low back pain chiropractic maintenance care

“Dr. Sellers, I think it’s just muscular.”

“What happened?” I ask.

The response is usually, “I’m not sure. I just woke up with it.”

As a chiropractor I hear this a lot in my office. On occasion it is true that the pain a patient presents with is just muscular. However, more often it is not.


First of all, a problem is never just muscular. Muscles move joints and what affects muscles affects the joints they move. Secondly, if a pain is purely muscular you won’t just wake with it. You will have done something to cause the muscle to hurt and will generally know what that “something” was. You will usually be able to associate your pain with an activity that over taxes or outright strains the muscle. If you injure or strain a muscle the pain is immediate. If you overtax a muscle it is possible that you will not feel it until the next day.

“So, if it’s not muscular, Doc, what is it?”

Good question! If 30 years of practicing chiropractic have taught me anything, it’s that nothing is ever as simple as it seems. There are a lot of things in the spine that can cause pain. Things we call pain generators. The three most common pain generators are discs, joints and nerves. Any of these, either alone or in combination, can lead a patient to believe that their pain is muscular.

Here’s what happens. When a disc, a joint or a nerve becomes inflamed, irritated or pinched the muscles that surround them begin to splint or tighten. This serves to protect the inflamed tissue. This tightness can be mild or it can be severe, like a spasm. The spasms are obviously painful. However, the less severe tightness can be too.

Why is that painful?

To help patients understand I ask them a few questions.

“What would happen if you were to do bicep curls all day long every day for a week or two?”

“Do you think your bicep muscle would become sore or painful?”

You bet it would. So, although the pain does not begin in the muscle it usually ends up there.

I fix the disc, joint or nerve problem and the muscle pain goes away.



Several years ago a friend and patient of mine was spending some time with his family at the beach. On one particular day he rose from the sand and began an easy jog toward the water. After three or four steps he experienced what he said felt like being struck in one of his calves with a baseball bat. He fell to the ground and was unable to rise and walk. After getting home, a visit to his orthopedist revealed that he had a rather severe spontaneous tear of his calf muscle. He spent a couple of months walking in a boot.

He had recently been on a round of the antibiotic, Cipro, and he knew that this drug could cause spontaneous tendon ruptures and muscle tears. That is what happened.

Cipro belongs to a class of drugs known as Fluoroquinolones. They are antibiotics commonly used to treat a variety of illnesses such as respiratory and urinary tract infections. These medicines include ciprofloxacin (Cipro), gemifloxacin (Factive), levofloxacin (Levaquin), moxifloxicin (Avelox), norfloxacin (Noroxin), and ofloxacin (Floxin). More than 23 million patients received a prescription for one of them in 2011.

Renata Albrecht, MD, who heads the FDA’s Division of Special Pathogen and Transplant Products, estimates that spontaneous ruptures occur in about one in 100,000 people. But, the agency says, taking the drugs appears to triple or quadruple the risk.

There are other bad things these drugs can cause. In a 2001 study by Dr. Jay Cohen, the following reaction rates were documented:
* Nervous system symptoms occurred in 91 percent of patients (pain, tingling and numbness, dizziness, malaise, weakness, headaches, anxiety and panic, loss of memory, psychosis)
* Musculoskeletal symptoms in 73 percent of patients (tendon ruptures, tendonitis, weakness, joint swelling)
* Sensory symptoms in 42 percent of patients (tinnitus, altered visual, olfactory, and auditory function)
* Cardiovascular symptoms in 36 percent of patients (tachycardia, shortness of breath, chest pain, palpitations)
* Skin reactions in 29 percent of patients (rashes, hair loss, sweating, intolerance to heat or cold)
* Gastrointestinal symptoms in 18 percent of patients (nausea, vomiting, diarrhea, abdominal pain)

The FDA has told companies that the drugs must now carry “black box” warnings alerting doctors and patients that the drugs can increase risk of tendinitis and tendon rupture in some patients. A “black box” warning is the FDA’s sternest warning.

A study published in Medical Science Monitor in 2014 showed that one of the drugs, levofloxacin, caused the cells in the discs of rat spines to break down . This is a particular importance to me as a chiropractor. If you have lower back pain and know that you have taken one of these drugs be sure to tell your chiropractor.

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