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NO.1 Low back pain

Do you know what is actually causing low back pain? I referred to some specialized books for information about low back pain.

At fast, I referred the representative textbook of Neurology.

“The most common cause of low back pain is herniated nucleus pulposus, but it is difficult to determine the exact frequency because acute attacks usually clear spontaneously, and chronic low back pain is colored by psychologic factors....

The pain of an acute lumbar disc herniation is so stereotyped that the diagnosis may be made even if there are no reflex, motor, or sensory changes. Chronic low back pain is a different matter. If neurologic abnormalities are present on examination, MRI is often indicated to determine whether the problem is caused by tumor, lumber spondylosis with or without spinal stenosis, or arachnoiditis.

If there are no
neurologic abnormalities or if the patient has already had a laminectomy, chronic low back pain may pose a diagnostic and therapeutic dilemma. …”

Lewis P. Roland ; Low back pain  pp35-36  Chapter 8 Diagnosis of pain and paresthesias,  Merritt`s Neurology 12 edition ; 2010 by Lippincott Wiiliams & Wilkins

To sum up, the lumber disk herniation may be accepted as a given cause of low back pain, even if there is no sign and symptom. Since a laminectomy might be the best treatment, chronic low back pain may pose a diagnostic and therapeutic dilemma. I think that is not true.

 Secondary, I checked two standard textbooks of internal medicine for primary care physicians.

“The differential diagnosis is broad and includes muscular strain, primary spine disease ( eg. disc herniation, degenerative arthritis), systemic diseases (eg. metastatic cancer), and regional diseases (eg. aortic aneurysm) A precise diagnosis cannot be made in the majority of cases.

Even when anatomic defects—such as vertebral osteophytes or a narrowed disc space—are present, causality cannot be assumed since such defects. The diagnostic challenge is to identify those patients who require more extensive or urgent evaluation.

In practice, this means identifying those patients with pain caused by (1) infection, (2) cancer, (3) inflammatory back disease such as ankylosing spondylitis, or (4) pain referred from abdominal or pelvic processes, such as penetrating peptic ulcer or expanding aortic aneurysm.”

David B. Hellmann, John B. Imboden Jr. ; Low back pain pp712-714  Chapter 20 Current medical diagnosis & treatment 2008 47 edition by the McGraw-Hill Companies, Inc.

The above is too good to miss serious conditions. The cause of low back pain would remain unclear.

 “Most back pain is caused by musculoligamentous strain, degenerative disc disease, or facet arthritis and responds to symptomatic treatment. … Occasionally, back pain may result from problems originating outside the spinal axis. … “

Allan H.Goroll, Albert G. Mulley, Jr. ; Evaluation of  back pain pp955-970 Chapter 147 2006 by Lippincott Wiiliams & Wilkins

 We ( S.Tsuchida and K. Ikeya) have mainly treated the sacroiliac joint dysfunction of many patients with the arthro-kinematic approach-Hakata method.

This dysfunction at a fraction of the time. Whether patients suffer from acute low back pain or from chronic low back pain, we evaluate the function of the sacroiliac joint and treat abnormalities of the intra-articular movements such as joint play, rolling, sliding, and spinning of the joint surface.

Accordingly, low back pain might actually disappear or reduce in a moment. We can treat single joint in extremity and trunk, including facet, sacroiliac, costal joints.

 Joint dysfunction may induce several symptoms such as the blow.
1. pain : motion pain, tenderness, referred pain
2. limited range of motion
3. abnormal sensation : paresthesia, hypesthesia, cold-feeling, etc
4. muscle spasm
5. muscle weakness and mild muscle atrophy
6. swelling and redness
7. hardening of skin
8. others : blurred vision, tinnitus, etc.


    Please come on my clinic to consult your low back pain.

 
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