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Common Causes of Mechanical Low Back Pain and/or Leg Pain

Treated by Johnston Town Center Chiropractor, Dr. Alan J. Schultz

The low back or leg pain you are experiencing can be very disturbing to your lifestyle. It may prevent you from completing your activities of daily living: sitting, riding, or even walking causes pain. You may feel frustrated with the recurrence of pain. Many have trouble understanding why they have back pain, or why it does not always resolve itself.

For some patients, control of pain rather than a cure is the goal. Many have been prescribed pills for pain control, with the use of opioids (for example medications containing oxycodone, such as Oxycontin and Percocet; and those containing hydrocodone, such as Norco before coming to see us.

With the use of opioids comes the risk of opioid addiction (prescription drug abuse). This is why chiropractic, acupuncture, and spinal decompression are so appealing: they are safe, effective and natural.

There are Two Basic Causes of Mechanical Back Pain

  1. A disc condition in which sprain or tearing of the disc can cause pain and sometimes swelling of the disc to compress a nerve,
  2. 2. Joint irritation (articular facets) at the motion areas, one vertebra with another vertebra.

Surgery is necessary for less than 2% of low back patients. At least 6-8 weeks of non-surgical, specialized chiropractic should be given before surgery is considered, unless neurological problems such as urination difficulties or progressive muscle weakening occur.

Common Causes of Mechanical Back Pain:

1. Disc Degeneration

Disc degeneration (can be seen with x-ray examination.)

2. Osteoarthritis

Pain, stiffness, tenderness, loss of flexibility, joint popping or grating, soft tissue swelling and inflammation. Usually in patients 40 years or older.

Disc Injuries

Ruptured or herniated disc; extruded disc; bulging or protruding disc. This is when the center of the disc (called the nucleus), pushes on the annular fibers of the disc pressing on spinal nerves. Usually detected via history and exam, and often confirmed with MRI. Dr. Schultz can order MRI’s and read the results. In some cases, when needed, he will arrange for orthopedic consultation or medical intervention.

When a disc’s nucleus pulpous losses it fluidity, the spine moves abnormally. Any tearing or ripping of the disc may result in shifting of the gel-like substance of this nucleus posterior (backward), gradually putting pressure against (“pinching”) the sciatic nerve roots.

Tearing of an annulus many cause pain when it happens in the outer rim of the disc. Tears more medially will exhibit no pain because there is no nerve innervation this region.

Complications With Disc Problems

Sciatica: Leg pain is referred to as “sciatica.” Sciatic pain is almost always in just one leg, not both. It’s pattern is down and into the buttock, then down the back of the leg, and then into the foot. It is “graded” according to the how far down the leg that the pain radiates.

  • Grade 1: to the buttocks
  • Grade 2: to the knee
  • Grade 3: to the foot/ankle

Sciatica most commonly occurs when a herniated disc or a bone spur narrows the opening where the nerve exits the spine.

As the condition gets more chronic, pain may leave the back, and be exclusively in the leg. Pain may also skip areas. Pain may also be replaced with burning, numbness, tingling or aching. In mild cases, some believe they have a pulled hamstring, even though it is actually a compressed nerve.

Sciatica is generally described as ranging from a dull ache to a sharp stabbing pain extending from the back to the foot. Others experience burning, numbness, pins and needles, or tingling. Severe cases may result in the inability to move the leg.

What Makes Sciatica Worse: Sciatica is made worse with sitting. It is also aggravated by bending, twisting and lifting. Disc
issues many times are made worse with coughing, sneezing, or bearing down at the stool.

4. Facet Syndrome

One vertebra is out of alignment with the one adjacent because the disc is narrowing at the back and widened at the front. Facets are where two vertebra articulate together. There are nerve receptors in the facet joints, and these receptors can be activated to cause pain. The spinal nerve root may also become compressed. Often, both facets and discs are irritated, all producing pain.

5. Stenosis

“Stenosis” is the narrowing of a canal or an opening. This narrowing causes compression of the nervous system.

There are two types of stenosis when it comes to back pain:
1. Foraminal Stenosis is the narrowing of the hole where the nerve exits the spinal canal.
2. Canal Stenosis is when the spinal canal is narrowed due to bone deposits/degeneration of the spine.

Foraminal Stenosis is treated with specific chiropractic manipulation, specifically the type that
mechanically moves the joint, and is done so by hand, not an instrument. Spinal
Decompression may also be used.

Canal Stenosis. In this type, the actual spinal canal (the space for the spinal cord) may be narrowed by bone deposits/degeneration. This causes cord compression. Best measured with x-ray measurement or MRI. For those with more severe symptoms of spinal stenosis, this type may best treated with surgical spinal decompression.

Generally speaking, canal stenosis patients feel better when they are bent forward at their waist, or when leaning into a counter or shopping cart. Usually, in addition to this, they feel worse with standing upright, and feel better when sitting.

6. Strain (Muscle Injury)

Over stretching of a muscle or tendon, usually from minor overuse of the back.

7. Sprain (Ligament Injury)

Over stretching of a ligament, usually involving bending, twisting and lifting at the same time, or with a trauma such as a car accident.

Back and Leg Pain Treatment in Johnston | (515) 270-2924