The spine consists of spinal disks and vertebrae and similar to a jelly donut, the disk has a softer “jelly” center. When the “jelly” pushes out through a tear in the tougher exterior, it is known as a herniated disk. Disk degeneration can cause disk herniation in the lower back or in the neck. The water content in the disks decrease as we get older and the flexibility of it decreases. Therefore, a minor strain, twist, and improper lifting can easily lead to a tear or rupture in the disk.
The signs and symptoms that someone will experience includes pain, numbness, tingling, or muscle weakness due to the irritation on the nerves. Pain can be felt in the thigh and calf when the herniated disk is in the lower back. Pain can be felt in the shoulder and arm when the herniated disk is in the neck.
Excess body weight and duties performed on the job that put extra stress on your lower back can increase the risk of disk herniation. A few things that you can do to prevent a herniated disk includes lifting heavy objects properly, strengthening trunk muscles, and maintaining a healthy weight.
Heel spurs are also known as calcaneal spurs or osteophytes. Someone with this condition would find a calcium deposit forming a bony protrusion along the plantar fascia. Running and jumping, especially on hard surfaces can wear down the heel and lead to heel spurs. If the membrane that covers the heel bone is torn or if the heel is bruised, it can cause heel spurs. Older adults, obesity, plantar fasciitis, and improper footwear can increase the chance of developing heel spurs.
Heel spurs can lead to a sharp pain in the heel when he or she stands up, a dull ache in the heel, and heat radiating from the affected area. Tenderness, swelling, and inflammation can occur at the heel and a bone-like protrusion beneath the heel may also be seen. One can reduce pain and swelling by resting and applying ice to the affected area. Orthotics can also be worn to remove some of the pressure off the heel.
Myositis ossificans is when bone tissue forms within a muscle. It is usually found in the thigh muscles where the hamstring and quadricep muscles are found. Myositis ossificans can develop when a contusion (bruise), repetitive trauma, or strain occurs to a muscle. Calcification and bony formation can occur in the injured muscle when a repetitive trauma occurs before the injured area has been completely recovered. Therefore, it is important to rest the muscle after an injury. To prevent a repetitive trauma from happening, one can use protective padding and perform stretches to avoid muscle strain. Intensive stretching and massage should be avoided because it inhibits healing and increases bleeding into the muscle. Myositis ossificans can also occur if the inflammation and swelling of the muscle is ignored after an injury.
Moreover, myositis ossificans can lead to swelling, pain when exercising, limited range of motion, a weaker limb, and a hard bump. However, it can be treated by resting the muscle, strengthening the injured muscle and the muscles around it, and working on flexibility and light stretching. In addition, ultrasound can also help with the healing process.
Bursae are small, fluid-filled sacs that act as a cushion for the bones, tendons, and muscles around the joints. When they become inflamed, it is known as bursitis. Bursitis can occur in the shoulder, hip, elbow, and knee. Repetitive movements or positions that can apply pressure on the bursae, such as lifting something over your head repeatedly or kneeling on your knees for a long time can lead to bursitis. Inflammatory arthritis, an injury or a trauma can also cause bursitis. Someone who has bursitis will notice their joint becoming red and swollen. In addition, the joint will feel achy or stiff and they will feel pain when they try moving the joint or when they apply pressure to it.
Older adults, overweight individuals, and individuals with rheumatoid arthritis have a higher risk of developing bursitis. However, one can reduce their risk by warming up and stretching before exercising, strengthening their muscles, lifting properly, carrying lighter loads, and taking breaks after performing repetitive movements. Rest, ice, and exercises can help relieve the pain. A corticosteroid drug can be injected into the bursa to reduce pain and inflammation. The pain will disappear within a few weeks if it is treated properly.
Osteoporosis is when your bones become thin and brittle. It is caused by a lack of bone strength or bone density. Similar to a sponge, your bones contain numerous holes which makes it fragile and can lead to hip, spine, or wrist fractures. This disease is usually found in older adults after age 60 and women are more likely to have osteoporosis than men. The risk of getting osteoporosis increases as we age and a woman who has gone through menopause has a greater risk. Other risk factors include a slender body, family history, people of European and Asian background, smoking, alcoholics, not getting enough weight-bearing exercises, and a lack of calcium and vitamin D intake.
The first sign of osteoporosis is usually seen after a fall or bump where a fracture is found in their hip, spine, or wrist. They would later on experience back pain, notice their height has shrunk, and notice a curved backbone.
A bone density test can be completed to measure the thickness of your bones and the risk for a fracture. Calcium and vitamin D is essential to building strong, healthy bones. In addition, exercising and quitting smoking can help slow osteoporosis. In order to avoid bone fractures from occurring, it is important to get a bone density test and get osteoporosis treated early.
Lordosis is located in your neck and spine. Cervical lordosis is when there is an inward curve in the region of your neck. When there is an inward curve in your lower back, it is known as lumbar lordosis. It is more common for an individual to have lumbar lordosis than cervical lordosis. Obesity, osteoporosis, poor posture, spondylolisthesis, and kyphosis are a few causes of lordosis. Someone who does not have this condition would notice their ears are lined up over their hips, shoulders, and ankles.
Individuals who experience lordosis would have a noticeable curve that could be seen. In addition, they might experience discomfort, severe back pain and/or tense muscles around the curve. Lordosis could restrict their movements and create a space in between their neck or lower back and the floor when they are laying down.
Physical therapy can help with strengthening, and increase your flexibility and range of motion for your neck and spine. Exercising, stretching, using extra pillows when you go to sleep to support your spine, and wearing a neck immobilizer or thoracic spine brace are all possible treatment options for lordosis.
A healthy spine is made up of vertebrae that look like cylinders put on top of one another to form a column. Kyphosis is when the vertebrae in the upper back is more wedge shaped, which leads to an excessive, forward rounding of the back. It can appear in infants or teens, but it is most commonly found in older women.
In addition to an abnormal curvature of the spine, someone who has mild kyphosis can experience back pain and stiffness. Fractures, disk degeneration, birth defects, osteoporosis can all lead to an abnormal vertebrae. Kyphosis is linked to weak back muscles and an individual can have difficulty walking, driving, and looking up. Pain can also be felt when the individual lies down and there can be problems with breathing and digestion if the situation is severe. Depending on the individual’s age and the cause, the treatment can vary for each individual.
Ankle sprains are a common injury that can lead to severe pain and weakness. We can work on various rehabilitation exercises to help our ankle heal and prevent future injuries.
After the injury has occurred, it is important to perform partial weight bearing to prevent muscle atrophy. When you are able to walk again without limping, you can work on full weight bearing. You should begin with range of motion exercises, such as plantar flexion, dorsiflexion, inversion, and eversion. You should not feel pain when you perform these ankle movements. You can then practice writing the alphabet with your toe and work on towel assisted stretches with the same ankle movements.
Next, you can do strengthening exercises, such as performing the ankle movements against the wall or using a rubber tubing looped around your feet for resistance. After, you can move on to balance exercises on a wobble board by doing a double leg stand with eyes opened and then closed. Then, standing on your injured foot with eyes opened and then closed.
By following these rehabilitation steps, you can help strengthen the ankle and prevent an injury from occurring again.
The Achilles tendon connects the muscles from the calf to the heel bone. It assists us with pointing our foot towards the ground, rising on our toes, and it allows us to push off our foot when we walk. A rupture can be caused when there is a sudden increase in training intensity. Sports that involve jumping, running, and sudden starts and stops can lead to injuries to the Achilles tendon.
Majority of the people describe Achilles tendon rupture as a feeling of being kicked in the calf. When the injury happens, a popping or a snapping sound can be heard. Due to the pain at the back of the ankle and lower leg, the rupture can affect the injured person from walking normally. In order to prevent Achilles tendon injuries, one can increase their intensity of training slowly, perform exercises that strengthens the calf, and avoid running on hard surfaces. If a rupture occurs, surgery or nonsurgical treatments can be used to repair the Achilles tendon.
Educate on nature and course of LBP, provide reassurance, and advise on physical activity and self-management strategies. Based on patient preference and practitioner experience, we suggest:
Acute (0-3 months) Low Back Pain
- Spinal Manipulative Therapy (SMT), other commonly used treatments or a combination of SMT and commonly used treatments to decrease pain and disability in the short term.
Remark: Other commonly used treatments may include advice on posture and physical activity, and usual medical care when deemed beneficial.
Chronic ( > 3 months) Low Back Pain
- Spinal Manipulative Therapy (SMT) over minimal intervention to decrease pain and disability in the short term.
Remark: Minimal intervention includes manually applied forces with diminished magnitude or 5-minute light massage.
- Spinal Manipulative Therapy (SMT) or other treatments for short-term reduction in pain and disability.
Remark: Other treatments include extension exercises, advice plus exercise, myofascial therapy, or usual medical care when deemed beneficial. Pain relief is most effective within the first 6 months and functional improvement was most effective at 1 month.
- Multimodal therapy with or without Spinal Manipulative Therapy (SMT) to decrease pain and disability.
Remark: Multimodal therapy with SMT treatment may also include exercise, myofascial therapy, advice, educational material, usual medical care when deemed beneficial. SMT (2 sessions per week for 4 weeks) plus standard medical therapy has shown better pain and functional outcomes than standard medical care alone. Pain and functional improvement was also shown at 3 and 12 months.
Chronic ( > 3 months) Back-Related Leg Pain (Sciatica or Radicular Low Back Pain)
- Spinal Manipulative Therapy (SMT) plus home exercise and advice to reduce back pain and disability.
Remark: Reduced chronic back-related leg pain (sciatica or radicular LBP) and disability were observed at 12 weeks follow-up. Home exercise includes positioning and stabilization exercises.
Canadian Chiropractic Guideline Initiative