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low back information

Volumes of information can and have been written regarding spine pain (the neck and low back seem to get the most attention). The purpose of these pages are to help give you a better understanding of the pain and it's many causes. Although this is a good starting point, it is not meant to be, nor should it be used as a self diagnostic tool. If you are experiencing pain, please seek Professional Medical attention. These pages are only meant to help you better understand some of the terminology and concepts that may be presented to you by your physician or other healthcare provider when you see them. Some back (or neck) injuries have the potential to cause irreversible damage if not treated quickly. If for example you have urinary retention, it may be caused by compression of the spinal nerves. This is considered a medical emergency and requires prompt medical attention. Low back pain is often self limiting and often resolves on it's own within a few days. Still, with a reoccurrence rate that has been published as high as 84% (Heiderscheit, B.and Sherry, M., 2007) with an average relapse rate of 58% (McKenzie, R., May, S., 2003) it is often still important to see a professional so that you can learn how to stop that from occuring.

Some statistics:

Anatomy the low back (lumbar spine)

In a very simplified manner we can consider the spine as a bunch of bones (Vertebrae) stacked up one on top of another. In between the bones are the Intervertebral discs. There are also ligaments that help hold everything in proper alignment and lastly (in this simplified description) there are Facet joints.

The discs help join the Vertebra from above and below together. More importantly they act as a shock absorber. They are like a Jelly doughnut and have a tough outer part (the Annular wall) and a more soft jell like inner part (the nucleus pulposus) . They act like shock absorbors and like a shock from a car they can be damaged. This may include: rupture (herniation), being over stretched, torn, losing height and flexibility, or they simply may be irritated and swollen from a trauma.

Nerve roots exit from in-between the Vertebras thru the Intervertebral foramen. The lumbar nerves blend together to form the Sciatic nerve that is responsible for the very well known "sciatica" (pain going from the back down the leg). Click below on the name of a structure that you would like to know more about.

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So what causes low back pain?

Well, this is not so easy to answer. There can be many reasons and the truth is we still have a lot to learn about back pain. There are bulging discstill a lot of unknowns. In one study where they tested structures during surgery the top contenders for causing significant pain in the leg from the back were the Nerve root (90%) and the Annulus (45%). Of course there were other structures that did too but they were much less staistically significant. As for causing some pain, muscles were found to be responsible 41% of the time when stimulated. It is my feeling that muscles are rarely the sole culprit. Maybe that's because when that is the case, it resolves on it's own. They don't ever make it to my clinic so I just don't see it. Usually if a person I see is having a lot of muscle spasm it's because a structure below it is injured. The muscle is doing it's best to immobilize that structure. Treat the structure below, and the muscle guarding and pain often go away without any direct attention or intervention.

The fact of the matter is that even an MRI which is a minimally invasive diagnostic tools can be misleading (and they are costly). In healthy people with no history of Low Back Pain it is not uncommon to find abnormal discs on an MRI. A good clinical exam is often the best and most cost effective way to figure out where the pain is coming from. What if you feel great laying down and that's how you are for the MRI? Is that useful? A good clinical exam will take into account what produces or reduces your pain to help determine why you have it. Once we know that we know how to treat it. That being said, MRI's are still a valuable tool depending on the intervention being performed and practioneer you are seeing. They just may not be needed in a lot of cases of low back pain.

Seek out a medical professional and they will help you alleviate your pain, or at least refer you to someone that can. The exam will shed light on what structure it could be and treatment will be provided accordingly. MRI's are not usually warranted except under certain circumstances. If you already have an MRI I encourage you to not be so wrapped up in the findings. Rather be concerned about what specific structure is causing the pain, what can be done to alleviate it and stop it from happening again in the future.

So what's the treatment for low back pain?

Tough to answer, and it will likely depend on what type of practitioner you go to. If it is a conservative treatment like PT, the goal will usually be to restore balance in the spine and body. That can occur in many ways such as with mobilizations, Lumbar Decompression (VAX D), Myofascial Release, strengthening exercises, and postural changes. We will look for reasons why you developed pain in the first place. If you are like many people there was not one specific episode that started it all. Your activities, postures, muscle imbalances, tightness, or weakness may all gradually contribute to a developing pain in the back (or neck). If there is a lot of pain and spasm we may use modalities to help the muscles relax and speed the healing. It is important to get reduction of inflammation in the tissues below. Things like Ultrasound, moist heat, and ice can help with that. Still, the underlying mechanical problem must be addressed.

There is no one generic treatment. It will vary because we are all individuals with our own set of specific issues. However, there are a lot of commonalities amongst patients with low back pain. Like weak core muscles for example, or a history of a herniated disc, or poor posture. Because of that it is not uncommon for people to have very similar treatments that they respond well too. However, that can only be determined once an evaluation is completed.

What about neck pain?

The neck and back have a lot of similarities, but also a lot of differences. Many of the same tools can be used such as modalities, mobilizations to get proper alignment, and traction to open up the disc spaces (like the VAX D) taking pressure off the nerves and helping reduce bulging discs. Muscular weakness and alignment issues also occur in the neck. It is not uncommon to have an underlying shoulder problem that is the cause of your neck pain. Of course there is Whiplash too which can leave a person with a lot of muscle and soft tissue pain. Once again it is difficult to pin point a treatment without having an actual patient and their specific circumstances to address. Your clinician will help identify the causing factors and help you to make the needed corrections to return to a painfree situation.

Reference list:

  • Croft, P, Papagergiou A, McNally R, (1997). Low Back Pain - Health Care Needs Assessment Radcliff Medical Press, Oxfor
  • Heiderscheit, B. and Sherry, M., (2007). Evidence-Based Sports Medicine (2nd edition): What effect do core strength and stability have on injury prevention and recovery?, page 63. (Domhnall, M., Ed., Thomas, B., Ed.). BMJ Books.
  • Frank, JW, Kerr MS, Brooker AS et al. (1996). Disability resulting from occupational low back pain. Part 1: What do we know about primary prevention? A review of the scientific evidence on prevention before disability begins. Spine 21.2908-2917.
  • McKenzie, R., May, S. (2003) The lumbar spine mechanical diagnosis and therapy, volume 1. Waikanae, New Zealand: Spinal Publications New Zealand LTD.
  • Netter, Frank H., M.D., Sharon Colacino, Ph.D, Consulting Editor. (1998). Atlas of Human Anatomy. Pharmaceuticals Division, CIBA-GEIGY Corporation. 
  • Waddell, G (1994). Epidemiology Review.  Annex to CSAG Report on Back Pain. HSMO, London.

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