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What is Lower Back Pain?Lower back pain affects 31 million Americans at even given time. Back pain is the number 1 reason people miss work and it is the number 2 reason people seek treatment from a doctor. Upwards of 100 billion dollars are spent each year on this debilitating condition. The epidemic seems like a recent event, the posture of the majority of people has some cause in these painful symptoms. People spend most of their day in the seated position whether it be at work behind a desk and in front of a computer, or at home on the couch in front of the television. This is how most of us spend our days and this is not good. The lower back consists of the lumbar spine (vertebrae), the pelvis and sacrum, the ligaments around the lumbar spine and pelvis, the discs between the vertebrae, the spinal cord and nerves, the muscles and ligaments of the low back that have many different functions, internal organs of the abdomen and pelvis, and finally the skin around the entire lower back. As you can see there are many different structures here that make diagnosing lower back pain somewhat a mystery. Often times it starts due to overuse secondarily to posture strains, little or no exercise, injuries, or poor dietary habits. Lack of a good exercise program can cause the "core," low back muscles, and gluteus muscles to become weak, inactive, and atrophy. Bad posture habits can cause the muscles of the low back to tighten, and the spinal joints in the low back to lock up or become restricted. Poor dietary choices can lead to chronic inflammation. All of these can increase your sensitivity to pain. We also need to realize low back pain can also be the result of a very serious pathological condition. This is rare, but in this case a medical doctor or specialist should be consulted. If lower back pain continues through the initial stages and progresses we consider this to be
chronic low back pain.
Lumbo-pelvic Sprain/Strain This condition is usually the result of an acute or overuse injury. It is a soft tissue/joint condition. The muscles of the low back become strained and the ligaments sprained. The most common injury is usually a lifting injury that causes the muscles and ligaments to stretch more than usual causing a small degree of tearing to the fibers. This can also cause a joint in the back to lock up or become restricted. The local tissues swell when ligaments, muscles, and tendons or different combinations of the tissues become overused. The swelling results from inflammation causing pain, tenderness, and stiffness.
Disc Herniation The spinal disc can rupture and a portion can push through its usual boundary this known as a "slipped disc" or a disc herniation. A common cause of a disc herniation is repeated forward flexion of the lumbar spine. Often times patients already have a condition known as spinal stenosis which makes experiencing a disc herniation more common. Spinal stenosis is a problem that causes narrowing of the space around the spinal cord and spinal nerves. When a portion of the disc moves out of the normal position it can cause leg pain or numbness and tingling down the leg into the foot from rubbing on a spinal nerve. Please see picture below. More serious symptoms can occur which include muscle weakness because of nerve irritation or bowel and bladder problems. If you are having bowel or bladder problems this is known as cauda equina syndrome and is a medical emergency. If loss of bowel or bladder control, or you have numbness around the genitals seek medical attention as soon as possible.
Facet Syndrome Facet syndrome is irritation to one of the facet joints in the spinal column. This is usually caused by excessive extension of the lumbar spine. Symptoms include a dull ache across the entire low back that has pinpoint tenderness over the facet joint that has been injured. Sciatica Sciatica is a condition caused by direct pinching of one of the largest nerves in the body the sciatic nerve. This nerve can get pinched causing buttock pain and sometimes pain down into the knee. A common place for the sciatic nerve to get pinched is by the piriformis muscle which functions as a hip external rotator (rotates the leg outward). Myofascitis Myofascitis is inflammation or irritation of the muscles and fascia of the low back. Myofascitis can happen anywhere in the body but here is for lower back pain purposes only. When a subluxation occurs the muscle and fascial tissues around the vertebra will get inflamed with the joint causing a need for soft tissue treatments as well as joint manipulations. Degenerative Joint Disease Degeneration of a joint is caused by excessive wear and tear or simply a hyper-mobile joint. When a joint in the body gets restricted in a plane of motion it causes other areas to move excessively and sometimes this excessive motion takes place in the lumbar spine causing bone spurs, thinning of the discs, and non-uniform loss of joint spacing, all of which can cause lower back pain.
Abdominal Aortic Aneurysm Metastatic Carcinoma Fracture Tumors Cauda Equina Syndrome Reproductive Conditions
Note: This list is non-inclusive, many other conditions exist that should be taken serious and one should seek proper care.
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