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"Presented here are a selected few summaries
of different treatment options for several conditions
causing lower back pain. This information is presented as
background material for further study and inquiry and not
as a means of self diagnosis or treatment. The reader is
advised to use caution in drawing conclusions and to use
critical thinking in evaluating any health condition.
Lower Back pain is a huge problem in our society. Often
those who suffer from chronic forms of the problem are
left with little hope. There is always hope; it may only
be
a matter of finding the right "tool" at the
right time. Unfortunately, there is a great deal of mis-information
spread by the popular media regarding back pain. Once thought to
be an isolated condition which normally gets better with time, we now know
that many times lower back pain can be recurrent and progressive. This
means that we must shift many of societies attitudes about lower back pains
causes, effects and treatments. We must learn to exercise, stretch and
care for injured tissues even After the pain has gone away"
Dr. Daniel Buch, B.S, D.C., Q.M.E.
Spinal Manipulation and Mobilization
Inversion
Traction and Vertebral Axial Decompression (Vax-D)
Selective
Nerve Root Injection
Functional
Stabilization Exercise and Physical Rehabilitation
Microdisctectomy,
Laminectomy and Fusion Surgeries
Spinal Manipulation and Mobilization - - - -Back to Top
Some Conditions which may benefit:
Contained
Intervertebral Disc Bulge / Annular Sprain
Mechanical Dysfunction of the soft tissue and facet
joints
Sprain and Strain Injuries
Uncomplicated Lower Back Pain
Facet Joint "Subluxation"
May effect somatic - visceral irritation syndromes
Special Tests and Examinations Prior
to Treatment May Include:
X-rays of the area of complaint may be
required
MRI is occasionally required
Performed By: The vast majority of manipulative therapy is performed by Doctors of Chiropractic, Osteopathic Doctors may perform as well. Mobilization is performed by Chiropractors, Osteopathic Doctors and Physical Therapists
What is Done:
Manipulation is performed in office setting. The affected
joint is gently moved through its full range of motion.
It is then quickly moved at its end of range to
"open" the joint space, realigning the joint
surface, stimulating motion sensitive nerves and
improving joint motion. Heat, electrical stimulation,
ice, exercise and other modalities may be part of the
treatment plan.
Click Here For
Further Detail On Manipulative Therapy
Inversion Traction and Vertebral Axial Decompression (Vax-D) - - - -Back to Top
Some Conditions which may benefit:
Contained
Intervertebral Disc Bulge
Intervertebral Disc Prolapse
Mechanical Dysfunction
Intervertebral Foraminal Compression
Special Tests and Examinations Prior
to Treatment May Include:
X-rays
are required to rule out potential contra-indications
MRI is often required to determine extent and type of
intervertebral disc injury
Performed By: Performed under supervision of Medical or Chiropractic doctors.
What is Done:
Inversion traction - is performed by being
suspended upside/down usually suspended at the thighs in a
seated position. Several repetitions may be used for 20 to
120 seconds.
Vax-D - While lying on stomach a harness placed
around the waist and the patient holds on to hand grips.
A computer monitored pneumatic traction device pulls in a
cyclic stretch/relax pattern. The forces of distraction
are substantial
With both of these treatments, the goal is to reduce the
compressive forces on the spine. By possibly reversing
the internal pressure of intervertebral disc, it may be
possible to reverse potentially compressive disc bulging
and swelling.
Other physical modalities of heat, ice, electrical
stimulation and exercise may be used as part of
treatment. For more information see: VAX-D, Vertebral Axial
Decompression Site
Selective
Nerve Root Injection - - - -Back to Top
Some Conditions which may benefit:
Nerve
Root Compression or irritation from Herniated
Intervertebral Disc / Scar Tissue / Degeneration
Central canal stenosis due to scar tissue or trauma
Special Tests and Examinations Prior to Treatment May
Include:
MRI
is generally obtained prior to treatment to determine
possibility of nerve root or cord compression
Regular blood labs may be required prior to treatment
Performed By:
Performed
by Medical doctor, with training in anesthesia, neurology
or orthopedics
What
is Done:
Performed with local anesthesia, injection is directed
under constant videoflouroscopy (video x-ray). Prior to
injection, dye is injected into the space surrounding the
nerve root. The movement of the dye is followed on the
video monitor. Areas of constriction around the nerve are
noted. The nerve is then electrically stimulated to see
where the pain is felt. It the area of pain is the same
as the patients primary complaint of AND the area is
shown to be constricted, anti-inflammatory medications
and anesthetics are injected at the site of constriction.
After treatment stabilization exercises and stretching
may be part of treatment plan
Functional Stabilization Exercise and Physical Rehabilitation - - - -Back to Top
Some Conditions which may benefit:
Contained
Intervertebral Disc Bulge / Annular Sprain
Mechanical Dysfunction
Sprain and Strain Injuries
Acute Reflex Muscular Hypertonicity
Uncomplicated Lower Back Pain
Performed By:
Performed
by Doctors of Chiropractic, Medical Physiatrists and
Physical Therapists
These exercises are designed to enhance the muscular
stability, control and "adaptive strength" of
the spine. Adaptive strength refers to the spines ability
to quickly and correctly adapt to the demands place upon
it. These exercises are usually performed daily and
progressively get more difficult over time. As function
increases, generally pain decreases.
Painful conditions over time may create "centralized pain"; pain which has been memorized by the brain and is every bit as real as the original pain. Exercise and motion help to trace NEW memory pathways which lessen this "memorized pain."
Microdisctectomy, Laminectomy and Fusion Surgeries - - - -Back to Top
Some Conditions which may benefit:
Intervertebral Disc Herniations and disc fragments
Unstable or fractured joints
Emergency situations where nerve tissue is being
irritated or compromised.
Conditions where multiple problems exist at the same
time, which are causing irritation to the nerves.
Performed By:
Performed
by orthopedic surgeons, neuro surgeons and pain
management surgeons
Special Tests and Examinations Prior
to Treatment May Include:
MRI
should always be obtained prior to treatment to determine
possibility of nerve root or cord compression
Regular blood labs may be required prior to treatment.
What is Done:
Unless it is a medical emergency this is
ALWAYS a FINAL resort. This should only be performed in
emergency situations or if conservative treatment has
failed. In non emergency conditions, conservative
treatment should be fully utilized for up to 3-6 months
prior to making surgical decisions.
Surgical decompression refers to surgery which is intended to remove intervertebral disc material, bone or other "lesions" which are irritating or crushing nerve or vascular tissue within the spinal canal or at the exit of the spinal nerves from the spinal canal. There are many techniques utilized. The type of surgery will depend on the extent of the condition, the general health and physical requirements of the patient and the preferred technique of the surgeon.
Microsurgical techniques have the advantage of limiting the amount of tissue damage and limiting many of the risks of more invasive surgery. Microsurgery refers to the use of "arthroscopic" or "endoscopic" surgical tools (small tubes) through which the surgery is performed. Not all conditions requiring surgery can be performed with microsurgical techniques.
Copyright 2002 DSB.