Lumbar disc herniation is a well-known cause of back pain, but it’s not as common as most people think. In fact, only about 5% of those who go to the doctor for low back pain have a disc herniation.

These people usually experience back and leg pain, as well as muscle spasms in their low back and leg. They also commonly report muscle weakness, numbness and pins and needles in the thigh, leg and foot.

As herniations usually occur on one side of a disk, the pain is generally worse on the corresponding side of the back. The pain can worsen with coughing, straining or sneezing, as well as slouching and bending, which compresses irritated discs in the spine. It often gets better with bending backward or leaning to one side (the one opposite to the pain), which takes pressure off irritated disks. Because of this, people with lumbar disc herniations often adopt a particular posture or walking stance to ease discomfort — bent sideways and forward, or with their knees slightly bent to relieve pain in the legs.

While the pain of lumbar disc herniation can radiate into one or both legs, the cause of the condition occurs in the lumbar spine, which is just above your buttocks. Your spine comprises bones called vertebrae, and in the lumbar spine there are five. Like the coils of a slinky, these vertebrae are stacked one on top of the other and move in unison.

To prevent friction during this movement, intervertebral discs cushion and protect the vertebrae. These disks are soft, fluid-filled pads, and when they become herniated, the gel-like material inside bulges out into the spinal canal.

Within the spinal canal lies the spinal cord, which contains spinal nerves that exit between vertebrae and branch out to the rest of the body. The displaced gel compresses these nerves, causing pain in the low back and the areas of the body to which nerves travel from the spinal cord. In severe cases, the displaced gel can even compress the spinal cord itself, and in such cases healthcare practitioners usually refer patients to a hospital.

Usually, a single event doesn’t trigger such a herniation. A disc herniation is more likely a result of steady abuse. People whose work involves lots of twisting, bending, sitting or heavy lifting are more at risk, as these activities cause disk stress and wear and tear. Truck drivers, for example, endure prolonged periods of sitting in a vibrating vehicle, which can cause tremendous stress for the intervertebral discs and over time lead to a herniation.

While extreme cases of this condition may require surgery, conservative care is usually sufficient.

Signs and Symptoms

• Fatigue
• Morning stiffness
• Paresthesia (tingling)
• Reynaud’s phenomenon
• Skin sensitivity
• Headaches
• Psychological disturbances
• Pain after exertion
• Memory lapses
• Sleep disorders
• Restless leg syndrome
• Dizziness
• Irritable bowel syndrome
• Joint pain and swelling

It’s likely that a number of factors contribute to the development of fibromyalgia. Other theories as to the cause of fibromyalgia include:

• Sleep disturbances. Some researchers theorize that disturbed sleep patterns may be a cause rather than just a symptom of fibromyalgia.
• Injury. An injury or trauma, particularly in the upper spinal region, may trigger the development of fibromyalgia in some people. An injury may affect your central nervous system, which may trigger fibromyalgia.
• Infection. Some researchers believe that a viral or bacterial infection may trigger fibromyalgia.
• Abnormalities of the autonomic (sympathetic) nervous system. Part of your autonomic nervous system — the sympathetic, or involuntary, system — controls bodily functions that you don’t consciously control, such as heart rate, blood vessel contraction, sweating, salivary flow and intestinal movements. It’s thought that sympathetic nervous system dysfunction occurs in people with fibromyalgia, particularly at night, which leads to fatigue, stiffness, dizziness and other signs and symptoms associated with the condition.
• Changes in muscle metabolism. For example, deconditioning and decreased blood flow to muscles may contribute to decreased strength and fatigue. Differences in metabolism and abnormalities in the hormonal substance that influences the activity of nerves may play a role.
• Psychological stress and hormonal changes also may be possible causes of fibromyalgia.

Complementary and alternative medicine

Under the concepts of functional medicine, assessment is oriented toward determining what is impeding your body’s ability to function normally. While some of the conventional medical approaches may help in this determination, they may not necessarily apply to a functional approach. Your healthcare provider will determine which assessment tools are most helpful in establishing a treatment strategy specific to your health needs.

Complementary and alternative therapies for pain and stress management aren’t new. Some, such as meditation and yoga, have been practiced for thousands of years. But their use has become more popular in recent years, especially with people who have chronic illnesses, such as fibromyalgia.

Several of these treatments do appear to safely relieve stress and reduce pain, and some are gaining acceptance in mainstream medicine. But many practices remain unproved because they haven’t been adequately studied. Some of the more common complementary and alternative treatments promoted for pain management include:

• Acupuncture: Acupuncture is a Chinese medical system based on restoring normal balance of life forces by inserting very fine needles through the skin to various depths. According to Western theories of acupuncture, the needles cause changes in blood flow and levels of neurotransmitters in the brain and spinal cord.
• Chiropractic care: This treatment is based on the philosophy that restricted movement in the spine may lead to pain and reduced function. Spinal adjustment (manipulation) is one form of therapy chiropractors use to treat restricted spinal mobility. The goal is to restore spinal movement and, as a result, improve function and decrease pain. Chiropractors are also able to talk to you about vitamins and supplements to manage the condition.
• Massage therapy: This is one of the oldest methods of health care still in practice. It involves use of different manipulative techniques to move your body’s muscles and soft tissues. The therapy aims to improve blood circulation in the muscle, increasing the flow of nutrients and eliminating waste products. Massage can reduce your heart rate, relax your muscles, improve range of motion in your joints and increase production of your body’s natural painkillers. It often helps relieve stress and anxiety.

Rear-end car collisions most commonly cause the injury, but collisions from the front and side, contact sports and convulsions can as well. Usually, someone in a stopped or slow-moving car gets hit from behind and doesn’t have time to react; the whole cervical acceleration-deceleration process takes only one-twentieth of a second. In rare and extreme cases, whiplash can cause a vertebral fracture, which can lead to severe spinal cord injuries. While the vast majority of whiplash injuries do not involve fractures that lead to instability, it’s important to have your healthcare practitioner evaluate and manage the injury. In severe cases, this may necessitate the use of an MRI or CAT scan, and possibly a cervical collar to stabilize the neck.

The cervical spine comprises seven vertebrae, which are the stacked bones of the spinal column. Ligaments attach to these vertebrae to provide stability and support the neck, and muscles attach to provide movement. There’s also a disk between every vertebra that acts like a shock absorber, and a capsule that surrounds the joints and provides stability by limiting their range of motion.

During whiplash, damage usually occurs when the neck overextends (moves too far backward), because while the chin prevents the head from moving too far forward, there’s little to stop it going back. This happens so quickly that the supporting structures can’t react. The ligaments and joint capsules usually get overstretched, the muscles get strained and the vertebrae are forced beyond their normal range of motion. When this happens, the whole spine can become stressed, causing changes in position, excessive inflammation and swelling. Sometimes, the trauma is so severe that it can even lead to visible changes in the spine’s shape. Even if you aren’t in pain and don’t see any change in the shape of your back, you should see your chiropractor after any whiplash injury.

For your chiropractor to offer proper care for your whiplash injury, it’s essential for you to remember the details of your accident. Were you wearing your seat belt? Was the car moving or stopped? What type of impact was it, rear or frontal? Did pain occur instantly? It’s challenging for chiropractors to care for whiplash injuries because of the variables they must consider. Answering your chiropractor’s questions as best you can will help with your care.

Some chiropractors categorize their diagnosis according to four stages. If you complain of some neck pain and stiffness, the injury falls into the category of grade one whiplash. If, however, you have lost motion in the neck and can’t flex, bend, extend or rotate it, your injury will fall into grade two. Grade three whiplash covers any injury that involves neurological symptoms such as numbness, weakness, tingling, or hot and cold sensations. Grade four is reserved for trauma that causes any sort of fracture in the spine.

After your chiropractor has diagnosed and classified your whiplash, he or she will get you started on a program of care. Initially, within the first 72 hours of your injury, he or she will probably recommend that you apply ice to your neck. This will prevent further swelling and reduce pain, by constricting blood vessels, numbing pain receptors and decreasing blood flow to the affected area. After the swelling has decreased, your chiropractor may gently mobilize your affected joints. He or she will perform this technique by gently moving your neck through its normal range of motion while your body is completely relaxed. This promotes circulation, stretches tight muscles, decreases the formation of scar tissue and lubricates the joints.

It may also be necessary for your chiropractor to perform an adjustment, also known as spinal manipulative therapy, to the cervical spine. This will return joints that are out of place to their correct position, increase the joints’ range of motion, relax tight muscles, increase blood flow and decrease inflammation.

In the initial stages of whiplash injury, your chiropractor may also care for you with physiotherapeutic tools like ultrasound and interferential current (IFC). Ultrasound refers to any sound wave that has a frequency above the range the human ear can perceive. Depending on the frequency, this can increase blood flow, decrease pain, reduce muscle spasm, lessen nerve root irritation, break down scar tissue and speed healing.

IFC works in a similar way, but sends electrical waves through the body instead of sound waves. These painless, mild electrical waves penetrate the skin into nerve fibers below, which causes the body to produce endorphins, its natural painkillers. By aiming the impulses at the cervical spine, your chiropractor can cause endorphins to interrupt the flow of pain signals from the affected tissues to the brain. IFC also helps decrease inflammation and speed up the healing process.

You should also avoid sports that put your neck at risk, like football, soccer and hockey, until your injury has fully healed. But that doesn’t mean you should be inactive. As soon as your pain decreases, your chiropractor will probably recommend that you perform a number of activities, including stretching, strengthening, proprioceptive, postural and aerobic exercises. These will help restore motion in your neck and strengthen muscles so that they are better able to provide support and stability.

By combining regular adjustments and therapy with an exercise program, you can overcome the symptoms of whiplash and avoid chronic symptoms that might otherwise linger for years.

The word migraine, derived from the Greek hemikrania, which means “half of the head,” refers to a throbbing pain in one side of the head that’s often accompanied by a stiff and tender neck, extreme sensitivity to light and noise, difficulty concentrating and nausea.

Despite the name’s origin, the pain may also travel throughout the entire head at times. The symptoms can last as little as four hours or as long as three days, and are often followed by a postdrome (after effect) phase during which patients feel exhausted and mentally inept.

Classic migraines also involve what health-care practitioners call an aura, which is a pre-migraine period lasting between 15 and 60 minutes that involves zigzag lines or shimmering stars in the field of vision. Some patients with the condition also report having blind spots and tunnel vision, and in rare instances report speech disturbances, confusion and odd sensations such as tingling, numbness or weakness in the arms or legs. Within an hour, the symptoms associated with the aura usually subside and the migraine headache pain develops.

All types of migraine headaches affect women more than men, by a ratio of about three to one. Genetics also plays a role, and the American Council for Headache Education reports that about 90% of people who get migraines have a family history of the condition.

Approximately 20% of people who have migraines will experience auras. Why some people get them and others don’t is still largely a mystery. In fact, researchers don’t even understand the exact cause of migraines in general. Currently, they’re focusing on the relationship between migraines and blood flow in the brain, electrical imbalances in cells, structural changes, and hormonal changes in the central nervous system in the hopes of uncovering the mechanism that causes the condition.

They already know, however, that a variety of things are correlated with migraines, including emotional stress, intense physical exertion, changes in the weather, environmental pollutants, certain medications, changes in sleep patterns and foods such as dairy products, red wine and chocolate.

Research also shows that people who get migraines, both with and without auras, have less frequent and less intense headaches after receiving proper care. If you get migraines with aura, your healthcare practitioner will investigate their nature by taking a detailed history of your condition and possibly performing a physical and neurological examination to rule out any organic causes, such as tumors. Following this, adequate care can begin.

Diagnosing the condition is not particularly difficult, but determining its true cause can be tricky. The main reason is that there are five structures that can irritate or aggravate the sciatic nerve. The structures that can cause sciatica are 1) a disk herniation (neurogenic sciatica); 2) a tight muscle (myogenic sciatica); 3) an irritated joint (scleretogenous sciatica); 4) a narrowing of the space where the nerve roots exit the spine (neurogenic claudication, also known as intervertebral foraminal encroachment); and 5) a space-occupying lesion (any kind of growth, such as a tumor) impinging on the sciatic nerve. Fortunately, healthcare practitioners have an expertise in differentiating between these different causes.

Chiropractic Care

Depending on the cause of your sciatica, your chiropractor will develop a care plan that is best for you. This will probably begin with a thorough assessment of the injury and its history, as well as a discussion of previous occurrences. Your chiropractor may also perform a comprehensive physical and neurological examination to assess your condition. In some cases, chiropractors also take x-rays or obtain an MRI to help determine the source of the problem. In such case, your chiropractor would review the test results with you, explain how he or she plans to manage your condition and set an immediate course of care. (In cases where the cause of the back pain is more serious, such as in the case of a tumor, your chiropractor will make an appropriate referral.)

Chiropractic care varies according to the cause of your sciatica. If muscles are involved, your chiropractor may co-manage you with a massage therapist. Alternately, you may benefit from electrical modalities such as interferential current or ultrasound, which help decrease inflammation and promote healing. In approximately 5% of cases involving disk herniation or other severe causes, surgery may be necessary. In such cases, your chiropractor would make an appropriate referral.

In most cases, your chiropractor will perform adjustments, otherwise known as spinal manipulative therapy to help correct subluxations or spinal joint dysfunctions that may be contributing to your condition. Adjustments help restore normal motion to joints and realign the spinal column. This helps to reduce pain and inflammation and allows surrounding structures, such as nerves and muscles, to heal and function properly. Other effective types of care include traction, acupuncture and, if necessary, over-the-counter anti-inflammatory medicines.

The bottom line? If you have a pain in the butt, or pain going down your leg, your chiropractor can determine its cause and implement an appropriate plan of care. Early care will generally result in a better prognosis and, with any luck, have you feeling better soon.