Shoulder pain is one of the most common conditions outside of neck and back pain treated by Chiropractors.
Some people are naturally predisposed to laxity or increased movement of the shoulder joint. Some sports which stress shoulder movement may also increase the condition of laxity. Some sports that stress shoulder movement include swimming and throwing sports. Most persons with laxity at the shoulder joint have minimal symptoms. In some persons shoulder impingement of the rotator cuff may become a problem. In shoulder impingement the tendons of the rotator cuff become impinged on the collar bone. The typical Chiropractic treatment recommendation for shoulder impingement includes exercises targeted to the rototator cuff and myofascial release treatment to the tendons of the rotator cuff.
Shoulder injury in persons with loosness of the shoulder can result in pain or weakness in the entire arm that is relieved by supporting the arm. Another common complaint in the injured shoulder is a sense of weakness/fatigue while working overhead.
Lower back pain is one of the most common complaints of patients consulting a Chiropractor. The sacro-iliac joints are the joints between the sacrum (tail bone) and hips. The ligaments of the sacro-iliac joints are very strong but allow some movement. The movement of these joints is greatest in the young and decreases with age. The sacro-iliac joints are felt just at or below the belt line in most people.
Theories on why the SI joints are pain sensitive vary. These joints do not have a disc as in the joints of the lumbar spine but may be effected by thinning of the cartilage, or lack of motion in the joint. Some of the pain that may result from SI joint problems may result from prolonged tightness of the muscles of the hips and back.
The pain from an SI problem may be felt in the groin, on the side of the hip, down the back of calf to the ankle or toes. An SI sprain may be the cause of sciatica which is pain that travels down the back of the leg.
Usually the SI joint is tender if pressed on at the two bumps in the back just below the belt line.
It has been estimated that around 40% of patients who consult a Chiropractor for lower back pain have some involvement of the SI joints. The SI joints are strong joints which transmit the weight of the upper body into the pelvis. The joint is protected by very strong ligaments but sprain of the joint is possible. Usually and injury of the SI joint will cause pain which is localized to the joint. The pain may also be referred to the groin, hamstrings or back of the thigh. The pain from a SI sprain is usually different than classic sciatica cause by a disc herniation in that the pain referred from the SI joint is more diffuse and may effect the side and or whole thigh rather than primarily the back of the thigh/leg.
Sprain of the ligaments of the SI joint are relatively uncommon due to the strong nature of the ligaments. Usually the joints of the lumbar spine will be injured before that joints of the SI joint will be involved. The most common injury that may sprain the SI joints is usually a twisting or torsion movement. Some conditions that may cause the ligaments of the SI joint to be more susceptible to sprain include pregnancy or degenerative arthritis. Prolonged periods of bending or lifting may also cause the ligaments to be more likely to sprain. Usually the mechanism of injury involves straightening up from a bent position.
Pain that travels down the back of the leg is called sciatica whether or not it is associated with pain in the lower back. Sciatica can travel all the way to the foot or toes. On the other hand sciatica may be caused by referred pain and travel in the opposite direction from the foot upwards. In some instances of sciatica trigger points in the muscles of the lower back may be able to reproduce sciatica. If these trigger points in the muscles are pressed on the pain may travel down the leg.
Herniation of the discs of the lower back are credited with causing most cases of sciatica but they do not account for all cases of sciatica. It has been estimated that up to a third of lower back pain sufferers treated by Chiropractors have some degree of herniation of the disc. The most common orthopedic test used by Chiropractors to diagnose a herniated lumbar disc is the straight leg raising test. In this test a person lies on the back and has one leg raised (with the leg straight). Pain that is produced with the leg at 30 degrees or less of elevation is suggestive of a disc herniation. MRI is the most valuable diagnostic imaging procedure that can detect a disc herniation.
Sciatica has a variety of causes some of which do not actually effect the sciatic nerve or its nerve roots. Some such causes include sprain or strain of the joints of the lower back and hips. Other such conditions that may cause sciatica include spinal infection, kidney involvement, vascular conditions and metabolic disorders.
Fibromyalgia is a condition associated with pain in the muscles, tendons and ligaments. Fibromyalgia in the lower back typically causes pain in a symetrical pattern in the back (meaning the pain is usually felt on both sides of the back). Fibromyalgia may also cause pain in the joints of the back. The pain is generally worse after getting up from bed in the morning. Persons suffering from fibromyalgia usually complain of stiffness but have to real restrictions to movement. Swelling of the joints is usually not an issue and only mild tenderness is present except over very tense muscles. Fibromyalgia of this type is not known to cause atrophy or shrinking of the muscles. Weight loss is also not usually associated with fibromyagia of this type. X-rays of the back of fibromyalgia sufferers is usually normal as well. Fibromyalgia sufferers are usually described as emotionally tense.
In my opinion the most effective Chiropractic technique which addresses the type of myofascial pain experience in fibromyalgia is myofascial release technique. Acupunture is often effective as well due to its ability to address trigger points in the larger muscles of the lower back.
Dr. Tom Etter is a Chiropractor and Acupuncture practitioner with over ten years of practice experience. Etter Chiropractic and Acupuncture serves Olathe, Kansas , Lenexa, Kansas and Overland Park, Kansas and the surrounding areas.