She was working at her desk, minding her own business all day. When she was finally able to stand up, she was knocked over by sudden low back pain. She said it “went from 0-100 in a minute.” The pain immobilized her, and if she tried to move, a jolt of electricity would go down the back of her leg. Her breathing was shallow, and wild thoughts of permanent incapacitation were running through her head.
Marcela had experienced these issues before, but never this badly. She had been to a local spinal specialist before who performed painful injections that did not provide any relief. Worse yet, she felt as if she wasn’t being listened to. Far too common we hear our patients say they’ve been to another provider who didn’t even look up from their clipboard. Imaging, tests, injections, and painful procedures were rendered without listening to the patient.
TIRED OF BEING TREATED LIKE A NUMBER AND NOT BEING HEARD, SHE FOUND US.
She called our office, barely able to get the words out. Luckily Dr. Cuiffo was working on his day off and agreed to see her. When she first came to the office, she required help from Dr. Cuiffo and her husband just to make it in to the building. Our evaluation and treatment was slow, but we got the work done.
Then something impressive happened..
SHE WALKED OUT ALL ON HER OWN…
Marcela had a low back disc injury. Luckily, even though she was experiencing sciatica - pain starting in her back and going down her leg - the disc injury was not as severe as she had feared. She did not have any numbness, tingling, or loss of strength, and she had full control over her bathroom functions. All good signs. What had happened is one of the discs in her spine had sustained an injury that caused some pressure on a nerve.
The discs in our low back are often compared to jelly doughnuts. There’s a tough exterior with a gooey center that sometimes gets squeezed outward. This grossly oversimplifies the situation and makes the reader think they are more fragile than they are. A better analogy would be a hockey puck with many layers and some toothpaste in the middle. The layers are called the annulus and there are many layers. They are very hard and wrap around the squishy part called the nucleus. The annulus has multiple crisscrossing layers which over time can weaken. The layers slowly start to come apart as they weaken, allowing the nucleus to get pushed outward. Eventually after many, many cycles of being stressed the last straw happens. This can look almost like a bubble and clinicians cl hat a bulging disc. If the nucleus comes out we call that a herniation. The layers crack and then the squishy bit might come out a bit. The outer layers have a lot of nerves, which relay the damage as pain signals to the brain, and the squishy bit coming out can cause pressure on nearby nerves that come out of the spine nd down the leg. This is why the pain is is intense in the low back and this is one way sciatica can be caused.
As a chiropractor in Centennial, Colorado, I see many low back pain and sciatica cases, but this one stood out. She was unable to walk at all and barely able to speak through the pain, which made the evaluation slow.
My job was to figure out what the heck was going on. Was this a muscle strain? A disc injury? Something else?
Marcela was unable to stand, so a postural evaluation was out. She was unable to move without pain, so my entire movement assessment would be worthless. I fell back on my fantastic orthopedic evaluation training and performed a batch of tests.
The straight leg raise test is a very simple, but informative test. Marcela exhibited “crossover sign.” When I very slowly lifted her right leg, her left leg felt intense radiating pain. This tells me that there is something putting pressure on a nerve root rather than further down the chain.
She also had pain on a simple slump test, where you sit and then allow yourself to slouch slowly, starting at the head. If simple head movement causes back pain, it points to some nerve root pressure which can be caused by a disc injury.
DOCTOR’S NOTE: if you are experiencing intense low back pain, even without sciatic or leg pain, always get checked out by a qualified healthcare provider. This blog is for informative purposes only and cannot diagnose or treat any illness or injury you may have. It does not establish a doctor-patient relationship.
Luckily we were closed the day Marcela first came in. Her first session was very slow and required constant feedback. After our initial evaluation, we did some very gentle adjustments focusing primarily on the low back and pelvis. Active Release Techniques also came in handy, moving very slowly. The cool thing is her pain went from a 10/10 down to a 4/10 in just one treatment and she was able to walk out of our office after having to be supported by two people to get in. That was very, very encouraging!
Our next several sessions focused on more adjustments as indicated, Active Release Techniques, and movement retraining. When someone is in extreme pain, it is very common to be apprehensive of any movement. We were able to find some exercises that were gentle but still effective. Many of our movements started laying on the back in order to help send a message to the brain that “this is okay; movement is good.” Here are a few of the exercises that helped Marcela through her journey.
This is a great exercise to help retrain core strength and stability. The idea is to engage the belly muscles and be able to keep them engaged while moving the arms and legs. The low back should stay pressed into the floor the whole time and the ribs should not flare. Done correctly, this is a super effective, evidence-backed movement that can help low back pain.
VIDEO - 90/90 HIP LIFT
Often times the glute muscles become inhibited or “shut off” when injury occurs. This was the case here, too. The 90/90 hip lift on the wall is a gentle way to help re-engage the glute muscles and introduce some global spinal flexion as well. Just like the dead bug, the person is laying on their back so the perceived threat by the deeper layers of the brain is reduced. This is just the first progression in a much longer series of movements to get the glutes stronger.
VIDEO - SCIATIC NERVE FLOSSING
There are two main nerves that go into your legs. The femoral nerve goes down the front and the sciatic nerve goes down the back. Both nerves provide muscle control and sensation to the skin before branching out a whole bunch and eventually ending up in the toes. These nerves also go all the way up to the brain via the spinal cord! Neurodynamics is the study of how the nerves move in the body. Think of an electrical cable running from your skull, through your neck, and out to the fingers. When your head moves, the cable is more tense at one end and when your fingers and arm move, it is more tense at the other end. We can take advantage of this dynamic and “floss” the nerve through the various tunnels it goes through. Although the movement of the nerve itself is small, the effects are huge! We implemented femoral and sciatic nerve flossing to help “unstick” the two main nerves of Marcela’s legs.
Marcela’s low back pain and sciatica are gone! She has regained her confidence to move again and trust that her body is a resilient healing machine! We are working on building up core strength and stability, using heavier weights and more difficult movement progressions each time she comes in! Best of all, she has not experienced any more low back pain or sciatica in weeks.
AND THAT’S WHY WE DO WHAT WE DO.
You have what it takes to finally get out of pain and get back to what’s most important to you. We can help.
Click the link below to schedule a no pressure consultation. There are never any high pressure sales or gimmicks. Hope to see you soon.