Debilitating pain in the neck and mid back is one of the most common issues among patients seeking relief at Dr. Dubin’s office. Here is a typical example of a patient’s problem, and the resulting treatment plan.
Most people suffer from low back pain at some time in their lives. Common cases of low back pain include people who work in a prolonged flexed posture while sitting at a computer, or the “weekend warriors” who attempt to participate in activities such as golf, biking, and basketball without a proper training program.
Understanding the biomechanics of the lumbar spine and pelvis while bending forward and returning to the neutral position will illustrate why the loss of strength and flexibility in particular muscles predispose individuals to the development of low back pain.
Sciatica is a condition in which the pain is typically perceived as radiating from the low back to the posterior buttocks, posterior thigh, and occasionally below the knee into the posterior calf and foot (Fig. 1). A disc herniation (Fig. 2B) or degenerative changes in the lumbar spine (Fig. 2C) can lead to sciatica. A normal, unherniated disc, in comparison, is shown in Figure 2A.
Sciatica may be caused by direct pressure on the lumbar nerve roots. Each nerve root has a sensory and motor component to it, supplying a particular part of the body. The sensory part carries sensory signals to the brain and the motor part carries signals that activate the muscles. In this case, the lumbar nerve roots supply the lower extremities, so excess pressure on the lumbar nerve roots causes discomfort and/or pain in the buttocks and legs.