What causes lower back and hip pain on the right side. How are leg length discrepancy and pelvic tilt related to back pain. What treatments are available for walking difficulties and pelvic-spine misalignment. How can you alleviate pain and improve mobility in cases of hip arthritis and sciatica.

Understanding Pelvic Incidence and Its Impact on Spinal Health

Pelvic incidence is a crucial measurement in understanding the relationship between the pelvis and spine. Rather than viewing these structures as separate entities, modern research suggests considering the pelvis as an extension of the spine. This perspective allows for a more comprehensive analysis of spinal alignment and its impact on overall body mechanics.

The pelvic incidence angle plays a significant role in regulating spinal curvature. When the pelvis is tilted, it can disrupt the natural curve of the lower spine, leading to various issues such as:

• Lower back pain
• Hip discomfort
• Muscle spasms
• Difficulty walking
• Stiffness after prolonged sitting

How does pelvic tilt affect spinal alignment?

Pelvic tilt can occur in two directions: anterior (forward) and posterior (backward). Each type of tilt has distinct effects on the lumbar spine:

1. Anterior pelvic tilt:
   • Increases lordosis (spinal curve)
   • Puts pressure on the front of the vertebrae
   • Can cause disc bulging
   • May lead to nerve compression
2. Posterior pelvic tilt:
   • Decreases lordosis
   • Strains spinal ligaments
   • Can cause disc herniation
   • May mimic stenosis or sciatica symptoms

The Connection Between Leg Length Discrepancy and Back Pain

Leg length discrepancy is a common issue that can significantly impact spinal alignment and contribute to lower back and hip pain. When one leg is shorter than the other, it can cause:

• Pelvic tilt
• Uneven gait
• Increased stress on the spine and hips
• Compensatory muscle imbalances

These factors can lead to chronic pain and difficulty performing daily activities. Identifying and addressing leg length discrepancy is crucial in managing and treating associated back and hip pain.

How can leg length discrepancy be diagnosed?

Diagnosis of leg length discrepancy typically involves:

1. Physical examination
2. X-rays or CT scans
3. Gait analysis
4. Measurement of pelvic tilt

Early detection and treatment of leg length discrepancy can help prevent long-term complications and improve overall quality of life.

Hip Arthritis: Symptoms, Causes, and Treatment Options

Hip arthritis is a common condition that can contribute to lower back and hip pain, especially when combined with other factors such as leg length discrepancy or pelvic tilt. Common symptoms of hip arthritis include:

• Pain in the hip joint
• Stiffness, especially after sitting or resting
• Reduced range of motion
• Difficulty walking or performing daily activities
• Grating or clicking sensations in the joint

What are the main causes of hip arthritis?

Hip arthritis can be caused by various factors, including:

1. Age-related wear and tear (osteoarthritis)
2. Inflammatory conditions (rheumatoid arthritis)
3. Previous joint injuries
4. Genetic predisposition
5. Obesity

Treatment options for hip arthritis range from conservative approaches to surgical interventions, depending on the severity of the condition and its impact on the patient’s quality of life.

Sciatica: Understanding the Connection to Hip and Leg Pain

Sciatica is a common condition characterized by pain that radiates along the path of the sciatic nerve, which extends from the lower back through the hips and down each leg. This condition can be closely related to lower back and hip pain, often exacerbated by factors such as pelvic tilt or leg length discrepancy.

What are the primary symptoms of sciatica?

Common symptoms of sciatica include:

• Lower back pain that extends to the buttocks and leg
• Numbness or tingling in the affected leg
• Weakness in the leg or foot
• Sharp, burning, or electric-like pain
• Difficulty walking or standing for long periods

Sciatica can be caused by various factors, including herniated discs, spinal stenosis, or pelvic misalignment. Proper diagnosis and treatment are essential for managing symptoms and preventing long-term complications.

Degenerative Disc Disease: Impact on Spinal Health and Mobility

Degenerative disc disease is a condition that affects the intervertebral discs, leading to pain, reduced mobility, and potential nerve compression. This condition can contribute significantly to lower back and hip pain, especially when combined with other factors such as pelvic tilt or leg length discrepancy.

How does degenerative disc disease progress?

The progression of degenerative disc disease typically involves:

1. Loss of disc height and hydration
2. Increased stress on surrounding structures
3. Development of bone spurs
4. Potential nerve compression
5. Gradual loss of spinal flexibility

Managing degenerative disc disease often requires a multifaceted approach, including physical therapy, lifestyle modifications, and in some cases, surgical intervention.

Comprehensive Treatment Approaches for Lower Back and Hip Pain

Addressing lower back and hip pain often requires a comprehensive treatment approach that takes into account the various factors contributing to the condition. Some effective treatment options include:

• Physical therapy and targeted exercises
• Chiropractic care and spinal manipulation
• Orthotics or shoe lifts for leg length discrepancy
• Anti-inflammatory medications
• Regenerative medicine techniques
• Lifestyle modifications and ergonomic improvements
• Surgical interventions in severe cases

How can regenerative medicine help with lower back and hip pain?

Regenerative medicine techniques, such as prolotherapy or platelet-rich plasma (PRP) injections, aim to stimulate the body’s natural healing processes. These treatments can help:

• Reduce inflammation
• Promote tissue repair
• Improve joint stability
• Alleviate pain and discomfort
• Enhance overall function and mobility

When combined with other treatment modalities, regenerative medicine can offer significant relief for patients suffering from chronic lower back and hip pain.

Improving Mobility and Quality of Life: Strategies for Long-Term Success

Managing lower back and hip pain requires a long-term commitment to improving overall health and mobility. Implementing the following strategies can help patients achieve lasting relief and enhanced quality of life:

1. Regular exercise and stretching routines
2. Maintaining a healthy weight
3. Proper posture and ergonomics
4. Stress management techniques
5. Adequate sleep and rest
6. Nutritional support for joint health
7. Regular check-ups and adjustments as needed

How can patients stay motivated in their pain management journey?

Staying motivated throughout the pain management process can be challenging. Some effective strategies include:

• Setting realistic, achievable goals
• Tracking progress and celebrating small victories
• Joining support groups or online communities
• Working with a supportive healthcare team
• Exploring new activities or hobbies that accommodate physical limitations

By adopting a proactive approach to managing lower back and hip pain, patients can significantly improve their overall well-being and reclaim their ability to enjoy daily activities.

Understanding the complex interplay between pelvic alignment, spinal health, and leg length discrepancy is crucial for effectively addressing lower back and hip pain. By taking a comprehensive approach that considers all contributing factors, patients can work with their healthcare providers to develop personalized treatment plans that address their unique needs and goals. With persistence, patience, and the right combination of therapies, many individuals can find significant relief from chronic pain and improve their overall quality of life.

Treatments for leg length discrepancy, pelvic tilt, pelvic incidence-lumbar lordosis mismatch, and walking difficulties – Caring Medical Florida

Ross A. Hauser, MD., Danielle R. Steilen-Matias, MMS, PA-C., Brian Hutcheson, DC

In this article, we look at the problems of leg length discrepancy in the adult patient, its role in back and hip pain, and, in walking difficulties. We will also discuss how these problems can be treated.

We realize that you have probably made your way here to our article because conventional and conservative care for your challenges has not worked that well for you and you are now exploring more options.

Before we get started, let’s go over some definitions and explanations:

What is pelvic incidence? 

Pelvic incidence is a measurement. It is not a diagnosis or condition. There was a 2016 paper published in the medical journal Spine (1) which gives a good introductory explanation of what Pelvic Incidence is and what it could mean to you.

“Medical textbooks present the pelvis and the spine as a distinct entities-an unfortunate practice that does not reflect the crucial and critical role that the pelvis plays in regulating spinopelvic alignment.”

What the researchers noted was the work of other researchers and previous studies who suggested that the pelvis be thought of as another vertebra or extension of the spine and that analysis of the spine requires simultaneous analysis of its relationship to the pelvis. To understand this pelvis-spine relationship better – the concept of pelvic incidence angle was introduced to understand who this pelvic angle helps regulate the curvature of the spine.

In other words, if your pelvis is tilted, it can disrupt the natural curvature of the lower spine.

What are we seeing in this image? If your pelvis is tilted, it can disrupt the natural curvature of the lower spine. An understanding of the symptoms of pelvic tilting and lumbar lordosis mismatch causing muscle spasms and low back pain and hip pain

As you will read below, some of the people that contact us report that one of their symptoms is stiffness and pain when they stand after sitting for some time. If you have stiffness and pain after sitting, this may account for it. In this image we see:

Anterior (the front) and posterior (the back) tilting of the pelvis and its effect on the kinematics (movement) of the lumbar spine. This image is divided into an A, B, C, D segment

• In the A image (anterior pelvic tilt with lumbar extension) and the B image (a close-up image of the vertebrae and intervertebral lumbar extension) the anterior or frontal tilt of the pelvis when the person is sitting puts pressure on the lumbar spine by increasing Lordosis or spinal curve (you start bending backward). In the B closeup we see that when the lower spine is bending backward, it increased pressure on the front of the vertebrae causing the disc innards, the nucleus pulposus to bulge the disc outward. To the rear of the vertebrae, this pressure causes a narrowing of the intervertebral foramen. We have a situation where the disc is bulging in the front and possibly pinching nerves in the rear.

In the C image (anterior pelvic tilt with lumbar extension) and the D image (a close-up image of the vertebrae and intervertebral lumbar flexion), we see that a rear tilt of the pelvis inwards towards the front curves the spine towards the front. This will decrease the lordotic curve of the spine. Stress is now placed on the spinal ligaments, the connective tissue that strains to keep the vertebra in proper alignment. In the D illustration, we see a stretching of the posterior ligament or ligamentous complex which includes the capsular ligaments of the spinal joints, the spinous and interspinous ligaments (the ligaments that attach the rear of each vertebra to the vertebra above and below it). The disc bulge occurs now in the rear, forcing the front of the vertebra to move towards a collision with the vertebra below.

Bulging discs, herniated discs, and a situation mimicking a stenosis/sciatica

In this illustration above we see many things happening. All these things lead to pain and loss of function. When this happens you get stories that go something like this:

Hip arthritis, leg length discrepancy

• I have hip arthritis, low back problems, and leg length discrepancy. My x-ray and MRI are bad. My main problems are I am walking with an uneven gait, I have stiffness when I stand after sitting. Fortunately, I can still function and perform daily normal movements.

Sciatica, hip, difficulty walking

• I am a former athlete, I have issues with the same side sciatica, hip, and leg pain. One leg is slightly shorter with some pelvic tilt. My doctors tell me that my pain is coming from degenerative disc disease and spinal compression on the nerves. I have walking issues. X-ray shows bone on bone knee and pelvic tilt. Physical therapy helps a little.

Sacroiliac joint dysfunction

What these three stories have in common is that there is a degenerative element to what is happening to these people. For some, these problems did not gradually develop because of spinal instability and wear and tear that comes with age-related conditions such as slipped vertebrae or spondylolisthesis. These people may have had a long history of spinal problems such as scoliosis developed during childhood that has become progressively worse into adulthood. Others had adult spinal deformity brought on them by spinal surgery and the problems of adjacent segment disease noted in failed back surgery syndrome. Each person is of course unique and their successful treatment will present unique challenges.

Which came first, developing lower spine curve deformity or leg length discrepancy and pelvic tilt?

The complexity of your problem with leg length discrepancy and pelvic tilt and why the diagnosis may be challenging was revealed in a 2015 study in the Journal of Physical Therapy Science. (2)

How leg-length inequality would affect the pelvic position and spinal posture

In this study, researchers created a computer-guided model to investigate how an artificially created leg-length discrepancy would affect the pelvic position and spinal posture. What they found were some significant changes in the pelvic position as a result of an artificially created leg-length discrepancy.

Increasing leg length discrepancy was not translating into increasing spinal deformity

Pelvic tilt is an indicator for observing pelvic changes in the coronal plane (looking at the body straight on from the front and observing if the left side pelvis is higher than the right side pelvis or vice versa, the tilt to one side to another).

However, what the researchers found was that in some models, while leg-length discrepancy increased, this did not translate to creating a significant difference in spinal posture resulting from the leg-length inequalities. (So the increasing leg length discrepancy was not translating into increasing spinal deformity), so leg length discrepancy would not come first in this model. The spinal deformity would.)

There appeared to be no significant changes in the trunk resulting from the temporal (over time) leg-length inequalities, but spinal changes were observed with different leg lengths for short periods of time in healthy adult male and female groups. The temporal changes in the pelvis and the trunk resulting from leg-length inequalities seem to show more of a compensation mechanism in the pelvis than in the trunk. (So the leg length discrepancy could come first in problems of pelvic tilt).

So what does this mean? Alleviation of symptoms related to leg length discrepancy may not be solved by spinal surgery.

If you had leg length discrepancy and you were given the choice of one surgery to solve it, it should not be a spinal surgery. Look at the hip first.

The hip joint joins the leg to the pelvis. Unfortunately for most people, both legs are not exactly the same. They may look the same, but from a biomechanical standpoint, they are not the same. One leg may be rotated either in or out, or one leg may be shorter than the other. The latter is especially common if one leg was broken during childhood. Because the hip joint connects the leg to the pelvis, the hip joint will sustain the brunt of any biomechanical abnormality that may occur.

So a leg length problem starting with the legs is a problem that may only confine itself to problems in the pelvis and hip pain. If you show spinal deformity, one may suggest a connection, but the connection is not clear and alleviation of symptoms related to leg length discrepancy may not be found in spinal surgery.

Doctors recommend the long fusion surgery as a means to prevent reoperations because of adjacent segment disease.

An August 2021 study in the journal World Neurosurgery (3) focused on pelvic incidence-lumbar lordosis mismatch as the possible cause of adjacent segment disease in spinal fusion patients and as the cause for the need for revision spinal fusion surgery.

What the researchers of this study set out to do was examine the clinical outcomes of 47 patients aged 40+ years who underwent repeat posterior lumbar interbody fusion after single-segment posterior lumbar interbody fusion due to adjacent segment disease. What they were looking for is what made these patients have a greater risk for revision surgery. What did they find? “Pelvic incidence-lumbar lordosis mismatch and thoracic kyphosis before repeat posterior lumbar interbody fusion were identified as predisposing factors for subsequent long corrective fusion.” Further, “Once the Pelvic incidence-lumbar lordosis mismatch occurs after initial posterior lumbar interbody fusion, it will be difficult to resolve the Pelvic incidence-lumbar lordosis mismatch during the second posterior lumbar interbody fusion.”

What are we seeing in this image?

Lumbar instability above fusion causing nerve compression. Narrowing of the intervertebral foramina at the L3 and L4 levels is seen on the extension view but open on the flexion view. This is diagnostic lumbar instability causing this person’s symptoms of lumbar radiculopathy.

Leg length discrepancy and degenerative joint forces straining the hip.

• If one leg is shorter than the other, the hip joints will be stressed as the leg-length discrepancy will cause an abnormal gait or walking motion. This is evidenced by the waddling gait of someone with a hip problem. This waddling gait helps remove pressure on the painful hip. The gait cycle is most efficient when the iliac crests are level, you have a straight pelvis, not a tilted pelvis. Unequal leg lengths cause the pelvis to move abnormally, this will cause stress on the pelvis and can include problems of Pelvic Floor Dysfunction, Pubic symphysis in Men, and Pelvic Girdle Pain.

Many people come in with a tilted pelvis. However, for many of these patients, that is not what is causing their pain.

In this brief video Danielle R. Steilen-Matias, MMS, PA-C. Caring Medical Florida explains.

The summary transcript:

• What is interesting about the diagnosis of tilted pelvis is that we see a lot of patients without that diagnosis and they in fact do have a tilted pelvis. So the question is, is the tilted pelvis the cause of their hip and back pain or not?

This seemingly obvious connection between leg length discrepancy, walking problems and hip and back pain is still a controversial subject.

In a recent study, doctors in Israel published findings in the medical journal Gait and Posture (4) that sought to determine if there is a relationship between the magnitude of leg length discrepancy and the presence of gait deviations.

• The first thing the researchers noted was that controversy still exists as to the clinical significance of leg length discrepancy in spite of the fact that further evidence has been emerging regarding the relationship between several clinical conditions and leg length discrepancy.
• Despite the controversy, the researchers found a significant relationship between anatomic leg length discrepancy and gait deviation.  The evidence suggests (something of the obvious) that gait deviations cause more pain and instability in the joints as the discrepancy increases.

Even a small deviation in leg length could impact joint stability and degenerative disc and joint disease

University researchers in Australia and Spain combined to publish research in the Journal of Manipulative and Physiological Therapeutics (5) that evaluated the correlation between mild leg length discrepancy and degenerative joint disease or osteoarthritis.

They looked at 235 adults, (121 women and 134 men) who went to the chiropractor for back pain. The researchers found a strong connection between leg length discrepancy and degenerative disc disease at the L5-s1 spinal segment and the L4-L5 spinal segment.

The researchers concluded that patients with hip and lower back pain should be evaluated for leg length discrepancy.

In Finland, doctors writing in the medical journal Acta Orthopaedica went back 29 years to show how different leg lengths affected patients over this near 30 year period.  (6)

• Of note: The researchers suggest that 7% of the population have leg-length inequality of 12 mm (almost a half-inch or greater) but display no symptoms or problems.
• It has been suggested that leg-length inequality of 5 mm (about 1/5th of an inch) can be associated with an increased risk of osteoarthritis of the knee and hip.
• The Finnish team followed the records of 193 individuals for 29 years. They all started with no leg-length discrepancy.
• When the patients were first observed they had no clinical histories or signs of leg symptoms. The initial standing radiographs of their hips revealed no signs of osteoarthritis.
• After 29 years :
  • 24 (12%) of the subjects still had no discernible leg-length difference,
  • 62 (32%), had a leg-length difference of 1-4 mm, (less than 1/5th of an inch)
  • 74 (38%) of 5-8 mm, (less than 1/3rd of an inch)
  • 21 (11%) of 9-12 mm, (almost a half inch)
  • and 12 (6%) of over 12 mm (More than a half-inch)
  • 16 (8%) of the subjects had undergone hip replacement arthroplasty for primary osteoarthritis. Half of the group had both hip and knee replacements.
• Another note: 10 individuals had undergone a joint replacement of the longer leg and only 3 of the shorter leg. In the group of equal leg length, 3 had had an arthroplasty of hip or knee.
• Interpretation – Hip or knee arthroplasty due to primary osteoarthritis had been done 3 times more often to the longer leg than to the shorter.

Treatment of pelvic tilt and leg length discrepancy

As mentioned above the diagnosis and treatment options for pelvic tilt, leg length discrepancy and a possible connection to adult spinal deformity can be challenging. Surgery may be called for. But what kind of surgery? Will the surgery help or make the problem worse? For many people, spinal surgery may be of great benefit. These are typically not the people we see in our office. Moreso, we may see patients following a hip replacement that caused greater leg length distortion and these people have shoe inserts to help straighten their pelvis.

Understanding and treating pelvic incidence-lumbar lordosis mismatch – Muscle spasms and low back pain

Many patients we see have terrible back pain and muscle spasms because of the struggles their musculoskeletal frame goes through trying to keep their body balanced and their head in its correct position. That is, the head up right and in vertical alignment with their pelvis. 

In your visits to your doctors, you may have heard terms such as “sagittal misalignment,” or “sagittal malalignment.” You may have been told you have “adult spinal deformity.” What you clearly have is pain and limitation in movement, and probably a suggestion to have multi-level spinal fusion surgery.

What are we seeing in this next image? Muscle spasms and low back pain

In this illustration, we see the muscles that help balance the pelvis and keep our body in proper alignment. It is typically these muscles that spasms and cause pain when there is spinal instability in the lumbar spine caused by lumbar ligament damage, weakness, and laxity.

• The erector spinae is comprised of three muscles, the Iliocostalis, the longissimus, and the spinalis. This muscle complex attaches the base of the skull to the pelvis. As the name implies, the Erector spinae keeps the spine erect.
• The abdominals are the four main muscle groups sometimes referred to as part of the “core muscles.”
  • The transversus abdominis stabilizes the trunk and are often the key to helping back pain patients in physical therapy.
  • The rectus abdominis or “six-pack,” muscles. These muscles connect the rib cage to the pelvis.
  • The external oblique muscles and internal oblique muscles –the muscles of the abdominal core that provides twisting motion

Again, will spinal surgery address the problem?

In September 2020, researchers wrote in The Spine Journal (7) of how surgical correction strategies for adult spinal deformity may or may not improve daily quality of life problems such as those created by pelvic tilt and lumbar lordosis.

The researchers suggested that: “Surgical correction strategies for adult spinal deformity relies heavily on radiographic alignment goals, however, there is often debate regarding the degree of correction and how static alignment translates to physical ability in daily life.”

In other words, the success of the surgery is based on what the post-surgical x-ray reveals. Are things lined up correctly? But these doctors have expressed concern that even if things are lined up correctly in the surgery, does this offer any benefit to the patient’s daily quality of life?

What the researchers then examined were various factors that they considered important in determining the surgical treatment success so they could assess “clinically meaningful estimates of dynamic changes in spinal alignment during activities of daily life.” For one thing, they looked at how the patient walked.

This is what they found:

Patients with severe adult spinal deformity had significantly larger dynamic maximum and minimums for sagittal vertical axes, T1 pelvic angle, lumbar lordosis, and pelvic tilt compared with Mild adult spinal deformity patients. However, adult spinal deformity patients exhibited little difference in dynamic alignment compared with healthy subjects. Only pelvic tilt had a significant difference in dynamic range of motion compared with healthy control subjects.

Conclusions: Mild and Severe adult spinal deformity patients exhibited similar global dynamic alignment measures during gait and had a comparable range of motion to healthy subjects except with greater pelvic tilt.

In other words, problems of walking and quality of life in patients with adult spinal deformity were more impacted by pelvic tilt than spinal problems. The answer for some of these people may be in correcting the pelvic tilt.

Did spinal surgery cause the problem? “Not aligned” patients had also a significantly higher pelvic incidence.

Here is a May 2021 study in the journal Advances in Orthopedics (8). The focus was on understanding how crucial it was to return a post-fusion surgical patient to a somewhat normal lumbar lordosis by lordosis repartition. What the results revealed was that in adjacent segment disease patients, postoperative malalignment was associated with a lack of distal (between L4-S1) lordosis restoration. “Not aligned” patients had also a significantly higher pelvic incidence. Specific attention must be paid to restore optimal distal lumbar lordosis in order to set the amount and the distribution of optimal postoperative lumbar lordosis.

The problem of pelvic tilt in Femoroacetabular impingement

We have a very extensive article on Femoroacetabular Impingement. We will summarize some of the learning points of this article here.

Femoroacetabular Impingement or sometimes diagnosed simply as Hip Impingement is a condition where abnormal contact and rubbing of the ball and socket portion of the hip bones creates joint damaging friction. For some people, the rapid degeneration of the hip joint causes the formation of bone spurs. The bone spurs are there because the body is trying to create stability in a joint that has become unstable. The loss of stability can be traced to a weakening of the ligaments and tendons of the hip, low back, groin and hamstring areas, and hip labrum degeneration.

Femoroacetabular Impingement may only be one part of a bigger problem – such as the problems of  leg length discrepancy, pelvic tilt, pelvic incidence-lumbar lordosis mismatch, and walking difficulties

As in the many conditions we see, Femoroacetabular Impingement is not a condition or diagnosis that sits in isolation. It is typically part of a bigger picture of hip instability. For some people, exercise programs that get the hip back into its natural and optimal position will work very well. For those it does not, we will present the information below on regenerative medicine injections that can accelerate the healing process.

A February 2021 study in the European Spine Journal (9) found that adult spinal deformity patients compensating with knee flexion have altered hip orientation which can lead to posterior femoroacetabular impingement, thus limiting pelvic retroversion (the natural movement of the pelvis behind the spine in part due to loss of the natural curve or lordosis of the lumbar region). This underlying mechanism could be potentially involved in the hip-spine syndrome.

What are we seeing in this image? The answer for some of these people may be in correcting the pelvic tilt by treating the spinal, hip, and pelvic ligaments

In this image we see the front of the pelvis and the many ligament attachments that hold the two halves of the pelvis together and connect the pelvis to the spine. Above we cited research that suggested that the pelvis be treated as an extension of the spine. When you look at the pelvic/spinal ligaments you can see how the spine and pelvic and spinal instability should not be treated in isolation. In this image, we see how the intertransverse ligament, anterior longitudinal ligament, anterior sacroiliac ligaments, iliolumbar ligaments, and the pubofemoral ligaments all interact to provide a “firm girdle.”

A patient case history: The patient is Ross Hauser, MD

In this video Brian Hutcheson, DC, and Danielle Matias, PA-C discuss one of their patients, Caring Medical medical director Ross Hauser, MD.

Here we have a pelvic and hip x-ray of our mentor and medical directory Ross Hauser, MD.

Summary learning points:

He has a tilt.

• In this x-ray of Dr. Hauser, we see that he has a problem: There is a reduction in the space between his ischium (the bone that forms the base of the pelvis) and his ileum (the bone that forms the upper part of the pelvis). When we compare this space reduction to his right side, his left side displays a bit of a lowering. In common terms. He has a tilt. The right side is higher than the left side.

Sciatica like symptoms and right knee pain

• Dr. Hauser noted that he was having sciatica-like symptoms on his left side. H was also suffering from a nagging pain in his right knee.
• Dr. Hauser’s symptoms are very common in patients we see. People will come in with back pain, hip pain, or knee pain and their pelvis are off. The patients will tell us that they already know that one of their hips rests higher than the other side, or they will tell us that their legs are two different lengths and that they have a leg-length discrepancy.
• Many patients assume that their legs are in fact two different lengths. But when we measure the legs, we find that are both equal and length and that their leg length problems are originating in their pelvis.

Leg-length discrepancy

• Leg length discrepancy, pelvic tilt, a higher hip, can be caused by many different things. It can be a lumbar problem or spinal instability tugging and pulling the pelvic bones out of position,  it could also be a problem with one of the femurs where they connect to the acetabulum (hip socket). One of the femurs can be jammed in the hip socket and the other one could be sitting in the correct position. So we’ll have to adjust or treat in that area also.
• In patients like Dr. Hauser, the knee will be a problem and if we look further down that chain, the ankle pain can be a symptom of this problem or a cause of sciatica-like symptoms and hip pain.

What are we seeing in this image? A lot of tilt

In this image, we see an x-ray of a patient. The x-ray is of Dr. Ross Hauser’s pelvic tilt. Dr. Hauser suffered from the sudden and acute onset of lower back pain on his left side. He also displayed symptoms of sciatica. The x-ray revealed on his left side a decrease in the distance from the ischial tuberosity to the top of the iliac crest. This means that there would be an increase in tilt between the left and right sides. This is displayed in the increase in distance from the sacroiliac joint to the midline compared to the right side. For Dr. Hauser, Prolotherapy treatments to his left iliolumbar, sacroiliac, and sacrotuberous ligaments resolved his pain and pelvic distortions.

With leg-length discrepancy, either hip joint can cause pain, and usually both hip joints hurt to some degree. To propel the leg forward, the hip joint must be raised which strains the gluteus medius muscle and connective tendons and the posterior hip ligaments. Leg-length problems are also associated with recurrent lower back problems because they cause the pelvis to be asymmetric.

Whether it is a low back problem, pubis problem, pelvic floor, or hip problem, leg length discrepancy can cause significant and disabling problems down the road.

Prolotherapy Injections for correcting spinopelvic instability and pelvic tilt

Prolotherapy is an injection treatment that stimulates the repair of connective tissues such as tendons and ligaments. It causes a mild inflammatory response which initiates an immune response. This mimics what the body does naturally to heal soft tissue injuries.

The most common pelvic instability is sacroiliac instability, caused by injuries to the stabilizing ligaments of the sacroiliac joint. These ligaments are typically injured through the combined movements of spinal flexion and rotation.

Prolotherapy: Treating the ligaments in sacroiliac joint dysfunction

We treat the whole low back area to include the sacroiliac or SI joint.

Summary and Learning Points of Prolotherapy to the low back

• Prolotherapy is multiple injections of simple dextrose into the damaged spinal area.
• Each injection goes down to the bone, where the ligaments meet the bone at the fibro-osseous junction. It is at this junction we want to stimulate repair of the ligament attachment to the bone.
• We treat the whole low back area to include the sacroiliac or SI joint. In the photo above, the patient’s sacroiliac area is being treated to make sure that we get the ligament insertions and attachments of the SI joint in the low back.

• Why the black crayon lines? This patient has a curvature of her spine, scoliosis, so it is important to understand where the midpoint (center) of her spine is. In this patient, we are going to go up to the horizontal line into the thoracic area which is usually not typical of all treatments.
• After treatment we want the patient to take it easy for about 4 days.
• Depending on the severity of the low back pain condition, we may need to offer 3 to 10 treatments every 4 to 6 weeks.

Ligaments are bands of fibrous tissue that connect bones to each other, like the vertebrae to each other and the sacrum to the pelvis.

In a December 2019 study, (10) doctors made these observations concerning Prolotherapy and Platelet Rich Plasma (PRP) Injections. Platelet Rich Plasma (PRP) Injections are considered a type of Prolotherapy when applied in a similar manner.  These injections are explained further below.

“SI joint pain can be generated from extra-articular elements including ligaments and capsules. (The SI joint pain does not necessarily have to come from the joint itself). Prolotherapy involves the injection of hyperosmolar dextrose or platelet-rich plasma (PRP) into the area where repairing and strengthening are thought to be needed. The application of prolotherapy for SI joint pain consists of making injections in the periarticular and intra-articular areas to treat pain and sacral ligament laxity. Some studies reported the positive clinical outcomes of prolotherapy for SI joint pain and even a superior effect and longer duration for relief of SI joint pain compared to the injection of a steroid into the joint. In recent studies, a significant reduction in the pain scores of SI joint pain was observed in patients receiving intra-articular PRP injections compared to those receiving steroid injections.

In this video, Ross Hauser, MD explains the use of Platelet Rich Plasma in treating this patient with problems of the sacroiliac instability caused by sacroiliac ligament damage. 

The actual treatment begins at 3:15 of the video

Summary learning points:

• Platelet Rich Plasma or PRP involves the application of concentrated platelets, which release growth factors to stimulate recovery in non-healing injuries.
• At 3:15 of the video, the pain is numbed and the injections begin
• Prolotherapy is used to treat the ligaments. PRP is used to more specifically treat the attachments of the SI Joint and Pelvis. The treatment is designed to correct SI joint instability by addressing the damaged and weakened ligaments of the SI / Pelvic region.

Summary and contact us. Can we help you?

We hope you found this article informative and it helped answer many of the questions you may have surrounding your leg length discrepancy, pelvic tilt, pelvic incidence-lumbar lordosis mismatch, and walking difficulties challenges.  If you would like to get more information specific to your challenges please email us: Get help and information from our Caring Medical staff

Brian Hutcheson, DC | Ross Hauser, MD | Danielle Steilen-Matias, PA-C

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References

1 Diebo BG, Lafage V, Schwab F. Pelvic Incidence: The Great Biomechanical Effort. Spine. 2016 Apr 1;41:S21-2. [Google Scholar]
2 Kwon YJ, Song M, Baek IH, Lee T. The effect of simulating a leg-length discrepancy on pelvic position and spinal posture. Journal of physical therapy science. 2015;27(3):689-91. [Google Scholar]
3 Nagamoto Y, Okuda S, Matsumoto T, Takenaka S, Takahashi Y, Furuya M, Iwasaki M. Pre-operative pelvic incidence minus lumbar lordosis mismatch in repeat posterior lumbar interbody fusion induces subsequent corrective long fusion. World Neurosurgery. 2021 Aug 5.
4 Murray KJ, Molyneux T, Le Grande MR, Mendez AC, Fuss FK, Azari MF. Association of Mild Leg Length Discrepancy and Degenerative Changes in the Hip Joint and Lumbar Spine. Journal of Manipulative and Physiological Therapeutics. 2017 Jun 30;40(5):320-9. [Google Scholar]
5 Khamis S, Carmeli E. Relationship and Significance of Gait Deviations Associated with Limb Length Discrepancy: A Literature Review. Gait & Posture. 2017 May 31. [Google Scholar]
6 Tallroth K, Ristolainen L, Manninen M. Is a long leg a risk for hip or knee osteoarthritis? A 29-year follow-up study of 193 individuals. Acta Orthopaedica. 2017 Sep 3;88(5):512-5. [Google Scholar]
7 Mar DE, Kisinde S, Lieberman IH, Haddas R. Representative Dynamic Ranges of Spinal Alignment During Gait in Patients with Mild and Severe Adult Spinal Deformities. The Spine Journal. 2020 Sep 20. [Google Scholar]
8 Mekhael M, Kawkabani G, Saliby RM, Skalli W, Saad E, Jaber E, Rachkidi R, Kharrat K, Kreichati G, Ghanem I, Lafage V. Toward understanding the underlying mechanisms of pelvic tilt reserve in adult spinal deformity: the role of the 3D hip orientation. European Spine Journal. 2021 Feb 27:1-9. [Google Scholar]
9 Chuang CW, Hung SK, Pan PT, Kao MC. Diagnosis and interventional pain management options for sacroiliac joint pain. Tzu-Chi Medical Journal. 2019 Oct;31(4):207. [Google Scholar]

This article was updated August 10, 2021

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3 stretches to relieve lower-back pain

Is a bad back slowing you down? When you have back discomfort, it’s natural to assume there is something brewing or damaged in that specific area to cause such symptoms. But for those living with the burden of lower-back pain, the source of soreness isn’t always so obvious. In fact, it may be stemming from another body part: the hips.

For the lower back to function properly, your hips must be happy. The hip flexors are a group of muscles that connect the lower back to the hips, thigh bones, and groin. When healthy, they work to stabilize the lower spine, as well as mobilize the legs during such daily activities as walking, stair climbing, balancing, and maintaining proper posture.

In order for the hip flexors to do their job, they require daily stretching. This is especially true because tight hip flexors can strike anyone at any age, whether you’re sedentary all day or an avid athlete who runs regularly. When these muscles shrink, or become rigid or weak, this tight tissue pulls on the front of the pelvis, causing a tilt that affects posture and results in imbalances, specifically in the lower back.

Flexibility is the key to having a body that is functional and free of pain. Help your hip flexors and reduce lower-back aches with these top strengthening stretches:

• Using a sturdy seat, cross your right leg over your left so that your right ankle is above your knee. Keep your spine straight, shoulders back, and left foot planted firmly on the floor. If your range of motion permits, try to lower your right knee so your crossed leg is parallel with the floor.

• From this position, lean forward at your waist until you feel a deep stretch in your right hip. Hold for 15 to 20 seconds, then release and repeat on the opposite side.

» READ MORE: 3 ways to strengthen shoulder flexibility

• Begin in a standing position. Take a step back with your left leg so it stays in line with your hip. Your right knee should be bent at about a 90-degree angle and stacked above your ankle with your weight in your heel. Extend your left leg straight. Rest your hands on your front thigh.

• Gently shift your weight forward at your hips, without extending your front knee past your toes. Keep your hips even, chest open, and gaze forward. You should feel a stretch at the front of your left hip. Remember to keep breathing evenly as you hold this stretch for 20 seconds, then switch sides.

• Using a mat, start in a tabletop position with shoulders stacked over hands and hips over knees.

• Rotate your right leg in at the knee to bring your lower leg under your torso. Your right knee will rest behind your right hand. Slide your left leg back until it is fully extended and your weight is on your right glute/hip. Open your chest and look forward. If this is challenging, simply place a rolled towel or pillow under your right glute for support. Hold for 20 seconds, then repeat on the left side.

Ashley Blake Greenblatt is a certified personal trainer and wellness coach in South Jersey. To learn more about her virtual training program, go to ashleyblakefitness.com.

Sharp Pain In Lower Right Side of Back/ Hip: 5 Common Reasons

Compensated Movement From Old Aches/ Pains

• Do you squat with a shift to one side?
• Do you have a slight limp?
• Have you had a repeated knee injury (or ankle) on the left side and experience chronic lower right side back pain?

Your body can and will compensate for accomplishing a task. A limp is a perfect example.

If the task were to cross a busy street, you would run with a limp if you had a sprained ankle, yet you would still accomplish the task of avoiding a car.

The body will find a way to achieve the mission. Yet, sometimes it retains these movement compensations as a default even after your ankle pain is long gone.

Limping in the absence of any pain happens. Allow me to explain.

Generally, we have three situations of compensated movement, which can create one-sided lower back pain.

1. You have a current ache/ pain in another part of your body that you’re compensating for (i.e., sprained ankle)
2. You had a past ache/ pain that you UNKNOWINGLY compensate for (Past left ankle sprain that shifts you AWAY from using the left leg).
3. You had a past ache/ pain that you KNOWINGLY compensate for (Past left ankle sprain that shifts you AWAY because you are afraid of hurting it again).

In Situation 1, you have a current injury in another part of the body. You may notice your 1 sided low back pain may reduce on its own in the same timeline as the active injury. The injured area is called a “painful/ dysfunctional” region, which creates short-term compensation.

Your body will reduce the need to compensate. You will gradually apply weight to the injured part of the body, which deloads the opposite side of your lower back.

In Situation 2, your past injury is categorized as a “non-painful/ dysfunctional” region that tends to create LONG-TERM compensation if not made functional again. I.e., Limping in the absence of pain or swelling of the said ankle.

Your knee connects to your hip, your hip connects to your low back, and so on… we all know the song. It turns out it is all true!

In this situation, a customized program should be implemented to address all NON-painful/ dysfunctional regions to deload the one side of your low back that hurts.

To do this, you may need a skilled eye to identify non-painful/ dysfunctional regions of your body that are forcing the low back to work too hard.

Using the Mobility, Stability, and Strength Model of program design typically works well. Yet, it’s always best to have someone narrow down what exercises will give you the most bang for your buck (and time).

Some of these programs can take 1-2 hours a day if they are not narrowed down. That’s way too long for most people to do daily!

The truth is you only need 30-60 minutes of activity to reverse the compensation process and reduce right or left-sided lower back stiffness quickly.

In Situation 3, where you know you are avoiding using certain joints, you should get 1-on-1 coaching to implement a similar program design as I mentioned above. Do not try to do this on your own.

We call this a “fear avoidance” case that needs reassurance that they are doing everything correctly.

If you are in Situation 3, don’t get paralysis by analysis.

Simply have a skilled coach, physical therapist, physiotherapist, sports chiropractor, or personal trainer tell you precisely what to do and how to do it.

You will be surprised about how much of your anxiety about movement will decrease by simply doing the exercises with the safety of a coach.

In Situations 2 and 3, no amount of massage, adjustments, electrical stimulation, heat, cupping, acupuncture, chiropractic adjustments, ice packs, medications, or surgery will change your movement patterns.

Correcting compensated movement patterns requires coaching. Just like a professional pitcher in baseball, we need a coach to optimize our movements sometimes.

How do you know if you’re compensating movement?

Usually, a simple mobility assessment gives enough information to move forward. A skilled trainer or medical professional can do this within 30 minutes or less.

Want to do it on your own first?

Have a friend take a video of you squatting, lunging, bending over, and backward. These movements will provide lots of information to start with a program. You will see and feel things that you have never noticed before. Consider this as your “discovery phase” of recovery.

You may notice your lower back rounding or extreme flatness as you move. You may notice your hips feel tight. You may see you dominantly shift towards one side or another.

You won’t know unless you look.

Chances are you are in Situation #2, where the movement compensation occurs without you knowing it. Don’t try to correct it. Typically the proper mobility, stability, and strength exercises will do it all for you, so you don’t have to overthink.

Just move, don’t think. The right program and coaching are all you need.

Telling The Difference Between Hip and Back Pain

Lower back pain and hip pain are often mistaken for one another. The
“hip” region often includes everything from the lower back around the side to the groin. Many times, this pain can be vague or even migrate around these areas, which makes localizing the problem a little more difficult. In this article, Dr. Boe will address several key aspects that he evaluates to form a diagnosis when a patient comes into the office with “hip” pain.

For example, is the pain worse in the groin, side of the hip or buttock? Is it worse with walking, bending over or turning? How would one describe the pain – achy, burning, sharp or does it feel like something in the hip is
catching? These symptom features will help us determine what is the main source of a patient’s pain. Generally, although there are exceptions, we
can separate these symptoms into three main problems: hip arthritis, Iliotibial (IT) band bursitis and lower musculoskeletal back pain.

Hip arthritis often presents with a sharp or catching groin pain that is often worse with stairs or turning. IT band bursitis is often achy with significant tenderness over the bony prominence on the side of the hip, which is worse when laying on the side or using stairs. Lower musculoskeletal back pain can vary in nature and occasionally radiate if nerve compression is involved, but it is often localized to the lower back and buttock areas. This lower back pain will tend to get worse with heavy lifting and bending over. Pain that radiates from the back down the legs should be evaluated for more significant problems with the spine and nerves.

All of these diagnoses can be treated with conservative measures upon evaluation by an orthopaedic surgeon.

Conservative Treatment Options

Medications

Therapy

• Stretching: IT band bursitis and lower back pain
• Strengthening: Lower back pain and hip arthritis
• Aquatic therapy: Hip arthritis and lower back pain

Alternative

• Heat: For relaxing tissues
• Ice: For reducing inflammation
• Steroid Injections

Of the three diagnoses mentioned above, hip arthritis is the only degenerative disease, which means it will continue to progress over time. While many patients do get relief with the conservative treatments, they often find the pain does return at some point and may continue to get worse with time. Once the symptoms are severe enough, it may be time to consider a total hip replacement.

There has been enormous progress made in total hip replacement technology, which was once called “the operation of the century” by the Lancet medical journal (Ian D
Learmonth, 2007). The use of state-of-the art implant designs
and materials allow for a vast majority of hip replacements to last greater
than 20-25 years (Nipun Sodhi,
2019).

Techniques have also progressed with the
increased use of direct-anterior total hip replacement. This direct-anterior approach for hip
replacement avoids cutting through the major muscles and tendons of the hip,
which results in less pain and increased mobility right after surgery. Patients are leaving the hospital quicker, or
having surgery at an outpatient surgery center, which allows them to get back
to the activities they enjoy most.

If you are suffering from any of
these symptoms, the total joint specialists at Resurgens Orthopaedics are here
to discuss treatment options with you.

References

Ian D Learmonth, C. Y. (2007). The operation of the
century: total hip replacement. The Lancet, 370(9597), P1508-1519.

Nipun Sodhi, M. M. (2019). Survival of total hip
replacements. The Lancet, 393(10172), P613.

8 third trimester pains and how to deal with them | Your Pregnancy Matters

Congratulations! You’ve made it through the early pregnancy morning sickness and fatigue. Now it’s the third trimester and you’re so close to meeting baby. Unfortunately, there may be a few uncomfortable symptoms still in store for you.

Swelling ankles, trouble sleeping, back pain, having to go to the bathroom every 20 minutes – these are all possibilities as you move into the pregnancy homestretch.

Patients often ask me how to make the third trimester a little more comfortable. This topic has been on my mind more in the last few months as my sister, Toral Patel, who is a neurosurgeon at UT Southwestern Medical Center, entered her third trimester and began dealing with some of these discomforts.

Let’s take a look at eight common symptoms during the third trimester of pregnancy: What causes them, how to help relieve them, and when you should call your doctor.

1. Swelling

Why it happens: When you hit 30 weeks of pregnancy, it may not just be your belly that’s swelling. You also may notice swelling (edema) in other parts of your body, especially in your lower extremities, such as your feet and ankles. 

During pregnancy, your body produces about 60 percent more blood volume. Meanwhile, your growing uterus is putting pressure on the large veins that return blood to your heart, leaving all the extra fluid to pool in your lower limbs.

This pressure also may cause some veins to become swollen or look purple or blue. These are called varicose veins, and they should go back to normal after the birth of the baby.

What you can do: The best thing you can do to avoid or reduce swelling is to reduce how long you’re on your feet. If you have to stand for a long period of time, take a break every couple hours to sit down and put your feet up for 10 minutes. This helps gravity pull fluids from the legs back into your circulatory system.

One of the best times to put your feet up is after dinner. While you don’t have to have them straight up, get them as high as you can. I often tell patients to prop their feet up on a few pillows on the coffee table. I recommend doing this a few hours before bed because all those fluids that you’re helping return to the heart will be filtered by the kidneys and you’ll have to pee it all out. If you elevate your feet right before bed, you’ll likely have to get up right as you’re falling into a deep sleep to use the bathroom!

When you need to be on your feet for a long time, wear compression stockings, or TED hose. These can go from your feet up to your knees or mid-calves. They help move fluids up to the heart and keep them from pooling in your legs. If you’re picturing your grandma’s stockings, don’t worry. Many manufacturers are making much more stylish versions these days. You wouldn’t even know some of them are compression stockings!

If your shoes are starting to feel tight, wear shoes with straps you can loosen. Or if it’s nice out, throw on some flip flops.

When to be concerned: If you notice sudden swelling, asymmetric swelling – such as one leg being larger than the other – or one calf being warm or tender to the touch, see your physician right away. These could be signs of a blood clot. Swelling in non-dependent parts of your body like hands and fingers may suggest the development of preeclampsia.

2. Insomnia

Why it happens: Insomnia – trouble falling asleep or staying asleep – often occurs in the first and third trimesters, although for different reasons. In the first trimester, it’s a result of hormonal changes, specifically due to a surge of progesterone. However, your progesterone levels off in the second trimester, returning you to peaceful slumber.

In your third trimester, sleep becomes more elusive because it’s difficult to get comfortable due to your growing belly.

What you can do: Find the position that’s most comfortable for you to sleep in, whether it’s your left or right side. It doesn’t matter which side you pick. Sleeping on your back is likely not comfortable, but if you want to sleep this way, it helps to shift your hips just a little to keep all the weight from being on your back.

There are a variety of body pillows you can try. My sister particularly liked the Snoogle pillow, which is C-shaped and goes up under the neck, around the shoulders, and between the legs.

Practice good sleep hygiene, such as not watching TV or looking at your phone right before you go to sleep. Other things you can try before going to bed are sipping warm milk or tea, taking a warm bath, or using lavender scents in your bath or lotion.

When to be concerned: If you’ve tried all of these things and you still can’t sleep, talk to your physician about which over-the-counter medications may be safe to take.

3. Reflux and feeling full faster

Why it happens: You may find that you can’t eat as much as you used to or that you’re experiencing reflux. As your uterus gets bigger, it begins to push up on your stomach. This means there just isn’t as much space for food. Also, the sphincter between your stomach and esophagus doesn’t work as well during pregnancy.

What you can do: Eat five small meals each day instead of three larger meals. Find foods that make you feel less full without lowering your caloric intake. For example, try a protein shake instead of a big sandwich.

If you’re having problems with reflux, avoid foods that are spicy or acidic. Instead, choose foods that are creamy, such as yogurt. Don’t eat within two hours of going to bed to allow foods time to leave your stomach prior to going to bed. Elevating your head and not lying flat also helps to avoid reflux.

When to be concerned: If you continue to have problems with reflux, talk to your doctor about an over-the-counter medication. If you are having reflux that is not related to something you ate, or you are experiencing heartburn or abdominal pain that doesn’t go away with medications such as Tums or Maalox, see your doctor. This could be an indication of a serious problem, such as preeclampsia.

4. Restless leg syndrome

Why it happens: Restless leg syndrome is a sensation of needing to move your legs. This can manifest in many ways, from a general feeling of discomfort to a burning or throbbing sensation. My sister said it made her feel like she needed someone to pull on her legs.

Restless leg syndrome is more common in the evening, making it impossible to fall asleep. While there are theories out there, we’re not 100 percent sure why restless leg syndrome affects so many pregnant women.

What you can do: There’s no real cure for restless leg syndrome, but there are lifestyle changes you can make to relieve the symptoms, including staying hydrated. We recommend pregnant women drink 80 to 100 ounces of water each day. Calcium and vitamin D supplements also may help.

Take a 20- to 30-minute walk around the time your legs are most restless to relieve the sensation. You also can try massaging the legs or using heat or ice packs.

When to be concerned: If these tricks don’t relieve your symptoms and your sleep is affected, talk to your doctor about medication.

5. Back and hip pain

Why it happens: Increased levels of progesterone during pregnancy relax the joints and muscles to accommodate the growing uterus and enhance flexibility in your pelvis so the baby can pass through the birth canal more easily. However, this also can cause pain.

Your posture may change due to carrying extra weight around. You may find yourself leaning more to one side or another, which can lead to lower back or hip pain.

What you can do: Wear a support belt under and over the belly to take some of the weight off the hips and back. There are a wide variety of types and brands to choose from. This won’t hurt your baby, so tighten it enough to get the support you need.

When you sit down, place pillows under your hips or try sitting on a balance or yoga ball instead of a chair. Take a warm bath or use a heating pad on your hips or back to help relieve the pain.

Remember, thanks to your growing belly, your center of gravity is much different these days. Skip the stilettos until after you give birth.

When to be concerned: If you have unrelenting pain, a deep and sharp pain, or have become unable to walk or get up, see your doctor. Also, if you are experiencing a rhythmic pain in your low back every few minutes, it may be contractions, which sometimes present as low back pain.

6. Breast pain

Why it happens: Sore breasts are common during pregnancy. Hormonal changes are preparing them to feed your baby, and you may find you go up a few cup sizes. Women with smaller breasts may find they have more pain than women with larger breasts.

What you can do: I see too many women in their third trimester try to wear the same bras they did before pregnancy. Plan to buy new bras a couple times as your breasts grow throughout pregnancy – your breasts and back will thank you.

When to be concerned: Sports bras may be comfortable during and right after pregnancy, but if they are too tight, they can inhibit milk production. We advise women who don’t want to breastfeed to wear a sports bra to help dry up their milk. If you plan to breastfeed, make sure your bra has good support, but don’t let it get too tight. 

7. Frequent urination

Why it happens: Needing to run to the bathroom frequently may be the most annoying part of the third trimester. The volume of fluids running through your kidneys doubles during pregnancy, meaning you will need to pee twice as much. As your baby grows, he or she also may press on your bladder.

What you can do: Unfortunately, there’s not much you can do about this. Don’t stop drinking liquids in order to avoid frequent urination. You need to stay hydrated. Dehydration can cause contractions, dizziness, and lightheadedness.

Know you’re going to need to pee more often and prepare for it. For example, sit on the aisle or near the exit when at an event.

When to be concerned: Sudden changes in urination may be cause for concern, such as if you’re peeing far more today than you were yesterday. Also, if you experience pain or burning when you urinate, or if there is blood in your urine, see your doctor right away.

8. Lightheadedness and dizziness

Why it happens: Along with swelling, fluid pooling in your legs instead of circulating throughout the body can cause dizziness or lightheadedness. You may notice this more when you have been standing for a prolonged period of time or when you get up too quickly.

What you can do: Again, compression stockings can help by pushing blood out of the legs and to the heart. If you have to stand for a long time, keep moving to increase circulation – shuffle your feet or bend your knees by bringing your lower leg up toward your rear end a few times.

Avoid getting up too quickly from sitting and lying positions. When you’re ready to get out of bed in the morning, sit up, put your feet on the floor, and wait a minute before you stand up and go. This will give your body time to adjust. This is another instance in which staying properly hydrated will help.

When to be concerned: If you are constantly feeling lightheaded or dizzy, if it happens even after a short period of standing, or if it’s accompanied by a racing heartbeat, call your doctor.

The upside to dealing with all of these issues? You are getting close to the end of the pregnancy! We understand these problems can make the third trimester feel like it will never end. However, a few simple changes can make it a little more comfortable. And remember, it’s worth it. Just ask my sister, who gave birth May 6, 2016, to a perfect little boy, Elliott. 

If you have questions about any third-trimester symptoms you are experiencing, request an appointment online or call 214-645-8300.

10 Piriformis Stretches To Get Rid Of Sciatica, Hip, And Lower Back Pain

There’s a tiny muscle you’ve probably never heard of that has a powerful effect on your daily movements, and can even be linked to sciatica. It’s called the piriformis and it enables you to move your hips, upper legs, and feet away from your body. The piriformis also covers the sciatic nerve that runs from your lower back and down towards your legs.

When the sciatic nerve becomes pinched, it results in the very painful condition called “sciatica.” 

The strains of daily life can place even more pressure on the sciatic nerve, causing numbness, tingling and even acute pain that can last from minutes to hours. This pain usually runs from the lower back toward the hip, buttocks, and legs. Before you realize it, sitting or changing positions becomes very difficult.

Luckily, there are several simple and effective ways to stretch out that tiny piriformis muscle and provide relief from your sciatica pain. Give these 10 powerful piriformis stretches a try— and be sure to watch the videos, too.

1. Simple Seated Stretch

1. Start by sitting in a chair and cross your sore leg over the knee of your other leg.
2. While keeping your spine straight, bend your chest forward. If you don’t feel pain, bend forward a little more.
3. Hold this position for about 30 seconds. 
4. Repeat this stretch with your other leg.

2. Standing Piriformis Stretch

If you have trouble balancing with this stretch, stand with your back against a wall and your feet about 24 inches from the wall for extra support.

1. While standing, place the leg that’s causing you pain over the knee of your other leg. It should create the shape of the number 4.
2. Lower your hips at a 45-degree angle until they reach the ground. Bend the leg you’re standing on as needed. 
3. As you bend forward at the waist, reach your arms down to the ground while keeping your spine straight.
4. Hold for 30-60 seconds.
5. Switch legs when done

3. Supine Piriformis Stretch

1. Lie down and bend your knees upwards.
2. Cross the affected leg over your other leg and bend it upwards toward your chest.
3. Grab your knee with one hand and your ankle in your other hand. Pull the bent leg across your body until your glutes are pulled tight.
4. Hold for 30 seconds to a minute and release.

4. Outer Hip Piriformis Stretch

1. Lying on your back, bend your sore leg upward and place your foot close to the back of your other knee.
2. Tuck your foot behind that knee and twist your leg to the opposite side. Your knee should be touching the ground (or as close as you can get).
3. Place the hand on your opposite knee and raise your opposite arm in the air.
4. Hold for 20 seconds.
5. Switch to the other leg.

You’ll want to recover from this stretch! Lie on your back, bend both knees together and gently pull them with your hands toward your chest.

5. Groin/Long Adductor Stretch

1. Sitting on the floor, stretch your legs straight out in front of you, spread as far apart as possible.
2. Place your hands on the floor next to each other while angling your torso forward toward the ground.
3. Lean forward and rest your elbows on the ground. If you encounter pain, stop right away!
4. Remain in the position for 10-20 seconds

6. Inner Thigh/Short Adductor Stretch

1. While sitting on the ground, put the soles of your feet together in front of your pelvis.
2. Hold your ankles with the opposite hands (left hand – right ankle and vice versa).
3. Gently push downward with your knees with the effort to touch the ground with them. You need to stop right before any pain occurs, which means that if you feel pain, get back an inch or two and stay there.
4. Hold for 30 seconds, release, and flutter your legs in that position (like a butterfly) for 30 seconds.

Want an even deeper stretch? Push your knees down with your elbows or bend your torso forward while keeping your back straight.

7. Side Lying Clam 

1. Lie down on the side of your body that isn’t in pain.
2. Bend your legs back, holding one foot over the other and keeping your legs parallel to each other. You should be creating an “L” shape.
3. Keeping your feet together, lift up the top knee while keeping the rest of your body in the original position.
4. Slowly bring your knee to the initial position.
5. Repeat 15 times.

8. Hip Extension 

1. Get down on the ground on all fours, making sure your hands are in line with your shoulders.
2. Raise your affected leg upward with your knee bent toward the ceiling.
3. Gradually lower your leg until it’s almost touching the ground. 
4. Repeat 15 times.

9. Supine Piriformis Side Stretch

1. Lie on the ground with your legs flat and back straight.
2. Bend your sore leg upward, resting the foot on the outer side of the opposite leg beside the knee.
3. Ease the knee of your affected leg across the middle of your body with your opposite hand until you feel a stretch, making sure to keep both your shoulders and hips on the ground.
4. Hold for 30 seconds, return to the starting position and switch legs. 
5. Repeat the process 2-3 times

10. Buttocks Stretch for the Piriformis Muscle

1. Place your hands and knees on the ground, getting into position on all fours.
2. Bring the foot of your affected leg underneath your stomach, twisting it toward the opposite side near the hip, while pointing with the knee toward the shoulder.
3. Lower your head, until your forehead touches the ground, and lean your forearms on the ground for support.
4. Slowly stretch the non-affected leg out behind you, while keeping your pelvis straight.
5. Push your hips slightly toward the floor.
6. Hold for 30 seconds and return to the initial position slowly. Repeat 2-3 times.

Note that home remedies are helpful in mitigating pain but do not address the root cause. A full chiropractic examination identifies the source of your pain, provides treatment to relieve the symptoms, and establishes a customized treatment plan to ensure you’ll keep the pain at bay, for good. Make an appointment online or call us at (256) 333-9429 today.

This content isn’t meant to diagnose or treat your medical condition and is not a substitute for in-person medical advice. 

This Overlooked Pelvis Problem Might Be Causing Your Lower Back Pain

Deep in the back of your pelvis, you have a joint called the sacroiliac (SI) joint, which connects the bottom of your spine to your pelvis on each side. Problems with these joints are associated with up to 30% of lower back pain cases.¹

The sacroiliac joint(s) can become a source of pain back and leg pain when there is either too much or too little movement in the joints. Inflammation of the sacroiliac joint (sacroiliitis) can also produce pelvic pain and stiffness. Watch Sacroiliac Joint Dysfunction Video

This blog highlights what you need to know about your SI joints and how they can contribute to lower back pain.

What is a sacroiliac joint?

The SI joint is where the base of your spine (sacrum) connects to the butterfly-shaped group of bones in your pelvis.¹

• The joint surfaces are covered with cartilage, held together by a fibrous capsule, and surrounded by synovial fluid (lubricating joint fluid).²
• Several ligaments surround the joint, providing strength and limiting its mobility.²

You have one of these joints on each side.¹

Read more about Sacroiliac Joint Anatomy

What does the sacroiliac joint do?

The SI joints support the weight of your upper body. They act as shock absorbers during the transfer of loads from the trunk of your body into your pelvis and legs. They also support your range of motion when you bend or twist at your hips.³

These joints are sturdy, have minimal mobility, and can withstand tremendous pressure.^1,3

How does the sacroiliac joint become painful?

SI joint pain occurs when there is malalignment or abnormal motion, such as too much or too little motion within the joint(s).³

These painful conditions may develop gradually over time or from an inciting event:

• External trauma. High energy impacts, such as from a motor vehicle accident or a fall, may fracture or cause malalignment of the SI joint. Traumatic injuries may also overstretch (strain) the joint’s ligaments, causing pain.^2,3
• Repetitive stress. Stressing the joint over time, such as daily jogging or weight lifting, may cause the SI joint and/or its surrounding ligaments to become painful.^2,3,4
• Arthritis. Degenerative arthritis (osteoarthritis) or inflammatory arthritis (reactive or psoriatic arthritis) of the SI joint may cause lower back pain.³
• Pregnancy. The SI joint’s ligaments become relaxed and loose during pregnancy, making the joint more mobile than usual. Increased body weight and added pressure in the abdomen and lower back increase loads on the SI joints and may cause lower back pain in up to 90% of pregnant women.^2,5

Less common causes of SI joint pain include:

Carrying excessive weight and/or leading a sedentary lifestyle are contributing factors to SI joint pain.³

What does sacroiliac joint pain feel like?

Problems with your SI joint can be experienced with a wide range of symptoms, for example:

• A sharp, stabbing, and/or shooting pain may be felt directly over your affected joint – on the right or left side of the back of your hip. Alternatively, you may feel more of a persistent, dull ache in that area.³
• The pain is usually localized to the lower back and/or over the buttock.^3,6 The pain may also extend down the back of your thigh, but typically does not extend below the knee.³
• Certain positions or activities may cause your pain to flare up, such as going from standing to sitting, climbing stairs, or lying on the affected side.³

In addition to lower back pain, problems in the SI joint may mimic radicular (spinal nerve-root related) pain,³ commonly referred to as sciatica.

Read more about Sacroiliac Joint Dysfunction Symptoms and Causes

How is sacroiliac joint pain treated?

The treatment of SI joint pain usually involves a multidisciplinary approach and may include a primary care provider, a physical therapist, and an orthopedic surgeon, among others.³

SI joint pain treatments typically include³:

If the pain is severe, assistive devices, such as walkers may be used. Sacroiliac belts may be worn temporarily for short periods in case of pelvic instability. Minimally invasive treatments, such as radiofrequency ablation (creating heat lesions on nerves to stop them from transmitting pain) may be considered in severe SI joint dysfunction. Rarely, SI fusion surgery may be recommended.³

See Surgical Treatment for Sacroiliac Joint Pain

If you suspect your SI joint(s) to be a cause of your lower back pain, consult your doctor for a medical examination. A doctor can conduct specific clinical tests, rule out serious underlying conditions, such as tumors or infections, and formulate an effective treatment plan for your SI joint pain.

See Accurate Diagnosis of Sacroiliac Joint Dysfunction

Learn more:

Treatment Options for Sacroiliac Joint Dysfunction

Slideshow: Sacroiliac Joint Exercises for Sciatic Pain Relief

90,000 Japanese doctor told how to get rid of lower back pain – Rossiyskaya Gazeta

Long sitting at the computer or buried in a smartphone leads to lower back pain. This is especially true now, when many have switched to a remote mode of operation. Ko Matsudaira, a professor at the University of Tokyo School of Medicine, described how to use simple exercises that take a few minutes to get rid of discomfort or at least ease them. The doctor’s recommendations were quoted by the Japanese newspaper Nihon Keizai.

According to the professor, the greatest load when sitting bent over falls on the lumbar region. “If you slouch, then the intervertebral disc between the fourth and fifth lumbar regions is affected by a load of 200 kilograms. As if you have one sumo wrestler on the intervertebral disc,” he said. And most of the back pain is caused precisely by minor injuries and displacements of the intervertebral discs or lumbar joints, as well as the resulting inflammation and poor blood circulation in the muscles of the back.Although it should be borne in mind that there are more serious cases, such as a herniated disc, fracture, sciatic nerve inflammation, spinal stenosis or a tumor.

However, in most cases, the pain is caused by an abnormal position of the back. The intervertebral discs that separate the vertebrae from each other act as a shock absorber. They consist of the nucleus pulposus and the annulus fibrosus surrounding it.

As explained by Professor Matsudaira, “The nucleus pulposus moves with a slight change in position.If you slouch for a long time, the likelihood of displacement of the nucleus pulposus located in the center of the intervertebral disc backwards increases. If you slouch, a load weighing 200 kilograms acts on the intervertebral disc between the fourth and fifth sections. For example, if you try to lift a child weighing 20 kilograms incorrectly, the intervertebral disc will be under pressure of more than 400 kilograms. This is already equivalent to two sumo wrestlers. According to the US National Institute for Occupational Safety and Health, a 340 kg load on the intervertebral disc increases the risk of injury to the lower back. “

While a person lifts, for example, a load, bending over or hunched over, preparing to sneeze, the load on the lower back increases, the nucleus pulposus shifts and threatens to damage the annulus fibrosus. In the worst case, the nucleus pulposus extends beyond the annulus of pulp and hits the nerves, which leads to a herniated disc.

To avoid this, Professor Matsudaira recommends doing elementary gymnastics:

1. Stand up, put your feet parallel to each other a little wider than your shoulders and relax;

2.Put your hands slightly above the buttocks and bend back as you exhale;

3. Fix this position for three seconds, and then slowly return to the starting position;

For prevention, do this exercise once or twice a day; for treatment – try starting ten times a day.

At the same time, Matsudaira recommends paying attention to pain. If the pain disappears within ten seconds after returning to the starting position, everything is in order. If it does not work, then you have bent too much.If there is pain or numbness in the hips, you should consult an orthopedist.

The professor also notes that those who work while standing, pregnant women and women who wear high-heeled shoes, the lower back bends to the other side. Therefore, he recommends them to do exercises, sitting on a chair and bending forward.

Dragging pain in the lower back and groin in men, women: reasons how to treat

It is quite difficult to determine why there was pain in the back, since there are many reasons that can cause pulling pain in the lower back and groin.Moreover, often the pain is not just pulling – it can be sharp, paroxysmal, stabbing, etc. In order to accurately determine the cause of this phenomenon, it is important not to hesitate in contacting a doctor and prescribing adequate treatment.

Diseases and pathologies due to which lower back pain radiates to the groin

If the pain in the lower back radiates strongly to the groin, it is likely that inflammation or degenerative process has begun in the spinal column or in the internal organs. It is worth familiarizing yourself with the main reasons why pain in the back may appear, radiating to the groin area.

Hard physical work

This is one of the most common causes of discomfort and soreness. If you carry a lot of weights at work, you may experience severe pain while moving. However, when physical activity ends, the pain may gradually decrease and then disappear completely.

Injury

The causes of pain in the groin and lower back often lie in back injuries. Such pain differs in that it manifests itself at the moment of loading and is practically unbearable, very sharp.The area near the groin begins to swell, the skin turns red and swells. The pain may not go away for up to a day, and the patient is forced to take strong painkillers, and is also often in a forced position, since this somewhat reduces the pain syndrome.

Osteochondrosis

The occurrence of pulling pain in the lower back and groin is not uncommon if you have osteochondrosis in the lower back. This condition manifests itself in that the cartilage tissue becomes less dense, and the cartilage itself becomes thinner and does not cope with its functions.The reasons may lie in low mobility, obesity, monotonous loads on the back, etc.

Osteoarthritis of the hip joint

Due to arthrosis, groin and lower back pain most often occurs in women over the age of 45. Both joints or one joint can be affected at once. It is not easy to define a disease; it disguises itself as a lot of others. The first manifestations may be that it “aches” around the buttocks, and the pain occurs with minimal exertion.

Herniated disc

With a hernia, pain manifests itself at the time of load on the lower back.They have an acute “shooting” character, and only after a while the pain syndrome “descends” to the lower abdomen.

Aseptic necrosis of the femoral head

Pain in the groin and lower back is often manifested in men 30-50 years old, the pain syndrome is sudden and sharp. The only relief is the use of prescription pain relievers.

Intestinal pathology

The problem may lie in intestinal pathologies, examples are appendicitis, obstruction, or even oncology.Against the background of lower back pain with a kickback in the groin, it happens that vomiting, bloating and abdominal pain, impaired bowel movements occur.

Pain in the groin and lower back in men

In some cases, groin and lower back pains are detected, the causes of which are associated with the functioning of the male reproductive system. There are several types of diseases that can cause pain in the groin and lower back.

Varicocele

It is a fairly common disease that occurs in about 15% of the stronger sex.Varicocele appears from the fact that the outflow of blood in the veins of the spermatic cord is disturbed. Men complain that the groin hurts and at the same time gives to the lower back, there is a pain syndrome near the scrotum or testicle, more often the left one.

Prostate cancer

Lower back pain most often occurs with a long and chronic course of the disease, when the kidneys or urinary ducts are already affected. The pains are of a different nature: long aching, shooting, or short sharp. At the same time, there is a burning sensation when urinating, stomach aches, erectile function is disturbed, discomfort appears during intercourse.

Cyst of the spermatic cord

The reason why lower back pain is given to the groin may lie in a funicocele, which means the development of a cyst – a cavity in a membrane filled with fluid. In this case, one side of the groin is clearly sore, the defeat can overtake the left or right cord. On examination, the doctor reveals swelling of the scrotum, the leg may swell on one side.

Pain in the groin and lower back in women

Treatment of lower back pain radiating to the groin is often required for women.The reasons may lie in the development or exacerbation of various diseases. It should be understood that self-diagnosis is impossible here, and you will need a timely appeal to a qualified specialist who carefully examines the state of health and prescribes medications.

Inflammation of the pelvic organs

These include the uterus and ovarian epididymis. The pain does not have a clear localization – the entire lower abdomen hurts, the lower back aches. There may be an increase in pain against the background of severe hypothermia, when the temperature rises, malaise and weakness appear.Often there is a vaginal discharge that is uncharacteristic for a healthy body.

Exacerbation of chronic cystitis

If the pain in the lower back on the right or on the left radiates to the groin, you have frequent and painful urges to go to the toilet, and the process itself does not bring relief, it hurts to go to the toilet, you want to urinate even with an empty bladder, then the matter is probably an exacerbation of cystitis. In this case, the color and smell of urine can change significantly.

Ovarian cyst

Apoplexy of the right ovary is similar to appendicitis, as it is accompanied by nausea, severe pain, vomiting and decreased pressure.With the left ovary, the situation is the same, only because of the localization of pain, a cyst in this case cannot be confused with appendicitis.

Trochanterite

If the lower back hurts on the left or on the right and radiates to the groin, this may be a symptom of inflammation of the tendons of the thigh, which is otherwise called trochanteritis. This phenomenon is sometimes observed during the climacteric syndrome, when the level of sex hormones in a woman’s blood drops. The pain can be given not only to the groin, but also to the inside of the thigh.

How to relieve pain

It is not always possible to get to the doctor right away if the lower back hurts and radiates to the groin. Sometimes you have to look for a temporary solution to relieve the pain in your lower body before going to the clinic. Taking antispasmodics, which include no-shpa and papaverine, can help. If you need to bring down the temperature, you can drink Ibuprofen or Nurofen, but if the temperature is below 38 degrees, it is not recommended to bring it down. In no case should you warm or cool a sore spot without a doctor’s instructions.It is also worth providing the patient with bed rest.

Which doctor should I contact

As it has already become clear, there are many reasons why there is pain in the groin and on the left or right in the lower back. It is not possible to independently determine whether it is required in this case to be treated by urologist-andrologist or gynecologist , neurologist or surgeon . The best solution in such a situation is to make an appointment with a general practitioner. After the specialist makes an examination, he will draw preliminary conclusions about your health status and prescribe the necessary types of diagnostics.As a result of a more detailed examination, it will become clear to which specialist you need to be redirected, and whether it will be needed at all. Then you will be assigned adequate treatment tactics that will improve your health.

“Diseases of the spine: causes of back pain”

Dr. Ivanov on how love troubles and kidney problems lead to back problems

Low back pain can occur for many reasons. It can be a herniated disc, and a violation of the position of the sacrum, and even prolapse of the kidneys.Often the cause of pain is psychological problems in a person’s life – quarrels with loved ones, job loss. Dr. Alexander Ivanov in his new article talks in detail about why your back may hurt and how to get rid of this pain.

Back pain is often emotional and psychosomatic in nature Photo: pixabay.com

THE BRAIN AS A CENTRAL PROCESSOR AND NERVES AS ELECTRICAL WIRES

Lumbar radiculopathy is pain in the lower back and lower extremities.The reason for this pain is that the nerve roots of the spinal cord are under pressure. Patients usually complain of numbness in the lower back and severe pain. People also call this pain “lumbago”. The cause of a sore lower back can also be a violation of the biomechanics of the sacrum, a herniated disc, narrowing of the intervertebral foramen, osteophytes (bone growth) and rarely a tumor. Back pain is often emotional and psychosomatic in nature.

Our brain and spinal cord are the central nervous system, or, in the language of programmers, the central processing unit of a computer.Nerves, like electrical wires, collect information from all organs and tissues and send it to the central processor, where it is analyzed and a response is formed – a command. By the way, the pain itself or the sensation of pain is formed not at all in the place where it hurts, but in the brain. This is the basis of the action of analgesics, which block signals in the brain, reducing pain in the periphery. If the nerves are compressed or damaged, information is transmitted to the center with failures: an excess flow of nerve impulses rushes to the brain, which gives the answer – it hurts! Pain is always an alarm, it’s like a siren that warns of danger.Pain cannot be tolerated, because this will lead to a disturbance in the brain itself, in which a pathological focus will form, constantly generating pain.

LUMBAR PAIN FROM THE POINT OF VIEW OF PSYCHOSOMATICS

Psychosomatics is a branch of medicine that studies the influence of our emotional state on the physical body. From the point of view of psychosomatic medicine, our spine is one of the most vulnerable organs in the body, subject to negative “emotions”. Renowned psychosomatics specialist Louise Hay writes: “When a person just gets sick, he first of all needs to think about whom he needs to forgive.”

Did you know that acute back pain can be caused by stress? Quite recently, a young woman came to see me complaining of acute pain in the lower back, radiating to the right leg, with numbness in the front of the thigh. According to the woman, her back never bothered her before, moreover, there were no provoking factors the day before – she did not lift weights, did not make sudden movements in the form of twisting and bending. Upon more detailed questioning, it turned out that on the eve of the onset of back pain, the woman had a violent quarrel and broke up with her boyfriend and was worried about this.Could this emotion be the trigger for back pain? As much as I could! Pain in the lumbar spine speaks of fear and uncertainty about the future, instability in interpersonal relationships, problems at work and material distress. The lumbar spine is a kind of support for the whole body, therefore, when a person loses this support (for example, they were fired from work or, as in the above example, there was a discord in relations with a loved one), the emotions of fear and self-doubt pass to the physical level and are manifested by pain.

The presence of back pain indicates that a person is trying to solve his problems on his own, puts an “unbearable burden on his back”, is afraid to ask for help from loved ones or just talk out. Often such people are afraid to admit their fear, even to themselves. Treatment of back pain on an emotional level is that a person must realize his problem, describe it in detail to himself, it is advisable to ask for help from relatives and friends.

Low back pain often speaks of the fear of poverty.A person works literally without straightening his back because of the fear of material distress. In this case, we are dealing with workaholism, inability to rest, relax. Such patients cannot relax even during an osteopathic session. In this case, therapy is aimed at relaxation through meditation, breathing practices or prayer.

There is data illustrating the relationship of dysfunction of each vertebra with emotions and other organs according to Louise Hay (see table 1)

== table2118 ==

These tables should not be interpreted literally and projected onto yourself, since in any situation you need to understand individually, taking into account the characteristics of the personality, lifestyle, and the course of the disease.

LUMBAR PAIN FROM THE POINT OF VIEW OF OSTEOPATHY

From the point of view of osteopathy, lower back pain can be associated with impaired biomechanics of the sacrum and pelvic bones, as well as impaired movement of internal organs, most often the kidneys. Most patients at the appointment do not talk about falling on the sacrum or tailbone, or attach little importance to it. Meanwhile, when falling onto a “soft spot,” our sacrum can shift and become fixed in the turn, which will lead to excessive movement on the overlying segments, namely, on the lumbar vertebrae.Over time, such an overload of the lumbar spine will make itself felt by a disc herniation or osteoarthritis of the lumbar spine, and, accordingly, pain will appear.

If you complain of lumbar pain, the osteopathic doctor will definitely check the position of the kidneys and their mobility during breathing. The prolapse of the kidneys or limitation of their movement can be a source of lower back pain. Treatment will be to correct the position of the kidneys and restore their movement.

EXAMINATION FOR LUMBAR PAIN

If lumbar radiculopathy is suspected, the doctor will refer you to magnetic resonance imaging of the lumbar spine (MRI), which is the gold standard for diagnosing spinal diseases.Lumbar radiculopathy is a clinical diagnosis based on physical examination, radiography, or MRI. For patients who cannot get an MRI (for example, with a pacemaker), computed tomography (CT) may be an alternative. In some cases, additional blood tests, ESR, determination of antinuclear antibodies, HLAB-27 antigen will be needed. In case of back pain, an osteopathic examination should be performed and somatic dysfunctions (biomechanical disorders) in the body should be identified.

TREATMENT OF LUMBAR RADICULOPATHY

This disease is treated by doctors-vertebroneurologists and doctors-osteopaths. Usually, medications are prescribed (NSAIDs + muscle relaxant), blockade with anesthetics and steroids is used. In addition to drug treatment, osteopathic correction, physiotherapy and psychotherapy are indicated. With complex and timely treatment, the prognosis of the disease is favorable.

So, there are many reasons for the appearance of back pain. They can be both structural changes, for example, a herniated disc or osteophyte, functional, caused by a violation of the biomechanics of the sacrum and kidneys, as well as psychological, caused by emotional experiences.In each case, you need to understand separately in order to reduce pain and eliminate its causes.

Sincerely yours,
Ivanov Alexander Alexandrovich – PhD in Medicine, osteopath, neurologist, naturopath, member of the Russian osteopathic association, popularizer of a healthy lifestyle and a conscious approach to health

The opinion of the author may not coincide with the position of the editorial board

90,000 Low back pain – causes, treatment and prevention

Why the lower back hurts: classification of painful sensations

If there is severe pain in the lower back in any part of the spine, this may indicate certain pathological changes.The doctor assesses not only the nature and severity of pain, but also other accompanying signs of problems in the lumbar region. A complete history collection is required.

Pain syndrome is classified as follows:

1. Nonspecific pain of a benign nature. In most situations, benign chronic or acute pain does not impose a difficult diagnosis. These unpleasant symptoms are in most cases reversible. Such unpleasant sensations are used to diagnose dorsopathy.Previously, the diagnosis sounded differently – osteochondrosis. This is not a dangerous disease that occurs in every person by age, which is characterized by subsidence of the intervertebral discs due to the action of gravity and muscle weakness.
2. Radiculopathy (radicular syndrome). The condition is associated with squeezing or irritation of the nerve root in the interdisk space. Such pains may indicate an inflammatory process, compression of the vertebrae of the intervertebral disc, the occurrence of protrusion and hernia. They greatly worsen the patient’s quality of life, especially during the acute period with any physical activity.
3. Specific or alarming back pain. Symptoms of such discomfort alone are difficult to diagnose, so an additional examination is often prescribed, which may include the exclusion of cancer, tuberculosis, kidney disease or fractures, injuries. Examples – pyelonephritis with fever, in pregnant women, low back pain , aching pain in the lower abdomen with diseases of the female reproductive system. In men, urological symptoms should be excluded.

The general classification of pain is divided into:

• strong;
• acute;
• aching;
• chronic;
• displaced.

Lower back pain – causes

The lower back hurts strongly with manifestations of osteochondrosis. Unpleasant sensations torment the patient almost all the time – while walking, sitting and even lying down. The lower back hurts during the day more intense due to movement. Aggravated by coughing, sneezing, carrying weights. Less often in , the lower back pain radiates to the leg , which is manifested by paresthesias – a feeling of numbness and running creepy feet.

If a patient has sciatica, the pain radiates to the lower part of the body – buttocks, pelvis, thighs or lower leg.Discomfort increases with active body movements, as in the case of dorsopathy. When such symptoms appear, it is necessary to consult a neurologist as soon as possible.

Pain in the lower back and lower abdomen indicates a bacterial lesion, which is often accompanied by painful urination. In women, lower back pain is often seen during pregnancy or during menstruation. Below the lower back, pain is the result of painful spasm or fetal pressure on internal organs.In the lower back, pain on the right or left indicates kidney disease. It is necessary to clarify the diagnosis with a doctor. The most reliable diagnostic methods are X-ray and MRI.

Often causes of lower back pain in women are associated with menstruation. Lower back pain in women due to uterine spasms. To combat painful periods, you need to take NSAIDs or use hormone therapy. Less commonly, the state of the ovulatory syndrome is observed. In addition to discomfort in the lower back, a woman observes alternating pains in the middle of the cycle in the right or left side.Why this condition occurs is still not thoroughly known.

During pregnancy, the lower back hurts due to a shift in the center of gravity and muscle weakness. The condition returns to normal after childbirth. Unpleasant sensations are observed at any time. It is important to be able to distinguish when the back hurt from the load, and when with pathology. If at any stage of pregnancy, in addition to pain in the back and lower abdomen, there is discharge like menstruation, you need to urgently consult a doctor.

In men, painful sensations of the lower back and below the waist, which radiate to the perineum, indicate the development of inflammation of the prostate.If, in addition to these symptoms, a man has an increase in body temperature and a deterioration in well-being, you need to contact a therapist or urologist. Treat inflammation with antibiotics.

Acute lower back pain occurs in the following situations:

• Sprain or inflammation of the back muscles;
• long stay in antalgic posture;
• if you suddenly lift a lot of weight;
• sharp turns of the side or body, injuries;
• draft or hypothermia.

What to do if your lower back hurts: When the condition indicates physical damage, you need to see a traumatologist. The specialist will prescribe drug therapy in the acute period to relieve unpleasant symptoms. At first, NSAIDs of systemic action are used, and then they switch to external forms of release. It is useful to take vitamin preparations, inject neurotropic drugs. During the recovery period, physiotherapy, massage, gymnastics are indicated.

Why unpleasant symptoms appear – aching lower back pain occurs due to inflammation of muscle fibers or myositis.The condition is not pleasant, since the patient feels stiffness below the waist, and normal body movements are difficult. To temporarily relieve the condition, you need to take a warm shower, and then wrap yourself in warm clothes. Often back hurts in the lumbar region after injuries, falls. It is also recommended to use warming ointments. If after a few days the condition does not improve, then it is better to see a doctor.

Pulls and pains in the lower back during spondylosis. The patient constantly has a pulling pain in the lower back, and over time there are problems with the legs.Loss of sensitivity and weakness are observed. Spondylosis deformans is dangerous if the symptoms are ignored, because the disease takes a long time to develop. Other causes pulling back pain – ankylosing spondylitis, other diseases, the pain from which radiates to the spine or cancer. You can not pull with such symptoms, you need to immediately seek help from a specialist.

Sometimes the patient is tormented by “displaced pains”, the nature of which he does not know.The patient has unpleasant sensations in the back, but this condition is not associated with the developing pathology of the spine. Irradiation of pain is associated with problems in the pelvis, stomach or duodenum, kidneys.

In what situations it is necessary to urgently contact a specialist:

1. The pain syndrome is intense, and the discomfort does not go away after 2-3 days or even intensifies.
2. The unpleasant sensations have arisen after an injury or as a result of an accident.There were falls on the back or blows.
3. With the simultaneous occurrence of pain in the lower back, lower leg, hips, pelvis.
4. Due to unpleasant sensations, sensitivity is lost in the limbs, pelvis, buttocks, thighs, legs, feet and groin.

Only a physician will find out the exact cause of back pain.

Treatment and ways to relieve back pain

After the diagnosis is made, the therapy is selected in accordance with the individual characteristics of the patient.Treatment is aimed at relieving unpleasant symptoms and preventing relapse. Usually, conservative therapies are combined with the principles of physiotherapy and rehabilitation. In advanced situations, surgical intervention may be required.

Drug therapy

The use of drugs is the most extensive field in the treatment of back diseases. From drugs for the spine, NSAIDs or analgesics, antispasmodics, neurotropic vitamins and muscle relaxants can be prescribed. Each group of drugs will be discussed separately.These funds are intended for symptomatic treatment – relieving pain during an exacerbation. They do not have an effect on the root cause of the disease.

NSAIDs (non-steroidal anti-inflammatory drugs) cope with several tasks at once during the symptomatic treatment of back pain. The funds effectively relieve and eliminate the inflammatory process, due to the reversible inhibition of the synthesis of inflammatory mediators. Systemic forms of release, in the form of tablets and injections, are used in the acute period for a short time to relieve severe pain syndrome.

Diclofenac and Movalis are the gold standard in the treatment of back pain. Less commonly, Indomethacin or Ketorolac are prescribed. After a few days of therapy, the patient is transferred to the use of external forms of release, which can be used much longer. Diclofenac gel, Naproxen, Ketanov, Piroxicam perfectly anesthetize. Among the warming ointments and gels, Deep Hit, Finalgon, Kapsikam or Nikoflex can be prescribed.

Antispasmodics can be used to treat a patient if the patient does not tolerate muscle relaxants.Classic antispasmodics – No-Shpa or Papaverine. They are prescribed to relieve spasm of smooth muscles, as a result of which radiating pains to the spine may occur. Such drugs are easier to tolerate than NSAIDs, but also have a weaker effect.

To drugs of muscle relaxants of the central type of action include Sirdalud, Mydocalm or Baclofen. Most often, Mydocalm is prescribed to treat muscle spasticity, although Sirdalud is stronger and has fewer side effects.Balofen is a prescription drug prescribed for really advanced cases. It is not a first-line drug of choice, as it exhibits many side effects. The average duration of therapy when taking muscle relaxants is 1–1.5 months. If during this period the spasticity has not disappeared, then the medications are removed.

Physiotherapy methods of rehabilitation

In this branch of medicine, it is customary to use the following recovery methods:

1. Electrophoresis. Medicines are injected through the skin under the action of a galvanic current.Usually, injectable B vitamins, nicotinic acid, chondroprotectors are used. This is a long-standing method of treating back pain, but it is effective and helps well in the rehabilitation period. Galvanic current has good conductivity, delivering drugs locally to where blood flow is impaired. The drugs are active for 15 hours.
2. Laser therapy for pain relief. With the help of point-tuned infrared radiation, the method is aimed at pain relief, elimination of spasms, stimulation of regenerative processes, improvement of microcirculation in tissues, relaxation and enhancement of immunity.Laser therapy is especially effective in the treatment of osteochondrosis, hernia, protrusion.
3. Acupuncture is an ancient therapeutic method officially approved by the WHO. Contraindications to the procedure are the period of pregnancy, age up to 1 year and after 75 years. With the help of acupuncture, pain syndrome of varying degrees is eliminated. The essence of the method is the effect of a needle on the nerve ending of the affected area. The average course of therapy is from 10 to 12 sessions. Effectively and quickly removes pain in any part of the back – in the side, to the left or to the right of the spinal column.
4. Physiotherapy is one of the most popular rehabilitation methods for back pain. If there are no contraindications to the procedure, then special exercises are selected by a rehabilitation therapist aimed at restoring the mobility of the spine, eliminating muscle pain, and strengthening hypotonic muscle structures. By strengthening the muscle corset, pain disappears.

Traditional medicine methods are also used, but research has not proven their beneficial effects on health.Any self-medication methods should be discussed with a neurologist.

Prevention of pain in the lower back

It is necessary to maintain the health of the spinal column from an early age. In the early period of maturation of the organism, the body is intensively formed – the limbs grow, the position of the organs changes, the skeleton lengthens. If, at an early age, you teach your child the correct posture and regular exercise, you will be able to avoid many back problems in the future.

The child is taught to do exercise therapy at home several times a week to get a permanent effect.In order to avoid mistakes in execution, you need to consult with a good rehabilitation therapist. The specialist will tell you how to do back gymnastics at home, select an individual exercise system. At a young age, it is important not to overdo it and alternate the principles of moderate exercise with stretching and thorough warm-up.

Good habits to prevent low back diseases in childhood and adulthood:

1. Prolonged and improper sitting at the workplace is fraught with scoliosis with a shift to the left or right side.You need to get up every 15-20 minutes and do stretching – tilting the neck and lower back forward, sideways will tone tired muscles, improve blood flow.
2. It is important to exclude prolonged stay in the antalgic position. Static overload of the ridge is fraught with pain.
3. Do not make sharp turns of the neck or back. If you do this several times, there is a high probability of injury. Most often, back injuries are caused by abrupt and unusual stress on the body.
4. Sit upright when working from home.When bending to the right or left side in a sitting position, an incorrect load on the muscles occurs. The result is uneven muscle tension with alternating hypertonicity or hypotension in any part of the back.
5. It is necessary to exclude carrying the bag on the left or on the right on one shoulder. An alternative is a backpack that evenly loads the shoulders without distortions to the right or left.
6. At home, it is recommended to carry out a complex of stretching for tired muscles. After a long day at work, the muscles lose their elasticity.Warming stretching is also good for ligaments and joints . Bending of the neck to the side and forward, light static loads are useful.

One of the best ways to prevent lower back discomfort is to visit the pool. It is enough to swim 1-2 times a week to feel relief in the back. If you have existing problems, experts recommend visiting the pool at least 3 times a week.

Editorial Opinion

When low back pain occurs, it is important to find out the exact cause of the discomfort.It is important to pay attention to the accompanying signs of the disease – whether there is irradiation radiating to the leg or foot, fever or abdominal pain. An accurate diagnosis can be made only after a complete examination by a doctor, after which treatment is prescribed.

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