Ever wonder what goes through your chiropractor’s head when treating your moderate back pain? Using a patient as an example, Dr. Jimenez shares his thought process through treating a patient with moderate low back pain. All the way from the first appointment through to the recovery process.

Patient’s Background

• Louis is a 47-year-old programmer who plays tennis regularly, especially in tournaments.
• However, low back pain has put Louis’ game on hold as he cannot manage the pain with the regular heating pad, ice, and over-the-counter pain reliever.
• His primary physician referred him to Dr. Jimenez.

Louis is referred to chiropractic care

Dr. Jimenez: Louis’ primary physician referred him to me instead of a spine surgeon because the pain is not yet serious enough for surgery. And so, there was a window to treat with a non-invasive approach. Secondly, I specialize in sports medicine and so maximize conservative, non-operative techniques/methods.

The United States has five times the surgical rate of other countries, so going to a non-operative spine specialist/chiropractor is the best approach at the beginning before the pain becomes severe/acute/chronic.

Louis’ first appointment, medical history, and current back pain

Dr. Jimenez: Once I went through his medical history, I saw it was pretty straightforward. So I dug deeper into other areas of Louis’ lifestyle.

I asked about the following:

• Diet
• Physical activity
• Emotional well-being
• Smoking status

Also, a factor of his occupation was contributing to his pain. He’s a programmer, so spends a lot of time sitting at a desk.  Sitting for prolonged periods and usually improperly/with poor posture are two of the worst things you can do to your spine.

Sitting for a long time without moving around causes the hip muscles to get tight and the glutes and spine muscles to weaken.

Louis sits most of the day working and spends the weekend, if not doing house chores, then playing tennis. Just imagine using weakened muscles during the week and then jumping into a sports activity on the weekend will definitely cause pain.

Louis said that his pain would worsen when serving, hitting a forehand, and bending over to pick up a ball. The pain would ease down once he was resting and sleeping.

Louis’ physical exam

Dr. Jimenez: With the physical examination, I looked at

• Alignment
• Motion
• Inflexibilities (not just the spine but the hips and lower extremities)
• Muscular imbalances
• Weaknesses

I saw that Louis had a flattened lumbar lordosis, meaning the gentle curve in his low back was now flat. Restricted motion in one direction— or a flexion. And weakness in the buttock muscles and hips, and tightness in the lower extremity muscles.

Pushing on certain areas along his spine presented tenderness in the mid to lower lumbar spine and joint areas.

Initial treatment for Louis’ moderate low back pain

1. Chiropractic
2. Physical therapy
3. Exercises
4. Stretching
5. Re-education – proper sitting/standing
6. Diet
7. Foot orthotics, if necessary

 The best initial treatment is to work chiropractically on the spine and lower extremities’ muscular imbalances affecting the body’s biomechanics.

Other exams?

Dr. Jimenez: If necessary, a functional movement screening examination.

This test is used in sports medicine to check for imbalances from the feet all the way up to the neck.

After this, Louis would be tested to see if foot orthotics could help and receive specially designed exercises from a physical therapist to address the muscular imbalances.

Radiographic, CT, or MRI imaging

Dr. Jimenez: Many believe that imaging tests are essential to the diagnostic process.

My goal for Louis and all my patients is to get them pain-free, functional, and back to health.

Are imaging tests important?

Dr. Jimenez: Imaging tests are important when there are neurologic discoveries/complaints, like muscle weakness, sensory loss, and immobility, as this can indicate the need for surgery.

Imaging tests are helpful for guiding targeted treatment like an epidural injection.

And if your doctor believes something serious, e.g., a spinal tumor or infection, then get an imaging test right away.

Louis’ diagnosis

Dr. Jimenez: Because Louis’ pain worsened while playing tennis and then eased during sleep, I diagnosed him with mechanical low back pain.

This back pain occurs through mechanical activities or a load on the spine.

Non-mechanical low back pain is pain that exists all the time.

Thought process while developing Louis’ treatment plan

Dr. Jimenez: The treatment plan is focused on controlling pain and inflammation.

I first recommended chiropractic treatment, physical therapy/massage, and heat/ice compress.

After completing the course of treatment, I suggested Louis take naturally derived supplements:

• Turmeric
• Bromelain
• High-dose omega 3’s

This would help reduce inflammation.

They have been proven effective without the serious side effects of over-the-counter and prescription medications.

Louis and I also discussed his diet

I recommended cutting back on carbohydrate and processed sugar intake, thus curbing inflammation and upping healthy fat consumption of natural sugars that are found in nuts and berries.

I taught Louis proper basic movement techniques, including positioning himself at work and stretches to do throughout the day.

I suggested that Louis work with a fitness physical therapist to build strength and flexibility, which would take shape in 4 to 6 weeks.

After a few sessions, the goal is to be able to do the exercises without help.

Return to Tennis

Dr. Jimenez:  Very soon, as long as he uses his natural anti-inflammatory supplements and follows through with regular chiropractic/physical therapy.

Slow and steady is the key to pain relief. Jumping into a tennis set before finishing treatment would set him back and possibly cause new injuries.

I recommended he start by playing non-competitive tennis and just rally after completing the treatment and then take a day or 2 to see how it feels.

Taking it slow should bring back full strength within two months after the initial visit.

Preventive tips:

A proper tennis swing should put minimal force on the spine.

• Tennis professionals start, stop, jump, slide, dive, run, and run. That is where a significant overload of the lower back occurs, and all the energy goes right into the spine.
• The key to a proper swing is to rotate the hips, take the proper arm swing, and hit through the ball.
• If you don’t have proper hip rotation, your body will pay for it through the spine.
• Bending at the hips and knees when picking up balls will greatly reduce stress on your low back.
• Work with a tennis pro to teach proper swing and specific tennis training, especially movement.

 

 

This will help you play well, alleviate/avoid back pain and enjoy the game.

---

Low Back Pain Chiropractic Care

 

David Garcia developed moderate low back pain, gradually affecting his quality of life. As his painful symptoms worsened, David Garcia could not walk, and his low back pain became unbearable. He first visited Dr. Alex Jimenez, a chiropractor in El Paso, TX, after a recommendation from his sister. Dr. Jimenez was able to provide David Garcia with the help he deserved for his low back pain, restoring his quality of life. David Garcia describes the wonderful service Dr. Alex Jimenez and his staff have given him to relieve his painful symptoms. He highly recommends chiropractic care as the non-surgical choice for moderate low back pain, among other health issues.

---

NCBI Resources

A chiropractor is the ideal medical professional to consult with for any unexplained pain in the musculoskeletal system. They are highly qualified professionals whose specialty is treating conditions like moderate lower back pain, and they are very affordable. 31 million Americans experience moderate low back pain at any given time. This condition affects many, but finding the exact cause can be challenging. Chiropractors are spinal specialists that are trained to not only alleviate pain but also find and help correct the cause of the problem.