Mike came in yesterday with sciatic pain. It was traveling from his low back into his butt and upper leg. it was mostly on the right side, but was occasional on both sides. it started in the middle and traveled down the leg to mid-thigh. the pain did not travel past the knee. as you know, sciatic pain has many causes so we looked at all the possible injuries during examination.
When we did our orthopedic testing, we did not see any big bad nasty signs of injury. By that I mean lumbar disc herniations, central canal occupying lesions, or major entrapments that make us nervous. The tests showed the injury was centralized to the low back joints. Specifically, it involved the lumbar facet joints.
Facet joints are located on the back portion of the lumbar vertebrae. The joints are weight bearing, but allow for an incredible amount of movement. They help us to flex, extend, and rotate while supporting our body weight. We couldn't do anything without the facet joints.
Facet joints also have pain sensors in them that scream at the brain. When a facet joint is injured, you know it. Muscle spasms and pain quickly follow any injury.
Facet joints respond to movement. Our treatments involve decreasing the muscle spasms with electric therapy. We can use a variety of treatments to block back pain, including ice, heat, cold laser, or massage therapy.
Chiropractic manipulation is a great treatment for opening up the facet joints. We utilize traditional crack and pop movements, Activator Technique, or Drop Table Adjustments. The joints really do not care what makes them move, just that they are moving.
Flexion distraction therapy is a common treatment with facet sprains. Flexion distraction helps pull the joints a part and relieve the stress. This pulling motion decreases the pain signals sent to the brain and decreases the spasms. Flexion distraction can be performed on someone in extreme pain or someone with a little stiffness. The intensity of the pull is controlled by the provider, who is feeling for muscle spasms and other signs the body does not want the joint to move further.
We commonly combine flexion distraction with intersegmental traction to further increase the motion in the back. Intersegmental traction provides a slow and controlled rock in the joints that increases motion and decreases pain. It is set to your level of comfort.
I like to describe joint motion by my rusty door hinge theory. A rusty hinge does not want to move but it needs to. you can make a rusty hinge move by kicking it open (which doesn't work too well on people). a repetitive slow and controlled rock works very well to (preferred by most people in pain).
Mike responded very well to flexion distraction therapy and intersegmental traction therapy. During flexion distraction he felt immediate relief. He could feel the joints loosen and the table moving further. His pain was cut in half after the treatment.
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