Spinal degeneration refers to a gradual deterioration in the function of the spine. Aging, injury or trauma can all contribute to wearing down the cartilage discs between the vertebrae.
Four stages mark the degeneration of the spine:
Phase 1 is the stage in which the spine loses its balance. Nerves are affected and joints and discs begin to age more rapidly. At this point, response to spinal care is generally positive.
Phase 2 involves a much greater degree of decay. As discs narrow even further, changes in posture become more evident. There is more pain than at Phase 1, but significant improvement is possible with chiropractic care.
Phase 3 is marked by further imbalances in posture, more advanced nerve damage, and bone deformation. A permanent loss of height can occur and loss of energy is significant. Disabilities may become more noticeable along with mental and physical weakness. Some reversal of symptoms may be experienced with the correct chiropractic care.
Phase 4 involves severely limited motion. Serious nerve damage, permanent scar tissue, and fusion of the bones may become noticeable. Phase 4 shows a significant increase in pain levels, while mental and physical abilities are severely compromised. Although considered irreversible, some relief from the condition may be expected from the appropriate chiropractic care.
The debilitating pain caused by a herniated disc is unfortunately all too common. This condition is the end result of a longer process of degeneration. Fortunately, chiropractic care can provide relief for most simple herniated disc injuries.
A herniated disc is commonly referred to as a slipped disc. Cartilaginous discs, situated between each vertebra in the spine, act as shock absorbers for your back. They provide cushioning between the hard, bony vertebrae that make up the spine. A disc injury is more accurately referred to as a bulge or a rupture, where the bulging disc puts pressure on nerves and can no longer function properly.
A herniated disc occurs as the end result of a degenerative process. Underlying factors of a disc injury may include:
- disc dehydration, where insufficient water absorption ages the tissues and causes rigidity;
- unusual types of stress on the discs, and
- excessive weight on the discs.
These factors cause slow degeneration of disc quality, leading eventually to the herniation. A rupture can occur through sudden movement, such as lifting a heavy item or even sneezing. It is important to note that the act of sudden movement is not the cause; the degenerative process is what causes the disc to ultimately slip.
Most simple herniated disc injuries can be treated with low-force chiropractic techniques or with traditional alignment methods. However, more extreme disc injuries that involve an advanced loss of strength, sensation or reflexes should be referred to a spine specialist for further evaluation and intensive treatment.
The Outcome of Surgical Lumbar Discectomy
Surgical decompression for prolapsed/herniated lumbar intervertebral disc is the most frequently performed spinal intervention. This recent study explored psychological assessments, in particular the psychosocial aspects of work, in predicting the outcome of lumbar discectomy. The authors also assessed general medical data and utilized MRI scanning to identify abnormalities. Their hope was that these varied assessments would help predict postoperative outcome and return to work status.
46 patients who had lumbar discectomy surgery were followed for two years. Before the operation the authors evaluated the patients’ low back pain history, performed a physical, and ran the MRI examinations. All patients reported at least radicular leg pain. 27 patients had minor neurological deficits and 11 had major deficits.
Two years later, with questionnaires, the authors investigated the patients’:
- Work-related mental stress
- Job Satisfaction
- Job Resignation
- Support Network at Work
- Level of Pain Relief
- Disability in Daily Activities
- Return to “any” work
- Surgical Outcome
The authors found that a high number of people had to quit their job, which is a feeling of dissatisfaction coupled with feeling forced to accept the job as it is, predicted disability in daily activities. Other significant predictors of disability and pain relief were MRI-identified nerve root compromise and neural compromise. The authors found that in most patients, the pain is likely to subside after resolution of the neurological problem. In cases where the irritation persists, however, “disc protrusion could be the initiating factor for low back and leg pain, but psychological factors might be more relevant in perpetuating pain.”
Yet, psychological aspects—not physical findings—played a vital role in predicting return to work. Since occupational mental stress, job satisfaction, and depression were major predictors, the authors then considered working conditions, rather than low back pain, as influencing return to work status. They write:
“These findings indicate that patients with stressful work conditions do not tend to return to work even if the discectomy was successful from a surgical point of view. Improvements in working conditions, particularly from the psychological point of view, could play a significant role in the rehabilitation of a patient after discectomy, a finding which needs further attention and evaluation…Furthermore, this study highlights the importance of psychological aspects of work which should be taken more into account, in further research. It also implies that psychologically favorable working conditions may be an important preventive factor for chronic disability.”
Schade V, Semmer N, Main C, Hora J, Boos N. The impact of clinical, morphological, psychosocial and work-related factors on the outcome of lumbar discectomy. Pain 1999;80:239-249.
Pain in the legs and lower back may be caused by compression of the sciatic nerve. Learn more about how decompression and laser therapy can help relieve the pain of sciatica.
Drugs are ineffective
The efficacy of common drugs for sciatica treatment has been called into question in a recent literature review. Although there are consistent guidelines for prescribing medication for low-back pain, “this is not the case for sciatica.” To address this lack of clear guidelines, researchers analyzed the results of current literature on treatment for sciatica using non-steroidal anti-inflammatory drugs (NSAIDs).
After evaluating 23 studies, researchers concluded that there is no clear evidence demonstrating “favorable effects of NSAIDs, corticosteroids, antidepressants, or opioid analgesics in the immediate term [relief of pain] even compared with placebo.” That means that in many studies, drugs were no more effective than a placebo in relieving pain. Several drugs also did not significantly impact leg pain, one of the primary symptoms of sciatica. Though some NSAIDs and an anticonvulsant called gabapentin did reduce overall pain in the short term, the long-term effective were unclear.
For long-lasting relief of sciatica pain, chiropractic care combined exercise may ultimately prove more effective by addressing the root cause of sciatic pain instead of simply easing symptoms.
Rafael Zambelli Pinto, Chris G Maher, Manuela L Ferreira, Paulo H Ferreira, Mark Hancock, Vinicius C Oliveira, Andrew J McLachlan, Bart Koes.”Drugs for relief of pain in patients with sciatica: systematic review and meta-analysis.” British Medical Journal. 2012, February; 344:e497 doi: 10.1136/bmj.e497.
Drug-free Sciatica Treatment
Pain medication is frequently prescribed for patients with sciatica, but a new article from the prestigious British Medical Journal reveals that there may be little efficacy in this practice. In the article, researchers reviewed 23 studies that compared placebo pills to various drugs typically prescribed for sciatica. In study after study, drugs were found to be no more effective than a placebo in relieving pain. Drugs also did not significantly help radiating leg pain, one of the primary symptoms of sciatica. Though two drugs did reduce overall pain, it was unclear how effective they were in the long-term.
This led researchers to conclude that there is no clear evidence demonstrating the efficacy or tolerability of common pain medications prescribed for sciatica.
Spinal Decompression and Laser therapy is a better approach to sciatica than drugs. A 2010 study found that decompression therapy does not pose the same risks as surgery yet it is just as effective.
Call our office today for natural, effective treatment of sciatica.
McMorland G, Suter E, Casha S, du Plessis SJ, Hurlbert RJ. Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. Journal of Manipulative and Physiological Therapeutics. 2010; 33(8): 576-584.
Pinto,Rafael Zambelli. Chris G Maher, Manuela L Ferreira, Paulo H Ferreira, Mark Hancock, Vinicius C Oliveira, Andrew J McLachlan, Bart Koes.Drugs for relief of pain in patients with sciatica: systematic review and meta-analysis. British Medical Journal. 2012, February; 344:e497 doi: 10.1136/bmj.e497.
The Effects of Sciatica on Your Muscles
Patients who suffer from sciatica are at risk for developing muscle atrophy. A recent British study found that patients with sciatica had decreased muscle mass, also known as muscle atrophy.
Muscle atrophy occurs in people that have a restricted range of motion due to an injury or medical condition. Developing atrophy can further reduce muscle strength and mobility. In patients with low-back pain, weakened muscles can cause patients to compensate in other ways leading to further injury.
That’s why it’s important to seek treatment for sciatica before it worsens. Unlike medications, Spinal Decompression and Laser treatment actually addresses the cause of sciatica – an injury or disc herniation pinching the sciatica nerve. Spinal Decompression and Laser therapy performed will reduce pressure on the sciatica nerve, and in doing so, significantly relieve the pain. This treatment, along with strong core and back muscles, is a powerful way to recover and prevent sciatica.
Ploumis A, Michailidis N, Christodoulou P, Kalaitzoglou I, Gouvas G, Beris A. Ipsilateral atrophy of paraspinal and psoas muscle in unilateral back pain patients with monosegmental degenerative disc disease. British Journal of Radiology. November 2010.0: 58136533.
Is sciatica worse for women?
Women with sciatica are more likely to have a slower recovery rate than men with the same condition. In a recent study, 28% of women had unsatisfactory outcomes after one year of treatment, compared to just 11% of men. Patients with unsatisfactory outcomes suffered from higher pain and disability levels as well as slower recovery rates compared to other patients.
The researchers tracked the progress of 283 patients with severe sciatica. The patients were treated with surgery, conservative care, or a combination of both. By the end of the study, 83% of patients had recovered, reflecting the generally positive prognosis of sciatica. But 17% of patients were still experiencing severe pain, and the majority of those patients were women. Gender differences in recovery rate were not affected by the type of treatment patients received.
Previous studies have shown that women are also more likely to have chronic pain and disability from other musculoskeletal conditions. Research suggests that there are various biological and social factors that could play a role in these gender differences. Smoking and obesity have also been linked to sciatica and chronic pain in women.
Since most of the women in the study did recovery after one year, it’s important to remember that being female doesn’t guarantee a poor recovery. Still it’s crucial to take steps to prevent chronic pain with early treatment, exercise, and improved posture.
Peul W, Brand R, Thomeer R, and Koes B. Influence of gender and other prognostic factors on outcome of sciatica. Pain 2008;138: 180-191.
Sciatica Pain Relief: No drugs, No surgery!
Backaches are very common ailments affecting nearly 80% of adults at one time or another in their lives. Backaches can stem from compressed or herniated disks in the spine, muscle strains and a combination of these. Often times, excessive weight (especially abdominal weight) and improper lifting are to blame.
Sciatica and Piriformis Syndrome affect the sciatic nerve that begins at the sacrum and extends down both legs. In sciatica, the sciatic nerve is not being directly compressed, but the nerve roots at the base of the spine that connect with the sciatic nerve are being compressed. In piriformis syndrome, the piriformis muscle in the buttocks region is directly compressing the sciatic nerve.
In either case, the classic marker is shooting pain down one or both legs. Though surgery and drugs (anti-inflammatories and pain meds) are often used to treat back problems, there are other options. First, it is imperative that a person loses weight, strengthens abdominal muscles and learns to lift properly. This may be difficult, however, if pain is not relieved in another way.
This is where therapy for sciatica pain can enable a person to carry on with daily activities and begin the path towards weight loss and strengthening their body. Your therapist may begin by assessing the lower back and buttock area to see if the pain stems from compression in the lower back, sacral area or buttocks. They will then concentrate on the piriformis. At this point, the therapy will depend on your particular pain. 1
1. Barrett C. : How to Reduce Pain in the Sciatic Nerve
Neck Pain Treatments
Neck pain is a common pain symptom experienced by most of us. Most neck pain begins with some kind of trauma, but sometimes the origin is difficult to identify.
With all neck pain—no matter what the cause—the pain itself tells us that there is some kind of problem in the functioning of the different parts of the spine.
The human spine is an amazingly versatile and complex structure that provides support, protects the internal organs and nervous system, but at the same time allows incredible flexibility and movement.
Many different pieces have to work together to maintain a healthy spine. The spinal cord and nerves of the back are the communication lines between the brain and the rest of the body. The bones of the spine—or the vertebrae—protect those nerves. The vertebrae are separated by fibrous discs. The ligaments of the spine hold the vertebrae together. And the muscles attach to the vertebrae and provide stability and allow us to move.
When all of these pieces are working together in harmony, we’re not even aware of them. When one piece fails to work properly, all of the other parts are affected, as well. The role of chiropractic is to make sure that all of the pieces work together the way they’re supposed to. Here are some articles that discuss the benefits of chiropractic for neck pain.
Chiropractic, Neck Pain, Disc Herniation
This study examined 27 patients in a private chiropractic practice who presented with neck or back pain and who had MRI-documented cervical or lumbar disc herniation’s that corresponded with clinical findings.
“Patients were treated with a course of care consisting of Spinal Decompression for the cervical spine or the lumbar spine in the acute phase of care, in addition to interferential/ultrasound combination and cryotherapy. In the subacute phase, rotational manipulation was judiciously added, as were isometric and flexibility exercises. In the chronic stage of care, distraction manipulation and rehabilitative exercises were continually employed. Rehabilitative exercise included extension exercises in addition to pelvic tilts, lifts and knee flexion stretching.”
“Treatment frequency was typically four to five times/wk for weeks 1 and 2, then three times/wk with decreasing frequency as the patient progressed. Duration of active care varied from 6 wk to 6 months.”
“When patients reached the point at which their VAS [visual analog scale] score was 1.2, their exam findings reversed and their extremity pain resolved, a repeat MRI was obtained. This scenario occurred as early as 6 wk after initiation of care.”
If the patients did not reach these milestones, follow-up MRI was performed 1 year after the initiation of care.
The study found that 22 of 27 (80%) had good clinical outcomes; 17 of the 22 (77%) “had not only good clinical outcome but also evidence of reduced or resolved disc herniation upon repeat MRI scanning.”
Five patients (18.5%) had a marginal or poor outcome, but none had worse clinical signs or pain ratings at the end of the study.
At the beginning of the study, all 27 patients had left work because of the severity of the pain; at follow-up, 21 (78%) were back to work in their former occupations.
VAS scores decreased from an average of 6.9 before treatment to 1.9 following treatment.
One important issue that the author addresses is the controversy of whether manipulation is contraindicated for disc herniation. After reviewing the literature, and from his clinical findings, he concludes that manipulation is indeed safe for disc herniation: “…in the cervical and lumbar spine, rotational manipulation most likely cannot be implicated in disc failure or exacerbation of a disc herniation, and for rotational forces from a manipulation to be involved in disc failure, facet fracture must occur first.” No complications occurred in this study.
BenEliyahu DJ. Magnetic resonance imaging and clinical follow-up: study of 27 patients receiving chiropractic care for cervical and lumbar disc herniations. Journal of Manipulative and Physiological Therapeutics 1996;19(9):597-606.