Understanding low back pain, sciatica, hip and knee pain
Back pain is a common condition that affects most people at some point during their life, but staying active, with the help of chiropractic treatment, may well be the best solution. Chiropractors treat problems with your muscles, joints and bones and the effects they have on your nervous system. Working on all the joints of your body but concentrating particularly on the spine, we use our hands to make gentle, specific adjustments (manipulation) to improve the efficiency of your nervous system enabling your body to release its natural healing ability. Chiropractic does not involve the use of drugs or surgery.
Chiropractor Michael Copland-Griffiths is shown visually assessing low back motion.
Treat the cause and not the symptoms of back pain
Pain is the way that the body tells you something is wrong. Unlike painkilling drugs, Chiropractic treats the causes of pain and not just the pain itself. Healthcare 2000 chiropractors will carry out a full examination and ask you detailed questions about your pain, your medical history and your lifestyle to seek out the cause of your back pain and offer a diagnosis of your complaint. One we have fully discussed with you your own individual diagnosis and how we can address your problem your treatment will begin, often with gentle, specific adjustments (manipulation) done by hand, to free stiff joints and to remove nerve irritation. This proven, effective, drugfree treatment is almost always painless, although some short-term discomfort can be felt if your back is very sore.
Your chiropractor may recommend ice or heat treatment and specific exercises. The illustration shows Chiropractic Assistant Mai Brain advising a patient on how to position her ice pack.
Poor posture may cause pain
Poor posture is a very common factor in the development of back pain. Your Healthcare 2000 chiropractor may advise you how to adapt your posture if you:
- spend hours each day at a desk, computer or in front of the TV
- sleep in a bed that is either too soft or too hard for your physique
- spend hours at the wheel in a car, van or lorry
- slouch at the end of a day at work or even at rest at weekends
- sit at your desk hunching your back and shoulders in stressful
Daily activities such as twisting, bending, lifting, driving and repetitive movements can lead to back pain. Because of this, your chiropractor will need to know how you tackle these daily movements. It will also be necessary to learn about any major traumas, such as car accidents, sporting injuries, lifting strains or falls, however long ago they may have occurred.
Do you have a “slipped disc”?
Spinal discs are fibrous rings with a soft gel-like central nucleus between each of your vertebrae. Discs cannot slip, because they are firmly attached to your vertebrae, but the term ‘slipped disc’ can refer to a tear in the ring, a disc bulge or a prolapse of the nucleus through the outer part of the disc. Any of these can lead to pressure or irritation on the nerves that exit your spine, causing localised pain in your back or ‘referred’ pain over any area through which the irritated nerves pass.
Buttock, hip, thigh or leg pain can be caused by nerve irritation or pressure in the lower spine. Your chiropractor will explain the cause of your pain. It may not be a ‘slipped disc’ - many other problems have similar pain patterns.
How long will chiropractic take to work?
Guidelines for medical practitioners backed by scientific evidence recommend spinal manipulation for back pain, especially if carried out within the first six weeks. The longer you have been in pain, the longer it may take to improve with treatment. Your chiropractor will advise you of your likely recovery time, and how to minimise the chances of the problem happening again. Early treatment is important, but scientific evidence has shown that chiropractors are also effective at treating long-standing or chronic pain.
Is chiropractic treatment possible after surgery?
It probably is. Your chiropractor has the training and experience to treat each patient as an individual. You will receive appropriate treatment and adjustments for your specific condition, while areas not suitable for treatment will be carefully avoided. Many chiropractors are able to offer post-surgical exercise, advice and rehabilitation.
Do I need an x-ray?
You probably don’t. Most back problems don’t show up on x-ray and are better diagnosed using a careful back examination and other tests such as muscle and nerve checks. Indeed, practitioners who advise routine x-rays, especially of the whole spine from top to bottom, may be flouting accepted guidelines.
Problems with the low back can often appear as “referred pain” in the hip. It is therefore important to rule out other factors, such as Arthritis or strains, when diagnosing hip pain.
Hip arthritis can be caused by a variety of factors but one of the earliest developments is weakness of the buttock, the bulk of which is made up of the Gluteus Maximus muscle. Gluteus Maximus muscle weakness is considered to be a major contributory factor in the onset of hip arthritis. It often arises from mechanical problems in the low
back, hip and pelvis. If muscles that support the hip become weak or imbalanced there are alterations in hip movement that can accelerate damage and the osteoarthritis worsens. Simple tests will be undertaken by your chiropractor to determine whether you have gluteus maximus muscle weakness.
Hip arthritis test
The commonest test for hip arthritis is the Fabere test. You can do this at home to test your own hips. Lying on your back with one leg out straight, place the toes of the other leg behind the straightened knee. You should then be able to extend the bent knee outwards to make the figure “4”. Repeat this on the other side. Both hips should move outward to the same degree and there should be no pain. If there is any pain, if you can’t push the knees out far or if one or both hips feel restricted call us for an appointment to check it out for you.
At Healthcare 2000 we can advise on the most appropriate management of your knee aches and pains, whether by our chiropractors, by our physiotherapist or by our sports & rehabilitation therapist.
Proper diagnosis is essential. For example, treatment for arthritis will be different from treatment for ligament injury, so effective management will depend on diagnosing what is causing your knee pain. Various combinations of treatment may be proposed depending on your knee condition, such as types of electrotherapy, laser therapy, massage, exercises, acupuncture (dry needling), physiotherapy and chiropractic.
The illustration shows physiotherapist Ivor Field using electrotherapy on a knee problem
Causes of knee pain
We will start by manually examining all the muscles and ligaments in your knee as well as testing for cartilage damage. The knee can be easily injured by twisting, especially when bent. One of the more common ligament injuries is to the Anterior Cruciate Ligament (ACL). There may be a tear in the cartilage in the knee. Bending the knee too far backwards can cause Posterior Cruciate Ligament (PCL) tears and over-pronation (flattened foot arches) can bring about early wear and tear leading to arthritis or Patello-Femoral Pain Syndrome. Injuries to the knee often occur during sports activities and can be due to weakened muscles that leave the knee vulnerable.
Sometimes knee pain is not be due to a knee problem at all - some symptoms can arise from pain being referred from the back or the hip and a careful examination will help us to work out what is causing your trouble.
Knee problems that our clinicians may be able to help:
- Torn cartilage
- Arthritis pain
- Anterior Cruciate Ligament injury
- Posterior Cruciate Ligament injury
- Patello-Femoral Pain Syndrome
What causes sciatica?
Sciatic pain is often caused by a trapped nerve from a bulging, herniated or prolapsed disc (“slipped disc”). The lowest discs in the spine are the most vulnerable as they lie at a greater angle, carry the most weight and one of the important spinal ligaments is narrow here. The transition between the highly mobile lumbar spine and the immobile pelvis puts more mechanical stress at this level.
The illustration shows the close relationship between the disc (dark brown) and the nerve (yellow). The vertebral boney structures show advancing signs of degenerative (arthritic) change.
In sciatica the one thing to be most concerned about is not the pain itself, but numbness and weakness. When the nerve roots that leave the spine, such as those that lead into the sciatic nerve, get trapped the first sign is pain as the nerve itself gets inflamed.
The illustration shows chiropractor Michael Copland-Griffiths using a pin wheel passed lightly over the skin surface to determine changes in skin sensitivity, such as numbness, which may occur with nerve root entrapment.
If nerve root compression continues then tingling, pins and needles follow, eventually leading to numbness and paralysis of muscles in the leg. Sometimes these symptoms can progress in the absence of a sore back. If the compression is not relieved urgently, there may be permanent problems. Should you develop loss of bladder or bowel control it must be treated as a medical emergency. However, all too often “sciatica” and “disc bulges” are misdiagnosed so it is essential to get an accurate diagnosis. The treatments you may be receiving for your medical condition could, if you have not been correctly diagnosed, be quite different from what you actually need to secure a lasting recovery.
In a study a while ago it was found that 40% of normal middle aged adults had a disc bulge showing on their MRI scans and yet they were not suffering any adverse symptoms. Many people who go to the GP with low back pain and sciatica from a lumbar joint problem will have an MRI that shows a bulging disc that is completely un-related to their pain. This factor may account for failures to resolve the symptoms after lumbar spine surgery. Although the offending disc bulge has been removed the patient soon finds out that the lumbar spine joint problem remains.
Sciatica pain can start in the back and travels into the buttock, the back of the thigh, into the back or outside of the calf, and finally into the outside or underneath of the foot and toes. The pain may skip some areas of the sciatic nerve pathway altogether. If the pain does not go beyond the knee it may not be sciatica but simply a referred pain from a back muscle or joint. If the pain is in the front of the thigh it is unlikely to be sciatica and may be arising from irritation to the femoral nerve.
Many cases of sciatic nerve irritation are not caused by compression of the nerve at all. New research has shown that the damage around the nerve root may be due inflammatory changes. These changes may be caused by an auto-immune response or other chemical changes initiated by the body due to leakage of the jelly like interior of the disc into the spinal canal. If this is true, new drug treatment options may be coming along in the future. In the meantime, we are stuck with traditional methods of treatment and chiropractic care may help.
It is well documented that that emotional stress (“psychosocial factors”) can play a role in some people’s pain. Back pain research shows that stress and levels of happiness influence symptoms and the same may be true for sciatica. Perhaps the stress hormones are the key here as they can have a pro-inflammatory effect which would be like pouring petrol on the embers of inflammation from a disc bulge.
GP’s will often prescribe anti-inflammatory medication and pain-killers which can help. If things are not settling down within a few days more active treatment may be needed.
Most chiropractors will use low back manipulation (“adjustment”) which frees up stiff joints, reduces adhesions and raises the pain threshold. The illustration shows Michael Copland-Griffiths delivering an adjustment to free the right sacroiliac joint.
Some encouraging studies have shown a reduction in the size of the disc bulge after manipulation. A recent review of all forms of manual therapy found that there is moderately positive evidence that manipulation is helpful for sciatica.
The most important thing for a quick and complete recovery is to stay as active as you can manage and to do the exercises that you are prescribed. Exercises are prescribed to strengthen the core stability trunk muscles and the tiny muscles between the vertebrae themselves. Strengthening these muscles reduces the mechanical strain on the discs and joints and not only helps with recovery but may help to prevent it happening again.