It may take patience and it will require some effort on your part.
For recovery to occur, optimal space and normal alignment needs to be established within the spine. There are two main keys to for this to happen:
- Achieve normal core strength.
- Restore normal flexibility.
In people with Degenerative Changes, there is a very strong correlation between normal core strength and a lower level of pain. For most people, a carefully guided program is required on order to achieve the above two keys.
This is not something most people are able to do on their own. In fact, further damage and injury can occur. The involvement of an expert is essential to achieve this quickly and safely.
However, as important as strength and flexibility are, sometimes other interventions may be required to reduce the pain and inflammation sufficiently to be able to tolerate the techniques and exercises involved. To determine the right approach for your specific symptoms, and to see which type of specialist may be right for you, click below.
Treatment for SIJ Dysfunction
We come across so many people who have suffered with Back Pain and Sciatica for a long time, but have found no relief. Often that is because no one had previously checked them for SIJ Dysfunction.
It is a relatively simple process to diagnose SIJ Dysfunction. The treatment can often be simple as well.
SIJ pain is usually due to the joint not being aligned correctly. Most of the stability of the joint comes from very thick and sturdy ligaments. When these ligaments become stretched or if there is an acute strain or impact injury, the joint can come out of alignment.
Sometimes all it takes is one treatment session to correctly align the SIJ.
Often it requires a course of treatment that includes manual therapy, massage, adjustments and stretching of the tight muscles around the joint.
One of the nice things about SIJ problems is that once successfully treated, it only usually requires a few home exercises to keep healthy. Our patients are so relieved when they learn that there is a cure for their SIJ problem.
To find out if your pain is due to SIJ Dysfunction, and to see what is the best type of specialist to treat your pain, click below.
Treatment options for Muscle Involvement
When muscle injuries are treated correctly, they recover very quickly. Sometimes it is hard for a patient to understand that their intense pain can be due to something that sounds as simple as Muscle Involvement.
Treatment will usually include modalities to promote healing and reduce pain. Examples are moist heat, ultrasound, laser and electrical stimulation.
Muscle spasm is often present and this can be addressed with muscle relaxants and soft tissue work, such as massage.
While the pain and muscle spasm are being addressed, it is also important to correct alignment issues and flexibility deficits in surrounding muscles.
The final steps in recovery require achieving normal muscle strength through the correct exercises, as well as normalizing functional movements.
The exercises that should be performed are different for every individual. In order to determine the appropriate exercises, extensive testing should be performed that identifies which of the 7 core muscle groups are below normal in strength and endurance.
At the end of this course of therapy, the patient should be armed with a small selection of exercises they can do at home to prevent this problem from reoccurring.
To find out if your pain is due to Muscle Involvement, and to see what is the best type of specialist to treat your pain, click below.
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