Dr. Barry Triestman, d.c.

Causes of Back Pain

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Spinal Subluxation

A vertebral subluxation is the improper motion or position of the moving bones of the spine that interfere with or irritate nerves. When a vertebra doesn't function properly, it causes mechanical stress which accelerates wear and tear on surrounding spinal muscles ligaments, discs and joints. Pain, tenderness, inflammation, decreased mobility and muscle spasms soon follow. Because of the direct relationship between the spine and nerve roots, vertebral subluxations can impair nerve functioning and lead to decreases in the communication within the body's nervous system and jeopardizes overall health and wellness of the individual.

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Muscle Strain

Muscle strain or muscle pull or even a muscle tear implies damage to a muscle or its attaching tendons. You can put undue pressure on muscles during the course of normal daily activities, with sudden, quick heavy lifting, during sports, or while performing work tasks. Muscle damage can be in the form of tearing (part or all) of the muscle fibers and the tendons attached to the muscle. The tearing of the muscle can also damage small blood vessels, causing local bleeding (bruising) and pain (caused by irritation of the nerve endings in the area).

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Disc Injury

What are spinal discs?

Spinal discs are a critically important part of your spinal column. Along with the vertebrae, also called the spinal bones, they perform many functions. The discs provide shock absorption, protecting the spinal cord and ensuring flexibility of the spine. They also perform other functions. The spinal discs are essentially ligaments (structures connecting bones) that attach to the top and bottom of each vertebra. They are thick, ligament-like outer rings, also known as annuli fibrosis. Because they are arranged in an alternating pattern with the vertebrae, annuli fibrosis allow flexibility while preventing the vertebrae from moving too much and causing injury. Inside a single annulus fibrosis is a jelly-like substance called the nucleus pulposis. It contains some proteins, but is primarily made up of water. The nucleus provides more shock absorption than does the annulus, and it also acts as a fulcrum to direct the type of movement through which each vertebra travels.

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Sacro-iliac joint

This is where the spine and pelvis meet. Low then the spine To diagnosis this correctly we need to have 3 of these test positive. According to this study in the orthopedic journal of physical therapy

• Distraction test

• Compression test

• Thigh thrust test

• Gaenslen test

• Sacral thrust test

Sacro-iliac pain generally responds to a combination of working the muscles surrounding the joint with Active Release Techniques. The Piriformis, gluteus medius, psoas, iliacus. There is also usually some hip joint or lumbar spine involvement that generally responds chiropractic adjustments. Rehabilitation is also part of the solution.

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Lumbar Facet injury AKA extension based low back pai, spondylolesthesis.

Pain when extending the back. This often happens during back bends in yoga. Many gymnastics and dance practices also injure these tissue and promote poor movement.
Here is a case report  from BMC Musculoskeletal Disorder journal with the big take away that we need to work on the poor motor patterns and as they improve progress them from simple/ easy to hard/complex as the athlete progresses. This about getting better awareness and control of the lumbar spine, most athletes are already strong.

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What are the most common disc problems?

 

• A disc "bulge" results from slight tears in the outermost fibers of an annulus fibrosis(the donut part). These small tears can be painful for a short time.

• A disc protrusion/extrusion, also called "herniation," is a more significant injury. It results from a complete or significant tear of the fibers of an annulus-when some of the nucleus leaks through(the jelly part). A herniation can also be painful and may even cause nerve compression. In the most severe cases, the spinal cord can become compressed.

• The most common disc problem suffered by adults is degenerative disc disease. This occurs when the nucleus loses water and small tears develop in it. The body then forms osteophytes (bone spurs), along the edges of the vertebra and the disc space narrows. We used to believe that this was a function of "wear and tear" as we aged. The most recent evidence shows that, most often, there is a hereditary link to the development of degenerative disc disease. Degenerative disc disease can also be caused by trauma/injury.

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