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Left Side Lower Back Pain: Effective Relief Techniques

Should individuals experiencing lower left back pain see a healthcare provider if it lasts more than a few weeks?

Left Side Lower Back Pain

Lower left back pain can impact your ability to go about your day. If left-side lower back pain lasts longer than a week, it is considered chronic back pain, which can severely impact one’s quality of life. This type of pain has various causes. Muscle or spine and nerve damage, including sciatica, can cause pain. Organs in the lower back, including the kidneys, can cause pain. Pregnancy-related changes, fibromyalgia, and other conditions can cause lower left-side back pain in females.

Causes

Back pain is common and affects almost everyone. (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2023) Lower left back pain can have many causes, ranging from muscle and spine issues to organ infections. One way to help tell what’s causing the symptoms is to determine whether there is also sciatica, sharp or burning pain that radiates down one side of the body. It happens when the sciatic nerve gets compressed or irritated. Possible causes include (Penn Medicine, 2020)

Muscle Injury

  • A muscle injury from an accident or injury can be a cause that can appear with or without sciatica.
  • If this is the cause, you’ll notice that the pain improves with rest but worsens after you’ve sat for a long time or after getting up from sleep.
  • There may also be a limited range of motion, tenderness, or swelling.

Arthritis or Bone Conditions

  • Arthritis and bone issues, like osteoporosis, can also be a cause.
  • This can happen if the arthritis is in the left hip or the root cause is on the right side, but the body compensates by overusing muscles on the left side of the back.

Unhealthy Posture and Body Positioning

  • Unhealthy postures and body positioning can contribute to back pain and musculoskeletal problems.
  • To avoid straining the muscles, try sitting and standing straight and keeping all the joints at a 90-degree angle.
  • Move around every 20-30 minutes and stretch out.

Kidneys

  • The kidneys are located in the middle back.
  • Kidney infections or kidney stones could cause pain on the left side.
  • Other symptoms include pain when urinating, fever, and nausea.

Ulcerative Colitis

  • Ulcerative colitis, inflammation of the large intestine, can also cause lower left back pain in some cases.
  • If this is the cause, there may also be abdominal pain, cramping, nausea, and fatigue.

Uterine-Related Pain

  • Several conditions related to the uterus can cause back pain symptoms, including PMS, period cramps, endometriosis, and more.
  • Sometimes, these conditions cause pain on both sides, but some individuals may experience pain just on the left side.

Pregnancy

  • The weight gain, hormonal changes, and limited movement can also contribute to lower left back pain. (Cedars Sinai, 2024)

Spinal Disease

Sciatica

Some causes can also cause sciatica.

In many cases, over-the-counter anti-inflammatory medications can help with sciatica. If it persists, it is recommended to see your healthcare provider to find the root cause. The causes include: (Aguilar-Shea, A. L. et al., 2022)

Herniated disc

  • A disc that pops out of place can add pressure to the sciatic nerve.

Spinal Stenosis

  • Spinal stenosis, or spine narrowing, can also cause sciatic symptoms.

Spondylolisthesis

  • Occurs when vertebrae are out of alignment, leading to sciatic symptoms.

Pregnancy

  • Pregnancy-related growth and bodily changes oftentimes lead to sciatic nerve symptoms and sensations.

Muscle Spasms

  • Spasms like piriformis syndrome, a spasm of the muscle in the buttocks, can cause back pain.

Surgery

  • It’s normal to have back pain for up to six weeks after a back procedure.
  • However, if there is new or worsening lower left back pain after surgery, consult the healthcare provider. (Penn Medicine, 2017)

Describing Symptoms

Knowing how to describe your symptoms when seeing a healthcare provider is helpful. Answering these questions can help explain symptoms (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2023)

  1. Have you had any accidents or injuries?
  2. Did the pain come on suddenly or gradually?
  3. Are you experiencing any limits to your range of motion?
  4. Do you have any numbness or tingling?
  5. What helps with the pain?
  6. What makes the pain worse?
  7. Do you have other symptoms, like a fever or trouble urinating?

Self Care

  • Self-care includes rest, ice, heat, and over-the-counter anti-inflammatory medications.
  • Non-steroidal anti-inflammatory drugs can help with pain.
  • Sleeping on a firm mattress and maintaining a healthy posture can help manage and improve symptoms. (See Q. Y., Tan J. B., & Kumar D. S. 2021)

Prescribed Treatment

  • Your healthcare provider may recommend massage, chiropractic care, and acupuncture treatments.
  • If pain can’t be managed at home, your healthcare provider may suggest prescription medications, including muscle relaxers.
  • These can allow the tissue to heal and reduce your pain as well.
  • If you have severe sciatica or vertebrae that have slipped out of place, the healthcare team might recommend a steroid injection into the lower left back to reduce pain by reducing inflammation.
  • In addition to prescription treatments, your healthcare provider might recommend physical therapy to retrain movements, build strength, and help prevent back pain.

Moving Around

It’s important not to move too much. Rest is important for healing, although don’t stop moving entirely. These tips can also help (National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2023)

  • Sleep on a firm mattress that will support your back.
  • Get a comfortable, ergonomic chair for your job.
  • If you work on your feet, learn to practice healthy posture and use shoes and insoles to facilitate and maintain correct posture.
  • Once you’ve healed, building your core strength may help avoid lower back pain in the future.

Injury Medical Chiropractic and Functional Medicine Clinic

Talk with a healthcare provider and request a referral to a specialist who can help with long-term management. Injury Medical Chiropractic and Functional Medicine Clinic works with primary healthcare providers and specialists to build optimal health and wellness solutions. We focus on what works for you to relieve pain, restore function, prevent injury, and mitigate issues through adjustments that help the body realign itself. The clinic can also work with other medical professionals to integrate a treatment plan to resolve musculoskeletal problems.

Lower Back Pain Chiropractor Treatment

References

National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2023). Back pain. Retrieved from https://www.niams.nih.gov/health-topics/back-pain

Penn Medicine, B. T., MD. (2020). 4 reasons you may have back pain on only one side. Penn Medicine. https://www.pennmedicine.org/updates/blogs/musculoskeletal-and-rheumatology/2017/november/back-pain-on-one-side

Cedars Sinai. (2024). Back pain during pregnancy. https://www.cedars-sinai.org/health-library/diseases-and-conditions/b/back-pain-during-pregnancy.html

Aguilar-Shea, A. L., Gallardo-Mayo, C., Sanz-González, R., & Paredes, I. (2022). Sciatica. Management for family physicians. Journal of family medicine and primary care, 11(8), 4174–4179. https://doi.org/10.4103/jfmpc.jfmpc_1061_21

Penn Medicine, V. G., MD. (2017). Back pain that won’t go away—even with surgery. Penn Medicine. https://www.pennmedicine.org/updates/blogs/musculoskeletal-and-rheumatology/2017/november/back-pain-that-wont-go-away

See, Q. Y., Tan, J. B., & Kumar, D. S. (2021). Acute low back pain: diagnosis and management. Singapore Medical Journal, 62(6), 271–275. https://doi.org/10.11622/smedj.2021086

By admin 0 Comments Chiropractic Care , , , , , , , , , , , , , , , , , ,

The Importance of the Long Thoracic Nerve in Shoulder Function

Can understanding the anatomy and function of the long thoracic nerve help individuals make informed healthcare decisions after an injury to the nerve?

Long Thoracic Nerve

Also referred to as the posterior thoracic nerve, the long thoracic nerve/LTN is a thin superficial nerve that runs from the cervical spine to the chest wall side of the trunk. It supplies motor function to the thorax’s serratus anterior muscle, helping stabilize the shoulder blade. Injury to this nerve can cause limited or abnormal shoulder and shoulder blade motion, including difficulty raising the arm during overhead reaching.

Anatomy

The long thoracic nerve originates from the ventral rami of cervical nerves C5, C6, and C7. (Waxenbaum JA, Reddy V, Bordoni B. 2023) In some individuals, the root from C7 is absent; in others, a small nerve root branches from C8. The nerve roots from C5 and C6 go through the medial scalene muscle to join the C7 nerve. It travels behind the brachial plexus axillary artery and vein and courses down the lateral side of the thorax. The long thoracic nerve terminates at the lower portion of the serratus anterior muscle, sending small nerve tendrils to each muscle’s projections, which attach to the ribs. Because the long thoracic nerve is located on the lateral side of the chest, it is vulnerable to injury during sports or surgical procedures. The nerve also has a smaller diameter than other cervical and brachial plexus nerves, which increases its potential for injury.

Function

The long thoracic nerve attaches to the underside of the shoulder blade and inserts as muscular slips into the ribs. It supplies motor function to the serratus anterior muscle, essential for normal shoulder motion. When it contracts, it pulls the shoulder blade against the ribs and thorax, helping to move and stabilize the arm as it moves forward and up during shoulder motions. Injury to the long thoracic nerve causes a condition called scapular winging. This occurs when the serratus anterior muscle becomes weakened or paralyzed after injury. (Lung K, St Lucia K, Lui F. 2024)

Susceptibility to Injury

The LTN is relatively unprotected and can be damaged by several things, including:

  • Heavy backpacks
  • Sports
  • Activities the body is not used to, like digging
  • Using crutches

Conditions

Injury to the long thoracic nerve may occur as a result of trauma, lifting heavy weights above the shoulder, or a surgical procedure. Surgical procedures that may place the nerve at risk for injury may include: (Lung K, St Lucia K, Lui F. 2024)

  • Axillary lymph node dissection
  • Improperly placed intercostal drains
  • Chest tube placements
  • Mastectomy
  • Thoracotomy

The long thoracic nerve is protected during these procedures by the surgeon and proper surgical technique, but occasionally, difficulties arise during surgery, and the nerve may become injured. Individuals may also have an anatomical variance that places their nerves in varying positions. The surgeon may not see it and accidentally injure their nerves during surgery.

The superficial long thoracic nerve may also be injured during sports or trauma to the trunk. A blow to the side or a sudden overhead stretch to the shoulder may be enough to damage the nerve, paralyzing the serratus anterior muscle.

Weakness or paralysis of the serratus anterior muscle will result in a winged scapula. To test for this:

  • Stand about two feet from a wall, facing it.
  • Place both hands on the wall and gently push against it.
  • If one of the shoulder blades sticks out abnormally, it could be a winged scapula.
  • Have a family member or friend stand behind you and check the shoulder blade position.
  • If you suspect a winged scapula, visit a physician who can assess the condition and determine if there is a long thoracic nerve injury.

Winging the scapula may result in difficulty lifting the arm overhead. The serratus anterior muscle works with other scapular stabilizers, such as the upper trapezius and levator scapula, to properly position the shoulder blade when lifting the arm. Failure of the serratus to stabilize the shoulder blade may make lifting the arm impossible.

Clinical examination is usually used to diagnose a long thoracic nerve injury. X-rays and MRIs cannot show the nerve injury directly, although an MRI can show some secondary signs to help confirm the diagnosis. An electromyographic or EMG test may also be performed to examine the function of the long thoracic nerve.

Treatment and Rehabilitation

Treatment for LTN pain and reduced movement may include:

  • Rest
  • Heat or ice
  • Anti-inflammatory pain medication
  • Neck support or a pillow
  • Avoiding strenuous activity and driving

If the long thoracic nerve is severely injured and the serratus anterior is completely paralyzed, the best course of action is to be active and monitor the condition. Full recovery of arm function can take one to two years. If permanent nerve injury has occurred, surgery may be an option to restore shoulder motion and function. Several different kinds of surgery can be used to address winged scapula. (Vetter M. et al., 2017)

  • One involves transferring the pectoralis major tendon to the scapula (Vetter M. et al., 2017) so it functions as the serratus.
  • Often, the tendon has to be lengthened, which may be done using part of the hamstring tendon.
  • After surgery, individuals will likely wear a sling on their arm for a few weeks, and then gentle range-of-motion exercises will be initiated.
  • After eight to ten weeks, gentle progressive strengthening of the new tendon can begin.
  • Full shoulder motion and strength recovery are expected six to 12 months after surgery.

Physical therapy may be used to help improve serratus anterior functions. (Berthold J. B., Burg T. M., & Nussbaum R. P. 2017) Exercises to strengthen serratus function may include:

Supine Punches

  • Lie on your back and raise both arms toward the ceiling.
  • Make a fist and punch up toward the ceiling.
  • Ensure the motion is steady and deliberate, and keep the elbow straight.
  • Hold the position for three seconds, then slowly lower the arm to the starting position.
  • Perform 10 to 15 repetitions.
  • Holding a small dumbbell in your hands can make the exercise more challenging.

Pushup

  • Lie on your stomach and place your hands flat on the ground by your shoulders as if you were going to perform a pushup.
  • Perform a pushup and press further, allowing the shoulder blades to wrap around the thorax.
  • Hold this position for three seconds, and slowly release.
  • Perform 10 to 15 reps.
  • If this is too difficult, perform the pushup against a wall to reduce the effect of gravity on the exercise.

Scapular Winging in Depth

References

Waxenbaum, J. A., Reddy, V., & Bordoni, B. (2024). Anatomy, Head and Neck: Cervical Nerves. In StatPearls. https://www.ncbi.nlm.nih.gov/pubmed/30844163

Lung, K., St Lucia, K., & Lui, F. (2024). Anatomy, Thorax, Serratus Anterior Muscles. In StatPearls. https://www.ncbi.nlm.nih.gov/pubmed/30285352

Vetter, M., Charran, O., Yilmaz, E., Edwards, B., Muhleman, M. A., Oskouian, R. J., Tubbs, R. S., & Loukas, M. (2017). Winged Scapula: A Comprehensive Review of Surgical Treatment. Cureus, 9(12), e1923. https://doi.org/10.7759/cureus.1923

Berthold, J. B., Burg, T. M., & Nussbaum, R. P. (2017). Long Thoracic Nerve Injury Caused by Overhead Weight Lifting Leading to Scapular Dyskinesis and Medial Scapular Winging. The Journal of the American Osteopathic Association, 117(2), 133–137. https://doi.org/10.7556/jaoa.2017.025