NO !! Your leg pain is not just SLIP DISC...

It won't be wrong if I quote that BACK PAIN is second most common condition after common cold which makes people suffer affecting their daily life. Every third person has faced atleast one episode of back pain in their life. Our SPINE encloses and protects spinal cord which carry information from brain to the body via nerves. Without such information the body cannot control, move or feel anything effectively making you senseless and motionless.

"Are you suffering from back pain? 

Or

Do you get a pain travelling down your one or both legs? 

Or

Is it difficult to walk few minutes or few steps without a back or leg pain? 

Or 

Do you know someone who is facing such a complaint?"

Read the article carefully to understand what is going wrong inside your body. Read it as you will get to know things beyond your doctor might have missed to share with you.

You may have a leg pain travelling down along with back pain or sometimes without any back pain. The reason for leg pain can be nerves compressed from the spine or even at your hip. Sometimes muscular pain mimics like a nerve pain in the leg which makes you and your doctor confused. The difference between leg pain due to nerve or muscles is that former causes sharp shooting or electric current like leg radiation whereas the latter creates a continuous dull achiness in the affected leg along with pain in the muscle involved.

If you have seen a human spine, it looks like a curvy snake formed by multiple bones called vertebrae arranged in a manner to give it "S SHAPE " when looked from side view. But from front or back view it looks like a straight vertical spine. Any deviation in these curves can put the spine structures under stress causing lot of muscle imbalances or vice a versa.

When your muscles doesn't support the spine symmetrically it can cause excessive stress between couple of vertebrae causing reduced space for the nerves exiting from the spine. Hence, leading to compressed nerves causing painful radiation in the leg. These imbalances can even create severe muscular spasm putting heavy pressure on your affected nerve and the result is your painful suffering again.

Interestingly, the above mentioned reasons can put the disc under pressure and making it appear like a bulge or on MRI Scan. This should be called as false or pseudo disc prolapse causing nerve irritation and leg pain. This type of bulging can disappear or improve once the pressure between vertebrae goes away.

   

I have come across patients who comes with a dull pain in the hip which also radiates down the leg but does not behave like sharp shooting pain. And the reason is not your spinal disc or nerve but a muscle around the hip known as GLUTES MEDIUS (the HIP Abductor) which may have a TRIGGER POINT - muscle knot causing nerve like pain which people often confuse with sciatica due to nerve compression. 

 A deep muscle of the hip known as PIRIFORMIS (the HIP Rotator) is placed right on top of your sciatic nerve and in some cases this nerve pierces from within the piriformis muscle. If this muscle becomes tight it can cause a similar nerve pain but thankfully then the reason is not your spine. This is more common in people who keep purse in their back pocket and also when people sit with scissored legs (Cross Leg Sitting).

A disc is a doughnut like structure with hard outer shell filled with jelly like material inside. Disc is found between the vertebrae of the spine adding shock absorbing effect. In case there is a sudden trauma or repetitive wrong movement pattern in daily life, the disc wall gets weakened and starts bulging mostly backwards and outwards. If the nerve gets compressed by this bulging disc as it is lying very close to it, you can get a sharp shooting pain radiating down the leg. This condition is popularly known as SLIP DISC OR SCIATICA. The people describe this feeling as painful electric spark travelling down the leg. Your bulging disc or slip disc cannot cause leg pain if it is not pressing on to a nerve.

Bulging discs are very common and not everyone who has a bulging disc go through pain. Infact, after 30 yrs of age, every 10 years increases the chance of finding one or more bulging discs with or without leg pain. So when disc bulge is so common then what is causing your leg pain. Careful examination can reveal whether your nerves are compressed due to muscular imbalance, a mis-alignment in the spine or a disc compression on your nerve.

This information is totally in contrast with MRI reports showing disc prolapse as the possible cause of your pain. Trusting the MRI reports without careful examination can misguide you towards unnecessary treatments not required for your stage of the disease.  If you are better informed then you can reduce your suffering by heading towards the effective treatment for your condition.

The information on this blog is helpful in creating awareness related to different problems which produces similar symptoms and often confuse against reaching better treatment approach. 

Please do not consider this blog as a medical advice and do visit your doctor or physiotherapist whenever you experience such symptoms.

Feel free to explore more information by commenting here anytime.

Regards,

Dr. Kunal Vashist,PT

MPT(Ortho), Manual Therapy

DryNeedling Practitioner

Email ID - kvashist.physio@gmail.com

Contact No. 9968302757

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Common Low Back Pain - Are You At RISK ?

"IGNORANCE MAKES YOU SUFFER"

While starting to write this topic on risk assessment for low back pain, today I simply searched on google the statistics related to low back pain. It was really shocking to read nearly 80% of population suffer from low back pain at least once in lifetime. You know what it means that leaving just one or two in our family, we all suffer from low back pain. 

Isn't it very disturbing that pain has become such a closest partner for us to live with? Something is seriously going wrong with our bodies. How can it be so fragile that all of us are not so comfortable and pain free to live with. Moreover it makes us less productive and creative as we can't think or move without pain. 

I have categorized different expressions given by your back under pain. If you know the level of severity then you can easily take decision on what action your back pain needs at that moment. Remember it is the ignorance which makes you suffer.

Self Limiting Back Pain

For most people low back pain starts with a dull ache or a tiring sensation around the lower back which comes with physical exertion and goes away with rest. Normally this is a hint by the body that you have done something beyond your body can handle. This kind of pain is usually self limiting and goes away in couple of days or when your exertion days are over.

Acute Back Pain

The issue comes when you keep ignoring this discomfort and the pain becomes stronger or acute which also last longer even with rest. But again just being conscious of basic do's and don'ts things can be managed by adding self management like rest,  ice or hot compress and activity modification. This is an alert by the body to kind of look into your daily routine and work on changing the lifestyle. Mainly look into your daily activities somewhere you might be abusing your body by over exertion or just being too sedentary. Get your nutrition sorted because you become what you eat. Have you been  sleeping enough? Or is it difficult get a good deep sleep?

If at all your discomfort or pain is not getting over in 2 weeks, there is a need to see your physician or physiotherapist who can do a basic examination and rule out anything major. 

Acute Back and Leg Pain (Yellow Alert)

Sometimes the back pain is very disabling and doesn't allow you to work or do any activity. It can also radiate a sharp pain in your leg usually in one leg upto the ankle. This is the time when you should definitely seek a specialist help like an orthopaedic doctor or a specialized physiotherapist. They can diagnose the problem and start your treatment soon. Usually, the leg pain is coming due to compression of a nerve root from the spine primarily on the right or the left side. The nerve can get pinched because of a Bulging Disc, a small bony growth (osteophytes), a stiff or locked vertebral movement or a bad muscular spasm etc. Here I would say follow your doctor's advice rather thinking to self manage as things can get worse if you ignore.

Back Pain Emergency (RED ALERT)

There are certain emergency situations in back pain. In case you feel a sudden numbness or weakness in your leg or gives you a feeling of "dead Leg" or you can't control passing of urine or stool; this is the time where you should rush to the hospital and get emergency checkup done. Our spinal cord and spinal nerves is the only connection between Brain and the Body which helps us regulating sensation and movement control. Without such connection the body can go in paralytic mode where you may loose any conscious control over your body movements.


Year Long (Chronic) Back Pain



I see many patients coming with year long back pain along with an MRI or X-RAY in their hands. They want me to see what their report says about them. And like always my answer is I want to see what your muscles and joints want to tell me regarding you. As with chronic back pain investigations can be MIS-LEADING where we might treat what is even not bothering in the first place. Most chronic back pain is coming from poor body functioning along with contribution from mental health, nutrition, level of physical activities and Tolerance.

Having a Low Back Pain is not always about a pathology, a spinal disease or an injury to the content of Low Back. It can just be a predictor of your general health, your physical activity status or your fitness. Low back pain is very vast when it comes to diagnosing a problem there ranging from Muscular Spasm, Disc Prolapse, Sciatica, Lumbar stenosis, Spondylosis, Spondylo-listhesis, Vertebrae Fractures, Infections and Tumors. Without making you too much scared the biggest relief is most of these issues are rare. But yes majority of back pains are just a poor physical or mental health.

Just keep in mind that if your back pain is associated with:

• fever and chills

• constant back pain not linked to your movements

• continuous pain especially at nights 

• sudden abnormal weight loss along with back pain

Please contact your general practitioner as not all back pains are just physical.

Carefully assessing the low back problems and their timely management can give full recovery. Let me just put certain evidence based facts which we know today about back pain:

• Recovery rate for a back pain case is as high as 99%.
• Investigations have a low value as most back pains are due to poor function where early X-RAY or MRI doesn't give much information to help the treatment.
• Your pain has no relation to how bad or good is your disease. Each one of us has different pain threshold. To some people needle feels like a sword while others can take lot of pain easily.
• 80 - 90 % of low back pain sufferers can get better with lifestyle modification, optimal physical activities and rehabilitation (Exercises).
• Your mental stress is a major contributor to your back pain especially in chronic back pain.
• Conservative treatment with Active Physiotherapy has to be the number one choice of treatment. 
• People who do not recover in due course of time may need Injections or Surgery as per their doctor's advice but there is no other choice but to EXERCISE.

This article is an effort to create awareness regarding back pain in general public. Always talk to your physiotherapist and seek specific advice as every condition is as unique as you.

Feel free to comment or contact in case you need more information on this topic. 

Regards,

Dr. Kunal vashist,PT

Mpt (Ortho), Manual Therapy 

Dryneedling practitioner

Email ID : kvashist.physio@gmail.com 

Contact no. 9968302757