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Low Back Pain

ANATOMY

THE LOWER BACK IS MADE UP OF 5 LUMBAR VERTEBRAE
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The disk is made up of a Nucleus Pulposus (Gel like substance) made up mostly of water with some proteoglycans. They help the disk retain water. The disk is held to the vertebrae endplates by ligaments. The amount of fluid in the disk varies depending on day and night. The disks act like shock absorbers for the spine. The Annulus Fibrosus is mainly made up of collagen and proteoglycans and less water.

Each vertebrae has spinal nerves that exit the sides of the vertebrae.  These nerves are known as spinal nerves.

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DIFFERENT CAUSES OF LOW BACK PAIN

A LOW BACK STRAIN VS A LOW BACK SPRAIN:
A low back strain is a tear to the muscles surrounding the lumbar spine. A low back strain is a tear to the ligaments surrounding the lumbar spine. The muscles and the ligaments surrounding the lumbar spine need to be flexible and mobile. The spine supports the nervous system and the weight of the body. It is prone to injury. When the body moves the spine moves with it. A sprain or strain is usually localize to lower the back with some pain in the buttocks. It does not have radiating pain down the leg and is usually relieved by rest and aggravated by activity. There may be inflammation (swelling) in the low back can be relieved with Therapy. Usually sprain/strains present with some type of trauma to the low back.
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Why are some people more prone to lumbar strain/sprain than others:

  • Excessive weight puts strain on the lower back. This increases the tightness of the ligaments and tendons and predisposes a person to back injury. The Sherman Program address weight loss as part of a long term recovery from chronic back strain.
  • Smoking:  weakens the joints. Smoke puts toxins into the body that interfere with the body’s ability to maintain proper homeostasis.
  • Improper lifting technique: Click on this link for proper lifting technique.
  • Weakness in core strength: Click on this link for Core Strength.
  • Lack of flexibility in the muscles and ligaments. Click on this link for exercises and ordering the low back stretching video.
  • Lack of movement. Having a job where you are sitting the majority of the time creates tightness in the lower back. Gravity is exerting a constant force on the back and sitting for too long in one place can strain an already weak back. Trying getting up periodically and moving around it will help stretch the spine.
  • Poor Posture: This often relates to a weak core, being overweight and tight muscles. Correct posture will help prevent back problems and reduce the chances for chronic arthritis.

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TREATMENT FOR LOW BACK SPRAIN/STRAIN

DURING THE INITIAL ACUTE STAGES ICE IS GREAT FOR REDUCING INFLAMMATION AND REDUCING PAIN. AS THE BACK IMPROVES ICE AND HEAT CAN BE USED IN CONTRAST THERAPY. REMEMBER WITH ICE NEVER LONGER THEN 20 MINUTES ON 2 HOURS OFF. APPLY THIS SAME  RULE FOR HEAT.  PHYSICAL THERAPY INVOLVING ULTRASOUND, ELECTRICAL STIMULATION, MASSAGE THERAPY ARE ALSO VERY HELPFUL IN THE ACUTE STAGE.  I RECOMMEND MINIMIZING YOUR DEPENDENCY ON PAIN MEDICATION IN THIS STAGE. FAR TOO OFTEN PATEINTS WILL GET A PRESCRIPTION FOR PAIN MEDICATION AND WILL MASK THE PROBLEM AND NEVER CORRECT THE PROBLEM. THE SHERMAN PROGRAM DOES OFFER NATURAL PAIN RELIEF. CLICK ON THE LINK : SHERMAN PRODUCTS FOR BACK AND NECK PAIN. THESE PRODUCTS ARE NON ADDICTIVE. ONCE THE ACUTE PHASE HAS SUBSIDED GENTLE MANIPULATION WITH A CORE STRENGTHENING PROGRAM SHOULD BE IMPLEMENT.

LOW BACK PAIN CAUSED BY A VERTEBRAE SUBLUXATION
VERTEBRAE SUBLUXATION
When one vertebrae moves past it’s normal physiological range of motion a subluxation occurs. Chiropractic manipulation fixes vertebrae subluxations.

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Dr. Sherman uses very gentle manipulation techniques. A common method of manipulation is diversified technique. This technique applies a specific force in a specific direction at a specific velocity for maximum joint correction. Many times manipulation is done to early. Dr. Sherman will recommend physical therapy while in the acute phase of your injury to address excess inflammation and pain. Massage may also be recommended. Once the acute phase has subsided gentle manipulation can be performed. Manipulation is important for people who are hypo-mobile (these are people who have restricted motion in the spine). If your spine is hyper-mobile manipulation is not warranted. Vertebrae Subluxation can be palpated and feel like a bone out of place or a bump. It is important to rule out more serious causes of back pain like: cancer, tumors and growths in the spine. A history followed by additional test may be necessary. Following manipulation you may notice some soreness and this is normal. Try to picture moving a rusty hinge on a window it does not move well when it has not moved for some time. The soreness should go away with in a day or two and normal range of motion and a decrease in pain should follow. Dr. Sherman uses very gentle techniques. Some patient’s prefer to not hear any cracking sounds. This can be accomplished with an activiator technique.

WHAT IS THAT CRACKING NOISE WHEN I GET A CHIROPRACTIC ADJUSTMENT?

The noise is nitrogen gas escaping between the capsular ligaments surrounding the joint. When a vertebrae moves the capsule squeeze gas out of the joint and a cracking or popping sound may be heard. The sound is normal and should be cause for concern. The sound may or may not occur when the adjustment takes place. If the noise creates fear Dr. Sherman has a technique for adjusting the neck without making any cracking sounds.
DR. SHERMAN  USES THE LATEST TECHNIQUES
DIVERSIFIED-MOVING A SUBLUXATION IN A SPECIFIC DIRECTION, WITH A SPECIFIC THRUST, WITH A SPECIFIC VELOCITY. 
ACTIVATOR- USING A SPECIFIC APPARATUS CALLED AN ACTIVATOR GUN TO MOVE A VERTEBRAE THAT HAS SUBLUXATED IN A SPECIFIC DIRECTION WITH A SPECIFIC VELOCITY.
COX-LEANDER TABLE-USING A SPECIFIC TYPE OF TRACTION TABLE TO REDUCE PRESSURE FROM HERNIATED DISK AND PINCHED NERVES.
SOFT TISSUE MOBILIZTION-USING MASSAGE AND STRECTCHING TO GET JOINTS TO RELEASE AND GET SOFT TISSUE TO MOBILIZE.
NUTRITION-USING BLOOD WORK AND OTHER METHODS TO SET UP DIET CHANGES TO CREATE A MORE BALANCE INDIVIDUAL.
REHABILITATION-USING THE LATEST REHAB TECHNIQUES TO STRENGTHEN WEAKEN JOINTS AND RETURN THEM TO NORMAL FUNCTION.

PINCHED NERVE HERNIATED DISK

This condition occurs when the gel-like center of a vertebral disc (the nucleus pulposus) breaks through the outer ligament (the annulus fibrosis) of the intervertebral disc. This bulge of extruded material puts pressure on the adjacent nerve root, causing it to function improperly and send pain signals.
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The symptoms of a pinched nerve may vary, depending on the location of the nerve or nerves involved.

Some symptoms may appear as:

  • burning
  • numbness
  • tingling ("pins and needles")
  • radiating pain down arm or leg
  • weakness in muscle

In some cases, symptoms may include a combination of these sensations, depending on the extent of the damage and the compression of the nerve.

PINCHED NERVE TREATMENT

Treatment of a pinched nerve can take a significant amount of time to stabilize.  In most case manipulation will not be done on a pinched nerve and preferred method of treatment is traction. A special traction table is used to open the disk space and take the pressure off the pinched nerve. Weight loss and posture issue will be addressed as well as a core strengthening program and stretching program. For long term success sometimes all of this measures will be necessary. If you condition does not improve over a significant amount of time you may be referred to a neurosurgeon for more serious intervention. Chiropractic and Physical Therapy should always be your first round of defense.

I am not a big advocate of prescription pain medication as many times addictions are formed. We prefer to use natural means to reduce your pain.
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Special traction table opens the vertebrae and allows the pressure to be taken off the nerve.
Once your inflammation is reduced your pain will decrease. This is the completion of Phase 1 the initial intensive care phase. During Phase 1 you are seen often up to 3 times per week.
As you improve you will go in to Phase 2 of care. This is the rehabilitation phase. During this phase you will be shown a series of core strengthening exercises and assisted stretching. During this phase your frequency of visits may be reduced as you get stronger and feel more confident.
Finally, you will reach Phase 3 of care. This is the maintenance phase. The goal here is to prevent the condition from returning. This Phase is very important because even though you are out of pain and stronger you still have weakened ligaments and if you have a herniated disk it still may be unstable. So maintaining that disk is crucial to long term health.

SPECIAL STUDIES
Radiographs may be taken to look at structural alignment and to see if a more serious complication may be causing your back pain.
MRI may also be taken to look at the integrity of the disk.

CAT  SCAN may be order if a more serious disorder may need to be ruled out.

PROGNOSIS
For patients who follow through with care the prognosis is excellent.  A large majority of our patient’s are able to fully rehabilitate without the use of drugs or surgery. See our patient testimonials.
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OSTEOARTHRITIS (DEGENERATIVE JOINT DISEASE)

OSTEOARTHRITIS USUALLY IS THE DEGENERATION OF THE INTERVETBRAL DISK. THE DISK BEGINS TO FLATEN AND LOSES IT SHAPE. THE VERTEBRAL END PLATES FORM CALCIFICATION KNOWN AS ONE SPURS. THE SPINAL NERVES BECOME PINCHED AND PAIN FOLLOWS.
OSTEOARTHRITIS CAN BE ACCLERATED FROM CONSTANT WEAR AND TEAR OF THE JOINTS. IT IS ALSO ACCLERATED FROM BEING OVERWEIGHT OR SMOKING.
OSTEOARTHRIS PRESENTS ITSELF WITH PAIN WHEN STARTING EXERCISE AFTER RESTING. THE JOINTS SWELL AND BECOME INFLAMMED. DURING MOTION THERE MAY BE CRACKING SOUNDS IN THE JOINT.  THIS CRACKING SOUND IS CALCIFICATION OF THE LIGAMENTS AND END PLATES. SERVERE OSTEOARTHRIS CAN CAUSE CONSTANT PAIN AND BE VERY RESTRICTIVE.
DIAGNOSIS CAN BE CONFIRMED WITH XRAY AND MRI.
TREATMENT
PHYSICAL THERAPY TO REDUCE THE INFLAMMATION SHOULD BE STARTED AS SOON AS POSSIBLE.  A REGULAR STRETCHING PROGRAM SHOULD BE IMPLEMENTED AS SOON AS POSSBILE. CLICK ON THE
LINK FOR LOW BACK STRETCHES AND DR. SHERMAN’S STRETCHING VIDEO.

FACET SYDROME

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THE FACET JOINTS WHICH HELP TO CONTROL MOVEMENT OF THE SPINE CAN WEAR OUT OVER TIME. DEGENERATIVE ARTHRITIS CAN EFFECT THE FACET JOINTS. BONE SPURS AND DEGENERATIVE CHANGES CAN CAUSE PAIN. PATIENTS TYPICALLY PRESENT HUNCHED OVER TO REDUCE THE FACET PAIN. THEY ARE ALSO RESTRICTED IN MOTION.
DIGANOSIS CAN BE MADE WITH AN XRAY OR CAT SCAN.
TREATMENT: PHYSICAL THERAPY CONSISTING OF ELECTRICAL STIMULATION, ULTRASOUND AND ICE MASSAGE CAN HELP REDUCE THE INFLAMMATION. TRACTION AND STRETCHING SHOULD BEGIN WHEN THE INFLAMMATION IS DOWN.

SPINAL STENOSIS

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THE SPINAL CANAL NARROWS CAUSING THE SPINAL NERVES TO BE PINCHED.  THIS CONDITION CAUSES PAIN IN THE LOWER BACK, BUTTOCKS AND POSSIBLY DOWN THE LEG. SPINAL STENOSIS IS A DEGENERATIVE DISEASE.  EXERCISING WITH THE BODY HUNCHED OVER IN FLEXION OR WALKNG WHILE IN FLEXION MAY DECREASE PAIN. SEE LUMBAR STRETCHING AND VIDEO FOR HELP WITH SPINAL STENOSIS.

OTHER CAUSES OF LOW BACK PAIN
PREGNANCY
APPENDITICITIS
ANEURYSMS
KIDNEY STONES
BLADDER INFECTIONS
TUMORS


Sherman Sports Injury Center
22222 Sherman Way Suite #110
Canoga Park, CA 91303
(818) 888-8058