LOWER LUMBAR BACK PAIN
LBP is a complex multi-factorial syndrome that causes immense pain and suffering, early loss of independence, and inablility to perform those things which bring us pleasure. Gardening becomes impossible, sitting for any length of time is painful, and a gentle amble window shopping is often hopelessly miserable. A weekly game of tennis is pie-in-the-sky. The treatment of LBP is the single high cost to the insurer - hence high monthly premiums for us. Whilst our chiropractic opinion has a high risk of bias! that we have an enormous contribution to make to lower lumbar back pain, the quality of people's lives, and the cost to the insurer, it's interesting that research done by two insurers found that inclusion of chiropractic saved them a vast sum of money. Nevertheless, entrenched medical interests continue to limit the payment to chiropractors despite powerful convincing independent research that manual therapy for LBP is more effective and more cost-effective than pills and surgery.
LOW BACK PAIN ...
Roy L. Smith
What may make the difference is whether you said your prayers, did you back exercises and enjoyed a dish from our healthy breakfast menu ... all necessary ingredients for "good day".
Bernard Preston's LONELY ROAD OF FAITH ... CASE FILEMrs B, a slender and tall 66 year old woman has had low back pain for as many years as she can remember. Five months before her first consult 11 months ago, a fellow player ran into her on the tennis court, and then the pain began to radiate down the side of her left thigh (an ache, 'zeurt' in Dutch), and the top of her foot. Walking became very difficult and painful and she had to stop tennis. She had no difficulty cycling and swimming. Prima! The only other history of significance was a broken left ankle 11 years ago. She had no trouble in her ankle/ foot until recently.
RADIOLOGIST REPORT 2003: LOWER LUMBAR BACK PAINMEDICAL X-RAY REPORT: 2003 LWK: Een links convexe scoliose is aanwezig. Zes lumbale type wervels zijn zichtbaar. Discopathie op niveau L5-L6, mindere mate L4-L5 en L3-L4. Haakvorming spondylose m.n. L3-L4 links. Geen hoogteverlies van de corpora. Paravertebrale arthrose laag lumbaal.In plain English: A left convex scoliosis (the radiologist got it wrong! That should read RIGHT convex, but never mind, we all make mistakes now and then!) is present. Six lumbar-type vertebrae are visible. (FIVE is normal). Degenerative disc disease is present at L5-L6 and to a lesser extent at L4-L5 and L3-L4. Hook-shaped osteophytes (spondylosis) especially at L3-L4 left. No loss of height of the vertebral bodies. Facet arthrosis in the lower lumbar paravertebral joints. To which I would add: A pelvic tilt due to a leg length inequality is seen. A short right leg. Aside: There is no mention either on the X-rays, or in the report, whether these X-rays were taken erect (standing) which can lead to considerable confusion when assessing a heel lift.
LEG LENGTH INEQUALITY ... ORTHOPAEDIC EXAMINATIONLOWER LUMBAR BACK PAINOn examination, a moderate right-convex scoliosis was immediately evident. The global range-of-motion of the lumbar spine was remarkably good and without pain. She could touch her toes, bend backwards and sideways without pain.The sacro-iliac tests were negative. The sciatic stretch test, and the Slump test, were both moderately positive in the posterior left leg with a mildly positive Bragards test (for a strongly irritated/ pinched Sciatic nerve.) Reflexes, skin sensation and muscle power were normal. Ranges of motion of the hips was normal.
CHIROPRACTIC EXAMINATIONLOWER LUMBAR BACK PAINThe pelvis was distinctly tilted, low right, the probable cause of the right-convex lumbar scoliosis. A proprioception test showed increased stability with both a 3mm and 5mm heel lift in her right shoe.No obvious sacroiliac fixations were evident on motion palpation. L2 and L5 were markedly fixated. No hip fixations were evident.
LEFT FOOT AND ANKLEEversion of her linker ankle was distinctly limited, but not painful. Both the talar and subtalar joints were tender on palpation.Fixations of the subtalar and cuboid joints were evident.
TREATMENT of LOWER LUMBAR BACK PAIN
PROGRESSNeither the 3mm lift (from me) or the 8mm lift from the podiatrist seemed to help. 8mm increased the back pain, 3mm didn't relieve it. Walking remained difficult. We continued to try different options with the heel lift, that both I and podiatrist agreed were important. Eventually we came to a compromise: he reduced the lift from 8mm to 6mm and now that helps.Within four weeks of treatment (6 treatments) she stated that the pain in her back, leg and foot was at least 50% better. The height of the heel lift was only settled after some months of trial and error. She had some temporary pain and discomfort after the manipulation, but that resolved within a day or two. Ice treatment helped. It's not perfect in Mrs B's back. Of course! She has much spinal degeneration. But she can walk normally again, she's playing tennis twice a week... "het gaat goed". She's happy, it's going well. She does the exercises faithfully.
DISCUSSION of LOWER LUMBAR BACK PAINMrs B had been told that she had a worn out (versleten) back and there's was nothing to be done. She must learn to live with the pain, and sadly tennis was a thing of the past.Certainly, she has a difficult back (these X-rays were taken 8 years ago, and it's without a doubt worse now). But nothing to be done? Nonsense. Where did the success of the case lie? Correction of her ankle complaint? The correction of her short leg? The rehab exercises? The chiropractic manipulation of her pelvis and lumbar spine?
RESEARCHOnly research done on 500 similar cases would answer this. One group of 100 would get only ankle treatment, another 100 only the heel lift...Instead, the power of Chiropractic is that we address all these shortcomings and the proof of the pudding is in the eating. At 67 in a month's time and she's playing tennis again twice a week. Now that's progress! Generally speaking, research is divided up into
A case-report of this nature should at best be considered Incomplete evidence. I confess without reservation to the charge of being biased! And you have no idea without independent investigation whether I am lying like my feet stink! Perhaps a photograph of Mrs B on the tennis court would give this lower lumbar back pain case report more substance. You be the judge. When she gets back from her summer holiday in the south of France I'll ask whether she would mind a photograph of her on the tennis court appearing on the web!
SPONDYLOLYSTHESIS CaseFileSpondylo-lys-thesis is a condition frequently contributing to lower back pain. One vertebra slides forwards on it's neighbour below trapping the nerve roots, and sometimes the spinal cord causing lumbar stenosis. SPONDYLOLYSTHESIS CaseFile ...
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