Category Archives: Sciatica

Chiropractic care for hikers with heel pain

We’re continuing our theme this month on hiking injuries. In the last video I talked about what can cause knee pain in hikers and how we treat it. Today I’m going to talk about another common hiking injury – heel pain. Heel pain is a very common complaint in both hikers and runners. A very common diagnosis for heel pain in hikers is Plantar Fasciitis, or inflammation of the connective tissue that supports the arch of your foot.

The plantar fascia attaches to the inside part of your heel, and that’s why this can be one cause of your heel pain. The problem is that not all heel pain is caused by plantar fasciitis. If you’re a hiker with heel pain, you may have tried or at least read online about several different methods of self treatment for heel pain – lacrosse balls, golf balls, heat, ice, kinesiotape, orthotic inserts, or special braces that stretch your foot while you sleep. If plantar fasciitis is not the cause of your heel pain, then perhaps none of those things will work. That is why it’s so important to see your healthcare provider for a proper examination and diagnosis, and your exam needs to include what we call the kinetic chain, or all the joints and tissues upstream from your foot. Your heel pain can be caused by anything from Achilles tendinitis, nerve entrapment at the ankle, peripheral neuropathy, stress fracture, or even a disc injury in your lower back.

Once we’ve gone through a thorough evaluation of a patient with heel pain, there are typically 3 areas we tend to focus on: The lower back, the ankle, and the foot.

If the lower back seems to be contributing to your heel pain, we have several different approaches to help with that. In the office, I can perform chiropractic adjustments as well as use a special table to apply traction to decompress your lower back and relieve pressure on irritated joints and nerve roots that can refer pain to your foot. I will also get you doing some stretches to relieve irritation on the same areas.

In the ankle and lower leg we typically see stiff joints, tight muscles and nerve irritation that contribute to heel pain and a potential diagnosis of plantar fasciitis. For that, we can do some adjusting and mobilization at the ankle, some neuromobilizations to help free up the nerves crossing through there, and deep tissue massage and stretching to loosen up tight muscles.

At the foot, we can also employ chiropractic adjustments, deep tissue massage to the plantar fascia, taping, orthotics, and strengthening exercises to improve the stability of the intrinsic muscles in your foot and reduce strain on the plantar fascia.

In the video above, I demonstrate a couple of mobility drills for the ankle and a strengthening exercise that, in addition to what we offer here at the clinic, can help you beat your heel pain and get back out on the trail.

Chiropractic care for herniated discs

Herniated disc treatment Beaverton Oregon

Chiropractic Care for Herniated Discs

A guest post by Dr. David Bennett, DC

A herniated disc can cause pain and can progress into other issues, such as sciatica. Seeking treatment for a herniated disc as soon as possible can help to minimize the pain experienced and prevent the condition from worsening. Many patients that suffer from herniated discs wish to find treatment options besides surgery. In some cases, chiropractic care may be an effective alternative.

What Is a Herniated disc?

To understand how treatment for herniated discs works, it is important to first understand what a herniated disc is. The discs between the vertebrae are composed of a harder outer layer called the annulus fibrosus and a gelatinous center called the nucleus pulposus. A herniation occurs when the annulus fibrosus is cracked and the nucleus pulposus begins to spill out. The disc is no longer able to properly cushion the vertebrae, which causes pain and can cause misalignments to develop.

Diagnosing a Herniated Disc

Not all back pain is caused by a herniated disc, so a chiropractor will start by evaluating the entire spine. A chiropractor will test the reflexes, look for signs of muscle weakening or deterioration, and test sensory functions along the spine. Depending upon the symptoms, a chiropractor may also order scan tests such as MRIs or X-rays. If a herniated disc is identified, the placement and severity of the herniation will be assessed to determine the best treatment options.

Determining the Proper Care

Chiropractic care is not always the most practical or effective way to treat a herniated disc. If a disc injury is causing issues with reflexes, mobility, or sensory functions, it may be necessary to undergo surgery. If a disc injury is associated with incontinence, a different treatment approach may also be necessary. Aside from these issues, however, herniated discs can generally be treated using chiropractic techniques.

Chiropractic Treatment Options

Spinal manipulation is the type of treatment that is most commonly associated with chiropractic care. Spinal manipulation can sometimes be helpful for treating herniated discs, as it can help to ease pain symptoms and can temporarily alleviate some of the pressure on the vertebrae. If pain sensations associated with the herniated disc are extreme, a chiropractor may recommend that spinal manipulation be performed while you are under anesthesia.

Flexion-Distraction Treatment

A flexion-distraction table can be used to stretch and cushion the spine so that the herniated disc or discs can be addressed directly. A gentle motion is used to push on the affected disc. This motion can help to reposition the leaked nucleus pulposus within the vertebrae. This may temporarily correct misalignments and alleviate pain.

If you suspect that you have a herniated disc, contact your local chiropractor to schedule an evaluation and begin treatment as soon as possible.

Author, Dr. David Bennett, DC, is a practicing chiropractor in Altamonte Springs, FL, and the owner of Physical Health and Rehabilitation clinic.

Our new table is here!

Chiropractic table | Low back pain treatment in BeavertonIntroducing our new Flexion-Distraction table from Hilllabs.com! Our chiropractor, Dr. Thompson, will be using this table for all of the usual treatments and adjustments he does in his routine chiropractic visits, but he will now have the ability to provide flexion-distraction therapy to patients with certain conditions.

Flexion-distraction is a method of adjusting the spine by gently stretching the lower back or neck as the table flexes. This movement creates space between specific vertebrae in the back or neck, which can reduce pressure on any pinched nerves, decrease the size of disc herniations, lessen the effects of stenosis (a narrowing of the space around the spinal cord and/or nerve roots), and forces vital nutrients into injured disc tissue to facilitate healing.

Conditions that can benefit from flexion-distraction treatment can range from neck and radiating arm pain to sciatica, stenosis, herniated discs, failed back surgery, and even the everyday mechanical back and neck pain that almost everybody has had at some point in their life.

Many people consider chiropractors to just be “back crackers.” Flexion-distraction therapy is just one of the many tools in our tool belt in addition to traditional manual adjustments (the twisting and “popping” that most people think of). A typical treatment plan at Catalyst will include education about your condition and what to do/what not to do to aid in recovery; adjustments to joints that aren’t moving well or are misaligned; soft tissue massage to relax tight muscles; and therapeutic exercises and stretches to stabilize affected area and make you more resilient to re-injury. Research is showing us that this type of multi-modal approach achieves superior results when compared to treatment involving just adjustments. Take spinal stenosis, for example. This is a condition that is commonly treated in chiropractic offices. In one study posted previously on the blog, stenosis symptoms responded better to flexion distraction therapy combined with an exercise program compared to flexion distraction alone. In another study, flexion distraction combined with typical therapeutic modalities (heat, e-stim, ultrasound), achieved larger reductions in pain and disability than the therapies alone. Studies like these are important because they show that there is not one silver bullet that works better than all other treatments, but it is usually a combination of treatments that achieves the greatest effect.

At Catalyst Chiropractic and Rehabilitation, your treatment is guided by the best available evidence combined with our chiropractor’s clinical experience in order to deliver you the most effective solution for your individual condition. Contact us today to get started on your comprehensive path to recovery.

Radiating arm or leg pain? Perseverance pays off

Pinched nerve Beaverton | Chiropractic treatment for sciaticaIf you have had neck and arm pain (cervical radiculopathy) or low back and leg pain (sciatica), you know that it can be debilitating. I see patients with these conditions often and here are some observations I’ve had over the years when treating them.

-It’s not as simple as a vertebra being out of place and causing a pinched nerve. The nerves in your arms and legs originate from the spinal cord at the level of your neck and your lower back, or lumbar spine. Those nerves exit the spinal column through gaps between each vertebrae, and that is where they can become pinched by either bulging discs or bone spurs. Disc bulges and bone spurs are much more complicated problems than a theoretical bone slipping out of place and pinching a nerve. In that scenario, the bone could be put back into place to take pressure off of the nerve and the pain would resolve quite rapidly. Don’t get me wrong, we do get some people better quite quickly. In the case of cervical radiculopathy or sciatica, though, it isn’t often that simple. Some people give up on treatment too soon because they want it to be that simple.

-Even though it is not just a bone out of place, a chiropractor can still help. Adjustments do more than just move bones. Adjustments can decrease the pressure inside the discs, which are soft and squishy and made mostly of water. Chiropractic adjustments can also relieve pressure on the pinched nerve by temporarily opening up the space where it passes between the vertebrae. Perhaps most importantly, adjustments affect the communication of pain signals from your arm or leg to your brain. In essence, getting adjusted can turn the volume down on the pain signal. Adjustments are just one tool in a chiropractor’s tool box. While they might not cure sciatica or radiating arm pain alone, they can help make the rest of your rehab more effective.

-If you end up needing surgery, doing it later rather than sooner shouldn’t affect your outcome. I’ve had patients give up after not seeing results after 1 or 2 treatments, only to consult with a surgeon and move forward with surgery. If the pain is caused by a bulging disc, and it is bearable and you aren’t progressively losing function in your arms or legs, it is safe to wait for surgery while you give conservative care a real chance at helping you. This study shows that even 1 and 2 years after the onset of symptoms, patients have a relatively equal chance of good surgical outcomes as those undergoing early surgical intervention. So when I recommend a trial of care lasting 4 weeks with 2 visits/week, I’m not doing it to pad my pocket book. In my experience, that is giving conservative treatment a fair chance before considering more invasive options. It’s enough time and enough visits to make a change, but not too much time that it could affect your surgical outcome if it comes to that.

If you or a loved one are suffering from cervical radiculopathy or sciatica, give conservative treatment a chance before doing anything more invasive. Contact us with any questions or to schedule a visit. (503) 526-8782

Research update – Chiropractic care for spinal stenosis

Stenosis research summary

Stenosis is a word that a lot of people have heard of and might even relate it to some sort of spinal condition, but it is not often well understood. In short, the word stenosis means “narrowing.” In the lumbar spine, it implies the narrowing of a canal where either the spinal cord itself runs or where the spinal nerve exits the spine to travel down into the leg. The canals that these neural structures run through can become narrowed either by overgrowth of the bone that makes up the canal or by a nearby bulging disc. It is not the stenosis itself that causes symptoms, but the pressure that the narrowed canal puts on the nerves. That pressure can cause pain, numbness, tingling, or weakness in the back and legs, or disturbed bowel or bladder function. Symptoms often worsen with prolonged standing or walking and may improve when sitting or bending forward. It occurs most often in people over the age of 50 and can have a significant impact on the quality of life.

In my practice stenosis is a particularly concerning finding, because it often discourages people from being active since they can’t walk or be on their feet for any significant length of time. It engenders inactivity, which further perpetuates poor health and physical fitness, which in turn lead to more back problems. The beauty of this study is that it gives hope to those who suffer from lumbar spinal stenosis. What I like about it is that it advocates a multimodal approach, attacking the problem from multiple directions to produce a long term, effective solution. It is similar to the way we approach each of our patients’ concerns – through education , simple, progressive home care stretches and exercises, and effective chiropractic adjustments and manual therapies. We believe that the best results are achieved when both the healthcare provider and the patient take appropriate action to treat pain and prevent further injury and disability and this study is a fantastic example of this approach.

More evidence for positive outcomes for chiropractic treatment of lumbar disc herniations

Lumbar disc herniation and chiropractic adjustments

This study adds to the preponderance of evidence that chiropractic care is both a.) viable and effective as an initial option for conservative treatment of lumbar disc herniations, and b.) safe. Now, I’m not selling chiropractic as a magic bullet, one hit wonder, walk in the park, sure-fire quick fix for disc herniations. I try to give my patients realistic expectations and goals. The discs between your vertebrae do not heal quickly. They, like other ligamentous tissue, do not have a great blood supply, therefore they heal predictably slower than other tissues of the body. Thus recovery is inherently not as quick as most people would like. It is not realistic to expect a few adjustments to reduce a bulging disc or put a bone back into place and for all to be well again. Recovery is a process that involves multiple aspects, such as:

1. Education: Spine-sparing strategies are taught in order to avoid movements and positions that create more strain on the injured disc(s). This aspect of treatment is extremely important. When you have a herniated disc and a pinched nerve, there are some stretches that feel good in the short term, but in the long term are inhibiting the healing process. The first step is to educate to remove any barriers to a successful outcome.

2. Passive care: Passive care includes any external interventions, or those that don’t involve any effort on your part. This includes chiropractic adjustments (only one tool in our bag), joint mobilizations, traction, electrotherapy, low level laser, and kinesiotaping. Passive therapies are effective (as shown in the study above), but have their limitations and are not always as powerful as #1 and/or #3.

3. Active care: This includes anything that requires effort on your part, which is basically any of the stretches and exercises that you will be taught to perform in the office and at home to complement the passive portion of your treatment. This can make or break your recovery from lumbar disc herniation. No matter what condition we see in the office, the patients who see the best results and are happiest with the outcome of their treatment are those who are the most involved in their care and the most consistent with active care.

Research update: Surgery vs chiropractic care for sciatica

Surgery vs chiropractic care for sciatica

In this month’s research update we review a study that compares the success of spinal manipulation (chiropractic adjustments) vs that of surgery for sciatic pain. Sciatic pain is nerve pain that courses down the back of your leg due to a pinched nerve in your low back. The nerve is often pinched by a bulging or herniated disc and can cause severe pain, numbness, tingling, and weakness in your leg. If you have any of these symptoms and show up at your doctor’s office, you could end up undergoing a whole spectrum of treatments and tests. A common protocol is to treat a problem like this with conservative care first, unless immediate surgery is warranted. Then consider surgery as a last option if all else fails. As this study demonstrates, “conservative care” can mean any number of things. From the medical perspective, a course of conservative care can go as follows: Oral pain medications, muscle relaxants, and a physical therapy referral. If this fails, steroid injections may be ordered as a final “conservative” approach prior to surgery.

The beauty of this study is that the group that underwent chiropractic treatment had already received at least three months of other conservative treatments that had failed to resolve their pain. After all was said and done, chiropractic care out performed the other non-operative treatments and showed very similar results as surgery, as shown in the graph above. This demonstrates that, while not the only option, chiropractic care should be considered as a valid first option  in the treatment of sciatica. Surgery can be quite effective, but one should note the potential risks and failure rate associated with surgery. If there is another option, it should be taken, especially if it is natural and has fewer potential risks and side effects. Be an educated consumer and patient. Advocate for yourself and ask your doctor what other options there are besides drugs and surgery. If those are necessary options, then ask what the risks and side effects are so you are clear about what you can expect.