Pain in the lumbar area of the spine has become increasingly common among adults in Western civilizations as people become more sedentary and overweight. Long hours spent sitting at a computer or in front of a TV screen have significantly decreased cumulative physical activity, reducing overall fitness and increasing musculoskeletal pain and discomfort. Low back pain can range from mild to debilitating, and often worsens over time. The condition accounts for a rising incidence of work absenteeism, costing both employers and workers time and money.
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Ongoing chronic low back pain is not normal and should be treated by a chiropractor or with physical therapy. Chronic LBP often arises from poor, inadequate or untimely treatment, poor patient beliefs and coping strategies, emotional stress, and inaccurate diagnosis that focuses on the symptoms and not the underlying cause.
The chiropractic and physical therapy professionals at NYDNRehab are experts in diagnostic musculoskeletal ultrasonography, a safe imaging technique that is much more useful than MRI for diagnosing low back pain:
In addition to ultrasonography, our clinic features a fully equipped motion and gait analysis laboratory. We are the only private clinic in NYC that offers state-of-the-art 3D gait analysis. Deficient gait mechanics are often a primary cause of LBP due to altered pelvic alignment.
Successful treatment of low back pain addresses the cause rather than the symptoms. To get to the root cause, two factors must be identified:
In many cases, a structure (muscle, joint, nerve) is irritated during specific movements. Since multiple structures can refer pain to the low back region, we must identify where the primary load transfer failure originates. Spinal stability has to be addressed from the perspective of dynamic stability rather than core strength.
Flexion-distraction is an old and very successful chiropractic concept that has recently been revived by new technology. The Manuthera 242 treatment table delivers a variety of gentle manipulations to the spinal vertebrae, relieving pressure on intervertebral discs, relaxing deep spinal muscles, and most importantly, releasing lumbo-dorsal fascia.
From research we know that there are different categories of people with LBP, and each should be treated with an individualized approach.
C.A.R.E.N., our computer assisted rehabilitation environment, successfully facilitates treatment of the following categories of LBP patients:
Protection against spinal injury requires proper anticipation of events, appropriate sensation of body position, and reasonable muscular responses.
Lumbar fatigue is known to delay lumbar muscle responses to sudden loads. Patients with chronic low back issues have a reduced ability to sense a change in lumbar position than control subjects, even when they are not fatigued.
However, most low back pain is caused by muscle imbalances, poor posture, lack of physical activity, weakened core muscles and other factors that exert pressure on the nerves that descend from the lower spine.
Pain medications may provide temporary relief from lower back pain, but they do not resolve it. Patients with persistent chronic pain are often advised to have surgery. However, most surgeries fail to resolve lower back pain over the long run, since the underlying cause of pain is not structural in nature. Even when pain stems from a herniated (bulging) disc, most disc herniations resolve themselves with conservative pain management and do not require surgery.
Conservative pain management like chiropractic and physical therapy seek to eliminate pain by correcting imbalances, strengthening weakened muscles and educating patients on healthy postural habits. Rather than focusing on symptoms and providing temporary pain relief, conservative care focuses on resolving the issues that cause lower back pain, saving patients from risky, costly and unnecessary surgery.
NYDNRehab now offers TeleHealth patient cate, making it easier than ever to see a chiropractor or get physical therapy from your home or office, or while traveling.
Dr.Kalika has revolutionized low back pain care by using high resolution diagnostic ultrasonography for structural diagnosis, combined with gait and motion analysis technology. He has published multiple studies on the effectiveness of ultrasound guided dry needling (UGDN) for pain relief, which he combines with multiple cutting edge rehab approaches. The NYDNRehab motion and gait analysis lab is the only private lab in the US to feature research-grade technologies found only in the world’s top research labs, and made available to patients in our private clinic. Dr.Kalika’s modern approach to back and neck pain has put him on the radar of some of the world’s top pro athletes and professional ballet dancers.
Pain in the low back is the most common musculoskeletal complaint of people over age 40, with almost everyone experiencing an episode of low back pain (LBP) at some time in their life. Many people suffer LBP for years on end, after efforts to resolve it medically, including surgery, have proven futile. However, most cases of LBP can be resolved with appropriate conservative treatment.
Contrary to what many people think, your low back is not fragile. It is designed to twist and bend, bear weight, transfer force loads between your upper and lower body during physical activity, and provide stability when lifting. Your lumbar spine is both flexible and powerful, enabling you to perform physical work and engage is challenging physical activities.
The five vertebrae of your low back that make up your lumbar spine are the largest non-fused vertebrae in your spinal column. The lumbar vertebrae are numbered L-1 to L-5 in descending order, with the lower vertebrae bearing the most weight. The two lower segments where L-4 meets L-5, and where L-5 meets S-1 (the first vertebra of the sacrum) are the most vulnerable to injury because they bear the greatest loads.
Most cases of low back pain occur at the L-4/L-5 and L-5/S-1 junctions, often due to pressure on the nerve roots of the sciatic nerve that exit the spinal column in the lumbar region. Muscle strains associated with lifting are a common cause of low back and sciatic nerve pain.
Low back pain can be debilitating at times, keeping you from performing even simple daily tasks.
LBP symptoms may include:
Low back pain falls under one of two categories:
Several lifestyle and behavioral factors can contribute to and increase the risk of LBP, including:
As with most musculoskeletal conditions, diagnosis of LBP begins with a detailed patient history and physical exam. The patient may be asked about recent and older injuries, sleep postures, lifestyle behaviors, activity level and athletic participation. A postural assessment may be performed. The physical exam may include palpation of the painful area, tests for range of motion and reflexes, and other motor assessments. A neurological exam may also be performed.
Imaging via MRI, X-ray or CT scan is often prescribed in hopes of revealing abnormalities in the low spine, but in many cases traditional static imaging scans are unable to identify the precise cause of pain, and some consider those diagnostic methods to be obsolete.
Medical treatment for LBP mainly focuses on eliminating pain to ease the patient’s discomfort. Treatments may include:
However, because most back pain is mechanical in nature, treating pain alone does not resolve the underlying issues that caused it, and back pain often returns once treatment is discontinued.
At NYDNRehab, we use the most advanced technologies and innovative therapies to diagnose and treat your low back pain. Many of our diagnostic and treatment tools are unique to our midtown Manhattan clinic, and cannot be found elsewhere.
Some of the diagnostic and treatment approaches that set NYDNR apart include:
Dr. Kalika and his team are dedicated to getting to the sources of low back pain, and devising individualized treatment plans to eliminate them, with the end goal of improving our patients’ quality of life.