Low Back Pain: What You Need to Know

Low Back Pain:  What You Need to Know

Low back pain is one of the most common conditions in the U.S, affecting approximately 80% of adults.  Low back pain ranges in intensity, frequency and duration, and may include leg pain and other symptoms as well.

Types of Low Back Pain

Axial Low back pain, the most common type of back pain, is confined to the lower back only. This type of low back pain does not travel into the buttocks or legs.  The pain usually worsens with certain activities (such as sports) or physical positions (such as sitting for long periods) and is relieved by rest.

Lumbar radiculopathy 

(sciatica) is the second most common type of back pain.  Caused by conditions that compress the nerve roots of the sciatic nerve, the pain is frequently more severe in the leg than in the back.  Pain or weakness is only felt on one side and can affect the buttock, leg and foot.

Low back pain with referred pain is pain in the lower back that also radiates to the groin, buttock and upper thigh, but rarely below the knee.  Patients describe the pain as dull and achy, often deep inside the leg with varying intensities.  Low back pain with referred pain is similar to axial pain, but often includes leg symptoms.

Diagnosis

In many cases, specific diagnosis of the cause of pain is sometimes not easy to clearly identify as many of the potentially painful low back structures share similar symptoms.  However, a clear understanding of the patient’s history, obtaining the results from a few clinical tests and identifying the type or category of back pain (described above) often is enough for a specialist to recommend treatment.

Imaging tests, such as an MRI and CT-myelogram, can help determine a diagnosis.

Patients with the same condition may experience pain differently, causing minor irritation to one while incapacitating another.

Common Causes and Symptoms of Low Back Pain

Muscle and ligament strains and sprains: Lifting a heavy object, twisting, or a sudden movement can cause muscles or ligaments to stretch or tear.  The pain is usually localized just in the low back (axial) and can be so severe that the patient is unable to walk or stand.

Lumbar disc herniation: A herniated disc in the lower spine puts direct pressure on the nerve roots that make up the sciatic nerve, causing pain to radiate in to the buttocks, leg and foot (sciatica).

Degenerative disc disease:  Even in young adults, spinal discs may begin to degenerate.  While some people never feel symptoms, others experience chronic, fluctuating low back pain that worsens with certain positions or activities.

Osteoarthritis: Facet joint osteoarthritis is a gradual breakdown of the cartilage that serves as a cushion between the facet joints in the spine.  Friction between the facet joints causes inflammation, triggering pain and stiffness.

Spinal stenosis:  Some conditions, including facet joint osteoarthritis, cause bone spurs to form on the facet joints.  When the bone spurs press on the sciatic nerve roots, they cause pain and numbness that can affect the buttocks, leg and foot.

Treatment Options for Low Back Pain

Treatment for lower back pain depends upon the patient’s history and the type and severity of pain.  The vast majority of lower back pain cases get better within six weeks and with nonsurgical treatment.

Rest

Resting for 1 to 2 days allows injured muscles, ligaments and even nerve roots to begin healing.  However, rest for more than a few days can lead to muscle atrophy, which can worsen low back pain because the weakened muscles do not adequately support the spine.

Heat vs. ICE

While heat packs may feel good, it is my experience that the first 24 to 48 hours of a new injury ICE should be the choice to help relieve most types of low back pain.  Usually ice is applied for approximately 20 minutes and repeated every 1-2 hours.  Rarely people find more relief with heat.  The important thing to understand is that heat causes tissues to swell, ice helps swelling to shrink. The swelling is normally the cause of the most common types of low back pain. Heat and Ice may be alternated which functions like a “pump” to remove swelling. Use heat first for 10 minutes then follow up with ice for 20 minutes.

Chiropractic Manipulation

Chiropractic manual manipulation focuses on improving spinal function to increase spinal range of motion, decrease pain and inflammation, and improve overall physical functioning.

Chiropractic manipulation typically involves a controlled, sudden force applied to a spinal segment to normalize motion and improve function.  Adjustments may be performed using high-velocity or low-velocity techniques.

Reducing joint restriction and restoring function allows the local inflammation and pain reflex responses to begin to subside.

In some cases, an accompanying, audible release of gas (joint cavitation or cracking) that is caused by the release of oxygen, nitrogen, and carbon dioxide, may be heard.  This is a phenomenon and has no known physiological effect, but signifies that pressure was released from the joint.

A relieving sensation is usually perceived.  Less frequently, minor discomfort may occur (that usually resolves with a few hours) if the surrounding muscles are in spasm or tense.

Exercise and Stretching

A central component of almost any lower back pain treatment plan includes aerobic conditioning, stretching and strengthening, which builds stronger support for the spine to help prevent future episodes of back pain. In our office we use very specific core conditioning to improve the risk factors of having the condition return.

Other Possible Treatments

In our office we use other therapies including ultrasound, electrotherapy/TENS, acupuncture, various forms of traction, massage therapy and other techniques, depending on the specific cause of the low back pain.

Beyond Chiropractic Care

As appropriate, I will refer a patient to other healthcare professionals as part of the patient’s treatment plan, such as a physical therapist, physiatrist, pain management physician or spine surgeon.  For example, if the pain is severe or has not improved within a reasonable time frame, I may refer the patient for an epidural steroid injection or surgery consult.