Friday, 22 April 2016

Back pain - sorry I can't get rid of advertisement,

Editor's Note:  From whiplash to sciatica, getting an adjustment is the go-to treatment for many people with joint and other problems.  Science will tell you that chiropractic may be helpful for such things as back pain, neck pain, neck related headaches, migraine, upper and lower extremity joint problems and whiplash associated disorders - but not so helpful for things like asthma, hypertension, and menstrual pain.

Two conditions researchers are not yet sure about are fibromyalgia and mid-back pain, according to the National Center for Complimentary and Integrative Health.

But what is the chiropractor's perspective?  How might he see the underlying cause of  the back pain he treats? This article is written by guest author, James Lehman, D.C. who talks about reasons why people see their chiropractors.

Spoiler:  There's one reason in particular that stands out from the others (and that he discusses, of course.) ~~~ Anne

Low Back Pain Introduction

Approximately 80% of the adult US population will experience low back pain at sometime in their lives. This statement is supported by research performed by NIH:

Low back pain continues to be a significant public health problem. Seventy to 85% of all people have back pain at some time in life, with the annual prevalence of back pain ranging from 15-45%. Back pain is the most frequent cause of activity limitation in people below 45 years and is a common reason for visiting a health care provider. Symptoms are most common in middle-aged adults, with back pain equally common in men and women; however, back pain secondary to disc disorders is more common in men. Reported rates of low back pain are generally higher for Whites than Blacks or other racial groups.



Chiropractic: An Introduction. Backgrounder. National Center for Complementary and Integrative Health website. NIH. Last Updated May 2012. Accessed Dec 2015.



Reasons for Low Back Pain

A good view of the annulus fibrosus of the disc.
A good view of the annulus fibrosus of the disc.. BSIP/UIG/Universal Images Group/Getty Images

There are many reasons for episodes of low back pain ranging from accidental trauma to zygapophyseal joint dysfunction. Historically, scoliosis has been labeled as a cause of low back pain but in reality this has been disproved by a fifty-year study, which revealed that individuals with scoliosis were less likely to suffer with low back pain than those without curvature of the spine.

My clinical experience points toward a much more benign cause of low back pain: Functional leg length inequality with resultant mild tilting of the pelvis. This cause of low back pain frequently sends low back pain sufferers to seek out chiropractic care.


Pehrsson K, Larsson S, Oden A, Nachemson A. Long-term follow-up of patients with untreated scoliosis. A study of mortality, causes of death, and symptoms. Spine. 1992 Sep;17(9):1091-6.



Examination and Treatment of Low Back Pain and Tilted Pelvis

A skeleton of the pelvis, sacrum, lumbar spine, hip joints and femur bones.
A skeleton of the pelvis, sacrum, lumbar spine, hip joints and femur bones.. sciencepics

The proper treatment of low back pain due to tilting of the pelvis (pelvic obliquity) requires the physician to differentiate anatomical leg length deficiency from a functional leg length inequality caused by a muscular imbalance. This examination involves the comparative measurement of the leg lengths with both static and functional components.

Static, or Anatomical Leg Length Difference

This biomechanical evaluation may be performed first, with the patient lying on the back. The doctor then measures and compares length of each leg. If there is a difference in leg length, it is considered an anatomical leg length discrepancy.

Functional Leg Length Difference

In addition, the leg lengths are measured and compared in both a back lying position (supine) and a seated position. This biomechanical test determines functional leg length inequality.

If one leg measures longer than the opposite leg while the patient is in the supine position but that same leg measures the same length or than the opposite leg in the seated position, the patient is demonstrating a functional leg length discrepancy. This asymmetrical leg length condition or functional short leg often causes a mild tilting of the pelvis and a postural imbalance.

Further examination will frequently reveal tenderness upon palpation of the iliopsoas muscles, especially on the side of the short leg while in the supine position.


Knutson, G. Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance. Chiropractic & Osteopathy 2005.



Most Frequent Causes of Low Back Pain and Tilted Pelvis

Young man with pain in his sacrum.
Young man with pain in his sacrum.. Stockbyte/Stockbyte/Getty Images

It has been my experience that the most frequent causes of low back pain and tilted pelvis include:

  • Lower torso muscle strain.
  • Tightness of the iliopsoas muscle due to prolonged sitting and a lack of stretching.
  • Inflammation of the iliopsoas muscle due to chronic dehydration.

Chiropractic Treatment of Low Back Pain and Tilted Pelvis

A chiropractor adjusts a patient.
Chiropractic may help prevent stenosis and relieve back pain.. Andy Crawford/Cultural Exclusive/Getty Images

Chiropractic treatment of low back pain and tilted pelvis normally involves a comprehensive approach that addresses the causative factors:

  • Spinal manipulation to resolve the pelvic tilting/obliquity.
  • Electrical muscle stimulation with heat to reduce muscle spasms.
  • Myofascial treatments to resolve trigger points.
  • Prescribed stretches to elongate the iliopsoas.
  • Hydration recommendations in order to eliminate myofasciitis (inflamed muscles).

What Should You Do if You have Low Back Pain and a Tilted Pelvis?

Physician examines a patient with low back pain.
Physician examines a patient with low back pain.. mangostock

If you notice that your back is crooked or one leg seems longer than the other, you might want to consult with a chiropractic physician to determine if you have a tilted pelvis.

If you would like to save some money and do a home check, ask your spouse or a friend to compare the length of your legs while lying on your back and then in a seated position. If the leg lengths change you might have a tilted pelvis.

Should you consider spinal manipulation, investigate the qualifications of the provider. I suggest that you seek out a chiropractic physician or an osteopathic physician licensed to practice manual medicine in your state.

It is most beneficial to have a physical examination, which includes a postural evaluation and specific testing to determine if you are in need of spinal manipulation and a comprehensive but conservative treatment program to resolve your low back pain and tilted pelvis.

Home Care for Low Back Pain and Tilted Pelvis

Hip Bridge Exercise - Height for Beginners
Hip Bridge Exercise - Height for Beginners. Summerseason

Home care should include:

  • Avoiding aggravating activities
  • Daily stretching of the psoas muscles
  • Proper hydration (40 ounces of water per day for every 100 pounds of body weight)
  • Regular exercises that include walking
  • Sleeping on your back with a pillow under knees or between knees if on side
  • Reduce body weight if obese.

If your low back pain persists, you should seek professional services from a properly trained chiropractor, osteopath, or medical doctor.

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