YOUR LOW BACK PAIN AND SCIATICA MIGHT BE RELATED TO YOUR NECK PAIN
Although it is certainly not discussed in public school today, ask the older generation who grew up being told to sit up straight —- POSTURE IS IMPORTANT! In the April issue of JMPT (The Effect of Adding Forward Head Posture Corrective Exercises in the Management of Lumbosacral Radiculopathy: A Randomized Controlled Study) a study was published on the relationship between people with FORWARD HEAD POSTURE and “Chronic Discogenic Lumbosacral Radiculopathy” (CDLR). Before we go any further, let’s talk for a moment about what this term means.
- CHRONIC: It’s been a problem for a long time. This likely (but not necessarily) means that the problem is associated with a DEGENERATIVE SPINE.
- DISCOGENIC: This means that the pain or dysfunction is being birthed or “generated” by the disc. To learn more about HERNIATED DISCS — another common cause of Disc Pain —- make sure to click the link.
- LUMBOSACRAL: This means that the problem disc as in the low back — probably at L5-S1 or L4-L5 — in the area of the belt line.
- RADICULOPATHY: When this term is applied to the upper extremity (where you see it used most of the time) it refers to numbness, tingling, pain, weakness, or combinations thereof in the arm that are originating in the neck (HERE). However, when applied to the lower extremity, it is essentially another name for SCIATICA.
In this study, 154 people with CDLR were divided into two groups. Group one did a “functional restoration program” for the low back (lumbar spine), which consisted of specific stretches, exercises, etc. Group two got the same, but they also, “received the forward head posture corrective exercises“. I cannot say for sure what they specifically used in this study, but I use the DAKOTA TRACTION DEVICE here in my clinic. Besides a baseline exam at the beginning of the study, participants were examined at 10 weeks and again at the end of the study, two years later. The results were rather amazing.
Although there were no significant differences at 10 weeks, by the time two years had rolled around, there were big differences in a number of measured criteria.
“At the 2-year follow-up, there were significant differences between the groups for all variables (anterior head translation, back pain, neck pain, leg pain, H-reflex amplitude and latency) adopted for this study. The addition of forward head posture correction to a functional restoration program seemed to positively affect disability, 3-dimensional spinal posture parameters, back and leg pain, and S1 nerve root function of patients with chronic discogenic lumbosacral radiculopathy.”
On top of this, there were pre and post x-rays of the neck that showed just how much correction of the cervical spine really took place.
The authors postulated that these positive changes might be because, “abnormal posture may lead to joint dysfunction and abnormal afferent information.” In English, this means that when abnormal posture (SUBLUXATION) is present, it adversely affects the sensory portion of the nerve, the majority of which has to do not with pain, but with something called PROPRIOCEPTION. Foul up proprioception and sooner or later you have major problems on your hands, including pain caused by “DJD“. By the way, this study was done by a PT and not a Chiro.
Global effects of Chiropractic Adjustments and Postural Restoration are not uncommon (HERE is an example of a not-quite-so-common one). Much of this has to do with proprioception, but it goes beyond that. Chiropractors frequently see things in their patients such as a return of bowel function, the ability to use their legs normally again, the ability to sleep through the night, or getting rid of CHRONIC PAIN.
While it’s definitely cool and I never get tired of it, it’s really just another DAY-IN-THE-LIFE. Patients, however, tend to see these things as ‘miracles’. They’re not. They’re just showing the way the body works, and science is beginning to figure out why.
In a 2012 issue of The Journal of Electromyography & Kinesiology (Changes in Pain Sensitivity Following Spinal Manipulation: A Systematic Review and Meta-Analysis) four PT’s, a Ph.D researcher, and a chiro, had this to say about S.M.T. (Spinal Manipulative Therapy / CHIROPRACTIC ADJUSTMENTS). “Reductions in pain sensitivity following SMT may be indicative of a mechanism related to the modulation of afferent input or central nervous system processing of pain.”
This indicates that the Chiropractic Adjustment relieves pain by effecting multiple areas of the body because they ultimately affect the brain (thalamus) as well as the descending pain pathways —– not just the spot that was adjusted. In fact, the authors said that, “these findings lend support to a possible general effect of SMT beyond the effect expected at the local region of SMT application.“
A couple years later (last year), JMPT published a study bearing this out (Effect of Spinal Manipulation Thrust Magnitude on Trunk Mechanical Thresholds of Lateral Thalamic Neurons). According to this paper, studies concerning….
“manual therapy have been clinically shown to increase mechanical pressure pain thresholds (i.e., decrease sensitivity) in both symptomatic and asymptomatic subjects. Cervical spinal manipulation has been shown to result in unilateral as well as bilateral mechanical hypoalgesia. Compared with no manual therapy, spinal manual therapy at T12 and L4 produced significantly higher paraspinal pain thresholds at T6, L1, and L3 in individuals with rheumatoid arthritis.
The immediate and widespread hypoalgesia associated with manual therapy treatments has been attributed to alterations in peripheral and/or central pain processing including activation of descending pain inhibitory systems. Increasing evidence from animal models suggests that manual therapy activates the central nervous system and, in so doing, affects areas well beyond those being treated.“
Let me go on record to state that I am not in favor of using anything, whether PERPETUAL ADJUSTMENTS or PAIN PILLS, on a constant basis to help patients achieve a certain degree of short term pain relief. I am into seeing people get better for the long haul. When Chiropractic Adjustments are added to a regimen of true postural correction, TISSUE REMODELING, and addressing OVERALL HEALTH FACTORS, there is at least a fighting chance that you, the patient, can actually get better — not just feel better for awhile, while you are waiting for your next “fix”.