Lower Back Pain

Back pain is not only one of the most common reasons patients comes to Miami Spine and Performance, but also one of the most common reasons patients sees any type of doctor around the country. Back pain can be both scary and debilitating if the condition is not properly understood.

A proper medical history combined with a comprehensive movement assessment can give us great indications as to how to proceed with your care.

What causes back pain?

Part of what makes back pain a challenging puzzle to solve is that there is a wide variety of issues that can ultimately present as pain in the back. This could range anywhere from too much time in one posture to a more serious condition involving internal organs.

Once a serious condition has been ruled out, it is our job to determine whether or not the pain you are experiencing is related to an obstruction to movement (bending forwards, backwards, or side to side), a soft tissue injury, or a compensation for a deficiency in movement in the lower extremity (tight hips, tight upper back) putting excessive pressure on the lower back. Once the condition can be placed into one of these categories, the intervention and treatment plan necessary become very clear and direct.

How do we treat lower back pain?

Once the root cause of the issue has been identified, the treatment will be governed by the goal at hand (improve range of motion, reduce tension, decrease perceived threat in the brain). If you are experiencing lower back pain in addition to pain down one or both legs, our first goal is to take the pain out of your leg and bring it locally to the lower back. Once we find the appropriate movement that “centralizes” your symptoms to your lower back, we can then focus on being sure that your back moves fully and freely and return you to the activities you love.

Can we prevent back pain from coming back?

Though the most common predictor of back pain is previous episodes of back pain, there are a number of steps an individual can take to maintain a resilient back and live an active and fruitful life free of pain or restriction. The three major goals we look to accomplish at Miami Spine and Performance for all of our patients with lower back pain is free and full motion in the joints of the back itself, full and free motion of the hips and proper breathing patterns ultimately leading to a stable core and adequate protection for the structures of the spine. Regularly working on these three elements will significantly reduce you chance of having another episode of back pain.

lower back pain

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:

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Degenerative Disc Disease

Degenerative Disc Disease otherwise known as DDD, is a commonly diagnosed condition that is associated with the normal aging process of the spine. An individual that does have findings of disc degeneration will not necessarily experience pain as a result.

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Because the physiology of the disc has changed at a cellular level, the spine will function slightly differently but all of the normal conditions for spinal health and longevity still apply.

The discs of the spine lie in between the vertebrae and are primarily made up of water when you are younger. Over time the disc become dehydrated which makes the disc thinner and less able to act as shock absorbers for the spine. If you are over the age of 50 and are concerned about this normal part of aging, be sure that you are taking your spine and hips through a full range of motion on a regular basis, you are doing some form of weight training, particularly for the core and lower body and you are taking extended walks (over 30 minutes) multiple times per week. The combination of mobility, strength and cardiovascular health is a perfect recipe for preventing and symptoms or disability associated with DDD.

At Miami Spine and Performance we will design a custom tailored treatment plan and exercise recommendations to keep your spine resilient and your body healthy to get ahead of the normal processes of aging.

Disc Herniation

Disc Herniations are one of the most frequently diagnosed conditions of the spine and unfortunately one of the most misunderstood. A disc herniation spans a wide variety of phenomenon within the spine from a minor disc protrusion to a disc sequestration (disc material breaks off) and can occur at different points around the disc.

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A disc herniation can also be an acute phenomenon or can progress slowly over time. Many individuals are currently walking around with disc herniations they are not aware of because they are not experiencing any symptoms are a result of the herniation(s).

The intervertebral disc of the spine has a jelly-like inside layer called the nucleus and a tough, rubbery exterior called the annulus. A disc bulge, which also qualifies as a herniation, is when the nucleus spills out of the center but remains within the annulus. Often times this phenomenon is non-painful, but in some cases can result in local lower back pain. A disc extrusion is when the disc material actually leaves the annulus, potentially resulting in back and leg pain. A disc sequestration is when a piece of the disc breaks off into the spinal canal is a more serious finding that requires an orthopedic consultation.

Due to the physiology of aging, disc herniation are more likely in individuals between the ages of 25-55. Individuals over the age of 55 have disc dehydration making a herniation less likely. At Miami Spine and Performance, if we suspect a disc herniation, our first action after taking a thorough history is to perform a movement assessment. Taking a problem-focused history combined with a thorough movement assessment is, in most cases, more effective at determining diagnosis, treatment and prognosis. For disc herniations, there are many tools that can be effective at mitigating pain and decreasing tension such as manipulation, manual therapy, dry needling, and flexion-distraction, but in a large percentage of cases, one or two specific movements performed by you over a period of time can resolve your symptoms and return your spine to full health.

Piriformis Syndrome

Piriformis syndrome is a condition that arises when the piriformis muscle compresses the sciatic nerve causing local inflammation, hip pain pain, and/or pain over buttocks. This condition commonly affects women more than men in the fourth and fifth decades of life due to the anatomical variations of the hip. 

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Patients may experience difficulty walking, sitting with legs for extended periods of time, radiating pain/paresthesia, or muscle weakness in the affected leg. Piriformis syndrome shares several common characteristics and may even co-exist with other lumbopelvic problems for this reason it is important to get properly assessed if you are experiencing symptoms of piriformis syndrome. It is important to examine the low back, hips, knees, and feet in order to arrive at a proper diagnosis. 

At Miami Spine and Performance we will design a custom treatment plan to ensure we understand the root cause of piriformis symptoms and optimize an individual’s biomechanics to prevent this condition from reoccurring.

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 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 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.

Sciatica Treatment

Sciatica is not a true medical diagnosis but rather a symptom of an underlying issue in the lower back, hip or leg. Sciatica like symptoms can be very acute (lasting only a few seconds) to a chronic occurrence (months to years) depending upon the root cause and the time of intervention. 

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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.

Generally, sciatica like symptoms are not as straightforward as generally believed. More often than not, the symptoms of sciatica are intermittent meaning that there are certain activities that produce the symptoms and others that don’t. If the symptoms change based upon position and movement, it is very likely that you will be able to find a conservative solution to your sciatica. If the symptoms are constant, but the location of symptoms changes, this is another great indicator that conservative chiropractic therapy is appropriate for you case.

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 at the third lumbar segment. At each level of the lumbar spine, a nerve root exits from the inside of the spinal canal, and each

Nerve Entrapment

A nerve entrapment is caused when a peripheral nerve losses mobility, flexibility, or becomes compressed by surrounding tissues. Nerve entrapment syndromes occur in individuals as a result of swelling of the surrounding tissues due to prolonged activities, dislocations, or systemic conditions such as diabetes.

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Symptoms of nerve entrapment may also occur due to anatomical abnormalities such as cysts, bone spurs, and/or scar tissue. Pain and/or loss of function of the nerves as a result of chronic compression may occur. Symptoms of a nerve entrapment will differ from person to person but may include numbness, tingling, paresthesia, and/or burning sensation.
Nerve entrapment signs and symptoms are highly variable. The location and cause of these symptoms can differ significantly from person to person. For this reason it is important to perform a thorough examination to assess each individual to uncover the source of their nerve entrapment symptoms. It is also important to rule out any involvement related to the spine. A repeated movement assessment can help in this process.
Postural and biomechanical corrections and nerve gliding are helpful tools to address the underlying mechanisms that are causing neural irritation. A movement based approach specific to the site of perceived entrapment is vital in the treatment of this condition. At Miami Spine and Performance we design a custom tailored treatment plan and exercise recommendations to understand the cause of your symptoms and ensure that the nerve tissues stay healthy and pain free.

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