Lower back pain

About Lower back pain

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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Symptoms of Low Back Pain

Low back pain can manifest in multiple ways, depending on its origins. Common symptoms of low back pain include:
  • Dull or achy pain in the general low back region
  • Stinging or burning pain on one side of the lower spine that travels to the backs of the thighs, lower legs and feet
  • Numbness or tingling in the lower extremities
  • Tightness and muscle spasms in the low back, pelvis, and hips
  • Pain that worsens after prolonged sitting or standing
  • Difficulty standing up straight, walking, or going from standing to sitting

Causes of Low Back Pain

There are many intrinsic and extrinsic factors that contribute to low back pain. Some of the more common include:
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Excessive sitting with low overall physical activity levels
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Being overweight or obese
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Improper lifting technique during work or exercise
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Repetitive overuse from sports or exercise
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Herniated or degenerative intervertebral discs
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Poor motor control of the lumbopelvic-hip complex
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Weakened core muscles
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Sacroiliac joint dysfunction
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Poor posture
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Trauma from sports or motor vehicle accidents

Chronic Low Back Pain

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.

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LBP Diagnosis at NYDNRehab

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:

  • Much higher resolution
  • Ability to view anatomical structures in motion
  • Ability to measure tissue elasticity with elastography
  • Repeatable for monitoring treatment progress
  • Provides guidance for injection therapies
We use high resolution diagnostic ultrasonography to:
  • Screen for disk pathology
  • Detect spinal stenosis
  • Identify facet joint disorders
  • Expose lumbodorsal fascia alterations
  • Diagnose and retrain core musculature
  • Diagnose cluneal nerve impingement
  • Diagnose LBP-related hip and pelvic floor dysfunction
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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.

Explore other advanced diagnostic options available only at NYDNRehab

Treatment of Low Back Pain

Successful treatment of low back pain addresses the cause rather than the symptoms. To get to the root cause, two factors must be identified:

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Movement dysfunction
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Pain generation

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.

At NYDNRehab, we employ a comprehensive individualized approach that includes meticulous diagnosis and integrative treatment. We combine the most advanced, scientifically proven low back treatment methods such as:

Old Treatment Reviewed And Improved With New Technology

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.

C.A.R.E.N. PHYSICAL THERAPY FOR LOWER BACK PAIN

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:

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Insufficient dynamic core activation
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Excessive core activation
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Gait (walking) impairment due to asymmetrical weight bearing
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Loss of balance
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Gravitational and postural disorders where there is uneven load distribution between the trunk, pelvis and feet, with loss of control of the center of mass (COM) over the base of support (BOS).
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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.

Lower Back Pain Treatment And Pain Management

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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 care and do not require surgery.

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Conservative care 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.

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Testimonials

Expert Testimonial

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Lev Kalika Clinical Director and DC, RMSK

Dr.Kalika revolutionized foot and ankle care by using high resolution diagnostic ultrasonography for structural diagnosis, combined with with gait and motion analysis technology. Dr.Kalika’s motion and gait analysis lab is the only private lab in the US that features research-grade technology found only at top research universities, made available to patients in his private clinic.

Our Specialists

mikhail Dr. Mikhail Bernshteyn MD (Internist)
pekar Dr. Christina Pekar DC
michelle Dr. Michelle Agyakwah DC
mariam Mariam Kodsy Physical Therapist
Low Back Pain

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.

Anatomy of the Lumbar Spine

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.

Symptoms of LBP

Low back pain can be debilitating at times, keeping you from performing even simple daily tasks.

LBP symptoms may include:

  • Dull aching pain in the low back
  • Stinging or burning pain that descends from the low back to the lower extremity
  • Numbness or tingling in the legs or feet
  • Muscle tightness and spasms in the low back
  • Pain when standing or walking

Common Causes of LBP

Low back pain falls under one of two categories:

  • Mechanical pain is the most common source of LBP, and involves injury or overuse of the mechanical structure of the low back, including muscles, tendons, ligaments and bones. Mechanical pain often resolves itself with rest, and abstaining from the activity that caused it.
  • Radicular pain is cause by an impinged or entrapped nerve root in the low back. It may accompany mechanical pain, if inflamed tissues or misaligned bones exert pressure on a nerve. Radicular pain is often described as sharp or burning, and may be accompanied by weakness, tingling or numbness in the buttocks and lower extremities.

Several lifestyle and behavioral factors can contribute to and increase the risk of LBP, including:

  • Sedentary lifestyle with excessive sitting
  • Poor physical conditioning with lax muscle tone
  • Weak core and low back muscles
  • Imbalances in muscle and connective tissue tension that cause joint misalignment
  • Poor postural habits
  • Faulty gait and movement mechanics
  • Poor lifting technique
  • Obesity
  • Overuse and injury from sports and exercise

LBP Diagnosis

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.

Traditional Treatment for LBP

Medical treatment for LBP mainly focuses on eliminating pain to ease the patient’s discomfort. Treatments may include:

  • Narcotic pain medication
  • Muscle relaxants
  • Corticosteroid injections
  • Bracing

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.

LBP Diagnosis and Treatment at NYDNR

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:

  • Diagnostic Ultrasound: Unlike traditional imaging methods, ultrasound imaging allows both the clinician and patient to see the inner structures of the low back in real time, including muscles, tendons, ligaments, bones and neural bodies. During the diagnostic session, the patient is able participate in the diagnostic process through movement and feedback. Ultrasound also provides important information about the patient’s progress following treatment.
  • 3D Video and Force Plate Technology, with EMG systems: This sophisticated technology enables us to analyze gait and biomechanics, to identify deficient movement patterns that are often at the source of pain.
  • Dynamic Neuromuscular Stabilization (DNS): This unique treatment approach helps patients to activate and coordinate intrinsic spinal stabilizers for optimal control of the lumbar spine and pelvic region.
  • Computer Assisted Rehabilitation Environment (C.A.R.E.N): NYDNR is first among a handful of private clinics to incorporate virtual reality technology into our treatment toolbox. Patients interact with a virtual reality environment while 12 infrared cameras capture their motion and provide real-time feedback to correct faulty movement patterns and improve performance.

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.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

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Complete tear of rectus femoris
with large hematoma (blood)

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Separation of muscle ends due to tear elicited
on dynamic sonography examination

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