Sciatica – PushAsRx Athletic Training Centers El Paso, TX https://www.pushasrx.com Chiropractic Science & Functional Fitness Fri, 23 Oct 2020 22:49:48 +0000 en-US hourly 1 https://wordpress.org/?v=5.5.1 https://i2.wp.com/www.pushasrx.com/wp-content/uploads/2019/06/IMG_8806_500_x_500.png?fit=32%2C32&ssl=1 Sciatica – PushAsRx Athletic Training Centers El Paso, TX https://www.pushasrx.com 32 32 111105572 Sciatica Fitness and Chiropractic A Win-Win! https://www.pushasrx.com/sciatica-fitness-chiropractic/ Fri, 23 Oct 2020 22:49:48 +0000 https://www.pushasrx.com/?p=26251 11860 Vista Del Sol, Ste. 128 Sciatica Fitness and Chiropractic A Win-Win!

Because sciatica is an inflammatory condition, with the sciatic nerve specifically being the target, sciatica fitness and exercise is one of the first recommendations from chiropractors. Sciatica is a series of symptoms from a variety of underlying medical causes and condition/s. This could be: Too much sitting, which most of us are doing these days […]

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11860 Vista Del Sol, Ste. 128 Sciatica Fitness and Chiropractic A Win-Win! Because sciatica is an inflammatory condition, with the sciatic nerve specifically being the target, sciatica fitness and exercise is one of the first recommendations from chiropractors. Sciatica is a series of symptoms from a variety of underlying medical causes and condition/s. This could be:
  • Too much sitting, which most of us are doing these days
  • Work injuries
  • Automobile accident injuries
  • Sports injuries
  • Awkward movements/motions that pulled the sciatic nerve in the wrong direction
  • Twisted sciatic nerve with other muscles
  • Back and leg muscle spasms
  • Herniated disc
  • Degenerative disc disease
  • Hernia
11860 Vista Del Sol, Ste. 128 Sciatica Fitness and Chiropractic A Win-Win!
 

A Proper/Correct Diagnosis Is Essential

A correct diagnosis of the cause is essential to help the chiropractor formulate a customized optimal treatment plan. Individuals can experience the same symptoms across the board, however, despite the similarities, sciatica requires a careful, customized precision approach to treatment. An ideal treatment plan often requires a very specific exercise regimen and chiropractic adjustment schedule. Therefore, there is no one-size-fits-all solution. Sciatica can be treated effectively with the right chiropractic approach with a high success rate for alleviated symptoms. Effectively treating sciatica requires direct treatment to the specific cause, rather than using techniques that only mask the pain. Example: If a herniated disc is the root cause, sciatica can be relieved by reducing the bulge of the disc, thus bringing down the irritation/inflammation and compression of the sciatic nerve.

Sciatica treatment/s depends on the cause

A stretching regimen for sciatica caused by a low back herniated disc will be different than stretches for treating low back spinal stenosis. Understanding how sciatica is the key to unlocking a treatment plan that will work to minimize pain and inflammation.  
 

Exercise Can Help

Exercising and sciatica fitness will help relieve sciatic pain in various ways. These include:
  • Alleviates the pressure on the sciatic nerve
  • Helps reduce inflammation
  • An increase in cortisol produced during exercise can reduce inflammation
  • Improves the range of motion, which reduces stress on the spine
  • Higher activity levels generate adrenaline and endorphins, to help combat the pain
Specific exercises/stretches need to be done that target the sciatic nerve and the root cause. Working with a chiropractor will bring an understanding of specifically how the body should be worked out, the intensity of the workout, and where on the body the focus should be. For example, if the nerve is irritated from a pelvic tilt and low back compression, a chiropractor could recommend a minimal cardio workout with combined strength exercises for the hamstrings, glutes, and lower body. A strength and conditioning regimen will increase stability in the lower body, prevent pelvic tilt, and reinforce the chiropractic adjustments/alignment.  
11860 Vista Del Sol, Ste. 128 Sciatica Fitness and Chiropractic A Win-Win!
 

Chiropractic Benefits

However, sciatica fitness and exercise on its own is not the complete solution for dealing with chronic sciatic pain. Chiropractic adjustments along with chiropractic prevention are necessary to restore the stability and integrity of the spine. When used in combination with exercise, the re-alignment and corrections can take effect sooner and maintain optimal spinal health. When individuals condition and strengthen their body, The musculature that supports the spine gets massive reinforcement. This minimizes the chances of a reoccurring pelvic tilt from weakened core muscles. The long-term effects of sciatica fitness/exercise and chiropractic spinal/hip manipulation work together to form a perfect combination.

Sciatica Fitness

For truly long-term effects of pain relief and a better quality of life, a chiropractic treatment plan is highly recommended. Specific targeted adjustments and re-alignment with a sciatica fitness program will promote optimal health and wellness.

Whole Body Wellness Foot Orthotics

 

 

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
References
Beavers, Kristen M et al. “Effect of exercise training on chronic inflammation.” Clinica chimica acta; international journal of clinical chemistry vol. 411,11-12 (2010): 785-93. doi:10.1016/j.cca.2010.02.069 Coulombe, Brian J et al. “Core Stability Exercise Versus General Exercise for Chronic Low Back Pain.” Journal of athletic training vol. 52,1 (2017): 71-72. doi:10.4085/1062-6050-51.11.16

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%%title%% %%sep%% PUSH as Rx %%excerpt%% alleviation,back,chiropractic,combination,exercise,fitness,health,lower,pain,relief,sciatica,wellness,sciatica fitness 11860 Vista Del Sol, Ste. 128 Sciatica Fitness and Chiropractic A Win-Win! 11860 Vista Del Sol, Ste. 128 Sciatica Fitness and Chiropractic A Win-Win! 26251
Sciatica or Osteonecrosis of Femoral Head? A Common Misdiagnosis https://www.pushasrx.com/sciatica-osteonecrosis-misdiagnosis/ Wed, 21 Oct 2020 02:14:08 +0000 https://www.pushasrx.com/?p=26237 11860 Vista Del Sol, Ste. 128 Sciatica or Osteonecrosis of Femoral Head? A Common Misdiagnosis

Osteonecrosis is a condition that causes the death of bone tissue from temporary or permanent loss of blood supply to the affected area. It is commonly known as Avascular necrosis and can lead to miniature/tiny breaks in the bone and the bone/s eventually collapsing. Specifically, it affects the upper part of the femur or femoral […]

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11860 Vista Del Sol, Ste. 128 Sciatica or Osteonecrosis of Femoral Head? A Common Misdiagnosis Osteonecrosis is a condition that causes the death of bone tissue from temporary or permanent loss of blood supply to the affected area. It is commonly known as Avascular necrosis and can lead to miniature/tiny breaks in the bone and the bone/s eventually collapsing. Specifically, it affects the upper part of the femur or femoral head and surrounding joints.  
11860 Vista Del Sol, Ste. 128 Sciatica or Osteonecrosis of Femoral Head? A Common Misdiagnosis
 
It can occur in any bone however, osteonecrosis typically affects the hip/s. Pain associated with osteonecrosis of the hip can be localized to the center of the groin, thigh, or buttock. Because of the hip joint’s close proximity to the sciatic nerve, misdiagnosis for sciatica is common.  
 

Mimicking Sciatica Symptoms

Unfortunately, many health care providers can misdiagnose osteonecrosis hip pain as sciatica. Whatever the cause of the hip injury, most individuals with hip pathology report pain in the groin, upper thigh, and buttocks. That is why a trained medical professional that knows the differences in the symptoms of each condition can make all the difference in making a proper diagnosis. And a proper diagnosis leads to proper and complete treatment of whichever condition it may be. With osteonecrosis, misdiagnosis often delays the proper treatment and continues to progress. Common symptoms of sciatica:
  • Leg pain is the primary symptom can be mild to severe
  • Low back pain is secondary can be mild to severe
  • Nerve-related symptoms
  • Numbness
  • Tingling
  • Shooting pain
  • Pins-and-needles sensation
  • Muscle weakness
  • Hip pain especially flexion and internal rotation of the hip.
  • Leg or foot weakness
11860 Vista Del Sol, Ste. 128 Sciatica or Osteonecrosis of Femoral Head? A Common Misdiagnosis
 

Osteonecrosis Symptoms and Similarities

For many, there are no symptoms in the early stages of osteonecrosis. As the condition worsens, the affected joint could present pain symptoms only when weight is placed on it. Eventually, individuals begin to feel the pain even when lying down. Pain can be mild to severe with a gradual development. Other symptoms that mimick sciatica:

Walking Inability

Walking gait is complicated with both conditions which is a major cause behind the misdiagnosis.

Limping

Individuals often limp with osteonecrosis of the hip and spinal disc problems. This is another reason that the condition is misdiagnosed as a spinal disc problem or nerve root compression of the sciatic nerve.

Hip Pain

The tributaries/veins of the sciatic nerve also supply the hip area and often cause confusion between the two conditions.  
 

Differences

Despite all of the similarities. There are differences in both conditions.

Nature of The Pain

  • With sciatica, the pain is related to the nervous system. Movement can complicate the pain. While rest helps to reduce the pain.
  • With Osteonecrosis the pain is geared toward the muscular. Rest does not help reduce the pain. In fact, the pain increases at night.

Location

  • Sciatica pain can radiate through the whole leg from the low back to the toe.
  • Osteonecrosis pain is confined to the hip joint, groin, and radiates to the knee joint only. Osteonecrosis pain does not radiate below the knee joint.

Restricted Movement

  • Osteonecrosis of the hip joint, means the movements involving the hip joint are restricted. Individuals cannot rotate the leg to the right and left. Individuals cannot bend or fold from the hip.
  • With sciatica, the rotation of the leg is not affected. Movements involving stretching the sciatic nerve can cause relief or pain.

Walking Gait Differences

Gait is the way an individual stands and walks.
  • Osteonecrosis of the hip joint causes individuals to not be able to open the hip joint properly or to step properly.
  • With sciatica, an individual tends to lean on their side to relax the compression on the nerve.

Risk Factors

More than 20,000 people enter hospitals for the treatment of osteonecrosis of the hip yearly. Other than the hip, areas of the body likely to be affected are the shoulder, knee, hand, and foot. The condition can occur for a variety of reasons. A few of these include:
  • Fracture – a broken bone can interrupt the blood flow to other sections of the bone.
  • Dislocation of bone or joint/s
  • Alcoholism
  • Trauma
  • Radiation damage
  • Steroid use
Some individuals can have more than one condition or injury that contributes to hip flexor pain. An example is that it is possible to have both hip osteoarthritis and hip impingement. Without proper treatment, the condition can worsen, causing joint or hip pain from the degradation of the bone.  
11860 Vista Del Sol, Ste. 128 Sciatica or Osteonecrosis of Femoral Head? A Common Misdiagnosis
 
Anyone can be affected, but osteonecrosis is most common in individuals aged 30 to 50. Treatment options include a total replacement of the hip known as arthroplasty. And if it is sciatica then chiropractic treatment is a first-line treatment protocol. However, a chiropractor can make the distinction between the two and treat the sciatica or refer the patient to the proper specialist.
 

Lower Back Pain Treatment


 

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
References
Li, Wen-Long et al. “Exploring the Risk Factors for the Misdiagnosis of Osteonecrosis of Femoral Head: A Case-Control Study.” Orthopaedic surgery, 10.1111/os.12821. 16 Oct. 2020, doi:10.1111/os.12821

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%%title%% %%excerpt%% back,chiropractic,chronic,classes,core,diagnosis,examination,exercise,femoral,fitness,head,health,modifications,osteonecrosis,pain,relief,sciatica,wellness,osteonecrosis 11860 Vista Del Sol, Ste. 128 Sciatica or Osteonecrosis of Femoral Head? A Common Misdiagnosis 11860 Vista Del Sol, Ste. 128 Sciatica or Osteonecrosis of Femoral Head? A Common Misdiagnosis 11860 Vista Del Sol, Ste. 128 Sciatica or Osteonecrosis of Femoral Head? A Common Misdiagnosis 26237
Chiropractic Spinal Mobilization Techniques and Sciatica https://www.pushasrx.com/spinal-mobilization-sciatica/ Tue, 20 Oct 2020 02:03:51 +0000 https://www.pushasrx.com/?p=26233 11860 Vista Del Sol, Ste. 128 Chiropractic Spinal Mobilization Manipulation Techniques and Sciatica

Chiropractic spinal mobilization techniques involve the slow and steady movements of the spine’s joints reestablishing their range of motion. Because it is a slower treatment style the techniques are done with the hands. However, a chiropractor can use various instruments/tools as well. Spinal mobilization treatment has the same focus as spinal manipulation. To get the […]

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11860 Vista Del Sol, Ste. 128 Chiropractic Spinal Mobilization Manipulation Techniques and Sciatica Chiropractic spinal mobilization techniques involve the slow and steady movements of the spine’s joints reestablishing their range of motion. Because it is a slower treatment style the techniques are done with the hands. However, a chiropractor can use various instruments/tools as well. Spinal mobilization treatment has the same focus as spinal manipulation. To get the body back to optimal health and allow the body to heal itself naturally. However, there can be a variety of reasons for utilizing spinal stabilization, with treatment depending on the patient’s needs, if there are underlying conditions, or previous injury/s, and individual preference. Some prefer mobilization because it is gentler and does not generate the pops or cracking sounds. And the chiropractor’s style/specialization comes into play. Some work in the firm manipulation high-velocity style, while others utilize the softer mobilization style and others work in combination.  
11860 Vista Del Sol, Ste. 128 Chiropractic Spinal Mobilization Manipulation Techniques and Sciatica
 

Manipulation High-Velocity Low-Amplitude Techniques

This adjustment re-alignment utilizes the necessary force to release the joint out of its restricted motion to improve mobility and reduce pain. There are various types of high-velocity low-amplitude manipulation approaches. These are the more common manipulation techniques:

Diversified Technique

 
  This high-velocity low-amplitude technique is the one that is commonly associated with chiropractic manual adjustments. The chiropractor applies a short – low-amplitude, quick high-velocity thrust of the restricted joints. This is done one at a time with the objective to restore the normal range of motion. The patient is positioned in various positions to optimize the adjustment/alignment.

Gonstead Adjustment

 
 
The Gonstead technique is another high-velocity low amplitude adjustment. It is similar to the diversified technique. The difference is the evaluation performed to specifically locate the painful joint and positioning of the body as the treatment is performed. Chiropractic or physical therapy chairs and tables can be used to position the patient for optimal treatment, like a cervical chair or a chest-knee table.  
 

Thompson Terminal Point Drop Technique

Here specialized treatment tables with sections that drop down during a high-velocity low-amplitude thrust. The idea is that as the table drops the piece dropped allows for easier movement of the joint. A cracking sound can sometimes be heard. It depends on the patient and their condition. This type of manipulation can also be done in a gentle fashion making it a form of spinal mobilization.  
 

Spinal mobilization

Slow steady motion/movements are performed to mobilize the joint. Spinal mobilization can be recommended for certain individuals for different reasons like:
  • Individual preference for spinal mobilization over spinal manipulation
  • Individuals with a sensitive nervous system can benefit from the gentle technique. This can keep the body from experiencing a negative reaction that can cause muscle spasms or other issues.
  • Individuals with certain conditions could be given a recommendation for spinal mobilization. This could be:
  1. Advanced osteoporosis
  2. Bone pathology
  3. Spinal deformity
  4. Types of inflammatory arthritis
  • Individuals in the acute stage of their condition and experiencing severe pain
  • Obesity can be a factor as the positioning and the manipulation procedures can be a challenge for the provider and the patient requiring a low force approach.

Mobilization Approaches

The more common spinal mobilization approaches include:

Activator Technique

 
11860 Vista Del Sol, Ste. 128 Chiropractic Spinal Mobilization Manipulation Techniques and Sciatica
 
The Activator is a hand-held, spring-loaded tool that generates a low-force impulse. A patient lies face down on the adjustment table, while the chiropractor:
  • Examines leg length
  • Performs muscle testing
  • Adjusts the spine and/or extremity joints

Cox Flexion-Distraction Technique

 
 
Here a gentle adjustment is designed to adjust the vertebrae by gently stretching the lower spine. This is usually performed in a series of repetitive slow movements like a steady rocking motion.

Toggle Drop

 
chiropractic toggle drop technique
 
Here gravity is utilized to apply the adjustment. The chiropractors’ hands are crossed and on top of each other. Then the chiropractor presses down quickly and firmly on the area of the spine while a section of the table drops. The table sections can be raised and dropped according to the localization of the spinal adjustment.  
 

McKenzie Technique

 
 
This technique incorporates active patient involvement, empowerment, and self-care as part of the treatment.  
11860 Vista Del Sol, Ste. 128 Chiropractic Spinal Mobilization Manipulation Techniques and Sciatica
 

Spinal Release

The chiropractor separates the misaligned vertebrae by applying gentle pressure using the fingertips, with the objective to restore the spine back to a natural position.  
11860 Vista Del Sol Ste. 128 Change of Weather Worsening Back Pain El Paso, TX.
 

Sacro-Occipital Technique – SOT

This technique utilizes wedges/blocks under the pelvis. This allows gravity with added low-force to assist the chiropractor to realign the pelvis.  
 

Sciatica Alleviation

All of these techniques can be utilized by a chiropractor for sciatic nerve pain alleviation or can discover other conditions that could be mimicking sciatica.
Nerve mobilization techniques have been recently used as a method to adjust radiating pain related to disc disease, and in particular, mobilization techniques for the sciatic nerves improve mobility of the sciatic nerves, decrease mechanosensitivity of the nervous system, and heighten compliance of nerve tissues, relieving low back pain. Jeong, Ui-Cheol et al. “The effects of self-mobilization techniques for the sciatic nerves on physical functions and health of low back pain patients with lower limb radiating pain.” Journal of physical therapy science vol. 28,1 (2016): 46-50. doi:10.1589/jpts.28.46

Sciatica Rehabilitation Causes and Symptoms


 

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

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%%title%% %%excerpt%% back,chiropractic,health,manipulation,mobilization,pain,relief,sciatica,spinal,techniques,wellness,spinal mobilization 11860 Vista Del Sol, Ste. 128 Chiropractic Spinal Mobilization Manipulation Techniques and Sciatica 11860 Vista Del Sol, Ste. 128 Chiropractic Spinal Mobilization Manipulation Techniques and Sciatica chiropractic toggle drop technique 11860 Vista Del Sol, Ste. 128 Chiropractic Spinal Mobilization Manipulation Techniques and Sciatica 11860 Vista Del Sol Ste. 128 Change of Weather Worsening Back Pain El Paso, TX. 26233
Sciatica or Aneurysm, A Deadly Mistake! https://www.pushasrx.com/sciatica-aneurysm-deadly/ Thu, 15 Oct 2020 02:16:07 +0000 https://www.pushasrx.com/?p=26221 11860 Vista Del Sol, Ste. 128 Sciatica or Aneurysm, A Deadly Mistake!

Sciatica or Aneurysm? Knowing how a missed diagnosis could be potentially fatal if not diagnosed accurately could be a deadly mistake! Doctors must not fall for a sciatica diagnosis when a possibly fatal iliac artery aneurysm lies looming and progressing.   Sciatica or Aneurysm An example is a patient who visited an emergency clinic after […]

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11860 Vista Del Sol, Ste. 128 Sciatica or Aneurysm, A Deadly Mistake! Sciatica or Aneurysm? Knowing how a missed diagnosis could be potentially fatal if not diagnosed accurately could be a deadly mistake! Doctors must not fall for a sciatica diagnosis when a possibly fatal iliac artery aneurysm lies looming and progressing.  
11860 Vista Del Sol, Ste. 128 Sciatica or Aneurysm, A Deadly Mistake!
 

Sciatica or Aneurysm

An example is a patient who visited an emergency clinic after a few weeks for a non-painful pulsing mass on the buttock. There was no:
  • Trauma
  • Injury
  • Back pain
  • Leg pain
  • Prior presentations of pain or sciatica issues
A physical examination found a small pulsing mass on the right buttock. Palpation around the site found no issues with the sensory and motor nerves.  
 
An ultrasound scan of the affected area revealed a developing aneurysm. This was followed by a CT scan of the abdomen along with the pelvis using a contrast dye found the aneurysm developing from the left internal iliac artery. If the mass was not present a doctor could easily diagnose sciatica or persistent sciatic artery. If the iliac artery presents with pulsating lesions is a tip-off that a vascular issue could be impinging on the sciatic nerve. Vascular surgery was discussed with the patient. Surgery was necessary, and the patient underwent sciatic aneurysm repair. The patient was discharged without any complications.  

Persistent Sciatic Artery

This is a very rare congenital vascular condition. The sciatic artery runs along the sciatic nerve and functions as the major blood supply to the lower extremities. During human embryo development, the femoral artery begins to form while the sciatic arteries start to return to a less developed state. The process continues until the femoral artery takes over as the major blood supply, with only bits of the sciatic artery left. Persistent sciatic artery can happen either from the sciatic artery not returning to its original size or during normal development the femoral artery developing properly. Most cases of persistent sciatic artery go unknown and are usually detected from another examination for another ailment. Aneurysms often develop based on the arteries/vessel’s tendency for minor trauma/injury when sitting or some form of pressure is applied on the site. Complications include: A vascular surgeon should be consulted. Treatment options include:
  • Surgical exclusion of the aneurysm
  • Surgical excision of the aneurysm
  • Endovascular stenting
  • Endovascular coiling
11860 Vista Del Sol, Ste. 128 Sciatica or Aneurysm, A Deadly Mistake!
 

Vascular Conditions In The Leg/s That Can Present As Sciatica

The legs’ blood vessels can get infected, bulged, ruptured, or blocked. This can cause sciatica symptoms, like leg pain, weakness, tingling, and numbness. Severe cases could require medical emergency surgery to save the affected limb.

Acute Limb Ischemia

This condition occurs from a decrease or loss of blood supply to the legs. If there is leg pain, it could feel similar to sciatica pain. However, symptoms can progress rapidly and become severe. That’s when it is not sciatica. Acute limb ischemia present one or more of the following symptoms:
  • Pain and/or numbness in the leg while walking and when resting
  • Severe pain at night
  • Sleep problems
  • Pain relief when sitting on a chair with the feet hanging down
  • Feet and ankles become swollen
  • A pale color and lowered skin temperature over the toes and feet when compared to the legs
Acute limb ischemia can develop from an aneurysm, blood clot, or from the thickening of the vessel walls. Treatment should be prompt in order to preserve leg function. Differentiation diagnosis between vascular and other causes like spinal problems that can cause leg pain. A doctor may perform an Ankle/Brachial Index which is a comparison of blood flow in the arms versus the legs. This can be critical in determining if there is vascular insufficiency.  
11860 Vista Del Sol, Ste. 128 Sciatica or Aneurysm, A Deadly Mistake!
 

Acute Compartment Syndrome

This places increased pressure in the muscle tissues of the leg. It can lead to loss of blood supply in and around the affected area. The sciatic nerve can also get compressed from the increased pressure in the buttock, thigh, or leg. The condition can cause pain, numbness, and weakness in the buttock, thigh, and leg. Individuals have also reported an unusual/altered sensation in the web of the great toe. This is similar to sciatica, as well as one or both legs can be affected. Differentiating symptoms include:
  • Leg becomes swollen
  • Pain and tenderness present when touching the leg
  • A pale color and lowered skin temperature over the leg
 
Acute compartment syndrome is a serious condition that is considered a medical emergency. It is possible for the condition to cause complete dysfunction of the limb if not addressed in time. There are risk factors that increase the chances of developing limb ischemia or compartment syndrome. These are:
  • Diabetes
  • Heart conditions
  • High cholesterol
  • Smoking
  • History of having the condition can also cause a recurrence. This can be from an injury or poor health.
Kidney stones, renal failure, or cysts in the kidney can also cause back and leg pain. Other symptoms can include blood in the urine or difficulty urinating. Any sign of distressing symptoms that present with sciatica can indicate the need for medical attention. This is to check for the possibility of a serious underlying condition or medical emergency. Medical emergencies that are treated in time can help preserve the tissue/s, restore function, and save an individual’s life. It is essential for a chiropractor or physical therapist to be familiar with diagnosing in a way that will help identify sciatica or aneurysm in individuals presenting with musculoskeletal issues/problems. Knowledge of these risk factors, understanding how to screen for non-musculoskeletal symptoms, basic competence in palpation, and how to interpret findings will help discover sciatica or aneurysm if it is there and begin timely treatment. And if it is not there then a sciatica treatment plan can be developed before it worsens.

Sciatica Remedy


 

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
References
  1. Javdanfar A, Celentano C. Sciatic artery aneurysm. West J Emerg Med. 2010;11(5):516-517.

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%%title%% %%sep%% PUSH as Rx %%excerpt%% aneurysm,artery,chiropractic,deadly,doctor,examination,health,iliac,issues,lesions,misdiagnosis,nerve,pulsating,sciatica,vascular,wellness,sciatica or aneurysm 11860 Vista Del Sol, Ste. 128 Sciatica or Aneurysm, A Deadly Mistake! 11860 Vista Del Sol, Ste. 128 Sciatica or Aneurysm, A Deadly Mistake! 11860 Vista Del Sol, Ste. 128 Sciatica or Aneurysm, A Deadly Mistake! 26221
Underlying Causes Of Abdominal Aortic Aneurysm and Sciatica Risks https://www.pushasrx.com/abdominal-aneurysm-sciatica-2/ Wed, 14 Oct 2020 01:58:32 +0000 https://www.pushasrx.com/?p=26216 11860 Vista Del Sol, Ste. 128 Underlying Causes Of Abdominal Aortic Aneurysm and Sciatica Risks

Underlying causes for an abdominal aortic aneurysm can be challenging to diagnose and identify. Combined with sciatica symptoms, doctors could misdiagnose the ailment and prescribe the wrong treatment protocol. Then an individual has to deal with two conditions that were not properly diagnosed, continue to develop, and worsen. This is why finding the right sciatica […]

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11860 Vista Del Sol, Ste. 128 Underlying Causes Of Abdominal Aortic Aneurysm and Sciatica Risks Underlying causes for an abdominal aortic aneurysm can be challenging to diagnose and identify. Combined with sciatica symptoms, doctors could misdiagnose the ailment and prescribe the wrong treatment protocol. Then an individual has to deal with two conditions that were not properly diagnosed, continue to develop, and worsen. This is why finding the right sciatica specialist that can also identify an abdominal aneurysm is so crucial to developing the right treatment plan. There can be a variety of factors that can lead to the development of an abdominal aneurysm. They include:
11860 Vista Del Sol, Ste. 128 Underlying Causes Of Abdominal Aortic Aneurysm and Sciatica Risks
 

Abdominal Aneurysm Contributing Health Conditions

Health conditions associated with an increased risk for an abdominal aneurysm include:

Atherosclerosis

This condition occurs when there is a buildup of fats, cholesterol, and other substances that create plaque buildup in the bloodstream. This causes vessels to harden and narrow. Atherosclerosis can develop during the young adult stage and becomes an issue later in life.  
 

High Cholesterol

Cholesterol is a waxy, fat-type substance that is found in all the cells in the body. The body needs some cholesterol for the production of hormones, vitamin D, and substances to help digest foods. The body makes all the cholesterol it needs. Too much can build up in the blood vessels, which narrows the bloodstream and hardens the arterial walls.  
11860 Vista Del Sol, Ste. 128 Underlying Causes Of Abdominal Aortic Aneurysm and Sciatica Risks
 

High Blood Pressure

High blood pressure or hypertension refers to a sustained increased force of blood moving through the aorta that can weaken artery walls. It is a common condition that is widespread among individuals that are older, those that smoke, and those that are overweight. There is an estimated 60-70% of individuals over 60 that are diagnosed with high blood pressure.  
 

Inflamed Arteries

When the arteries become inflamed, it can cause blood flow constriction and cause the arterial walls to weaken. This increases the risk of an aneurysm. Arteries can get inflamed through:
  • Genetics
  • High cholesterol
  • Trauma/injury to the abdomen
  • Arterial Disease/s like:
  1. Abdominal Aortic Aneurysm
  2. Thoracic Aortic Aneurysm
  3. Peripheral Arterial Disease
  4. Thoracic Outlet Syndrome
  5. Vasculitis
11860 Vista Del Sol, Ste. 128 Underlying Causes Of Abdominal Aortic Aneurysm and Sciatica Risks
 

Connective Tissue Disorders

There are hereditary conditions that can weaken the body’s connective tissues. This can lead to degeneration of the aortic walls and raise an individual’s risk for an aneurysm. Two of the most common connective tissue disorders are Ehlers-Danlos syndrome, which affects collagen production, and Marfan Syndrome. This condition increases the production of fibrillin, which is a protein that helps to build the elastic fibers in connective tissue.  
 

Other Risk Factors

Additional health factors can strain the cardiovascular system. This increases the risk of weakening or damaging blood vessels. This significantly raises the chances of developing an abdominal aortic aneurysm. Risk factors include:

Smoking and Tobacco

All types of tobacco use can contribute to diminished cardiovascular health. Individuals that smoke or use some tobacco product pose a significantly higher risk of developing an abdominal aneurysm.

Age

Aneurysms occur most often in older adults. This is because they are more likely to have cardiovascular issues and are more likely to have higher levels of plaque buildup.

Genetics and Family History

Immediate relatives of an individual with an abdominal aneurysm often have a 12-19% chance of developing the condition.

Lack of Physical Activity

Not getting adequate physical activity puts an individual at a higher risk for heart and cardiovascular disease. Aerobic activity done on a regular basis increases the heart rate and blood flow through the body. This keeps the tissues and blood vessels strong and flowing properly.

Gender

Both men and women can develop an abdominal aortic aneurysm. However, the majority of those that do develop the condition are men. This is because men are more likely to go through heart and cardiovascular issues.  

Diagnosis

Underlying conditions that can cause sciatic pain can vary or be a combination of several conditions. The most important action to take is to consult a doctor or chiropractic sciatica specialist for a clinical diagnosis. While rare, sciatica-type pain could be caused by medical conditions like:
  • Spinal tumor
  • Spinal infection
  • Cauda equina syndrome
These factors can contribute to an increased chance of developing an abdominal aortic aneurysm. However, individuals can have unknown risk factors and still develop the condition. Treatments may range from regular monitoring, lifestyle changes, and physical therapy/chiropractic to urgent or emergency surgery. If you feel symptoms of pain in the buttocks, leg, numbness, tingling, or other neurological symptoms in the back and/or leg, it is very important to see a doctor or chiropractor for clinical diagnosis that identifies the cause of the symptoms.

Sciatica Pain Rehabilitation


 

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

The post Underlying Causes Of Abdominal Aortic Aneurysm and Sciatica Risks appeared first on PushAsRx Athletic Training Centers El Paso, TX.

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%%title%% %%excerpt%% abdominal,aneurysm,aortic,back,causes,chiropractic,conditions,disorders,health,low,pain,present,sciatica,wellness,aneurysm 11860 Vista Del Sol, Ste. 128 Underlying Causes Of Abdominal Aortic Aneurysm and Sciatica Risks 11860 Vista Del Sol, Ste. 128 Underlying Causes Of Abdominal Aortic Aneurysm and Sciatica Risks 11860 Vista Del Sol, Ste. 128 Underlying Causes Of Abdominal Aortic Aneurysm and Sciatica Risks 26216
Sciatica Chiropractic Diagnosis Specialist and Abdominal Aortic Aneurysm https://www.pushasrx.com/sciatica-chiropractic-diagnosis/ Tue, 13 Oct 2020 02:11:46 +0000 https://www.pushasrx.com/?p=26213 11860 Vista Del Sol, Ste. 128 Sciatica Chiropractic Diagnosis Specialist and Abdominal Aortic Aneurysm

Finding the right sciatica chiropractic specialist to diagnose the cause especially, when it is an abdominal aortic aneurysm can be a challenge. There can cause diagnostic confusion with the root cause never being discovered or identified. Fortunately, Dr. Jimenez is a sciatica specialist with over 30 years of experience in differential sciatica diagnosis, and treatment. […]

The post Sciatica Chiropractic Diagnosis Specialist and Abdominal Aortic Aneurysm appeared first on PushAsRx Athletic Training Centers El Paso, TX.

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11860 Vista Del Sol, Ste. 128 Sciatica Chiropractic Diagnosis Specialist and Abdominal Aortic Aneurysm Finding the right sciatica chiropractic specialist to diagnose the cause especially, when it is an abdominal aortic aneurysm can be a challenge. There can cause diagnostic confusion with the root cause never being discovered or identified. Fortunately, Dr. Jimenez is a sciatica specialist with over 30 years of experience in differential sciatica diagnosis, and treatment.

Sciatica Chiropractic Specialist Diagnosis

 

Diagnostic Tools

Abdominal aneurysms are usually discovered for another ailment like a hernia or for routine tests like an ultrasound of the heart or stomach. Diagnosis of an abdominal aneurysm depends on the condition, medical and family history, and the physical examination. If a doctor or sciatica chiropractic specialist suspects an aortic aneurysm, then specialized tests will help with a confirmation.  
 
11860 Vista Del Sol, Ste. 128 Sciatica Chiropractic Diagnosis Specialist and Abdominal Aortic Aneurysm
 

Ultrasonography

The simplest and most used diagnostic test is ultrasonography. It utilizes sound waves for diagnostic purposes that send the recorded images to a monitor. It gives an accurate assessment of the size and location of the aneurysm. The patient will lie on a table while a technician moves a wand around the abdomen.  
 

Computed tomography CT scan

This test is often used in conjunction with ultrasonography if more data/info is needed. Usually, this is to determine the exact location of the aneurysm in relation to the visceral or renal arteries. It provides cross-sectional detail with clear images of the aorta and can detect the size and shape. The patient lies on a table inside a machine. A contrast dye could be injected into the blood vessels to make the arteries more visible on the images known as CT angiography.  
 

Magnetic Resonance Imaging

Magnetic resonance imaging or MRI uses a magnetic field and radio wave energy pulses to record images of the body. The patient lies on a table that slides into the imaging compartment. Contrast dye can also be injected into the blood vessels to make the images more visible known as magnetic resonance angiography.  
11860 Vista Del Sol, Ste. 128 Sciatica Chiropractic Diagnosis Specialist and Abdominal Aortic Aneurysm
 

Emergency Symptoms

Certain symptoms can indicate an emergency. The conditions are rare, but it is very important to seek medical attention should any of these symptoms present with back pain:
  • Severe abdominal pain
  • Fever out of nowhere
  • Bowel and/or bladder incontinence
  • Loss of or an unusual sensation in the groin, as well as the legs and possibly into the foot
  • If back pain presents after an injury medical care is recommended to check for damage/injury to the spine.

Abdominal Aneurysm Symptoms

Abdominal aneurysms often don’t present any symptoms, which is why individuals go through their days unaware, and when back pain does present a doctor may only focus on the back pain symptoms and not the cause, leaving the aneurysm to continue to develop and worsen. Aneurysms do occur in women but are more common in men and those ages 65 and older. The main cause is atherosclerosis which is a hardening of the arteries. But injury and infection can also cause an aneurysm. Those with symptoms can include:
  • Throbbing pain around the back or side
  • Deep pain in the back or side
  • Pain in the buttocks, groin, or legs
  • Sciatica symptoms

The Sciatic Connection

A diagnosis of the root cause of the sciatica is crucial for developing an effective treatment plan to alleviate the sciatic pain. If an aneurysm is present then referring the individual to the proper aortic aneurysm repair specialist is a top priority. If sciatica is suspected, a doctor or chiropractor will review medical history and perform a physical examination. Medical imaging tests and diagnostic nerve blocks could be used if necessary. Sciatica pain usually follows the dermatome or areas of the skin that is supplied by the sciatic nerve. The pain can also include deeper tissues called dynatomes.  
11860 Vista Del Sol, Ste. 128 Sciatica Chiropractic Diagnosis Specialist and Abdominal Aortic Aneurysm
 
 

Physical examination

During a physical examination, the sciatica chiropractic specialist will look for various responses when:
  • Straightening the leg with movements that elongate the nerve
  • Gently pressing the toes or calf area
  • Seeing if there is any type of pain associated with these movements in the low back, buttock, thigh, leg, and foot

Sciatica Clinical Tests

Two examples of clinical tests for sciatica include:

Straight leg raise – SLR

The patient lies on their back and the chiropractor lifts one leg at a time with the other leg remaining flat or bent at the knee. If pain presents while lifting the affected leg this is usually an indication of sciatica.  
 

Slump

The patient sits upright with their hands behind their back. The patient then bends/slumps forward at the hips. The neck bends down with the chin touching the chest and one knee is extended as far as possible. If pain occurs in this position, sciatica could be present.  
 
These tests could possibly be positive only when the nerve is mechanically compressed. Other causes like inflammation or chemical irritation of the nerve might not cause pain when performing these tests. This test could also help reveal a possible abdominal aneurysm as abdominal pain could present.  

Chiropractic Sciatica Treatment

Manual manipulation improves the alignment of the spine. This technique helps address the underlying condition/s that can cause sciatic nerve pain, like herniated discs or spinal stenosis. Manual manipulation also creates an optimal healing environment. An aortic aneurysm specialist could work with a sciatica chiropractic specialist to help with spinal realignment if the aneurysm caused any kind of shifting or slipping of the discs along with releasing the sciatic nerve if it is compressed.  

Massage Therapy

Massage therapy like deep tissue massage can also have benefits. Massage:
  • Improves blood circulation, which also creates an optimal healing response in the body
  • Releases toxins in the low back muscles that spasmed or knotted up
  • Relaxes tight muscles that could be contributing to the pain
  • Releases endorphins or the hormones that function as the body’s natural pain relievers

 

Sciatica Specialist


 

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

The post Sciatica Chiropractic Diagnosis Specialist and Abdominal Aortic Aneurysm appeared first on PushAsRx Athletic Training Centers El Paso, TX.

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11860 Vista Del Sol, Ste. 128 Sciatica Chiropractic Diagnosis Specialist and Abdominal Aortic Aneurysm 11860 Vista Del Sol, Ste. 128 Sciatica Chiropractic Diagnosis Specialist and Abdominal Aortic Aneurysm 11860 Vista Del Sol, Ste. 128 Sciatica Chiropractic Diagnosis Specialist and Abdominal Aortic Aneurysm 26213
Treatment For An Abdominal Aortic Aneurysm https://www.pushasrx.com/treatment-abdominal-aneurysm/ Sat, 10 Oct 2020 01:43:28 +0000 https://www.pushasrx.com/?p=26200 11860 Vista Del Sol, Ste. 128 Treatment For An Abdominal Aortic Aneurysm

An abdominal aortic aneurysm refers to an enlargement of the abdominal aorta. If the blood vessel is enlarged and starts to leak blood or rupture, it will cause severe abdominal and lower back pain. This is a serious medical emergency that necessitates emergency surgery. Unfortunately, there is no way to reverse the damage. A prominent […]

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11860 Vista Del Sol, Ste. 128 Treatment For An Abdominal Aortic Aneurysm An abdominal aortic aneurysm refers to an enlargement of the abdominal aorta. If the blood vessel is enlarged and starts to leak blood or rupture, it will cause severe abdominal and lower back pain. This is a serious medical emergency that necessitates emergency surgery. Unfortunately, there is no way to reverse the damage. A prominent symptom from a rupture is severe, persistent low back pain, and pain in and around the abdomen. Treatment for an abdominal aortic aneurysm depends on the possible complications that could develop. Approaches for treatment:
  • Nonsurgical treatments like anti-biotics calcium channel blockers and exercise along with monitoring are used for individuals that have a low risk of rupture.
  • If an aneurysm is not found until it becomes an emergency, then surgery to repair the ruptured artery is absolutely necessary. If ruptured or there is a high risk of rupturing is considered an emergency.
  • If a rupturing aneurysm has been diagnosed, some treatment/management will be implemented to prevent severe/fatal bleeding.
11860 Vista Del Sol, Ste. 128 Treatment For An Abdominal Aortic Aneurysm
 

Cardiac

For low-risk cases, lifestyle changes and possible medication/s may be recommended to slow the development. Small aneurysms are monitored using ultrasound. This can be every 6 to 12 months depending on the size and growth rate of the artery. Medications for lowering blood pressure and cholesterol could be prescribed. This is to limit the amount of plaque buildup in the aorta and reduce any pressure on the arterial walls. Quitting smoking and removing tobacco altogether whether dip, chew, vape is a significant action an individual can do to minimize the risk of aortic rupture. Other lifestyle changes involve maintaining a healthy diet and regular exercise will help lower blood pressure and cholesterol levels decreasing the chance of rupture.

Surgery

Surgical treatment when necessary is to stop a rupture if leaking blood or to prevent a rupture. Surgery requires replacing the damaged portion of the aorta with a stent-graft. This is an artificial artery made from a high-tech mesh/fabric. There are two standard surgical treatments:

Open Repair

Open repair is the most common surgical treatment. It takes the enlarged portion of the aorta removes it and replaces it with a stent-graft. Open surgery repair consists of the following:
  • The incision is made in the abdomen at the site of the aneurysm.
  • The aorta gets clamped with the blood temporarily blocked from flowing through the damaged portion.
  • The damaged part is removed.
  • A tube graft is placed where the damaged portion was.
If the damage was not severe and does not require the removal and complete replacement, then less invasive options will be offered.  
11860 Vista Del Sol, Ste. 128 Treatment For An Abdominal Aortic Aneurysm
 

Endovascular Aortic Aneurysm Repair

EVAR endovascular aneurysm repair surgery is a minimally invasive procedure. There is no need for a large abdominal incision or removal of the damaged portion of the artery. This procedure does not require blood flow stoppage, which places less stress on the heart. Endovascular surgery involves:
  • A fluoroscopy or live X-ray is used. This is so the surgeon can look at the repair, and guide the stent into place.
  • 2 small incisions are made in the groin.
  • A catheter is inserted into the femoral artery in the groin and guided to the abdominal aorta.
  • Through the catheter, the stent is guided to the aneurysm.
  • Once it reaches the aneurysm, it is compressed and closed.
  • The stent is placed in position, and the wireframe is expanded to fit the artery.
  • The stent is sewn/secured into place at both ends.
  • Once in place, the blood gets redirected from the enlarged area and flows only through the stent-graft. This takes the pressure off the artery’s walls and allows for size reduction over time, and decreases the risk of rupture.
The procedure is not an option for individuals with an aorta that cannot be accessed safely through the femoral arteries. Or if the artery is severely damaged that the aneurysm portion needs to be replaced. And if the aneurysm is too big or complex where an open repair is a more favorable option.

Follow Up

Follow-up monitoring is necessary after any aortic aneurysm surgical procedure. This is to ensure the stent works and the aorta is functioning without a high risk of rupture. Individuals will be advised to maintain a healthier heart and cardiovascular system. A surgeon/doctor will suggest:
  • Diet adjustments
  • Regular exercise
  • Quitting smoking/tobacco intake
  • Taking cholesterol and blood pressure medication
  • Chiropractic/Physical therapy for any spinal misalignment, herniation, sciatic nerve compression back pain relief.

Sciatic Nerve Pain Treatment

 

 

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

The post Treatment For An Abdominal Aortic Aneurysm appeared first on PushAsRx Athletic Training Centers El Paso, TX.

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%%title%% %%sep%% PUSH as Rx %%excerpt%% abdominal,aneurysm,aortic,back,chiropractic,health,non-surgical,pain,relief,sciatica,surgery,wellness,abdominal 11860 Vista Del Sol, Ste. 128 Treatment For An Abdominal Aortic Aneurysm 11860 Vista Del Sol, Ste. 128 Treatment For An Abdominal Aortic Aneurysm 26200
Abdominal Aneurysm Can Present With Sciatica and Low Back Pain https://www.pushasrx.com/abdominal-aneurysm-sciatica/ Fri, 09 Oct 2020 02:16:51 +0000 https://www.pushasrx.com/?p=26195 11860 Vista Del Sol, Ste. 128 Abdominal Aneurysm Can Present With Sciatica and Low Back Pain

An abdominal aortic aneurysm is an enlarging of the lower portion of the aortic artery that resides in the abdomen. The aorta is the body’s main artery that supplies blood to the body and stretches from the heart down into and through the abdomen. The abdominal aorta is the part that sits within the abdomen. […]

The post Abdominal Aneurysm Can Present With Sciatica and Low Back Pain appeared first on PushAsRx Athletic Training Centers El Paso, TX.

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11860 Vista Del Sol, Ste. 128 Abdominal Aneurysm Can Present With Sciatica and Low Back Pain An abdominal aortic aneurysm is an enlarging of the lower portion of the aortic artery that resides in the abdomen. The aorta is the body’s main artery that supplies blood to the body and stretches from the heart down into and through the abdomen. The abdominal aorta is the part that sits within the abdomen. It is below the kidneys and in close proximity to the front of the spine. Because of this closeness sudden intense pain can be felt in the lower back along with sciatica symptoms.  
11860 Vista Del Sol, Ste. 128 Abdominal Aneurysm Can Present With Sciatica and Low Back Pain
 

Abdominal Aorta Function

Its function is to deliver blood from the heart throughout the body. It circulates blood down through the chest and abdomen. Smaller arteries branch off the artery to the different organs and systems of the body.

Enlargement/Weakening

If it becomes weak or expands in size, the condition is known as an aortic aneurysm. This condition can cause severe abdominal pain, back pain, sciatica and can lead to artery leakage or rupture. This is when it becomes an emergency. Being the largest blood vessel in the body means that a rupture can cause life-threatening bleeding. Aneurysms can develop anywhere on the artery, but most occur in the abdomen portion. Depending on the size and growth rate, treatment/therapies can vary from observation to emergency surgery. Abdominal aneurysms usually progress slowly without symptoms, making them difficult to detect. However, some abdominal aneurysms never rupture. They can start small and remain the same size while others can expand over time, and others faster.

Rupture

A weakened aorta can develop a leak known as a rupture. Blood can also begin to accumulate and pool up between layers in the arterial walls can also lead to rupture known as a dissection. Internal bleeding is the primary complication of an abdominal aneurysm. Loss of blood is considered a potentially fatal medical emergency. Mortality rates increase when the artery leaks. The risk for rupture depends on the:

Size

Aneurysms that are smaller than 5 cm in diameter are considered a low risk for rupture. Aneurysms larger than 5 cm are considered high risk. The size is often the best predictor for predicting the chance of rupture.

Growth Rate

Expansion of more than half a centimeter over 6 months is considered accelerated growth and is a high risk. A faster growth rate has been seen in individuals that smoke or have high blood pressure. Abdominal pain, lower back pain, sciatica, or other symptoms usually do not present until the artery has ruptured. However, a significantly expanded aneurysm, symptoms similar to a rupture can occur.  
11860 Vista Del Sol, Ste. 128 Abdominal Aneurysm Can Present With Sciatica and Low Back Pain
 

Symptoms

In most cases, the aneurysm develops slowly with no symptoms or minor symptoms like a nagging/gnawing or throbbing sensation in or around the abdomen. This type of aneurysm can be detected from a standard physical exam or from the monitoring of another condition. Symptoms depend on the location and can include some combination of the following:
  • Deep, constant pain in the abdomen or on the side. It could also be a stabbing pain deep inside that is felt between the sternum and the belly button. The pain can be continuous with no relief from rest or adjusting positions. Severe pain can cause individuals to bend over and down.
  • Difficulty standing or the ability to straighten the upper body.
  • Low back pain caused by the abdominal pain radiating/spreading out into the lower spine from the aorta’s closeness to the spine. The pain can also spread to the groin, pelvis, and legs.
  • Sciatica symptoms typically come from low back pain.
  • A pulse near or around the bellybutton. Tenderness, along with a pulsing sensation can be felt. The pulse can be felt through the skin and could be sensitive to touch or pressure.
  • Blood loss will result in low blood pressure, known as hypotension. This causes lightheadedness, dizziness, nausea/vomiting, blurred vision, and confusion. Symptoms are exacerbated when standing generating the feeling for the need to sit or lie down.
  • Shock symptoms from the internal bleeding. This includes:
  1. Sudden and rapid heartbeat
  2. Shallow breathing
  3. Clammy skin
  4. Cold sweats
  5. General weakness
  6. Confusion
  7. Agitation
  8. Anxiety
  9. Loss of consciousness
 

Causes

Various causes can be involved in developing an abdominal aneurysm, including:
  • Hardening of the arteries known as atherosclerosis. It happens when fat along with other substances build up on the lining of blood vessel/s.
  • High blood pressure can damage and weaken the walls of the aorta.
  • Blood vessel diseases can cause blood vessel inflammation.
  • Aortic infection is rare but a bacterial or fungal infection could cause an abdominal aneurysm.
  • Trauma like being in an automobile accident can cause an aneurysm.

Risk Factors

The pathology principally stays asymptomatic until a rupture occurs. This pathology affects mostly men with quite a few risk factors. Risk factors include:
  • Men develop abdominal aneurysms more often than women.
  • Smoking is the strongest risk factor. It weakens the aortic walls and increases the risk of developing an aneurysm, and rupture. The longer an individual smokes or chews tobacco, the higher the chances.
  • Individuals aged 65 and older are the most targeted group for this condition.
  • A family history of abdominal aneurysms increases the risk.
  • Aneurysm in another blood vessel, like the artery behind the knee or the chest aortic region, could increase the risk.

Sciatic Nerve Compression

Sciatica is usually caused by compression on the nerve. Spinal and non-spinal disorders are known to cause pain include:
  • Low back misaligned vertebral body/s
  • Herniated/bulging/slipped discs
  • Pregnancy/childbirth
  • Spinal tumors
  • Diabetes
  • Constipation
  • Sitting too long
Sciatic nerve compression can cause a loss of feeling known as sensory loss, paralysis of a limb, or group of muscles known as monoplegia, and insomnia.

Proper Diagnosis Is Essential

Because of the many disorders that can cause sciatica, a doctor’s first step is to determine the cause. This involves forming a diagnosis based on a thorough review of an individual’s medical history, a physical and neurological examination. The sciatic nerve has several smaller nerves that branch off. These smaller nerves enable movement motor function and feeling sensory functions in the thighs, knees, calves, ankles, feet, and toes. If a chiropractor determines the patient’s disorder requires treatment by another specialist, then the individual will be referred to the proper doctor. In some cases, the chiropractor could be called upon to continue spinal therapy and help manage the individual’s treatment plan with the other specialist/s.

Sciatica Nerve Pain Rehabilitation

 

   

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

The post Abdominal Aneurysm Can Present With Sciatica and Low Back Pain appeared first on PushAsRx Athletic Training Centers El Paso, TX.

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%%title%% %%excerpt%% abdominal,aneurysm,aortic,back,chiropractic,enlargement,health,pain,sciatica,symptoms,treatment,wellness,abdominal aneurysm 11860 Vista Del Sol, Ste. 128 Abdominal Aneurysm Can Present With Sciatica and Low Back Pain 11860 Vista Del Sol, Ste. 128 Abdominal Aneurysm Can Present With Sciatica and Low Back Pain 26195
Finding the Right Spinal Surgeon Asking the Right Questions https://www.pushasrx.com/right-spinal-surgeon-questions/ Thu, 24 Sep 2020 01:52:09 +0000 https://www.pushasrx.com/?p=26137 11860 Vista Del Sol, Ste. 128 Finding the Right Spinal Surgeon Asking the Right Questions

Finding the right surgeon that specializes in an individual’s specific spinal conditions and physical health means doing some research. There are several types of procedures for spinal problems. The type of surgery depends on the condition and an individual’s medical history. If surgery is recommended for a lumbar herniated disc or LHD combined with sciatica […]

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11860 Vista Del Sol, Ste. 128 Finding the Right Spinal Surgeon Asking the Right Questions Finding the right surgeon that specializes in an individual’s specific spinal conditions and physical health means doing some research. There are several types of procedures for spinal problems. The type of surgery depends on the condition and an individual’s medical history. If surgery is recommended for a lumbar herniated disc or LHD combined with sciatica here are a few things to think about.  
11860 Vista Del Sol, Ste. 128 Finding the Right Spinal Surgeon Asking the Right Questions
 

Researching a spine surgeon

First and foremost look for surgeons with:
  • Medical credentials like are they board-certified or board-eligible
  • Completed a fellowship in spine surgery
  • Devotes at least 50% of their practice to spinal conditions
  • Specializes in treating herniated disc/s and sciatica. This means they will have added/specialized knowledge and expertise.
It is extremely important that an individual feels comfortable and feels they are able to communicate freely with the surgeon. A professionally qualified surgeon should:
  • Spend adequate time with the individual
  • Answer all questions
  • Provide all information needed about the condition and treatment
  • Listen to what the individual has to say
  • Is open-minded
  • Is not hard to get in contact with
  • Has experience in the latest methods and techniques

What to look at and think about

Individuals can feel uncomfortable asking questions, but thorough communication is key. Remember, it is your body, and it is your right to know the details of the spinal disorder, along with non-surgical and surgical approaches to treatment that are available. There is time to consider the options and make an informed decision about the treatment plan as most spinal procedures are elective. Ask the surgeon all the questions you have to help decide wisely and with confidence. Make sure they address all concerns, and any others not listed.

The surgeon’s specialization/focus

Orthopedic surgeons and neurosurgeons perform spinal procedures. Each will have a specific interest and expertise in certain spinal condition/s. For example, some surgeons may specialize in treating adult or pediatric patients, and some may only treat either lumbar/low back or cervical/neck conditions. Within those groups, some focus on:
  • Spinal deformities
  • Tumors
  • Myelopathy a spinal cord disease
  • Specific spinal cord diseases

Minimal invasive surgery option

Minimally invasive spine involves tiny incisions, that reduces the recovery time needed to heal. With this type, individuals can be up and walking within hours after surgery. Unfortunately, not all conditions can take this approach.

Is the surgery absolutely necessary, or can it be treated non-surgically?

Sciatica and herniated discs can be quite painful and cause disability. Never rush into surgery just to relieve symptoms. As surgery can cause other types of pain symptoms and issues. Herniation and sciatica can be resolved with:
  • Chiropractic
  • Physical therapy
  • Medications
  • Injections
  • Lifestyle changes
  • Diet adjustments
  • Regular exercise
  • Weight loss
However, if there are neurologic symptoms, like weakness in the leg, foot, numbness, or loss of bladder or bowel control – this is considered a medical emergency – then surgery is absolutely needed.  
11860 Vista Del Sol, Ste. 128 Finding the Right Spinal Surgeon Asking the Right Questions
 

The number of similar procedures performed

The surgeon’s experience is very important. The more experienced, the better. Ask if they can refer to other patients who have had similar procedure/s.

Recovery time

Every patient is unique, as is the type of surgery, and recovery times. They all vary accordingly. General health, physical condition, and the severity of the disorder play a role in how long and how involved recovery time will be. Experienced surgeons can provide more specific answers concerning recovery/healing time.

Complication rate

All surgeries carry some risk of complication. Complication rates that are more than 10% is a red flag. Possible post-surgery complications.

Infection rate

Surgeons should have an infection rate lower than 10%. However higher rates do not always mean that surgeon is at fault as higher rates can come from performing highly complex procedures. Another reason for high infection rates could be the patients themselves like smokers or individuals with diabetes have increased risks for infection. However, do not feel uncomfortable asking the surgeon to explain a high infection rate.

Decide to not opt for spine surgery

As a surgeon produces a diagnosis, they should present a recommended treatment plan, including alternative treatments/therapies. Ask for another explanation of any part of the evaluation, diagnosis, or available treatment options.

Get a second opinion

A second opinion should be encouraged. A second opinion can reinforce the surgeon’s recommendations and offers a new perspective. The surgeon should be comfortable with a second opinion. This does not mean that the individual does not trust the surgeon. It does mean that there is considerable interest in achieving optimal health and making sure that surgery is the absolute right thing to do. Pass on surgeons that discourage or disapprove of second opinions and continue looking.
 

Whiplash Chiropractic Massage Rehabilitation

 

 

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

The post Finding the Right Spinal Surgeon Asking the Right Questions appeared first on PushAsRx Athletic Training Centers El Paso, TX.

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%%title%% %%excerpt%% chiropractic,disc,health,herniated,pain,questions,relief,sciatica,spine,surgeon,surgery,wellness,surgeon 11860 Vista Del Sol, Ste. 128 Finding the Right Spinal Surgeon Asking the Right Questions 11860 Vista Del Sol, Ste. 128 Finding the Right Spinal Surgeon Asking the Right Questions 26137
Medication For Sciatica and Natural Chiropractic Medicine https://www.pushasrx.com/medication-sciatica-chiropractic/ Thu, 17 Sep 2020 01:49:33 +0000 https://www.pushasrx.com/?p=26096 11860 Vista Del Sol, Ste. 128 Medication For Sciatica and Natural Chiropractic Medicine

The use of prescription medication for sciatica is being discouraged while natural treatments/therapies are becoming the new standard. This is currently happening in the United Kingdom and its National Institute for Health and Care Excellence. The focus is to reduce the use of medication for sciatica and aim for natural treatments unless absolutely necessary. This […]

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11860 Vista Del Sol, Ste. 128 Medication For Sciatica and Natural Chiropractic Medicine The use of prescription medication for sciatica is being discouraged while natural treatments/therapies are becoming the new standard. This is currently happening in the United Kingdom and its National Institute for Health and Care Excellence. The focus is to reduce the use of medication for sciatica and aim for natural treatments unless absolutely necessary. This is to help reduce the opioid epidemic, along with reducing the use of medications and their negative side effects that cause other conditions and illnesses.  
11860 Vista Del Sol, Ste. 128 Medication For Sciatica and Natural Chiropractic Medicine
 
The National Institute for Health Care Excellence has updated its guidelines with specific language that discourages the use of multiple classes of drugs for various ailments/conditions like sciatica. The United States has already set up similar guidelines limiting the use of prescription medications for sciatica until after a regimen of non-pharmacological treatment/therapies like physical therapy, chiropractic, acupuncture, massage, etc. If no improvement is seen in four to six months then medication can be administered. The guidelines say that individuals with acute or chronic sciatica should not be given gabapentinoids, this is a class of drugs designed to treat seizures, other antiepileptics, oral corticosteroids, and opioids. They also report that there is no evidence on the use of antidepressants for sciatica. However, it is recognized that it can benefit some individuals but should not just be handed out for every case.

Medication for Sciatica

Medication does work for sciatica. It’s the side effects and addiction issues they are trying to avoid. Options include:
  • Nonsteroidal anti-inflammatory drugs
  • Gabapentinoids
  • Corticosteroids
  • Benzodiazepines
Opioids have been overprescribed for all types of pain. However, they don’t help in repairing the damaged/pinched nerves and only relieve/sedate the pain symptoms. In addition side effects like confusion, dizziness, and sleep problems are increased leading to more health issues.

Treatment Options

When it comes to acute pain over the counter medications, NSAIDs, oral steroids, and gabapenitoids can be recommended for a brief period and not long term. This is just to settle the pain until a non-medication treatment plan is developed to realign, adjust, and restore the sciatic nerve to its proper position. A physician or physical therapist/chiropractor can diagnose the difference between actual sciatica and low back pain.  
11860 Vista Del Sol, Ste. 128 Medication For Sciatica and Natural Chiropractic Medicine
 

Physical Therapy and Chiropractic

Chiropractic treatment and physical therapy for sciatica first look to determine the cause of the condition and how the individual spends their day as far as do they sit or stand for a good portion of the day along with the types of activities like lifting, bending, stretching, twisting, etc. The nerves are irritated and send signals to the brain. This could be tingling with pain, numbness, or a combination. The body wants to protect itself. Once the source of irritation is identified the chiropractor or physical therapist works with the patient to workout/massage/release the muscles, ligaments, joints to work the sciatic nerve back to full health and function. The chiropractor/therapist challenges the nerve to get back into proper form in a safe fashion. How the condition resolves depends if it’s acute or chronic. In acute cases, the pain level is higher but is easier to treat. The faster chiropractic and physical therapy intervention are sought out the better the odds additional treatment will not be required. The first sessions of chiropractic and physical therapy are designed to calm the system down. Then the body will begin to heal itself within about four weeks without medication.

Conservative Therapy

Preference for non-surgical treatment is the way to go whenever possible. Only when significant weakness in the leg or foot from nerve compression, surgery could be necessary. It can become an emergency situation if there is numbness around the groin and if it affects bowel or bladder function. Six to eight weeks of conservative treatment is the key. And if no improvement correlated with an MRI is achieved, then surgical treatment could be the next phase of treatment.

Sciatica Pain Rehabilitation

 
 

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

The post Medication For Sciatica and Natural Chiropractic Medicine appeared first on PushAsRx Athletic Training Centers El Paso, TX.

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%%title%% %%excerpt%% adjustment,alignment,chiropractic,health,medications,pain,sciatica,wellness,medication for sciatica 11860 Vista Del Sol, Ste. 128 Medication For Sciatica and Natural Chiropractic Medicine 11860 Vista Del Sol, Ste. 128 Medication For Sciatica and Natural Chiropractic Medicine 26096
When Sciatica Is Not Spine Related https://www.pushasrx.com/when-sciatica-is-not-spine-related/ Fri, 21 Aug 2020 02:26:09 +0000 https://www.pushasrx.com/?p=26009 11860 Vista Del Sol, Ste. 128 When Sciatica Is Not Spine Related

There are other causes of sciatica that are not spine-related. It is sometimes called non-spinal pathology, which means not related to the spine. The most common cause of sciatic pain is a herniated disc. Non-spine-related causes of sciatica can imitate/copy the symptoms of a herniated disc in the low back. When a lumbar herniated disc […]

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11860 Vista Del Sol, Ste. 128 When Sciatica Is Not Spine Related There are other causes of sciatica that are not spine-related. It is sometimes called non-spinal pathology, which means not related to the spine. The most common cause of sciatic pain is a herniated disc. Non-spine-related causes of sciatica can imitate/copy the symptoms of a herniated disc in the low back. When a lumbar herniated disc causes sciatica, people typically report a sudden onset of pain with leg pain worse than any back pain that might be present. In addition to pain in the leg, there are also reports of leg weakness, numbness, and tingling. Leg pain becomes worse after:
  • Long periods of sitting/standing
  • Forward bending
  • Body maneuvers that increase pressure in intervertebral discs
  • Coughing
  • Sneezing
Individuals also report when lying down and the spine is extended the back pain reduces and alleviates the pain. Determining the source of sciatica pain correctly means that it is important to:
  • Characterize the activities leading up to when the symptoms first presented
  • Location of the pain
  • Associated factors that reduce and worsen the pain
  • Medical history
11860 Vista Del Sol, Ste. 128 When Sciatica Is Not Spine Related
 
Because there are quite a few non-spine-related causes, it can be helpful to keep in mind:
  • The way the sciatic nerve runs through the lower body. It starts in the lower lumbar and upper sacral nerve roots. It exits through the pelvis and runs down the back of the thigh to the knee where it branches out into nerves that provide the motor and sensory functions to the legs and feet.
  • Non-spinal sciatica causes. Non-spinal causes usually are the result of irritation of the nerve itself. The most common ways to irritate the nerve is compression, traction, or injury.
  • Symptoms perceived as sciatica may not be related to the nerve at all. Injury/s to structures close to the nerve, like the hip, can copy symptoms caused by irritation of the nerve.

Hip joint disorders can emulate sciatica symptoms

Because the sciatic nerve is close to the hip joint, an injury to the hip could resemble symptoms of sciatica. Whatever the cause of the hip injury, those with hip pathology often report pain in the groin, upper thigh, and buttocks. The pain gets worse with activity, specifically bending, and rotation of the hip. Leg pain that turns into a limp when walking means that more likely the hip, and not the lower back, is the cause of the leg pain. X-rays and if necessary MRIs of the hip can help in determining if the hip is the cause of leg pain. An example of hip pathology that mimics spine-related sciatica:

Hip Osteoarthritis

This is characterized by the loss of cartilage. This results in the narrowing of the ball and socket joint. Individuals with arthritis of the spine and hip, a doctor could use a steroid injection as a therapeutic providing pain relief and a diagnostic to help identify the root cause/pain generator.  
 

Osteonecrosis

The femoral head can collapse from a lack of blood flow. Risk factors include:
  • Alcohol abuse
  • Sickle cell disease
  • Chronic steroid use
  • Femoral neck fracture
  • Hip dislocation

Femoroacetabular Impingement

This can stem from constant abnormal rubbing between the femoral neck and acetabulum from a bone deformity of the femur, or the acetabulum. Hip impingement at the joint can start the onset of arthritis along with tears of the labrum. This is cartilage that surrounds the hip joint and provides stability.

Trochanteric Bursitis

There are fluid-filled sacs called bursas/bursae that help decrease friction between the bones, surrounding tendons, and muscles. They are at multiple locations on the body. Bursitis means that the bursa is inflamed and can be quite painful. The greater trochanter is a bony outward bump that extends from the femur. Trochanteric bursitis refers to inflammation of the bursa that separates the greater trochanter with the muscles and tendons of the thigh. Common symptoms are pain on the outside of the thigh that worsens by pressing on the area and can interfere with proper sleep when lying on the affected side.

Femoral Neck Stress Fracture

Incomplete fracture/s of the femoral neck typically occur in individuals that walk or run long distances regularly like runners and soldiers. The pain is usually focused around the groin and can be subtle when it presents. Walking or running makes the pain worse.

Sacroiliac joints and fractures

The sacroiliac joints connect the spine to the pelvis. There are two joints, one on either side of the sacrum. While they are relatively immobile, they go through tremendous force doing routine daily activities. Sacroiliac joint pathology that can mimic spine-related sciatica include:

Sacroiliitis

This is inflammation of the sacroiliac joints. The pain presents in a slow fashion with no obvious injury or cause. The pain is usually localized to the buttocks and can radiate down the back of the thigh. It is believed to be caused by irritation of the sciatic nerve by the inflammatory molecules in the sacroiliac joint or could present as referred pain from the joint. This is pain that is detected in a location other than the area of the pain generator. The pain reduces with light walking.  
11860 Vista Del Sol, Ste. 128 When Sciatica Is Not Spine Related
 

Sacral Fracture

A fracture of the sacrum can occur in those with a weakened bone after a minor injury and without trauma. Risk factors include:
  • Advanced age
  • Osteoporosis
  • Chronic steroid use
  • Rheumatoid arthritis
  • Vitamin D deficiency.
The pain usually localizes in the low back that radiates to the buttocks, or groin, and worsens with activity.

Trauma-related

Trauma to the pelvis or thigh can definitely cause sciatica pain and symptoms. With high-energy injuries, it is possible for the nerve roots of the sciatic nerve to get pulled or torn. More common causes include:
  • Posterior hip dislocation
  • Pelvic fracture
The hamstring muscles are in close proximity to the sciatic nerve. A torn hamstring can irritate the sciatic nerve either through direct compression from the localized bleeding known as a hematoma or from an inflammatory response triggered when the injury happened.  
 

Penetrating trauma

If some sharp object like a tool or shrapnel penetrates any area where the sciatic nerve is, it could cause sciatica by cutting the nerve. Or the object tears the nerve, known as a laceration. Most cases of trauma-induced sciatica result from a mild form of nerve injury known as neuropraxia. This is an injury that temporarily blocks nerve function. Neuropraxia can develop from the shock waves that surround the object as it travels through the tissue.

Benign tumors and metastatic cancer

Discovering cancer during diagnosis for sciatica is rare. Symptoms that increase the possibility of cancer being the cause include:
  • Cancer in medical history
  • 50 years and older
  • Leg pain that goes on through the night
  • No relief from lying on the back
  • Night sweats
  • Unexplained weight loss
When back pain presents in a subtle fashion without a history of trauma or injury and is not affected by activity or changes in position can also suggest cancer as the cause. Tumors usually cause sciatica by applying direct compression on the nerve. They can be benign or malignant. Tumor/s can arise from the sciatic nerve itself:

Shingles

Shingles is a painful rash that occurs on one side of the body. It is caused by the varicella-zoster virus, which is the virus that causes chickenpox. The virus can lie dormant in nerve cells for years without causing any symptoms. Older individuals and individuals with underlying conditions in an immunocompromised state can cause the virus to activate. If the virus reactivates around the buttock and thigh, it can feel like sciatica. The presence of a red rash with blisters around the painful area is consistent with shingles.

Childbirth and endometriosis

During pregnancy, the pelvis can become compressed between the growing baby and the bones in the pelvis. Also, having the hips and knees flexed and supported in stirrups too long can also cause sciatica. However, pregnancy-related sciatica is often temporary. A less common cause that occurs in women is endometriosis. Endometriosis is the growth of tissue somewhere other than the uterus, usually the ovaries and fallopian tubes. In some cases, this tissue can accumulate around the sciatic nerve or the nerve itself. As the tissue responds to the changes taking place during a normal menstrual cycle, recurrent sciatica pain can present.

Vascular diagnoses

Arteries and veins in the pelvis and lower extremities that have become abnormal can cause sciatica. Either through compression or lack of oxygen from poor blood flow. An aneurysm can happen when the wall of the artery weakens and cannot withstand the pressure of the blood flowing through. This enlarges the artery and in some cases, the artery grows large enough to compress the nerve. Peripheral artery disease can cause sciatica when not enough blood is circulated from the heart to the muscles in the legs. If not enough oxygen is delivered to the muscles, leg pain and numbness can occur. It’s called claudication and is characterized by pain that is aggravated when walking and relieved when standing still. Risk factors for peripheral artery disease include:
  • Smokers both current and those who have quit
  • High blood pressure
  • High cholesterol
  • Diabetic

Diabetes/high blood sugar

Diabetic peripheral neuropathy happens from nerve damage caused by high blood sugar. Nerves that are exposed to chronic high blood sugar can get damaged from the disruption of proper blood flow or from an alteration of the cellular structure of the nerve.

Prescription meds

Nerve and muscle damage can happen as a side effect from prescription meds. Neuropathy and myopathy can cause symptoms that mimic sciatica brought on by disc herniation. Sometimes, if the medication is no longer taken the symptoms go away. The list of medications include:
  • Chemotherapy agents
  • Antibiotics
  • Statins medication to help lower cholesterol

Piriformis syndrome and back pocket wallets

 
 
The piriformis muscle originates on the sacrum, runs through the sciatic notch, shown above, and attaches the top of the femur. The sciatic notch also includes the sciatic nerve. Piriformis syndrome is caused when the piriformis muscle compresses the sciatic nerve. Individuals typically report pain in the buttocks that shoots down the same leg and is made worse when sitting. Piriformis syndrome can be difficult to diagnose, but physical exam maneuvers have been developed in aiding the diagnosis of the syndrome. They involve some form of hip abduction resistance and external rotation to cause a contraction of the piriformis muscle.  
11860 Vista Del Sol, Ste. 128 When Sciatica Is Not Spine Related
 

Back pocket wallet

Also known as wallet neuritis, and wallet sciatica are terms that have been used to describe compression of the sciatic nerve by a heavy/bulky wallet in a back pocket. It is similar to symptoms of piriformis syndrome and presents in the buttocks and the same leg that can get aggravated from sitting. Usually, if the wallet is the sole cause, taking the wallet from the back pocket to another pocket or other storage option often brings pain relief.

Conclusion non-spine related causes

While the majority of sciatica cases are caused by a back problem, injury, etc. There are various causes outside of the spinal column. Being able to describe the:
  • Location
  • Pain severity
  • Associated symptoms
  • Factors that aggravate and alleviate the pain
These can absolutely help your doctor, chiropractor, specialist accurately diagnose and generate an optimal customized treatment plan for spine-related or non-spine-related sciatica.

Chiropractors & Sciatica Syndrome Expose


 

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

The post When Sciatica Is Not Spine Related appeared first on PushAsRx Athletic Training Centers El Paso, TX.

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%%title%% %%sep%% PUSH as Rx %%excerpt%% back,causes,chiropractic,health,mimic,pain,related,sciatica,spine,symptoms,treatment,wellness,spine related 11860 Vista Del Sol, Ste. 128 When Sciatica Is Not Spine Related 11860 Vista Del Sol, Ste. 128 When Sciatica Is Not Spine Related 11860 Vista Del Sol, Ste. 128 When Sciatica Is Not Spine Related 26009
Lumbar Stenosis Surgery for Sciatica https://www.pushasrx.com/lumbar-stenosis-surgery-sciatica/ Fri, 24 Jul 2020 02:17:10 +0000 https://www.pushasrx.com/?p=25745 11860 Vista Del Sol, Ste. 128 Lumbar Stenosis Surgery for Sciatica

Lumbar stenosis surgery for sciatica, like any type of surgical procedure does not always yield the most successful results. This is why it’s important to carefully and methodically assess all of the personal risk factors. Sciatica causes severe pain and surgery could be an option and hopefully of last resort. However, it’ is important to […]

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11860 Vista Del Sol, Ste. 128 Lumbar Stenosis Surgery for Sciatica Lumbar stenosis surgery for sciatica, like any type of surgical procedure does not always yield the most successful results. This is why it’s important to carefully and methodically assess all of the personal risk factors. Sciatica causes severe pain and surgery could be an option and hopefully of last resort. However, it’ is important to first attempt non-surgical/non-pharmacological treatment/s for six to twelve weeks before surgery to relieve symptoms and root cause. A full course of conservative treatment could include:
  • Physical therapy
  • Chiropractic
  • Aerobic exercise
  • Pain meds
  • Epidural steroid injection
11860 Vista Del Sol, Ste. 128 Lumbar Stenosis Surgery for Sciatica
 

Sciatica and Stenosis

Sciatica can be caused by stenosis. This is when the spinal canal narrows, constricting, and pinching the nerves specifically the sciatic. Around ninety percent of cases stem from a herniated disc compressing the nerve roots. The damaged disc extends out and pinches the roots of the sciatic nerve. This pinching causes:  
 
  • Pain
  • Numbness
  • Tingling
  • Muscle weakness
If it stays like this for a long time an individual can experience incontinence, along with permanent nerve and muscle damage.
BulgingandHerniatedDiscs ElPasoChiropractor
 

Lumbar Stenosis Surgery Options

  • Lumbar stenosis surgery depends on the cause of sciatica: A single herniated disc could be pressing the nerve, which would only require the removal of just that portion of the disc that’s causing the compression. This procedure is known as a discectomy or microdiscectomy.
  • If the stenosis is caused by a bone problem like an arthritic bone spur, then space has to be made in the canal. This means a portion of the lamina or the back of the spinal column. This is called a hemilaminectomy. Sometimes the whole lamina has to be removed. This is known as a laminectomy.
third and fourth lumbar vertebrae lumbar vertebra lumbar spine vertebral bone
 
  • If there is the instability of the spinal column, some of the lumbar vertebrae will be fused together to prevent further instability and added nerve compression.
A non-operative treatment course lasting a few weeks to months could reduce swelling in the nerve and improve sciatica symptoms. What happens is sometimes the disc gets reabsorbed over time and does not irritate the sciatic nerve.

Surgical Success

If the non-surgical options yielded minimal positive results or completely failed and surgery is the last resort talk with your surgeon to discuss the risks and benefits. The discussion will focus on factors like:
  • Age
  • Health status – levels of wellness and illness
  • Underlying conditions
  • Bodyweight
  • Smoker
  • Type of work
Individuals sixty-five and older, multiple health problems, being overweight or a smoker will place an individual at a higher risk of post complications from surgery. Studies found individuals who underwent surgery for sciatica from lumbar stenosis, identified added risk factors that could affect the outcome including:
  • Depression: this was because there were patients that continued to have sciatica symptoms after surgery. This means they are more likely to take antidepressants or anticonvulsants.
  • Quality of life from health perspective was low.
  • Previous spine surgery
11860 Vista Del Sol, Ste. 128 Lumbar Stenosis Surgery for Sciatica
 
Knowing about these factors and the possible success of sciatica surgery is something to keep in mind. The best way to understand what and how the surgery will be beneficial is to understand the risks and to remember that the risks are not the same for everybody.

Optimization

Surgical success depends on making sure patients are optimized before surgery. Increasing the chances of successful surgery after conservative treatment/s a surgeon will ask the patient to take these steps:
  • Weight loss is difficult, but it has been shown to improve surgical outcomes.
  • A healthy but sensible diet with a moderate calorie deficit is essential.
  • Light aerobic exercise, such as stationary or recumbent cycling can help keep the body’s blood flowing properly.
  • Exercising with pain is difficult but it will increase the cardiovascular system along with keeping the heart and lungs healthy enough to undergo surgical stress.
  • If the exercising causes too much pain ask the doctor about anti-inflammatory, muscle relaxants, or steroid medication along with the non-surgical treatment that can provide relief allowing exercise to resume.
 

Quit smoking

Smoking increases the rate of spinal degeneration and impairs the body’s ability to heal properly and optimally after surgery. If the surgery is elective, meaning it is not a medical emergency, then it is strongly encouraged to quit smoking before surgery. This will increase the chances of eliminating the habit. Don’t be afraid to get support. cancer.org/smokeout.

Pro-activeness

If taking antidepressant/s for depression, do not quit taking the medication thinking it will improve sciatica surgery success. Mental health is extremely important. The same goes for anticonvulsant meds as well. Stopping anticonvulsant medication for spinal surgery will more than likely cause extended damage or pre/post-surgical complications. Pre-existing conditions like depression means bringing the mental health provider and other specialists into the pre-surgical discussion.
 

Sciatica Pain Rehabilitation

 
 

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

The post Lumbar Stenosis Surgery for Sciatica appeared first on PushAsRx Athletic Training Centers El Paso, TX.

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%%title%% %%sep%% PUSH as Rx %%excerpt%% chiropractic,health,lumbar,relief,sciatica,spinal,stenosis,success,surgery,wellness,lumbar stenosis surgery 11860 Vista Del Sol, Ste. 128 Lumbar Stenosis Surgery for Sciatica BulgingandHerniatedDiscs ElPasoChiropractor third and fourth lumbar vertebrae lumbar vertebra lumbar spine vertebral bone 11860 Vista Del Sol, Ste. 128 Lumbar Stenosis Surgery for Sciatica 25745
Times When Surgery for Sciatica Could Be Necessary https://www.pushasrx.com/times-surgery-sciatica-necessary/ https://www.pushasrx.com/times-surgery-sciatica-necessary/#respond Wed, 24 Jun 2020 02:25:12 +0000 https://www.pushasrx.com/?p=25561 11860 Vista Del Sol, Ste. 128 Times When Surgery for Sciatica Could Be Necessary

Surgery for sciatica is sometimes necessary if medications, chiropractic, and physical therapy are not working to relieve sciatica symptoms, but don’t worry. Individuals sometimes have sciatica that just does not respond to conservative treatment can find relief through surgical procedures.   Questions begin to pop up, as to which procedure makes the most sense, what […]

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11860 Vista Del Sol, Ste. 128 Times When Surgery for Sciatica Could Be Necessary Surgery for sciatica is sometimes necessary if medications, chiropractic, and physical therapy are not working to relieve sciatica symptoms, but don’t worry. Individuals sometimes have sciatica that just does not respond to conservative treatment can find relief through surgical procedures.  
11860 Vista Del Sol, Ste. 128 Times When Surgery for Sciatica Could Be Necessary
 
Questions begin to pop up, as to which procedure makes the most sense, what will the experience be like, and how long will it be until you can get back to a normal, pain-free life?

Sciatica

Sciatica is pain that runs down the longest nerve in the body, known as the sciatic nerve. Pain starts in the lower back and spreads down one leg, into the calf and possibly the foot. It is rare but sciatica can occur in both legs. The pain is mild to severe and feels worse when sneezing, coughing, bending, and standing/sitting in certain positions. The pain is often accompanied by numbness, tingling, or weakness in affected legs.  
 
Sciatica a set of symptoms caused by other medical problems like an injury, tumor, or the most common cause around 90% of the time is a herniated disc in the lower back. The soft-gel center of the disc pushes through the tough exterior, where it can pinch or press on the sciatic nerve causing pain. Research shows that sciatica affects 1% to 5% of the population, and around 40% will experience sciatica at some point in their life. Men between the ages of 30 and 50 have a higher risk along with smokers, individuals that sit for a long time, and those that perform physically strenuous work. Doctors and chiropractors can diagnose cases of sciatica with a medical history and physical exam. Diagnostic imaging can also be used in some cases.

When it’s Time to Consider Surgery for Sciatica

 
11860 Vista Del Sol, Ste. 128 Times When Surgery for Sciatica Could Be Necessary
 
Most individuals with sciatica respond positively with non-surgical treatments like chiropractic, physical therapy, acupuncture, medication, spinal injection/s, etc. This makes spine surgery a rarely needed treatment for low back and leg pain caused by sciatic nerve compression. But there are situations when surgery for sciatica could be beneficial.
  • With bowel or bladder dysfunction, this is also rare, but it can happen with spinal cord compression and cauda equina syndrome.
  • Spinal stenosis, where the doctor believes that surgery is the best approach.
  • There are neurologic dysfunctions like severe leg weakness
  • Symptoms become severe and non-surgical treatment is no longer effective
There are different types of surgical procedures for spine surgery. A spine surgeon will recommend the best approach for each patient’s sciatica. Which procedure they recommend will be based on the disorder causing sciatica with the entire procedure clearly explained so that you understand completely. Ask any questions to better understand the surgeon’s recommendation. Remember, the final decision is always up to you. A second opinion is recommended before deciding. Sciatica usually goes away on its own with the majority of cases managed with conservative treatment. Depending on the cause, this could be heat or ice packs, chiropractic, therapeutic massage, pain medication, stretching exercises, physical therapy, or injections.  

Sciatica for Surgery Options

Surgery for sciatica is performed to relieve the added compression/pressure on the nerves and relieve the pain. Options include a microdiscectomy and laminectomy. Each has its similarities and differences when it comes to the preparation, process, and recovery for the operation.  
 

Microdiscectomy

During a microdiscectomy, part or all of the herniated disc is removed. Research has shown the effectiveness of relieving pain to be around 80 to 95 percent of patients. The operation is done in a hospital or surgery center and requires about one hour to complete. General anesthesia is administered during this procedure.
  • A surgeon will make an incision over the affected disc.
  • Skin and tissue covering the disc will be opened and moved for better access. Some of the bone could be taken out as part of the procedure called a laminotomy.
  • The surgeon will use various tools to remove all or part of the herniated disc.
  • Once the removal is done, the surgeon will close the incision and send you to a recovery room.
  • To quicken the healing process patients are encouraged to start walking within hours of the procedure.
  • Most go home the same day. Some patients will have to stay at the hospital for observation. This could be from other conditions present.
  • You will not be allowed to operate a vehicle the same day. Therefore a designated driver will be necessary.

Laminectomy

third and fourth lumbar vertebrae lumbar vertebra lumbar spine vertebral bone
 
Preparation for a laminectomy is similar to a microdiscectomy. The lamina is the back part of the vertebrae, which protects the spinal canal. This procedure relieves pain by creating space for the nerves to move around.
  • The procedure takes about one to three hours from start to finish.
  • Both sides of the laminae are removed, along with the spinous process in the middle.
  • The patient lies face-down as the surgeon makes an incision near the affected vertebrae.
  • Skin and muscles are moved around and various tools/instruments are used to remove all or part of the lamina. Overgrowth of bone or spinal disc could also be removed.
  • The incision is stitched or stapled, bandaged, and sent to a recovery room.
  • Just like a microdiscectomy the individual will be encouraged to begin walking the same day.
  • Most individuals leave the hospital after surgery, however, a one to possible three-night could be required for others.
  • A driver does need to be designated for the ride home.
A microdiscectomy is recommended for stenosis caused by a herniated disc. However, if the stenosis is caused by another health issue/condition like bone spurs developed from arthritis, then a laminectomy could be the best approach. Laminectomies are usually performed on individuals in their 50s or 60s. While micro discectomies vary when it comes to age but are usually performed on younger individuals.

Recovery

 
 
At home, post-op rules need to be followed no matter what surgery for sciatica was performed. The incision area needs to stay clean and no lifting of heavy objects, bending and sitting for extended times. Surgery for sciatica is considered safe with complications being uncommon. All operations come with risks. These include nerve damage, blood clots, and infection. The provider needs to know about unusual symptoms after the procedure. This could be fever, excess drainage, or pain around the incision area. Pain meds could be prescribed to ease the post-surgery pain, and chiropractic along with physical therapy could be implemented to speed recovery. Individuals are typically cleared to return to work two to four weeks after the procedure. It could be six to eight weeks if their job/occupation is physically demanding and strenuous. Depending on how complex the spine surgery is an individual could be sitting upright the same day and walking within 24 hours. A course of pain meds could be prescribed to help manage postoperative pain. Instructions will be given on how to sit, rise, get out of bed, and stand in a careful manner. The body needs time to heal, so a doctor could recommend activity restriction. This could be anything that moves the spine too much. For sure contact sports, twisting, or heavy lifting during recovery are to be avoided. Report any problem/s like fever, increased pain, infection right away.

Spine Surgery Relief

Many individuals benefit from sciatica surgery, but it doesn’t work for everyone. A small percentage of individuals continue to feel discomfort in the weeks/months after. And sciatica can return in the future and in a different location. Your healthcare provider can help you decide if surgery for sciatica is the right choice for you.

Treating Severe & Complex Sciatica Syndromes

 

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

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What is Degenerative Disc Disease (DDD)?: An Overview https://www.pushasrx.com/what-is-degenerative-disc-disease-ddd-an-overview/ https://www.pushasrx.com/what-is-degenerative-disc-disease-ddd-an-overview/#respond Tue, 23 Jun 2020 22:49:57 +0000 https://www.pushasrx.com/?p=25563 What is Degenerative Disc Disease (DDD)?: An Overview | El Paso, TX Chiropractor

Degenerative Disc Disease is a general term for a condition in which the damaged intervertebral disc causes chronic pain, which could be either low back pain in the lumbar spine or neck pain in the cervical spine. It is not a “disease” per se, but actually a breakdown of an intervertebral disc of the spine. […]

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What is Degenerative Disc Disease (DDD)?: An Overview | El Paso, TX Chiropractor

Degenerative Disc Disease is a general term for a condition in which the damaged intervertebral disc causes chronic pain, which could be either low back pain in the lumbar spine or neck pain in the cervical spine. It is not a “disease” per se, but actually a breakdown of an intervertebral disc of the spine. The intervertebral disc is a structure that has a lot of attention being focused on recently, due to its clinical implications. The pathological changes that can occur in disc degeneration include fibrosis, narrowing, and disc desiccation. Various anatomical defects can also occur in the intervertebral disc such as sclerosis of the endplates, fissuring and mucinous degeneration of the annulus, and the formation of osteophytes.

 

Low back pain and neck pain are major epidemiological problems, which are thought to be related to degenerative changes in the disk. Back pain is the second leading cause of the visit to the clinician in the USA. It is estimated that about 80% of US adults suffer from low back pain at least once during their lifetime. (Modic, Michael T., and Jeffrey S. Ross) Therefore, a thorough understanding of degenerative disc disease is needed for managing this common condition.

 

Anatomy of Related Structures

 

Anatomy of the Spine

 

The spine is the main structure, which maintains the posture and gives rise to various problems with disease processes. The spine is composed of seven cervical vertebrae, twelve thoracic vertebrae, five lumbar vertebrae, and fused sacral and coccygeal vertebrae. The stability of the spine is maintained by three columns.

 

The anterior column is formed by anterior longitudinal ligament and the anterior part of the vertebral body. The middle column is formed by the posterior part of the vertebral body and the posterior longitudinal ligament. The posterior column consists of a posterior body arch that has transverse processes, laminae, facets, and spinous processes. (“Degenerative Disk Disease: Background, Anatomy, Pathophysiology”)

 

Anatomy of the Intervertebral Disc

 

Intervertebral disc lies between two adjacent vertebral bodies in the vertebral column. About one-quarter of the total length of the spinal column is formed by intervertebral discs. This disc forms a fibrocartilaginous joint, also called a symphysis joint. It allows a slight movement in the vertebrae and holds the vertebrae together. Intervertebral disc is characterized by its tension resisting and compression resisting qualities. An intervertebral disc is composed of mainly three parts; inner gelatinous nucleus pulposus, outer annulus fibrosus, and cartilage endplates that are located superiorly and inferiorly at the junction of vertebral bodies.

 

Nucleus pulposus is the inner part that is gelatinous. It consists of proteoglycan and water gel held together by type II Collagen and elastin fibers arranged loosely and irregularly. Aggrecan is the major proteoglycan found in the nucleus pulposus. It comprises approximately 70% of the nucleus pulposus and nearly 25% of the annulus fibrosus. It can retain water and provides the osmotic properties, which are needed to resist compression and act as a shock absorber. This high amount of aggrecan in a normal disc allows the tissue to support compressions without collapsing and the loads are distributed equally to annulus fibrosus and vertebral body during movements of the spine. (Wheater, Paul R, et al.)

 

The outer part is called annulus fibrosus, which has abundant type I collagen fibers arranged as a circular layer. The collagen fibers run in an oblique fashion between lamellae of the annulus in alternating directions giving it the ability to resist tensile strength. Circumferential ligaments reinforce the annulus fibrosus peripherally. On the anterior aspect, a thick ligament further reinforces annulus fibrosus and a thinner ligament reinforces the posterior side. (Choi, Yong-Soo)

 

Usually, there is one disc between every pair of vertebrae except between atlas and axis, which are first and second cervical vertebrae in the body. These discs can move about 6ᵒ in all the axes of movement and rotation around each axis. But this freedom of movement varies between different parts of the vertebral column. The cervical vertebrae have the greatest range of movement because the intervertebral discs are larger and there is a wide concave lower and convex upper vertebral body surfaces. They also have transversely aligned facet joints. Thoracic vertebrae have the minimum range of movement in flexion, extension, and rotation, but have free lateral flexion as they are attached to the rib cage. The lumbar vertebrae have good flexion and extension, again, because their intervertebral discs are large and spinous processes are posteriorly located. However, lateral lumbar rotation is limited because the facet joints are located sagittally. (“Degenerative Disk Disease: Background, Anatomy, Pathophysiology”)

 

Blood Supply

 

The intervertebral disc is one of the largest avascular structures in the body with capillaries terminating at the endplates. The tissues derive nutrients from vessels in the subchondral bone which lie adjacent to the hyaline cartilage at the endplate. These nutrients such as oxygen and glucose are carried to the intervertebral disc through simple diffusion. (“Intervertebral Disc – Spine – Orthobullets.Com”)

 

Nerve Supply

 

Sensory innervation of intervertebral discs is complex and varies according to the location in the spinal column. Sensory transmission is thought to be mediated by substance P, calcitonin, VIP, and CPON. Sinu vertebral nerve, which arises from the dorsal root ganglion, innervates the superficial fibers of the annulus. Nerve fibers don’t extend beyond the superficial fibers.

 

Lumbar intervertebral discs are additionally supplied on the posterolateral aspect with branches from ventral primary rami and from the grey rami communicantes near their junction with the ventral primary rami. The lateral aspects of the discs are supplied by branches from rami communicantes. Some of the rami communicantes may cross the intervertebral discs and become embedded in the connective tissue, which lies deep to the origin of the psoas. (Palmgren, Tove, et al.)

 

The cervical intervertebral discs are additionally supplied on the lateral aspect by branches of the vertebral nerve. The cervical sinu vertebral nerves were also found to be having an upward course in the vertebral canal supplying the disc at their point of entry and the one above. (BOGDUK, NIKOLAI, et al.)

 

Pathophysiology of Degenerative Disc Disease

 

Approximately 25% of people before the age of 40 years show disc degenerative changes at some level. Over 40 years of age, MRI evidence shows changes in more than 60% of people. (Suthar, Pokhraj) Therefore, it is important to study the degenerative process of the intervertebral discs as it has been found to degenerate faster than any other connective tissue in the body, leading to back and neck pain. The changes in three intervertebral discs are associated with changes in the vertebral body and joints suggesting a progressive and dynamic process.

 

Degeneration Phase

 

The degenerative process of the intervertebral discs has been divided into three stages, according to Kirkaldy-Willis and Bernard, called ‘‘degenerative cascade’’. These stages can overlap and can occur over the course of decades. However, identifying these stages clinically is not possible due to the overlap of symptoms and signs.

 

Stage 1 (Degeneration Phase)

 

This stage is characterized by degeneration. There are histological changes, which show circumferential tears and fissures in the annulus fibrosus. These circumferential tears may turn into radial tears and because the annulus pulposus is well innervated, these tears can cause back pain or neck pain, which is localized and with painful movements. Due to repeated trauma in the discs, endplates can separate leading to disruption of the blood supply to the disc and therefore, depriving it of its nutrient supply and removal of waste. The annulus may contain micro-fractures in the collagen fibrils, which can be seen on electron microscopy and an MRI scan may reveal desiccation, bulging of the disc, and a high-intensity zone in the annulus. Facet joints may show a synovial reaction and it may cause severe pain with associated synovitis and inability to move the joint in the zygapophyseal joints. These changes may not necessarily occur in every person. (Gupta, Vijay Kumar, et al.)

 

The nucleus pulposus is also involved in this process as its water imbibing capacity is reduced due to the accumulation of biochemically changed proteoglycans. These changes are brought on mainly by two enzymes called matrix metalloproteinase-3 (MMP-3) and tissue inhibitor of metalloproteinase-1 (TIMP-1). (Bhatnagar, Sushma, and Maynak Gupta) Their imbalance leads to the destruction of proteoglycans. The reduced capacity to absorb water leads to a reduction of hydrostatic pressure in the nucleus pulposus and causes the annular lamellae to buckle. This can increase the mobility of that segment resulting in shear stress to the annular wall. All these changes can lead to a process called annular delamination and fissuring in the annulus fibrosus. These are two separate pathological processes and both can lead to pain, local tenderness, hypomobility, contracted muscles, painful joint movements. However, the neurological examination at this stage is usually normal.

 

Stage 2 (Phase of Instability)

 

The stage of dysfunction is followed by a stage of instability, which may result from the progressive deterioration of the mechanical integrity of the joint complex. There may be several changes encountered at this stage, including disc disruption and resorption, which can lead to a loss of disc space height. Multiple annular tears may also occur at this stage with concurrent changes in the zagopophyseal joints. They may include degeneration of the cartilage and facet capsular laxity leading to subluxation. These biomechanical changes result in instability of the affected segment.

 

The symptoms seen in this phase are similar to those seen in the dysfunction phase such as “giving way” of the back, pain when standing for prolonged periods, and a “catch” in the back with movements. They are accompanied by signs such as abnormal movements in the joints during palpation and observing that the spine sways or shifts to a side after standing erect for sometime after flexion. (Gupta, Vijay Kumar et al.)

 

Stage 3 (Re-Stabilization Phase)

 

In this third and final stage, the progressive degeneration leads to disc space narrowing with fibrosis and osteophyte formation and transdiscal bridging. The pain arising from these changes is severe compared to the previous two stages, but these can vary between individuals. This disc space narrowing can have several implications on the spine. This can cause the intervertebral canal to narrow in the superior-inferior direction with the approximation of the adjacent pedicles. Longitudinal ligaments, which support the vertebral column, may also become deficient in some areas leading to laxity and spinal instability. The spinal movements can cause the ligamentum flavum to bulge and can cause superior aricular process subluxation. This ultimately leads to a reduction of diameter in the anteroposterior direction of the intervertebral space and stenosis of upper nerve root canals.

 

Formation of osteophytes and hypertrophy of facets can occur due to the alteration in axial load on the spine and vertebral bodies. These can form on both superior and inferior articular processes and osteophytes can protrude to the intervertebral canal while the hypertrophied facets can protrude to the central canal. Osteophytes are thought to be made from the proliferation of articular cartilage at the periosteum after which they undergo endochondral calcification and ossification. The osteophytes are also formed due to the changes in oxygen tension and due to changes in fluid pressure in addition to load distribution defects. The osteophytes and periarticular fibrosis can result in stiff joints. The articular processes may also orient in an oblique direction causing retrospondylolisthesis leading to the narrowing of the intervertebral canal, nerve root canal, and the spinal canal. (KIRKALDY-WILLIS, W H et al.)

 

All of these changes lead to low back pain, which decreases with severity. Other symptoms like reduced movement, muscle tenderness, stiffness, and scoliosis can occur. The synovial stem cells and macrophages are involved in this process by releasing growth factors and extracellular matrix molecules, which act as mediators. The release of cytokines has been found to be associated with every stage and may have therapeutic implications in future treatment development.

 

Etiology of the Risk Factors of Degenerative Disc Disease

 

Aging and Degeneration

 

It is difficult to differentiate aging from degenerative changes. Pearce et al have suggested that aging and degeneration is representing successive stages within a single process that occur in all individuals but at different rates. Disc degeneration, however, occurs most often at a faster rate than aging. Therefore, it is encountered even in patients of working age.

 

There appears to be a relationship between aging and degeneration, but no distinct cause has yet been established. Many studies have been conducted regarding nutrition, cell death, and accumulation of degraded matrix products and the failure of the nucleus. The water content of the intervertebral disc decreases with the increasing age. Nucleus pulposus can get fissures that can extend into the annulus fibrosus. The start of this process is termed chondrosis inter vertebralis, which can mark the beginning of the degenerative destruction of the intervertebral disc, the endplates, and the vertebral bodies. This process causes complex changes in the molecular composition of the disc and has biomechanical and clinical sequelae that can often result in substantial impairment in the affected individual.

 

The cell concentration in the annulus decreases with increasing age. This is mainly because the cells in the disc are subjected to senescence and they lose the ability to proliferate. Other related causes of age-specific degeneration of intervertebral discs include cell loss, reduced nutrition, post-translational modification of matrix proteins, accumulation of products of degraded matrix molecules, and fatigue failure of the matrix. Decreasing nutrition to the central disc, which allows the accumulation of cell waste products and degraded matrix molecules seems to be the most important change out of all these changes. This impairs nutrition and causes a fall in the pH level, which can further compromise cell function and may lead to cell death. Increased catabolism and decreased anabolism of senescent cells may promote degeneration. (Buckwalter, Joseph A.) According to one study, there were more senescence cells in the nucleus pulposus compared to annulus fibrosus and herniated discs had a higher chance of cell senescence.  (Roberts, S. et al.)

 

When the aging process goes on for some time, the concentrations of chondroitin 4 sulfate and chondroitin 5 sulfate, which is strongly hydrophilic, gets decreased while the keratin sulfate to chondroitin sulfate ratio gets increased. Keratan sulfate is mildly hydrophilic and it also has a minor tendency to form stable aggregates with hyaluronic acid. As aggrecan is fragmented, and its molecular weight and numbers are decreased, the viscosity and hydrophilicity of the nucleus pulposus decrease. Degenerative changes to the intervertebral discs are accelerated by the reduced hydrostatic pressure of the nucleus pulposus and the decreased supply of nutrients by diffusion. When the water content of the extracellular matrix is decreased, intervertebral disc height will also be decreased. The resistance of the disc to an axial load will also be reduced. Because the axial load is then transferred directly to the annulus fibrosus, annulus clefts can get torn easily.

 

All these mechanisms lead to structural changes seen in degenerative disc disease. Due to the reduced water content in the annulus fibrosus and associated loss of compliance, the axial load can get redistributed to the posterior aspect of facets instead of the normal anterior and middle part of facets. This can cause facet arthritis, hypertrophy of the adjacent vertebral bodies, and bony spurs or bony overgrowths, known as osteophytes, as a result of degenerative discs. (Choi, Yong-Soo)

 

Genetics and Degeneration

 

The genetic component has been found to be a dominant factor in degenerative disc disease. Twin studies, and studies involving mice, have shown that genes play a role in disc degeneration. (Boyd, Lawrence M., et al.) Genes that code for collagen I, IX, and XI, interleukin 1, aggrecan, vitamin D receptor, matrix metalloproteinase 3 (MMP – 3), and other proteins are among the genes that are suggested to be involved in degenerative disc disease. Polymorphisms in 5 A and 6 A alleles occurring in the promoter region of genes that regulate MMP 3 production are found to be a major factor for the increased lumbar disc degeneration in the elderly population. Interactions among these various genes contribute significantly to intervertebral disc degeneration disease as a whole.

 

Nutrition and Degeneration

 

Disc degeneration is also believed to occur due to the failure of nutritional supply to the intervertebral disc cells. Apart from the normal aging process, the nutritional deficiency of the disc cells is adversely affected by endplate calcification, smoking, and the overall nutritional status. Nutritional deficiency can lead to the formation of lactic acid together with the associated low oxygen pressure. The resulting low pH can affect the ability of disc cells to form and maintain the extracellular matrix of the discs and causes intervertebral disc degeneration. The degenerated discs lack the ability to respond normally to the external force and may lead to disruptions even from the slightest back strain. (Taher, Fadi, et al.)

 

Growth factors stimulate the chondrocytes and fibroblasts to produce more amount of extracellular matrix. It also inhibits the synthesis of matrix metalloproteinases. Example of these growth factors includes transforming growth factor, insulin-like growth factor, and basic fibroblast growth factor. The degraded matrix is repaired by an increased level of transforming growth factor and basic fibroblast growth factor.

 

Environment and Degeneration

 

Even though all the discs are of the same age, discs found in the lower lumbar segments are more vulnerable to degenerative changes than the discs found in the upper segment. This suggests that not only aging but, also mechanical loading, is a causative factor. The association between degenerative disc disease and environmental factors has been defined in a comprehensive manner by Williams and Sambrook in 2011. (Williams, F.M.K., and P.N. Sambrook) The heavy physical loading associated with your occupation is a risk factor that has some contribution to disc degenerative disease. There is also a possibility of chemicals causing disc degeneration, such as smoking, according to some studies. (Battié, Michele C.) Nicotine has been implicated in twin studies to cause impaired blood flow to the intervertebral disc, leading to disc degeneration. (BATTIÉ, MICHELE C., et al.) Moreover, an association has been found among atherosclerotic lesions in the aorta and the low back pain citing a link between atherosclerosis and degenerative disc disease. (Kauppila, L.I.) The disc degeneration severity was implicated in overweight, obesity, metabolic syndrome, and increased body mass index in some studies. (“A Population-Based Study Of Juvenile Disc Degeneration And Its Association With Overweight And Obesity, Low Back Pain, And Diminished Functional Status. Samartzis D, Karppinen J, Mok F, Fong DY, Luk KD, Cheung KM. J Bone Joint Surg Am 2011;93(7):662–70”)

 

Pain in Disc Degeneration (Discogenic Pain)

 

Discogenic pain, which is a type of nociceptive pain, arises from the nociceptors in the annulus fibrosus when the nervous system is affected by the degenerative disc disease. Annulus fibrosus contains immune reactive nerve fibers in the outer layer of the disc with other chemicals such as a vasoactive intestinal polypeptide, calcitonin gene-related peptide, and substance P. (KONTTINEN, YRJÖ T., et al.) When degenerative changes in the intervertebral discs occur, normal structure and mechanical load are changed leading to abnormal movements. These disc nociceptors can get abnormally sensitized to mechanical stimuli. The pain can also be provoked by the low pH environment caused by the presence of lactic acid, causing increased production of pain mediators.

 

Pain from degenerative disc disease may arise from multiple origins. It may occur due to the structural damage, pressure, and irritation on the nerves in the spine. The disc itself contains only a few nerve fibers, but any injury can sensitize these nerves, or those in the posterior longitudinal ligament, to cause pain. Micro movements in the vertebrae can occur, which may cause painful reflex muscle spasms because the disc is damaged and worn down with the loss of tension and height. The painful movements arise because the nerves supplying the area are compressed or irritated by the facet joints and ligaments in the foramen leading to leg and back pain. This pain may be aggravated by the release of inflammatory proteins that act on nerves in the foramen or descending nerves in the spinal canal.

 

Pathological specimens of the degenerative discs, when observed under the microscope, reveals that there are vascularized granulation tissue and extensive innervations found in the fissures of the outer layer of the annulus fibrosus extending into the nucleus pulposus. The granulation tissue area is infiltrated by abundant mast cells and they invariably contribute to the pathological processes that ultimately lead to discogenic pain. These include neovascularisation, intervertebral disc degeneration, disc tissue inflammation, and the formation of fibrosis. Mast cells also release substances, such as tumor necrosis factor and interleukins, which might signal for the activation of some pathways which play a role in causing back pain. Other substances that can trigger these pathways include phospholipase A2, which is produced from the arachidonic acid cascade. It is found in increased concentrations in the outer third of the annulus of the degenerative disc and is thought to stimulate the nociceptors located there to release inflammatory substances to trigger pain. These substances bring about axonal injury, intraneural edema, and demyelination. (Brisby, Helena)

 

The back pain is thought to arise from the intervertebral disc itself. Hence why the pain will decrease gradually over time when the degenerating disc stops inflicting pain. However, the pain actually arises from the disc itself only in 11% of patients according to endoscopy studies. The actual cause of back pain seems to be due to the stimulation of the medial border of the nerve and referred pain along the arm or leg seems to arise due to the stimulation of the core of the nerve. The treatment for disc degeneration should mainly focus on pain relief to reduce the suffering of the patient because it is the most disabling symptom that disrupts a patient’s lives. Therefore, it is important to establish the mechanism of pain because it occurs not only due to the structural changes in the intervertebral discs but also due to other factors such as the release of chemicals and understanding these mechanisms can lead to effective pain relief. (Choi, Yong-Soo)

 

Clinical Presentation of Degenerative Disc Disease

 

Patients with degenerative disc disease face a myriad of symptoms depending on the site of the disease. Those who have lumbar disc degeneration get low back pain, radicular symptoms, and weakness. Those who have cervical disc degeneration have neck pain and shoulder pain.

 

Low back pain can get exacerbated by the movements and the position. Usually, the symptoms are worsened by the flexion, while the extension often relieves them. Minor twisting injuries, even from swinging a golf club, can trigger the symptoms. The pain is usually observed to be less when walking or running, when changing the position frequently and when lying down. However, the pain is usually subjective and in many cases, it varies considerably from person to person and most people will suffer from a low level of chronic pain of the lower back region continuously while occasionally suffering from the groin, hip, and leg pain. The intensity of the pain will increase from time to time and will last for a few days and then subside gradually. This “flare-up” is an acute episode and needs to be treated with potent analgesics. Worse pain is experienced in the seated position and is exacerbated while bending, lifting, and twisting movements frequently. The severity of the pain can vary considerably with some having occasional nagging pain to others having severe and disabling pain intermittently.  (Jason M. Highsmith, MD)

 

The localized pain and tenderness in the axial spine usually arises from the nociceptors found within the intervertebral discs, facet joints, sacroiliac joints, dura mater of the nerve roots, and the myofascial structures found within the axial spine. As mentioned in the previous sections, the degenerative anatomical changes may result in a narrowing of the spinal canal called spinal stenosis, overgrowth of spinal processes called osteophytes, hypertrophy of the inferior and superior articular processes, spondylolisthesis, bulging of the ligamentum flavum and disc herniation. These changes result in a collection of symptoms that is known as neurogenic claudication. There may be symptoms such as low back pain and leg pain together with numbness or tingling in the legs, muscle weakness, and foot drop. Loss of bowel or bladder control may suggest spinal cord impingement and prompt medical attention is needed to prevent permanent disabilities. These symptoms can vary in severity and may present to varying extents in different individuals.

 

The pain can also radiate to other parts of the body due to the fact that the spinal cord gives off several branches to two different sites of the body. Therefore, when the degenerated disc presses on a spinal nerve root, the pain can also be experienced in the leg to which the nerve ultimately innervates. This phenomenon, called radiculopathy, can occur from many sources arising, due to the process of degeneration. The bulging disc, if protrudes centrally, can affect descending rootlets of the cauda equina, if it bulges posterolaterally, it might affect the nerve roots exiting at the next lower intervertebral canal and the spinal nerve within its ventral ramus can get affected when the disc protrudes laterally. Similarly, the osteophytes protruding along the upper and lower margins of the posterior aspect of vertebral bodies can impinge on the same nervous tissues causing the same symptoms. Superior articular process hypertrophy may also impinge upon nerve roots depending on their projection. The nerves may include nerve roots prior to exiting from the next lower intervertebral canal and nerve roots within the upper nerve root canal and dural sac. These symptoms, due to the nerve impingement, have been proven by cadaver studies. Neural compromise is thought to occur when the neuro foraminal diameter is critically occluded with a 70% reduction. Furthermore, neural compromise can be produced when the posterior disc is compressed less than 4 millimeters in height, or when the foraminal height is reduced to less than 15 millimeters leading to foraminal stenosis and nerve impingement. (Taher, Fadi, et al.)

 

Diagnostic Approach

 

Patients are initially evaluated with an accurate history and thorough physical examination and appropriate investigations and provocative testing. However, history is often vague due to the chronic pain which cannot be localized properly and the difficulty in determining the exact anatomical location during provocative testing due to the influence of the neighboring anatomical structures.

 

Through the patient’s history, the cause of low back pain can be identified as arising from the nociceptors in the intervertebral discs. Patients may also give a history of the chronic nature of the symptoms and associated gluteal region numbness, tingling as well as stiffness in the spine which usually worsens with activity. Tenderness may be elicited by palpating over the spine. Due to the nature of the disease being chronic and painful, most patients may be suffering from mood and anxiety disorders. Depression is thought to be contributing negatively to the disease burden. However, no clear relationship between disease severity and mood or anxiety disorders. It is good to be vigilant about these mental health conditions as well. In order to exclude other serious pathologies, questions must be asked regarding fatigue, weight loss, fever, and chills, which might indicate some other diseases. (Jason M. Highsmith, MD)

 

Another etiology for the low back pain has to be excluded when examining the patient for degenerative disc disease. Abdominal pathologies, which can give rise to back pain such as aortic aneurysm, renal calculi, and pancreatic disease, have to be excluded.

 

Degenerative disc disease has several differential diagnoses to be considered when a patient presents with back pain. These include; idiopathic low back pain, zygapophyseal joint degeneration, myelopathy, lumbar stenosis, spondylosis, osteoarthritis, and lumbar radiculopathy. (“Degenerative Disc Disease – Physiopedia”)

 

Investigations

 

Investigations are used to confirm the diagnosis of degenerative disc disease. These can be divided into laboratory studies, imaging studies, nerve conduction tests, and diagnostic procedures.

 

Imaging Studies

 

The imaging in degenerative disc disease is mainly used to describe anatomical relations and morphological features of the affected discs, which has a great therapeutic value in future decision making for treatment options. Any imaging method, like plain radiography, CT, or MRI, can provide useful information. However, an underlying cause can only be found in 15% of the patients as no clear radiological changes are visible in degenerative disc disease in the absence of disc herniation and neurological deficit. Moreover, there is no correlation between the anatomical changes seen on imaging and the severity of the symptoms, although there are correlations between the number of osteophytes and the severity of back pain. Degenerative changes in radiography can also be seen in asymptomatic people leading to difficulty in conforming clinical relevance and when to start treatment. (“Degenerative Disc Disease – Physiopedia”)

 

Plain Radiography

 

This inexpensive and widely available plain cervical radiography can give important information on deformities, alignment, and degenerative bony changes. In order to determine the presence of spinal instability and sagittal balance, dynamic flexion, or extension studies have to be performed.

 

Magnetic Resonance Imaging (MRI)

 

MRI is the most commonly used method to diagnose degenerative changes in the intervertebral disc accurately, reliably, and most comprehensively. It is used in the initial evaluation of patients with neck pain after plain radiography. It can provide non-invasive images in multiple plains and gives excellent quality images of the disc. MRI can show disc hydration and morphology-based on the proton density, chemical environment, and the water content. Clinical picture and history of the patient have to be considered when interpreting MRI reports as it has been shown that as much as 25% of radiologists change their report when the clinical data are available. Fonar produced the first open MRI scanner with the ability of the patient to be scanned in different positions such as standing, sitting, and bending. Because of these unique features, this open MRI scanner can be used for scanning patients in weight-bearing postures and stand up postures to detect underlying pathological changes which are usually overlooked in conventional MRI scan such as lumbar degenerative disc disease with herniation. This machine is also good for claustrophobic patients, as they get to watch a large television screen during the scanning process. (“Degenerative Disk Disease: Background, Anatomy, Pathophysiology.”)

 

Nucleus pulposus and annulus fibrosus of the disc can usually be identified on MRI, leading to the detection of disc herniation as contained and non contained. As MRI can also show annular tears and the posterior longitudinal ligament, it can be used to classify herniation. This can be simple annular bulging to free fragment disc herniations. This information can describe the pathologic discs such as extruded disc, protruded discs, and migrated discs.

 

There are several grading systems based on MRI signal intensity, disc height, the distinction between nucleus and annulus, and the disc structure. The method, by Pfirrmann et al, has been widely applied and clinically accepted. According to the modified system, there are 8 grades for lumbar disc degenerative disease. Grade 1 represents normal intervertebral disc and grade 8 corresponds to the end stage of degeneration, depicting the progression of the disc disease. There are corresponding images to aid the diagnosis. As they provide good tissue differentiation and detailed description of the disc structure, sagittal T2 weighted images are used for the classification purpose. (Pfirrmann, Christian W. A., et al.)

 

Modic has described the changes occurring in the vertebral bodies adjacent to the degenerating discs as Type 1 and Type 2 changes. In Modic 1 changes, there is decreased intensity of T1 weighted images and increased intensity T2 weighted images. This is thought to occur because the end plates have undergone sclerosis and the adjacent bone marrow is showing inflammatory response as the diffusion coefficient increases. This increase of diffusion coefficient and the ultimate resistance to diffusion is brought about by the chemical substances released through an autoimmune mechanism. Modic type 2 changes include the destruction of the bone marrow of adjacent vertebral endplates due to an inflammatory response and the infiltration of fat in the marrow. These changes may lead to increased signal density on T1 weighted images. (Modic, M T et al.)

 

Computed Tomography (CT)

 

When MRI is not available, Computed tomography is considered a diagnostic test that can detect disc herniation because it has a better contrast between posterolateral margins of the adjacent bony vertebrae, perineal fat, and the herniated disc material. Even so, when diagnosing lateral herniations, MRI remains the imaging modality of choice.

 

CT scan has several advantages over MRI such as it has a less claustrophobic environment, low cost, and better detection of bonny changes that are subtle and may be missed on other modalities. CT can detect early degenerative changes of the facet joints and spondylosis with more accuracy. Bony integrity after fusion is also best assessed by CT.

 

Disc herniation and associated nerve impingement can be diagnosed by using the criteria developed by Gundry and Heithoff. It is important for the disc protrusion to lie directly over the nerve roots traversing the disc and to be focal and asymmetrical with a dorsolateral position. There should be demonstrable nerve root compression or displacement. Lastly, the nerve distal to the impingement (site of herniation) often enlarges and bulges with resulting edema, prominence of adjacent epidural veins, and inflammatory exudates resulting in blurring the margin.

 

Lumbar Discography

 

This procedure is controversial and, whether knowing the site of the pain has any value regarding surgery or not, has not been proven. False positives can occur due to central hyperalgesia in patients with chronic pain (neurophysiologic finding) and due to psychosocial factors. It is questionable to establish exactly when discogenic pain becomes clinically significant. Those who support this investigation advocates strict criteria for selection of the patients and when interpreting results and believe this is the only test that can diagnose discogenic pain. Lumbar discography can be used in several situations, although it is not scientifically established. These include; diagnosis of lateral herniation, diagnosing a symptomatic disc among multiple abnormalities, assessing similar abnormalities seen on CT or MRI, evaluation of the spine after surgery, selection of fusion level, and the suggestive features of discogenic pain existence.

 

The discography is more concerned about eliciting pathophysiology rather than determining the anatomy of the disc. Therefore, discogenic pain evaluation is the aim of discography. MRI may reveal an abnormally looking disc with no pain, while severe pain may be seen on discography where MRI findings are few. During the injection of normal saline or the contrast material, a spongy endpoint can occur with abnormal discs accepting more amounts of contrast. The contrast material can extend into the nucleus pulposus through tears and fissures in the annulus fibrosus in the abnormal discs. The pressure of this contrast material can provoke pain due to the innervations by recurrent meningeal nerve, mixed spinal nerve, anterior primary rami, and gray rami communicantes supplying the outer annulus fibrosus. Radicular pain can be provoked when the contrast material reaches the site of nerve root impingement by the abnormal disc. However, this discography test has several complications such as nerve root injury, chemical or bacterial diskitis, contrast allergy, and the exacerbation of pain. (Bartynski, Walter S., and A. Orlando Ortiz)

 

Imaging Modality Combination

 

In order to evaluate the nerve root compression and cervical stenosis adequately, a combination of imaging methods may be needed.

 

CT Discography

 

After performing initial discography, CT discography is performed within 4 hours. It can be used in determining the status of the disc such as herniated, protruded, extruded, contained or sequestered. It can also be used in the spine to differentiate the mass effects of scar tissue or disc material after spinal surgery.

 

CT Myelography

 

This test is considered the best method for evaluating nerve root compression. When CT is performed in combination or after myelography, details about bony anatomy different planes can be obtained with relative ease.

 

Diagnostic Procedures

 

Transforaminal Selective Nerve Root Blocks (SNRBs)

 

When multilevel degenerative disc disease is suspected on an MRI scan, this test can be used to determine the specific nerve root that has been affected. SNRB is both a diagnostic and therapeutic test that can be used for lumbar spinal stenosis. The test creates a demotomal level area of hypoesthesia by injecting an anesthetic and a contrast material under fluoroscopic guidance to the interested nerve root level. There is a correlation between multilevel cervical degenerative disc disease clinical symptoms and findings on MRI and findings of SNRB according to Anderberg et al. There is a 28% correlation with SNRB results and with dermatomal radicular pain and areas of neurologic deficit. Most severe cases of degeneration on MRI are found to be correlated with 60%. Although not used routinely, SNRB is a useful test in evaluating patients before surgery in multilevel degenerative disc disease especially on the spine together with clinical features and findings on MRI. (Narouze, Samer, and Amaresh Vydyanathan)

 

Electro Myographic Studies

 

Distal motor and sensory nerve conduction tests, called electromyographic studies, that are normal with abnormal needle exam may reveal nerve compression symptoms that are elicited in the clinical history. Irritated nerve roots can be localized by using injections to anesthetize the affected nerves or pain receptors in the disc space, sacroiliac joint, or the facet joints by discography. (“Journal Of Electromyography & Kinesiology Calendar”)

 

Laboratory Studies

 

Laboratory tests are usually done to exclude other differential diagnoses.

 

As seronegative spondyloarthropathies, such as ankylosing spondylitis, are common causes of back pain, HLA B27 immuno-histocompatibility has to be tested. Estimated 350,000 persons in the US and 600,000 in Europe have been affected by this inflammatory disease of unknown etiology. But HLA B27 is extremely rarely found in African Americans. Other seronegative spondyloarthropathies that can be tested using this gene include psoriatic arthritis, inflammatory bowel disease, and reactive arthritis or Reiter syndrome. Serum immunoglobulin A (IgA) can be increased in some patients.

 

Tests like the erythrocyte sedimentation rate (ESR) and C- reactive protein (CRP) level test for the acute phase reactants seen in inflammatory causes of lower back pain such as osteoarthritis and malignancy. The full blood count is also required, including differential counts to ascertain the disease etiology. Autoimmune diseases are suspected when Rheumatoid factor (RF) and anti-nuclear antibody (ANA) tests become positive. Serum uric acid and synovial fluid analysis for crystals may be needed in rare cases to exclude gout and pyrophosphate dihydrate deposition.

 

Treatment

 

There is no definitive treatment method agreed by all physicians regarding the treatment of degenerative disc disease because the cause of the pain can differ in different individuals and so is the severity of pain and the wide variations in clinical presentation. The treatment options can be discussed broadly under; conservative treatment, medical treatment, and surgical treatment.

 

Conservative Treatment

 

This treatment method includes exercise therapy with behavioral interventions, physical modalities, injections, back education, and back school methods.

 

Exercise-Based Therapy with Behavioral Interventions

 

Depending on the diagnosis of the patient, different types of exercises can be prescribed. It is considered one of the main methods of conservative management to treat chronic low back pain. The exercises can be modified to include stretching exercises, aerobic exercises, and muscle strengthening exercises. One of the major challenges of this therapy includes its inability to assess the efficacy among patients due to wide variations in the exercise regimens, frequency, and intensity. According to studies, most effectiveness for sub-acute low back pain with varying duration of symptoms was obtained by performing graded exercise programs within the occupational setting of the patient. Significant improvements were observed among patients suffering from chronic symptoms with this therapy with regard to functional improvement and pain reduction. Individual therapies designed for each patient under close supervision and compliance of the patient also seems to be the most effective in chronic back pain sufferers. Other conservative approaches can be used in combination to improve this approach. (Hayden, Jill A., et al.)

 

Aerobic exercises, if performed regularly, can improve endurance. For relieving muscle tension, relaxation methods can be used. Swimming is also considered an exercise for back pain. Floor exercises can include extension exercises, hamstring stretches, low back stretches, double knee to chin stretches, seat lifts, modified sit-ups, abdominal bracing, and mountain and sag exercises.

 

Physical Modalities

 

This method includes the use of electrical nerve stimulation, relaxation, ice packs, biofeedback, heating pads, phonophoresis, and iontophoresis.

 

Transcutaneous Electrical Nerve Stimulation (TENS)

 

In this non-invasive method, electrical stimulation is delivered to the skin in order to stimulate the peripheral nerves in the area to relieve the pain to some extent. This method relieves pain immediately following application but its long term effectiveness is doubtful. With some studies, it has been found that there is no significant improvement in pain and functional status when compared with placebo. The devices performing these TENS can be easily accessible from the outpatient department. The only side effect seems to be a mild skin irritation experienced in a third of patients. (Johnson, Mark I)

 

Back School

 

This method was introduced with the aim of reducing the pain symptoms and their recurrences. It was first introduced in Sweden and takes into account the posture, ergonomics, appropriate back exercises, and the anatomy of the lumbar region. Patients are taught the correct posture to sit, stand, lift weights, sleep, wash face, and brush teeth avoiding pain. When compared with other treatment modalities, back school therapy has been proven to be effective in both immediate and intermediate periods for improving back pain and functional status.

 

Patient Education

 

In this method, the provider instructs the patient on how to manage their back pain symptoms. Normal spinal anatomy and biomechanics involving mechanisms of injury is taught at first. Next, using the spinal models, the degenerative disc disease diagnosis is explained to the patient. For the individual patient, the balanced position is determined and then asked to maintain that position to avoid getting symptoms.

 

Bio-Psychosocial Approach to Multidisciplinary Back Therapy

 

Chronic back pain can cause a lot of distress to the patient, leading to psychological disturbances and low mood. This can adversely affect the therapeutic outcomes rendering most treatment strategies futile. Therefore, patients must be educated on learned cognitive strategies called “behavioral” and “bio-psychosocial” strategies to get relief from pain. In addition to treating the biological causes of pain, psychological, and social causes should also be addressed in this method. In order to reduce the patient’s perception of pain and disability, methods like modified expectations, relaxation techniques, control of physiological responses by learned behavior, and reinforcement are used.

 

Massage Therapy

 

For chronic low back pain, this therapy seems to be beneficial. Over a 1 year period, massage therapy has been found to be moderately effective for some patients when compared to acupuncture and other relaxation methods. However, it is less efficacious than TENS and exercise therapy although individual patients may prefer one over the other. (Furlan, Andrea D., et al.)

 

Spinal Manipulation

 

This therapy involves the manipulation of a joint beyond its normal range of movement, but not exceeding that of the normal anatomical range. This is a manual therapy that involves long lever manipulation with a low velocity. It is thought to improve low back pain through several mechanisms like the release of entrapped nerves, destruction of articular and peri-articular adhesions, and through manipulating segments of the spine that had undergone displacement. It can also reduce the bulging of the disc, relax the hypertonic muscles, stimulate the nociceptive fibers via changing the neurophysiological function and reposition the menisci on the articular surface.

 

Spinal manipulation is thought to be superior in efficacy when compared to most methods such as TENS, exercise therapy, NSAID drugs, and back school therapy. The currently available research is positive regarding its effectiveness in both the long and short term. It is also very safe to administer under-trained therapists with cases of disc herniation and cauda equina being reported only in lower than 1 in 3.7 million people. (Bronfort, Gert, et al.)

 

Lumbar Supports

 

Patients suffering from chronic low back pain due to degenerative processes at multiple levels with several causes may benefit from lumbar support. There is conflicting evidence with regards to its effectiveness with some studies claiming moderate improvement in immediate and long term relief while others suggesting no such improvement when compared to other treatment methods. Lumbar supports can stabilize, correct deformity, reduce mechanical forces, and limit the movements of the spine. It may also act as a placebo and reduce the pain by massaging the affected areas and applying heat.

 

Lumbar Traction

 

This method uses a harness attached to the iliac crest and lower rib cage and applies a longitudinal force along the axial spine to relieve chronic low back pain. The level and duration of the force are adjusted according to the patient and it can be measured by using devices both while walking and lying down. Lumbar traction acts by opening the intervertebral disc spaces and by reducing the lumbar lordosis. The symptoms of degenerative disc disease are reduced through this method due to temporary spine realignment and its associated benefits. It relieves nerve compression and mechanical stress, disrupts the adhesions in the facet and annulus, and also nociceptive pain signals. However, there is not much evidence with regard to its effectiveness in reducing back pain or improving daily function. Furthermore, the risks associated with lumbar traction are still under research and some case reports are available where it has caused a nerve impingement, respiratory difficulties, and blood pressure changes due to heavy force and incorrect placement of the harness. (Harte, A et al.)

 

Medical Treatment

 

Medical therapy involves drug treatment with muscle relaxants, steroid injections, NSAIDs, opioids, and other analgesics. This is needed, in addition to conservative treatment, in most patients with degenerative disc disease. Pharmacotherapy is aimed to control disability, reduce pain and swelling while improving the quality of life. It is catered according to the individual patient as there is no consensus regarding the treatment.

 

Muscle Relaxants

 

Degenerative disc disease may benefit from muscle relaxants by reducing the spasm of muscles and thereby relieving pain. The efficacy of muscle relaxants in improving pain and functional status has been established through several types of research. Benzodiazepine is the most common muscle relaxant currently in use.

 

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

 

These drugs are commonly used as the first step in disc degenerative disease providing analgesia, as well as anti-inflammatory effects. There is strong evidence that it reduces chronic low back pain. However, its use is limited by gastrointestinal disturbances, like acute gastritis. Selective COX2 inhibitors, like celecoxib, can overcome this problem by only targeting COX2 receptors. Their use is not widely accepted due to its potential side effects in increasing cardiovascular disease with prolonged use.

 

Opioid Medications

 

This is a step higher up in the WHO pain ladder. It is reserved for patients suffering from severe pain not responding to NSAIDs and those with unbearable GI disturbances with NSAID therapy. However, the prescription of narcotics for treating back pain varies considerably between clinicians. According to literature, 3 to 66% of patients may be taking some form of the opioid to relieve their back pain. Even though the short term reduction in symptoms is marked, there is a risk of long term narcotic abuse, a high rate of tolerance, and respiratory distress in the older population. Nausea and vomiting are some of the short term side effects encountered. (“Systematic Review: Opioid Treatment For Chronic Back Pain: Prevalence, Efficacy, And Association With Addiction”)

 

Anti-Depressants

 

Anti-depressants, in low doses, have analgesic value and may be beneficial in chronic low back pain patients who may present with associated depression symptoms. The pain and suffering may be disrupting the sleep of the patient and reducing the pain threshold. These can be addressed by using anti-depressants in low doses even though there is no evidence that it improves the function.

 

Injection Therapy

 

Epidural Steroid Injections

 

Epidural steroid injections are the most widely used injection type for the treatment of chronic degenerative disc disease and associated radiculopathy. There is a variation between the type of steroid used and its dose. 8- 10 mL of a mixture of methylprednisolone and normal saline is considered an effective and safe dose. The injections can be given through interlaminar, caudal, or trans foramina routes. A needle can be inserted under the guidance of fluoroscopy. First contrast, then local anesthesia and lastly, the steroid is injected into the epidural space at the affected level via this method. The pain relief is achieved due to the combination of effects from both local anesthesia and the steroid. Immediate pain relief can be achieved through the local anesthetic by blocking the pain signal transmission and while also confirming the diagnosis. Inflammation is also reduced due to the action of steroids in blocking pro-inflammatory cascade.

 

During the recent decade, the use of epidural steroid injection has increased by 121%. However, there is controversy regarding its use due to the variation in response levels and potentially serious adverse effects. Usually, these injections are believed to cause only short term relief of symptoms. Some clinicians may inject 2 to 3 injections within a one-week duration, although the long term results are the same for that of a patient given only a single injection. For a one year period, more than 4 injections shouldn’t be given. For more immediate and effective pain relief, preservative-free morphine can also be added to the injection. Even local anesthetics, like lidocaine and bupivacaine, are added for this purpose. Evidence for long term pain relief is limited. (“A Placebo-Controlled Trial To Evaluate Effectivity Of Pain Relief Using Ketamine With Epidural Steroids For Chronic Low Back Pain”)

 

There are potential side effects due to this therapy, in addition to its high cost and efficacy concerns. Needles can get misplaced if fluoroscopy is not used in as much as 25% of cases, even with the presence of experienced staff. The epidural placement can be identified by pruritus reliably. Respiratory depression or urinary retention can occur following injection with morphine and so the patient needs to be monitored for 24 hours following the injection.

 

Facet Injections

 

These injections are given to facet joints, also called zygapophysial joints, which are situated between two adjacent vertebrae. Anesthesia can be directly injected to the joint space or to the associated medial branch of the dorsal rami, which innervates it. There is evidence that this method improves the functional ability, quality of life, and relieves pain. They are thought to provide both short and long term benefits, although studies have shown both facet injections and epidural steroid injections are similar in efficacy. (Wynne, Kelly A)

 

SI Joint Injections

 

This is a diarthrodial synovial joint with nerve supply from both myelinated and non-myelin nerve axons. The injection can effectively treat degenerative disc disease involving sacroiliac joint leading to both long and short term relief from symptoms such as low back pain and referred pain at legs, thigh, and buttocks. The injections can be repeated every 2 to 3 months but should be performed only if clinically necessary. (MAUGARS, Y. et al.) 

 

Intradiscal Non-Operative Therapies for Discogenic Pain

 

As described under the investigations, discography can be used both as a diagnostic and therapeutic method. After the diseased disc is identified, several minimally invasive methods can be tried before embarking on surgery. Electrical current and its heat can be used to coagulate the posterior annulus thereby strengthening the collagen fibers, denaturing and destroying inflammatory mediators and nociceptors, and sealing figures. The methods used in this are called intradiscal electrothermal therapy (IDET) or radiofrequency posterior annuloplasty (RPA), in which an electrode is passed to the disc. IDET has moderate evidence in relief of symptoms for disc degenerative disease patients, while RPA has limited support regarding its short term and long term efficacy. Both these procedures can lead to complications such as nerve root injury, catheter malfunction, infection, and post-procedure disc herniation.

 

Surgical Treatment

 

Surgical treatment is reserved for patients with failed conservative therapy taking into account the disease severity, age, other comorbidities, socio-economic condition, and the level of outcome expected. It is estimated that around 5% of patients with degenerative disc disease undergo surgery, either for their lumbar disease or cervical disease. (Rydevik, Björn L.)

 

Lumbar Spine Procedures

 

Lumbar surgery is indicated in patients with severe pain, with a duration of 6 to 12 months of ineffective drug therapy, who have critical spinal stenosis. The surgery is usually an elective procedure except in the case of cauda equina syndrome. There are two procedure types that aim to involve spinal fusion or decompression or both. (“Degenerative Disk Disease: Background, Anatomy, Pathophysiology.”)

 

Spinal fusion involves stopping movements at a painful vertebral segment in order to reduce the pain by fusing several vertebrae together by using a bone graft. It is considered effective in the long term for patients with degenerative disc disease having spinal malalignment or excessive movement. There are several approaches to fusion surgery. (Gupta, Vijay Kumar, et al)

 

  • Lumbar spinal posterolateral guttur fusion

 

This method involves placing a bone graft in the posterolateral part of the spine. A bone graft can be harvested from the posterior iliac crest. The bones are stripped off from its periosteum for successful grafting. A back brace is needed in the post-operative period and patients may need to stay in the hospital for about 5 to 10 days. Limited motion and cessation of smoking are needed for successful fusion. However, several risks such as non-union, infection, bleeding, and solid union with back pain may occur.

 

  • Posterior lumbar interbody fusion

 

In this method, decompression or diskectomy methods can also be performed via the same approach. The bone grafts are directly applied to the disc space and ligamentum flavum is excised completely. For the degenerative disc disease, interlaminar space is widened additionally by performing a partial medial facetectomy. Back braces are optional with this method. It has several disadvantages when compared to anterior approach such as only small grafts can be inserted, the reduced surface area available for fusion, and difficulty when performing surgery on spinal deformity patients. The major risk involved is non-union.

 

  • Anterior lumbar interbody fusion

 

This procedure is similar to the posterior one except that it is approached through the abdomen instead of the back. It has the advantage of not disrupting the back muscles and the nerve supply. It is contraindicated in patients with osteoporosis and has the risk of bleeding, retrograde ejaculation in men, non-union, and infection.

 

  • Transforaminal lumbar interbody fusion

 

This is a modified version of the posterior approach which is becoming popular. It offers low risk with good exposure and it is shown to have an excellent outcome with a few complications such as CSF leak, transient neurological impairment, and wound infection.

 

Total Disc Arthroplasty

 

This is an alternative to disc fusion and it has been used to treat lumbar degenerative disc disease using an artificial disc to replace the affected disc. Total prosthesis or nuclear prosthesis can be used depending on the clinical situation.

 

Decompression involves removing part of the disc of the vertebral body, which is impinging on a nerve to release that and provide room for its recovery via procedures called diskectomy and laminectomy. The efficacy of the procedure is questionable although it is a commonly performed surgery. Complications are very few with a low chance of recurrence of symptoms with higher patient satisfaction. (Gupta, Vijay Kumar, et al)

 

  • Lumbar discectomy

 

The surgery is performed through a posterior midline approach by dividing the ligamentum flavum. The nerve root that is affected is identified and bulging annulus is cut to release it. Full neurological examination should be performed afterward and patients are usually fit to go home 1 – 5 days later. Low back exercises should be started soon followed by light work and then heavy work at 2 and 12 weeks respectively.

 

  • Lumbar laminectomy

 

This procedure can be performed thorough one level, as well as through multiple levels. Laminectomy should be as short as possible to avoid spinal instability. Patients have marked relief of symptoms and reduction in radiculopathy following the procedure. The risks may include bowel and bladder incontinence, CSF leakage, nerve root damage, and infection.

 

Cervical Spine Procedures

 

Cervical degenerative disc disease is indicated for surgery when there is unbearable pain associated with progressive motor and sensory deficits. Surgery has a more than 90% favorable outcome when there is radiographic evidence of nerve root compression. There are several options including anterior cervical diskectomy (ACD), ACD, and fusion (ACDF), ACDF with internal fixation, and posterior foraminotomy. (“Degenerative Disk Disease: Background, Anatomy, Pathophysiology.”)

 

Cell-Based Therapy

 

Stem cell transplantation has emerged as a novel therapy for degenerative disc disease with promising results. The introduction of autologous chondrocytes has been found to reduce discogenic pain over a 2 year period. These therapies are currently undergoing human trials. (Jeong, Je Hoon, et al.)

 

Gene Therapy

 

Gene transduction in order to halt the disc degenerative process and even inducing disc regeneration is currently under research. For this, beneficial genes have to be identified while demoting the activity of degeneration promoting genes. These novel treatment options give hope for future treatment to be directed at regenerating intervertebral discs. (Nishida, Kotaro, et al.)

 

 

Degenerative disc disease is a health issue characterized by chronic back pain due to a damaged intervertebral disc, such as low back pain in the lumbar spine or neck pain in the cervical spine. It is a breakdown of an intervertebral disc of the spine. Several pathological changes can occur in disc degeneration. Various anatomical defects can also occur in the intervertebral disc. Low back pain and neck pain are major epidemiological problems, which are thought to be related to degenerative disc disease. Back pain is the second leading cause of doctor office visits in the United States. It is estimated that about 80% of US adults suffer from low back pain at least once during their lifetime. Therefore, a thorough understanding of degenerative disc disease is needed for managing this common condition. – Dr. Alex Jimenez D.C., C.C.S.T. Insight

 

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas*& New Mexico* 

 

Curated by Dr. Alex Jimenez D.C., C.C.S.T.

 

References

 

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  19. Gupta, Vijay Kumar et al. “Lumbar Degenerative Disc Disease: Clinical Presentation And Treatment Approaches.” IOSR Journal Of Dental And Medical Sciences, vol 15, no. 08, 2016, pp. 12-23. IOSR Journals, doi:10.9790/0853-1508051223.
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  28. Bartynski, Walter S., and A. Orlando Ortiz. “Interventional Assessment Of The Lumbar Disk: Provocation Lumbar Diskography And Functional Anesthetic Diskography.” Techniques In Vascular And Interventional Radiology, vol 12, no. 1, 2009, pp. 33-43. Elsevier BV, doi:10.1053/j.tvir.2009.06.003.
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  35. Furlan, Andrea D. et al. “Massage For Low-Back Pain: A Systematic Review Within The Framework Of The Cochrane Collaboration Back Review Group.” Spine, vol 27, no. 17, 2002, pp. 1896-1910. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/00007632-200209010-00017.
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  37. “A Placebo Controlled Trial To Evaluate Effectivity Of Pain Relief Using Ketamine With Epidural Steroids For Chronic Low Back Pain.” International Journal Of Science And Research (IJSR), vol 5, no. 2, 2016, pp. 546-548. International Journal Of Science And Research, doi:10.21275/v5i2.nov161215.
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  39. MAUGARS, Y. et al. “ASSESSMENT OF THE EFFICACY OF SACROILIAC CORTICOSTEROID INJECTIONS IN SPONDYLARTHROPATHIES: A DOUBLE-BLIND STUDY.” Rheumatology, vol 35, no. 8, 1996, pp. 767-770. Oxford University Press (OUP), doi:10.1093/rheumatology/35.8.767.
  40. Rydevik, Björn L. “Point Of View: Seven- To 10-Year Outcome Of Decompressive Surgery For Degenerative Lumbar Spinal Stenosis.” Spine, vol 21, no. 1, 1996, p. 98. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/00007632-199601010-00023.
  41. Jeong, Je Hoon et al. “Regeneration Of Intervertebral Discs In A Rat Disc Degeneration Model By Implanted Adipose-Tissue-Derived Stromal Cells.” Acta Neurochirurgica, vol 152, no. 10, 2010, pp. 1771-1777. Springer Nature, doi:10.1007/s00701-010-0698-2.
  42. Nishida, Kotaro et al. “Gene Therapy Approach For Disc Degeneration And Associated Spinal Disorders.” European Spine Journal, vol 17, no. S4, 2008, pp. 459-466. Springer Nature, doi:10.1007/s00586-008-0751-5.

 

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Auto Accidents Caused by Sciatica Delayed Braking Time Part 2 https://www.pushasrx.com/sciatica-accidents-braking-time2/ https://www.pushasrx.com/sciatica-accidents-braking-time2/#respond Sat, 20 Jun 2020 02:15:02 +0000 https://www.pushasrx.com/?p=25549 11860 Vista Del Sol, Ste. 128 Auto Accidents Caused by Sciatica Delayed Braking Time Part 2

Part 2 delayed braking reaction time caused by sciatica, we continue with the spinal cord, nerves, and how they communicate with the brain. A herniated disc can cause sciatica, which is a compressing of the nerve/s in and around the spinal cord. This compression causes a pinching of the nerve/s like bending a water hose […]

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11860 Vista Del Sol, Ste. 128 Auto Accidents Caused by Sciatica Delayed Braking Time Part 2 Part 2 delayed braking reaction time caused by sciatica, we continue with the spinal cord, nerves, and how they communicate with the brain. A herniated disc can cause sciatica, which is a compressing of the nerve/s in and around the spinal cord. This compression causes a pinching of the nerve/s like bending a water hose cuts off the flow and damages the hose, is what happens to the spinal nerve/s cutting proper blood flow, and proper synapse/signal flow. This occurs from the damage to the nerve/s and could delay braking signals for a split second. But that is all that is needed for an auto accident to happen. A delay in braking time has been found in individuals with herniated/bulging/ruptured/slipped discs. Fortunately, through chiropractic and physical therapy, the nerves can be re-stimulated and brought back to optimal function.
11860 Vista Del Sol, Ste. 128 Auto Accidents Caused by Sciatica Delayed Braking Time Part 2
 

Communication

The spinal cord is about one inch across at its widest and around eighteen inches long. The spinal cord is a type of tube that is filled with nerves and cerebrospinal fluid. This protects and nourishes the cord. Spinal cord added protection includes:
There are three types of membranes surrounding the spinal cord referred to as meninges. The outer membrane is known as the dura mater, the middle membrane is the arachnoid mater and the innermost membrane is the pia mater.  
  These membranes can become inflamed and damaged by disease or trauma. Arachnoiditis is caused by inflammation of the arachnoid lining that results in intense stinging and burning pain. This can happen post-surgery and can cause the scarring of nerve/s. The nerves exit the spinal column and branch out to the rest of the body. All parts of the body are controlled by specific spinal nerves. The nerves are placed in and around the area they control. Like the nerves in the neck area branch out into the arms. This is why a neck ache/pain issue can lead to pain spreading into the arms and hands.
  • Thoracic spine controls the middle of the body,
  • The lumbar spine extends into the outer legs controlling that area
  • Sacral nerves control the middle of the legs and organ functions of the pelvis
11860 Vista Del Sol, Ste. 128 Auto Accidents Caused by Sciatica Delayed Braking Time Part 2
 

The brain

Two major types of nerves: sensory and motor. Sensory nerves send information like:
  • Touch
  • Temperature
  • Pain
These get sent to the brain via the spinal cord. Motor nerves relay signals from the brain back to the muscles making them contract voluntarily or reflexively. Peripheral nervous system – the PNS has nerves that extend down the spinal canal and branch out at openings in the vertebrae called foramina.  
radiculopathies chiropractic care el paso tx.
 
Blog Image Anatomy of Pelvis and Force Distribution e
 
Signals/messages get sent to and from the brain aka the central nervous system. It sends all types of signals including pain and initiates movement. For example, the nerves reflexively make the spine twist and turn when driving to keep balance when turning and braking. The peripheral nervous system is a collection of millions of nerves throughout the torso and limbs. This system conveys messages to the central nervous system.

Referred pain

When a health problem/issue/condition takes place in one part of the body with pain being felt in another or several areas, pain specialists call it referred pain.

Nerves

Nerves exiting the spinal cord is done in pairs with one being a sensory nerve, and the other a motor nerve. Motor nerves initiate movement and bodily function. Damage to a motor nerve could cause a weakness in a muscle or loss of function. For example, a prick in the foot that is not felt could mean there is some sensational loss, indicating a problem with the sensory nerves and or possible nerve damage. These are the nerves that control pain, temperature, etc. Sensory nerve issues can feel like shooting electrical pain Continuing with activities could exacerbate the nerve damage.

Cauda Equina

  The spinal cord ends at the lumbar low back, where the nerves extend in a bundle of strands called cauda equina, called this because it looks like a horsetail. These nerves provide motor and sensory function to the:
  • Legs
  • Intestines
  • Genitals
  • Bladder
Therefore, based on this knowledge there is adequate information displaying how sciatica could cause a delayed braking reaction time based on the nerves’ dysfunctional signal firing. Chiropractic treatment could be an option to help an individual realign their spine, work out tight muscles, nerves, ligaments preventing any further damage, and getting the individual back in top form.

Chiropractors & Sciatica Syndrome Expose

 
 

NCBI Resources

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

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Disc Bulge & Herniation Chiropractic Care Overview https://www.pushasrx.com/disc-bulge-herniation-chiropractic-care-overview/ https://www.pushasrx.com/disc-bulge-herniation-chiropractic-care-overview/#respond Fri, 19 Jun 2020 20:27:25 +0000 https://www.pushasrx.com/?p=25546 Disc Bulge & Herniation Chiropractic Care Overview | El Paso, TX Chiropractor

Disc bulge and disc herniation are some of the most common conditions that can affect the spine of both young and middle-aged patients. It is estimated that approximately 2.6% of the US population annually visits a clinician for the treatment of spinal disorders. Approximately $ 7.1 billion alone is lost due to the time away […]

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Disc Bulge & Herniation Chiropractic Care Overview | El Paso, TX Chiropractor

Disc bulge and disc herniation are some of the most common conditions that can affect the spine of both young and middle-aged patients. It is estimated that approximately 2.6% of the US population annually visits a clinician for the treatment of spinal disorders. Approximately $ 7.1 billion alone is lost due to the time away from work.

 

Disc herniation is when the whole or part of the nucleus pulposus is protruded through the torn or weakened outer annulus fibrosus of the intervertebral disc. This is also known as the slipped disc and frequently occurs in the lower back sometimes also affecting the cervical region. Herniation of the intervertebral disc is defined as a localized displacement of disc material with 25% or less of the disc circumference on an MRI scan according to the North American Spine Society 2014. The herniation may consist of nucleus pulposus, annulus fibrosus, apophyseal bone or osteophytes, and the vertebral endplate cartilage in contrast to disc bulge.

 

There are also mainly two types of disc herniation. Disc protrusion is when a focal or symmetrical extension of the disc comes out of its confines in the intervertebral space. It is situated at the level of the intervertebral disc and its outer annular fibers are intact. A disc extrusion is when the intervertebral disc extends above or below the adjacent vertebrae or endplates with complete annular tear. In this type of disc extrusion, there is a neck or base which is narrower than the dome or the herniation.

 

A disc bulge is when the outer fibers of the annulus fibrosus are displaced from the margins of the adjacent vertebral bodies. Here, the displacement is more than 25% of the circumference of the intervertebral disc. It also does not extend below or above the margins of the disc because it is limited by the annulus fibrosus attachment. It differs from disc herniation because it involves less than 25% of the circumference of the disc. Usually, the disc bulge is a gradual process and is broad. The disc bulge can be divided into 2 types. In circumferential bulge, the whole disc circumference is involved. In asymmetrical bulging, more than 90 degrees of the circumference is involved in an asymmetric way.

 

Normal Intervertebral Disc Anatomy

 

Before going into detail into the definition of disc herniation and disc bulge, we need to take a look at how the normal intervertebral disc looks like. According to spine guidelines in 2014, a normal disc is something that has a normal shape without any evidence of degenerative disc changes. Intervertebral discs are responsible for one third to one-fourth of the height of the spinal column.

 

One intervertebral disc is about 7 – 10 mm thick and measures 4 cm in anterior-posterior diameter in the lumbar region of the spine. These spinal discs are located between two adjacent vertebral bodies. However, no discs can be found between the atlas and axis and in the coccyx. About 23 discs are found in the spine with 6 found in the cervical spine, 12 in the thoracic spine, and only 5 found in the lumbar spine.

 

Intervertebral discs are made of fibro cartilages and they form a fibrocartilaginous joint. The outer ring of the intervertebral disc is known as the annulus fibrosus while the inner gel-like structure in the center is known as the nucleus pulposus. The cartilage endplates sandwich the nucleus pulposus superiorly and inferiorly. The annulus fibrosus is made up of concentric collagen fiber sheets arranged in a radial tire-like structure into lamellae. The fibers are attached to the vertebral endplates and oriented at different angles. The endplates with its cartilaginous part, anchor the discs in its proper place.

 

The nucleus pulposus is composed of water, collagen, and proteoglycans. Proteoglycans attract and retain water hence giving the nucleus pulposus a hydrated gel-like consistency. Interestingly, throughout the day the amount of water found in the nucleus pulposus varies according to the level of activity of the person. This feature in the intervertebral disc serves as a cushion or a spinal shock-absorbing system to protect the adjacent vertebra, spinal nerves, spinal cord, brain, and other structures against various forces. Although the individual movement of the intervertebral discs is limited, some form of vertebral motion like flexion and extension is still possible due to the features of the intervertebral disc.

 

Effect of Intervertebral Disc Morphology on Structure and Function

 

The type of components presents in the intervertebral disc and how it is arranged determines the morphology of the intervertebral disc. This is important in how effectively the disc does its function. As the disc is the most important element which bears the load and allows movement in the otherwise rigid spine, the constituents it is made up of have a significant bearing.

 

The complexity of the lamellae increases with advancing age as a result of the synthetic response of the intervertebral disc cells to the variations in the mechanical load. These changes in lamellae with more bifurcations, interdigitation, and irregular size and number of lamellar bands will lead to the altered bearing of weight. This in turn establishes a self-perpetuated disruption cycle leading to the destruction of the intervertebral discs. Once this process is started it is irreversible. As there is an increased number of cells, the amount of nutrition the disc requires is also increasingly changing the normal concentration gradient of both metabolites and nutrients. Due to this increased demand, the cells may also die increasingly by necrosis or apoptosis.

 

Human intervertebral discs are avascular and hence the nutrients are diffused from the nearby blood vessels in the margin of the disc. The main nutrients; oxygen and glucose reach the cells in the disc through diffusion according to the gradient determined by the rate of transport to the cells through the tissues and the rate of demand. Cells also increasingly produce lactic acid as a metabolic end product. This is also removed via the capillaries and venules back to the circulation.

 

Since diffusion depends on the distance, the cells lying far from the blood capillaries can have a reduced concentration of nutrients because of reduced supply. With disease processes, the normally avascular intervertebral disc can become vascular and innervated in degeneration and in disease processes. Although this may increase the oxygen and nutrient supply to the cells in the disc, this can also give rise to many other types of cells that are normally not found in the disc with the introduction of cytokines and growth factors.

 

The morphology of the intervertebral disc in different parts of the spine also varies although many clinicians base the clinical theories based on the assumption that both cervical and lumbar intervertebral discs have the same structure. The height of the disc was the minimum in T4 – 5 level of the thoracic column probably due to the fact that thoracic intervertebral discs are less wedge-shaped than those of cervical and lumbar spinal regions.

 

From the cranial to caudal direction, the cross-sectional area of the spine increased. Therefore, by L5 – S1 level, the nucleus pulposus was occupying a higher proportion of the intervertebral disc area. The cervical discs have an elliptical shape on cross-section while the thoracic discs had a more circular shape. The lumbar discs also have an elliptical shape though it is more flattened or re-entrant posteriorly.

 

What is a Disc Bulge?

 

The bulging disc is when the disc simply bulges outside the intervertebral disc space it normally occupies without the rupture of the outer annulus fibrosus. The bulging area is quite large when compared to a herniated disc. Moreover, in a herniated disc, the annulus fibrosus ruptures or cracks. Although the disc bulging is more common than disc herniation, it causes little or no pain to the patient. In contrast, the herniated disc causes a lot of pain.

 

Causes for Disc Bulging

 

Bulging disc can be due to several causes. It can occur due to normal age-related changes such as seen in degenerative disc disease. The aging process can lead to structural and biochemical changes in the intervertebral discs and lead to reduced water content in the nucleus pulposus. These changes can make the patient vulnerable to disc bulges with only minor trauma. Some unhealthy lifestyle habits such as a sedentary lifestyle and smoking can potentiate this process and give rise to more severe changes with the weakening of the disc.

 

General wear and tear due to repeated microtrauma can also weaken the disc and give rise to disc bulging. This is because when the discs are strained, the normal distribution of weight loading changes. Accumulated micro-trauma over a long period of time can occur in bad posture. Bad posture when sitting, standing, sleeping, and working can increase the pressure in the intervertebral discs.

 

When a person maintains a forward bending posture, it can lead to overstretching and eventually weakness of the posterior part of the annulus fibrosus. Over time, the intervertebral disc can bulge posteriorly. In occupations that require frequent and repetitive lifting, standing, driving, or bending, the bulging disc may be an occupational hazard. Improper lifting up of items, improper carrying of heavy objects can also increase the pressure on the spine and lead to disc bulges eventually.

 

The bulging intervertebral discs usually occur over a long period of time. However, the discs can bulge due to acute trauma too. The unexpected sudden mechanical load can damage the disc resulting in micro-tears. After an accident, the disc can become weaken causing long term microdamage ultimately leading to bulging of the disc. There may also be a genetic component to the disc bulging. The individual may have a reduced density of elastin in the annulus fibrosus with increased susceptibility for disc diseases. Other environmental facts may also play a part in this disease process.

 

Symptoms of Disc Bulging

 

As mentioned previously, bulging discs do not cause pain and even if they do the severity is mild. In the cervical region, the disease will cause pain running down the neck, deep pain in the shoulder region, pain radiating along the upper arm, and forearm up to fingers.

 

This may give rise to a diagnostic dilemma as to whether the patient is suffering from a myocardial infarction as the site of referred pain and the radiation is similar. Tingling feeling on the neck may also occur due to the bulging disc.

 

In the thoracic region, there may be a pain in the upper back which radiates to the chest or the upper abdominal region. This may also suggest upper gastrointestinal, lung, or cardiac pathology and hence need to be careful when analyzing these symptoms.

 

The bulging discs of the lumbar region may present as lower back pain and tingling feeling in the lower back region of the spine. This is the most common site for disc bulges since this area holds the weight of the upper body. The pain or the discomfort can spread through the gluteal area, thighs, and to the feet. There may also be muscle weakness, numbness or tingling sensation. When the disc presses on the spinal cord, the reflexes of both legs can increase leading to spasticity.

 

Some patients may even have paralysis from the waist down. When the bulging disc compresses on the cauda equine, the bladder and bowel functions can also change. The bulging disc can press on the sciatic nerve leading to sciatica where the pain radiates in one leg from back down to the feet.

 

The pain from the bulging disc can get worse during some activities as the bulge can then compress on some of the nerves. Depending on what nerve is affected, the clinical features can also vary.

 

Diagnosis of Disc Bulging

 

The diagnosis may not be apparent from clinical history due to similar presentations in more serious problems. But the chronic nature of the disease may give some clues. Complete history and a physical examination need to be done to rule out myocardial infarction, gastritis, gastro-oesophageal reflux disease, and chronic lung pathology.

 

MRI of Disc Bulge

 

Investigations are necessary for the diagnosis. X-ray spine is performed to look for gross pathology although it may not show the bulging disc directly. There may be indirect findings of disk degeneration such as osteophytes in the endplates, gas in the disc due to vacuum phenomenon, and the loss of height of the intervertebral disc. In the case of moderate bulges, it may sometimes appear as non-focal intervertebral disc material that is protruded beyond the borders of the vertebra which is broad-based, circumferential, and symmetrical.

 

The magnetic resonance imaging or MRI can exquisitely define the anatomy of the intervertebral discs especially the nucleus pulposus and its relationships. The early findings seen on MRI in disc bulging include the loss of normal concavity of the posterior disc. The bulges can be seen as broad-based, circumferential, and symmetrical areas. In moderate bulging, the disc material will protrude beyond the borders of the vertebrae in a non-focal manner. Ct myelogram may also give detailed disc anatomy and may be useful in the diagnosis.

 

Treatment of Disc Bulging

 

The treatment for the bulging disc can be conservative, but sometimes surgery is required.

 

Conservative Treatment

 

When the disc bulging is asymptomatic, the patient does not need any treatment since it does not pose an increased risk. However, if the patient is symptomatic, the management can be directed at relieving the symptoms. The pain is usually resolved with time. Till then, potent pain killers such as non-steroidal anti-inflammatory drugs like ibuprofen should be prescribed. In unresolved pain, steroid injections can also be given to the affected area and if it still does not work, the lumbar sympathetic block can be tried in most severe cases.

 

The patient can also be given the option of choosing alternative therapies such as professional massage, physical therapy, ice packs, and heating pads which may alleviate symptoms. Maintaining correct posture, tapes, or braces to support the spine are used with the aid of a physiotherapist. This may fasten the recovery process by avoiding further damage and keeping the damaged or torn fibers in the intervertebral disc without leakage of the fluid portion of the disc. This helps maintain the normal structure of the annulus and may increase the recovery rate. Usually, the painful symptoms which present initially get resolved over time and lead to no pain. However, if the symptoms get worse steadily, the patient may need surgery.

 

If the symptoms are resolved, physiotherapy can be used to strengthen the muscles of the back with the use of exercises. Gradual exercises can be used for the return of function and for preventing recurrences.

 

Surgical Treatment

 

When conservative therapy does not work with a few months of treatment, surgical treatment can be considered. Most would prefer minimally invasive surgery which uses advanced technology to correct the intervertebral disc without having to grossly dissect the back. These procedures such as microdiscectomy have a lower recovery period and reduced risk of scar formation, major blood loss, and trauma to adjacent structures when compared to open surgery.

 

Previously, laminectomy and discectomy have been a mainstay of treatment. However, due to the invasiveness of the procedure and due to increased damage to the nerves these procedures are currently abandoned by many clinicians for disc bulging.

 

Disc bulging in the thoracic spine is being treated surgically with costotransversectomy where a section of the transverse process is resected to allow access to the intervertebral disc. The spinal cord and spinal nerves are decompressed by using thoracic decompression by removing a part of the vertebral body and making a small opening. The patient may also need a spinal fusion later on if the removed spinal body was significant.

 

Video-assisted thoracoscopic surgery can also be used where only a small incision is made and the surgeon can perform the surgery through the assistance of the camera. If the surgical procedure involved removing a large portion of the spinal bone and disc material, it may lead to spinal instability. This may need bone grafting to replace the lost portion with plates and screws to hold them in place.

 

What is a Disc Herniation?

 

As mentioned in the first section of this article, disc herniation occurs when there is disc material displaces beyond the limits of the intervertebral disc focally. The disc space consists of endplates of the vertebral bodies superiorly and inferiorly while the outer edges of the vertebral apophyses consist of the peripheral margin. The osteophytes are not considered a disc margin. There may be irritation or compression of the nerve roots and dural sac due to the volume of the herniated material leading to pain. When this occurs in the lumbar region, this is classically known as sciatica. This condition has been mentioned since ancient times although a connection between disc herniation and sciatica was made only in the 20th century. Disc herniation is one of the commonest diagnoses seen in the spine due to degenerative changes and is the commonest cause for spinal surgery.

 

Classifications of Disc Herniation

 

There are many classifications regarding intervertebral disc herniation. In focal disc herniation, there is a localized displacement of the disc material in the horizontal or axial plane. In this type, only less than 25% of the circumference of the disc is involved. In broad-based disc herniation, about 25 – 50 % of the disc circumference is herniated. The disc bulge is when 50 – 100 % of the disc material is extended beyond the normal confines of the intervertebral space. This is not considered a form of disc herniation. Furthermore, the intervertebral disc deformities associated with severe cases of scoliosis and spondylolisthesis is not classified as a herniation but rather adaptive changes of the contour of the disc due to the adjacent deformity.

 

Depending on the contour of the displaced material, the herniated discs can be further classified as protrusions and extrusions. In disc protrusion, the distance measured in any plane involving the edges of the disc material beyond intervertebral disc space (the highest measure is taken) is lower than the distance measured in the same plane between the edges of the base.

 

Imaging can show the disc displacement as a protrusion on the horizontal section and as an extrusion on the sagittal section due to the fact that the posterior longitudinal ligament contains the disc material that is displaced posteriorly. Then the herniation should be considered an extrusion. Sometimes the intervertebral disc herniation can occur in the craniocaudal or vertical direction through a defect in the vertebral body endplates. This type of herniation is known as intravertebral herniation.

 

The disc protrusion can also be divided into two as focal protrusion and broad-based protrusion. In focal protrusion, the herniation is less than 25% of the circumference of the disc whereas, in broad-based protrusion, the herniated disc consists of 25 – 50 % of the circumference of the disc.

 

In disc extrusion, it is diagnosed if any of the two following criteria are satisfied. The first one is; the distance measured between the edges of the disc material that is beyond the intervertebral disc space is greater than the distance measured in the same plane between the edges of the base. The second one is; the material in the intervertebral disc space and material beyond the intervertebral disc space is having a lack of continuity.

 

This can be further characterized as sequestrated which is a subtype of the extruded disc. It is called disc migration when disk material is pushed away from the site of extrusion without considering whether there is continuity of disc or not. This term is useful in interpreting imaging modalities as it is often difficult to show continuity in imaging.

 

The intervertebral disc herniation can be further classified as contained discs and discs that are unconfined. The term contained disc is used to refer to the integrity of the peripheral annulus fibrosus which is covering the intervertebral disc herniation. When fluid is injected into the intervertebral disc, the fluid does not leak into the vertebral canal in herniations that are contained.

 

Sometimes there are displaced disc fragments that are characterized as free. However, there should be no continuity between disc material and the fragment and the original intervertebral disc for it to be called a free fragment or a sequestered one. In a migrated disc and in a migrated fragment, there is an extrusion of disc material through the opening in the annulus fibrosus with a displacement of the disc material away from the annulus.

 

Even though some fragments that are migrated can be sequestered ones the term migrated means just to the position and it is not referred to the continuity of the disc. The displaced intervertebral disc material can be further described with regard to the posterior longitudinal ligament as submembranous, subcapsular, subligamentous, extra ligamentous, transligamentous, subcapsular, and perforated.

 

The spinal canal can also get affected by an intervertebral disc herniation. This compromise of the canal can also be classified as mild, moderate, and severe depending on the area that is compromised. If the canal at that section is compromised only less than one third, it is called mild whereas if it is only compromised less than two-third and more than one third it is considered moderate. In a severe compromise, more than two-thirds of the spinal canal is affected. For the foraminal involvement, this same grading system can be applied.

 

The displaced material can be named according to the position that they are in the axial plane from the center to the right lateral region. They are termed as central, right central, right subarticular, right foraminal, and right extraforaminal. The displaced intervertebral disc material’s composition can be further classified as gaseous, liquefied, desiccated, scarred, calcified, ossified, bony, nuclear, and cartilaginous.

 

Before going into detail on how to diagnose and treat intervertebral disc herniation, let us differentiate how cervical disc herniation differs from lumbar herniation since they are the most common regions to undergo herniation.

 

Cervical Disc Herniation vs. Thoracic Disc Herniation vs Lumbar Disc Herniation

 

Lumbar disc herniation is the commonest type of herniation found in the spine which is approximately 90% of the total. However, cervical disc herniation can also occur in about one-tenth of patients. This difference is mainly due to the fact that the lumbar spine has more pressure due to the increased load. Moreover, it has comparatively large intervertebral disc material. The most common sites of intervertebral disc herniation in the lumbar region is L 5 – 6, in the Cervical region between C7, in the thoracic region T12.

 

Cervical disc herniation can occur relatively commonly because the cervical spine acts as a pivoting point for the head and it is a vulnerable area for trauma and therefore prone to damage in the disc. Thoracic disc herniation occurs more infrequently than any of the two. This is due to the fact that thoracic vertebrae are attached to the ribs and the thoracic cage which limits the range of movement in the thoracic spine when compared to the cervical and lumbar spinal discs. However, thoracic intervertebral disc herniation can still occur.

 

Cervical disc herniation gives rise to neck pain, shoulder pain, or pain radiating from neck to the arm, tingling, etc. Lumbar disc herniation can similarly cause lower back pain as well as pain, tingling, numbness, and muscle weakness seen in the lower limbs. Thoracic disc herniation can give rise to pain in the upper back radiating to the torso.

 

Epidemiology

 

Although disc herniation can occur in all age groups, it predominantly occurs in between the fourth and fifth decade of life with the mean age of 37 years. There have been reports that estimate the prevalence of intervertebral disc herniation to be 2 – 3 % of the general population. It is more commonly seen in men over 35 years with a prevalence of 4.8% and while in women this figure is around 2.5%. Due to its high prevalence, it is considered a worldwide problem as it is also associated with significant disability.

 

Risk Factors

 

In most instances, a herniated disc occurs due to the natural aging process in the intervertebral disc. Due to the disc degeneration, the amount of water that was previously seen in the intervertebral disc gets dried out leading to shrinking of the disc with narrowing of the intervertebral space. These changes are markedly seen in degenerative disc disease. In addition to these gradual changes due to normal wear and tear, other factors may also contribute to increasing the risk of intervertebral disc herniation.

 

Being overweight can increase the load on the spine and increase the risk of herniation. A sedentary life can also increase the risk and therefore an active lifestyle is recommended in preventing this condition. Improper posture with prolonged standing, sitting, and especially driving can put a strain on the intervertebral discs due to the additional vibration from the vehicle engine leading to microtrauma and cracks in the disc. The occupations which require constant bending, twisting, pulling and lifting can put a strain on the back. Improper weight lifting techniques are one of the major reasons.

 

When back muscles are used in lifting heavy objects instead of lifting with the legs and twisting while lifting can make the lumbar discs more vulnerable to herniation. Therefore patients should always be advised to lift weights with the legs and not the back. Smoking has been thought to increase disc herniation by reducing the blood supply to the intervertebral disc leading to degenerative changes of the disc.

 

Although the above factors are frequently assumed to be the causes for disc herniation, some studies have shown that the difference in risk is very small when this particular population was compared with the control groups of the normal population.

 

There have been several types of research done on genetic predisposition and intervertebral disc herniation. Some of the genes that are implicated in this disease include vitamin D receptor (VDR) which is a gene that codes for the polypeptides of important collagen called collagen IX (COL9A2).

 

Another gene called the human aggrecan gene (AGC) is also implicated as it codes for proteoglycans which is the most important structural protein found in the cartilage. It supports the biochemical and mechanical function of the cartilage tissue and hence when this gene is defective, it can predispose an individual to intervertebral disc herniation.

 

Apart from these, there are many other genes that are being researched due to the association between disc herniation such as matrix metalloproteinase (MMP) – 3, MMP – 9, cartilage intermediate layer protein, thrombospondin (THBS2), collagen 11A1, carbohydrate sulfotransferase, and asporin (ASPN). They may also be regarded as potential gene markers for lumbar disc disease.

 

Pathogenesis of Sciatica and Disc Herniation

 

The sciatic pain is originated from the extruded nucleus pulposus inducing various phenomena. It can directly compress the nerve roots leading to ischemia or without it, mechanically stimulate the nerve endings of the outer portion of the fibrous ring and release inflammatory substances suggesting its multifactorial origin. When the disc herniation causes mechanical compression of the nerve roots, the nerve membrane is sensitized to pain and other stimuli due to ischemia. It has been shown that in sensitized and compromised nerve roots, the threshold for neuronal sensitization is around half of that of a normal and non-compromised nerve root.

 

The inflammatory cell infiltration is different in extruded discs and non-extruded discs. Usually, in non extruded discs, the inflammation is less. The extruded disc herniation causes the posterior longitudinal ligament to rupture which exposes the herniated part to the vascular bed of the epidural space. It is believed that inflammatory cells are originating from these blood vessels situated in the outermost part of the intervertebral disc.

 

These cells may help secrete substances that cause inflammation and irritation of the nerve roots causing sciatic pain. Therefore, extruded herniations are more likely to cause pain and clinical impairment than those that are contained. In contained herniations, the mechanical effect is predominant while in the unconfined or the extruded discs the inflammatory effect is predominant.

 

Clinical Disc Herniation and What to Look for in the History

 

The symptoms of the disc herniation can vary to a great deal depending on the location of the pain, the type of herniation, and on the individuals. Therefore, history should focus on the analysis of the main complaint among the many other symptoms.

 

The chief complain can be neck pain in cervical disc herniation and there can be referred pain to the arms, shoulders, neck, head, face, and even to the lower back region. However, it is most commonly referred to the interscapular region. The radiation of pain can occur according to the level the herniation is taking place. When the nerve roots of the cervical region are affected and compressed, there can be sensory, motor changes with changes in the reflexes.

 

The pain that occurs due to nerve root compression is called radicular pain and it can be described as deep, aching, burning, dull, achy, and electric depending on whether there is mainly motor dysfunction or sensory dysfunction. In the upper limb, the radicular pain can follow a dermatomal or myotomal pattern. Radiculopathy usually does not accompany neck pain. There can be unilateral as well as bilateral symptoms. These symptoms can be aggravated by activities that increase the pressure inside the intervertebral discs such as Valsalva maneuver, lifting.

 

Driving can also exacerbate pain due to disc herniation due to stress because of vibration. Some studies have shown that shock loading and stress from vibration can cause a mechanical force to exacerbate small herniations but flexed posture had no influence. Similarly, the activities that decrease intradiscal pressure can reduce the symptoms as in lying down.

 

The main complaint in lumbar disc herniation is lower back pain. Other associated symptoms can be a pain in the thigh, buttocks, anogenital region which can radiate to the foot and toe. The main nerve affected in this region is the sciatic nerve causing sciatica and its associated symptoms such as intense pain in the buttocks, leg pain, muscle weakness, numbness, impairment of sensation, hot and burning or tingling sensation in the legs, dysfunction of gait, impairment of reflexes, edema, dysesthesia or paresthesia in the lower limbs. However, sciatica can be caused by causes other than herniation such as tumors, infection, or instability which need to be ruled out before arriving at a diagnosis.

 

The herniated disc can also compress on the femoral nerve and can give rise to symptoms such as numbness, tingling sensation in one or both legs, and a burning sensation in the legs and hips. Usually, the nerve roots that are affected in herniation in the lumbar region are the ones exiting below the intervertebral disc. It is thought that the level of the nerve root irritation determines the distribution of leg pain. In herniations at the third and fourth lumbar vertebral levels, the pain may radiate to the anterior thigh or the groin. In radiculopathy at the level of the fifth lumbar vertebra, the pain may occur in the lateral and anterior thigh region. In herniations at the level of the first sacrum, the pain may occur in the bottom of the foot and the calf. There can also be numbness and tingling sensation occurring in the same area of distribution. The weakness in the muscles may not be able to be recognized if the pain is very severe.

 

When changing positions the patient is often relieved from pain. Maintaining a supine position with the legs raised can improve the pain. Short pain relief can be brought by having short walks while long walks, standing for prolonged periods, and sitting for extended periods of time such as in driving can worsen the pain.

 

The lateral disc herniation is seen in foraminal and extraforaminal herniations and they have different clinical features to that of medial disc herniation seen in subarticular and central herniations. The lateral intervertebral disc herniations can when compared to medial herniations more directly irritate and mechanically compress the nerve roots that are exiting and the dorsal root ganglions situated inside the narrowed spinal canal.

 

Therefore, lateral herniation is seen more frequently in older age with more radicular pain and neurological deficits. There is also more radiating leg pain and intervertebral disc herniations in multiple levels in the lateral groups when compared to medial disc herniations.

 

The herniated disc in the thoracic region may not present with back pain at all. Instead, there are predominant symptoms due to referred pain in the thorax due to irritation on nerves. There can also be predominant pain in the body that travels to the legs, tingling sensation and numbness in one or both legs, muscle weakness and spasticity of one or both legs due to exaggerated reflexes.

 

The clinician should look out for atypical presentations as there could be other differential diagnoses. The onset of symptoms should be inquired to determine whether the disease is acute, sub-acute, or chronic in onset. Past medical history has to be inquired in detail to exclude red flag symptoms such as pain which occurs at night without activity which can be seen in pelvic vein compression, non-mechanical pain which may be seen in tumors or infections.

 

If there is a progressive neurological deficit, with bowel and bladder involvement is there, it is considered a neurological emergency and urgently investigated because cauda equine syndrome may occur which if untreated, can lead to permanent neurological deficit.

 

Getting a detailed history is important including the occupation of the patient as some activities in the job may be exacerbating the patient’s symptoms. The patient should be assessed regarding which activities he can and cannot do.

 

Differential Diagnosis

 

  • Degenerative disc disease
  • Mechanical pain
  • Myofascial pain leading to sensory disturbances and local or referred pain
  • Hematoma
  • Cyst leading to occasional motor deficits and sensory disturbances
  • Spondylosis or spondylolisthesis
  • Discitis or osteomyelitis
  • Malignancy, neurinoma or mass lesion causing atrophy of thigh muscles, glutei
  • Spinal stenosis is seen mainly in the lumbar region with mild low back pain, motor deficits, and pain in one or both legs.
  • Epidural abscess which can cause symptoms similar to radicular pain involving spinal disc herniation
  • Aortic aneurysm which can cause low back pain and leg pain due to compression can also rupture and lead to hemorrhagic shock.
  • Hodgkin’s lymphoma in advanced stages can lead to space-occupying lesions in the spinal column leading to symptoms like that of intervertebral disc herniation
  • Tumors
  • Pelvic endometriosis
  • Facet hypertrophy
  • Lumbar nerve root schwannoma
  • Herpes zoster infection results in inflammation along with the sciatic or lumbosacral nerve roots

 

Examination in Disc Herniation

 

Complete physical examination is necessary to diagnose intervertebral disc herniation and exclude other important differential diagnoses. The range of motion has to be tested but may have a poor correlation with disc herniation as it is mainly reduced in elderly patients with a degenerative disease and due to disease of the joints.

 

A complete neurological examination is often necessary. This should test the muscle weakness and sensory weakness. In order to detect the muscle weakness in small toe muscles, the patient can be asked to walk on tiptoe. The strength of muscle can also be tested by comparing the strength to that of the clinician. There may be dermatomal sensory loss suggesting the respective nerve root involvement. The reflexes may be exaggerated or sometimes maybe even absent.

 

There are many neurologic examination maneuvers described in relation to intervertebral disc herniation such as Braggart sign, flip sign, Lasegue rebound sign, Lasegue differential sign, Mendel Bechterew sign, Deyerle sign both legs or Milgram test, and well leg or Fajersztajin test. However, all these are based on testing the sciatic nerve root tension by using the same principles in the straight leg raising test. These tests are used for specific situations to detect subtle differences.

 

Nearly almost all of them depend on the pain radiating down the leg and if it occurs above the knee it is assumed to be due to a neuronal compressive lesion and if the pain goes below the knee, it is considered to be due to the compression of the sciatic nerve root. For lumbar disc herniation detection, the most sensitive test is considered to be radiating pain occurring down the leg due to provocation.

 

In the straight leg raising test also called the Lasegue’s sign, the patient stays on his or her back and keeps the legs straight. The clinician then lifts the legs by flexing the hip while keeping the knee straight. The angle at which the patient feels a pain going down the leg below the knee is noted. In a normal healthy individual, the patient can flex the hip to 80 – 90ᵒ without having any pain or difficulty.

 

However, if the angle is just 30 – 70ᵒ degrees, it is suggestive of lumbar intervertebral disc herniation at the L4 to S1 nerve root levels. If the angle of hip flexion without pain is less than 30 degrees, it usually indicates some other causes such as tumor of the gluteal region, gluteal abscess, spondylolisthesis, disc extrusion, and protrusion, malingering patient and acute inflammation of the dura mater. If pain with hip flexion occurs at more than 70 degrees, it may be due to tightness of the muscles such as gluteus maximus and hamstrings, tightness of the capsule of the hip joint, or pathology of sacroiliac or hip joints.

 

The reverse straight leg raising test or hip extension test can be used to test higher lumbar lesions by stretching the nerve roots of the femoral nerve which is similar to the straight leg raising test. In the cervical spine, in order to detect stenosis of the foramina, the Spurling test is done and is not specific to cervical intervertebral disc herniation or tension of the nerve roots. The Kemp test is the analogous test in the lumbar region to detect the foraminal stenosis. Complications due to the disc herniation include careful examination of the hip region, digital rectal examination, and urogenital examination is needed.

 

Investigation of Disc Herniation

 

For the diagnosis of intervertebral disc herniation, diagnostic tests such as Magnetic resonance imaging (MRI), Computed tomography (CT), myelography, and plain radiography can be used either alone or in combination with other imaging modalities. Objective detection of disc herniation is important because only after such finding the surgical intervention is even considered. Serum biochemical tests such as prostate-specific antigen (PSA) level, Alkaline phosphatize value, erythrocyte sedimentation rate (ESR), urine analysis for Bence Jones protein, serum glucose level and serum protein electrophoresis may also be needed in specific circumstances guided by history.

 

Magnetic Resonance Imaging (MRI)

 

MRI is considered the best imaging modality in patients with history and physical examination findings suggestive of lumbar disc herniation associated with radiculopathy according to North American Spinal Society guidelines in 2014. The anatomy of the herniated nucleus pulposus and its associated relationships with soft tissue in the adjacent areas can be delineated exquisitely by MRI in cervical, thoracic, and lumbosacral areas. Beyond the confines of the annulus, the herniated nucleus can be seen as a focal, asymmetric disc material protrusion on MRI.

 

On sagittal T2 weighted images, the posterior annulus is usually seen as a high signal intensity area due to radial annular tear associated with the herniation of the disc although the herniated nucleus is itself hypointense. The relationship between the herniated nucleus and degenerated facets with the nerve roots which are exiting through the neural foramina are well-demarcated on sagittal images of MRI. Free fragments of the intervertebral disc can also be distinguished from MRI images.

 

There may be associated signs of intervertebral disc herniation on MRI such as radial tears on the annulus fibrosus which is also a sign of degenerative disc disease. There may be other telling signs such as loss of disc height, bulging annulus, and changes in the endplates. Atypical signs may also be seen with MRI such as abnormal disc locations, lesions located completely outside the intervertebral disc space.

 

MRI can detect abnormalities in the intervertebral discs superiorly than other modalities although its bone imaging is a little less inferior. However, there are limitations with MRI in patients with metal implant devices such as pacemakers because the electromagnetic field can lead to abnormal functioning of the pacemakers. In patients with claustrophobia, it may become a problem to go to the narrow canal to be scanned by the MRI machine. Although some units contain open MRI, it has less magnetic power and hence delineates less superior quality imaging.

 

This is also a problem in children and anxious patients undergoing MRI because good image quality depends on patient staying still. They may require sedation. The contrast used in MRI which is gadolinium can induce nephrogenic systemic fibrosis in patients who had pre-existing renal disease. MRI is also generally avoided in pregnancy especially during the first 12 weeks although it has not been clinically proven to be hazardous to the fetus. MRI is not very useful when a tumor contains calcium and in distinguishing edema fluid from tumor tissue.

 

Computed Tomography (CT)

 

CT scanning is also considered another good method to assess spinal disc herniation when MRI is not available. It is also recommended as a first-line investigation in unstable patients with severe bleeding. CT scanning is superior to myelography although when the two are combined, it is superior to both of them. CT scans can show calcification more clearly and sometimes even gas in images. In order to achieve a superior imaging quality, the imaging should be focused on the site of pathology and thin sections taken to better determine the extent of the herniation.

 

However, CT scan is difficult to be used in patients who have already undergone laminectomy surgical procedures because the presence of scar tissue and fibrosis causes the identification of the structures difficult although bony changes and deformity in nerve sheath is helpful in making a diagnosis.

 

The images will show a soft tissue mass and displaced thecal sac along with the effacement of the fat in the epidural region. An irregular, lobulated mass near the margin of the disc is seen in fragments that are not restrained by the posterior longitudinal ligament but are still in contact with the margin of the disc. The nuclear fragment of the disc that is fragmented is 80 – 120 HU.

 

The herniated intervertebral discs in the cervical disc can be identified by studying the uncinate process. It is usually projected posteriorly and laterally to the intervertebral discs and superiorly to the vertebral bodies. The uncinate process undergoes sclerosis, and hypertrophy when there is an abnormal relationship between the uncinate process and adjacent structures as seen in degenerative disc disease, intervertebral disc space narrowing, and general wear and tear.

 

Myelopathy can occur when the spinal canal is affected due to the disc disease. Similarly, when neural foramina are involved, radiculopathy occurs. Even small herniated discs and protrusions can cause impingement of the dural sac because the cervical epidural space is narrowed naturally. The intervertebral discs have attenuation a little bit greater than the sac characterized in the CT scan.

 

In the thoracic region, a CT scan can diagnose an intervertebral disc herniation with ease due to the fact that there is an increased amount of calcium found in the thoracic discs. Lateral to the dural sac, the herniated disc material can be seen on CT as a clearly defined mass which is surrounded by epidural fat. When there is a lack of epidural fat, the disc appears as a higher attenuated mass compared to the surrounding.

 

Radiography

 

Plain radiography is not needed in diagnosing herniation of the intervertebral discs, because plain radiographs cannot detect the disc and therefore is used to exclude other conditions such as tumors, infections, and fractures.

 

In myelography, there may be deformity or displacement of the extradural contrast filled thecal sac seen in herniation of the disc. There may also be featured in the affected nerve such as edema, elevation, deviation, and amputation of the nerve root seen in the myelography image.

 

Diskography

 

In this imaging modality, the contrast medium is injected into the disc in order to assess the disc morphology. If pain occurs following injection that is similar to the discogenic pain, it suggests that that disc is the source of the pain. When a CT scan is also performed immediately after discography, it is helpful to differentiate the anatomy and pathological changes. However, since it is an invasive procedure, it is indicated only in special circumstances when MRI and CT have failed to reveal the etiology of back pain. It has several side effects such as headache, meningitis, damage to the disc, discitis, intrathecal hemorrhage, and increased pain.

 

Treatment of Herniated Disc

 

The treatment should be individualized according to the patient-guided through history, physical examination, and diagnostic investigation findings. In most cases, the patient gradually improves without needing further intervention in about 3 – 4 months. Therefore, the patient only needs conservative therapy during this time period. Because of this reason, there are many ineffective therapies that have emerged by attributing the natural resolution of symptoms to that therapy. Therefore, conservative therapy needs to be evidence-based.

 

Conservative Therapy

 

Since the herniation of the disc has a benign course, the aim of treatment is to stimulate the recovery of neurological function, reduce pain, and facilitate early return to work and activities of daily living. The most benefits of the conservative treatment are for younger patients with hernias that are sequestered and in patients with mild neurological deficits due to small disc hernias.

 

Bed rest has long been considered as a treatment option in herniation of the disc. However, it has been shown that bed rest has no effect beyond the first 1 or 2 days. The bed rest is regarded as counterproductive after this period of time.

 

In order to reduce the pain, oral non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen can be used. This can relieve the pain by reducing inflammation associated with the inflamed nerve. Analgesics such as acetaminophen can also be used although they lack the anti-inflammatory effect seen in NSAID. The doses and the drugs should be appropriate for the age and severity of the pain in the patient. If pain is not controlled by the current medication, the clinician has to go one step up in the WHO analgesics ladder. However, the long term use of NSAID and analgesics can lead to gastric ulcers, liver, and kidney problems.

 

In order to reduce the inflammation, other alternative methods such as applying ice in the initial period and then switching to using heat, gels, and rubs may help with the pain as well as muscle spasms. Oral muscle relaxants can also be used in relieving muscle spasms. Some of the drugs include methocarbamol, carisoprodol, and cyclobenzaprine.

 

However, they act centrally and cause drowsiness and sedation in patients and it does not act directly to reduce muscle spasm. A short course of oral steroids such as prednisolone for a period of 5 days in a tapering regime can be given to reduce the swelling and inflammation in the nerves. It can provide immediate pain relief within a period of 24 hours.

 

When the pain is not resolved adequately with maximum effective doses, the patient can be considered for giving steroid injections into the epidural space. The major indication for the steroid injection into periradicular space is discal compression causing radicular pain that is resistant to conventional medical treatment. A careful evaluation with CT or MRI scanning is required to carefully exclude extra discal causes for pain. The contraindications for this therapy include patients with diabetes, pregnancy, and gastric ulcers. Epidural puncture is contraindicated in patients with coagulation disorders and therefore foraminal approach is used carefully if needed.

 

This procedure is performed under the guidance of fluoroscopy and involves injecting steroids and an analgesic into the epidural space adjacent to the affected intervertebral disc to reduce the swelling and inflammation of the nerves directly in an outpatient setting. As much as 50% of the patients experience relief after the injection although it is temporary and they might need repeat injections at 2 weekly intervals to achieve the best results. If this treatment modality becomes successful, up to 3 epidural steroidal injections can be given per year.

 

Physical therapy can help the patient return to his previous life easily although it does not improve the herniated disc. The physical therapist can instruct the patient on how to maintain the correct posture, walking, and lifting techniques depending on the patient’s ability to work, mobility, and flexibility.

 

Stretching exercises can improve the flexibility of the spine while strengthening exercises can increase the strength of the back muscles. The activities which can aggravate the condition of the herniated disc are instructed to be avoided. The physical therapy makes the transition from intervertebral disc herniation to an active lifestyle smooth. The exercise regimes can be maintained for life to improve general well-being.

 

The most effective conservative treatment option that is evidence-based is observation and epidural steroid injection for the relief of pain in the short-term duration. However, if the patients so desire they can use holistic therapies of their choice with acupuncture, acupressure, nutritional supplements, and biofeedback although they are not evidence-based. There is also no evidence to justify the use of trans electrical nerve stimulation (TENS) as a pain relief method.

 

If there is no improvement in the pain after a few months, surgery can be contemplated and the patient must be selected carefully for the best possible outcome.

 

Surgical Therapy

 

The aim of surgical therapy is to decompress the nerve roots and relieve the tension. There are several indications for surgical treatment which are as follows.

 

Absolute indications include cauda equina syndrome or significant paresis. Other relative indications include motor deficits that are greater than grade 3, sciatica that is not responding to at least six months of conservative treatment, sciatica for more than six weeks, or nerve root pain due to foraminal bone stenosis.

 

There have been many discussions over the past few years regarding whether to treat herniation of intervertebral disc disease with prolonged conservative treatment or early surgical treatment. Much research has been conducted in this regard and most of them show that the final clinical outcome after 2 years is the same although the recovery is faster with early surgery. Therefore, it is suggested that early surgery may be appropriate as it enables the patient to return to work early and thereby is economically feasible.

 

Some surgeons may still use traditional discectomy although many are using minimally invasive surgical techniques over recent years. Microdiscectomy is considered to be in the halfway between the two ends. There are two surgical approaches that are being used. Minimally invasive surgery and percutaneous procedures are the ones that are being used due to their relative advantage. There is no place for the traditional surgical procedure known as a laminectomy.

 

However, there are some studies suggesting microdiscectomy is more favorable because of its both short term and long-term advantages. In the short term, there is a reduced length of operation, reduced bleeding, relief of symptoms, and reduced complication rate. This technique has been effective even after 10 years of follow up and therefore is the most preferred technique even now. The studies that have been performed to compare the minimally invasive technique and microdiscectomy have resulted in different results. Some have failed to establish a significant difference while one randomized control study was able to determine that microdiscectomy was more favorable.

 

In microdiscectomy, only a small incision is made aided by an operating microscope and the part of the herniated intervertebral disc fragment which is impinging on the nerve is removed by hemilaminectomy. Some part of the bone is also removed to facilitate access to the nerve root and the intervertebral disc. The duration in the hospital stay is minimal with only an overnight stay and observation because the patient can be discharged with minimal soreness and complete relief of the symptoms.

 

However, some unstable patients may need more prolonged admission and sometimes they may need fusion and arthroplasty. It is estimated that about 80 – 85 % of the patients who undergo microdiscectomy recover successfully and many of them are able to return to their normal occupation in about 6 weeks.

 

There is a discussion on whether to remove a large portion of the disc fragment and curetting of the disc space or to remove only the herniated fragment with minimal invasion of the intervertebral disc space. Many studies have suggested that the aggressive removal of large chunks of the disc could lead to more pain than when conservative therapy is used with 28% versus 11.5 %. It may lead to degenerative disc disease in the long term. However, with conservative therapy, there is a greater risk of recurrence of around 7 % in herniation of the disc. This may require additional surgery such as arthrodesis and arthroplasty to be performed in the future leading to significant distress and economic burden.

 

In the minimally invasive surgery, the surgeon usually makes a tiny incision in the back to put the dilators with increasing diameter to enlarge the tunnel until it reaches vertebra. This technique causes lesser trauma to the muscles than when seen in traditional microdiscectomy. Only a small portion of the disc is removed in order to expose the nerve root and the intervertebral disc. Then the surgeon can remove the herniated disc by the use of an endoscope or a microscope.

 

These minimally invasive surgical techniques have a higher advantage of lower surgical site infections and shorter hospital stays. The disc is centrally decompressed by either chemically or enzymatically with the use of chymopapain, laser, or plasma (ionized gas) ablation and vaporization. It can also be decompressed mechanically by using percutaneous lateral decompression or by aspirating and sucking with a shaver such as a nucleosome. Chemopapin was shown to have adverse effects and eventually withdrawn. Most of the above techniques have shown to be less effective than a placebo. Directed segmentectomy is the one that has shown some promise in being effective similar to microdiscectomy.

 

In the cervical spine, the herniated intervertebral discs are treated anteriorly. This is because the herniation occurs anteriorly and the manipulation of the cervical cord is not tolerated by the patient. The disc herniation that is due to foraminal stenosis and that is confined to the foramen are the only instances where a posterior approach is contemplated.

 

The minimal disc excision is an alternative to the anterior cervical spine approach. However, the intervertebral disc stability after the procedure is dependent on the residual disc. The neck pain can be significantly reduced following the procedure due to the removal of neuronal compression although significant impairment can occur with residual axial neck pain. Another intervention for cervical disc herniation includes anterior cervical interbody fusion. It is more suitable for patients with severe myelopathy with degenerative disc disease.

 

Complications of the Surgery

 

Although the risk of surgery is very low, complications can still occur. Post-operative infection is one of the commonest complications and therefore needs more vigorous infection control procedures in the theatre and in the ward. During the surgery, due to poor surgical technique, nerve damage can occur. A dural leak may occur when an opening in the lining of the nerve root causes leakage of cerebrospinal fluid which is bathing the nerve roots. The lining can be repaired during the surgery. However, headache can occur due to loss of cerebrospinal fluid but it usually improves with time without any residual damage. If blood around the nerve roots clots after the surgery, that blood clot may lead to compression of the nerve root leading to radicular pain which was experienced by the patient previously. Recurrent herniation of the intervertebral disc due to herniation of disc material at the same site is a devastating complication that can occur long term. This can be managed conservatively but surgery may be necessary ultimately.

 

Outcomes of the Surgery

 

There has been extensive research done regarding the outcome of lumbar disc herniation surgery. Generally, the results from the microdiscectomy surgery are good. There is more improvement of leg pain than back pain and therefore this surgery is not recommended for those who have only back pain. Many patients improve clinically over the first week but they may improve over the following several months. Typically, the pain disappears in the initial recovery period and it is followed by an improvement in the strength of the leg. Finally, the improvement of the sensation occurs. However, patients may complain of feeling numbness although there is no pain. The normal activities and work can be resumed over a few weeks after the surgery.

 

Novel Therapies

 

Although conservative therapy is the most appropriate therapy in treating patients, the current standard of care does not address the underlying pathology of herniation of the intervertebral discs. There are various pathways that are involved in the pathogenesis such as inflammatory, immune-mediated, and proteolytic pathways.

 

The role of inflammatory mediators is currently under research and it has led to the development of new therapies that are directed at these inflammatory mediators causing damage to the nerve roots. The cytokines such as TNF α are mainly involved in regulating these processes. The pain sensitivity is mediated by serotonin receptor antagonists and α2 adrenergic receptor antagonists.

 

Therefore, pharmacological therapies that target these receptors and mediators may influence the disease process and lead to a reduction in symptoms. Currently, cytokine antagonists against TNF α and IL 1β have been tested. Neuronal receptor blockers such as sarpogrelate hydrochloride etc have been tested in both animal models and in clinical studies for the treatment of sciatica. Cell cycle modifiers which target the microglia that is thought to initiate the inflammatory cascade has been tested with the neuroprotective antibiotic minocycline.

 

There is also research on inhibiting the NF- kB or protein kinase pathway recently. In the future, the treatment of herniation of the intervertebral disc will be much more improved thanks to the ongoing research. (Haro, Hirotaka)

 

 

A disc bulge and/or a herniated disc is a health issue that affects the intervertebral discs found in between each vertebra of the spine. Although these can occur as a natural part of degeneration with age, trauma or injury as well as repetitive overuse can also cause a disc bulge or a herniated disc. According to healthcare professionals, a disc bulge and/or a herniated disc is one of the most common health issues affecting the spine. A disc bulge is when the outer fibers of the annulus fibrosus are displaced from the margins of the adjacent vertebral bodies. A herniated disc is when a part of or the whole nucleus pulposus is protruded through the torn or weakened outer annulus fibrosus of the intervertebral disc. Treatment of these health issues focuses on reducing symptoms. Alternative treatment options, such as chiropractic care and/or physical therapy, can help relieve symptoms. Surgery may be utilized in cases of severe symptoms. – Dr. Alex Jimenez D.C., C.C.S.T. Insight

 

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas*& New Mexico* 

 

Curated by Dr. Alex Jimenez D.C., C.C.S.T.

 

References

  • Anderson, Paul A. et al. “Randomized Controlled Trials Of The Treatment Of Lumbar Disk Herniation: 1983-2007.” Journal Of The American Academy Of Orthopaedic Surgeons, vol 16, no. 10, 2008, pp. 566-573. American Academy Of Orthopaedic Surgeons, doi:10.5435/00124635-200810000-00002.
  • Fraser I (2009) Statistics on hospital-based care in the United States. Agency for Healthcare Research and Quality, Rockville
  • Ricci, Judith A. et al. “Back Pain Exacerbations And Lost Productive Time Costs In United States Workers.” Spine, vol 31, no. 26, 2006, pp. 3052-3060. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/01.brs.0000249521.61813.aa.
  • Fardon, D.F., et al., Lumbar disc nomenclature: version 2.0: Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology. Spine J, 2014. 14(11): p. 2525-45.
  • Costello RF, Beall DP. Nomenclature and standard reporting terminology of intervertebral disk herniation. Magn Reson Imaging Clin N Am. 2007;15 (2): 167-74, v-vi.
  • Roberts, S. “Disc Morphology In Health And Disease.” Biochemical Society Transactions, vol 30, no. 5, 2002, pp. A112.4-A112. Portland Press Ltd., doi:10.1042/bst030a112c.
  • Johnson, W. E. B., and S. Roberts. “Human Intervertebral Disc Cell Morphology And Cytoskeletal Composition: A Preliminary Study Of Regional Variations In Health And Disease.” Journal Of Anatomy, vol 203, no. 6, 2003, pp. 605-612. Wiley-Blackwell, doi:10.1046/j.1469-7580.2003.00249.x.
  • Gruenhagen, Thijs. “Nutrient Supply And Intervertebral Disc Metabolism.” The Journal Of Bone And Joint Surgery (American), vol 88, no. suppl_2, 2006, p. 30. Ovid Technologies (Wolters Kluwer Health), doi:10.2106/jbjs.e.01290.
  • Mercer, S.R., and G.A. Jull. “Morphology Of The Cervical Intervertebral Disc: Implications For Mckenzie’s Model Of The Disc Derangement Syndrome.” Manual Therapy, vol 1, no. 2, 1996, pp. 76-81. Elsevier BV, doi:10.1054/math.1996.0253.
  • KOELLER, W et al. “Biomechanical Properties Of Human Intervertebral Discs Subjected To Axial Dynamic Compression.” Spine, vol 9, no. 7, 1984, pp. 725-733. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/00007632-198410000-00013.
  • Lieberman, Isador H. “Disc Bulge Bubble: Spine Economics 101.” The Spine Journal, vol 4, no. 6, 2004, pp. 609-613. Elsevier BV, doi:10.1016/j.spinee.2004.09.001.
  • Lappalainen, Anu K et al. “Intervertebral Disc Disease In Dachshunds Radiographically Screened For Intervertebral Disc Calcifications.” Acta Veterinaria Scandinavica, vol 56, no. 1, 2014, Springer Nature, doi:10.1186/s13028-014-0089-4.
  • Moazzaz, Payam et al. “80. Positional MRI: A Valuable Tool In The Assessment Of Cervical Disc Bulge.” The Spine Journal, vol 7, no. 5, 2007, p. 39S. Elsevier BV, doi:10.1016/j.spinee.2007.07.097.
  • “Lumbar Disc Disease: Background, History Of The Procedure, Problem.” Emedicine.Medscape.Com, 2017, http://emedicine.medscape.com/article/249113-overview.
  • Vialle, Luis Roberto et al. “LUMBAR DISC HERNIATION.” Revista Brasileira de Ortopedia 45.1 (2010): 17–22. PMC. Web. 1 Oct. 2017.
  • “Herniated Nucleus Pulposus: Background, Anatomy, Pathophysiology.” http://emedicine.medscape.com/article/1263961-overview.
  • Vialle, Luis Roberto et al. “LUMBAR DISC HERNIATION.” Revista Brasileira De Ortopedia (English Edition), vol 45, no. 1, 2010, pp. 17-22. Elsevier BV, doi:10.1016/s2255-4971(15)30211-1.
  • Mulleman, Denis et al. “Pathophysiology Of Disk-Related Sciatica. I.—Evidence Supporting A Chemical Component.” Joint Bone Spine, vol 73, no. 2, 2006, pp. 151-158. Elsevier BV, doi:10.1016/j.jbspin.2005.03.003.
  • Jacobs, Wilco C. H. et al. “Surgical Techniques For Sciatica Due To Herniated Disc, A Systematic Review.” European Spine Journal, vol 21, no. 11, 2012, pp. 2232-2251. Springer Nature, doi:10.1007/s00586-012-2422-9.
  • Rutkowski, B. “Combined Practice Of Electrical Stimulation For Lumbar Intervertebral Disc Herniation.” Pain, vol 11, 1981, p. S226. Ovid Technologies (Wolters Kluwer Health), doi:10.1016/0304-3959(81)90487-5.
  • Weber, Henrik. “Spine Update The Natural History Of Disc Herniation And The Influence Of Intervention.” Spine, vol 19, no. 19, 1994, pp. 2234-2238. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/00007632-199410000-00022.
  • “Disk Herniation Imaging: Overview, Radiography, Computed Tomography.” Emedicine.Medscape.Com, 2017,
  • Carvalho, Lilian Braighi et al. “Hérnia De Disco Lombar: Tratamento.” Acta Fisiátrica, vol 20, no. 2, 2013, pp. 75-82. GN1 Genesis Network, doi:10.5935/0104-7795.20130013.
  • Kerr, Dana et al. “What Are Long-Term Predictors Of Outcomes For Lumbar Disc Herniation? A Randomized And Observational Study.” Clinical Orthopaedics And Related Research®, vol 473, no. 6, 2014, pp. 1920-1930. Springer Nature, doi:10.1007/s11999-014-3803-7.
  • Buy, Xavier, and Afshin Gangi. “Percutaneous Treatment Of Intervertebral Disc Herniation.” Seminars In Interventional Radiology, vol 27, no. 02, 2010, pp. 148-159. Thieme Publishing Group, doi:10.1055/s-0030-1253513.
  • Haro, Hirotaka. “Translational Research Of Herniated Discs: Current Status Of Diagnosis And Treatment.” Journal Of Orthopaedic Science, vol 19, no. 4, 2014, pp. 515-520. Elsevier BV, doi:10.1007/s00776-014-0571-x.

 

 

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Auto Accidents Caused by Sciatica Delayed Braking Time Part 1 https://www.pushasrx.com/sciatica-accidents-braking-time/ https://www.pushasrx.com/sciatica-accidents-braking-time/#respond Fri, 19 Jun 2020 02:08:40 +0000 https://www.pushasrx.com/?p=25538 11860 Vista Del Sol, Ste. 128 Auto Accidents Caused by Sciatica Delayed Braking Time Part 1

Research has found that individuals with disc herniation/s can have a delayed braking time when driving. After undergoing surgery these individuals showed significant improvement in braking time. Based on this information Dr. Jimenez looks at how individuals with functional sciatica, (often caused by a herniated disc) meaning they can move and operate a vehicle to […]

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11860 Vista Del Sol, Ste. 128 Auto Accidents Caused by Sciatica Delayed Braking Time Part 1 Research has found that individuals with disc herniation/s can have a delayed braking time when driving. After undergoing surgery these individuals showed significant improvement in braking time. Based on this information Dr. Jimenez looks at how individuals with functional sciatica, (often caused by a herniated disc) meaning they can move and operate a vehicle to a certain point without generating pain, however they often put themselves in extreme/awkward positions just to operate, could also have a delay in brake reaction time.  
Sciatica Diagram 1 | El Paso, TX Chiropractor

Sciatic Nerve

The sciatic nerve is a large nerve that travels from the lower back down both of the legs and into the feet. Sciatica begins in the low back. The nerve roots in the lower spine come together and turn into the sciatic nerve. Sciatica happens when these nerves get pinched/compressed. This usually occurs from a herniated disc or when the spinal canal narrows called stenosis.

Symptoms

Typically, sciatica causes:
  • Pain in the leg/s
  • Shooting pain that goes down from the low back, through the leg, calf and sometimes into the foot
  • Electrical pain running/shooting down the leg
  • Burning pain
  • Pain from slight movement
  • Numbness
  • Weakness
11860 Vista Del Sol, Ste. 128 Auto Accidents Caused by Sciatica Delayed Braking Time Part 1
 
A car accident can cause sciatica, but now it seems that sciatica can cause an automobile accident because of delayed braking reaction time. People with sciatica that is present without pain often say there is a constant non-painful tingling, numbness, or numbing sensation along the leg that lets them know the sciatica is still there. This could be insufficient blood flow from wherever the impingement is happening. Keep in mind that there could be multiple areas of impingement. Just like the slow blood flow, they may find when they drive the impingement slows the motor-sensory signal and braking time to depress the brake pedal fast enough to avoid a collision.

Nerve Treatment

Sciatica can be treated non-surgically with:
  • Chiropractic
  • Physical therapy
  • 24 to 48 hours of rest
  • Over the counter pain relievers like ibuprofen or acetaminophen
  • Muscle spasms can be treated with heat or ice
11860 Vista Del Sol, Ste. 128 Auto Accidents Caused by Sciatica Delayed Braking Time Part 1
  Patients with sciatica feel better with time, usually a few weeks. However, if pain continues, other forms of treatment can be discussed. A doctor or chiropractor may advise light exercise and therapeutic stretching. As recovery progresses they may give you exercises to strengthen the back and core. With new automobiles implementing automatic braking systems has helped significantly reduce accidents, however, there are still bugs to sort out. This is normal with these computerized systems. Reliance upon these systems, especially those with sciatica, herniated, or bulging disc/s, could be a dangerous combination, specifically when it comes to braking reaction time.
 

Sciatica Pain Chiropractor


Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require added explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

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Spinal Conditions That Affect Long-Haul Truck Drivers https://www.pushasrx.com/spinal-conditions-long-haul-truck-drivers/ https://www.pushasrx.com/spinal-conditions-long-haul-truck-drivers/#respond Thu, 18 Jun 2020 02:46:11 +0000 https://www.pushasrx.com/?p=25535 11860 Vista Del Sol, Ste. 128 Spinal Conditions That Affect Long-Haul Truck Drivers

Chiropractor Dr. Alexander Jimenez of Injury Medical and Chiropractic Clinic focuses on long-haul truck drivers and non-invasive spinal treatments. Truck drivers are at a much higher risk of developing degenerative spinal disorders from the stress that constant driving and repetitive lifting can place on the spinal muscles of the lower back. Driving a huge truck […]

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11860 Vista Del Sol, Ste. 128 Spinal Conditions That Affect Long-Haul Truck Drivers Chiropractor Dr. Alexander Jimenez of Injury Medical and Chiropractic Clinic focuses on long-haul truck drivers and non-invasive spinal treatments. Truck drivers are at a much higher risk of developing degenerative spinal disorders from the stress that constant driving and repetitive lifting can place on the spinal muscles of the lower back. Driving a huge truck for eight to ten hours every day/night means the person sits in a stationary position for a long time. The muscles, joints, and ligaments tend to become stiff, and proper blood circulation is affected over time. Ailments can last for weeks, even up to several years if drivers don’t take time to focus on their health and find the right treatment.  
11860 Vista Del Sol, Ste. 128 Spinal Conditions That Affect Long-Haul Truck Drivers
 
Teams are in a truck that never stops. Even sleeping in the bunk, these drivers are subject to constant vibration and bouncing as the truck moves. Roads that are poorly maintained can cause impact trauma to both the driver and the person in the bunk. Various factors can cause musculoskeletal pain like:
  1. Awkward sitting posture/s
  2. Constant body vibration
  3. Extended sitting
  4. Lifting and loading
  5. Repetitive motions
  6. Strained muscles, nerves, discs, and joints
  7. Improper mechanics
  8. No exercise
  9. Improper Diet
Having limited mobility can lead to structural problems like pain in the back, hip, knee, shoulder, arms, and legs. This is compounded by the fact that prescription medications are the norm for these issues and can be dangerous.

Long Haul

These individuals are taught proper lifting techniques but with time forget to follow them during the rush to make the delivery/s on time. Driving for extended periods regularly places added strain on the back. This is due in part because these individuals can’t use their feet to support the lower part of their bodies while working the pedals of the truck. The continuous instability, vibrations, and positional changes that come with long haul driving can cause tension in the spine and surrounding muscles in the area. Research has shown that vibration of the body while driving increases the load on the lower back and driving on roads that are not maintained can exacerbate the condition.
worker with backache while lifting box in the warehouse
 
The continuous bouncing can lead to spinal disc compression, which in turn causes degeneration pain in the spine and nerves. This continuous strenuous routine can lead to herniated/bulging discs, which can cause pain and lead to the development of other spinal conditions like sciatica. Improper alignment of the spine can lead to dysfunction and pain in one or several areas of the body. Other conditions that could develop include:
  • Facet joint syndrome – the cartilage wears away making the spinal joints stiff and swollen. This syndrome can lead to reduced mobility.
  • Vertebrae rubbing together
  • Spinal compression from sitting in a single position for a long time places pressure on the spinal column. As the spinal column compresses, it causes tightness in the lower and upper back muscles.
  • Sciatica is a combination of symptoms and pain that travel from the lower back to the knee and even into the foot. Usually, caused by a herniated disc that compresses the sciatic nerve, it can cause shooting electrical pain down the leg. Drivers with sciatica can also have tight gluteal muscles that place pressure on the nerve.
  • Neck pain from tight and tender muscles can affect the middle back and cervical/neck area of the spine causing soreness.
  • Tension headaches begin with the muscles at the base of the skull. When these muscles are tight, they can pinch the nerves, beginning a headache.
  • Shoulder pain can be caused by overuse when loading, along with rotator cuff injuries and bicep tendonitis. An inflamed bicep can cause inflammation and pain in the shoulder.

Preventable and Treatable

Prevention and proper treatment are key. Here are a few simple ways to improve the drive:
  • Better seating to reduce vibration
  • Correct sitting posture
  • Chiropractic/physical therapy
  • Exercise
  • Proper diet
  • Ice therapy
  • Proper sleep support
11860 Vista Del Sol, Ste. 128 Spinal Conditions That Affect Long-Haul Truck Drivers

Proper Seat

The seats that are standard in a truck do not offer proper support for a driver’s back, shoulders, neck, and legs. A seat pad for extra comfort or a memory foam seat with a massage base can relax the muscles. For quick lumbar support roll up a pillow, towel or t-shirt and place it behind the lower back. An ergonomic truck seat helps fight the discomfort and awkward positions, that result in positive posture. A proper seat will force the back into its healthy arch. Driving with less strain helps:
  • Boost circulation
  • Distribute the body weight evenly
  • Helps drivers operate longer
  • Reduces the vibrations running through the body
These long haul drivers can choose to bypass invasive procedures that can take months to heal. This is because of the inability to drive means they don’t earn a check. And being taken out of a driving job for any period can cause financial difficulties. Chiropractic provides long haul truck drivers with a non-invasive, drug-free way to treat injuries, manage conditions, and relieve pain. Regular chiropractic can help correct postural habits that expose the body to injury or move the body and the spine out of alignment. It can identify emerging issues before they become a severe condition. Larger truck stops offer drivers access to medical and chiropractic services allowing them to get treatment when they need it. Long haul drivers can be out for weeks and may not be able to get their regular adjustments. But it is still a good idea to have a regular chiropractor at home so you can stay healthy and on the road.

18 Wheeler Accident Chiropractic Treatment

 

Dr. Alex Jimenez’s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

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Metabolic Syndrome: Home Solutions https://www.pushasrx.com/metabolic-syndrome-home-solutions/ https://www.pushasrx.com/metabolic-syndrome-home-solutions/#respond Fri, 21 Feb 2020 16:57:25 +0000 https://www.pushasrx.com/?p=24846 11860 Vista Del Sol, Ste. 128 Chiropractic A Drug-Free Approach to Pain Relief El Paso, TX.

Metabolic Syndrome affects many people. In fact, more than a quarter of the United States has it!

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11860 Vista Del Sol, Ste. 128 Chiropractic A Drug-Free Approach to Pain Relief El Paso, TX.

Metabolic Syndrome affects many people. In fact, more than a quarter of the United States has it! Metabolic Syndrome is not a disease, but instead a cluster of disorders. These disorders on their own are not necessarily alarming but when you have more than one, the body starts to feel the repercussions.

Symptoms

Those with metabolic syndrome often suffer from frequent headaches, inflammation, nausea, fatigue, joint pain, and many more. On top of these symptoms, metabolic syndrome can put individuals at a higher risk for Type 2 Diabetes, Heart Disease, Stroke, Obesity, Sleep Apnea, and Kidney Disease.

Risk Factors

Individuals who have an “apple or pear” body shape, are at an increased risk for developing metabolic syndrome. There are no “obvious” signs of metabolic syndrome, but rather one with metabolic syndrome has 3/5 of these risk factors.

  • A fasting blood glucose level of 100 mg/DL
  • High Blood Pressure, measuring 130/85
  • High Triglycerides
  • Low HDL (Good Cholesterol)  measuring <40mg/DL Men & <50mg/DL Women
  • Excess Waist Fat (>40in Men & >35in Women)

What Can You Do About It?

Of course, no one wants to be left feeling sick and stranded. There are ways to help prevent metabolic syndrome at home. Below there are five tips for each risk factor and how to prevent/reduce your symptoms.

A Fasting Blood Glucose Level Of 100 mg/DL

  • Ketogenic Diet
  • Increase Fiber
  • Control Portions
  • Set “Carb Goals”
  • Choose complex carbs over simple carbs

High Blood Pressure, measuring 130/85

  • Reduce Sodium
  • Lower caffeine
  • DASH diet (Dietary Approaches to Stop Hypertension)
  • Boost Potassium
  • Read Food labels

High Triglycerides

  • Limit sugar intake
  • Increase fiber
  • Establish a regular eating pattern
  • Eat more “tree nuts” ( almonds, cashews, pecans)
  • Switch to unsaturated fats

Low HDL ( Good Cholesterol) measuring <40mg/DL Men & <50mg/DL Women

  • Reduce Alcohol
  • Do not smoke
  • Choose better fats
  • Purple Produce (antioxidants to help inflammation)
  • Increase fish consumption

Excess Waist Fat >40 in Men & >35 in Women

  • Ketogenic Diet
  • Exercise Daily
  • Walk after dinner
  • Grocery Shop without Aisles
  • Increase in Water Consumption

Solutions

Aside from doing these tricks and tips at home, a doctor or health coach will be able to further assist one in healing. The main goal is to take these symptoms and disorders and correct them before they become a full-blown diagnosis.

Rather than just running a basic blood panel, they now have tests that allow us to see multiple different levels and numbers. these elaborate blood tests provide great insight to allow us to see the full picture. By completing these labs, it allows the doctor to evaluate the patients better and provide a more specific treatment plan.

In addition to detailed lab work, there are all-natural supplements that have been shown to help improve these symptoms along with proper diet and exercise. Some of these supplements include Vitamin D, Berberine, and Ashwagandha.

On top of these things, there is also an app that is available to download. This app is called, “Dr. J Today”. This app connects you directly to our clinic and allows us to monitor your diet, supplements, activity, BMI, water weight, muscle mass, and more! This app also gives you a direct portal to message Dr.Jimenez or myself.

As stated before, our main goal is to help you decrease your symptoms before they turn into a full-blown diagnosis. One thing we want to surround our patients with is knowledge and a team atmosphere. With the right team, anything is possible and better health is more attainable than you think!

Having Type 1 Diabetes, I have experienced metabolic syndrome before. It is one of my least favorite feelings that exist. I want our patients to know that they do not have to feel that way and there are treatment plans that can help! I will help to create a personalized plan that is tailed to you, so success is the only option. – Kenna Vaughn, Senior Health Coach 

The scope of our information is limited to chiropractic, musculoskeletal, and nervous health issues or functional medicine articles, topics, and discussions. We use functional health protocols to treat injuries or disorders of the musculoskeletal system. Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. To further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900.

References:
Mayo Clinic Staff. “Metabolic Syndrome.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 14 Mar. 2019, www.mayoclinic.org/diseases-conditions/metabolic-syndrome/symptoms-causes/syc-20351916.
Sherling, Dawn Harris, et al. “Metabolic Syndrome.” Journal of Cardiovascular Pharmacology and Therapeutics, vol. 22, no. 4, 2017, pp. 365–367., doi:10.1177/1074248416686187.

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Nutraceuticals for Sciatica https://www.pushasrx.com/nutraceuticals-for-sciatica/ https://www.pushasrx.com/nutraceuticals-for-sciatica/#respond Fri, 14 Feb 2020 00:49:26 +0000 https://www.pushasrx.com/?p=24715 Nutraceuticals for Sciatica | El Paso, TX Chiropractor

Nutraceuticals can help relieve several different types of chronic pain, including sciatica or sciatic nerve pain. Stephen DeFelice, MD, coined the term in 1989, which is a combination of the words nutrition and pharmaceutical. He defined nutraceuticals as food that offers a variety of health benefits as well as prevention and/or treatment of health issues. […]

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Nutraceuticals for Sciatica | El Paso, TX Chiropractor

Nutraceuticals can help relieve several different types of chronic pain, including sciatica or sciatic nerve pain. Stephen DeFelice, MD, coined the term in 1989, which is a combination of the words nutrition and pharmaceutical. He defined nutraceuticals as food that offers a variety of health benefits as well as prevention and/or treatment of health issues. Although these foods are considered to be natural products, it’s essential to discuss nutraceutical options for chronic pain, including sciatica or sciatic nerve pain, with a healthcare professional to avoid any side-effects or interactions with drugs/medications.

 

Several nutraceuticals are also considered to be dietary supplements. According to the Dietary Supplement Health and Education Act (DSHEA) is a product that is taken orally in pill, capsule, tablet, or liquid form which is made-up of any chemical ingredient that adds to what a person normally gets in their diet, including vitamins, minerals, amino acids, and herbs as well as substances made from organs or glands and enzymes. Dietary supplements can also be an extract or concentrate. Several examples of dietary supplements include vitamin C, vitamin D, calcium, and fish oil, best known as omega-3 fatty acids.

 

Nutraceuticals aren’t only limited to dietary supplements, as Dr. Stephen DeFelice previously described. It can also include genetically engineered food, such as food with added antioxidants, vitamins, and minerals. Nutraceuticals offer people extra nutrients that the body needs to use as fuel for energy. Nutrients, such as proteins, fats, and carbohydrates are broken down by the body’s metabolism, a process that uses energy to regulate breathing and heartbeat, among other essential bodily functions. In the following article, we will discuss how nutraceuticals can help improve sciatica or sciatic nerve pain.

 

How Nutraceuticals Can Help Improve Sciatica

When people have chronic pain, including sciatica or sciatic nerve pain, the body will generally require more nutrients to repair itself. Nutraceuticals can help supplement the nutrients people are already getting from their diet by giving the body more nutrients to use. According to several research studies, nutraceuticals can help reduce pain and inflammation associated with low back pain and other health issues. Sciatica or sciatic nerve pain is a collection of symptoms, rather than a single condition, which is caused by a variety of health issues, including a bulging disk, herniated disk, or degenerative disk disease.

 

“Nutraceuticals, as well as dietary supplements, work best when used in combination with proper diet, regular exercise or physical activity, and stress management”, stated Carrie Bowler, DO, a physician with One Medical Group in New York. Although these foods are considered to be natural products, it’s essential to discuss nutraceutical options for chronic pain, including sciatica or sciatic nerve pain, with a healthcare professional to avoid any side-effects or interactions with drugs/medications. Below, we will discuss several nutraceuticals that can ultimately help improve sciatica or sciatic nerve pain.

 

Nutraceuticals for Sciatica

Vitamin D

According to researchers, vitamin D deficiency can make sciatica or sciatic nerve pain worse. One research study published in Pain Physician in 2013 found that chronic pain may be associated with an increased prevalence of vitamin D deficiency in people with spinal stenosis in their lumbar spine or low back, a common cause of sciatica or sciatic nerve pain. A healthcare professional will determine an individual’s recommended dosage of vitamin D based on their individual needs and requirements. Sunlight exposure and vitamin D-fortified foods, such as vitamin D milk, may also help supply the nutrient.

 

Omega-3 Fatty Acids

Healthcare professionals recommend increasing the intake of omega-3 fatty acids to help reduce inflammation that can ultimately cause chronic pain. Many dietary supplements are available in pill, capsule, tablet, or liquid form. Make sure to talk with your healthcare professional about the proper dosage of omega-3 fatty acids because increased doses of this nutrient can increase the risk of bleeding and other complications. It can also interfere with any blood-thinning drugs and/or medications. You can also increase the intake of omega-3 fatty acids by eating tuna, salmon, sardines, and dark leafy greens.

 

Glucosamine and Chondroitin

Glucosamine and chondroitin are organic compounds that are naturally produced in the body. According to the U.S. National Library of Medicine, glucosamine can be found in the fluid around the joints while chondroitin can be found in the cartilage surrounding the joints. Navid Farahmand, MD, an interventional pain management physician with the Brain and Spine Institute of California in Newport Beach, stated that, although there aren’t many research studies on the effectiveness of glucosamine and chondroitin for people with back pain, others have shown a meaningful impact on chronic knee pain.

 

Turmeric or Curcumin

Turmeric or curcumin, the active ingredient in the yellow-ish plant, is one of the most recommended dietary supplements for chronic pain, including sciatica or sciatic nerve pain. The spice, which is commonly used in Indian curry dishes, can be taken as a powder in capsules, mixed into tea, or as a liquid extract. The National Center for Complementary and Alternative Medicine (NCAAM) reports that turmeric is considered safe for most adults but prolonged use could cause an upset stomach. As a dietary supplement, it’s not recommended for people with gallbladder disease because it can make the condition worse.

 

Dr. Alex Jimenez Insights Image

Nutraceuticals can help relieve several different types of chronic pain, including sciatica or sciatic nerve pain. Nutraceuticals are foods that offers a variety of health benefits. It’s essential to discuss nutraceutical options for sciatica or sciatic nerve pain with a healthcare professional to avoid any side-effects or interactions with drugs/medications. Several nutraceuticals are also considered to be dietary supplements. Several examples of dietary supplements include vitamin C, vitamin D, calcium, and fish oil, best known as omega-3 fatty acids. Nutraceuticals can also include genetically engineered food. Nutraceuticals offer people extra nutrients that the body needs to use as fuel for energy to regulate breathing and heartbeat, among other essential bodily functions. In this article, we will discuss how nutraceuticals can help improve sciatica or sciatic nerve pain. – Dr. Alex Jimenez D.C., C.C.S.T. Insight

 

Nutraceuticals can help relieve several different types of chronic pain, including sciatica or sciatic nerve pain. Stephen DeFelice, MD, coined the term in 1989, which is a combination of the words nutrition and pharmaceutical. He defined nutraceuticals as food that offers a variety of health benefits as well as prevention and/or treatment of health issues. Although these foods are considered to be natural products, it’s essential to discuss nutraceutical options for chronic pain, including sciatica or sciatic nerve pain, with a healthcare professional to avoid any side-effects or interactions with drugs/medications.

 

Several nutraceuticals are also considered to be dietary supplements. According to the Dietary Supplement Health and Education Act (DSHEA) is a product that is taken orally in pill, capsule, tablet, or liquid form which is made-up of any chemical ingredient that adds to what a person normally gets in their diet, including vitamins, minerals, amino acids, and herbs as well as substances made from organs or glands and enzymes. Dietary supplements can also be an extract or concentrate. Several examples of dietary supplements include vitamin C, vitamin D, calcium, and fish oil, best known as omega-3 fatty acids.

 

Nutraceuticals aren’t only limited to dietary supplements, as Dr. Stephen DeFelice previously described. It can also include genetically engineered food, such as food with added antioxidants, vitamins, and minerals. Nutraceuticals offer people extra nutrients that the body needs to use as fuel for energy. Nutrients, such as proteins, fats, and carbohydrates are broken down by the body’s metabolism, a process that uses energy to regulate breathing and heartbeat, among other essential bodily functions. In the article above, we ultimately discussed how nutraceuticals can help improve sciatica or sciatic nerve pain.

 

The scope of our information is limited to chiropractic, musculoskeletal, and nervous health issues or functional medicine articles, topics, and discussions. We use functional health protocols to treat injuries or disorders of the musculoskeletal system. Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. To further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900

 

Curated by Dr. Alex Jimenez

 

References:

  1. Tennant, Forest. “Nutraceuticals for Chronic Pain.” Practical Pain Management, 18 July 2016, www.practicalpainmanagement.com/patient/treatments/nutraceuticals/nutraceuticals-chronic-pain.
  2. Mosenthal, William P. “Sciatica Pain, Symptoms, Causes, Diagnosis, and Treatment.” SpineUniverse, 9 Jan. 2020, www.spineuniverse.com/conditions/sciatica/sciatica-pain-symptoms-causes-diagnosis-treatment.
  3. Theobald, ByMikel. “Photo Gallery: 7 Supplements That Help Back Pain.” EverydayHealth.com, 22 Jan. 2015, www.everydayhealth.com/pictures/best-worst-supplements-help-back-pain/.

 


 

Neurotransmitter Assessment Form

 

The following Neurotransmitter Assessment Form can be filled out and presented to Dr. Alex Jimenez. The following symptoms listed on this form are not intended to be utilized as a diagnosis of any type of disease, condition, or any other type of health issue.

 


 

Additional Topic Discussion: Chronic Pain

Sudden pain is a natural response of the nervous system which helps to demonstrate possible injury. By way of instance, pain signals travel from an injured region through the nerves and spinal cord to the brain. Pain is generally less severe as the injury heals, however, chronic pain is different than the average type of pain. With chronic pain, the human body will continue sending pain signals to the brain, regardless if the injury has healed. Chronic pain can last for several weeks to even several years. Chronic pain can tremendously affect a patient’s mobility and it can reduce flexibility, strength, and endurance.

 

 


 

Neural Zoomer Plus for Neurological Disease

Neural Zoomer Plus | El Paso, TX Chiropractor

 

Dr. Alex Jimenez utilizes a series of tests to help evaluate neurological diseases. The Neural ZoomerTM Plus is an array of neurological autoantibodies which offers specific antibody-to-antigen recognition. The Vibrant Neural ZoomerTM Plus is designed to assess an individual’s reactivity to 48 neurological antigens with connections to a variety of neurologically related diseases. The Vibrant Neural ZoomerTM Plus aims to reduce neurological conditions by empowering patients and physicians with a vital resource for early risk detection and an enhanced focus on personalized primary prevention.

 

Food Sensitivity for the IgG & IgA Immune Response

Food Sensitivity Zoomer | El Paso, TX Chiropractor

 

Dr. Alex Jimenez utilizes a series of tests to help evaluate health issues associated with a variety of food sensitivities and intolerances. The Food Sensitivity ZoomerTM is an array of 180 commonly consumed food antigens that offers very specific antibody-to-antigen recognition. This panel measures an individual’s IgG and IgA sensitivity to food antigens. Being able to test IgA antibodies provides additional information to foods that may be causing mucosal damage. Additionally, this test is ideal for patients who might be suffering from delayed reactions to certain foods. Utilizing an antibody-based food sensitivity test can help prioritize the necessary foods to eliminate and create a customized diet plan around the patient’s specific needs.

 

Gut Zoomer for Small Intestinal Bacterial Overgrowth (SIBO)

Gut Zoomer | El Paso, TX Chiropractor

 

Dr. Alex Jimenez utilizes a series of tests to help evaluate gut health associated with small intestinal bacterial overgrowth (SIBO). The Vibrant Gut ZoomerTM offers a report that includes dietary recommendations and other natural supplementation like prebiotics, probiotics, and polyphenols. The gut microbiome is mainly found in the large intestine and it has more than 1000 species of bacteria that play a fundamental role in the human body, from shaping the immune system and affecting the metabolism of nutrients to strengthening the intestinal mucosal barrier (gut-barrier). It is essential to understand how the number of bacteria that symbiotically live in the human gastrointestinal (GI) tract influences gut health because imbalances in the gut microbiome may ultimately lead to gastrointestinal (GI) tract symptoms, skin conditions, autoimmune disorders, immune system imbalances, and multiple inflammatory disorders.

 


Dunwoody Labs: Comprehensive Stool with Parasitology | El Paso, TX Chiropractor


GI-MAP: GI Microbial Assay Plus | El Paso, TX Chiropractor


 

Formulas for Methylation Support

Xymogen Formulas - El Paso, TX

 

XYMOGEN’s Exclusive Professional Formulas are available through select licensed health care professionals. The internet sale and discounting of XYMOGEN formulas are strictly prohibited.

 

Proudly, Dr. Alexander Jimenez makes XYMOGEN formulas available only to patients under our care.

 

Please call our office in order for us to assign a doctor consultation for immediate access.

 

If you are a patient of Injury Medical & Chiropractic Clinic, you may inquire about XYMOGEN by calling 915-850-0900.

xymogen el paso, tx

 

For your convenience and review of the XYMOGEN products please review the following link. *XYMOGEN-Catalog-Download

 

* All of the above XYMOGEN policies remain strictly in force.

 


 

 


 

Modern Integrated Medicine

The National University of Health Sciences is an institution that offers a variety of rewarding professions to attendees. Students can practice their passion for helping other people achieve overall health and wellness through the institution’s mission. The National University of Health Sciences prepares students to become leaders in the forefront of modern integrated medicine, including chiropractic care. Students have an opportunity to gain unparalleled experience at the National University of Health Sciences to help restore the natural integrity of the patient and define the future of modern integrated medicine.

 

 

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https://www.pushasrx.com/nutraceuticals-for-sciatica/feed/ 0 Nutraceuticals for Sciatica | PushAsRx Athletic Training Centers El Paso, TX Nutraceuticals can help relieve chronic pain, including sciatica or sciatic nerve pain. Nutraceuticals are foods that offers a variety of health benefits. dralexjimenez,Functional Medicine,health,nutraceuticals,sciatica,wellness,nutraceuticals Dr. Alex Jimenez Insights Image Neural Zoomer Plus | El Paso, TX Chiropractor Food Sensitivity Zoomer | El Paso, TX Chiropractor Gut Zoomer | El Paso, TX Chiropractor Dunwoody Labs: Comprehensive Stool with Parasitology | El Paso, TX Chiropractor GI-MAP: GI Microbial Assay Plus | El Paso, TX Chiropractor Xymogen Formulas - El Paso, TX xymogen el paso, tx 24715
Sciatica Chiropractic Solution Pain Relief El Paso, Texas https://www.pushasrx.com/sciatica-chiropractic-solution-el-paso/ https://www.pushasrx.com/sciatica-chiropractic-solution-el-paso/#respond Thu, 13 Feb 2020 03:15:41 +0000 https://www.pushasrx.com/?p=24685 11860 Vista Del Sol, Ste. 126 Sciatica Chiropractic Solution Pain Relief El Paso, Texas

The sciatic nerve can be compressed, pinched, twisted, moved out of position by a variety of things, including injury/s and spinal conditions, diseases, and the most common a herniated disc. This could be time to try the chiropractic solution that can treat sciatica symptoms and bring relief quickly. If you are experiencing a shooting, electrical, […]

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11860 Vista Del Sol, Ste. 126 Sciatica Chiropractic Solution Pain Relief El Paso, Texas

The sciatic nerve can be compressed, pinched, twisted, moved out of position by a variety of things, including injury/s and spinal conditions, diseases, and the most common a herniated disc. This could be time to try the chiropractic solution that can treat sciatica symptoms and bring relief quickly. If you are experiencing a shooting, electrical, tingling, numb pain down one of your legs could be a presenting of sciatica symptoms.

 

11860 Vista Del Sol, Ste. 126 How Topical Medications Alleviate Back/Neck Pain El Paso, TX.

Sciatica

Sciatica is really a symptom itself caused by lumbar radiculopathy. Lumbar radiculopathy is a medical term referring to a low back condition/injury/disorder that is affecting the nerves in this area. The sciatic nerve travels from the lower back down both of the legs and into the feet. Added pressure placed on the nerve from a herniated disc can lead to common symptoms.

 

Symptoms

Sciatica symptoms include:

  • Pain in the leg/s
  • Shooting pain that goes down from the low back, through the leg, calf and sometimes into the foot
  • A feeling of electricity down one leg
  • Burning pain
  • Pain from moving
  • Numbness
  • Weakness

11860 Vista Del Sol, Ste. 126 Sciatica Chiropractic Solution Pain Relief El Paso, Texas

Causes

Causes of sciatica include:

Vertebrae Out of Alignment

Misaligned vertebrae, referred to as subluxations can put pressure on nerves in the spine – including the sciatic nerve.

Disc Herniation

The discs that cushion the vertebrae are made up of a tough outer layer and a softer inner layer. When the outer layer is damaged and the inner layer comes out into the spine, it is referred to as disc herniation.

A herniated disc means that the inner layer of the disc is putting pressure on nerves in the spine. A herniated disc impacts the sciatic nerve and can lead to sciatica.

 

11860 Vista Del Sol, Ste. 126 Sciatica Chiropractic Solution Pain Relief El Paso, Texas

Car Accidents

A car accident can easily damage the spine and soft tissues. An accident can cause a misalignment of the spine, a herniated disc, or other injuries that cause symptoms of sciatica.

Sports Injury/s

Even the fittest athletes are susceptible to back injuries, which in turn can cause sciatica. The spine and discs can be damaged due to a large impact, repetitive motion injuries, or even twisting the wrong way.

 

11860 Vista Del Sol, Ste. 126 Back/Spine Care and Standing Work El Paso, Texas

Work Injuries

Many sufferers of sciatica do not realize that their workplace activities – including repetitive motions and sitting or standing in one position for long periods of time – can lead to sciatica.

How Chiropractic Solution Helps

Prevention found that sixty percent of individuals with sciatica failed to find relief from other treatments found their symptoms improved after chiropractic treatment.

The chiropractic solution works because it gets to the source of the problem and relieves pressure on the sciatic nerve. Chiropractic treatments include:

Realignment

Spinal misalignments are often the cause of sciatica can be corrected through careful chiropractic adjustments. The chiropractor analyzes the misalignment, then applies pressure to the area to correct the misalignment. The pressure is removed from the sciatic nerve, and this is done on and off to get the correct position and massaging the inflamed tissues until symptoms improve.

Spine Decompression

For those whose sciatica is caused by a herniated disc, spinal decompression can bring real relief. Using a specially designed table, the chiropractor can gently stretch the spine – creating space for the disc to heal and pull back from the sciatic nerve.

Find Relief

Please contact our chiropractic team today to schedule an appointment if you are experiencing symptoms of sciatica. We are ready to help you feel better and get back on your feet again. We focus on improving your ability through flexibility, mobility and agility programs tailored for all age groups and disabilities. We do this so that we may reach as many El Pasoans who need us, no matter the affordability issues.


Sciatic Nerve Pain Treatment | El Paso, Tx


 

 

NCBI Resources

Patients with sciatica feel better with time, usually a few weeks. If pain continues, other treatment modalities can be discussed. Muscle spasms can accompany sciatica symptoms and can be treated with heat or ice therapy. A doctor may advise light exercise like short walks and once recovery is established they may give you exercises to strengthen your back and core.

 

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https://www.pushasrx.com/sciatica-chiropractic-solution-el-paso/feed/ 0 %%title%% %%excerpt%% care,causes,chiropractic,health,nerve,numbness,pain,physical,relief,sciatica,sensation,solution,therapies,tingling,treatment,wellness,chiropractic solution 11860 Vista Del Sol, Ste. 126 How Topical Medications Alleviate Back/Neck Pain El Paso, TX. 11860 Vista Del Sol, Ste. 126 Sciatica Chiropractic Solution Pain Relief El Paso, Texas 11860 Vista Del Sol, Ste. 126 Sciatica Chiropractic Solution Pain Relief El Paso, Texas 11860 Vista Del Sol, Ste. 126 Back/Spine Care and Standing Work El Paso, Texas 24685