One of the most common health problems people suffer with is low back pain, with or without related leg pain. If the source of pain can be clearly identified, appropriate effective treatment can be administered. I make it a priority to clearly explain to all my patients what is causing your pain, where your problems are coming from, what will be done in the office to help your condition, what you should and should not be doing at home, and, most importantly, what you can do to stay well after the pain is gone. Medical research has clearly indicated that the number one source of low back pain is the intervertebral discs. Most of my patients with lower back pain and/or leg pain receive a diagnosis such as “disc irritation.” This means the discs are the source of pain, and the discs have become irritated from slow wear and tear, abuse and neglect, poor posture, and injuries. Therefore treatment must focus on the restoration of disc health.
Discs are fibrocartilaginous pads that separate the bones of the spine. The center of a disc is called the nucleus and is filled with a gel-like substance. Strong, criss-crossing fibers, called annular fibers, surround the nucleus and give the disc its shape and strength. Discs allow for motion of the spine and handle gravitational and mechanical loads. The discs of the spine are well supplied with nerve endings called receptors. These receptors are called mechanoreceptors and are sensitive to motion and gravity. If the discs and joints of the spine are healthy and flexible the mechanoreceptors are continuously stimulated. Mechanoreceptor nerve traffic is essential to keep the brain happy and healthy. If the discs and joints become irritated, stuck, glued, stiff, and scarred, from daily postural and ergonomic abuse and from injuries, inflammation and scar tissue form. Another group of receptors, called nociceptors, which are sensitive to inflammation and pain, begin to grow and sprout into the scar tissue. Some of the healthy mechanoreceptor (motion) traffic is now replaced with nociceptor (pain) traffic. As pain nerve endings increase in number and send more pain traffic to the brain, you may get the uncomfortable perception of pain. This pain is reported in many different forms such as sharp, dull, aching, burning, weakness, stiffness, spasms, and shooting pain.
During the early stages of disc irritation one may not have any pain, which is one of many reasons why using pain to judge our health may be dangerous and misleading. Spine and disc irritation begins to accumulate early in life from birth, early childhood trauma, poor posture, sports injuries, sitting at school desks, heavy backpacks, and lack of physical activity (all of which reduce flexibility and motion), and working at computers. Other injuries including falls, lifting, and automobile accidents may lead to injury and scar tissue in discs and joints. This combination of acute injuries, plus the often forgotten daily wear and tear eventually accumulate irritation to the joints and discs. Sometimes people may have brief episodes of pain that go away, and they often erroneously think the problem is gone because the pain is gone. Unfortunately, the disc and joint damage continues to accumulate, and the damage is repaired with scar tissue. Scar tissue is a cheap grade of the original tissue and is weaker, stiffer, and more painful and sensitive (it has more nociceptors in it). People often report that they get pain from mild activities that they never had pain from before. Even barometric pressure changes may cause pain. The accelerated wear and tear and scarring may continue to a point when many years later the patient has pain and does not know why. Please remember that this gradual wear and tear (arthritis) is NOT a normal consequence of aging. Unfortunately, because it is so common, many of us think it is normal.
Disc problems (injury plus slow and steady degeneration) usually develop slowly over time and often with little or no pain; therefore the person is not aware of the problems until later stages. This is why it can be so dangerous to evaluate your health by pain, or lack of it. X-ray and MRI tests may or may not find any abnormalities, but more likely than not the pain is still coming from irritated discs and joints. Obviously when you are told “your x-rays and MRI are normal,” they are confused about where the pain is coming from. Most disc irritation cases, even herniated discs and advanced arthritis, may be helped with chiropractic care, appropriate exercises, ergonomic changes and posture improvements. Many of you with back and leg pain may also find relief with physical therapy, acupuncture, massage, yoga, and other regular exercise programs. If chiropractic does not achieve the results you are looking for, I recommend trying all of these conservative options before doing other invasive procedures. Keep in mind that not all chiropractors use the same methods and techniques, so if you did not gain relief from one chiropractor, it does not necessarily mean that chiropractic treatment will not help. Often a different chiropractor who uses different adjustments and methods may help you get well again. This is similar to other providers; medical doctors, physical therapists, massage therapists, acupuncturists, and personal trainers all differ with their methods of treatment and philosophies. Remember, emergency situations require emergency intervention, so check with your doctor if you are not sure about the severity of your problem. Some symptoms that may require emergency intervention include sudden onset of incontinence, sudden onset of other bowel or bladder symptoms, and severe leg pain with progressive leg weakness on one or both sides.
If you have low back pain, you may have been told or think that muscles are the cause of pain. You may be given a diagnosis of “pulled muscles,” or “back strain” or “muscle spasm.” Treatment is often painkiller drugs, muscle relaxer drugs, anti-inflammatory drugs, heat, and rest. Although you may have tight, sore, tender muscles, muscles are rarely the primary cause of your suffering. Muscles are typically secondary sources of pain. In almost all cases I have seen, irritated discs and joints are the primary causes of back pain. I have also found that ice clearly outperforms heat. (Ice also works directly on the site of the swelling, instead of systemically, and without side effects.) Unfortunately you are still told to use heat, and many still use heat because it feels good to use it. But, heat increases inflammation, and may actually lengthen the time to get well. Many people don’t like using ice because it is not as comfortable as heat, so you may think it is less beneficial, or you simply don’t want to do it. Many of my patients have reported some pain relief in several hours or a day after switching from heat to ice. I recommend 15 minutes of ice every 2 hours, and make sure ice is not put directly on your skin. Use a t-shirt, sock, or thin towel between your ice and skin, and make sure this layer stays dry, or you can burn your skin with ice. Movement (obviously within your tolerance) is a better choice than bedrest, under a doctor’s supervision. Current medical research suggests that anti-inflammatory drugs taken after 72 hours following injury may actually interfere with proper healing, and drugs have serious side effects.
Muscles have an abundant blood supply and heal quickly, with few residuals. Discs have no blood supply after adolescence and joint blood supply is poor, therefore healing is slow and poor. Think of this scenario: If you go to the gym and lift weights, your muscles may get sore. In a day or two, the soreness is gone, until you exercise again. You probably don’t rush to the doctor for this type of soreness. In contrast, most of you with back problems have pain that lasts more than a day or two, and most of you report that the type of pain you feel in your back is quite different than the sore muscles from exercise. Treat your back problem like a sprained ankle. Modify your activity for your back, as you would a sprained ankle. Ice your back as long as you have pain, even for weeks, as you would a sprained ankle. And stretch and exercise your back, but keeping stretches within your comfort zone, as you would a sprained ankle. Don’t think you can aggressively stretch the pain out. Reintroduce activity only when the back is ready, not sooner.
In many cases properly administered chiropractic care can help improve many disc conditions. At Fuller Chiropractic patients undergo a thorough history and examination, perhaps including x-rays, to accurately determine the source of pain and your spinal condition. Chiropractic evaluations not only look for spinal damage, but they also look for alignment issues in the spine which we call spinal subluxations. These alignment problems and subluxations may be irritating discs, joints, and muscles, which are causing your pain, and chiropractic adjustments are designed to reduce spinal alignment problems and subluxations. After a diagnosis is formulated, the diagnosis is explained to you in simple terms, with a written report to take home. You are offered treatment plan options to address your problems, both short and long term, and you get to choose the course of action which best suits you. We never want our patients to feel like they are being pushed or asked to receive more care than they feel as though they really need. We also conduct health classes at Fuller Chiropractic. These classes are free and open to the public, and you can ask any questions about your condition. You will also learn about your spine, health and wellness, and what you should and should not do to get, and stay, well. Our object is to help you save time, pain and money, and reduce the chances of having future problems and pain.
I encourage patients to consider wellness and maintenance adjustments after the pain is gone. Some patients chose this option to help prevent problems from returning. In my opinion, it is easier, cheaper, and more sensible to keep you well when you are well, than it is to wait until you break, and try to put you back together again. But we leave this up to you. Acute episodes of pain require more treatment, and therefore costs you more money, time and suffering. The office also offers other wellness information such as food choices to help reduce pain and arthritis, and supplement advice to support health. The program at my office is designed so you can once again enjoy your work, relationships, sports, and playtime. If you or someone you know suffers with lower back pain (or other pain and problems), give Fuller Chiropractic a call to schedule an appointment and see how chiropractic care may be part of the solution.
Written April 2000, updated September 2007