Conditions 

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Conditions Chiropractic Care Can Help 

 

CHRONIC BACK NECK PAIN

Chronic back and neck pain, which can extend to chronic leg and arm pain, can have many different causes. The pain can be generated from an annular disc tear, a disc herniation, a disc bulge, facet syndrome, spinal stenosis, disc osteophyte complex, spondylolisthesis, a synovial cyst, degenerative disc disease, atrophy of the spinal muscles, muscle spasm, a pinched nerve, musculoskeletal imbalances, neurological imbalances, rheumatoid arthritis, and ankylosing spondylitis to name a few! We utilize the principles of functional rehabilitation and conduct a thorough evaluation resulting in an accurate diagnosis to determine the root cause of the pain. This will lead us to the options available for your treatment, from completely non-invasive to very minimally invasive

 

DEGENERATIVE DISC DISEASE

Degenerative Disc Disease (DDD) is a condition where the nucleus of the disc loses its water, and the annulus of the disc weakens and dries out causing the entire disc structure to being to collapse. This can lead to disc bulges of disc herniations, and often bone spurs on the edge of the vertebral body, if the bone spurs get big enough, they can cause a bony narrowing of the canal leading to spinal stenosis. While we see a fair amount of degenerative disc disease and bone spurs off the lip of the vertebra, we rarely see it as the only cause of stenosis. It does happen, but it is fairly infrequent. What often happens is the disc begins to dry out or become a dessicate disc, it alters the way your disc can distribute weight and the forces it is subjected to on a daily basis. AS the disc weakens it can bulge out, something we call a bulging disc or disc bulge. As the disc bulges outward it pushes into the spinal canal, or it can push into the neuro-foramen causing—you guessed it, spinal stenosis, or neuro-foraminal stenosis. In the same way, as the disc weakens, and you move in such a way that the disc suffers a catastrophic failure you can cause a disc herniation, which might be a disc protrusion, a disc extrusion, or a disc sequestration—a breakdown of those definitions can be found on another page here. When a disc herniates posteriorly (backwards), it can and will most definitely cause stenosis of the spinal canal or the neuro-foramen. Interestingly enough, disc bulges tend to be broader even though there is less damage to the disc and contribute to spinal stenosis more frequently and disc herniation’s tend to be more focal and lead to neuro-foraminal stenosis.

If you are having sciatic nerve pain or have symptoms of leg pain and numbness due to an arthritic condition or Degenerative Disc Disease and you want to find out what’s causing your pain, then it’s time to call us and schedule an appointment.

 

Herniated Discs, Disc protrusions, Disc Extrusions, Disc Sequestration, and a Ruptured Disc—What does it all mean?


The Basic Anatomy

Your intervertebral disc is the structure that sits between the vertebrae in your spine to absorb the shock of your body in gravity and to resist gravity, and to give flexibility to your spine. You have discs from C2 al the way down to your sacrum, the triangular bone that sits at the bottom of your spine and connects to your two ilium bones. The disc can be thought of as a jelly donut. It has a soft gel like center that is contained by a tough outer band of ligaments called the annulus fibrosis that run at cross angles to one another. The center of the disc is called the nucleus pulposis. The nucleus pulposis is made up of this crazy thing called proteoaminoglycosaminoglycans—it’s ok if you can’t pronounce it! Basically it’s a gel like structure that helps the vertebrae rotate and pivot and distribute weight and forces applied to it. The term cervical herniated disc, thoracic herniated disc, or lumbar herniated disc all refer to the same problem simply differentiated by region in the spine. Cervical refers to neck, thoracic herniated disc refers to the middle of your back where your ribs attach, and lumbar herniated disc refers to your low back.


The Basic Definitions

When the disc “herniates” it means that the gel like substance has pushed the annulus fibrosis out or it has pushed through the annulus which is generally called a ruptured disc / disk, as if you put your hand down on a jelly donut and watched the jelly leak out the side—this is what it looks like. In general, there are three- four types or classifications of disc herniations.

 

Disc Protrusions: This is where the herniation simply protrudes straight out of the disc. The most common place for this to occur is in the postero-lateral position, that means to the back and outside portion of the disc, the reason this happens is that there is a ligament called the posterior longitudinal ligament that runs along the back of the spine inside the spinal canal, and generally acts as guard against the disc herniating straight back, although herniated discs can and do push that ligament back and herniate into the spinal canal.

 

Disc Extrusions: A disc extrusion means that the protruded part of the disc took a turn. The material might drop behind the disc and migrate down like candle wax dripping down a candle, or it might take a right or left turn and the disc material might migrate to the side, or the herniated disc material can move superiorly or upward behind this disc defying gravity!


Disc Sequestereation: This generally means that if you had a disc protrusion, or a disc extrusion, that a piece of the disc has broken of and you now have a fragment that might be loosely attached to the original herniation, or it might be what we call a free floating fragment. This is usually called a sequestered fragment by the radiologgist, but all radiologist use these terms somewhat loosely, and so when in question, it’s always best to confirm with the radiologist exactly what he means.

 

Ruptured Discs. This usually means that the nucleus of the disc whether protruded or extruded has gone beyond the bounds of the annulus fibrosis, and has ruptured the annulus fibers, ergo “ ruptured disc”

These are terms used by radiologists that help us determine the amount of disc damage, the direction of the disc herniation and the size of the disc herniation are listed in order of severity in terms of disc damage, it should be noted that some people with smaller or less severe disc herniation’s can have more neurological problems, and more pain than people with more severe disc herniation’s. Why? Everyone’s spinal canals (area the protects the spinal cord) and neuroforamina (area where the nerve exits the spine) can be a slightly different size or shape. In addition, there are other structures that can narrow these openings along with the disc.

 

Sciatic Nerve Pain & Spinal Stenosis - Diagnosing it

To truly get proper sciatic nerve relief, or for example, relief from a disc herniation causing spinal stenosis, a properly performed neurological examination must be correlated with any MRI. This is to be certain as to what is actually causing the pain to then determine the appropriate therapy. It is all to easy to look at an MRI and assume that you can see what the problem is, but we often find that the examination leads us to a different conclusion. For example, if a surgeon looks at an MRI and sees a large lumbar disc protrusion on an mri, and a patient tells him that he has back pain, the surgeon may look at the mri and make the conclusion that it is the herniation that is giving the patient the problem, and convince the patient that surgery is necessary. But what if this persons back pain wasn’t caused by the disc herniation, but instead was actually caused by the disc breaking down above the level of the herniation --called discogenic pain? Then this person would undergo an unnecessary surgery and would be put into the classification of failed back surgery syndrome. Then you might be told there is nothing we can do except possibly another surgery, and or pain medications.

We take a different approach and triangulate all of the patients’ examination findings and come up with an alternative treatment plan unique to each individual patient.

Are you ready to take the next step? 

Call us at 310-575-5575  to find out if you’re a candidate for our alternative treatments including Non-Surgical Spinal Decompression.

 

JOINT & KNEE PAIN

As with all other pain, joint and knee pain can generate from several causes including autoimmune diseases like rheumatoid arthritis or gout, trauma or injury to the area, and abnormal biomechanics causing accelerated degeneration of the knee or joint. Treatment for will be provided depending on the underlying cause. Knee and joint pain caused by trauma or injury is treated with Class IV Laser therapy, several types of injections which will relieve pain to facilitate healing, soft tissue work, and exercises. Joint pain caused by auto immune disorders is treated by dampening the response through functional medical testing and treatment. And joint pain due to abnormal biomechanics can be treated by remedying the abnormality with tools such orthotics and laser VibraCussor.


Sciatica and Sciatic Nerve Relief

Many people come to us and tell us that they have sciatica, or have been diagnosed with sciatica. Sciatica is simply a description of pain in the back of the thigh and leg—it is not in and of itself a diagnosis. It would be similar to you telling a doctor that you get headaches, and he then looks down at you and states ever so smartly that you have “cephalgia”, cephalgia is simply a latin word for head pain that you told your doctor you had in English, and while it’s found in our diagnosis codes, it isn’t a diagnosis at all—it’s simply a description of where the pain is.

Neuro- Anatomy Made Simple

The sciatic nerve itself is made up of 5 nerve roots that leave the lower lumbar spine and the sacrum from L4 to S3. The nerve further divides into the tibial and peroneal nerves as it descends past the knee into the leg supplying motor and sensory function to many different muscles in the thigh and lower leg and foot. Anatomically it is the largest nerve in the body. Because the sciatic nerve is made up of so many nerve roots, and because of it’s divisions, simply stating that one has sciatica is somewhat meaningless.

Stop Stretching for “Sciatic Pain Relief” until you know the cause.

Determining the Cause of Sciatica

What must be determined is if the pain down the back of your leg is being caused by a disc bulge or herniation(s), spinal stenosis, facet syndrome, a synovial cyst, an arthritis disorder an epidural lipoma, sponylolisthesis, retrolisthesis, a combination of the above, or rarely cancer in the spine. Further, at what level, or levels are affecting which nerves before they become a part of the sciatic nerve. In addition, the sciatic nerve can become compressed or trapped anywhere along it’s path. For example, the piriformis muscle can often compress the sciatic nerve as it passes underneath it, and in some people the nerve actually pierces the piriformis, leading to what is often diagnosed as “piriformis syndrome.” The piriformis further can become hypertonic (tight or spasmed) by hip problems—such as arthritis, and cause abnormal firing of the sensory and motor branches of the sciatic nerve.

Further, the major hip flexor muscle of our body, the psoas, attaches to every vertebrae & disc in the lumbar spine and connects to the hip; therefore, anything that can affect the psoas muscle can contribute to hip and or low back pain, and ultimately “sciatica” because hip motion and lumbar spine (low back) motion are so intimately linked. It’s important to know the cause of your sciatic pain before stretching for sciatic nerve relief.

Therefore the diagnosis of “sciatica” can only be determined by a proper neurological examination, and possibly more advanced diagnostic studies such as a weight bearing MRI, NCV, or EMG testing and comparing that to other diagnostic studies. The sciatic nerve can cause pain not only in the back of the leg, but often patients complain of no lower back pain, yet have pain or numbness and tingling in their calves, or sometimes in the heel or outside of their foot, or the bottom of their feet. If you’re having sciatic pain then, It’s time for you to get an accurate diagnosis for your sciatic pain?

As a leader of Non Surgical Spinal Decompression technology for the treatment of sciatic related conditions, we’ve successfully treated and diagnosed thousands of sciatic pain sufferers and helped them achieve lasting relief from the pain of sciatica. Get an accurate diagnosis today, call us.

NEUROPATHY

Peripheral neuropathy is damage to the nerves of your extremities and is felt as a tingling, painful, and numbing feeling in your hands, feet, arms, and/or legs. Damage to the nerves can be caused by metabolic diseases such as diabetes and shingles, treatments for diseases such as chemotherapy and statin drugs, or damage to the spinal discs such as disc herniations or stenosis. We apply the principles of functional medicine to focus first on understanding the root cause of your neuropathy and then applying a variety of effective treatments, including enlightened health and lifestyle changes, Class IV Laser treatments, in-depth metabolic therapies, non-surgical spinal decompression, and more. These treatment methods not only alleviate the discomfort associated with neuropathy, but also support the healing of other systems of the body.

HEADACHES

Headaches are classified as tension headaches, migraine headaches, and cluster headaches. While pain medication may be necessary to get through a particularly bad headache, it’s important to classify and treat the underlying cause of your headache. Causes can include changes in blood vessel diameter, anything that puts pressure on the meninges, a skull fracture, a strained muscle in the back of your neck, vertebral and disc dysfunction, vision problems, TMJ dysfunction, and more. We aim to provide you with a full evaluation and health history to get to the root cause of the pain, resolve the issue at the source, and ensure that you are pain free without the use of medication.

FIBROMYALGIA

Fibromyalgia is often misdiagnosed and misunderstood. The diagnosis is typically one of exclusion, meaning no other cause can be found. It will typically present itself as brain fog, aches and pains, malaise, fatigue, and depression. In general, you can think of your symptoms as a constellation of problems that feed on one another. Most fibromyalgia patients have an early stage metabolic condition as well as a poorly functioning brain and brain stem. These conditions are functional issues, and an MRI and conventional lab work will rarely lead to a definitive conclusion for most doctors. At IPMG we are experienced in putting the myriad of fibromyalgia puzzle pieces together and understanding the interrelatedness of all the systems of your body.

SPINAL STENOSIS

Spinal stenosis is an abnormal narrowing of the spinal canal where the nerves run from the brain down the back or an abnormal narrowing of the passage between the discs of the spine where nerves typically exit or enter the spine. Spinal stenosis can be inherited or acquired. Acquired causes include wear and tear in the discs, arthritis, inflammation, degenerated facet joints, herniated discs, or previous trauma or injury to the spine. Treatment for spinal stenosis will depend on the cause but for most cases a combination of non-surgical spinal decompression, class IV laser therapy, Active Therapeutic Movement®, in-depth metabolic therapies, and more are used.

Definition of Spinal Stenosis

Spinal Stenosis is an abnormal narrowing of the spinal canal. The spinal canal is what houses and protects our spinal cord. There is also something called neuro-foraminal stenosis, and this is a narrowing of the opening between the vertebrae where our spinal nerves exit from the spinal cord to travel into out arms, legs, and organs.

Understanding Anatomy / Spinal Stenosis

There are many potential causes of stenosis, it used to be thought of as only a degenerative condition of the spine, but as the definition states—it’s a narrowing of the spinal canal. So in order to understand what can narrow the spinal canal, or the neuro foramen, it’s important to look at the anatomy of the spine.

The anterior part of the spine (front) is made up of the vertebral body and the disc, it is the largest part of the spine as it’s also the weight bearing portion of the spine. The vertebral bodies are joined to the back of the spine by a structure called the pedicle—which can be fractured or weakened from birth and create something called a spondylolysis, and a spondylolisthesis.

The pedicle attaches to the Facet joint and then the lamina and spinous process at the back of the spine. So the borders of the spinal canal are essentially made up of the vertebral body, the intervertebral disc, the facet joint and lamina, and a ligament called the ligamentum flavum, which connects from the lamina of one vertebra to the lamina of the one above and below. There is also a capsular ligament around the facet joint.

Causes of Spinal Stenosis?

So, what could possible go wrong to cause stenosis? Essentially, anything that affects any of thestructures bordering the canal can potentially cause stenosis. Let’s look at them. Degenerative Disc Disease (DDD) is a condition where the nucleus of the disc loses its water, and the annulus of the disc weakens and dries out causing the entire disc structure to being to collapse. This can lead to disc bulges of disc herniations, and often bone spurs on the edge of the vertebral body, if the bone spurs get big enough, they can cause a bony narrowing of the canal leading to spinal stenosis. While we see a fair amount of degenerative disc disease and bone spurs off the lip of the vertebra, we rarely see it as the only cause of stenosis. It does happen, but it is fairly infrequent. What often happens is the disc begins to dry out or become a dessicate disc, it alters the way your disc can distribute weight and the forces it is subjected to on a daily basis. AS the disc weakens it can bulge out, something we call a bulging disc or disc bulge. As the disc bulges outward it pushes into the spinal canal, or it can push into the neuro-foramen causing—you guessed it, spinal stenosis, or neuro-foraminal stenosis. In the same way, as the disc weakens, and you move in such a way that the disc suffers a catastrophic failure you can cause a disc herniation, which might be a disc protrusion, a disc extrusion, or a disc sequestration—a breakdown of those definitions can be found on another page here. When a disc herniates posteriorly (backwards), it can and will most definitely cause stenosis of the spinal canal or the neuro-foramen. Interestingly enough, disc bulges tend to be broader even though there is less damage to the disc and contribute to spinal stenosis more frequently and disc herniation’s tend to be more focal and lead to neuro-foraminal stenosis.

When the disc breaks down as in degenerative disc disease, or when the disc bulges from the disc herniation this alters the distribution of forces that the disc is designed for and puts stress on other structures of the spine that aren’t designed to be weight bearing.

Are you ready to find out if you’re a candidate for our alternative treatments like Non-Surgical Spinal Decompression for Spinal Stenosis? Call to schedule your no cost MRI Review or call us, we’re here to help.

What about this Fancy Ligamentum flavum?

Its job is to provide stability and strength to the back part of the spinal canal and aid in extension when the spine is returning from bending forward. Remember it essentially connects from the lamina of one vertebra to the lamina of the vertebrae above and below, so its anatomical position is inside the back part of the spinal canal. When there is undue stress on the spine in the form of abnormal mechanics due to disc breakdown these ligaments can thicken and even fold inward into the spinal canal and contribute to spinal stenosis.

 

New Patient Special, Call Today 310.575.5575 


          Integrated Physicians Medical Group
          Dr. Jeffrey James DC DACNB

          2001 S. Barrington Avenue,
          Suite 103,
          Los Angeles, CA 90025

          Phone. 310-575-5575

          Fax. 310-575-5570

          Email. info@integratedphysicians.com

 
Hours

  

 Monday - Friday   | 7:30 AM - 5:30 PM

Saturday - Sunday | CLOSED