QuestionI apparently have a bulging disk that causes lumbar radicularopathy (L5-S1). Why does forward flexion cause me more pain? I get that the bulge during forward flexion increases the pressure on the L5 nerve, but I would think that the opposite would occur. It seems to me that a flexing spine would create more space at the back of the spine and increase the foramen opening for the nerve. I want to understand the mechanics. Thanks much!
Pete
AnswerBack Pain, Staten Island Chiropractic, Staten Island Back Pain, Back Pain with forward flexion,
Hello Peter,
I am sorry to hear of your pain and complaints.
"I apparently have a bulging disk that causes lumbar radicularopathy (L5-S1)....", with this description, I assume you have had an MRI to come with the phrase 'Disc Bulge'. Discopathy is actually quite common. A 'Disc Bulge' MAY be a cause of pain, and may not be. Even a Herniated Disc may or may NOT cause pain. More important than MRIs or even orthopedic tests- is how YOU function, how YOU feel, how is your life, how are your activities of daily living (ADLs) affected?
A disc bulge is a quite common situation, so now we have to ask is that the cause of your pain, the cause of your complaint. You may have a disc bulge that is NOT the cause of your pain. Perhaps something concurrent with the disc bulge is the CAUSE of your pain. See: http://www.aafp.org/afp/991115ap/2299.html ---> ".....Range of Motion
The examiner should record the patient's forward flexion, extension, lateral flexion and lateral rotation of the upper torso. Pain with forward flexion is the most common response and usually reflects mechanical causes. If pain is induced by back extension, spinal stenosis should be considered. Unfortunately, the evaluation of spinal range of motion has limited diagnostic use,10 although it may be helpful in planning and monitoring treatment....."
Your pain may be purely mechanical in nature- a joint dysfunction, perhaps a vertebral subluxation.
Same Source: "....Some patients have symptoms primarily in the back that suggest neither nerve root compromise nor a serious underlying condition.1 Mechanical low back pain is in this category. These patients also usually improve with conservative treatment....." --http://www.aafp.org/afp/991115ap/2299.html - - -
'.....These patients usually improve with conservative treatment....' - given no contraindications to treatment, I would highly recommend evaluation by your local Doctor of Chiropractic (DC) for examination and possible CONSERVATIVE noninvasive treatment of this common complaint.
"Why does forward flexion cause me more pain?...", depending upon YOUR specific biomechanics, perhaps a narrowed spinal canal, perhaps a bulging- weakened disc that protrudes MORE into the spinal canal placing pressure upon the cauda equina nerves, or the nerves exiting the neuroforamina, YOUR specific biomechanics may emphasize that bulge and it's pressure upon the nerves (IF that is the pain producer).
My Staten Island Chiropractic office utilizes an MRI facility that can take films in the upright, sitting, flexion, extension, supine or prone positions; depending upon the patient complaint the spine can be examined in any or all of the possible positions. Perhaps your chiropractic doctor can order an MRI from such a 'full service' MRI facility ( see: http://www.hmca.com/mri_locations.html ).
"I get that the bulge during forward flexion increases the pressure on the L5 nerve, but I would think that the opposite would occur....", your bulge could be bulging INTO the spinal canal when you forward flex, and you may have a small canal space. The neuroradiologist should measure your canal and evaluate if you have a narrowed, average or spacious canal.
"It seems to me that a flexing spine would create more space at the back of the spine and increase the foramen opening for the nerve...." If your Disc Bulge is very weak, it will bulge more into the space; if your disc bulge is not very weakened, it may not protrude more during that flexion. YOUR mechanics are specific to you. And- again, the disc bulge may not even be the pain producer. See your local doctor for a chiropractic evaluation!
"I want to understand the mechanics...." you need a hands on approach- someone in person to evaluate your MRI, look at canal size, perhaps take pictures in different positions, and evaluate IF this is the pain CAUSE.
Interesting information:
http://health.yahoo.com/back-overview/low-back-pain-symptoms/healthwise--hw56480...
http://www.youtube.com/watch?v=UDEHlZ2dHeM
In my Staten Island Chiropractic office I give out many different information sheets- perhaps these will be of help to you:
PAIN
Pain is a 憆ed light on the dashboard?
Pain is your body telling you that something is wrong.
Think you should listen??
That RED LIGHT on the dashboard of your car-
-- do you ignore it until the car breaks down,
or do you get it checked and correct the problem?
Pain,
pain in your body-
-- do you ignore it until your body breaks down,
or do you get it checked and correct the problem?
Pain,
do you cover up the pain by taking a painkiller?
Take a painkiller,
mask the pain,
and allow a problem to progress in your body?
Pain Killing medication??? = 16,000 deaths ( probably under-reported )
DEATH ! ? ! ? better watch out on those medications!!!
NOTICE ON PAIN RELIEVERS:
Label changes ORDERED by FDA; the FDA announced proposed label changes for OTC over-the-counter pain relievers to include the potential for stomach bleeding and liver damage (FDA news 206- 207; 12-9-06) ;
SIXTEEN THOUSAND DEATHS: "Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective medications for the treatment of many chronically painful medical conditions. However, it is estimated that 25% of all serious adverse drug reactions involve NSAIDs, with more than 100,000 hospitalizations and 16,000 deaths occurring annually due to NSAID-induced gastrointestinal (GI) events."----- http://hhc.sagepub.com/cgi/content/abstract/13/6/468 Home Health Care Management & Practice, Vol. 13, No. 6, 468-475 (2001) Motrin, Advil = NSAIDS
The American Heart Association issued a scientific statement recommending medical doctors change the way they prescribe OTC pain relievers from a first choice to an alternate of recommending non-pharmacologic treatment (AHA statement 2-26-07).
NSAID Acceleration of ARTHRITIS; an important side effect of Aspirin and other NSAIDS is that it will inhibit cartilage repair and accelerate cartilage destruction ( Journal of Rheumatology, 1982; 9: 3- 5 ). Many times people take NSAIDS for the pain of Arthritis, not realizing these drugs may make the underlying condition worse. These medications cover up the pain, and cause the problem to worsen.
Pain can often be the result of the Vertebral Subluxation Complex.
Vertebral Subluxation ( 慥SC?, 憇ubluxation? )
Vertebral Subluxation is actually a quite common condition. Doctors of Chiropractic look for pathological conditions which may require referral to other specialties, and also look for 慡ubluxation? Other disciplines look for pathology, but overlook the importance of alignment and movement in the spine which affects our nervous system (the master control system- ALL health disciplines learn this). VSC- 慡ubluxation??can be the cause of many symptoms and conditions.
Only a Doctor of Chiropractic will evaluate and treat for VSC, as well as other pathology.
The course of VSC is highly variable. Some patients with VSC literally cannot walk, yet other patients with similar test findings may be able to run marathons or lift heavy weights. Some patients immediately develop symptoms related to the VSC, some patients take years to develop symptoms. Some people suffer for only a few days with pain and symptoms, some people suffer for months. Some people recover in days, some take months or years, depending upon severity of the condition.
A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.
The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position. When subluxated, joints are in a stressed, vulnerable, compromised condition. Subluxation may cause Arthritis, Disk Herniation, or aggravate such conditions.
Vertebral Subluxation cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone. Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction- - - a manipulation, best performed with the chiropractic adjustment.
Dr. Victor E. Dolan, Doctor of Chiropractic; Diplomate, American Chiropractic Board of Sport Physicians; Diplomate, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST Chief of Chiropractic in a Hospital in New York State (DHSI); As Seen in PREVENTION Magazine , Invited to Colorado Springs (Olympic Training Center) to Care for USA Olympic Athletes 2010
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Lower Back Pain (LBP): Low Back Pain can be caused by many different things. Big, BAD, catastrophic things like a tumor or a cancer can cause low back pain (only a proper exam by a licensed doctor, like your Doctor of Chiropractic, or your family Doctor of Medicine, can evaluate your signs and symptoms, and perhaps refer for testing). Big, bad things like a Herniated Disc, sciatica, possible fracture or dislocation can cause LBP (again, best evaluated by your DC or MD, and perhaps referral). Bad things, like - Sprains, Strains, contusion, or Vertebral Subluxation Complex (all very efficiently diagnosed and treated by your Doctor Of Chiropractic. LBP can come from a motor vehicle accident, sport injury, slip, trip, fall, arthritis, lifting improperly, or even bad posture in standing, sitting or sleeping. All of these things often have a Lumbar (Low Back) Vertebral Subluxation involved.
Disk Herniation
Low Back Pain can be caused by many different things.
Big, BAD, catastrophic things like a tumor or a cancer can cause low back pain (only a proper exam by a licensed doctor, like your Doctor of Chiropractic, or your family Doctor of Medicine, can evaluate your signs and symptoms, and perhaps refer for testing). Big, bad things like a Herniated Disc, sciatica, possible fracture or dislocation can cause LBP (again, best evaluated by your DC or MD, and perhaps referral).
Bad things, like - Sprains, Strains, contusion, or Vertebral Subluxation Complex (all very efficiently diagnosed and treated by your Doctor Of Chiropractic. Sometimes LBP is caused by a Herniated disc: Herniated disk is actually a quite common condition. However, the course of the condition is highly variable.
Some patients with a herniated disk literally cannot walk, yet other patients with similar MRI findings may be able to run marathons or lift heavy weights.
Some people suffer for only a few days with pain and symptoms, some people suffer for months.
Although the course is highly variable, there are certain steps that are always helpful to follow: Ice the area when painful- 10/ 15minutes on, 30/ 45 minutes off; avoid certain postures and movements; bend the knees when coughing or sneezing; bend the knees when lifting anything; do not extend legs straight out when sitting, laying down, lifting, or driving. Avoiding certain movements and postures will prevent aggravation of the condition. Practicing good postures and movement patterns will help the condition heal and be less painful. Disk Herniation is often caused by, or often concurrent with the Vertebral Subluxation Complex.
Vertebral Subluxation Complex (a.k.a. 憇ubluxation?
The vertebral subluxation complex is the underlying cause of many healthcare problems.
A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.
Subluxation is a serious condition identified by its five parts:
Spinal Kinesiopathology:
This is fancy way of saying the bones of the spine have lost their normal motion and position. It restricts your ability to turn and bend. It sets in motion the other four components.
Neuropathophysiology:
Improper spinal function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve system dysfunction can cause symptoms elsewhere in the body.
Myopathology:
Muscles supporting the spine can weaken, atrophy, or become tight and go into spasm. The resulting scar tissue changes muscle tone, requiring repeated spinal adjustments.
Histopathology:
A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation. Discs can bulge, herniate, tear, or degenerate. Other soft tissues may suffer permanent damage.
Pathophysiology:
The VSC contributes to OsteoArthritic degeneration. Bone spurs and other abnormal bony growths attempt to fuse malfunctioning spinal joints. This spinal decay, scar tissue, and long-term nerve dysfunction can cause other systems of the body to malfunction.
The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position. When subluxated, joints are in a stressed, vulnerable, compromised condition. Subluxation may cause Arthritis, Disk Herniation, or aggravate such conditions.
Vertebral Subluxation cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone. Subluxation- a neuro/skeletal/muscular- mechanical- problem requires a mechanical correction- - - a manipulation, best performed with the chiropractic adjustment.
Dr. Victor E. Dolan, Doctor of Chiropractic; Diplomate, American Chiropractic Board of Sport Physicians; Diplomate, American Academy of Pain Management; Certified Clinical Nutritionist (IAACN); FIRST Chief of Chiropractic in a Hospital in New York State (DHSI); As Seen in PREVENTION Magazine , Invited to Colorado Springs (Olympic Training Center) to Care for USA Olympic Athletes 2010
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I hope this information helps.
I wish you good luck and good health naturally, If you need further- do not
hesitate to REcontact me here at AllExperts.com :
http://www.allexperts.com/ep/965-100794/Chiropractors/Victor-Dolan-DC-DACBSP.htm
Thank You for the question,
Dr. Victor Dolan, DC, DACBSP
Email newsletter:.........http://drvictordolan.chiroweb.com
