Hidden Causes of Low Back Pain (Part 2)

Last blog we talked about how your low back pain may not be coming from your low back! Quick refresher: Sitting all the time at a computer/desk job can leave us with hyper-kyphotic (hunch back) posture. Sitting can also lead to tight hip flexors and lack of movement in your hips and pelvis. The idea is that if your thoracic spine and hips can’t move the way they are supposed to, your lumbar spine (low back) will try to compensate and do the work for them. That means that your low back is working over-time!

Last post we covered mobility drills for your thoracic spine, and so this time we will talk about how to open up your hips.The muscular around your hips/pelvis is quite extensive. Check out the image below to get an idea of the muscles we are targeting with these stretches. 

90-90-90 Hip Stretch

The easiest way to start the 90-90-90 hip stretch is to start sitting on the floor with both legs in front of you. Have your heels on the ground and your legs bent to about 90 degrees. From there, let both knees fall to the right side. Your right leg will likely be close to the ideal position, but you may have to move your left leg back a bit but keeping your knees bent at 90 degrees. You want your legs to make ALL the right angles. (Ignore that my left knee may be a bit smaller than 90 degrees.) 

Depending on how tight your hips are, you may already start feeling a stretch. When moving into the next stretches of this complex, only stretch as far as feels comfortable. This should never feel painful! 

From this 90-90-90 position, lean forward on your front leg (your right leg). As you lean forward, you can support yourself on your hands/elbows. When you do this, you should feel a deep stretch in the posterior muscles on your right leg and gluteal region. You may also feel some stretches other places. It depends on where exactly your tightest muscles are. If you are familiar with yoga, this should feel similar to pigeon pose. 

Next slowly come back to your seated 90-90-90 position. From here try to square your shoulders so you are directly facing your back leg (your left leg). I think of trying to line up my sternum with my leg. Then slowly lean back until you feel a good stretch in the front of your left leg. Again you can support yourself on your hands/forearms depending on your flexibility. You should feel a stretch on top of your left leg/front part of your hip. You may feel stretches other places, too, this again depends on where your tightest muscles are. 

Slowly come out of this stretch, then switch your legs, and repeat! 

Modified Lunge 

The modified lunge stretch is just that! For this one, you need a prop! It can be a stair, sofa, or chair (leopard print optional)! You may also want to do this on softer floors or put a yoga mat down for padding. To get into this modified lunge, rest the top of your foot on top of your prop, then drop into a lunge position. Having your foot elevated, will increase the stretch down the font of your leg.

Focus on kneeling really tall. You should also focus on having a posterior pelvic tilt to feel the stretch more. This means make sure that you are NOT sticking your butt back and out along with letting your abdomen go forward. To initiate a posterior pelvic tilt, I think of pulling my belly button in trying to approximate it to my spine then moving my butt down and forward. To better understand pelvic tilts, check out the image below of the side view of the pelvis. 

Make sure to do each of these stretches on BOTH sides! I recommend holding each stretch for at least 30 seconds and going through these 2-3 times. 

Questions? Hopefully these stretches will help with your hip mobility. We can also always go through them during your next appointment. Don't have a next appointment yet? Call us today to set one up!

Hidden Causes of Low Back Pain (Part 1)

“My low back hurts! Why are you messing with my hips and mid back?” That’s a great question! Low back pain can’t just be lumped together in a simple category. Two people may both have low back pain, but they can each have a different cause of low back pain. For example, two people may be coughing. One could be coughing because he choked on some food while the other could be coughing because of a cold. You shouldn’t go offer both cough medicine because of their presentation; they have different causes!

This week we will be looking at how to do some at home mobility work for your thoracic spine (mid-back). Next week we will continue by looking at your hips. Sitting all the time at a computer/desk job can leave us with hyper-kyphotic (hunch back) posture. Sitting can also lead to tight hip flexors and lack of movement in your hips and pelvis. The idea is that if your hips and thoracic spine can’t move the way they are supposed to, your lumbar spine (low back) will try to compensate and do the work for them. That means that your low back is working over-time!

When looking at mobility for your thoracic spine, you can always consult our older blog post on exercises/stretches for better posture. We also have some new mobility drills for you to work on.

Basic Foam Rolling

This is a good way to warm up and do a broad sweep of mobilizing your spine. When foam rolling, I like to start just above the curve in my low back and roll up to the base of my neck. I often like to have my arms crossed across my chest like I’m giving myself a big hug. (Why not hug yourself! Show your body some love!) I feel this is nice in the area between my shoulder blades. You can also use your hands to support your head if your neck starts to get sore holding up your head. (It’s hard being smart and having such a heavy brain.) Do this for a minute or so, and then move on to the other stretches.

Double Tennis Ball

Grab two tennis balls, and use athletic tape or a wide enough tape to attach the two balls together. These are going to allow you to really work out the muscles on either side of your spine. Check out the picture below to get an idea of how the double tennis ball will cradle your spine while massaging the muscles.

Lay on the tennis balls where the divot between the tennis balls aligns with the spinous process (the sticky outty part of your spine that you can feel on your back). From there just relax on top of the ball and then crunch up a little. Think of bending your back around the balls. Then move the tennis balls up your spine and repeat. Some spots may be a little more tender than others. Feel free to hang out in those spots for a little while. Focus on your breathing and trying to relax, and the sore spots in your muscles will hopefully do the same.

Quadruped Rotational Drill

This drill can be done in two positions. You can either be on your hands and knees or go back to a position where you are sitting on your heels. For some people, the hands and knees positioning is more comfortable, especially if they lack the mobility to get in to the position where they are sitting on their heels. Once you are in position, place one hand on the back of your head, and work on rotating from the ground then looking up towards the sky. When doing the rotational movements, think of making all the movement come from your mid-back. Keep your low back, hips, and pelvis all stationary. The kneeling position can allow for a bit easier isolation of the thoracic spine movement. Do 5 rotational reps on each side and repeat 1-2 times. Each set try to rotate a bit further.

Questions? Hopefully these drills will help with your thoracic mobility. We can also always go through them during your next appointment. Don't have a next appointment yet? Call us today to set one up!

Sciatica

Sciatica is a common term that many people have heard. Low back and leg pain? Oh yeah, that’s just sciatica. Discomfort after driving for a long time? Oh that’s that sciatica acting up again. Sciatica has turned into a catch all phrase that’s casually thrown around. But what exactly is sciatica? What causes that irritating pain?

Definition and Causes of Sciatica

Sciatica is simply pain and tenderness at some point(s) along the sciatic nerve. Check out the image below of the sciatic nerve. (This anatomy picture is looking at the back side of a right leg. The sciatic nerve is shown coming out from under the piriformis muscle down to the back part of the knee.) 

There is a lot going on around the sciatic nerve. The pain can be caused by irritation of any part of the nerve.

Below is a picture of a healthy spine and nerve roots leaving your spinal cord. You can have irritation of the sciatic nerve starting here! The sciatic nerve is made up of nerve branches from the spinal cord from the L4 level to the S3 level. If any of the discs in this area bulge or herniate (where the inside material of the disc is pushed outwards), they can irritate the nerves exiting the spinal cord. If you have degenerative joint disease (DJD), the amount of space for the exiting nerve (aka the foramen for spinal nerve) decreases in size. The smaller space for the nerves to exit the spinal cord can lead to increases in nerve iritation.  

The pain can also be caused from irritation of the nerve as it travels through/in/around any of the muscles. A common site of irritation can be from the piriformis muscle. In most people the muscle passes underneath the muscle (as seen in the first anatomy pic), but in some people, the nerve travels through or around the muscle. The piriformis muscle is important muscle used in walking and stabilizing the hips and pelvis. If the piriformis muscle gets tight, it can lead to irritation of the sciatic nerve.  The nerve also travels along the hamstrings (which are actually 3 muscles--semimembranosus, semitendinosus, and biceps femoris). Strain on these muscles can also cause sciatic symptoms. 

Signs and Symptoms

Sciatica presents with increased pain and or paresthesia along the back part of the leg to the knee or even all the way down into your foot. This can lead to an altered walking pattern, which can cause even MORE pain. Pain can increase while bending forward like if you were going to touch your toes/tie your shoes/etc. Patients with sciatica can also notice pain in the back of the knee or in the gluteal area, especially when palpated. 

Chiropractic Approach

First off, a chiropractic exam is performed to determine the cause of the sciatica. A series of orthopedic tests, neurological tests, and palpation of the muscles and joints give us a good understanding of what is causing your pain. Through this exam, we can usually identify what the cause(s) of the pain are. The cause of the sciatica dictates the treatment. 

If there is disc irritation from DJD, the patient is usually treated with flexion and distraction. If there is muscle inflammation or strain causing the problem, we will perform muscle release techniques, electrical stimulation, or various other modalities to help relieve the inflammation, relax the muscles, and take pressure off of the nerve. Some patients may have multiple causes contributing to their sciatica, so we treat all the causes. We are also a big fan of home stretches to help eliminate future flair ups. After your first treatment, we will go through those exercises and make sure that you are comfortable with your home care stretches. 

There is no need to live with insistent, irritating low back and leg pain. Call us today!