Causes Of Back Pain/ Treatable Conditions
With DRX9000 Spinal Decompression

Low back pain and lower extremity pain often get put into one category, but the causes, and therefore the treatments, can be different. Lower extremity pain, when it radiates from the low back, is usually the result of pressure on a nerve. The pain is often in the distribution which the nerve supplies. Low back pain is often related to the mechanics of the spine. Muscle strain, arthritis, trauma, osteoporosis, and fracture are often causes. Often, disease processes which cause lower extremity pain can also cause low back pain, and vice versa. The causes of back pain can be very complex, and there are many structures in the lower back that can cause pain. The following conditions can cause pain:

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Degenerative Disc Disease and Low Back Pain
Degenerative Disc Disease (DDD) is a gradual process that may compromise the spine. Although DDD is relatively common, its effects are usually not severe enough to warrant medical attention. In this discussion we address Degenerative Disc Disease in the lumbar spine.
Degenerative Changes to a Disc
Degenerative changes in the spine are often referred to those that cause the loss of normal structure and/or function. The intervertebral disc is one structure prone to the degenerative changes associated with wear and tear aging, even misuse (e.g. smoking).
Long before Degenerative Disc Disease can be seen radiographically, biochemical and histologic (structural) changes occur. Some of these changes are not unlike those associated with osteoarthritis.

Over time the collagen (protein) structure of the annulus fibrosus weakens and may become structurally unsound. Additionally, water and proteoglycan (PG) content decreases. PGs are molecules that attract water. These changes are linked and may lead to the disc's inability to handle mechanical stress. Understanding the lumbar spine carries a large portion of the body's weight; the stress from motion may result in a disc problem (e.g. herniation).

Non-Operative Treatment: Yesterday vs. Today
DDD is a disorder that may cause low back pain. It is interesting to note that although 80% of adults will experience back pain, only 1-2% will need lumbar spine surgery!
In the past some physicians prescribed long courses of bedrest and/or lumbar traction for their patients with low back pain. However, that is not the attitude today. During the acute phase, bedrest may be recommended for a few days, but beyond that experts advocate stretching, flexion and extension exercises, and no/low impact aerobics. Of course, each patient is different and therefore so is their treatment plan.

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Herniated Disc
Herniation of the nucleus pulposus (HNP) occurs when the nucleus pulposus (gel-like substance) breaks through the anulus fibrosus (tire-like structure) of an intervertebral disc (spinal shock absorber).

 

A herniated disc occurs most often in the lumbar region of the spine especially at the L4-L5 and L5-S1 levels (L = Lumbar, S = Sacral). This is because the lumbar spine carries most of the body's weight. People between the ages of 30 and 50 appear to be vulnerable because the elasticity and water content of the nucleus decreases with age.

The progression to an actual HNP varies from slow to sudden onset of symptoms. There are four stages: (1) disc protrusion (2) prolapsed disc (3) disc extrusion (4) sequestered disc. Stages 1 and 2 are referred to as incomplete, where 3 and 4 are complete herniations. Pain resulting from herniation may be combined with a radiculopathy, which means neurological deficit. The deficit may include sensory changes (i.e. tingling, numbness) and/or motor changes (i.e. weakness, reflex loss). These changes are caused by nerve compression created by pressure from interior disc material.

Progression of Herniated Disc
The extremities affected are dependent upon the vertebral level at which the HNP occurred. Consider the following examples:
Cervical - Pain in the neck, shoulders, and arms
Thoracic - Pain radiates into the chest
Lumbar - Pain extends into the buttocks, thighs, legs
Cauda Equina Syndrome occurs from a central disc herniation and is serious, requiring immediate surgical intervention. The symptoms include bilateral leg pain, loss of perianal sensation (anus), paralysis of the bladder, and weakness of the anal sphincter.

Diagnosis of a Herniated Disc
The spine is examined with the patient laying down and standing. Due to muscle spasm, a loss of normal spinal curvature may be noted. Radicular pain (inflammation of a spinal nerve) may increase when pressure is applied to the affected spinal level.
A Lasegue test, also known as Straight-leg Raising Test, is performed. The patient lies down, the knee is extended, and the hip is flexed. If pain is aggravated or produced, it is an indication the lower lumbosacral nerve roots are inflamed.
Other neurological tests are performed to determine loss of sensation and/or motor function. Abnormal reflexes are noted as these changes may indicate the location of the herniation.
Radiographs are helpful, but Computed Axial Tomography (CAT) or Magnetic Resonance Imaging (MRI) provides more detail. The MRI is the best method enabling the physician to see the soft spinal tissues unseen in a conventional x-ray

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Sciatica
This is a condition which causes pain down the back of one or both thighs. Inflammation of the sciatic nerve (which is the largest nerve in the body-about the diameter of your little finger) can be either constant or intermittent. Success in solving this problem is directly correlated to the diagnosis. Sciatica can be caused by a pinched nerve as it exits the low back spine or it can be caused by prostatic cancer. Odds are usually that the cause is some structural imbalance, but there are so many potential causes, some serious and some benign, it is better to at least know that there may be a grave cause to the symptoms.
This doesn't mean that you shouldn't immediately incorporate a strategy to eliminate any structural imbalances. In most cases, this will resolve the problem. If the problem doesn't respond to these basic efforts, then professional assistance may be needed. The first effort in relieving sciatic symptoms should be to review Hip Pain.
Trigger points can accumulate in the piriformis muscle forcing a contraction and strangulation of the sciatic nerve. The tennis ball exercise should be incorporated to help to relax the piriformis muscle. Stretching may be beneficial, but that is more of a "try an see" exercise.
If there are no improvements with this approach, refer to Low Back Pain to better understand the relationship between the sciatic nerve and the low back spine. Seeking help from a chiropractor or orthopedist may be indicated if the solution can't be found at home.

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Facet Joint Syndrome:
Is a common cause of pain related to the spine. The facet joints are the articulations or connections between the vertebraes in the spine. They are like any other joint in the body like the knee or elbow that enable the bending or twisting movements of the spine. The facet joints can get inflamed secondary to injury or arthritis and cause back pain and stiffness. When the facet joints are affected in the neck or cervical spine it typically causes pain in this area as well headaches and difficulty rotating the head.
People who suffer from this problem usually complain that they have to turn their entire body to look over to the right or left. Pain can be felt in other areas such as the shoulders or midback area. Low back pain is commonly caused by Facet Joint Syndrome. Pain is felt in the lower back and sometimes it can be felt in the buttock as well in the thighs usually not going below the knee.

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Spinal Stenosis
This refers to a narrowing of the spinal canal. Certain individuals may have a narrow canal from birth, but the majority of individuals develop narrowing with age. With age, wear and tear arthritic spurs build up on the facet joints in the posterior part of the spine. These arthritic spurs then encroach on the spinal canal and pinch the lumbar nerve roots.

This condition can be worsened as well by narrowing and degeneration of the disc at that level as the space for exit of the nerve root (called the foramen) is narrowed further by a degenerated disc. Spinal stenosis is most common in the last three levels of the lumbar spine namely L3-4, L4-5 and L5-S1. It is diagnosed and confirmed by an MRI or CAT scan/myelogram. There are various signs and symptoms of spinal stenosis. A common one is referred to as spinal claudication. This refers to pain in the legs, the calves or the buttocks.

This pain is associated with activity. The pain is often relieved by sitting and resting. It will then often times start up again with activity. A common complaint is that an individual will be able to walk several blocks then develops leg pain, is able to get rid of the leg pain by sitting and resting for five to ten minutes and then, upon trying to walk another several blocks the pain will return. The pain may be a radiating pain like a sciatica or it may be a cramping pain. At times though, the stenosis may be severe enough that the leg pain is constant and unremitting. It may at times be indistinguishable from the kind of pain that occurs with a herniated disc. Spinal stenosis is uncommon in younger people. It usually occurs at age 50 or older. Leg pains from spinal pathology are more common from herniated discs in people under 50. Over 50 it is more common that spinal stenosis will be the problem.

In addition to developmental degenerative spinal stenosis, entrapped nerve roots may be caused as well by spondylolisthesis and scotiosis. There is really no conservative treatment for a spinal stenosis. It will rarely cause paralysis. The condition will tend to gradually worsen with time and cause increasing pain however. Patients with congenital spinal stenosis (such as achondroplastic dwarfs) may develop symptomatic stenosis as early as age 15 or 20.

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Osteoarthritis
Osteoarthritis, also called degenerative joint disease, is the most common type of arthritis. It is associated with a breakdown of cartilage in joints and can occur in almost any joint in the body. It most commonly occurs in the fingers, hips, knees and spine.
Cartilage is a firm, rubbery material that covers the ends of bones in normal joints. Its main function is to reduce friction in the joints and serve as a "shock absorber." The shock-absorbing quality of normal cartilage comes from its ability to change shape when compressed (flattened or pressed together).

Osteoarthritis causes the cartilage in a joint to become stiff and lose its elasticity, making it more susceptible to damage. Over time, the cartilage may wear away in some areas, greatly decreasing its ability to act as a shock absorber. As the cartilage wears away, tendons and ligaments stretch, causing pain. If the condition worsens, the bones could rub against each other.

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