Dr. Blood's Blog

What's causing the LOW BACK to be so PAINFUL?

(posted 9/13/2017)

There are a multitude of pain generators in the lower back: Muscles, joints, discs, nerves, or commonly, several of these factors combined.

In my opinion, one of the most commonly overlooked joint complexes in on-going lower back pain is the Sacroiliac Joint or SI Joint.

Why is this SI joint commonly overlooked? 

For starters, it typically does not have a positive finding on x-ray or MRI which are common diagnostic tools to investigate low back pain. 

Also, it can mimic referral pain of Sciatica or nerve pain.

Common symptoms may include pain at the base of the back into the top of the buttock area, usually one-sided but can be both, or can alternate.

It can refer a diffuse, achy type pain through the butt into the thigh, but typically stops by the knee, sometimes extending into the top of the calf.

The SI joint can also refer pain from the lower back around the hip and into the groin region. 

A lot of patients with SI joint pain have problems with sitting for periods and frequently have to switch positions while sitting.

Also, the sit to stand movement can feel very stiff and often may feel like the back won't straighten out. Sometimes it feels better once start walking for a bit, but too much standing and walking will tighten the lower back up across the belt line. 

If there is presence of any of these signs and symptoms, consideration of the SI joint complex as a primary pain generator should be made.

The good news is, the SI joint(s), as painful as they can become, typically respond very well to non-invasive treatments like care we provide in our office.

More info at:

https://www.spine-health.com/…/spi…/sacroiliac-joint-anatomy

 

Piriformis Syndrome: Possible cause of SCIATICA?

(posted 5/4/2018)

There is a group of muscles in the hip/glut region Commonly referred to as the hip rotators.

When these muscles contract, they help point out foot outwards.

The significance of the Piriformis muscle is that it commonly overlies the Sciatic Nerve as the nerve exits out of our pelvis. For some individuals, the sciatic nerve actually pierces through this particular muscle.

So if the Piriformis is tight, shortened, and/or in spasm, it can irritate the sciatica nerve and trigger the common condition known as Sciatica.

The Piriformis issue can also be commonly involved with Sacro-Iliac joint pain.

This syndrome can mimic sciatica nerve pain from a disc issue and can be often overlooked.

https://www.spine-health.com/conditions/sciatica/what-piriformis-syndrome

 

 

Diagnostic Imaging: Is it always beneficial?

(posted 5/4/18)

One of the normal standards to evaluate neck or back pain is to order an X-ray and/or an MRI to search for the source of pain.

Often times, depending on a few variables including age, the results will come back relatively normal or will find 'normal age-related changes'.

The question from most patients then becomes 'why does my neck or back hurt then?'

Frustration sets in...

Medications are then often prescribed. For some people, the medications do well at alleviating symptoms, but for others, pain still persists.

More frustration sets in for these patients. What do we do next?

Here is the thing about most neck or back pain: pain is usually experienced due to functional reasons versus structural reasons.

What do I mean?

X-rays and MRIs are very good at showing the structure of our spine. They are great at making sure there is not any fractures, dislocations, or other pathologies of concern.

But they may not tell the whole story, especially if the findings are relatively normal.

For example, I can take a picture of a door similar to taking a picture (x-ray) of your spine.

The picture of the door shows me:

Hinges (like your joints)

Spacing around the door (like the spacing between your bones)

Ultimately, we can tell if the door looks like it should (like we can make sure your spine looks like it should).

But what the picture of the door doesn't tell me is: does that the door actually work?

Does the door open and close like it is supposed to?

What if the door was glued shut?

What if the door is stuck and will not operate like it should?

If we try to move an inoperable door it will be a lot of stress/strain on the frame.

This is what happens when we deal with back and neck pain. The structures of our spine including joints and muscles are not doing what they need to do.

Joints may 'get stuck'.

Muscles may be to tight/shortened which will not allow us to move like we were designed to move.

This triggers irritation and pain pathways to let us know 'something isn't working like it is supposed to.'

The pain signal is similar to the check engine light in your car: it alerts us that something isn't working.

If this is the case, which often times it is, the only way to get and keep the pain symptoms under control is to get everything working like it should and keep it working like it should.

Once this is achieved, pain should subside.

When pain subsides, we can get back to experiencing life.