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Back Pain
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COMMON CAUSES OF BACK PAIN!
1 Facet locking.
2 Muscle spasm.
3 Sacroiliac joint (SIJ) obliquity: ligamentous tension - joint compression - sprain.
4 Facet ligamentous sprain.
5 Disc: annular tears, inflammation.
6 Sacrum: obliquity, unfused segment, lumbosacralisation, Fracture.
7 Bastrups (boney bridges developing between spinous processes, or spinous processes coming together).
8 Disc: prolapse (Of varying degrees, and locations).
9 Fracture.
You may be subjecting your back to unnecessary postural strain or joint loading, either when you walk, run, sit down and even lay in bed , depending on your occupation or activity (Videman 1990)1.
Less common causes of back pain that either need urgent medical attention, or have a poorer prognosis)
BACK PAIN ASSOCIATED WITH DANGER
Go and see your GP straight away or A & E if you have any of the following with recent back pain:
If you have gnoring back pain at night.
Night sweats.
Feel generally unwell.
Fever.
Unexpected weight loss.
Severe prolapsed disc with or without back pain and usually with leg pain, numbness in the foot and:
Inablity to walk on heels or toes.
Loss of bowel control.
Bladder retention.
Numbness around the anus.
If you fit this profile, you probably have an 18 hour window for surgical decompression Go to A&E!
One of the causes of low back pain, and skeletal dysfunction is the REAL SHORT LEG (Children’s Hospital Boston, 2009)7, and I believe one of the most overlooked, which is distinct from pelvic misalignment, but nearly always present with pelvic misalignment, therefore missed by those unable to distinguish one from the other. At our practice you will always be screened within the first course of treatment for this accurately, diligently, and treated overall for this condition.
I have painstakingly been measuring lower limb length since being an intern at chiropractic college, and have evaluated most of the current methods used by GPs, chiropractors and osteopaths, and have found as many useful methods as there are inadequate methods still in practice today. Fortunately, I have devised an acurate protocol for this checking leg length without the use of X-rays, but it can take time with some patients due to the way the pelvis and legs behave.
The term sciatica is sometimes used when leg pain occurs. In some cases this is due to referred back pain and inflammation causing local nerves and associated leg nerves to send pain signals to the brain, so a person feels the pain in the leg. In other cases a more serious condition arises from a buldging inter-vertebral disc (IVD) that can touch nerves that pass into the leg Other causes of leg pain can occur, but are not mentioned here.
Seek help if in doubt.
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Chiropractic for Acute, Subacute and Chronic low back pain, Neck pain, Migraine, Cervicogenic Headache, Shoulder girdle pain and dysfunction, Adhesive Capsulitis, Tennis Elbow, Hip and Knee Osteoarthris, Patellofemoral Pain Syndrome, Sports injuries, Spinal Rehabilitation
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FOOTNOTES
1 Videman, Nurman, and Troup. (1990) Lumbar spinal pathology in cadaveric material in relation to history of back pain, occupation and physical loading. Spine, 15: 728-740.
2 NICE. (2009) Low Back Pain: Early management of persistent non-specific low back pain. NHS, National Institute for Health and Clinical Excellence, May; NICE clinical guideline 88.
The NHS key priorities for implementation also include spinal manipulation up to a maximum of nine sessions up to 12 weeks. Normally, we do not need so many sessions to achieve lasting results
3 UK BEAM Trial Team (2004) United Kingdom back pain exercise and manipulation (UK BEAM) randomized trial: cost effectiveness of physical treatments for back pain in primary care. British Medical Journal; 329:1377 (11 December), doi:10.1136/bmj.38282.669225.AE (published 19 November 2004).
Manipulation was more affective at 12 months than exercise. The team concluded, adding spinal manipulation to "best care" in general practice is effective, and cost efficient for patients with back pain.
4 Hondras MA, LongCR, Cao Y, Rowell RM, Meeker WC. (2009) A randomized controlled trial comparing 2 types of spinal manipulation and minimal conservative care for adults 55 years older with subacute or chronic low back pain. J Manipulative Physiol Ther. June;32(5): 330-43.
5 Zhang WB, Cao Y, Sun YA, Wang CS, Wang Y, Dong SL, Ren GZ, Yang YX, Zhang JZ. (2008) Manipulative reduction for lumbar intervertebral disc herniation: a controlled clinical trial] Zhongqquo Gu Shang. Apr;21(4):273-5. (The Beifang Hospital of General Hospital of Shenyang Military Command, Shenyang 110032, Liaoning, China.)
6 Hallegraeff HJ, de Greef M, Winters JC, Lucas C. (2009) Manipulative therapy and clinical prediction criteria in treatment of acute nonspecific low back pain. Percept Mot Skills. Feb;108(1): 196-208.
7 Children’s Hospital Boston. (2009) http://www.childrenshospital.org/az/Site1100/mainpageS1100P0.html 23rd July. (Structural Discrepancy is synonymous with Real Short Leg.)
8 Foot Note: You will not find any medical text books that even remotely recognize a malposition of the the pelvis, only fractures, which is why this has become the domain of chiropractors and osteopaths.
9 L G F Giles. (1981) Lumbosacral Facetal ‘JOINT ANGLES’ Associated With Leg Length Inequality. British Society for Rheumatology.
10 Children’s Hospital Boston. (2009) http://www.childrenshospital.org/az/Site1100/mainpageS1100P0.html 23rd July. (Structural Discrepancy is synonymous with Real Short Leg.)
It is implied that gross deficits of “as little as 2 cm”, which may result in limping, are a threshold from which we need to start being concerned. As the physicians of the Children’s hospital specialize in caring for a wide variety of health issues, orthopaedics being one of many, they neither specialize the way some chiropractors do in biomechanics, nor do they see the children become adults, when there is more bone than cartilage in patients body, and less weight. Further, an infant has an outstanding repair system compared to an adult whose skeleton has stopped growing. We need to look at any deficit from 3 mm upwards, and take into account several other factors before we dismiss difference in real leg length.
