There are many different treatment approaches for lower back pain. One that has been available for quite some time is lumbar traction. Lumbar traction is a treatment approach where the patient lies on their back and has some form of a belt around their waist. The traction machine applies a gentle pull toward the direction of the feet. In simple terms, the spine is being pulled apart or “decompressed”. 

Traction for Lower Back Pain

Traction for lower back pain is intended to pull the spinal levels apart and “decompress” the spine. The proposed benefit is to mobilize each level of the spine and provide relief to the various weight bearing structures of the spine (especially the intervertebral discs) since they are normally subjected to compression during our daily upright activities.

What conditions does Spinal Traction Treat?

According to various texts and websites, most clinics use spinal traction to treat disc herniations, disc bulges, degenerative disc disease, spinal stenosis and general, uncomplicated mechanical lower back pain.

Scientific Evidence for Spinal Traction

A 2006 systematic review published in the journal Spine investigated the effectiveness of spinal traction. (For those who aren’t aware, a systematic review is when the authors of a paper pool together and analyze all the available published literature on a topic, so the results of a systematic review are usually quite meaningful). In a nutshell, the authors of the systematic review concluded that traction is not recommended as a stand-alone treatment. In other words, if that is the only treatment you’re having on your lower back the balance of the scientific literature doesn’t support it.  On the other hand, the review was unable to say anything about this approach when combined with other treatments.

What is Spinal Decompression?

To be honest, I’m not sure.  Spinal decompression is not offered at our facility so I’m far from an expert.  From what I’ve read, it seems very similar to spinal traction (as discussed above) but more computerized and modern.  Again, I’m unable to find scientific literature (published in a reputable peer reviewed journal to eliminate bias) that recommends it as a stand-alone treatment for back pain.  Perhaps a reader with more knowledge or experience in this treatment approach will help us out and comment!

Treatment of Lower Back Pain

According to the literature then, spinal traction may be helpful for those with lower back pain when combined with other therapies.  If you are attending a clinic that utilizes spinal traction as a treatment approach, it might be wise to combine this treatment with another form in order to maximize your results!  For further information about the services offered at Burlington Sports Therapy or our approach to treating lower back pain, feel free to contact us. info@burlingtonsportstherapy.com

References
Clark et al. Traction for low back pain with or without sciatica: an updated systematic review within the framework of the Cochrane Collaboration. Spine 2006; 31(14):1591-1599.

If you haven’t already heard the analogy, a jelly donut is a really easy way to get the idea of a lumbar disc herniation. If you recall from previous blogs, our spine is made up of boney blocks separated by cartilage discs. These cartilage discs have a tough outer cartilage (like the dough of a donut) and a soft jelly substance in the middle (like the jelly in a donut). In very simple terms, a disc herniation is much like having a crack or tear in the dough of the donut and the jelly in the middle leaking out that crack.

Lumbar Disc Herniation

Should I have Surgery for Lumbar Disc Herniation?

On occasion we encounter patients who are considering surgery for their lumbar disc herniation. This is a tough decision and should be made with careful consideration. Obviously, there are many different factors to consider. For some, surgery is an obvious choice because the symptoms are so severe and not improving. In fact, some surgeries can be necessary (rather immediately) if the disc injury is compressing the spinal cord. For most people though, surgery is one option among many.

Physiotherapy, Chiropractic or Surgery?

A 2006 study published in the journal of the American medical association investigated the benefits of surgery for lumbar disc herniation and whether or not it was superior to conservative treatment. This study was a rather large undertaking, with many study participants and lots of media attention. The results indicated that there was no added benefit to one over the other. Given the inherent risks of any surgery, it is recommended for many patients with lumbar disc herniation to consider conservative treatment first.

Treatment for disc herniation (at Burlington Sports Therapy)

At Burlington Sports Therapy, our physiotherapists and chiropractors treat lumbar disc herniation quite regularly. It is actually quite rare for any of our patients to require surgery for their lumbar disc herniation, so we’re always happy when new patients give us a call before having surgery. Depending on such factors as pain levels, previous treatments and imaging findings, a carefully constructed treatment plan will be outlined by the chiropractor or physiotherapist. The specific treatment used might include one or a combination of modalities like laser therapy, chiropractic adjustments, mobilization (which are gentle movements of the joints), interferential current (IFC) and exercise.  As mentioned above, surgery is sometimes necessary for lumbar disc herniation.  In these cases, consultation with a spinal surgeon may help to determine whether surgery is appropriate.  Unsure what to do? We can help you find the right treatment approach for your specific situation…feel free to contact us. info@burlingtonsportstherapy.com

References
Rhee JM, Schaufele M, Abdu WA. Radiculopathy and the herniated lumbar disc. Controversies regarding pathophysiology and management. Journal of Bone & Joint Surgery 2006; 88: 2070-2080.
Unlu Z et al. Comparison of 3 physical therapy modalities for acute pain in lumbar disc herniation measured by clinical evaluation and magnetic resonance imaging. Journal of Manipulative and Physiological Therapeutics 2008; 31: 191-198.
Weinstein JN et al. Surgical vs. nonoperative treatment for lumbar disk herniation: the spine patient outcomes research trial (SPORT): a randomized trial. JAMA 2006; 296: 2441-2450.
Weinstein JN et al. Surgical vs. nonoperative treatment for lumbar disk herniation: the spine patient outcomes research trial (SPORT): observational cohort. JAMA 2006; 296: 2451-2459.

Leg pain associated with back pain is quite common. In fact, it is estimated that 25-57% of all cases of lower back pain have associated leg pain. The pain can take various forms and be described in various ways. Common descriptors include numbness, tingling, pins and needles, weakness, tooth-ache pain, a dull ache or even pain that is sharp, like a lightning bolt. There are various conditions associated with these symptoms (as discussed in previous blogs) such as disc herniation, lateral stenosis, degenerative disc disease, degenerative joint disease, spondylolisthesis and piriformis syndrome (to name a few). But why do we get the leg pain?

Pinched Nerve

The simplest mechanism to understand is the idea of a “pinched nerve”. Quite often the analogy of a garden hose is used. Similar to stepping on a garden hose, a nerve can get compressed or “pinched” by various structures in the spine. This can cause excruciating symptoms of sciatica down the leg, following the path of the sciatic nerve. In the case of piriformis syndrome, the nerve is actually compressed in the area of the buttocks, not near the spine.

Inflammation in the Lower Back

Regardless of the actual diagnosis, the area of the nerve root can get inflamed. That is, the area where the nerve leaves the spine can get “annoyed” by an injury to the surrounding tissue. Similar to when you twist your ankle and it balloons up with fluid, certain spinal injuries can do something similar. The swelling brings tiny cells to the area which can irritate the adjacent nerve causing the nerve to send pain down the leg.

Central Events

In a nutshell, if you’ve had symptoms of sciatica for a long time our brains and other “central” structures can actually change. Unfortunately, this can be a change for the worse as it may allow the leg symptoms to easily perpetuate…your brain views it as its “new normal”.

Referred Pain

Referred pain is a difficult concept to simplify. Generally speaking, a part of your spine can send a pain signal down your leg, but not necessarily along the nerve. The reason this happens stems all the way back to when we were just a collection of dividing cells…obviously, a little beyond the scope of this blog! The take home point with referred pain is that the nerve is not necessarily carrying the pain signal continuously down the leg; treatment should be focused to the damaged tissue at the spine.

Treatment for Sciatica

As with any condition, the treatment for sciatica will depend on a number of individual factors. The treatments offered by our physiotherapists and chiropractors include laser therapy, acupuncture, manual treatments like spinal adjustments or mobilizations, soft tissue therapy (like active release technique) or the use of modalities like interferential current (IFC). For more information about our services or the approach that might be right for you, feel free to contact us at info@burlingtonsportstherapy.com.

References

Schafer et al. Classification of low back-related leg pain – a proposed patho-mechamism-based approach. Manual Therapy 2009; 14: 222-230.

Chiropractic Burlington Ontario and Degenerative Disc Disease

Our spine is made up of boney blocks called vertebrae. Separating each vertebrae are cartilage discs. These discs can wear down with time and use, which lead to the diagnosis of degenerative disc disease. Degenerative disc disease can be considered a relatively normal process that occurs in the spine. Unfortunately, it can also be associated with considerable pain and disability for some individuals.

Facts About Degenerative Disc Disease

In a nutshell, degenerative disc disease is a process that occurs over a considerable length of time.  Various factors (age, genetics, occupation, previous trauma) wear the disc down and cracks can form.  The jelly like material on the inside dries up and the overall height of the disc decreases.  The surrounding joint structures (such as ligament, bone and cartilage) can also be involved. Significant reduction in disc height can also affect the nerves that exit at each level of the spine.

Who Gets Degenerative Disc Disease?

For many people, signs of degenerative disc disease begin when they are in their twenties.  Although the prevalence of degenerative disc disease increases with age, genetics seem to be the best predictor of those who will be prone to the condition.  The activities that you do on a regular basis also seem to play a role. I often use the analogy of the tires on your car; you can’t expect to drive your car day after day and not see any wear in the tires. Your spine (and the discs in your spine) is somewhat similar.

Disc Bulge or Disc Herniation?

An easy way to understand the intervertebral disc is to picture a jelly donut. There is an outer crust to the disc and an inner jelly material. Simply stated, a disc herniation is when the crust is torn right through to the jelly in the middle and the jelly pushes out of the crack. A disc bulge is when the jelly in the donut squishes really close to the edge of the donut (because there are tears in the crust) but the jelly doesn’t pierce through the entire dough to be visible from the exterior.

Treatment for Degenerative Disc Disease

Surgical treatment for degenerative disc disease is usually viewed as a last resort if conservative treatment didn’t do the job. Conservative treatment usually consists of treatment like chiropractic, physiotherapy, laser therapy, acupuncture and massage therapy.  At Burlington Sports Therapy we have a variety of treatment techniques and services that can assist patients with degenerative disc disease. What is right for each individual patient depends on a variety of factors, including duration of symptoms, severity of symptoms and previous failed treatments.

For more information about how we can assist you, please email us at info@burlingtonsportstherapy.com

References
Adams MA and Roughley PJ. What is intervertebral disc degeneration and what causes it? Spine 2006; 31(18): 2151-2161.
Beattie P. Current understanding of lumbar intervertebral disc degeneration: a review with emphasis upon etiology, pathophysiology and lumbar magnetic resonance imaging. Journal of Orthopaedic & Sports Physical Therapy 2008; 38(6): 329-340.
De Schepper EIT, Damen J, van Meurs JBJ et al. The association between lumbar disc degeneration and low back pain. Spine 2010; 35(5): 531-536.
Viderman J, Gibbons LE, Kaprio J, Battie MC. Challenging the cumulative injury model: positive effects of greater body mass on disc degeneration. The Spine Journal 2010; 10: 26-31.

“Sciatica” is a slang term often used to describe pain in the sciatic nerve distribution.  More often than not, this involves symptoms down the back of the thigh below the knee and into the foot.  This is caused by an irritation of the sciatic nerve.  As we’ve mentioned in previous blogs, sciatica is not actually a diagnosis but rather a slang term used to describe nerve irritation in the back of the thigh and leg.

Physical Therapy Burlington Ontario for Sciatica

Numbness, Tingling in the Leg

One of the more common causes of numbness, tingling, pain or aching in the lower limb (following a sciatic pattern) is lumbar disc herniation.  Many people refer to this condition as a “slipped disk”, a “pinched nerve” or a disc bulge.  Lumbar disc herniation is an area of considerable interest for researchers as the treatment options range from exercises, clinical treatment (like that from a physiotherapist or chiropractor) to surgery.

Treatment for Sciatica

There is ample evidence supporting each avenue of treatment for sciatica.  For example, a large 2006 study published in the Journal of the American Medical Association found no difference between patients who underwent micro-discectomy (surgery) to a group that were treated with physical therapy modalities and steroidal injections.  Another study, published in the Journal of Manipulative and Physiological Therapeutics found that lumbar spine traction, ultrasound and low intensity laser therapy were all effective in the reduction of sciatic nerve pain and the reduction of the size of the lumbar disc protrusion.

Sciatica Exercises…Do They Work?

A third example of research for sciatica treatment is a 2006 study published in the journal Physical Therapy.  The authors of this paper found that exercise-based management of a patient with lumbar disc herniation not only decreased symptoms after nine weeks, but demonstrated resolution of disc extrusion and relief of the nerve root compression on a follow-up MRI. So what is the best way to treat a lumbar disc herniation?

Treatment For Lumbar Disc and Sciatica

There are many variables that play a role in the decision making process for lumbar disc herniation management.  Our clinic usually recommends starting with the most conservative approach that is appropriate for an individual’s symptoms. Occasionally, in severe cases, surgical intervention may be warranted.  In the province of Ontario, your medical doctor or your doctor of chiropractic have the ability to diagnose this condition for you.  Obviously, a proper diagnosis is the first step for a successful treatment outcome!  Need help?  Give us a call! 905.220.7858  info@burlingtonsportstherapy.com

Want to meet our Chiropractor?  Click here.  Our Physiotherapist?  Click here.

References

Hahne AJ, Ford JJ. Functional restoration for a chronic lumbar disk extrusion with associated radiculopathy. Physical Therapy 2006; 86(12): 1668-1680.

Unlu Z et al. Comparison of 3 physical therapy modalities for acute pain in lumbar disc herniation measured by clinical evaluation and magnetic resonance imaging. Journal of Manipulative and Physiological Therapeutics 2008; 31: 191-198.

Weinstein JN et al. Surgical vs. non-operative treatment for lumbar disk herniation: the spine patient outcomes research trial (sport): a randomized trial. JAMA 2006; 296: 2441-2450.

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Dragon boat paddling has been known to cause lower back pain.  In fact, rowing in general has been linked to lower back pain.  But why?  What specific lower back conditions are caused by these activities?

Rowing and Lower Back Pain

Two of the more common lower back injuries associated with paddling and rowing are lumbar disc herniation (also commonly called sciatica, slipped disk or slipped disc) and lumbar spondylolisthesis (degenerative spondylolisthesis).  These are very common lower back conditions that are not exclusive to rowing.  The movement of rowing is similar to many daily tasks that require bending forward and pulling.

Lumbar Disc Herniation and Rowing

In the case of lumbar disc herniation, repeatedly flexing the spine forward can lead to a weakening of the outermost structure of the disc, eventually allowing the inner “jelly-like” material to bulge out.  More often than not, this inner material protrudes posteriorly (backwards) and laterally (to the side).  This movement of disc material can cause pressure and irritation of the nerves which exit the spine, often leading to sensations of pain, numbness and tingling or pins and needles into the buttock and leg.  Many people refer to this pain as “sciatica” or “sciatic nerve pain”.  For many rowers, the repeated flexion and extension of the spine creates muscle fatigue and a loss of support, compression and herniation of the lumbar disc.  This creates persistent lower back pain with symptoms of sciatica.  This type of low back pain and rowing are very common and can also occur with dragon boat paddling.

Spondylolysis and Spondylolisthesis

Spondylolysis typically involves an acute or stress fracture at the pars interarticularis and can lead to a forward displacement of one vertebrae relative to the one below (spondylolisthesis).  The risk of developing a spondylolisthesis greatly increases in sports that demand a significant level of hyperextension or extension and rotation of the lumbar spine.  As mentioned above, rowing and paddling are good examples of sports related to back pain, especially lumbar spondylolisthesis, degenerative spondylolisthesis and spondylolytic spondylolisthesis.

Burlington Chiropractor Back Pain Tips…

Given the fact that these are all non contact injuries, one can assume that they are preventable to a certain degree.  Here are some tips to think about when considering low back pain and rowing or lower back soreness from rowing…

1. Maintain a neutral spine throughout the entire stroke.  Rowers who adopt a slumped position at the catch or finish tend to have a higher incidence of low back injuries.

2. Maintain an anterior pelvic tilt throughout the catch phase to decrease the amount of lumbar flexion necessary and thus reducing the amount of stress on spinal structures.

3. Endurance training should be emphasized in the lumbar erector spinae muscles to help reduce excess flexion of the lumbar spine.

4. Stretching of the hamstrings and gluteals can help to obtain an adequate anterior pelvic tilt. Stretching the hip flexors may also help to decrease the amount of anterior pull on the spine.

5. Finally, many injuries are actually created or worsened by your actions on land and in the gym. Be sure that you have proper instruction on technique and training regimen before beginning an exercise program.

Treatment for Lower Back Pain

Of course, all of the aforementioned suggestions can really depend on your particular diagnosis and your individual spinal mechanics.  Our clinic in Burlington offers a number of treatment approaches for the patient with low back pain.  These services can be provided by our Chiropractors or our Physiotherapists.  Call us at 905.220.7858. info@burlingtonsportstherapy.com

References
Rumball JS, Lebrun CM, Di Ciacca SR, Orlando K. Rowing injuries. Sports Medicine 2005; 35(6): 537-555.
Ho SR, Smith R, O’Meara D. Biomechanical analysis of dragon boat paddling: a comparison of elite and sub-elite paddlers. Journal of Sports Sciences 2009; 27(1): 37-47.

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Last week, several patients asked me for the best back stretches for the relief of back pain. Although stretching is something that most of us do (including my dog when she wakes up in the morning) you may be surprised to hear that it is not always helpful! Several studies have found that static stretching before sports participation does not prevent injury and may actually decrease performance. Despite this, it is common to see sports teams spending considerable time stretching before games. In the case of low back stretches, stretching may actually exacerbate the injury.

Best Stretches for Low Back Pain?

Many cases of back pain during pregnancy are related to laxity in the ligamentous structures around the pelvis. Although it may feel great (for a moment) to do low back stretches, it may create more laxity which is the opposite of what is helpful. Perhaps a more common example is when patients do flexion stretches for sciatica…not good!

Stretches for Sciatica?

Stretches for Sciatica

Injury to the spinal disc can create nerve pain or tingling and is often referred to as sciatica. (Other common terms used to describe this condition are sciatic, sciatic nerve injury, sciatic pain, herniated disc, or a slipped disc). In this situation of disc injury, lower back stretching has the potential to exacerbate the damage to the disc by placing the spine in positions that likely contributed to the problem. Although the sensation of the lower back stretch feels good, we can’t always appreciate the compression being placed on the underlying tissues that are damaged with excessive compression.

Stretching for Back Pain

So when do we stretch? Some authors recommend it as a way to address asymmetries in muscles or when there is significant shortening of a muscle after injury. There is also some literature suggesting that stretching after exercise may assist in decreasing the affects of delayed onset muscle soreness. Our clinic in Burlington tries to limit the prescription of stretching to these situations. That being said, we try to keep the big picture in mind…a few minutes of static stretching is usually harmless. The safest thing to do is contact a knowledgeable practitioner who can provide you some safe exercises.

Treatment for Back Pain in Burlington

Many patients come to our clinic and have been given inappropriate exercises for their back pain. We love when these patients call us! Our Chiropractors and Physiotherapists will assist you in finding the most suitable exercises for your condition. In terms of actual treatment for your back pain, we have options. Feel free to look around our site and learn about our different treatment techniques. For more information about “our people”, feel free to learn a bit about our chiropractors and our physiotherapists. To schedule an appointment feel free to email us at info@burlingtonsportstherapy.com or call 905.220.7858.

References

Andersen JC. Stretching before and after exercise: effect on muscle soreness and injury risk. Journal of Athletic Training 2005; 40: 218-220.

Bradley PS, Olsen PD, Portas MD. The effect of static, ballistic, and proprioceptive neuromuscular facilitation stretching on vertical jump performance. Journal of Strength & Conditioning Research 2007; 21: 223-226.

Church JB, Wiggins MS, Moode FM, Crist R. Effect of warm-up and flexibility treatments on vertical jump performance. Journal of Strength & Conditioning Research 2001;15:332-336.

Herbert RD, Gabriel M. Effects of stretching before and after exercising on muscle soreness and risk of injury: systematic reviews. British Medical Journal 2002; 325:468.

Thacker SB, Gilchrist J, Stoup DF, Kimsey CD. The impact of stretching on sports injury risk: a systematic review of the literature. Medical Science Sports Exercise 2004; 36: 371-378.

Weldon SM, Hill RH. The efficacy of stretching for prevention of exercise-related injury: a systematic review of the literature. Manual Therapy 2003; 8: 141-150.

Young WB, Behm DG. Effects of running, static stretching and practice jumps on explosive force production and jumping performance. Journal Sports Med Phys Fitness 2003; 43: 21-27.

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