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Understanding Lower Back Pain

Understanding Lower Back Pain

Understanding Lower Back Pain – Is it an epidemic?

Lower Back pain is one of the most common reasons an individual visits a doctors office. Over 80% of Americans suffer from lower back pain at some point in their life, and 50% of these individuals have multiple occurrences within 1 year’s time of their first episode. Many companies, large and small are seeing increases in medical cost as it related to back pain as well as a greater number of disability claims. These increase in costs and disability are driven by poor diagnostics, over-utilization of procedures, rising costs of invasive procedures/medications, increased length of disability claims and high recurrence of injury. Current research in the field of orthopedic spine pain indicates that the following factors result in increased disability during the course of treatment for the presenting complaint: early MRI, multiple MD providers, more than 5 MD visits, specialist consultations, early use of narcotics. Conservative care has been shown to be highly effective in many cases as a first line of strategy to avoid the stress and pitfalls of invasive therapy.

What can cause lower back pain?

There are a number of sources of lower back pain and even more predisposing factors that make understanding lower back pain a challenging puzzle and ultimately an epidemic.  Lower back pain can be caused by a seemingly harmless activity such as sitting in a poor posture to more serious conditions involving internal organs referring pain to the low back. The wide range of conditions responsible for lower back pain is why it is very important to get a thorough assessment once you start to feel symptoms.

                               Specific Lower Back Conditions

understanding lower back pain worker in the officeDegenerative Disc Disease: DDD is a commonly diagnosed condition associated with the normal aging process of the spine. When you are younger, your spinal discs function as the perfect shock absorbers, but as you get older the disc(s) slowly loses hydration and the space between vertebrae decreases. Because degeneration is a normal part of aging, not every individual with degeneration will experience pain, so if you are experiencing lower back pain and have been told you have “DDD”, be sure to see a clinician that performs a thorough movement assessment.  

Disc Herniation: Disc herniations are one of the most frequently diagnosed conditions of the spine but unfortunately because diagnostics are heavily reliant on imaging (MRI primarily), disc herniation can be misdiagnosed as the pain generator or even operated on inappropriately due to a lack of understanding of the source of pain thus a thorough movement assessment is needed to compliment and confirm imaging findings. A disc herniation occurs when the disc material called “nucleus pulposus” leaves the outer casing called the “annulus fibrosus”. The severity of a herniation can range anywhere from a minor bulge (nucleus still within the annulus) to a disc sequestration in which the discal material is displaced into the spinal canal. A more severe disc herniation will produce symptoms into the leg and can potentially cause neurological deficit (weakness, numbness, tingling).

Lumbar Stenosis: Similar to degenerative disc disease, lumbar stenosis is often found in individuals over the age of 60. An individual with stenosis will prefer a bent-over posture and will generally feel discomfort walking around and standing for too long. Also, an individual with stenosis may not only feel symptoms in the lower back but down the leg as well. Physiologically, the stenosis is narrowing of the spinal canal itself that can be caused by bone spurs, hardening on the disc and herniation into the canal, spondylolisthesis (vertebra slips forward onto the bone below it) and a number of other space occupying lesions.

Facet Syndrome: Facet joint syndrome is a painful condition of the spine involving degenerative arthritis of the joints that connect the lateral ends of the vertebrae that ultimately results in poor movement and inflammation in the area leading to pain. Facet syndrome can also come as a result of aging, but staying active, maintaining good spinal mobility and performing strength training for the core can help prevent and/or mitigate symptoms of spinal discomfort. Inflammation of the facet joint itself can result in muscle spasm as well as referred pain into the lower back, buttock and lateral hip. An X-ray can help point out areas of degeneration but does not necessarily correlate to the cause of symptoms for this reason it is critical that an appropriate orthopedic and neurological exam follow an X-ray for the diagnosis of a facet issue.

Understanding Lower Back Pain patient treatmentHow do we treat lower back pain?

The treatment for lower back pain is largely dependent upon dependent upon the findings of the orthopedic and neurological exam. If you are experiencing a neurological deficit (weakness, numbness, tingling) or pain that does not change with position, it is likely you may benefit from a referral to a pain medicine specialist or orthopedic doctor. If the pain is above the knee and intermittent (comes and goes with specific positions), it is more likely that your condition can be resolved with conservative therapy which may include chiropractic manipulation, soft tissue therapy and therapeutic exercise. The specific “diagnosis” must be supplemented with a functional diagnosis that includes a thorough history, palpation as well as a movement exam. X-ray and/or MRI imaging does not provide your healthcare provider with sufficient information to construct a treatment plan designed to reduce pain and improve function long term.

What are a few ways you can prevent future occurrences of lower back pain?

A few of the predisposing factors for lower back pain include being overweight, smoking, being physically inactive, poor posture, aberrant breathing, limited motion in the upper back and restricted hip range of motion. 

  • Breathing is one of the most overlooked aspects of spinal stability and decompression. Due to aesthetics and stress, individuals generally with through their chest and use the superficial musculature of their neck (scalenes, SCM, Upper trapezius, pec minor) to create a forceful inhale. Learning to breathe using your diaphragm and expanding your abdomen at 360 degrees can assist with spinal stability, improved posture as well as spinal decompression.
  • Posture can be a critical piece of the puzzle when it comes to preventing lower back pain. The lumbar spine naturally has a lordotic curvature (concave) which means that it can be easily irritated by spending excessive amounts of time in the reverse position (rounded out). Unfortunately due to the nature of a lot of jobs requiring time at a computer, on flights or at a desk, individuals are required to sit for a long period of time in a disadvantageous position. This can be offset by using a “lumbar pillow” to assist in maintaining the natural curvature and taking frequently microbreaks to move you spine through a full range of motion. 
  • Improve the range of motion in the joint surrounding you lower back (Thoracic Spine/Upper back as well as hips) can also help relief excessive tension on your spine. In general, the thoracic spine and hips are more mobile joints meant to provide a lot of the movement during activities such as walking, running, squatting and twisting. If the hips and upper back cannot provide adequate movement for these activities, the low back will take excessive load and can potentially be predisposed to injury.

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3 key factors to consider as a chiropractic patient

chiropractic patient

Many individuals today are frustrated with the current state of healthcare and feel let down. As the chiropractic patient, you deserve to be listened to, assessed thoroughly and guided down a clear path to resolution and success. Often times, those who are injured find themselves more frustrated and confused after seeing a healthcare provider than before. A thorough evaluation and conservative care are not factored into the game plan and as a result, individuals don’t find lasting resolution to their condition. In this article, we will speak specifically about musculoskeletal pain and injuries.

chiropractic patient 3 fundamentals puzzle

There are 3 fundamental aspects of care you deserve as chiropractic patient

  1. Comprehensive Evaluation and Assessment
  2. Conservative Treatment Options
  3. Prevention Training

Comprehensive Evaluation and Assessment

When patients go to visit their primary care physician or specialist, they are generally given a proper history and consultation but the musculoskeletal system is generally assessed very minimally or not at all. Doctors seldom assess movement, muscle tone or joint function but rather defer to orthopedic tests and potentially diagnostic imaging, followed by medication to “manage” your condition and advice to rest.

As a patient it is important to understand what you should expect from a comprehensive musculoskeletal examination. Following you exam you should be given a clear diagnoses as well as indirect causes for the condition at hand. This should be communicated clearly so that there is no misunderstanding between the physician and patient.

 

In order determine an appropriate working diagnoses, an evaluation should include at a minimum:

A thorough history & consultation

Functional Movement Assessment

Orthopedic and neurological exam

Muscle and joint palpation

When a healthcare provider includes the 4 above categories in the evaluation, he or she will be able to provide you with a working diagnosis and ultimately the appropriate course of care. At this point, conservation treatment options can be discussed and treatment plan can be custom tailored to your needs.

Conservative Treatment Options

Patients deserve a comprehensive, hands-on approach to their pain or injury. Most chiropractic patient presentations can be classified into a specific group that responds to a particular therapy or combination of therapies. This may include a combination of chiropractic adjustments, manual therapy, rehabilitation exercises, training advice, nutrition counseling or acupuncture. You may not need all of the above conservative therapies, but generally some combination is required for excellent clinical outcomes.

Conservative treatment is not about a “one size fits all” approach. From your first encounter through your treatment plan, every step should be customer tailed to your assessment findings and goals.

Prevention Training

One of the most frustrating occurrences for both the patient and the doctor is the re-aggravation of a condition that has already “resolved”. For most conditions, recurrence is over 50% within one year of an episode and this can be due to many factors. Work life, sport, exercise, lack of education can all contribute to recurrence of a musculoskeletal injury. When being treated for a condition and concluding a treatment plan you should expect to discuss the following with you healthcare provider:

  • Activities of Daily Living: Ergonomics advice related to activities performed on a regular basis in your life
  • Return to Work or Sport: Proper time frame and modifications
  • Body Awareness and Preparation: lifting, moving, bending, posture
  • Corrective Exercise: Mobility and/or Stability exercises custom to you
  • Desk Ergonomics: How to take micro breaks and use proper posture while at work
  • Proper Equipment: running shoes, weight belts, braces, etc.
  • Skill/Technique training: Exercise or Sport technique from a trained professional

In Summary, as a chiropractic patient there are many potential roadblocks that can prevent you from achieving efficient and lasting relief when working with a healthcare provider for a musculoskeletal injury. The first step is being an informed patient and understands what is to be expected from a quality healthcare experience. I have outlined key points below that you as an informed patient should expect from a provider treating you for a musculoskeletal condition.

  • A comprehensive assessment including a thorough history, functional movement assessment, hands-on palpation of joints and soft tissue structures.
  • An exam that assessment more than just the area of complaint but the body as a whole to determine the root cause of the presenting complaint. For example a lack of hip mobility and stiffness In the middle back can often contribute to symptoms in the lower back due to over-stress.
  • A specific diagnosis based upon the findings in the history and comprehensive exam
  • All conservative treatment options explained and discussed in detail as well as an opportunity to ask the physician questions
  • Advice beyond pain resolution but also education and training in how to prevent future recurrences or aggravations