Back Pain
The fast-paced lifestyles of today have taken their toll on the backs of America.
If you're suffering from back pain, you're not along. Back pain is currently the number one cause of disability in those aged 19-45, and is the second leading cause of missed work days. At some point in their life, more than 80% of North Americans will suffer from the disabling confines of lower back pain. Total annual costs for back pain in the US alone are estimated to be in excess of $60 billion.
A number of factors contribute to these statistics, including:
- Overall increases in work demands
- Overall decreases in physical activity
- Increases in prolonged sitting (at the desk, in the car, in front of the television)
- Lack of periodic spinal checkups and preventative care
- Failure to seek immediate care following injury
- Failure to receive adequate treatment for back injuries (i.e. medications only without proper rehabilitation of tissues)
- Poor postural habits and lifting techniques
The latest research shows most lower back problems which cause low back pain do not fully resolve without extensive treatment and proper rehabilitation, contrary to previous beliefs. Our treatments primarily focus on the cause of your problems, which not only results in rapid and effective pain-relief, but most importantly, minimizes the chance of future back problems. The chiropractic doctor is unique in the health care field in that much of the training in chiropractic colleges is specifically aimed at identifying and successfully treating and managing middle and lower back conditions. General medical practitioners generally lack adequate training in this area and have not learned the skills necessary to most effectively identify and treat most back conditions.
Anatomy
Lower Back Anatomy
The lumbar spine contains 5 moderately large vertebrae which sit atop the sacrum. These bony segments act as attachments for muscles and ligaments in the lumbar spine and also encase and protect the lower spinal cord and lumbar nerve roots.
Because the lumbar vertebrae are located between the pelvis and upper torso, the degree of stresses endured by the lumbar spine are great. These abnormally high degrees of stress result in frequent lumbar vertebral subluxations – misalignments and improper motion patterns of the lumbar vertebrae. If left uncorrected, these misalignments and faulty biomechanics of the lower spine can result in spinal injury and irreversible degenerative changes.
The lumbar discs connect adjacent lumbar vertebrae to one another and cushion the spine as well as permit motion between the individual vertebrae. As stated above, the lumbar spine is a “transitional” area between the pelvis and upper torso, thus, resulting in high degrees of spinal stress. This results in the 4th and 5th lumbar discs suffering more injuries than all other spinal discs combined.
Disc herniations in the lumbar spine are the most common causes of “sciatica”, meaning pain running down the back of the leg in the area of the sciatic nerve. Possible symptoms include pain, numbness, tingling or weakness in the legs and/or feet.
In rare cases, a lumbar disc herniation can compress the spinal nerves which provide motor control to the bowel and bladder. Although rare, if you’re having back pain and experience a loss of bowel and/or bladder control, immediate medical intervention is required. Without immediate decompression the loss may become permanent.
The facet joints in the lumbar spine allow for considerable amounts of flexion but a much lesser degree of extension and rotation. These joints must withstand large amounts of stress from the body and as a result are prone to acute and repetitive injuries and degenerative arthritis.
Facet joints are most commonly injured during movements involving a rotational or twisting component. When injured, pain is often sharp and localized to the area of the affected facet joint. Later in life, if spinal problems have been allowed to linger without appropriate rehabilitation, arthritis will likely be present. If severe enough, as is commonly the case, bony arthritic enlargement of the joint can impinge upon spinal nerve roots and produce symptoms pain, numbness, and tingling down the leg, as well as leg weakness, in addition to back pain.
The lumbar spinal nerve roots exit openings formed between adjacent lumbar vertebrae termed the intervertebral foramina or IVF. The weakest aspect of the spinal disc is unfortunately in close proximity to the IVF. Thus, disc injuries commonly result in discal materials compressing, stretching or irritating the nerve roots exiting the IVF’s.
Because the nerve roots exiting the lumbar spine innervate structures in the lower extremities, any compression, stretching or other irritation will result in numbness, tingling, pain or weakness in the leg(s) and/or feet. This may result from vertebral malpositions, disc herniations, arthritic changes to the vertebrae and facet joints, or even abnormalities within the muscles (piriformis syndrome).
The paraspinal muscles in the lumbar spine attach to the spinal vertebrae and pelvis to provide the torso with movement. These muscles must be strong to control the upper torso about the pelvis and thus are frequently overworked and injured. The pain associated with paraspinal muscle injury is generally a dull, boring, generalized ache in the area of the lower back.
The sacroiliac joints are located between the sacrum and the ilium bones of the pelvis. These joints may also become irritated or injured resulting in lower back pain, buttock pain, and occasionally leg pain.
This condition tends to be more common in women, especially during pregnancy when hormonal changes and pressure from the forming fetus increase the stress on these joints.
Mid Back Anatomy
The thoracic spine contains 12 medium sized vertebrae all of which form articulations (joints) with 2 opposing ribs. Like the other spinal vertebrae, the thoracic vertebrae act as attachments for muscles and ligaments in the mid spine and also encase and protect the median aspect of the spinal cord and thoracic nerve roots.
Because the thoracic vertebrae form relatively strong articulations with the ribs, the mobility of the thoracic spine is less than that of the cervical and lumbar spines. However, this same characteristic also protects the thoracic spinal discs and facet joints from the wear and tear experienced by these structures in the other areas of the spine.
Common vertebral problems in the thoracic spine include vertebral subluxations, a condition where the vertebrae of the thoracic spine become statically misaligned and/or function abnormally resulting in pain, muscle spasm, and sometime nerve malfunction.
The intervertebral discs in the thoracic spine are located between adjacent vertebrae. They function as spacers to provide clearance for exiting spinal nerves, as connectors to link adjacent vertebrae together and allow for movement, and also as spinal shock absorbers.
The discs of the thoracic spine are less likely to become injured compared to those of the cervical and lumbar spines, making up only 2% of intervertebral disc herniations. This is because of the rib articulations made by the vertebrae which significantly increases the stability of the thoracic spine. This does not mean that the discs of the thoracic are immune from damage, rather, statistically less likely to become injured.
The facet joints in the thoracic spine allow for considerable amounts of flexion and extension. The facet joints can become injured with excessive amounts of rotation and extension. Golfers are prime candidates for facet joint injury due to their repetitive twisting motions as they swing their golf clubs. When injured, pain is often sharp and localized to the area of the affected facet joint.
The thoracic spinal nerve roots exit openings formed between adjacent thoracic vertebrae termed the intervertebral foramina or IVF. The spinal nerves from the thoracic spine innervate the many muscles of the back as well as the many visceral organs and tissues of the chest and abdominal regions.
Spinal nerve root irritation or compression in the thoracic region commonly leads to intercostal pain (between the ribs). Sharp shooting pains are often experienced along the path of the ribs. Additionally, an increased susceptibility to herpes zoster or “shingles” in some individuals (generally the elderly or immunocompromised) is thought to occur when the thoracic spinal nerves are irritated or compressed. Herpes zoster involves infection to an area of the nerve root, the dorsal root ganglion, with the herpes virus.
The paraspinal muscles of the thoracic spine are numerous. They are responsible for the majority of trunkal movements as well as a number of upper extremity movements and are a common source of injury and pain.
Over exertion of the muscles from lifting and pulling and poor posture are the major contributors in mid back strains. Pain originating from these muscles characteristically produces a dull generalized ache.
The thoracic is unique in that each of it’s vertebrae attaches to a pair of ribs. There are 12 thoracic vertebrae and thus, 24 ribs (12 on the left and 12 on the right). Just like adjacent connecting vertebrae can misalign and biomechanically malfunction, so too can the thoracic vertebrae and it’s adjacent ribs. When ribs “go out” or misalign in relation to their connecting vertebrae, the individual will often experience sharp pains in the area of the misaligned rib head, especially on twisting movements of the torso.
As with vertebral subluxations, chiropractors can successfully treat rib misalignments with the chiropractic spinal adjustment. The adjustment repositions the rib to it correct position and normalizes impaired motion patterns.
Causes of Back Pain
Causes of Lower Back Pain
Many tissues can generate low back pain. Unfortunately, research shows that the exact tissues causing low back pain cannot be specifically identified in up to 80% of individuals. In other words, we cannot single out the tissue(s) responsible for the pain. These patients are said to suffer from "nonspecific low back pain"; the specific cause of the pain cannot be determined. Although the specific tissues causing low back pain are difficult to identify, chiropractic doctors have found a number of factors consistently present in low back pain patients. These factors include vertebral subluxations, faulty spinal biomechanics, deconditioned spinal musculature and the practice of poor postural habits and techniques. By addressing these factors - the actual causes of the tissue injury - chiropractic doctors are able to obtain extraordinary results in low back pain sufferers.
Common events leading or contributing to the development of lower back pain include:
- Incomplete rehabilitation of past injuries
- Lack of proper and periodic lumbar spinal alignments
- Presence of lumbar spine subluxations
- Improper lifting techniques
- Auto accidents
- Improper workstation setup
- Poor posture
- Prolonged sitting
- Prolonged use of non-ergonomically designed equipment
- Excessive repetitive torsal motions
- Exposure to vibratory forces (truck drivers, jack hammer operators)
- Scoliosis (lateral deviation of the spine)
- Fallen foot arches and other foot abnormalities
- Physical inactivity
- Poor diet and nutritional practices
- Smoking
Structures which are often the source of lower back pain include:
- Lumbar intervertebral discs
- Lumbar facet joints and joint capsules
- Lumbar and pelvic muscles and ligaments
- Lumbar and sacral spinal nerves
- Sacroiliac joints
Causes of Mid Back Pain
Mid back pain is most commonly caused by irritation or injury to the muscles and ligaments of the thoracic spine. The high incidence of poor postural habits, lack of adequate exercise and muscle conditioning, as well as the ever more popular "seated" lifestyles of Americans are all major contributors. Chiropractors work hard to identify the exact problems of mid back pain so that only the safest and most effective treatments can be provided. Since the majority of mid back pain cases are caused by soft tissue problems or have a significant soft tissue component, hands on chiropractic treatments are extremely beneficial and have been shown to be superior to other forms of "back" care.
Common events leading or contributing to the development of mid back pain include:
- Incomplete rehabilitation of past injuries
- Lack of proper and periodic thoracic spinal alignments
- Presence of thoracic spine subluxations
- Improper lifting techniques
- Auto accidents
- Improper workstation setup
- Poor posture
- Prolonged sitting
- Prolonged use of non-ergonomically designed equipment
- Excessive repetitive torsal motions
- Scoliosis (lateral deviation of the spine)
- Physical inactivity
- Poor diet and nutritional practices
- Smoking
Structures which are often the source of mid back pain include:
- Thoracic facet joints and capsules
- Thoracic paraspinal muscles and ligaments
- Costovertebral joints (joints between the thoracic vertebrae and ribs)
- Thoracic intervertebral discs
- Thoracic spinal nerves
Treating Back Pain
Treating Lower Back Pain
Doctors of chiropractic are the health care leaders in the treatment of low back pain as well as other spinal conditions. Treatments are gentle, safe, natural, noninvasive and highly effective. Also, the treatments are designed to correct the root cause of your problem and not simply cover up the symptoms you experience. In fact, a Canadian government commissioned study on the effectiveness and cost effectiveness of chiropractic management of low back pain concluded,
Chiropractic manipulation is safer than medical management of low back pain. Chiropractic management is greatly superior to medical management in terms of scientific validity, safety, cost-effectiveness and patient satisfaction.
The first step in treating low back pain is to determine what has and is causing the low back pain. Once the causes and contributing factors are identified, a successful treatment plan can be structured to eliminate the pain and achieve the goals of the patient.
Most individuals experiencing low back pain have a combination of:
- Vertebral subluxations
- Faulty spinal biomechanics
- Deconditioned and weak spinal musculature
- Improper firing patterns of spinal musculature
- Poor postural habits
- Poor diet and nutritional practices
- A history of activities (work or play) generating high levels of spinal stress
The Treatment
Chiropractic doctors have successfully treated low back pain for over 100 years. Through the use of natural and safe procedures, chiropractors correct the underlying problems which cause and contribute to the majority of low back pain cases.
The main treatment employed by the chiropractor is the chiropractic spinal adjustment. This noninvasive therapy consists of a gentle, manually or mechanically applied force into the segments of the spinal column. Spinal adjustments have been shown to decrease pain, increase spinal range of motion, decrease muscle spasm, reduce inflammation, optimize spinal biomechanics, and reduce the recurrence of old injuries.
Clinical practice guidelines for the management of acute low back pain released by the US Department of Health and Human Services (AHCPR) stated:
- Conservative treatment such as spinal manipulation should be pursued in most cases before considering surgical intervention.
- Prescription drugs such as oral steroids, antidepressant medications and colchicine are not recommended for acute low back problems.
- The risk of serious complications from lumbar spinal manipulation is rare
Spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for low back pain. Many medical therapies are of questionable validity or are clearly inadequate.
Proper Habits and Techniques
Another key ingredient to a successful low back pain treatment plan includes the learning of proper postural habits and other techniques. Proper posture is a significant factor in the health of the back and proper posture should always be practiced. Techniques common to daily living and work also play a major role in the development or lack of development of low back pain. This includes proper lifting techniques, avoidance of repetitive motions, avoidance of prolonged sitting, and much more. We can teach you correct habits and techniques which will protect your back from discomfort and injury.
Other Therapies
Other manual therapies such as massage, trigger point therapy, proprioceptive neuromuscular facilitation, and acupressure therapy may be utilized to assist in the relaxation of lumbar muscles and increase lumbar spine mobility.
Low back stabilization exercises are commonly prescribed to patients suffering from low back pain. These exercises are designed to teach the patient a "neutral spine" position as well as subconsciously enhance the muscles ability to stabilize and protect the spine from injury. Exercises and stretches are unique in that they can be performed outside the office without the assistance of the doctor.
Physical therapies may also be employed and include hot and cold applications, muscle stimulation, interferential therapy, therapeutic ultrasound, and diathermy. Diet and nutrition also play a key role in the health of the spine. Without the proper nutrients, the lumbar spine and rest of the body are less able to remain healthy and heal once injured. If your diet and nutritional status is poor, we can help get you on track.
How to Maintain a Healthy Lower Back:
- Regular Spinal Checkups - Maintaining proper alignment and functioning of the lower back through periodic spinal adjustments minimizes the stresses to structures of the lower back. Also, keeping the nervous system free from interference ensures proper communication between the various structures of the lower back.
- Proper Lifting and Ergonomics - Practicing proper lifting techniques and ergonomics are key in preventing lower back injury at work and preventing future recurrences of old injuries.
- Regular Exercise - Routine physical activity keeps the heart healthy and keeps the spine and the rest of the body strong and healthy. A minimum of 3 times per week for 40 minutes should be your goal. Involve friends and family, mix up the activities, keep it fun and stay consistent!
- Proper Diet and Nutrition - Providing your body with the proper fuel increases performance, reduces the likelihood of injury and sickness, speeds recovery after injury, and keeps you feeling good. If, like the rest of us, you're finding it difficult to get all the nutrients your body needs, it's probably time to supplement.
If you're suffering from low back pain, join the millions of other individuals who have benefited from gentle, safe and natural chiropractic care. Our treatments provide fast, effective relief which not only eliminates pain, but can help increase the performance and health of the entire body.
Treating Mid Back Pain
Doctors of chiropractic are the health care leaders in the treatment of mid back pain as well as other spinal conditions. Treatments are gentle, safe, natural, noninvasive and highly effective. Also, the treatments are designed to correct the root cause of your problem and not simply cover up the symptoms you experience.
Identifying the Cause
The first step in treating mid back pain is to determine what has and is causing the mid back pain. Once the causes and contributing factors are identified, a successful treatment plan can be structured to eliminate the pain and achieve the goals of the patient.
Most individuals experiencing mid back pain have a combination of:
- Vertebral subluxations
- Faulty spinal biomechanics
- Deconditioned and weak spinal musculature
- Improper firing patterns of spinal musculature
- Poor postural habits
- Poor diet and nutritional practices
- A history of activities (work or play) generating high levels of spinal stress
The Treatment
Chiropractic doctors have successfully treated mid back pain for over 100 years. Through the use of natural and safe procedures, chiropractors correct the underlying problems which cause and contribute to the majority of mid back pain cases.
The main treatment employed by the chiropractor is the chiropractic spinal adjustment. This noninvasive therapy consists of a gentle, manually or mechanically applied force into the segments of the spinal column. Spinal adjustments have been shown to decrease pain, increase spinal range of motion, decrease muscle spasm, reduce inflammation, optimize spinal biomechanics, and reduce the recurrence of old injuries.
Proper Habits and Techniques
Proper Habits and Techniques Another key ingredient to a successful mid back pain treatment plan includes the learning of proper postural habits and other techniques. Proper posture is a significant factor in the health of the back and proper posture should always be practiced. Techniques common to daily living and work also play a major role in the development or lack of development of mid back pain. This includes proper lifting techniques, avoidance of repetitive motions, avoidance of prolonged sitting, and much more. We can teach you correct habits and techniques which will protect your back from discomfort and injury.
Other Therapies
Other manual therapies such as massage, trigger point therapy, proprioceptive neuromuscular facilitation, and acupressure therapy may be utilized to assist in the relaxation of paraspinal muscles and increase spinal mobility.
Back exercises are commonly prescribed to patients suffering from mid back pain. These exercises are designed to strengthen the muscles of the mid back so that they are less likely to fatigue during the day. When the muscles of the mid back are weak and fatigue easily the risk for injury is increased and the ability to maintain proper posture throughout the day is reduced. Stretches are commonly provided to stretch the muscles of the chest as tightness in these muscles can place increased stress on the muscles of the mid back. Exercises and stretches are unique in that they can be performed outside the office without the assistance of the doctor.
Physical therapies may also be employed and include hot and cold applications, muscle stimulation, interferential therapy, therapeutic ultrasound, and diathermy.
Diet and nutrition also play a key role in the health of the spine. Without the proper nutrients, the thoracic spine and rest of the body are less able to remain healthy and heal once injured. If your diet and nutritional status is poor, we can help get you on track.
How to Maintain a Healthy Mid Back:
- Regular Spinal Checkups - Maintaining proper alignment and functioning of the back through periodic spinal adjustments minimizes the stresses to structures of the back. Also, keeping the nervous system free from interference ensures proper communication between the various structures of the back.
- Proper Posture, Lifting, and Ergonomics - Practicing proper lifting techniques and ergonomics are key in preventing back injury at work and preventing future recurrences of old injuries. Maintaining proper posture keeps the spine in a minimal stress environment and prevents the abnormal stretching of the supportive spinal structures.
- Regular Exercise - Routine physical activity keeps the heart healthy and keeps the spine and the rest of the body strong and healthy. A minimum of 3 times per week for 40 minutes should be your goal. Involve friends and family, mix up the activities, keep it fun and stay consistent!
- Proper Diet and Nutrition - Providing your body with the proper fuel increases performance, reduces the likelihood of injury and sickness, speeds recovery after injury, and keeps you feeling good. If, like the rest of us, you're finding it difficult to get all the nutrients your body needs, it's probably time to supplement.
If you're suffering from mid back pain, join the millions of other individuals who have benefited from gentle, safe and natural chiropractic care. Our treatments provide fast, effective relief which not only eliminates pain, but can help increase the performance and health of the entire body.
Research
- Canadian government's findings on the effectiveness and cost effectiveness of chiropractic care in the treatment of low back pain (The Manga Report)
- Guidelines for the Treatment of Acute Low Back Pain - released by the Agency of Health Care Policy and Research, US Department of Health and Human Services
- Randomized comparison of chiropractic and hospital outpatient management for low back pain
- 90% of individuals with low back pain still suffer 1 year later under regular medical care
- Heavy lifting damages spinal discs
- Back exercises help back injuries
