Low back pain. As ubiquitous as the air we breathe. Everyone knows someone who deals with low back pain on the daily. One person may get low back pain after sitting too long, another may get it while squatting, and yet another may get it when eating fatty foods. One person may have localized low back pain while another has leg pain accompanied by their low back pain. There are a lot of different types of low back pain, some scary, some not. Due to that fact it is hard to diagnose low back pain. This article (and subsequent low back articles) will discuss some of the common causes of low back pain, how to identify it, and most importantly, how to treat it.
Red Flags
- First, we should discuss some of the Red Flags of Low back pain. When dealing with low back pain there are a few conditions that can cause concern.
- Of course, cancer metastasizing to the back and infection are large concerns. This type of pain is typically constant, deep and boring, and it more noticeable at night. Heat and swelling around the joint may be present. There may be other symptoms present or not.
- Another is called Cauda Equina Syndrome. This is caused by compression of the nerve roots at the bottom of the spine. This can be caused by trauma, infection, tumor, or other space occupying lesion (including reduction of space due to ligamentum flavum hypertrophy or spinal foramen stenosis). The symptoms of this include intense low back pain, pain going down both legs, issues with urination, and paresthesia (numbness and/or tingling) in the inner thighs and groin area.
- In these emergent situations an MRI or other advanced imaging may be necessary. At this point conservative treatment options are not viable, and will often require surgery and other advanced treatment options. Always speak to your provider for specific information to you and what you are dealing with at this time.
Local versus Radicular
Next we are going to separate localized pain versus pain with radicular symptoms. Radicular pain will be addressed in another article.
Local
Local Pain includes pain that is localized to the low back. You don’t get pain that goes down into your legs or even your hips. This type of pain is usually achy or stiff. Moving can often time help, but can also cause the back to hurt more depending on the root cause.
Non-specific Low Back Pain (NSLBP)
Non-specific low back pain is the most common cause of low back pain. This is because the mechanism of pain is complex, as are humans and our lifestyles. There is typically inflammatory processes going on, overuse issues, and improper movement patterns. Non-specific low back pain can be as varied as its name suggests.
The best treatment for NSLBP is to find what works best for you. This is most often introducing exercise into your weekly routine. Strengthening the muscles and tissue within the low back can help provide a lot of relief. Changing your diet to be more anti-infammatory focused can also help. If you don’t want to make a whole lifestyle change taking supplements such as turmeric or other supplements can also help. Other
Other more passive treatment for NSLBP can be chiropractic, PT, acupuncture, and massage. These treatment methods should be adjuncts to a more active lifestyle.
Spondylolisthesis (Grade 1 and maybe 2)
Spondylolisthesis is when a segment of your spine slips forward on the bottom segment. This causes a narrowing of the spinal canal. Now, if there is no impingement on nerves the pain is typically manageable, intermittent, and local. However, the further grades will be included in the radicular section.
The cause includes trauma at some point. You may not know that a spondylolisthesis occurred at the time. Oftentimes people who played competitive football will have a spondylolisthesis that goes undiagnosed for years. Or it may be in the elderly population when degeneration causes enough deformation to the facet joints that the segment is able to slip forward.
This is usually worse with activity. Especially activity that requires lifting and extending the back. Laying on your stomach may be uncomfortable, and the pain is often relieved by bending forward (such as leaning on a counter or shopping cart).
The treatment for a grade 1 spondylolisthesis is strengthening of the core muscles, and stabilizing. Chiropractic, acupuncture, and PT should be considered to manage pain. However, extension adjustments and exercises should be discouraged. At this point surgery shouldn’t be considered, as it can fix the problem, but possibly not the pain.
Sprain/Strain
This is typically easy to identify. You were moving something heavy and your “back went out”. Difficult to move. Standing up straight is impossible. No pain down the legs, no numbness tingling, and no weakness. Heat tends to help this pain.
Unfortunately for this one time is the biggest healer here. Chiropractic and massage can help make the healing process quicker and easier, but your body will have to come out of the spasm.
Osteoarthritis
Osteoarthritis is a common cause of low back pain. This is typically experienced in the elderly population, however depending on lifestyle and genetics you may have osteoarthritis in the low back at an earlier age. This should fall in the NSLBP group however. The treatment aligns with the NSLBP diagnosis, and often osteoarthritis will be an ingredient in the NSLBP stew. There are a few situations that we should look at Osteoarthritis separately, and that is when it is so bad that the nerves are being encroached by an osteophyte or the pedicles (bone) of the spine. In this situation it will be included in the radicular article.
Herniated disc
Herniated disc (as I’m sure you’ve guessed) can belong to either local or radicular depending on the severity. If the disc has damage to the annular fibers (disc fibers) it can cause local pain. The cause is typically overuse or trauma. People who played physical sports or have a history of labor are likely candidates for a herniated disc. The best treatment is activity that promotes a strong core and movement. The body will heal itself depending, again, on the severity. The worse the disc is, the quicker it will prioritize the injury and heal it.
Chiropractic and PT can be very helpful in allowing the body to heal itself. It can also make the healing process more comfortable, and get you back to work in the duration.
Lumbar facet syndrome
This condition presents similar to spondylolisthesis in terms of symptoms. This may radiate pain down into the leg if it is severe enough. The facet joints (joints between the spinal segments) get irritated and inflamed. This bothers the sensory nerves around the joints and can send pain down the leg. The history usually includes overuse of standing and working overhead or lifting. Avoid Extension exercises and movements if possible.
Chiropractic is one of the best alternative choices for this condition. It helps the joints by lubricating them, reducing inflammation, and improving proprioception (the bodies ability to tell where it is in space) which helps with pain.
In Conclusion getting a handle on these conditions early can prevent the problems getting worse. Most of these conditions can progress to leg pain, but start as local. Being proactive about your back health can save you a lot of money and pain in the future. Chiropractic care is one of the most cost effective preventative treatment methods for staying healthy. However, you can not ignore a healthy active lifestyle as the best and most cost effective method.