- Disability due to low back pain has increased by 54% between 1990 and 20151.
- At any point in time, 7.5% of the world's population (~577 million people) is suffering from activity-limiting low back pain2.
- 84% of the population will suffer from back pain at one point in their adult lifetime.3
- An estimated $87.6 billion was spent on back and neck pain in the United States as of 2013.4 To better understand the causes of low back pain, it’s helpful to know more about what the low back actually is.
The spine is a series of 26 individual bones called vertebrae stacked on top of one another. There are 7 bones in the neck, 12 in the mid-back, 5 in the low back, 1 called the sacrum, and 1 known as the coccyx, or tail bone. Between each vertebra is a disc. The intervertebral disc acts as a cushion to keep the vertebrae spaced apart. I like to imagine the disc like a jelly donut.
The outer layer of the disc is called the annulus. The annulus is home to a lot of crisscrossing bands, which allow it to endure some amount of force. Inside the disc is a gel-filled center called the nucleus, like the jelly inside of a donut. The bony connection between two vertebrae is called the facet joint. These give the spine a hard limit to how far you can move the spine.
In the center of the vertebrae is the spinal canal. This is a hollow area that houses the spinal cord. The spinal cord connects your brain to your body and vice versa. That connection controls how you sense and interact with the world. Spinal nerves branch off the spinal cord and travel to different parts of your body. They act like “electrical wire” carrying information from your body back to the brain.
Muscle strains and ligament sprains:
Muscles and ligaments in the back can over stretch or tear due to overactivity or overuse. Sprains and strains may experience stiffness or pain in the lower back, or even muscle spasms.
Disc bulge/disc herniation:
The disc can become injured as it is the part of the back that undergoes the most movement. This risk increases with age as its flexibility decreases. As it becomes stressed, the outside of the disc can “herniate,” or tear. A disc bulge/disc herniation, also known as a slipped disc, occurs when the disc pushes against the nerves that run through the spinal canal. This compression of the nerves can create localized pain or pain that shoots into your leg. The area of the leg that feels pain can also be dependent on which nerve root gets irritated.
Sciatica:
Sciatica has multiple causes, one of which is a herniated disc that irritates the sciatic nerve causing shooting pain down the leg. Symptoms include burning, or pins and needles in the foot and leg.
Lumbar spinal stenosis:
Stenosis means narrowing. Spinal stenosis is when the spinal column narrows. This narrowing puts pressure on your spinal cord and spinal nerves. Stenosis is often caused by advanced arthritis between the vertebrae. The compression of the spinal nerves can cause numbness, cramping, or weakness. People with lumbar spinal stenosis complain of symptoms while standing or walking. But the symptoms improve if they sit down or rest. This presentation is also known as “neurogenic claudication.”
Facet syndrome:
Facet syndrome is like lumbar spinal stenosis. Both have pain that occurs with walking or standing and improves with sitting and rest. The main difference is that facet syndrome is not a narrowing, but an irritation of the facets. This irritation causes swelling and pressure on the nearby nerve.
Abnormal spine curvature:
The clinical term for abnormal spine curvature is scoliosis. There are two common forms of scoliosis: congenital and acquired. Congenital scoliosis is something you are born with. Acquired scoliosis develops based on changes in how you move. Scoliosis is often diagnosed during childhood and adolescence. Advanced curvatures may need co-management with a spine orthopedist.
The quick and easy answer is probably not. The more nuanced answer is “it depends.” For the average back pain, x-rays and other advanced imaging is not needed. Imaging identifies disc bulges, disc herniations, and joint/disc degeneration. Yet, these are normal findings in healthy, pain-free patients. The numbers below represent 20 year olds with no pain5.
· 37% of people aged 20-years had disc degeneration
· 30% of people aged 20-years had disc bulges
· 29% of people aged 20-years had disc protrusions In older populations, the numbers are even higher!
· 96% of people aged 80-years had disc degeneration
· 84% of people aged 80-years had disc bulges
· 43% of people aged 80-years had disc protrusions
While imaging may be beneficial, it should be used to rule out more serious causes for back pain. We call those serious causes “red flags,” as they do not respond to conservative treatment. As chiropractors, we use our examination to spot those “red flags.” If one is present, we refer you to speak to a primary care physician or appropriate specialist.
- Fractures: direct trauma can cause fractures. In some cases of no trauma, there might be some underlying process that lead to the bone weakening.
- Cancer: if cancer spreads to the bone, sometimes the bone will change in density. The change in density can make the bone more brittle, leading to fracture. How we "look for" cancer is by listening for subtle clues in your story. Clues like rapid weight loss without any change in diet or activity, or excessive night sweats. If cancer starts in the spinal cord, you may experience less common symptoms affecting sensation and muscle strength.
- Infection: bone infections can cause a lot of pain and can have dangerous consequences if not treated soon enough.
- Cauda equina syndrome: sudden or progressive loss of feeling in the legs with loss of control over bowel/bladder caused by “choking” of the spinal cord
- Kidney infections: organs do not have traditional pain sensors, so they usually refer pain towards your flank (beside your spine). The pain can be so intense that it feels like spine pain. Proper evaluation and understanding of the cause of your pain is critical so that you can get to the appropriate specialist as soon as possible.
During an evaluation, your doctor will review your medical history with you. Then, they will conduct a thorough physical examination. This process is to rule out any serious causes of back pain.
If symptoms are going into the leg, it is our job to determine where the nerve is being irritated. For example: determining if it is a central irritation (disc bulge) or a peripheral irritation of the nerve (piriformis syndrome).
Finding out the “what” is only half the job. The “what” is the structure that is causing you pain.
Finding out the “why” of your back pain is of utmost importance. We need to find out “why” the “what” is being irritated. The sooner we know the “why”, the sooner you can figure out how to move so that the “what” is no longer irritated.
Here's What Kevin Said About Ending His Low Back Pain And Returning To His Active Lifestyle.
“It’s been four months now since my first visit at Capital Sports Medicine and the persistent soreness I once had is now an afterthought. I’ve regained a significant amount of strength and flexibility in my lower back, I’m pain-free, and I’m thinking about starting a yoga class. Amazing. I wish I had called Capital Sports Medicine earlier.”
STEP #1 - WE WANT TO LISTEN TO YOUR STORY
Our medical system is frustrating. You wait weeks, sometimes months, for an appointment, only to get to talk to the doctors for 10 minutes before they have to run to the next patient and you’re left sitting there wondering, “What just happened?”
Even most chiropractic clinics operate this way. They’re not attentive, they’re fast-paced, and your therapist doesn’t have time to actually touch where you hurt.
This is why our first step is to listen to your story.
After working with lots of people with back pain and stiffness, we know that no two people are alike. Each person has a different body, a different history, and different types of pain.
That is why our first step is to have an open conversation and time for you to tell your story. That way we get a deep understanding of what’s going on not just with your body, but also how it’s impacting your life.
Many people have a diagnosis, or medical term for what’s going on with their body. Maybe their doctor gave it to them, maybe test rests showed the diagnosis, or maybe you found it online.
You could have been told that your only choice was to rest, use ice and heat, or take pain medicine.
Sometimes, those things bring temporarily relief, but they’re not addressing what CAUSED the problem in the first place.
Every person’s cause of back pain and stiffness is different. No one has the exact same problem caused by the exact same thing as another person.
Our goal at Capital Sports Medicine is to find that original cause of your pain, so not only does your pain go away, it STAYS AWAY!
We understand that you still might be skeptical or unsure if physical therapy is right for you. That’s why we created a free discovery visit. (Yes! That means the first session is ON US!)
Our Discovery Visits are meant specifically for those people who are skeptical, unsure, or have even been let down in the past. During the Discovery Visit you’ll find out what’s wrong, how long it’s going to take to fix it, and give you peace of mind that your problem can be fixed naturally!
This is when the big transformations occur. We develop a personalized plan that allows you to…
…Get back to exercising without fear of your pain coming back
…Be able to play with your kids, get back to your workouts, etc.
…Get back to your pre-injury lifestyle you love
…step outside to go walk/hike without having to worry about whether or not you can handle the distance/time
Our best clients are those who are motivated and ready to win back their active lifestyle. (Even if they feel stuck right now!)
Want to know more about our availability and costs before making any commitment to coming in?
- https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(18)30480-X.pdf
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186678/
- https://www.ncbi.nlm.nih.gov/books/NBK538173/
- https://jamanetwork.com/journals/jama/fullarticle/2594716
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464797/
- https://bjsm.bmj.com/content/54/13/76
