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Kinds of Lower Back Pain

By Dr. Tim Fargo, Chiropractor

After nearly 40 years in practice, I can safely say that I have probably seen every kind of low back pain. Some cases are mild and transient, while others are utterly debilitating and life-changing. The way to begin this discussion is to understand that there are various tissues and combinations of tissues which are capable of producing low back pain. It is common to have more than one such tissue involved in the production of lower back pain.

Of course, everyone understands that muscles in the low back can become strained or injured. There are also ligaments surrounding, protecting, and supporting all the bones of the spine (vertebrae); and these too can be injured. There are joints that create connection points between adjacent vertebrae. These joints are called “facet joints”. Like any other joint in the body, these joints are invested with pain fibers and can be injured, become inflamed, and produce significant back pain. The cushions between each vertebra are known as “discs”. This tissue is comprised mostly of cartilage with a gelatinous center known as a “nucleus”. At times, this nuclear material (gel) can squish out and either start to deform the outer coverings of the disc, or herniate beyond the confines of the disc. We describe this phenomenon as either a “disc bulge” in the case of the former, or a “disc herniation” in the case of the latter. It is debatable whether discs themselves are pain producing, but the spinal cord and nerves that emanate from the cord certainly are.

When we are trying to figure out what to do about lower back pain, our testing and analysis must, at minimum, attempt to identify which tissue or tissues have been injured. Physical examination, including orthopedic and nerve testing, is always done. X-ray analysis is another essential in this process. In more severe and prolonged cases of lower back pain, it may be appropriate to obtain advanced imaging such as MRI or CT. There are also instances, when we are trying to identify the source of nerve pain, where modalities such as electromyography (EMG) are used. EMG is used to measure the speed of nerve transmission and help identify the location of “disruption” in that transmission.

It is quite common for people to strain the muscles of their low back when doing activities for which they are poorly trained and conditioned. Depending upon the severity of injury, low back muscle strain can be mild and transient, or can take some time to resolve. Sometimes rest over a few days will see the pain resolve. The use of ice intermittently for 10 to 15 minute periods can be helpful to reduce any inflammation in the first 24 to 48 hours. Most such injuries are self-limiting and of short duration. Chiropractic care can be of benefit because muscular injury will also create a compounding impact on joint mobility. The typical medical approach would be to use analgesic (pain relieving) and anti-inflammatory agents, whether prescription or over-the-counter.

Moving up the scale of severity, facet joints and ligamentous tissues can be injured by lifting, twisting, or any load or impact that exceeds the capacity of that tissue. This is more akin to what happens when you sprain your ankle. Once again, the traditional treatment for such injuries includes medication, as discussed above, rest, and ice. Notice that, nowhere thus far have you heard me recommend the use of heat. The application of heat, particularly to a fresh or acute low back injury, might feel good temporarily, but will generally increase inflammation. Chiropractic care also plays a significant role in alleviating pain and inflammation associated with ligamentous injury. By creating proper movement and alignment of spinal joints chiropractic adjustments reduce pain and inflammation, and speed healing. We also have other modalities, in addition to adjustments, to reduce pain, muscle spasm, and inflammation. We use various forms of electrical muscle stimulation, cold laser therapy, and gentle rehabilitative exercise.

When back pain becomes more severe, and particularly when there is suspected involvement of the spinal cord and nerves, it is sometimes necessary to do advanced imaging. Typically, chiropractors pursue a course of conservative treatment including adjustments, adjunctive modalities for pain and muscle spasm, and even, sometimes, decompression traction therapies. We closely monitor any such case to make sure that the neurological symptoms are resolving and, if not, we refer for advanced imaging and often work in tandem with medical orthopedists and neurologists.

No discussion of lower back pain would be complete without recognizing that our susceptibility to low back injury and spinal conditions increases as we age. Many of us become heavier, lose muscle mass, and flexibility as we get older. All of these things increase the likelihood of lower back pain with aging. As we age, disc tissue tends to become dehydrated and degenerates (becomes thinner). Ligaments supporting the spinal joints can become thickened. Spinal joints themselves can become arthritic. All of these factors, when combined, reduce the space available for the spinal cord and associated nerves. Suffice it to say that lower back pain becomes much more common in older people because of these combined factors. In decades of working with older adults I have seen chiropractic care be very effective in increasing mobility, and reducing pain and disability associated with low back pain.

As you can see, there is no “one-size-fits-all” approach to lower back pain. Any treatment protocol must be predicated on accurate identification of the source, severity, and extent of injury. Chiropractors are trained to identify and treat virtually every type of lower back pain. In my experience, there have been very few instances where we have been unable to help patients with lower back pain. If you, a loved one or friend suffers with lower back pain, please do not hesitate to contact one of the doctors at Chiropractic Health and Wellness. We are here to help you.

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