Swayback (Hyperlordosis)

Swayback or hyperlordosis is an abnormal excessive front-to-back curvature of the Lumbar Spine and is one of the most common causes of Lower Back Pain. Swayback is fundamentally a postural and developmental problem that develops over a period of time rather than a condition that happens overnight. Hyperlordosis can be caused by anything that causes the pelvis to rotate forward, such as a protruding abdomen, (pregnancy, and obesity) or with wearing high healed shoes. Other causes are resultant from muscular imbalance, weak abdominal muscles and tight low back muscles, tight hip flexor muscles and weak gluteal and hamstring muscles, this is known as the “Lower Crossed Syndrome”

The improperly positioned lumbar spine due to Hyperlordosis results in unbalanced, uneven, and abnormal weight bearing load upon the Lumbar Vertebrae and the Intervertebral Discs, which could result in nerve impingement and/or Sciatica. The excessive curve also results in incorrect Lumbar Facet Joint movement which can turn into a Lumbar Facet Syndrome. Additional Pain symptoms over time would be a result of degeneration of the facet joints and intervertebral discs, and development of Osteophytes (Bone Spurs, arthritis) that would have an effect upon nerve roots in the Lumbar area. In either case the pain could be localized, radiating, or Radicular (pain down the leg) in nature.

When Hyperordosis occurs, the resultant excessive soft tissue loading as well as reduced circulation also causes Lower Back Pain. Reduced circulation results in the inability to move waste products out of the muscles, ligaments, tendons, and other soft tissue, as well as impeding the flow of nutrients into cell structures. Significantly reduced circulation can result in Ischemia (lack of Blood Flow), Myofascial Pain Syndrome or Trigger Points.

Piriformis Syndrome

The Piriformis syndrome is a pressure on the sciatic nerve caused by an enlarged or inflamed piriformis muscle. A painful condition arises if the sciatic nerve is compressed between the Piriformis muscle fibers and the pelvic bones, or if the piriformis muscle is contracted with adhesions due to injury. The pain can radiate from the sacrum to the hip joint, into the buttock and posterior thigh.

Irritation of the Piriformis muscle can also cause Coccydynia, (tail bone pain) or dyspareunia, (painful intercourse). The main function of the Piriformis muscle is to externally rotate the hip; pain may be increased with sitting or squatting. The patient may notice that when lying on their back that the foot on the involved side rotates laterally while the other foot remains straight.

Piriformis muscle contracture may also cause the involved limb to shorten. Pain is reproduced when trigger points within the Piriformis muscle and surrounding gluteal muscles are pressed, or when the muscle is stretched by externally rotating the hip. Women are 6 times more likely to have Piriformis syndrome than men. Piriformis syndrome wcan mimic other causes of sciatic pain such as herniated discs, arthritis, infection or tumor. Piriformis syndrome is treated by stretching the muscle, friction massage, trigger point therapy, ultrasound, electrical muscle stimulation, and adjustments to the low back and pelvic joints.

Muscular Pelvic Pain

Pelvic pain is often caused by tight muscles in the abdomen, thighs, groin, and buttock’s, as well as muscles of the pelvic floor. Myofascial trigger points are tender areas in these muscles that can refer pain to all structures in the pelvic region, leading to chronic pain syndromes. Trigger Points in specific muscles of the posterior half of the pelvic floor can be the source of poorly defined pain in the perineal region and discomfort in the anus, rectum, coccyx and sacrum and is commonly labelled as coccygodynia or levator ani syndrome. Trigger Points in muscles in the anterior half of the pelvic floor refer pain to genital structures (vagina, vulva, penis and scrotum). Active Trigger Points in these muscles can interfere with intercourse by causing an aching pain in the vaginal or in the perineal region. Myofascial Trigger Points in the deeper pelvic muscles can effect bowel and bladder function, and can be linked to symptoms of interstitial cystitis, urinary urgency and frequency, pelvic pain and painful intercourse.

Pelvic pain due to muscular involvement can come about from tissues being overstretched, torn or cut in childbirth or from abdominal surgery. The muscles can also weaken or tighten from disuse and injury; and habitual postures and movements can slowly stretch or compress structures in the pelvis, leading to pain and dysfunction. The pelvic muscles, joints and nerves may be the sole cause of pain or just part of the problem.

Trigger Points are linked with hypertonicity, spasmed or shortened muscles and an inability to relax pelvic musculature voluntarily. By reducing pelvic floor hypertonicity and manually releasing myofascial trigger points, many painful pelvic conditions can be relieved.

Pain of organic or infectious nature must be ruled out before the diagnosis of pelvic pain of muscular origin can be made and manual therapy started.

The ilustrations below show the locations of many trigger points that cause pelvic pain.

Marek Jantos School of Psychology, University of Adelaide

Hip Flexor Strain

A hip flexor strain is an injury characterized by over stretching or tearing of one or more of the hip flexor muscles, and typically causes pain in the front of the hip or groin; the groups of muscles at the front of the hip are called the hip flexors. The most commonly involved muscle(s) in a hip flexor strain are the iliopsoas and illiacus. aThe iliopsoas muscle originates from the lower back and pelvis and inserts into the thigh bone (femur).The illiacus originates from the pelvis and inserts into the thigh bone as well.

The hip flexors are responsible for moving the knee towards the chest (i.e. bending the hip) during activity and are particularly active when sprinting or kicking. Whenever the hip flexors contract or are put under stretch, tension is placed through the hip flexor muscle fibers. When this tension is excessive due to too much repetition or high force, the hip flexor muscle fibers may tear. When this occurs, the condition is known as a hip flexor strain.

Hip flexor strains generally occur due to a sudden contraction of the hip flexor muscles (particularly in a position of stretch). They often occur during sprinting or kicking activities. Patients may also develop this condition gradually due to repetitive or prolonged strain on the hip. The hip flexors may also become shortened due to prolonged sitting postures, resulting in painful trigger points and developing a lower crossed syndrome. (Many people who have chronic low back pain that does not respond to therapy have tight and shortened hip flexor muscles).

Patients with acute injury usually feel a sudden sharp pain or pulling sensation in the front of the hip or groin: however, the pain of chronic hip strain is a dull ache in the thigh or groin, and or the low back. (chronic unresponsive low back pain may result from hip flexor injury).Patients with this condition usually experience pain when lifting the knee towards the chest (especially against resistance) or during activities such as running, kicking or going upstairs. It is also common for patients to experience pain or stiffness after rest, especially upon waking in the morning. Swelling, tenderness and bruising may also be present in the hip flexor muscles

Most patients with this condition will heal with appropriate therapy. The success rate of treatment is largely dictated by patient compliance. One of the key components is that the patient rests from any activity that increases their pain until they are symptom free. Activities which place large amounts of stress through the hip flexors should be minimized, particularly running and kicking activities. Rest from aggravating activities ensures the body can begin the healing process in the absence of further tissue damage. If not treated properly the condition can become chronic, and healing slows significantly resulting in markedly increased recovery times and an increased likelihood of future recurrence.

There are several factors which can predispose patients to developing this condition. Some of these factors include:

– muscle weakness (particularly of the quadriceps, hip flexors or gluteals)
– muscle tightness (particularly of the hip flexors, quadriceps, hamstrings or gluteals)
– inappropriate training
– inadequate warm up
– joint stiffness (especially the lower back, hip or knee)
– poor biomechanics
– poor posture
– inadequate rehabilitation following a previous hip flexor injury
– decreased fitness
– fatigue
– poor pelvic and core stability
– neural tightness
– muscle imbalances

Treatment for hip flexor strain consists of:

– soft tissue massage
– Trigger point therapy
– electrotherapy (e.g. ultrasound, electrical stimulation)
– joint mobilization (especially the lower back and hip)
– stretches
– ice or heat treatment
– progressive exercises to improve strength and flexibility (particularly of the hip flexors)
– education
– biomechanical correction
– activity modification advice
– establishment of an appropriate return to activity or sport plan

Upper Crossed Syndrome

Upper crossed syndrome, also known as “student syndrome” or “corporate syndrome”, is a pattern of tight and weak muscles of the upper body that develops from improper postures. People with this syndrome experience pain or tightness in the upper trapezius muscle (the muscle in between the edge of your shoulder and your neck) neck, base of the skull sometimes in the top of the chest. This syndrome is very common and many people are plagued by it.

People that sit all day in front of a computer or at a desk are the most likely candidates hence the term student or corporate syndrome! Due to poor ergonomics, most people in these situations either find themselves leaning over a desk to read, or hunched at a computer typing all day. Prolonged texting is also a major cause of this syndrome. In order to maintain this unnatural position, the body has to continually contract certain muscles. If you hold that contracted position for long periods of time, the muscle will shorten, and the resulting tight muscles will produce chronic pain. The muscles that you are not using when in these positions, those opposite to the ones doing all of the work will eventually stretch out and get weak, making it harder to attain proper posture, thus perpetuating the syndrome. Due to the tightness of these muscles, people carry their head in a forward flexed position, where the center of their head is far more in front of their body, this posture straightens the normal curve in the neck and can eventually lead to spinal and disc degeneration. As with any muscle being tight for a prolonged period of time, trigger points tend to develop within the muscle, and this can cause referred pain into the shoulders, arms, chest or other areas of the back.

The muscles most likely to be tight on a person with upper crossed syndrome include:
– Upper trapezius (upper shoulder muscles)
– Sub occipital (Base of the skull)
– Deep neck extensors (back of the neck)
– Pectoralis major (upper chest)
– Levator scapuli (top of the shoulder blade)

The muscles that tend to be weak or lengthened include:
– Rhomboids (between the shoulder blades)
– Middle and lower trapezius (mid back)
– Deep neck flexors (front of the neck)

Due to the hours of texting, younger people are developing this syndrome, and are showing signs of early spinal and disc degeneration. Early detection, treatment, and instruction on proper ergonomic postures can help prevent this from becoming a chronic lifelong condition.

Sacroiliac joint pain

The Sacroiliac joints are located in the lower area of the back. The sacral bone consists of 5 fused vertebra with the tail bone(coccyx) at the end. The sacroiliac joints are on ether side the sacral bone and join the spine to the pelvis.

The function of the SI joints is to allow twisting movements of the pelvic bone when we move our legs. The legs act like levers and along with the pubic bone (at the front of the pelvis),allow these movements.

Dysfunction of the sacroiliac joint refers to either hypo (locked) or hyper (too much) mobility. This can then lead to problems with surrounding astructures such as the iliolumbar ligaments and gluteal as well as other pelvic muscles. SIJ problems can cause a wide range of symptoms throughout the lower back and buttocks, or even the thigh or groin.

Symptoms of SI Joint injury includes pain located either to the left or right of your lower back. The pain can range from an ache to a sharp pain which can restrict movement. The pain may radiate out into your buttocks and low back and will often radiate to the front into the groin. Occasionally there may be referred pain into the lower limb which can be mistaken for sciatica.

Classic symptoms are difficulty turning over in bed, struggling to put on shoes and socks and pain getting your legs in and out of the car. Stiffness in the lower back when getting up after sitting for long periods and when getting up from bed in the morning. Aching to one side of your lower back when driving long distances. There may be tenderness on palpating the ligaments which surround the joint.

Causes of Sacroiliac joint pain can be split into four categories:

Traumatic : injuries to the SIJ are caused when there is a sudden impact which ‘jolts’ the joint. A common example is landing on the buttocks. This kind of injury usually causes damage to the ligaments which support the joint.
Biomechanical : Pain due to biomechanical injuries will usually come on over a period of timeand often with increased activity or a change in occupation/sport etc. The most common biomechanical problems include:Leg length discrepancy,Overpronation of the feet,’Twisted pelvis’ and Muscle imbalances
Hormonal : Hormonal changes, most notably during pregnancy can cause sacroiliac pain. In preparation for giving birth, the ligaments of the pelvis especially increase in laxity. Combining this with an increase in weight putting extra strain on the spine, may lead to mechanical changes which can result in pain.
Inflammatory joint disease: Spondyloarthropathies are inflammatory conditions which affect the spine. These include Ankylosing Spondylitis which is the most common inflammatory condition to cause SI joint pain.

Stress

Stress is a natural part of everyday life. Weather at work or home, stress can not be avoided, but we need to find ways to reduce or relieve it in order to keep it from physically ruining our life. Daily physical and mental demands or changes in our normal routines can cause stress. There is good and bad stress, the stress we can deal with is good stress, since it does not lead to additional problems. The stress we cannot handle or cope with is bad stress. Our reactions to bad stress comes about in many ways–anxiety, hyperventilation, muscular tension, neck, shoulder or back pain, headaches, fatigue, sleep disorders, bowel problems, panic attacks, or total “burn out”. There are many other stress related pain or disease processes that affect us on a daily basis that can cause physical illness.

Stress management and relief are difficult because stress symptoms are generally mistaken for other symptoms of a physical, mental, behavioral, or emotional conditions. Physical signs of stress can include fatigue, insomnia, muscle pain, headaches, heart palpitations, cramps, trembling, cold extremities and perspiration. Mental stress includes short attention spans, forgetfulness, indecisiveness, confusion loss of a sense of humor. Behavioral stress symptoms include angry outbursts, crying, and smoking, drinking, over eating, nail-biting and foot or finger tapping. Emotional stress can be seen in depression, worry, impatience, anxiety and nervousness. Because of the overlap in symptoms it is difficult to get to the root cause of stress and the pain it’s triggering.

Stress can be acute (Immediate) or Chronic (long term). Acute stress comes on with a temporary incident (like an argument or being stuck in traffic), which creates unexpected circumstances in our lives. We usually adapt readily to this sudden change and the stress is resolved; however, sudden stress like this can induce physical reactions such as headache pain which may last for hours. Sudden changes to our daily life can also be viewed as acute stress, but their impact can result in physical illness. The death of a loved one, divorce, injuries, job loss etc. are stressful events and can have a devastating impact on our physical and mental health.

Unlike acute stress, chronic stress is the result of continuous, unchanging circumstances, like persistent physical pain or an unpleasant lifestyle. Unrelenting stress can cause continuous muscle or joint pain, and headaches. Chronic stress can also lead to internal problems such as ulcers, or increased blood pressure which in turn can lead to heat attack or stroke.

Chronic back or neck pain , arthritis, bursitis, tendonitis, tension and migraine headaches, sciatica, fibromyalgia and whiplash all can set off a chain reaction of physical and mental side effects, and can affect the nervous and immune system. It can also intensify negative reactions to everyday stress. Coping with chronic pain can bring on anxiety and or depression, causing the brain to perceive even more pain, which subsequently creates even greater chronic stress. The tension (stress), anxiety pain cycle.

It is very difficult to treat stress-related conditions since it is often not possible to eliminate the stressors. Most people treat the pain symptoms with medications, unfortunately, the side effects of long term use of pain medications, generally lead to further health problems which will itself increase stress. Chiropractic, massage, acupuncture, as well as exercise and yoga, can naturally help reduce the symptoms of stress. You also need to personally try to alter your behavior and learn to recognize and manage the warning signs, cope with pain, and deal with stress-generating situations to avoid the pain they produce.

Nerve Disorders

Nerves are part of a complex network that begins in the brain and works its way down the spinal column, eventually exiting through more than 60 different locations near the top of the lower back. This complex system can become damaged in the spinal column, as well as other bony structures such as wrists, hip, knees, ankles, and shoulders, in numerous ways.

“Compressive neuropathy” is the general term for nerve disorders in the spine. These occur when the nerves in the spine are compressed and cause the exiting nerves to become trapped and swollen. This causes a pain that radiates from the buttocks and can range all the way down to your toes.

Mild cases of nerve damage result in numbness or weakness, but severe cases can lead to fatigue, stabbing pain, loss of motor control, or even, in extreme cases, paralysis. Permanently damaged nerves in the spine can leas to blurred vision or headaches, loss of hearing, slurred speech, bowel and bladder problems, and other symptoms.

Failed Back Surgery

Sometimes patients of back surgery will visit a chiropractor for help if their problems still persist. This is rather unfortunate, seeing as the symptoms the patient is feeling could have been addressed by the chiropractor prior to going through surgery.

Common causes of back injury include:

  • Overuse injuries – Injuries that occur due to everyday activities such as housework or exercise.
  • Acute or traumatic injuries – Injuries that occur unexpectedly such as a fall, vehicular accident, or sports injury. If it feels like you may have sustained a traumatic injury, it is important that you DO NOT move until help arrives.
  • Spinal Fractures – One of the most serious types of back injuries. Whole some people who sustain a spinal fracture can eventually return to normal activities, less fortunate can be left paralyzed. If a fracture occurs that only damages the spinal column without affecting the spinal chord, it is likely that paralysis will be avoided.

If you have incurred a back injury and experience any of the following symptoms, please seek immediate medical attention:

  • Numbness or tingling in the groin, buttocks, or legs
  • Crushing pain in the chest
  • Loss of bladder or bowel control
  • Signs of shock
  • Weakness in the legs

Knee Pain

Here are some common causes of knee pain:

  • Arthritis of the Knee – Osteoarthritis is the most common form of arthritis in the knee and is caused by gradual degradation of the cartilage in the joint. Rheumatoid arthritis results in inflammation of the joint and destroy surrounding cartilage. While deformity can lead to arthritis in the knee, it is more often the result of excesses weight or repetitive stress injuries (such as sports injuries). Stiffness and/or locking joints are common symptoms.
  • Cartilage injuries – Cartilage injuries occur most often in runners, cyclists, skiers, and soccer players. Chondromalacia patella, which is a softening of the kneecap cartilage, is a common cartilage injury.
  • Illobtibial band syndrome – Often caused by stress of the tendon from longterm overuse, Illobtibial band syndrome results in inflammation of a tendon after having been rubbed over the outer knee repeatedly. This pain can also radiate and move up the thigh.
  • Ligament injuries – A large amount of pain can be felt when the anterior cruciate ligament (ACL) and posterior cruciate ligament become sprained. Sudden twisting motions can stretch or tear the ACL. Direct impact is what most often causes injury to the PCL (most often the result of sports collisions and automobile accidents). Injury the PCL typically consists of a pop sound followed by buckling of the knees.
  • Meniscus injuries – Repetition of quick twists and/or rotations of the knee while under a significant amount of weight can cause meniscus injuries.
  • Osgood-Schlater disease – Repetitive stress to the upper tibia or leg bone can cause the condition called Osgood-Schlater disease. Inflammation occurs in the patellar tendon and surrounding soft tissues. This condition is particularly prone to pre-adolescent boys who are involved in frequent athletic activities.
  • Tendon injuries – Anything from tendonitis to a tendon getting ruptured or torn can result in knee pain. Overuse and continual stretching of tendons can result in feelings of inflammation.