Low Back Pain
Low back pain... Where to start? It's definitely the number one condition I treat in the clinic and, also, the main reason chiropractors are so popular. Most of us will have an episode of low back pain (LBP) in our lifetime. If you haven't had one yet, just wait, it's coming for you too. Speaking to those of you "in the know", LBP is the worst. It affects everything, you can't hardly move without having to use your low back. It can be debilitating at worst and annoying at best. There are a few conditions of the low back that can lead to permanent disability in rare cases. However, the greatest risk that LBP presents is chronic pain which is very different from that time when you "pulled a muscle". Frequent and/or severe LBP is one of the primary pathways to chronic pain. Unfortunately, once an individual is in chronic pain our cells amplify the pain signals and no longer require an injury to produce severe and debilitating pain. There is some good news though, Chiropractic care has shown to help with both acute and chronic LBP. Even the American College of Physicians now recommends chiropractic care for LBP..
Common Causes of Low Back Pain
Muscle Strain
The degree of injury with a muscle strain is highly variable. It ranges from severe and crippling to mild and annoying. A muscle strain may only be symptomatic for a few hours or as long as four weeks. It really just depends on how injured the muscle fibers are. Most of the time, muscle strains heal themselves adequately without any need for treatment. People often get a massage after straining a muscle and for those with minimal tears in the muscle fibers it it often helpful but those with more significant tearing may prolong the healing time and find themselves in pain longer than necessary. Its not that massage isn't helpful, it's that the soft tissue work has to match the injury and the stage in the healing process. We have a lot of treatments at the clinic for different phases of injury and a detailed exam will reveal just how bad the injury is so that we may apply the most appropriate treatment for your specific injury. One last thing to remember is that, just like scar tissue on your skin is different, scar tissue in muscles is different. For the best outcomes, we must treat the injury and we must treat the scar tissue once things have healed up adequately. This can significantly reduce future episodes of LBP caused by damaged and improperly functioning muscles due to scar tissue.
Lumbar Facet Joint Injuries
The low back has 5 discs, 5 lumbar vertebrae, and 10 facet joints. Just like how you can jamb your thumb, you can injure your facet joints. It could be anything from a sneeze to an improper lift. The pain from facet joints is characteristic and easy to test for. Great news here is that they are often quick to heal. however, in advanced arthritic conditions they may develop bone spurs and the joint surfaces wear down causing movements to be painful. When we do an "adjustment" this is the joint that we are trying to manipulate and they typically respond very well to manipulation.
Ligament Strain
It's not easy to injure a ligament in the low back. Usually the muscles give out well before ligaments do. So why are we even talking about it? Because ligaments in the low back are frequently injured in trauma such as car wrecks. If you don't think care accidents are common, just start asking people how many wrecks they have been in in their lives. I assure you it will be illuminating. I often document injuries from car accidents in the years leading up to episodic LBP or chronic LBP. Ligaments, unlike muscle, are relatively avascular (meaning that they don't have a good blood supply) and take weeks to months to heal depending on the grade of sprain. Treating a sprain is a very different process to treating a muscle strain too. When you come into the office the Doctor will do a detailed exam to determine the degree of injury and implement a plan to help you heal up.
Disc Injuries (Bulges / Protrusions / Extrusions)
Disc injuries may occur during all sorts of movements and often occur with the most trivial of things like simply bending over to pick something up from the floor. Unlike our muscles and ligaments which are constantly healing, our discs have a tendency to deteriorate as we age just like how our hair turns gray and our skin wrinkles. There are two major types of disc injury. First is the acute disc injury which often occurs in our 20s, 30s and 40s as our discs haven't dessicated yet (gotten all dried up and thinned). We have 5 discs in our low back and of those just three represent over 90% of disc injuries with the lower discs being most prone to injury. At worst, a dinc injury may pinch a nerve due to the swelling that occurs as the disc fibers tear. I will talk about pinched nerves down below. Second is chronic disc deterioration, which may be genetic, related to overuse, old injuries, etc. I see a lot of this type in the older population 50+. We have excellent treatments for all types of disc injury including spinal decompression. Occasionally surgery is required for disc injuries. our job is to perform a trial of conservative care (which has a high success rate) before sending people to surgeons.
Pinched Nerves (Sciatica)
Unfortunately, our spinal nerves have small openings to exit the vertebral column and send signals to our muscles and skin to provide movement and sensations. When a disc bulges in the proximity of a spinal nerve, nerve irritation occur. Because nerves are wired to sense or feel a given area of our skin, when a nerve becomes irritated that pain seems to come from that area. For example, a disc bulge in the lower spine near the L5 nerve root may cause severe pain in the foot. Fortunately, the distribution of all the spinals nerves is well known and the symptoms of sciatica originating from the low back are easily recognizable. Most of the time, we are able to successfully treat pinched nerves without a referral to a surgeon, nevertheless an expensive MRI. In those rare cases where paralysis begins to develop or a 4-6 week trial of conservative care has failed to yield results surgery may be warranted. Low back surgery is not the outcome anybody prefers but it is occasionally necessary and its important to know that you did everything you could before going under the knife.
Arthritis
This may be getting repetitive but arthritis is a common and significant cause of LBP. Arthritis causes disc deterioration, bone spurring and is the primary cause of LBP in individuals over the age of 50. Your classic arthritis (osteo arthritis) is coming for us all. Its, quite frankly, an inevitable part of aging. Bulging discs, facet arthritis, inflammatory pain are all part of it. While we can't stop arthritis, we can manage it and keep the pain that comes with it at bay. There is another main type of arthritis (inflammatory arthritis) that causes significant LBP and destruction of the structure of the low back. The main types of inflammatory arthritis are rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. However, there are several others and sometimes we see more than one type in an individual. A full work-up with a rheumatologist including blood work is necessary to make the diagnosis.
