Lower back pain, disc damage, sciatica and hip pain are common conditions treated by Chiropractors. Essentially we treat small joints at the back of the spine called facet joints, restoring normal function to these joints eliminates pain.In addition hip pain is addressed be correcting the alignment of the pelvis.
This movie below is of normal segmental lower back movement
What makes a person suffering from lower back pain, disc damage, sciatica and hip pain a Chiropractic patient is based on Chiropractic's principle that joint dysfunction termed "Subluxation" is the cause of a patient's signs and
symptoms. The American Chiropractic Association has defined subluxation as "the
alignment / physiological function of a motion segment as being altered although
contact between the joint surfaces remains intact (1)."
This altered alignment / physiological function (2) to the musculoskeletal system
notably cause changes in tissue sensory beds, which have been implicated in
subluxation theories.
The effects of altered sensory input on central and efferent activity is of great
interest to clinicians as Chiropractic analyses have been developed in an attempt
to locate dysfunction or subluxation.
Changes that occur due to joint alterations from micro trauma, sustained loading
such as in an abnormal posture, repetitive motions, many times work related may
also be a mechanism of injury.
Sports, hobbies, and recreation which may lead to acute or chronic dysfunction and
pain syndromes. In addition the effects of ageing, or of a lifetime of micro trauma
and macro trauma injuries leading to degeneration immobilization and pain.
Below is a 3D creation of the lower 3 lumbar vertebrae (lower back)
Red arrows indicate osteophyte formation / spurs -a form of arthritis
Red circle indicates contact points between vertebrae-facet joints
Connective tissue changes as a result of inflammation and oedema reorganize
tissues, possibly perpetuating immobility and further degeneration.
Under normal conditions (2) the nociceptive system is silent because the high
threshold of the nociceptor does not receive the amount of sensory
stimulation necessary to initiate an action potential. However when adequately stimulated nociceptors fire continuously in a non adaptive nature until the stimulus is removed. Thus the person is apprised of a damaging stimulus that causes pain as long as it persists. Three types of stimuli excite nociceptors, mechanical, thermal and chemical.
It is this subluxation that we as Chiropractors, find and restore to normal alignment and hence function.
What we do with the Activator Adjusting Instrument is adjust these subluxations, in doing so we initiate passive joint movement , which results in stimulating movement as well as the nerves that sense movement, this stops the nerves that are responsible for pain from being active, and hence abolish or diminish pain (3).
Creation of normal joint structure and function through Chiropractic adjustments may cause the nerves responsible for sensing normal joint movement, and those nerves responsible for sensing pain to work appropriately, meaning that when the joints are working properly then the pain fibre nerves remain dormant, only when there is joint damage or dysfunction are the pain fibres to operate (3).
e informCatiocn listed is only to be sed as a guide, and does not necessarily
Disc damage (4) Findings of a research of 193 patients showed the most common tissue of pain origin
was the outer layer of the annulus fibrosis and the posterior longitudinal ligament. More recently biomechanical factors have been shown to be involved in pain syndromes with degenerative disc disease. Similar studies (5) of local anaesthetic and confirmatory blocks have also implicated the lumbar facet joints as a source of pain. In summary the way (6) Chiropractic adjustments work is (i) Reduce a subluxation by 1-2mm of the facet joints (ii) Stretching of hypertonic posterior segmental spinal muscles abolishing pain coming from muscles, ligaments
and tendons because of sretching (iii) increased neural output produced by mechanoreceptor stimulation that may modulate pain.
Examples below of lower back disc injuries as shown by M.R.I.
Sciatica (4) Is a result of a spinal nerve root being irritated / compromised by herniated discs, posterior osteophytes, facet hypertrophy, spinal stenosis, spondylolisthesis, infection, tumour, fracture or disease.
Other structures within the I.V.F may also be compromised creating a pathological state. Notably lymphatic channels, segmental arteries, communicating veins and venous plexuses, or recurrent meningeal nerves. Authors have noted some degree of inflammation and irritation of the nerve root must exist to lead to the objective signs and symptoms of sciatica.
Diagram below shows Sciatica(inflamed
sciatic nerve) the hip joint (red arrow) &
the sacro-iliac joints ( aqua arrows)
Hip joint One of the largest (7) and most stable joints in the body. The orientation of the hip articulationssuch as that of weight bearing and mobility generate large stresses on the neck of the femur, the femoral head, the acetabular fossa in the innominate bone of the pelvis. Consequentlypain from the hip can be referred to other areas.
Common causes of hip pain are: Osteoarthritis / Osteoporosis / Hip muscle spasm trochanteric bursitis / Groin –inguinal pain / unstable pelvis / Sacro-iliac joints / low back pain. In Chiropractic restoring proper joint alignment can help eliminate pain.
Below is an animation of the pelvis showing
the 2 iliac bones, sacrum and ligaments
Sacro-iliac joint syndrome The sacro-iliac joint (8) has well developed cartilage surfaces, a synovial membrane,
strong anterior and posterior ligaments, and a large internal sacro-iliac ligament.
The joint surfaces can rotate 3-5 ° in the younger symptom free patient. The joint
has two functions to provide elasticity to the pelvic ring and to serve as a buffer
between the lumbo-sacral spine and hip joints. The pain syndrome presents with
pain over one sacro-iliac joint in the region of the posterior superior iliac spine.
This maybe accompanied by referred pain in the leg. In the sacro-iliac joint
syndrome (9) local and reflex pain is present and movement is restricted. Chiropractic
adjustments directed specifically to this joint however often relieve the symptoms.
Possibly the effects they produce is by stretching posterior muscles, breaking
intra-articular adhesions and relieving the joint fixation with resultant stimulation
of the surrounding mechanoreceptors.
The diagram below is a 3D creation of the lumbar spine (lower back) and the sacro-iliac joints (pelvis/hips)
The 2 blue arrows are the sacro-iliac joints which you can consider as part of your pelvis/ hips
The green arrow is your sacrum
The red arrows indicate a pars defect / fracture-spondylolysis
I have treated many patients who suffer from pars defects, in particularly patients who are in Womens Artistic Gymnastics (WAG) and respond very well to my treatment. The classic symptoms are prolonged lower back pain that is persistant, even with rest.
References:
(1)
Colloca, C.J. (1997). Articular Neurology, Altered Biomechanics and Subluxation Pathology. In A. Fuhr, C. J. Colloca, J.R.Green, T.S. kellar. ACTIVATOR METHODS CHIROPRACTIC TECHNIQUE. (PG. 20). Mosby;U.S.A.
(2)
Colloca, C.J. (1997). Articular Neurology, Altered Biomechanics and Subluxation Pathology. In A. Fuhr, C. J. Colloca, J.R.Green, T.S. kellar. ACTIVATOR METHODS CHIROPRACTIC TECHNIQUE. (PG. 38). Mosby;U.S.A.
(3)
Colloca, C.J. (1997). Articular Neurology, Altered Biomechanics and Subluxation Pathology. In A. Fuhr, C. J. Colloca, J.R.Green, T.S. kellar. ACTIVATOR METHODS CHIROPRACTIC TECHNIQUE. (PG. 42). Mosby;U.S.A.
(4)
Colloca, C.J. (1997). Articular Neurology, Altered Biomechanics and Subluxation Pathology. In A. Fuhr, C. J. Colloca, J.R.Green, T.S. kellar. ACTIVATOR METHODS CHIROPRACTIC TECHNIQUE. (PG. 31-32). Mosby;U.S.A.
(5)
Colloca, C.J. (1997). Articular Neurology, Altered Biomechanics and Subluxation Pathology. In A. Fuhr, C. J. Colloca, J.R.Green, T.S. kellar. ACTIVATOR METHODS CHIROPRACTIC TECHNIQUE. (PG. 26). Mosby;U.S.A.
(6)
Kirkaldy-Willis, W.H. (1988). A Comprehensive Outline of Treatment. In W.H. Kirkaldy-Willis. MANAGING LOW BACK PAIN. SECOND EDITION. (PG 251). Churchill Livingstone: U.S.A.
(7)
Fuhr, A.W., Green, J.R., Colloca, C. J. (1997) Sacrum, Pelvis and Related Structures. In A. Fuhr, C.J. Colloca, J.R. Green, T.S. Kellar. ACTIVATOR METHODS CHIROPRACTIC TECHNIQUE. (PG. 214-218). Mosby;U.S.A.
(8)
Kirkaldy-Willis, W.H. (1988). The site and nature of lesion. In W.H. Kirkaldy-Willis. MANAGING LOW BACK PAIN. SECOND EDITION. (PG 135). Churchill Livingstone: U.S.A.
(9)
Kirkaldy-Willis, W.H., Cassidy J.D. (1988) Manipulation. In W.H. Kirkaldy-Willis. MANAGING LOW BACK PAIN. SECOND EDITION. (PG135). Churchill Livingstone: U.S.A.
Click here for 3D Animations, learn correct postures, about your nervous system, and subluxations.
