As we investigate the patterns of low back pain simply through understanding the history of how patients experience pain, we start coming to a working diagnosis of what the cause of pain is. So far we have evaluated two components. Firstly, we want to know if the pain is present more in the low back or felt more in the leg. Next, we want to determine if the pain is constant or intermittent. To understand more as to why these things are important, read our previous two blog posts.

We are moving on to a very valuable question that helps narrow down the pain generating structures in our spine that can elicit pain. If you take a moment to evaluate your pain, you will find that it will either be worse when bending forward or when extending & arching your back. You may likely feel that you have pain in every position. However, pay close attention and determine which position is even marginally worse. This is an important criteria to start to determine not only what structure is primarily causing the pain but also in which direction your treatment should start.

Majority of worsening pain in extension of the low back can be related to posterior boney elements of the spine with some secondary association with soft-tissues. Worsening pain in the low back with forward bending is typically a sign of pain emanating from a disc, nerve or other soft-tissues of the spine with secondary involvement of boney structures.

These positional questions along with others we are investigating start to give us a bigger picture as to the length of time your pain will typically last, what hands-on treatment is appropriate as well as the stretches & exercises that are recommended specifically for you.

We are continuing our conversation about the patterns of low back pain so that you at home can start to understand that the vast majority of low back pain problems are completely treatable. If you haven’t read our previous blog post on this topic, make sure you go back to read that first.

Patterns are useful for us to evaluate the main cause of low back pain and provide appropriate treatment for it. Our first question was about whether the pain is more dominant in the low back or more dominant in the leg? The next question in evaluating the pattern is finding out if the pain is constant or intermittent?

A good way to evaluate this is to ask yourself, “Is there ever a time when you are in a certain position, during a particular time of the day, when everything is going well & you find that your pain stops (if only for a moment)?” It is likely going to come back, but the question is if there is even a short window when the pain is gone?

Next, evaluate if when your pain stops, does it stop completely? Is it all gone? Are you completely without pain?

Rest assured, that if your pain stops even for a few moments, in a particular position or at a certain time of the day, then your condition is treatable. It can most likely be treated successfully in a conservative way without significant drugs or surgery.

We recognize that the number 1 reason people will think of seeing a chiropractor will be for low back pain. Over the next few months, we will be diving deeper into helping you understand how we evaluate the clinical patterns of low back pain that lead to appropriate treatment. Pattern recognition is based on the history of your complaint and confirmed on our physical examination. It begins with the question, “where is the pain worst?” Pain may be present in the low back and/or in the leg, but it will always be worse in one location. That is an important distinction to make.

Back dominant pain is referred pain from a physical structure in the spine, often with local tenderness. The locations include:

• Back
• Upper buttocks
• Tailbone
• Sides of the hips
• Groin

Leg dominant pain is radicular pain from direct nerve root involvement. The locations include:

• Around and below the buttock. May extend down the leg.
• Thigh
• Calf
• Ankle
• Foot

If you have a hard time localizing your pain, it is helpful to ask yourself: “If you could stop one pain today, which one would you want gone first?” This is a starting point for us to understand the main cause of your low back pain. Always remember, your body is allowed to have more than one thing happening at a time. The question is about prioritizing the areas that will give you the relief quickest so that you can get back to doing things that you love to do.

In anatomy, a plexus is an area where several nerves and blood vessels bundle together as they pass through the same spot. The result looks like a tangle or net that, while great at saving space, can be very problematic when damaged.

The brachial plexus is located in each shoulder and contains nerves going from the spinal cord to the shoulder and down to the rest of the arm. These nerves are responsible for the movement, feeling, and strength of the arm they connect to, and so when they’re irritated or damaged, the effect can extend through the entire arm. Minor injuries where the nerves get too stretched or squeezed are common in sports, although they can also come from inflammation, tumors, or even from birth in newborns. These injuries usually come with a sharp electric or burning pain, numbness, and weakness along the arm. They typically last only a few seconds or minutes, but they can sometimes last a day or more.

More severe injuries usually come from motor vehicle accidents. They occur when the nerves are seriously hurt – even torn or broken. In the most severe cases, the nerves can be disconnected from the spinal cord at their roots. This causes much more severe pain, and other symptoms can range anywhere from weakness and loss of muscle control to complete numbness and paralysis. These especially require medical attention as a bad injury can have permanent effects.

Similar to the arms, the legs and hips are also controlled by nerves going through the lumbar plexus, located near the bottom of your spine. Injury or irritation can lead to the same symptoms as the nerves in the brachial plexus, but in the legs, hips, and the lower abdomen. Since these nerves connect to multiple other organs, a bad injury here can also lead to a loss of bowel and bladder control.

Treating an injury to either plexus involves treating the source of each symptom. In cases where the issue is from an underlying condition like cancer or untreated diabetes, the first priority is to take care of those to stop the injury from getting worse. Then, you can focus on the immediate effects of the injury, and eventually on healing and restoring function to the affected limbs. This is where your chiropractor can help!

Chiropractors are trained to handle problems of the muscles, bones, and nerves, and know how to take physiological stress off of injuries. They can help you with regular exercises and procedures that get your muscles and bones used to moving once again.

If you’ve ever had the misfortune of seeing this creature, called a sensory homunculus, you’ve probably wondered what it is. In short, this model is a visual representation of the way the human brain perceives the sensory information it receives from the body.

The body is equipped with receptors that sense touch, feeling, temperature, and pain; and they relay information about that touch through the nerves and into the brain. This information is sent by electrical and chemical “messengers” to an area of the brain called the somatosensory cortex. This area is responsible for interpreting and understanding these senses and the information it relays (for example, you can tell by touch whether a surface is rough or smooth).

The cortex is fairly large, but it still has a limited amount of space and therefore only has so many signals it can process at a time. This is why it has to consider where it would be most useful to focus more of its processing power. There are areas of the body where it doesn’t need to pay as much attention to the fine detail of what it senses from outside – for example, the leg or chest – since they don’t usually receive too much information at a time. There are other places, however, that receive much more information and require a lot more effort to understand.

For example, we explore a lot of the world using our hands. We pick things up with them and use them to feel objects or environments around us, meaning they’re constantly picking up a lot of sensory information. This is why it’s useful for the brain to spend a lot of processing power on interpreting the many signals coming from the hands. The lips and tongue are also very important to understand, because they come into contact with everything we eat. They receive detailed sensory information very often, so much like the hands, the brain devotes a lot of sensory “real estate” to interpreting the information they collect.

All this means that the sensory centers in your brain aren’t evenly divided, with much more space dedicated to analyzing the most “important” areas. This is, finally, where the sensory homunculus (literally meaning little man) comes in – the more space and sensory processing power the brain devotes to a certain area, the more exaggerated the area is on the homunculus. This results in a somewhat cartoonish figure with a gigantic head, mouth, and hands; much like the one you see above. In a sense, it represents how this part of the brain sees your body when it processes everything you touch.

In human biology, tissues are categorized into four types: nervous, muscular, epithelial, and connective. Connective tissue, as the name implies, serves to connect one tissue to another. These tissues use stretchy collagen and other fibres to help connect your organs and keep them in place, and denser collagen to make up the tendons and ligaments in your muscles and joints.

In the musculoskeletal system, connective tissues keep your bones, muscles, and joints functioning properly by keeping them together and in good shape. Tendons, for example, connect muscles to the bones they move and can even facilitate their motion, while still maintaining a high resistance to tension thanks to their dense collagen fibres. Ligaments, on the other hand, keep joints together and ensure proper function by connecting bones to other bones. While they are tough, if a ligament stays in the wrong position or endures too much load for a long time, it gets weaker and becomes more prone to future problems, such as dislocations.

Muscles in general are composed of very small fibres strung together into larger structures by a connective fascia wrapping around large groups, giving them the strength they need to contract properly and connecting them to other muscles. These fasciae also connect to the skin, sitting just under the lowest layer, called the dermis. When fasciae become tight, weakened, or scarred, due to injury or inactivity it can impair movement. This is why fasciae are important in chiropractic – since they are attached to the skin, a chiropractor can use a roller or exercises to loosen them. Adjustments and regular exercise can also strengthen and loosen fasciae in between muscles, allowing for better, less restricted motion.

These fasciae and other connective tissues aren’t only in the muscles and skin – they are present all around the body, notably around the brain and spinal cord. These are called the meninges, and they protect the central nervous system from infection and injury. When the meninges around the spine are disrupted, it can lead to pain, paralysis, or loss of bowel or bladder control. While bacterial infections of the meninges should be treated with antibiotics, a chiropractor can relieve pressure on the meninges by adjusting posture and making sure the muscles and joints of the spine are in their proper place.

Relax! This statement is not a jab at men. When trying to understand how our body perceives pain, we will often bring the conversation to discussing what happens in the brain. After all, that is where all pain signals are processed no mater where the signal starts. It is important to know that there are established differences in how that pain is processed between a male or female.

Imagine an analogy of two guitars connected to amplifiers. In this scenario, both guitars are playing the same tune but one amplifier is set at a lower setting than the other. The end result being that this amplifier will produce a lower volume of sound compared to the other.

As pain signals from different parts of the body travel up the spinal cord, they will eventually end up in areas of the brain that are meant to process them. One such part of the brain essentially serves as the amplifier of these signals and research shows that it is naturally less sensitive in males as compared to females.

So, how do we make sense of all of this? Does it mean that men are stronger than women? Or that women have a natural disadvantage? No.

With evolutionary roles in mind for each sex, our bodies are designed to facilitate the roles we have played for centuries. Parts of a female’s brain that are sensitive to the amplification of pain signals are also parts of the brain that contribute to her having the ability to be more empathetic, feel more emotion and create familial/social bonds. Men are not just less sensitive to pain signals, they are naturally less sensitive to the other aspects described above.

These are generalizations based on research. When applied to the masses, we know that there will always be outliers to these rules. For instance, females who show less sensitivity to pain and men who show more. However, these are points of interest in a clinical setting or for research because it encourages us to engage with patients in a way that is more suitable and appropriate to their condition. It is also an important consideration when we start to discuss why we see more females presenting with chronic pain type symptoms as compared to males.

As a family member, friend or significant other – people of the male gender need to be understanding and support females in their immediate circle who are complaining of feeling pain that is hard to describe, difficult to diagnose and has not yet been treated properly.

As previously discussed, we want to review the most common general recommendations to reduce inflammation through dietary change. As always, you should speak to your family doctor before making drastic changes to make sure they are suitable for your health profile.

A diet that controls inflammation is high in antioxidants from fruits and vegetables that are known for their anti-inflammatory properties. Incorporate these foods in your diet. Remember to stay within your allowed macros and calories listed previously.

• Fruits: apples, acerola berries, fresh pineapple, guavas, grapefruits and rhubarb, kiwi fruit, lemons, limes, oranges, kumquats, black currants, blueberries, raspberries, mulberries and strawberries, papaya, cherries, and tomatoes.
• Vegetables: Spinach, sweet potatoes, bell peppers, cabbage, bok choy, onions, leeks, garlic, green onions, broccoli, cauliflower, broccoli sprouts, brussel sprouts and greens.
• Herbs & Spices: basil, oregano, mint, cloves, turmeric, cayenne peppers, chili peppers, parsley, rosemary
• Fish & Meats: Cod, Halibut, Salmon, snapper, bass, whitefish, herring, trout, sardines, grass-fed beef, pork, naturally-raised (not on grain) chicken and turkey.
• Whole Grains: brown rice, whole wheat, buckwheat, barley, rye, millet, spelt.
• Fats: extra virgin olive oil, avocado, hazelnuts, almonds, walnuts.

Foods you should avoid because they have been shown to increase inflammation in the body:

• Scientists and health practitioners know that consuming sugar, margarine, too many nuts and too many omega-6-polyunstaturated oils like corn, soy, walnut, vegetable and canola oil will increase inflammation in the body. They do this by traversing your arteries and activating prostaglandins in the body that are responsible for inflamed tissues.
  
• What happens is this: you eat a food. That food is then digested. The individual component parts of that food get absorbed in your bloodstream and travel throughout your body. If you ate a carbohydrate food, such as bread, sugary desserts, rice, cereal, milk products, pasta and candy – that food will affect the pancreas and send a signal to release insulin. Insulin brings down the blood sugar level. The higher the insulin level, the more that insulin will cause effects in the body. Some of these effects will cause increased inflammation. It makes sense to cut your “added” sugar consumption down to nothing.

You may have heard the term inflammation being used to describe the swelling that happens when you get injured. This type of swelling is considered acute (short-lived) and is a response from your body to send the appropriate cells to heal the affected tissue. Immune cells will release various substances such as hormones bradykinin and histamine. They cause the small blood vessels to become wider (dilate), letting more blood to get to the injury. For this reason, inflamed areas turn red and feel hot. Both of these hormones also irritate nerves and cause pain signals to be sent to the brain.

Different areas of the body will swell at different rates when they are injured. Areas that are highly vascularized (supplied with more blood vessels than others) like the ligaments in your ankles or the discs in your spine, will have more inflammation happen as they heal. Typically, acute inflammation can last 6 – 10 days and the body will naturally reduce it once the injury is healed.

Chronic (long-term/persistent) inflammation can occur due to many reasons. Sometimes it is a response to systemic disease and other times it can be a response to your body reacting to a “perceived” injury – one that may not lead to a damaged tissue but perhaps mimics the presentation of one due to poor mechanics.

Whatever the reason may be for chronic inflammation, it is a largely concerning problem because it affects different areas of the body. When a local area gets inflamed due to injury for a short term, the inflammatory cells are limited to that region. With chronic inflammation, the inflammatory cells can stay elevated in your blood stream and affect different areas of the body. Research shows that chronic inflammation can contribute to heart disease, diabetes, arthritis or even cancer.

The good news is that there are a lot of natural ways to at least reduce chronic inflammation (even if it cannot be completely treated due to another health issue). Things like eliminating pro-inflammatory foods from your diet, taking the right supplements, breathing techniques and meditation/exercise have shown to effectively help with reducing levels of chronic inflammation. Next time, we will elaborate on a few of these suggestions that you can start at home to manage chronic inflammation.