Low back pain is described as musculoskeletal pain generated by irritation to pain sensitive structures comprising the lower back. This may involve joints, muscles, bones, discs and ligaments. Statistically, 80% of Australians will suffer from back pain at some point during their lives. Understanding the most likely causes of low back pain can help you make a more informed choice of management and work towards resolution of your symptoms.
Low Back Pain is basically the brain perceiving nociceptive or pain information from disturbed tissue. The tissues responsible for mechanical Low Back Pain include facet joints between spinal vertebrae, larger sacroiliac or pelvic joints, the intrinsic muscles and ligaments of the spine, nerves and intervertebral discs. Damage via injury to any of these structures can lead to inflammation and pain which will generally heal with time. However, ongoing states of pain are most often due to residing dysfunction causing a repetitive stress mechanism to these pain generating structures.
Macrotrauma involves a more notable or serious injury. Generally the person sustaining such an event can recall the incident and relate the commencement of their symptoms to the injury. Some examples include the following:
Heavy Lifting incident
Heavy fall onto the back
Motor vehicle or bike accident
Microtrauma involves less noticeable forces, is generally repetitive and can have an accumulative effect on the back over time. Some common examples are:
Lumbar Subluxation or Misalignment - often patients with this mechanical problem are diagnosed with muscle strain, facet joint syndrome or a pinched nerve. These are simple explanations for a more complex problem involving mechanics which can invariably cause these phenomena secondarily. Lumbar misalignments can cause inflammation to joints and discs, affecting neighbouring spinal nerves and generate protective muscle spasm. In more severe cases, pain can radiate into the leg and may involves pins and needles, numbness and or weakness.
Pain can be sharp, shooting, a constant ache or stiffness
Sitting prolonged can aggravate, and activities such as driving a car can be difficult
Position change such as standing from seated can cause pain
Pain first thing in the morning which may ease as the day progresses
Pain on bending forward
More Severe Presentations involve
Severe pain on movement
Pain shooting or radiating down one or both legs which is commonly known as Sciatica. This may also involve pins and needles, numbness and leg weakness
Acute pain pain which is debilitating in nature and may have you stand crooked or bent over, or unable to stand and weight bear
Pain when you cough or sneeze
Sacral Subluxation or Misalignment - The sacrum is the large triangular bone the spine sits on and is suspended between the two larger pelvic bones. A hard fall on the sacrum or tailbone, as it is sometimes referred, is a common mechanism for injury to this structure which can compromise its articulation with the last lumbar vertebra, usually L5, or one or both of the pelvic joints known as the sacroiliac joints. Patients with a mechanical sacrum problem are often diagnosed with facet syndrome of the lumbosacral facets (L5/S1), muscle spasm, pinched nerve or sacroiliac joint strain. The sacrum when dysfunctional is also a common cause of intervertebral disc problems such as bulge or herniation via abnormal forces it can subject adjacent disc structures to.
Pain is generally across the sacrum and can affect one or both pelvic joints
Standing prolonged can lead to stiffness
Sitting prolonged can be difficult
More Severe Presentations
Inability to stand straight
Acute pain disc pain
Pelvic Subluxation or Misalignment - Often patients refer to this as hip pain. The pelvic problem can generate inflammation in the sacroiliac joint causing irritation to local nerves.
Can produce generalised low back ache
long walking can aggravate
Short walks can provide relief
It can ache whilst you lie in bed and can wake you during the night
Pain can refer to the hip, buttock or groin
More Severe Presentations
Pain referring down the thigh and knee
The pain may refer to the groin or testes
You may not be able to weight bear or walk properly
Chiropractic is not a therapy for low back pain. It offers specific corrective care for mechanical problems detected through thorough spinal analysis. Restoration of function creates the best environment for healing and appropriate strengthening of weakened tissue.