Articles in Category: General Health

Case Study: Low Back Disc Complaint

on Wednesday, 06 March 2019. Posted in Newsletters, General Health, Ergonomics, Chiropractic

Case Study: Low Back Disc Complaint

A 39 year old female presented to our clinic complaining of severe low back pain with left leg referral down into the toes. The problem had started ten days previously for no apparent reason; however, it may have been related to a lifting incident. The patient had presented to the hospital for assessment. She was given pain killers and sent her home. She presented two days later to her GP who once again gave her a prescription for pain killers and sent her home.

On presentation at our clinic she was unable to stand on the toes on the left leg. Presentations of leg referral with weakness or loss of ability to stand on the toes or standing on the heels are always a concern to practitioners. “ Hard neuro signs” can indicate significant compression on nerve roots that can create long standing complications if not addressed readily. Further examination revealed a loss of heel reflex and a straight leg raise of 25 degrees on the left hand side. Additionally there was loss of sensation in parts of the foot and lower leg on the left hand side.

The patient was referred for an MRI which showed a significant disc bulge at L5/S1 on the left hand side, compressing the S1 nerve root. Due to the loss of reflexes and muscle weakness, treatment was initiated with the requirement that significant progress needed to be made within a week or otherwise urgent referral for a neurosurgical consultation was required.

Due to lack of progress she was referred to a neurosurgeon who performed a micro discectomy. The patient presented to our clinic 1 week post-operatively for rehabilitation.

We progressed through a range of decompression exercises, re-strengthening and postural re-training exercises to help her return to normal and fortify the system to protect against future injury.

For these types of cases, patients return to work within 4-6 weeks for office work or 6-12 weeks for manual workers. Full resolution is reached within 12 months.

In this instance the patient had a very good outcome and returned to normal work and activities with no long standing disabilities or ramifications.

This type of case highlights the importance of doing affective neurological and orthopaedic testing to identify correctly what is happening. This appropriate imaging and management to ensure that serious problems are not missed and they are cared for in the most appropriate manner.

We have unfortunately seen other cases similar to this that have not been managed well that have ended up with permanent disability as a result of miss-management.

If you have a significant low back and leg referral complaint, it is always advisable to have this analysed affectively by your trusted health care practitioner.

Curbing the Low Back Pain while Driving

on Thursday, 24 January 2019. Posted in Newsletters, General Health, Chiropractic

Low Back Pain while Driving

You are not alone if driving, especially for long periods or through heavy traffic make your back, neck and shoulders stiff.

While these days car seats are more “adjustable friendly'' than before, often still they do not have enough lumbar support and the proper seat angles to take the pressure off your spine.

This then encourages poor low back posture, which in a cascade of events then stresses the mid back and neck at the same time.

If your work requires you to drive for long periods, then you are definitely more vulnerable to this problem.

How Do You Fight Against a Flawed Design?

The answer to this is WORK WITH WHAT WE CAN CONTROL.

STEP 1: START FROM SCRATCH

Push your seat as far back as possible. If the steering wheel is adjustable, bring it high and close to the driver.

Drop the seat height and cushion to their lowest and the seat's backrest reclined back to 30 degrees.

STEP 2: SEAT DISTANCE FROM PEDALS

 

Slowly move the seat forward one notch at a time until you find a comfortable position allowing your leg to have good control over the pedals (ideally the knees should not be over bent).

STEP 3: BACKREST AND CUSHION HEIGHT

 

Again, recline the backrest one notch at a time until your back feels supported. Make sure it is not excessively declined because this will interrupt the driver's field of vision.

As for the cushion height, the rule of thumb is “Knees LOWER or at the SAME height as your Hips”.

This can be a bit tricky because most cushions are in an inclined position making the knees sit higher than the hips (which is not what we want). Bring it up to the point where your knees are at the same height as your hips. Then, sit on a cushion or a rolled up towel to help lift the hips up higher than the knees relieving some of the pressure in the lower back.

STEP 4: STEERING WHEEL

 

Move the steering wheel to a distance where your wrist is comfortably resting on it at 10 and 3 o’clock position with a slightly bent elbow.

It should also be adjusted to a height where the controls are clearly viewed and not touching your legs while driving.

STEP 5: GET OUT OF THE CAR

 

This is probably the simplest thing anyone can do if the back is hurting when driving. Yes. Get out of the car and take a short 5-10 minute walk ideally at each hour of driving.

Studies have shown that the likelihood of a back hurting sitting in a car verse an office chair is a lot higher due to the vibration of the vehicle whilst driving as more strain is inflicted on the spine as a whole.

So, do your back a favour and get that car seat set up right!

 

Written By Iris Tan
B.App Sc (Chiropractic)
M.Clin Chiropractic

Degenerative Low Back Pain

Written by Don Williams BSc, MChiro, ICSSD. on Wednesday, 23 September 2015. Posted in General Health, Ergonomics

Degenerative Low Back Pain

By Don Williams

B.Sc., M.Chiro., ICSSD., PG Dip. NMS Rehabilitation,

Cert. DNS. Memb: CAA. FICS, CEA.

 

Low back pain is an extremely common problem impacting on a huge proportion of our population.

Statistics suggest that 80% of society will suffer back pain in their lives and in any given year, almost 60% of the working population will miss at least 1 day of work due to back pain.

 

But what causes back pain and how do we address it?

 

There are many different structures within our back, neck and body which can cause pain, including; the intervertebral disc, muscles, ligaments and facet (or zygopophyseal) joints. These are simply the basic musculoskeletal structures, however, sometimes back pain can be referred from internal organs, some common culprits are; uterine fibroids in females, bowel obstructions, kidney infections, aortic aneurysms, gall stones, stomach ulcers and malignancies or cancers.

 

Obviously, it is important when you have back pain to have it thoroughly assessed to identify whether it is a musculoskeletal complaint or whether it is a referred problem or something more sinister.

 

If the problem is musculoskeletal then there may be a range of treatment options available; Including Acupuncture, Chiropractic, Remedial Massage, Exercise or Physiotherapy. Some people will find heat or ice may help and some people will respond to pharmaceuticals. In fact, if you believe some of the advertisements on Television (with celebrity swimmers posing as experts) you could be forgiven for thinking that drugs will in fact cure that back pain, rather than the reality of which they will mask the pain until the body has recovered.

 

Certain presentations or complaints seem to respond well to different intervention strategies.

What works for one person will not always work for the next person. Good practitioners should have a range of available strategies to apply based on the response of the patient.

 

We sometimes have patients present to our clinic who have been told that they have “Arthritis”, or a “Degenerative Back” and they will have to live with it, however rarely is back pain this simple. We know that in clinical presentations, the amount or level of degeneration is not well correlated with the amount of back pain people experience. This simply means, sometimes people have awful degeneration and no pain and sometimes people have great xrays with no degeneration and lots of pain. If you have been given a diagnosis of, “it is arthritis and you will have to live with it”, then seek a second opinion. You may be able to have treatment which will significantly reduce or even eliminate your pain.

 

 Degenerative Spine         Healthy Spine

                            Degenerative Spine                                                            Healthy Spine

 

There are a number of different types of arthritis which can influence or affect the spine, broadly categorised into inflammatory arthritis (such as Rheumatoid Arthritis) and Degenerative arthritis.

Inflammatory arthritis can be quite problematic. Although the disease process is not directly treatable my musculoskeletal practitioners, the normal mechanical pain and dysfunction can still be treated.

Degenerative arthritis is the process in which wear and tear over a period of time causes the joints to degenerate. This can result in stiffness or a reduction in the range of motion.  This will often respond quite well to treatment. The biggest question generally surrounds the issue of whether the degeneration has actually been there for a period of time and the pain is as a result of an overload or injury which has triggered the reaction or whether the body has hit a tipping point in which the degeneration has built up to a degree that the body is not going to tolerate it anymore.

 

Everyone starts to degenerate when they reach adulthood. Essentially there is an age correlated expectation for the amount of degeneration that we have. Issue may arise when we degenerate more quickly than expected, or when this degenerative change starts to impact on the nerve and spinal cord. The interesting thing about degenerative compression of the nerves is that the signs and symptoms are somewhat different than those we see from an abrupt episode of compression or a disc injury. This is thought to be as a result of the body’s innate ability to adapt to change and degeneration.

 

Generally speaking, the more degeneration is present, the more conservative treatment is. Just because you have advanced degenerative change does not mean you cannot have conservative treatment. Skilled practitioners will always assess your presentation and will apply treatment that takes your history and presentation into account.  People with significant degeneration may be contraindicated for certain treatment methods, which will normally be discussed at the time of treatment.

The unfortunate circumstance is that people who don’t respond well or not at all often face quite aggressive intervention and surgery, which is of course a last resort when all else has failed.

 

If you have been told that you have “arthritis”, or “spinal degeneration”, then all is not necessarily lost, they may still be conservative strategies that work for you.