When patients present with low back pain, it is not uncommon for pain to arise from areas other than the low back, such as the hip. There are many tissues in the low back and hip region that are susceptible to injury with have overlapping pain pathways that often make it challenging to isolate the truly injured area. Hip pain can present in many different ways.

When considering the anatomy of the low back (lumbar spine) and hip, and the nerves that innervate the hip come from the low back, it’s no wonder that differentiating between the two conditions is often difficult. Complaints may include the inside, outside, front or back of the thigh, the knee, the buttocks, the sacroiliac joint, or the low back and yet, the hip may truly be the pain generator with any of these presentations. To make diagnosis even more complex, the hip pain patient may present one day with what appears to be sciatic nerve pain (that is, pain shooting down the back of the leg to the knee if mild or, to the foot if more severe) but the next time, with only groin pain. When pain radiates down a leg, the almost automatic impression by both the patient and the health care provider is, “…it’s a pinched nerve.” But again, it could be the hip and NOT a pinched nerve that is creating the leg pain pattern. Throwing yet another wrench in the works is the fact that a patient can have more than one condition at the same time. So, they truly MAY simultaneously have BOTH a low back problem AND a hip problem. In fact, its actually unusual to x-ray the low back of a hip pain patient without seeing some low back condition(s) like degenerative disk disease, osteoarthritis (spurs off the vertebrae), or combination of these. So, how do we differentiate between hip vs. low back pain when it is common for both low back and hip pain to often coincide?

During our history, we often ask the question, “…what activities make your pain worse?” If the patient replies that weight bearing activities like standing, walking, getting up from sitting, etc., provoke the pain (and they point to the front or side of the hip), a hip related diagnosis is favored but, it STILL may be arising from the low back or both! If they say, “…crossing my right leg over the other hurts in my groin,” that’s getting more hip pain specific as hip rotation is frequently lost before the forward flexion motion. When we ask the hip pain patient to point to the area of greatest discomfort, they usually point to the front of the hip or groin, and less often to the inner and/or anterior thigh or knee. Non-weight bearing positions like sitting or lying are almost always immediately pain relieving. When there is arthritis in the hip, motion loss is often reported and may include a shorter walking stride and pain usually gets worse the longer these patients are on their feet. Initiating motion often hurts, sometimes even in bed when rolling over. During the chiropractic examination, with the patient lying on the back with the knee and hip both bent 90˚, moving the bent knee outwards or inwards will almost always reproduce hip/groin area pain. Pulling on or, applying traction to the affected leg usually, “…feels good.” Knee & ankle reflexes and sensation are normal but muscle strength may be weak due to pain. Bending the low back into different positions does not reproduce pain if the pain is only coming from the hip. Though challenging sometimes, we are well trained to be able to differentiate between hip and low back pain and will treat both areas when it is appropriate.

We realize you have a choice in who you choose to provide your healthcare services. If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

When people think of chiropractic, they immediately think of low back pain and are often surprised to find out that chiropractic can benefit many conditions such as carpal tunnel syndrome, tennis elbow, rotator cuff tears, as well as hip, knee, and ankle conditions. There is also research support for manipulation (a key component of chiropractic) and its role in managing “somatovisceral” related conditions such as pneumonia, dizziness, stage 1 hypertension, PMS, asthma, colic, and bed wetting.

Research clearly shows that chiropractic manipulation out performs other forms of treatment for acute, subacute and chronic low back pain. But, the question remains, can “maintenance chiropractic” PREVENT problems down the road? Ironically, two medical doctors in August of 2011 published an article in a leading medical journal (SPINE) entitled, “Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome?” The study’s objective was to determine if treating chronic low back pain patients (pain >6 months) after a course of 12 treatments in the first month would do better, the same or worse if treatments were continued at 2-week intervals for an additional 9 months. They compared 3 groups of patients: 1.) 12 treatments of “sham” (placebo) manipulation over a 1-month period. 2.) 12 treatment of “real” spinal manipulative therapy (SMT) for 1 month but no treatments for the subsequent 9 months. 3.) The same as #2 but with treatments every 2 weeks over the next 9 months. To determine the differences between these 3 groups, the authors measured pain and disability scores (using questionnaires), generic health status (questionnaire), and back-specific patient satisfaction (questionnaire) at 1, 4, 7 and 10-month intervals.

The results showed that groups 2 (SMT for 1 month only) and 3 (SMT for 1 month + every 2 weeks for 9 months) had significantly lower pain and disability scores than the 1st group (sham/placebo group) at the end of the 1st month or, 12 visits. However, only group 3 (treatments were continued for 9 months at 2 week intervals) showed more improvement in pain and disability scores at 10 months. Equally important, the scores for the non-maintained group 2 patients returned to near their pre-treatment levels by month 10!

The authors concluded that not only is spinal manipulative therapy effective for chronic low back pain, but more importantly, REGULAR ADJUSTMENTS EVERY 2 WEEKS after the initial course of concentrated care (3x/week for 4 weeks) was needed, “…to obtain long-term benefit,” suggesting that, “…maintenance SM after the initial intensive manipulative therapy,” is appropriate care to obtain long-term results.

This study FINALLY supports the recommendations made by chiropractors for many years –regular adjustments are beneficial to obtain a higher quality of life, less pain and less disability!

We realize you have a choice in who you choose to provide your healthcare services. If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

For many years, Chiropractic has been at the forefront of treating low back pain (LBP) with both greater patient satisfaction and less lost time at work when compared to other non-surgical treatment approaches. There have been many explanations as to why chiropractic manipulation therapy (CMT) works but many of these studies include other treatment modalities or methods and the benefits are ,therefore, not clearly derived only from CMT. A recent study has tried to clear this up and the results are very interesting!

This study included two chiropractors and two a physical therapists (PT) from Canada and the US. What is unique about this study is that they measured clinical or symptomatic improvement by tracking improvement in activity tolerance using a standard questionnaire commonly used by chiropractors and PTs all over the world, as well as changes in the spinal stiffness using a valid/reliable instrument before and after CMT was utilized. The importance of these findings is that only CMT was utilized and hence, other forms of treatment commonly utilized by chiropractors did not cloud the findings. There were 48 patients included in the study and the initial 2 treatments were administered 3-4 days apart, followed by an assessment 3-4 days after the 2nd treatment. Assessments were also performed before and after each treatment. The assessments included use of the questionnaire and a stiffness measurement using the special instrument. Also, “recruitment of the lumbar multifidus muscle” (a muscle in the low back that helps stabilize the trunk or core) was measured by ultrasound. After each treatment, significant improvement was found in the overall pain level and in reduced spinal stiffness (which remained improved 3-4 days after the last/second treatment).

The study conclusions revealed less pain, more activity tolerance and less spinal stiffness after the administration of the 2 treatments. The greatest clinical improvement was found in those who had the most dramatic reduction in stiffness after each treatment. They found that the level of muscle recruitment was directly related to the degree of spinal stiffness. They also found that patients who received thrust manipulation (CMT) had immediate improvements with reduced pain, stiffness and improved muscle recruitment measurements. However, this same effect was NOT obtained when non-thrust mobilization techniques were used. This means many non-thrust manual techniques such as mobilization, massage, and other soft tissue release methods do not create the immediate benefits that were produced by thrust manipulation.

With this new information, we are now able to explain with confidence to patients the reasons why they typically feel better after the spinal adjustment. The patient can then appreciate receiving an answer that makes clear sense and has been “proven.” It’s important to realize that the “bonus” of receiving chiropractic care for low back pain includes not only just pain reduction, but more importantly, improvement in tolerating activities such as vacuuming, washing dishes, golfing, walking and of course, working.

We realize you have a choice in who you choose to provide your healthcare services. If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

Scoliosis is a curvature of the spine that is shaped like a “C” or an “S” when looking at the person from behind. I’m sure you’ve noticed when you’re at a beach, at a swimming pool, or walking in an airport, some people have a high shoulder, walk with a bit of a limp if one leg is short, and may have a shoulder blade that sticks out more than the other. Scoliosis often develops for unknown reasons (hence the term, “idiopathic”) during the adolescent age range between 10 or 11 years old and can progress, not change or less often, improve up to age 16 to 18. During these 4-6 years, the time when the adolescent is growing quickly, the curve often worsens without any intervention but few studies have looked at what types of treatment or combinations of treatment work the best, especially non-surgical methods.

A recent study was conducted that looked at the response to non-surgical treatment using conventional medical treatment (MT) vs. conventional MT plus chiropractic, as well as conventional MT and “sham” (fake) chiropractic treatment. This is a pilot study using a small population of patients in order to determine if a larger scale study would be important to run (which was determined to be the case).

The conventional medical treatment approach included two groups – observation (a “wait and watch” approach) in a braced group verses a non-braced group. The chiropractic treatment group received spinal manipulation using “diversified technique” which is widely used where the patient is treated while lying on their stomach, sides, and back and the type of manipulation used was the thrust type where the “cracking” sound occurs (which is caused by the release of gas from the joint capsules and is technically called cavitation). This was applied to the regions determined by the chiropractor as requiring the treatment by using palpation (touch) methods, postural examination, range of motion, and x-ray and all chiropractors involved had 6-hours of training to assure consistent and similar approaches were used. Treatments were administered (determined by a survey of many chiropractors) at 3x/week for a month, 2x/week for a month, 1x/week for a month, and 2x/month for 3 months or as needed for a total of 6 months. The “sham” or fake chiropractic treatment used the same treatment frequency and similar positioning of the patient but purposely did not obtain a joint cavitation or “crack” but still seemed “real” to the patient.

The primary outcome used to determine “success” was a reduction of the scoliosis curve measured on x-ray at a 6-month point. Using the standard medical model, those with curves of 20-25 degrees require careful observation, curves 26-40 degrees are potential candidates for bracing, those greater than 40 degrees are potential candidates for surgery and, an increase in curve by more than 5 degrees measured twice a year or every 6-months is considered failure.

The results are interesting. Of those receiving only conventional medical treatment, none improved and one failed. The same occurred in the conventional MT plus sham/fake chiropractic. NO ONE failed and one improved in the chiropractic treatment plus MT group making it the only successful non-surgical treatment approach in the study. The preliminary findings from this study are huge! Chiropractic treatment in this group of adolescent children was determined to be THE ONLY non-surgical approach that had the ability to maintain (not allow the curve to progress) or even better, improve the curve!

We realize you have a choice in who you choose to provide your healthcare services. If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

Patient education is a very important aspect of caring for our patients. In fact, it can be one of the most important aspects of care. For example, when patients present with a brand new injury and pain levels are off the map, it’s quite common for that acute suffering patient to inappropriately think that, “I’m going to die… this hurts so much!” Hence, one of the very first things we do as chiropractors is to determine what structures are generating the pain so we can tell you!

Once you have an understanding of where the pain is coming from and why it hurts so bad, then you can be reassured that it’s not life threatening or dangerous. Also, at this acute point of time, the patient often unknowingly puts heat on the back, often for hours. This is the WORST thing you can do as the area is already swollen and putting heat on a swollen area draws more blood and fluids into the area. It’s literally like throwing gas on a fire. So, receiving proper information from us such as, put ice on the area for 15-20 minutes on and off several times in a row to “PUMP” the swelling out of the area will make complete sense.

Also, did you know that 2/3rds of our body’s weight is above the waist? That means, when a 150# person bends over, they are “lifting” 100#! That’s one of several reasons why bending over can be so dangerous. To “fix” that, squat by bending the knees keeping the back straight and keep objects that you might be lifting close to your body as that weight literally weighs 10x more when your arms are straight and you’re lifting. When you can’t squat and have to bend over, bend the knees, arch your back (literally “stick your butt out”), and bend over at your hip joints – DON’T use your back. You’ll need to practice that one a few times before it’s fully understood.

As your back pain improves, we will review these important self-help approaches and add new “tricks of the trade” like certain stretches, some strengthening and perhaps some balance exercises. Did you know that your thigh muscles shrink just by sleeping overnight? It’s true! When you wake up in the morning, your thigh muscles are smaller than when you went to bed. Well, this same muscle shrinkage (technically called “atrophy”) occurs in the lower back and hips, so strengthening exercises are REALLY IMPORTANT! Just think, if your muscles shrink overnight just from laying in bed, what about when you might have been told to use bed rest for several days or more? There potentially is a lot of muscle shrinkage and weakness that can occur in a relatively short amount of time and therefore, strengthening exercises also need to be taught in order to regain your strength so you can more safely do your activities.

Now what about back pain prevention? What methods to you think will help us NOT get low back pain? That’s right – managing weight! If your BMI (body mass index or, the ratio between your height and weight) is >25, you need to trim down a bit (or more). Go on line and SEARCH BMI, and pick one of many “BMI Calculators” to figure out your BMI. So, what do chiropractors know about weight loss? Did you know the chiropractic college curriculum includes more nutritional courses than most medical schools? We will help you find a way to lose weight – whether its calorie restriction, a special diet like no/low salt, gluten-free, or a diabetes-specific diet. Another prevention trick for the low back (actually, whole body!) is to STAY FIT! Make aerobic exercise and even a light weight lifting program part or your daily ritual. Other methods help too, so come in and let us guide you in this journey to better health!

We realize you have a choice in who you choose to provide your healthcare services. If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

Low back pain can arise from many conditions, one of which is a mouthful: spondylolisthesis. The term was coined in 1854 from the Greek words, “spondylo” for vertebrae and “olisthesis” for slip. These “slips” most commonly occur in the low back, 90% at L5 and 9% at L4. According to www.spinehealth.com and others, the most common type of spondylolisthesis is called “isthmic spondylolisthesis,” which is a condition that includes a defect in the back part of the vertebra in an area called the pars interarticularis, which is the part of the vertebra that connects the front half (vertebral body) to the back half (the posterior arch). This can occur on one, or both sides, with or without a slip or shift forwards, which is then called spondylolysis. In “isthmic spondylolisthesis,” the incidence rate is about 5-7% of the general population favoring men over women 3:1. Debate continues as to whether this occurs as a result genetic predisposition verses environmental or acquired at some point early in life as noted by the increased incidence in populations such as Eskimos (30-50%), where they traditionally carry their young in papooses, vertically loading their lower spine at a very young age. However, isthmic spondylolisthesis can occur at anytime in life if a significant backward bending force occurs resulting in a fracture but reportedly, occurs most frequently between ages 6 and 16 years old.

Often, traumatic isthmic spondylolisthesis occurs during the adolescent years and in fact, is the most common cause of low back pain at this stage of life. Sports most commonly resulting in spondylolisthesis include gymnastics, football (lineman), weightlifting (from squats or dead lifts) and diving (from over arching the back). Excessive backward bending is the force that overloads the back of the vertebra resulting in the fracture sometimes referred to as a stress fracture, which is a fracture that occurs as a result of repetitive overloading over time, usually weeks to months.

If the spondylolisthesis lesions do not heal either by cartilage or by bone replacement, the front half of the vertebra can slip or slide forwards and become unstable. Fortunately, most of these heal and become stable and don’t progress. The diagnosis is a simple x-ray, but to determine the degree of stability, “stress x-rays” or x-rays taken at endpoints of bending over and backwards are needed. Sometimes, a bone scan is needed to determine if it’s a new injury verses an old isthmic spondylolisthesis.

Another very common type is called degenerative spondylolisthesis and occurs in 30% of Caucasian and 60% of African-American woman (3:1 women to men). This usually occurs at L4 and is more prevalent in aging females. It is sometimes referred to as “pseudospondylolisthesis” as it does not include defects in the posterior arch but rather, results from a degeneration of the disk and facet joints. As the disk space narrows, the vertebra slides forwards. The problem here is that the spinal canal, where the spinal cord travels, gets crimped or distorted by the forward sliding vertebra and causes compression of the spinal nerve root(s), resulting pain and/or numbness in one or both legs. The good news about spondylolisthesis is that non-surgical approaches, like spinal manipulation in particular, work well and chiropractic is a logical treatment approach!

We realize you have a choice in who you choose to provide your healthcare services. If you, a friend or family member requires care for low back pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.