Back Pain

If you have ever had lower back pain, you are not alone. Back pain is one of the most common reasons people see a doctor or miss days at work. Even school-age children can have back pain. It can range from a dull, constant ache to a sudden, sharp or shooting pain. It can beging suddenly as a result of an accident or by lifting something heavy, or it can develop slowly and occur at random. Getting too little exercise followed by a strenuous workout also can cause back pain (1).

Who we are

What sets our back pain treatments apart from so many others is the incorporation of our deep understanding of the nervous system and how that translates into healing- it's not just about changing the structure but also changing the pathways that connect the structure to the brain. And it's this reconnection and reintegration that serve as the backbone of what we do. We are New England's premier center for chiropractic neurology.

We understand that everything in the body is conected. From the spine to the brain, the nervous system is the engine of feeling. And when a connection is broken, you feel it. The connection and reintegration is the inspiration behind our care, demonstrating the core of who we are: restoring connections in our patients.

A person's pain is a result of a combination of factors involving muscle, joint, nerve and brain. Thereby, a diagnostic and treatment approach that involves all of those structures will create the best possible, long-term outcome. That's what the Portland Chiropractic Neurology model incorporates, reconnecting all of these structures through a multi-modal appraoch that combines chiropractic, physical therapy, occupational therapy, neurology and hyperbaric oxygen therapy. Our analysis allows us to determine which therapies are right for you and then applied over a certain treatment plan we achieve long-lasting, permanent results if possible.

What causes back pain?

It's a combination of injury to joint, muscle, inflammation, neurological pathway disruption and sensory misperception in the brain. You can't affect one without affecting them all as described through Hilton's Law. Hilton's law is a powerful springboard to understand articular anatomy and pathophysiology (2). Through diagnostic testing, we're able to determine the source of your back pain and treat it appropriately using a multi-modal approach.

There are two types of back pain:

Acute, or short term back pain that lasts a few days to a few weeks
Chronic back pain, or pain that continues for 12 weeks or longer. About 20 percetn of people affected by acute low back pain develop chornic low back pain with persistent symptoms at one year (1).

What structures make up the lower back?

The lumbar spine, pelvis and sacrum are what most people are describing when they discuss their lower back pain, involving one or all of the structures. Many people point to their pelvis when telling us they have hip pain, which is just a matter of nomenclature. You have discs between your five lumbar vertebrae that act as shock absorbers and cushion your back when you're moving. There are thiry-one pairs of nerves that are rooted to the spinal cord and transmit signals from the body to brain (1).

Causes of lower back pain?

Most acute low back pain is mechanical in nature, meaning there is disruption in the way the compenents of the back (the spine, muscle, discs, and nerves) fit together and move (1). This is why multi-modal, or combining treatments, is so important to treat all the structures involved in your back pain.

Congenital issues (meaning from birth)- Scoliosis (curvature of spine), lordosis (exaggerated arch in lower back), kyphosis (excessive outward arch of spine); spina bifida (incomplete development of spional cord and/or its protective covering can cause problems involving malformation of vertebrae and abnormal sensations and even paralysis).

Injuries- Sprains (overstretched or torn ligaments); strains (tears in tendons or muscle); spasms (sudden contraction of a muscle or group of muscles); traumatic injury (sports, car accidents, or fall)
Degenerative problems- Intervetrebral disc degeneration (occurs when the rubbery disc wears down); Spondylosis (the general degeneration of the spine associated with wear and tear that occurs in joints, discs and bones); Arthritis or other inflammatory disease (occurs in the spine, including osteoarthritis and rheumatoid arthritis as well as spondylitis, an inflammation of the vertebrae)
Nerve and spinal cord problems- Spinal nerve compression, inflammation and/or injury; Sciatica (pressing on the sciatic nerve tha travels though the buttocks and extends down the back of the leg); Spinal stenosis (narrowing of the spinal column that puts pressure on the spinal cord and nerves); Spondylolisthesis (vertebrae of the lower spine slips out of place, pinching the nerves exiting the spinal column); Herniated or ruptured discs (occur when the disc becomes compressed and bulges outward); Infections (involving the veretebrae, a condition called osteomyelitis, in the discs it's known as discitis and the in the sacroiliac joints connected the lower spine to pelvic, it's called sacroiliitis; Cauda Equina Syndrome (occurs when a ruptured disc pushes into the spinal canal and presses on the bundle of lumbar and sacral neve roots; Osteoporosis (progressive decrease in bone density and strengh that can lead to painful fractures of vertebrae)
Non-spine sources- Kidney stones (can cause sharp pain in lower back, usually on one side); Endometriosis (build up of uternine tissue in places outside the uterus); Fibromyalgia (a chronic pain syndrome involving the widespread muscle pain and fatigue); Tumors (press on or destroy the bony spine or spinal cord and nerves); Pregnancy (back symptoms almost always completely go away after giving birth) (1).

Influencing factors in low back pain can include age, fitness level, weight gain, genetics (ankylosing spondylitis), job-related factors, mental health, smoking, heavy backpacks in children, pyschological factors, previous concussions (3).

Previous, or undiagnosed concussions

Based on existing literature, athletes appear more likely to sustain a subsequent musculoskeletal injury in the year after sustaining a concussion. Neuromuscular contorl refers to the many aspects that contribute to how the nervous system controls muscle activation and ultimately postural control (3). Our chiropractic neurologists are trained to diagnose and treat these types of conditions, see http://www.portchiro.com/our-care/condition/post-concussion-syndrome/85/

Lower back pain testing will include a thorough clinical examination (Neurology, Proprioceptive, Respiration) as well as gait analysis and any further recommendations that may be necessary for a complete diagnosis--> imaging- x-ray, MRI , CT, bone scan, discography; EMG (electromyography) to detect if muscle weakness is due to nerve problem; evoked potential studies (EP) to detect speed of nerve transmission to brain; nerve conduction studies (NCS) to detect nerve damage.

PCN core spinal treatments (may include one, two or many within the list below, depending on your particular condition)

Specific Corrective Spinal Chiropractic Neurological Manipulations (SCSCNM)
Disc Decompression Therapy (traction therapy) (DDT)
Electrical Muscle Stimulation (EMS)
Active Muscle Release Therapy (ART)
Percussor Muscle Therapy (PMT)
Graston Soft Tissue Technique (GSTT)
Postural Restoration (PR)
Specific Corrective Chiropractic Neurological Manipulations for Oxygenation L/S/T (SCCNM-O)
Gait protocol Non-Invasive Nerve Stimulation (NINS-gait)
Vestibular Rehabilitation (VR)
Occuptational Therapy (OT)
Physical Therapy (PT)
Co-treatment (CT)
Functional Neurological Rehabilitation/Neuroplasticity Retraining Exercises (FNR/NRE)
Hyperbaric Oxygen Therapy

(1) "Back pain fact sheet", NINDS, Publication date March 2020.

(2) Herbert-Blouin et al. Hilton's Law Revisited. Clin Anat. 2014 May (27)4: 548-455

(3) Howell et al. Neuromuscular Control Deficits and the Risk of Subsequent Injury after a Concussion: A scoping review.