“What Causes Low Back Pain?”
Next to the common cold, low back pain,(LBP) is the most common malady and is the number one lost time medical event and expense in North America. While figures are not available for Canada the costs, at slightly less that 10 % of the population of the USA are comparable. The costs of treatment and lost wages are between $100-200 Billion. The most common type of LBP is called Mechanical LBP or non-specific LBP. Moreover, 60% of LBP sufferers experience some form of functional limitation or disability as a result of their pain. Despite the enormous technological advances, treatment and costs have not change much in the last decade.
The most common cause of low back pain is faulty Spinal Biomechanics. When the joints of the back get overloaded beyond there ability to handle said load, they will become inflamed. This swelling and inflammation is the primary cause of mechanical LBP. The Joints of the spine like most of joints in your body are called synovial diarthroidal joints. This means joints of the back have a capsule(synovium) around them and the joint has fluid lubricant in it. When the joint is overloaded the excess swelling will cause pain and limitation in motion. Fluid does not compress.
Your family doctor is not wrong when he tells you that you have Arthritis, Osteoarthritis, (OA) in your back. He/She, often implies that it is a disease and that nothing can be done about it except take pain pills, anti-inflammatory medicine and live with it, or rest it and stop doing things that aggravated your back?
However, understanding the biomechanical cause of the faulty mechanics that causes the overload will not only decrease your pain, but prevent the overload from happening in the future. The sacroiliac joints and their symmetrical function are key to normal back function. The diagrams below demonstrate the central point of center of gravity and the normal figure of eight range of motion. If one of the pelvic joints(SI) joints gets restricted, (often on the right) The range of motion shift will cause increase stress and strain on the lumbar joints (facets). The overload will lead to pain and inflammation of the joint capsule. Adjusting the SI joints back to normal function will treat one of the major causes of LBP. It usually takes a series of 6-8 adjustments to begin the process of restoring normal motion. Muscle strengthening and balancing exercises are then implemented. The typical presentation for mechanical low back pain is for the patient to wake up with pain and stiffness and the pain subsides as standing and movement dissipates the accumulated fluid in the joint capsules. Quick movements, twisting motions, and lifting can exacerbate the pain and trigger painful muscle tightening and spasms. Follow the link.
Most of your weight is on the body of the vertebrae, and the disc. The movement of the joints pivots about the facet joints. The muscle of the back control the pivot motion. As we all age the disc loose there compactive ability, your shocks are worn out, and the joints get overloaded (LBP)
The muscles of the back get overloaded and can often spasm, as a protective mechanism your body is telling you, “don’t do that”. The most commonly irritated muscles of the deep layer of muscles of the back are the Multifidus. (see below).
Of course a Doctor of Chiropractic has to rule out more serious causes of LBP, X-rays and other imaging techniques are often necessary. Recently advances forms of MRI imaging, called Fat-Saturated MRI have confirmed this swollen joint hypothesis as being a major cause of both acute and chronic LBP.
This cross section of a MRI shows the progressively swollen joint capsules, Facet capsules, and technically call Facet synovitis. “itis” is latin for inflammation. This is OA of the back. See diagram below.
There are many types of Chiropractic treatment and approaches for the treatment of LBP. This is a future topic for a future Column.
My approach is to first to assess the Sacroiliac Joint function, or more commonly Dysfunction. There is a pre-disposition for the Right side to loose it full range of motion. This will cause a overload to the L4 and the L5 joints(facets) and hence the pain so commonly felt.
The loading factors and the skill to move the SIJ is still a topic that is up for debate in both the Scientific Community and the Chiropractic Community.
Our office is currently re-instating a continuation of a Study on LBP. I have great success over my 32 years, in correcting chronic and acute LBP by addressing this SIJ dysfunction issue. If this is a major factor in the cause of your LBP, we can usually change your symptom pattern in 4 visits. A questionnaire, and analysis is done on the initial visit and follow up questions and examination and evaluations are performed. The study is being supervised by two top Australian researchers. See my web site link here.
So if you have been suffering from chronic or sever Low Back Pain, you might want to consider in participating in this Clinical Trial. “You Don’t have to LIve with the Pain”.
Please call our office 613-662-2106 for more detail on how to participate.
I have many pages of information on LBP, the anatomy and the Pathophysiology of LBP, Inflammation and many relevant health topics. See my website and the relevant links to topics here.
Remember … You Don’t have to Live with the Pain