When patients present with low back pain, it is not uncommon for pain to arise from areas other than the low back, such as the hip. There are many tissues in the low back and hip region that are susceptible to injury with have overlapping pain pathways that often make it challenging to isolate the truly injured area. Hip pain can present in many different ways.
When considering the anatomy of the low back (lumbar spine) and hip, and the nerves that innervate the hip come from the low back, it’s no wonder that differentiating between the two conditions is often difficult. Complaints may include the inside, outside, front, or back of the thigh, the knee, the buttocks, the sacroiliac joint, or the low back and yet, the hip may truly be the pain generator with any of these presentations. To make diagnosis even more complex, the hip pain patient may present one day with what appears to be sciatic nerve pain (that is, pain shooting down the back of the leg to the knee if mild or to the foot if more severe) but the next visit, with only groin pain.
When pain radiates down a leg, the almost automatic impression by both the patient and their healthcare provider is, “…it’s a pinched nerve.” But again, it could be the hip and NOT a pinched nerve that is creating the leg pain pattern. Throwing yet another wrench in the works is the fact that a patient can have more than one condition at the same time. So, they truly MAY simultaneously have BOTH a low back problem AND a hip problem. In fact, its actually unusual to x-ray the low back of a hip pain patient without seeing some low back condition(s) like degenerative disk disease, osteoarthritis (spurs off the vertebrae), or combination of these. So, how do we differentiate between hip vs. low back pain when it is common for both low back and hip pain to often coincide?
During our history, we often ask the question, “…what activities make your pain worse?” If the patient replies that weight bearing activities like standing, walking, getting up from sitting, etc., provoke the pain (and they point to the front or side of the hip), a hip-related diagnosis is favored but it STILL may be arising from the low back or both! If they say, “…crossing my right leg over the other hurts in my groin,” then that’s getting more hip pain-specific as hip rotation is frequently lost before the forward flexion motion.
When we ask the hip pain patient to point to the area of greatest discomfort, they usually point to the front of the hip or groin, and less often to the inner and/or anterior thigh or knee. Non-weight bearing positions like sitting or lying are almost always immediately pain relieving. When there is arthritis in the hip, motion loss is often reported and may include a shorter walking stride and pain usually gets worse the longer these patients are on their feet. Initiating motion often hurts, sometimes even in bed when rolling over. During the chiropractic examination, with the patient lying on the back with the knee and hip both bent 90°, moving the bent knee outwards or inwards will almost always reproduce hip/groin area pain. Pulling on or applying traction to the affected leg usually, “…feels good.” Knee & ankle reflexes and sensation are normal but muscle strength may be weak due to pain. Bending the low back into different positions does not reproduce pain if the pain is only coming from the hip.
Though sometimes challenging, doctors of chiropractic are well-trained to be able to differentiate between hip and low back pain and will treat both areas when it is appropriate.
Low back pain (LBP) is one of the most common ailments that chiropractors treat. That’s probably because MOST of us will suffer from low back pain that requires outside help at some point in our lives! Posture has long been studied as a potential cause of low back pain, and this month’s topic will take a closer look at some recent research discussing this issue.
A December 2014 study looked at low back posture in two groups of LBP patients and its relationship with problems associated with intervertebral disk diseases. Looking at a person from the side, have you noticed that the low back area has an arched or inward curve? This is called the “lumbar lordosis” (or, the “sway back” area), and this can be highly variable in terms of the angle or amount of arch. It normally differs between males and females. Degenerative disk disease (DDD) is a common condition affecting virtually all of us at some point in time. DDD results in narrowing of the disk spaces, which there are five total in the lumbar spine (twelve in the thoracic spine/mid-back, and six in the cervical spine/neck).
One particular study evaluated a group of 50 patients with long-term intractable (chronic) low back pain with intervertebral disk disease and a group of 50 chronic LBP patients without DDD that served as a “control group.” Researchers measured the degrees of lordosis, or amount of curve (lumbar lordosis), by looking at the person from the side using two different methods in the two patient groups and compared the data. The group with degenerative disk disease had an overall reduction in the lumbar lordosis curve (less arched) using both methods of measuring. The authors concluded that the patients with intervertebral disk lesions had a straighter, or more flat curve (less sway back), when compared to those without disk degeneration. What they were unable to determine was which came first, the disk degeneration or the reduction in the lumbar lordosis?
This study points out several important points. When treating patients with low back pain, some patients feel better when placed in a bent forwards position, or they favor a flat low back curve. Others have the opposite response, or their position of preference favors a more curved (arched) lower spine. The reason for this difference is that LBP is generated from different tissues in the low back, and some tissues favor or feel better in one position and typically feels worse in the opposite direction when injured. The intervertebral disks in the spine lie between the vertebral bodies and serve as “shock absorbers” for the spine and trunk. The center, or “nucleus,” of the disk is liquid-like and is usually well contained inside the disk, held by a tough, outer fibrocartilage material (the “annulus”).
The disk is approximately 80% water, and as we age, the water content gradually reduces and the disk spaces narrow, thus limiting the mobility of that part of the spine. More importantly, DDD usually narrows the size of the canals through which the spinal cord and nerve roots travel. When we bend forward, these canals open up wider placing less pressure on the nerves and/or spinal cord.
This is why we often see elderly people leaning on grocery carts when shopping, as it hurts less and they can walk longer / farther. Those with herniated disks tend to be the opposite, as they favor bending backwards as this position shifts the nucleus or liquid center forwards and away from the nerve root thus reducing the pinched nerve resulting in less or complete elimination of radiating leg pain.
Have you ever had neck or back pain and considered Chiropractic but feared you’d be required to commit to a long term plan?
You are not alone.
Even though there is plenty of research backing up Chiropractic, some patients just can’t afford the time or expense of long-term, corrective care.
That is why we now offer “pay per visit” Chiropractic for your neck pain or back pain.
This means you can call and come in on the same day and provided that there are no contraindications, get exactly what you want; an adjustment without pressure to keep coming back over and over again.
As a matter of fact, this mainstream approach is featured on www.Chiro-Trust.org… one of the most visited online back pain information websites in the country.
So, if you, your spouse, or a friend is complaining of aches and pains, rest assured that you can come in and get the care you want and can afford.
Give us a call at 772-286-5277. We’ll take good care of you.
According to the World Health Organization, headaches are among the most common disorders of the nervous system affecting an estimated 47% of adults during the past year. Headaches place a significant burden on both quality of life (personal, social, and occupational) and financial health. They are usually misdiagnosed by healthcare practitioners, and in general, are underestimated, under-recognized, and under-treated around the world. So, what about chiropractic and headaches… Does it help?
Suffice it to say, there are MANY studies showing chiropractic care helps headache sufferers. For instance, in a review of past research studies using an “evidence-based” approach, chiropractic treatment of adults with different types of headaches revealed very positive findings! Researchers note that chiropractic care helps those with episodic or chronic migraine headaches, cervicogenic headache (that is, headaches caused by neck problems), and tension-type headaches (chronic more than episodic). There appears to be additional benefit when chiropractic adjustments are combined with massage, mobilization, and/or adding certain types of exercises, although this was not consistently studied. In the studies that discussed adverse or negative effects of treatment, the researchers noted no serious adverse effects.
In patients suffering from athletic injuries, particularly post-concussion headache (PC-HA), chiropractic care can play a very important role in the patient’s recovery. With an estimated 1.6 to 3.8 million sports-related brain injuries occurring each year, approximately 136,000 involve young high school athletes (although some argue this is “grossly underestimated”).
Several published case studies report significant benefits for post-concussion patients after receiving chiropractic care, some of which included PC-HA from motor vehicle collisions, as well as from slips and falls. For example, one described an improvement in symptoms that included deficits in short-term memory as well as attention problems. In this particular study, a six-year-old boy fell from a slide in the playground, and after 18 months of continuous problems, underwent a course of chiropractic care. After just three weeks of care, his spelling test scores improved from 20% to 80% with even more benefits observed by the eighth week of care!
Another case study looked at a 16-year-old male teenager with a five-week-old football injury who had daily headaches and “a sense of fogginess” (concentration difficulties). He reported significant improvement after the second visit, with near-complete symptom resolution after the fifth visit (within two weeks of care). After seven weeks of care, he successfully returned to normal activities, including playing football.
Dizziness and vertigo are also common residuals from concussion and were present in a 30-year-old woman just three days following a motor vehicle accident. She also complained of headache, neck pain, back pain, and numbness in both arms. The case study noted significant improvement after nine visits within an 18-day time frame.
We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend, or family member requires care for neck pain or headaches, we would be honored to render our services.
Content Courtesy of Chiro-Trust.org. All Rights Reserved.
Surging levels of Cortisol in the beginning phase of a panic attack can increase as high as 40%.9. If your adrenal reserve is low, you can experience rapid drops in blood sugar (hypoglycemia) during stress because there is not enough cortisol to maintain sugar levels. Your body will automatically respond by producing and secreting another adrenal hormone called adrenaline, Adrenaline will raise blood sugar to provide energy for the ‘fight or flight’ reaction AND it also causes anxiety.
People who have torched their stress system and burned up reserves will now have difficulty producing enough cortisol. If you have poor or low adrenal cortisol production, then you are more prone to flare-ups of temper, nervousness or shaking, palpitations and irritability You will have difficulty concentrating, you will crave salt and your sleep cycle will be greatly upset.
You can and will progress to have fear of situations that are even moderately stressful, and can have panic attacks and fatigue. Your body will feel cold, and you may have depression.
Does this sound like you? A spark that ignites an uncontrollable downward spiral and you end up in a full blown panic attack.
Can you reduce the cortisol response to stress right now? Yes. This is the precise impact that the short range strategies will provide for you. These reliable, safe and healthy strategies will impact your symptoms by stopping the downward spiral of your health and your stress system. The first action step is supplementing your body with iStressedOut™, a phosphatidylserine product formulated to modulate your cortisol response to stress.
There are over 3,000 published research studies that have confirmed that phosphatidylserine can rejuvenate your brain cell membranes, strengthen your memory, increase vigilance and attention, boost learning, increase mental acuity, intensify your concentration, relieve depression and improve your mood, inhibit exercise and stress induced increases in cortisol, AND decrease stress whether you are young or old. iStressedOut is available in the office for purchase now. Please call 772-286-5277 to check availability.
The sheer magnitude of America’s prescription opioid abuse epidemic has evoked visceral responses and calls-to-action from public and private sectors. As longtime advocates of drug-free management of acute, subacute
and chronic back, neck and neuro-musculoskeletal pain, the chiropractic profession is aligned with these important initiatives and committed to actively participate in solving the prescription opioid addiction crisis. A profession dedicated to health and well-being, Doctors of Chiropractic (DCs) are educated, trained and positioned to deliver non-pharmacologic pain management and play a leading role in “America’s Opioid Exit Strategy.”
Data released by the Centers for Disease Control and Prevention (CDC) revealed that “opioid deaths continued to surge in 2015, surpassing 30,000 for the first time in recent history. CDC Director Tom Frieden said, “The epidemic of deaths
involving opioids continues to worsen. Prescription opioid misuse and use of heroin and illicitly manufactured fentanyl are intertwined and deeply troubling problems.”
The human toll of prescription opioid use, abuse, dependence, overdose and poisoning have rightfully become a national public health concern.
For the overwhelming number of people who suffer with chronic pain, chiropractic care offers a drug-free, non-invasive and cost-effective alternative to opioid drugs. Chiropractic is the largest, most regulated and best recognized of the complementary and alternative care professions. In fact, patient surveys reported in the Annals of Internal Medicine show that chiropractors are used more than any other alternative provider group and patient satisfaction with chiropractic care is very high. Patient use of chiropractic in the United States has tripled in the past two decades.
The importance of chiropractic care is further amplified since many individuals are prescribed opioids for back, low back and neck pain, headaches, neuro-musculoskeletal conditions and other related conditions. An estimated 126.6 million Americans (one in two adults) are affected by a musculoskeletal condition. Providers in multiple disciplines and throughout the health care continuum are now advocating chiropractic care as a leading alternative to usual medical care for chronic pain conditions.
"Chiropractic: A Key to America’s Opioid Exit Strategy’ is a follow-up discussion to ‘Chiropractic: A Safer Strategy than Opioids’ (June 2016), which examines the positive steps as well as the shortcomings of initiatives undertaken from July 2016 - March 2017 to address the opioid crisis. It also assesses the current landscape of opportunities to offer patients, doctors and payers meaningful programs to effectively address acute, subacute and chronic neck, low back and neuro-
musculoskeletal pain without the use of painkillers. Based upon the evidence articulated in this ground-breaking positioning paper, it becomes clear that chiropractic care is a key component of ‘America’s Opioid Exit Strategy’ on several levels.
Cliff Atwell, B.S., D.C.