“Cauda Equina Syndrome: When NOT to See Your Chiropractor”

Your Doctor of Chiropractic can help you with a myriad of health problems. Numerous studies have proven both the efficacy and safety of chiropractic treatment as a cure for lower back pain, neck pain, whiplash and many other issues.

This article however, explains a particular situation “When NOT to See Your Chiropractor.”

Cauda Equina Syndrome
There is a fairly rare, but very serious condition known as “Cauda Equina Syndrome.” Thankfully, very few readers will have direct experience with this condition. But it is nonetheless important to discuss because if you ever develop these symptoms or know someone who does, you’ll know the quick action to take to avoid serious complications.

Horse Anatomy
The last several nerve roots come off of the spinal cord as strands resembling a horse’s tail, thus the Latin term “Cauda Equina” (Horse’s Tail). Cauda Equina Syndrome refers to pressure of these nerve rootlets that branch off of the terminal end of the spinal cord.

Symptoms of Cauda Equina Syndrome
These are the tell-tale signs you have Cauda Equina Syndrome. You can have one or all.

• Weakness of legs
• Atrophy (loss of muscles girth) of legs
• Numbness, pain or tingling into legs or feet
• Numbness and or anesthesia (total loss of sensation) around the anus
• Loss of bowel or bladder control

 

Cause of Cauda Equina Syndrome

There are several conditions that can cause Cauda Equina Syndrome:

• Large disc herniation in lumbar spine
• Spinal Stenosis
• Spondylolisthesis Grade III or greater
• Fracture/Dislocation of lumbar vertebrae
• Tumor

 

Complications

If not treated properly and in time, permanent irreversible paralysis could occur. Therefore, going to your chiropractor or general medical physician when you have these symptoms only further delays proper care.

 

What to Do if You Have These Symptoms
You should immediately report to an emergency room for an examination and MRI and/or CT scan. Once the cause of the syndrome is found, proper treatment may commence.

 

 

Cause of Lower Back Pain: Facet Syndrome

Back Anatomy

The spine has 2 sets of joints: A large joint between the large weight bearing part of the spine which is held in place by the disc and a smaller pair of joints in the back of the spine that guide movement.

It’s the latter joints that this article will address.

The smaller paired joints in the spine are called “facet” (fuh-set) joints. These joints are designed to help guide movement within the spine.

Cause of Facet Syndrome
Facet syndrome is a cause of chronic back pain that results from prolonged stress on the facet joints. It is a form of osteoarthritis of a specific joint. Work injuries, accidents, subluxation, prolonged poor posture and disc disease all contribute to facet joint malfunction. Continued malfunction over time results in the breakdown of the cartilaginous facet joint linings. In time, the bones react by forming spurs in an attempt to fuse the joint shut.

Symptoms of Facet Syndrome
The hallmark of facet syndrome is a deep aching pain that is aggravated by sitting and leaning backwards or twisting at the waist. The pain is usually located within an inch or two of the midline of the spine. It may occur just on one side or it can be on both. Facet syndrome does not ordinarily cause radiating pain (sciatica).

Diagnosing Facet Syndrome
A thorough physical examination of the spine must be done. A simple maneuver where the patient’s back is extended over the doctor’s hand as a fulcrum (Kemp’s test) will usually cause reproduction of the pain. Oblique (angled) plain film x-rays will show characteristic signs of facet joint narrowing, irregularity and often spurs. A loss of disc height is often found at the same level. Advanced imaging like an MRI is not usually required.

For more detailed information and a video tutorial on facet syndrome follow this link.

Cause of Lower Back Pain: Bulging Disc Herniation

Intervertebral discs are “spacers” between the spinal bones. They provide room for the joints to move allowing flexbility of the spine. They also provide room for the nerves to exit from the spinal cord to the rest of the body.   

Discs are usually filled with water and are quite flexible, almost rubbery. Due to lifting injuries, repeated physical stress, automobile accidents, etc the outer disc fibers (annulus) become damaged allowing water to escape from the disc. In time, the disc become more and more dehydrated and beghins to weaken. Just like a car or bicycle tire that’s sidewall is weak, a bulge forms. The bulge may put pressure within the canal that nerves pass through causing not only back pian, but also butt, thigh, leg or foot pain (sciatica).

The disc bulge may worsen and the outer fibers may actually tear open and allow inner disc material (nucleus) to protrude outward (herniation) into the nerves or spinal cord. In most instances, a herniation like this will cause back pain and sciatica, but also serious physical signs such as loss of muscle strength in the legs, shrinking of leg muscles (atrophy) and/or loss of reflexes. See video tutorial of disc herniation here: http://www.CureForLowerBackPain.com

Diagnosis of disc bulge and herniation are by careful phsyical examination and confirmed conclusively on MRI scan. Plain x-rays will NOT show disc bulges or herniation. A seemingly normal x-ray may show up as a severe herniation on MRI.

Cause of Lower Back Pain: Degenerative Disc Disease

Degenerative disc disease refers to the breakdown and malfunction of one or more intervertebral discs. “Discs” are the spacers and shock absorbers between the spinal bones.

Discs are naturally about 75% water. With physical exertion, gravity, injuries and chronic postural stress the discs begin to lose their water content and become dehydrated. When this occurs the disc begins to shrink or contract. Rather than their usual “rubbery” consistency, they become dried out and leathery.

Under pressure of your body and gravity, the discs begin to thin. This allows the vertebrae (spinal bones) to crowd eachother causing pain in lower back. As the condition deteriorates, more pressure is built up around the spinal nerves passing between the spinal bones, which can cause back and leg pain otherwise known as sciatica. In time, the nerves become more irritated and begin to become damaged resulting in not only sciatica, but more seriously, muscle and reflex weakness.

See a flash video of degenerative disc disease here: http://www.secretdiscsolution.com/flash/HERN.swf

Diagnosing degenerative disc disease is straight forward. A thorough history, physical examination and plain film x-rays will detect this common cause of lower back pain.

Morning back pain and stiffness that improves after a hot shower or period of walking and/or stretching is a characteristic symptom of degenerative disc disease. Physical examination will usually show painful and reduced back mobility with tenderness over the affected joints. X-rays will show the characteristic signs of thinning disc space(s), and lipping or spurring on the vertebral bodies.

Degenerative disc disease is a slowly progressive condition that deteriorates over time. It begins as dehydration and then eventually leads to nerve damage.

Cause of Lower Back Pain: Subluxation

There are many causes of lower back pain. Most cases of lower back pain are caused by mechanical malfunction or structural defects from injury or chronic physical stress.

The most common and widespread cause of mechanical lower back pain is subluxation. Subluxation is a term that refers to two adjacent spinal bones (vertebrae) that are malfunctioning. They may be misaligned with each other or the usual freedom of movement has been lost.

This may occur as a result of an injury, but often times stems from our daily activities of bending, lifting, stooping, etc. Chronic postural strain from our work or daily activities may also cause subluxation to result in lower back pain.

Once the joints have lost their normal motion and/or alignment that triggers other processes to kick in.

Nerve endings within the joints send signals to the brain that joint malfunction has occurred, which results in the brain telling the surrounding muscles to tighten up. This is a protective measure to “splint” the joint and prevent further damage. The problem with this is that it causes further loss of motion and yes, you guessed it, even more reciprocal muscle spasm.

The next event to occur is nerve facilitation or irritation. The nerve roots that exit between the two spinal bones become irritated. At first, this causes abnormally high amounts of nerve impulses to be sent outward to wherever that particular nerve goes. The nerve irritation will cause hyper-function of that end organ. For example, the middle back nerves supply the stomach. If you are subluxated in the mid back or thoracic spine, the nerve facilitation will cause increased acid production which could result in an upset stomach or heartburn and often diarrhea.

After a period of time the nerves become “burned out” from facilitation and they begin to lessen their activity. This results in the end organ slowing down its activity. As in the example above, this would eventually result in not enough stomach acid being produced causing maldigestion and the associated problems of bloating, gas and constipation.

If a subluxation has been around long enough, damage or deterioration of the soft tissues begins. In particular, the discs begin to lose become dehydrated, shrink and crack. Long standing dehydration leads to disc bulges and/or herniation. This is noticeable on x-ray as a loss of disc height and on MRI as disc dessication (dehydration), bulging or herniation.

The final process is bone remodeling. Due to chronic malfunction and loss of normal disc function the body begins laying down extra bone to try to bridge the gap of the joints and fuse the spine in order to protect it. This is visible on x-ray as bone spurring and lipping.

Subluxation is the most common causes of lower back pain and ahs a wide variety of signs and symptoms. In order to repair or correct subluxation, your doctor must first know how to locate subluxations, measure them and then lay out a strategic plan to eliminate them.

For more information on back pain caused by subluxations and how to accurately diagnose it, follow this link:

http://www.spinediscrehab.com/locate_cause_of_back_pain.html