Spinal Manipulation and Headaches

 

Cervicogenic headache (CGH) refers to headaches caused by dysfunction in the neck, and expects estimate that 18% of chronic headache patients have cervicogenic headaches.  Spinal manipulative therapy (SMT) is a form of treatment most commonly provided by doctors of chiropractic, and several studies have demonstrated that SMT is highly effective for patients suffering musculoskeletal disorders of the neck, including those with cervicogenic headaches.  However, there remains little consensus on the appropriate number of SMT treatments to achieve maximum benefits for CGH.

In a 2018 study, a team of researchers conducted a large-scale study involving 256 chronic CGH patients to determine how many treatments are needed to achieve optimum results using SMT for CGH.  The investigators randomly assigned participants to one of four dose levels (0,6, 12, or 18 visits) of SMT for six weeks.  The type of SMT consisted of a manual high-velocity, low-amplitude (HVLA) thrust manipulation in the cervical and upper thoracic regions.  The location of the spinal adjustment was determined by a brief, standard spinal palpatory examination from the occiput to T3 to assess for pain and restricted motion.  For older patients and/or those in acute pain, the manual therapy was modified to a low-velocity, low-amplitude mobilization.  To control for visit consistency and provider attention, patients continued to receive a light massage treatment once a patient’s assigned number of visits was satisfied, until the six-week treatment period ended.

 

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After the conclusion of the treatment phase of the study, the participants used a headache diary to keep track of their headaches for the next year.  The results showed that the patients who received the most SMT treatments had fewer headaches over the following twelve months.  More specifically, the researchers calculated that six additional SMT visits resulted in about twelve fewer days with headaches over the next year.

If you suffer from headaches, consider consulting with a doctor of chiropractic to determine if cervical dysfunction is a potential cause or contributing factor and whether you are a candidate for spinal manipulative therapy.

 

November 1, 2019 by CHIROTRUST

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9 Risk Factors for Developing Sciatica

Sciatica is a common pain problem that affects about 5% of adults. Sciatica is a symptom rather than a specific diagnosis: sciatic pain can have a number of different causes, and getting a proper diagnosis is key in getting relief from this condition.

While pinpointing the root cause of sciatica can be challenging, the medical research has established the factors that increase the risk of a person developing sciatic nerve pain.

Sciatica

Here are the nine most common risk factors for developing sciatica:

1. Aging

As we get older, we lose flexibility and it takes us longer for our body to heal from injuries. One of the most common types of pain associated with aging is lower back pain, and back pain is very closely linked to sciatica.1,2

2. History of Low Back Pain

Research shows that patients who have problems with low back pain are more likely to eventually develop sciatica. Low back pain can result in a general inflammation in the lumbar spine, and this can start to spread to the sciatic nerve.

3. Smoking

It’s no secret that smoking is bad for your health, and it’s also clear that smokers are more likely to suffer from back pain and sciatica.3

Smoking isn’t just bad for your lungs and cardiovascular system; it’s also associated with inflammation, poor circulation, and a weakened immune system. This makes it harder for your body to function properly and makes it more difficult for your body to heal from injuries.

4. Overall Poor Health

Wellness is about flexibility and movement, and if our general health is poor, it’s difficult to stay active and healthy. Research shows that physical fitness is a great way to prevent and treat back pain.4

In addition, poor cardiovascular health is closely associated with a general inflammatory response in the body, which also increases the chances of musculoskeletal pain and sciatica.5

5. Obesity

Being overweight is one of the strongest predictors of back pain and other musculoskeletal problems, including sciatica.

Research shows that adipose tissue actually creates inflammatory markers which can affect our whole body, including our cardiovascular and nervous system. Remember: all sciatica pain is caused by inflammation of the sciatic nerve, and sciatica is more likely if your whole body is in an inflammatory state.

6. Work-Related Injuries

Repetitive movements or being too sedentary are detrimental to your musculoskeletal health, and this holds true for sciatica, as well.

Studies show that work-related activities can lead to sciatic nerve pain. Here are a few of the work conditions that have been associated with sciatica in the medical literature:

  • Standing or walking for long stretches.
  • Driving for long periods of time.
  • Pulling or kneeling for more than 15 minutes at a time.
  • Whole-body vibration.

If your work includes any of these activities, it’s critical to take breaks frequently, rest, and stretch a bit to prevent muscle injury and pain.

7. Sleep Problems

Research shows that poor sleep quality is associated with back pain and sciatica. This is a difficult issue, as poor sleep is also associated with other health issues, such as poor general health, obesity, and chronic pain. Sleep dysfunction is also associated with generalized inflammation, which is also linked to chronic pain.

8. Direct Injury

Less frequently, sciatica can be caused by an injury to the hip or buttocks, resulting in pain. One example of this would be sitting on a bulky wallet, which puts pressure on the nerve directly.

9. Psychological Distress

Low back pain and sciatica are linked to stress, as well. Monotonous or unsatisfying work and general stress can lead to chronic musculoskeletal pain.

A Whole Body Approach to Recovery

As you can see, many different factors play a role in the development of sciatica. Typically, it’s not just a single issue that results in pain, but a combination of factors. That’s why the most effective treatment and prevention of future episodes require a whole-body approach that looks at the root cause of your pain.

Medical References

  1. Cook CE, Taylor J, Wright A, Milosavljevic S, Goode A, Whitford M. Risk factors for first time incidence sciatica: a systematic review. Physiotherapy Research International 2014 Jun;19(2):65-78. doi: 10.1002/pri.1572. Epub 2013 Dec 11. Review. PubMed PMID: 24327326.
  2. Parreira P, Maher CG, Steffens D, Hancock MJ, Ferreira ML. Risk factors for low back pain and sciatica: an umbrella review. Spine J. 2018 Sep;18(9):1715-1721. doi: 10.1016/j.spinee.2018.05.018. Epub 2018 May 21. Review. PubMed PMID: 29792997.
  3. Lee J, Taneja V, Vassallo R. Cigarette smoking and inflammation: cellular and molecular mechanisms. Journal of Dental Research 2012;91(2):142-9.
  4. Gordon R, Bloxham S. A Systematic Review of the Effects of Exercise and Physical Activity on Non-Specific Chronic Low Back Pain. Healthcare (Basel). 2016;4(2):22. Published 2016 Apr 25. doi:10.3390/healthcare4020022
  5. da Cruz Fernandes IM, Pinto RZ, Ferreira P, Lira FS. Low back pain, obesity, and inflammatory markers: exercise as potential treatment. J Exerc Rehabil. 2018;14(2):168-174. Published 2018 Apr 26. doi:10.12965/jer.1836070.035

 

 

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Written by Michael Melton

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Whiplash and Mid-Back Pain – How Can This Happen?

Research regarding whiplash or whiplash associated disorders (WAD) classically focuses on neck pain; however, the data show acute thoracic spine / mid-back (MBP) occurs in 66% of WAD injures with 23% still complaining of MBP at one-year post-injury.

It’s easy to visualize how the cervical spine or neck can be injured in an automobile collision (or sport-related collision or a fall) as the head, which weighs an average or twelve pounds, whips back and forth in a “crack-the-whip” like manner, often well beyond the normal, physiological range of motion. This same stretching (eccentric loading) followed by compression (concentric loading) also occurs in the mid-back, which can injure ligaments, joint capsules, neural structures, and more. Also, the thoracic spine contributes to 33% of flexion and 21% of rotation IN THE NECK, making the mid-back a vital spinal region that facilitates neck movement and function!

In WAD cases, mid-back pain hides in the shadows of a more obvious and often more serious neck injury, as the brain typically perceives pain from the greatest source. Additionally, the neuronal input to the sensory cortex of the brain (the area of the brain that perceives pain) is most highly represented from the head, hands, and feet and less from the mid-back or torso.

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The seat belt may also contribute to injury—both to the anterior chest region including rib cage, sternum, breast tissue, abdominal organs, as well as to the mid-back. The oblique angle of the chest-restraint is an important factor when discussing the mechanism of injury, as it causes trunk/torso rotation during the rebound or flexion phase of WAD. Another mechanism of injury includes blunt trauma, of which the driver is especially at risk due to the close proximity of the steering wheel and the chest. This can lead to contusion or bruising, fracture, and/or injury to the steering wheel and the chest. This can lead to contusion or bruising, fracture, and/or injury to the abdominal and/or chest organs (heart and lungs).

Obviously, the speed of impact, angle of the collision, bracing of the person (or lack thereof), and overall physical condition of the patient can greatly affect the outcome of WAD-related injuries. The importance of assessing the whole person is essential in obtaining an accurate diagnosis and establishing a comprehensive treatment for the WAD patient.

Chiropractic management focuses on the entire person, frequently uncovering complains in other spinal regions as well as in the extremities in WAD-related patients. Moreover, treating postural issues such as a short leg, ankle pronation, oblique pelvis, forward head posture, protracted shoulders, and more is vitally important in obtaining satisfying outcomes!

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Low Back Pain

Doctors of chiropractic offer a non-surgical, treatment protocol for both acute and chronic low back pain (LBP), as do several other healthcare delivery systems. However, due to patient preference and a rising concern for potentially harmful side-effects, many LBP patients seek management strategies that offer a natural, non-pharmaceutical approach, of which chiropractic is the most commonly sought after practitioner-type. So what evidence is there regarding the benefits of chiropractic vs. other forms of care in managing LBP and its associated pain-related functional loss?

A 2018 study published in the online Journal of the American Medical Association focused directly on this question by comparing patient outcomes of those receiving usual medical care to a second group of patients that also received chiropractic care.

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Data was collected at three sites—two large military medical centers and one smaller hospital at a military training site—over the 3.5-year time period. Eligible participants included active duty United States service members between 18 and 50 years in age who were diagnosed with mechanical low back pain.

Patients in each group received usual medical care for six weeks that included self-care, medications, physical therapy, and pain clinic referral. Participants in one group also received chiropractic care that included spinal manipulative therapy in the low back and adjacent regions and additional therapeutic procedures such as rehabilitative exercise, cryotherapy, superficial heat, and other manual therapies.

Up to six weeks after the conclusion of care, the researchers reported that patients that patients in the chiropractic group scored higher with respect to LBP intensity, disability, perceived improvement, satisfaction, and medication use. The researchers concluded that this trial clearly shows the need for chiropractic care for those suffering from LBP- reminding the reader that current LBP guidelines have embraced chiropractic care as a FIRST line of treatment for LBP.

This is not the first study to show the benefits of chiropractic care, as prior high-quality studies have reported higher patient satisfaction levels, less medication use, higher quality of life scores, and less LBP-related disability and recurrence rates for patients receiving chiropractic treatment vs. usual medical care. This article was published in a highly regarded medical journal (JAMA) and CLEARLY supports the need for chiropractic care in the management of LBP.

 

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Is It My Low Back Or My Hip?

When patients present with low back pain, it is not uncommon for pain to arise from areas other than the low back, such as the hip. There are many tissues in the low back and hip region that are susceptible to injury with have overlapping pain pathways that often make it challenging to isolate the truly injured area. Hip pain can present in many different ways.

When considering the anatomy of the low back (lumbar spine) and hip, and the nerves that innervate the hip come from the low back, it’s no wonder that differentiating between the two conditions is often difficult. Complaints may include the inside, outside, front, or back of the thigh, the knee, the buttocks, the sacroiliac joint, or the low back and yet, the hip may truly be the pain generator with any of these presentations. To make diagnosis even more complex, the hip pain patient may present one day with what appears to be sciatic nerve pain (that is, pain shooting down the back of the leg to the knee if mild or to the foot if more severe) but the next visit, with only groin pain.

When pain radiates down a leg, the almost automatic impression by both the patient and their healthcare provider is, “…it’s a pinched nerve.” But again, it could be the hip and NOT a pinched nerve that is creating the leg pain pattern. Throwing yet another wrench in the works is the fact that a patient can have more than one condition at the same time. So, they truly MAY simultaneously have BOTH a low back problem AND a hip problem. In fact, its actually unusual to x-ray the low back of a hip pain patient without seeing some low back condition(s) like degenerative disk disease, osteoarthritis (spurs off the vertebrae), or combination of these. So, how do we differentiate between hip vs. low back pain when it is common for both low back and hip pain to often coincide?

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During our history, we often ask the question, “…what activities make your pain worse?” If the patient replies that weight bearing activities like standing, walking, getting up from sitting, etc., provoke the pain (and they point to the front or side of the hip), a hip-related diagnosis is favored but it STILL may be arising from the low back or both! If they say, “…crossing my right leg over the other hurts in my groin,” then that’s getting more hip pain-specific as hip rotation is frequently lost before the forward flexion motion.

When we ask the hip pain patient to point to the area of greatest discomfort, they usually point to the front of the hip or groin, and less often to the inner and/or anterior thigh or knee. Non-weight bearing positions like sitting or lying are almost always immediately pain relieving. When there is arthritis in the hip, motion loss is often reported and may include a shorter walking stride and pain usually gets worse the longer these patients are on their feet. Initiating motion often hurts, sometimes even in bed when rolling over. During the chiropractic examination, with the patient lying on the back with the knee and hip both bent 90°, moving the bent knee outwards or inwards will almost always reproduce hip/groin area pain. Pulling on or applying traction to the affected leg usually, “…feels good.” Knee & ankle reflexes and sensation are normal but muscle strength may be weak due to pain. Bending the low back into different positions does not reproduce pain if the pain is only coming from the hip.

Though sometimes challenging, doctors of chiropractic are well-trained to be able to differentiate between hip and low back pain and will treat both areas when it is appropriate.

Chiro-Trust.org

 

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Neck Pain? We can help!

Did you know, in a given month, 31% of people will experience some sort of neck pain? Neck pain is the second most common reason why people see a chiropractor. Chiropractors have specialized training in the assessment and treatment of neck conditions. They will determine the source of the neck problems and then perform a series of corrective treatments to restore balance in the cervical spine. Chiropractic care provides a safe and effective treatment for people suffering from neck pain.

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¿Sabía que, en un mes dado, el 31% de las personas experimentará algún tipo de dolor de cuello? El dolor de cuello es la segunda razón más común por la que las personas ven a un quiropráctico. Los quiroprácticos tienen capacitación especializada en la evaluación y el tratamiento de las afecciones del cuello. Determinarán la fuente de los problemas del cuello y luego realizarán una serie de tratamientos correctivos para restablecer el equilibrio en la columna cervical. La atención quiropráctica proporciona un tratamiento seguro y eficaz para las personas que sufren de dolor de cuello.

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Sciatic Nerve/ Nervio Ciatico

The sciatic nerve is the largest nerve in the body. It is a combination of smaller nerves (nerve roots) that join together and become the sciatic nerve. When the sciatic nerve is being compressed very specific symptoms in the legs arise. Pain, numbness, tingling and/or weakness in one leg are the most common signs of sciatic nerve compression. The most common site for nerves to be compressed is as they exit the spine. As the nerves exit the spine they travel through a small opening which can be narrowed by a herniated disc, degeneration of the spine, or inflammation in the area. The nerve can also potentially be compressed by tight or spastic muscles in the low back and back of the legs. Chiropractors are well trained to treat patients who are suffering from sciatica. They will perform a detailed assessment to determine which nerves are being compressed and create a comprehensive plan to treat the problem. Your chiropractor my consult other health professionals or recommend additional test such as x-rays or MRI‘s. Chiropractic treatment and other conservative types of care are the most effective treatments for most cases of sciatica. Do you suffer from sciatica?

GIVE CHIROPRACTIC A TRY!

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El nervio ciático es el nervio más grande del cuerpo. En realidad, es una combinación de varios nervios más pequeños (raíces nerviosas) que se unen para convertirse en el nervio ciático. Cuando el nervio ciático se comprime, surgen síntomas muy específicos en las piernas. El dolor, entumecimiento, hormigueo y / o debilidad en una pierna son los signos más comunes de la compresión del nervio ciático. El sitio más común para comprimir los nervios es cuando salen de la columna vertebral. A medida que los nervios salen de la columna vertebral, viajan a través de una pequeña abertura que puede ser estrechada por una hernia discal, degeneración de la columna vertebral o inflamación en el área. El nervio también puede ser comprimido por los músculos tensos o espásticos en la parte baja de la espalda y la espalda de las piernas. Los quiroprácticos están entrenados para tratar a los pacientes que sufren de ciática. Realizarán una evaluación detallada para determinar qué nervios se están comprimiendo y crearán un plan integral para tratar el problema. Su quiropráctico puede consultar a otros profesionales de la salud o recomendar pruebas adicionales, como radiografías o resonancias magnéticas. El tratamiento quiropráctico y otros tipos de cuidados conservadores son los tratamientos más efectivos para la mayoría de los casos de ciática. ¿Sufres de ciática?

¡Visita tu quiropráctico!

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Neck Pain – Chiropractic and the Older Patient

People of all ages suffer from neck pain, and many frequently turn to chiropractors for care because it’s been found to be one of the most effective and efficient forms of treatment available, and it carries minimal side effects! It has been projected that by 2030, nearly one in five residents in the United States will be 65 or older. Currently, approximately 14% of the patients treated by chiropractors are 65 or older, making it one of the most frequently utilized forms of complementary and alternative care used by older adults. What kind of care can a senior citizen expect when seeking treatment from a chiropractor?

Let’s take a look…

Musculoskeletal pain—pain in the neck, back, arms, and/or legs—drives the majority of elderly patients to chiropractors. While low back and neck pain are the most common complaints, it’s not unusual for patients to also have one or two other conditions (or more) that they did NOT know chiropractic care could help. In fact, common “goals” for managing every patient (not just the elderly) include services related to patient assessment, maintenance of health, and prevention of illness, in addition to treatment of illness or injury. Common chiropractic treatment approaches include spinal manipulation and/or mobilization, nutritional counseling, physical activity/exercise, and (especially important for the elderly population) fall prevention.

Cervical-Strain-Sprain

We will now focus on neck pain as it relates to the elderly population and the various chiropractic management strategies that might be encountered by an elderly patient. Common reasons patients present regarding the neck include limited movement, stiffness, and pain. Neck pain can also interfere with sleep, as finding a comfortable position in bed can be quite challenging! Lifting, carrying, and playing with grandchildren is a very common issue for either causing a new complaint or irritating an existing one. Neck pain may also interfere with reaching and lifting. Thus, activities like yard or garden work may become more difficult and less enjoyable. Neck pain is often associated with headaches, which can make daily tasks even more challenging.

When an elderly patient visits a chiropractor for the first time or for a new complaint, he/she can expect to fill out some initial paperwork, as well as provide a history of the main complaint and any lesser complaints. This may also include providing a family and medical history. The examination usually includes general observations, palpating or feeling for muscle tightness, tenderness, warm/cool, range of spinal motion (neck, back, extremities), orthopedic tests, neurological tests, and possibly x-rays. Treatment of the neck may include massage or mobilization to loosen up the neck, manipulation to free up restricted joint motion, and even exercise training. The goal of treatment is to improve neck motion, activity tolerance, and quality of life (less pain, improved sleep, etc.). So, whether you are 10, 20, 50, 70, or 90 years old, give chiropractic a chance to help you manage your neck pain.

Chiro-Trust.org

 

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Back Pain and Posture

Low back pain (LBP) is one of the most common ailments that chiropractors treat. That’s probably because MOST of us will suffer from low back pain that requires outside help at some point in our lives! Posture has long been studied as a potential cause of low back pain, and this month’s topic will take a closer look at some recent research discussing this issue.

A December 2014 study looked at low back posture in two groups of LBP patients and its relationship with problems associated with intervertebral disk diseases. Looking at a person from the side, have you noticed that the low back area has an arched or inward curve? This is called the “lumbar lordosis” (or, the “sway back” area), and this can be highly variable in terms of the angle or amount of arch. It normally differs between males and females. Degenerative disk disease (DDD) is a common condition affecting virtually all of us at some point in time. DDD results in narrowing of the disk spaces, which there are five total in the lumbar spine (twelve in the thoracic spine/mid-back, and six in the cervical spine/neck).

One particular study evaluated a group of 50 patients with long-term intractable (chronic) low back pain with intervertebral disk disease and a group of 50 chronic LBP patients without DDD that served as a “control group.” Researchers measured the degrees of lordosis, or amount of curve (lumbar lordosis), by looking at the person from the side using two different methods in the two patient groups and compared the data. The group with degenerative disk disease had an overall reduction in the lumbar lordosis curve (less arched) using both methods of measuring. The authors concluded that the patients with intervertebral disk lesions had a straighter, or more flat curve (less sway back), when compared to those without disk degeneration. What they were unable to determine was which came first, the disk degeneration or the reduction in the lumbar lordosis?

This study points out several important points. When treating patients with low back pain, some patients feel better when placed in a bent forwards position, or they favor a flat low back curve. Others have the opposite response, or their position of preference favors a more curved (arched) lower spine. The reason for this difference is that LBP is generated from different tissues in the low back, and some tissues favor or feel better in one position and typically feels worse in the opposite direction when injured. The intervertebral disks in the spine lie between the vertebral bodies and serve as “shock absorbers” for the spine and trunk. The center, or “nucleus,” of the disk is liquid-like and is usually well contained inside the disk, held by a tough, outer fibrocartilage material (the “annulus”).

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The disk is approximately 80% water, and as we age, the water content gradually reduces and the disk spaces narrow, thus limiting the mobility of that part of the spine. More importantly, DDD usually narrows the size of the canals through which the spinal cord and nerve roots travel. When we bend forward, these canals open up wider placing less pressure on the nerves and/or spinal cord.This is why we often see elderly people leaning on grocery carts when shopping, as it hurts less and they can walk longer / farther. Those with herniated disks tend to be the opposite, as they favor bending backwards as this position shifts the nucleus or liquid center forwards and away from the nerve root thus reducing the pinched nerve resulting in less or complete elimination of radiating leg pain.

Chiro-Trust.org

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What’s This Tingling in My Leg?

When you think of low back pain, you may visualize a person half-bent over with their hand on the sore spot of their back. Since many of us have experienced low back pain during our lifetime, we can usually relate to a personal experience and recall how limited we were during the acute phase of our last LBP episode. However, when the symptoms associated with LBP are different, such as tingling or a shooting pain down one leg, it can be both confusing and worrisome – hence the content of this month’s article!

Let’s look at the anatomy of the low back to better understand where these symptoms originate. In the front of the spine (or the part more inside of the body), we have the big vertebral bodies and shock absorbing disks that support about 80% of our weight. At the back of each vertebrae you’ll find the spinous and transverse processes that connect to the muscles and ligaments in the back to the spine. Between the vertebral body and these processes are the tiny boney pieces called the pedicles. The length of the pedicle partially determines the size of the holes where the nerves exit the spine.

Digital blue human rubbing highlighted red lower back pain

When the pedicles are short (commonly a genetic cause), the exiting nerves can be compressed due to the narrowed opening. This is called foraminal spinal stenosis. This compression usually occurs later in life when osteoarthritis and/or degenerative disk disease further crowds these “foramen” where the nerves exit the spine. Similarly, short pedicles can narrow the “central canal” where the spinal cord travels up and down the spine from the brain.

Later in life, the combined effects of the narrow canal plus disk bulging, osteoarthritic spurs, and/or thickening or calcification of ligaments can add up to “central spinal stenosis.” The symptoms associated with spinal stenosis (whether it’s foraminal or central) include difficulty walking due to a gradual increase in tingling, heavy, crampy, achy and/or sore feeling in one or both legs. The tingling in the legs associated with spinal stenosis is called “neurogenic claudication” and must be differentiated from “vascular claudication”, which feels similar but is caused from lack of blood flow to the leg(s) as opposed to nerve flow.

At a younger age, tingling in the legs can be caused by either a bulging or herniated lumbar disk or it can be referred pain from a joint – usually a facet or sacroiliac joint. The main difference in symptoms between nerve vs. joint leg tingling symptoms is that nerve pinching from a deranged disk is located in a specific area in the leg such as the inside or outside of the foot.

In other words, the tingling can be traced fairly specifically in the leg. Tingling from a joint is often described as a deep, “inside the leg,” generalized achy-tingling that can affect the whole leg and/or foot or it may stop at the knee, but it’s more difficult to describe by the patient as it’s less geographic or specific in its location. Chiropractic management of all these conditions offers a non-invasive, effective form of non-surgical, non-drug care and is the recommended in LBP guidelines as an option when treating these conditions.

Chiro-Trust.org


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