Quick Fix 12/03/2010
 
          Rarely a day goes by that I don’t have a patient in my office with neck or low back pain. Surprisingly, many of these people truly believe that when they go to see a chiropractor or physiotherapist that a “quick fix” is readily available.  Even though I have personally witnessed many people make incredible improvements with only a single chiropractic treatment, expecting that outcome out of every treatment would be wrong.

     In most cases, regardless of the type of practitioner or their preferred method of treatment, correcting a physical problem often requires a series of treatments over time. In any injury, there are always a few phases that a person must pass through. First, there is the “acute” phase. This is the initial period of time immediately after the injury where there is lots of inflammation, pain, muscle spasm, etc. Second, there is the “healing” phase. This is when your body is healing itself naturally. There are no medications that can do this for you. Third, there is the “rehabilitative” phase. This is after the pain and other symptoms have subsided and the injured area is strengthened or rehabilitated. It is important to understand that even though the pain is gone at this stage, the area is still vulnerable to re-injury.

      Although many people would disagree, a lack of pain does not mean that you are healthy or a problem has been completely fixed. Eliminating the “pain” or symptoms is only one of the necessary steps to a full recovery. The theory “if it ain’t broke, don’t fix it” is usually wrong no matter what you apply it to. What I am getting at is that an absence of pain or simply “feeling better” does not mean that you should discontinue your treatment and assume you are 100%.  Pain is commonly the first symptom to disappear.  What I see on a daily bases is a patient will go back to gardening or push mowing the yard the moment they are “pain free”.  Since they are feeling better, they believe they can go back to life as normal.  With this mindset they end up re-injuring themselves and possibly making the condition worst than is initially was all because they went back to doing too much too soon because they were “pain free”.  With that in mind, follow through with a practitioner’s treatment recommendations so that you fully rehabilitate your injury. This will prevent the problem from re-occurring.

      Another important point is that even after you fully recover from an injury, you must make the necessary changes so that it doesn’t happen again. For example, if you slipped in the tub and sprained your shoulder, put a non-slip mat in the bottom of the tub.  But what if your low back is sore from your job sitting all day while driving or working at a desk? Do you simply quit your job? I would think not. In this instance, you must do more to look after yourself so that your body can tolerate the physical stress your job creates. You may have to exercise more, work less, lose weight, see your chiropractor more often, etc. None of these are easy things to do. But, you can’t expect your chiropractor, or any other practitioner, to fix your problem and keep it that way when you are not willing to reduce or compensate for the aggravating factors that are creating your problem in the first place.

      If you have any questions about neck pain or a topic for my next blog, email me at landrumdc@gmail.com or visit my website, http://www.landrumdc.com



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There are many different instigators of pain in the lower back. Two of the most common ones are the joints of the spine (facet joints) and a degenerated/herniated disk. Both of these can cause irritation of the nerves such as numbness, tingling and produce a referred pain further down the leg (sciatica). However, another very common one that is often misdiagnosed by some practitioners is the sacroiliac joint. It is actually the joint between the “sacrum” and “ileum” bones located at each side of the pelvis and not in the spine at all.

Back not too long ago, it was thought that this joint did not move at all and was not a potential source of pain. A recent study has disproved this theory. The researchers in this study injected “freezing or anesthetic” specifically into this joint in people with low back pain. They used x-rays to be sure the needle was actually inside of the “sacroiliac joint”. Once the anesthetic was given time to take affect, the low back pain was significantly better and then the pain returned when the anesthetic wore off. Although it was not a cure for their back problem, it clearly demonstrated that the sacroiliac joint should be added to the list of possible causes of acute and chronic low back pain.

Problems with the sacroiliac joint are one of the most common causes of acute low back pain that I see in my office. It can occur in the absence of any heavy lifting or accidents. When sore, you will feel the pain two to three inches to one side from the middle of the low back. It can even occur on both sides at the same time. The nerves that control pain in this joint can cause pain to be referred to the hip, groin, and leg. As well, strong and painful muscle spasms can accompany the pain in the joint.

Research has also shown that the fastest way for any joint to heal, particularly in the low back and pelvis, is to restore the movement or mobility of the joint. All the joints in your body are designed to nourish themselves, remove swelling, and heal after injury. But, for this to occur, the joint has to be able to move properly. In cases of low back pain, the joints become very “stiff or jammed”. It is the job of the chiropractor to do “adjustments” to restore and maintain this movement, allowing it to heal.
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“Piriformis syndrome” is caused by an entrapment (pinching) or irritation of the sciatic nerve as it exits the back of the pelvis, deep within the buttock region. The sciatic nerve usually exits the back of the pelvis immediately below a muscle, called the piriformis muscle.  The piriformis muscle is located on both sides of your body, deep within the buttock area. In rare situations (11% of population), the nerve actually passes right through the piriformis muscle. For various reasons, the piriformis muscle can go into spasm and entrap or even pinch the sciatic nerve.  This can result in pain along the back of the thigh and knee, with further pain and/or numbness extending as far down as the sole of the foot, called “sciatica”.

Piriformis syndrome can result in “sciatica”. These same sciatica symptoms feel very comparable to that of a herniated disk. A herniated disk usually pinches directly on one of the five nerves that eventually form the sciatic nerve. Because the resulting symptoms of both of these problems are very similar (pain, numbness and tingling below the knee and into the foot), it is not hard to misdiagnose what is actually going on if you don’t look for both potential causes.

Specific diagnostic tests performed by your chiropractor are what distinguish a herniated disk from piriformis syndrome. In simple terms, with piriformis syndrome your chiropractor will not find many positive test results that indicate that the lumbar spine is involved. More often, the acute pain or tenderness is localized to the buttock and hip, while the low back appears quite normal and often pain free.

Many weekend athletes and people who spend long hours sitting in cars or at work are prone to this syndrome. The athlete's cause is commonly due to improper stretching and warm-up exercises as well as overuse during activity. In this case it is most likely that the piriformis muscle is irritated and usually in spasm. For the patient who sits for extended periods of time, their primary cause is due to contracture or tightening of the piriformis muscle. In this case the piriformis muscle is shortened and does not allow for the smooth movement of the sciatic nerve during leg motion.

Any treatment plan must include stretching of the gluteal or buttock muscles as well as stretching of the piriformis muscles. Dr. Landrum can help you by instructing you on the proper stretches and the correct way to perform them. A series of spinal and hip joint adjustments may also be required to relieve your symptoms. 

 If you are currently diagnosed with a disk herniation but are wondering if the symptoms you are experiencing may at least be partially from piriformis syndrome, call my office for an appointment to have it checked thoroughly. It is always a good idea to rule out other possible causes of your sciatica before simply having surgery.
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