Low back pain (LBP) is the leading global cause of disability overall in both males and females. Accounting for 7.6% or 42.5 million years lived with disability across all age groups.
There are three distinct sources of LBP, which are axial lumbosacral, radicular or referred pain. Axial lumbosacral pain refers pain to the lumbar and sacral spine being L1-L5 and S1-S5, i.e., the lower back. Radicular pain travels along the spinal nerve and often radiates from your back into your hips and legs. Referred pain, on the other hand, can ‘spread’ or be present in other regions alongside your low back pain. However, the pain may be unrelated to your back and could be originating elsewhere. A good example is LBP along with hip or gluteal pain.
Causes of Low Back Pain
There are plenty of factors that can contribute to low back pain. It’s important to determine the most likely cause (diagnosis) of your LBP because a different diagnosis can imply a different course of treatment.
Myofascial pain is a common complaint of patients who suffer LBP and is characterised by paraspinal muscle discomfort and pain which may radiate to the buttocks or thigh. In this instance, physical examinations are needed to determine the presence of localised tender spots within a taut pain. Typically, the patient will recognise the pain upon being physically examined.
Facet-mediated pain is produced from the facet joint capsule and can be caused by things such as osteoarthritis, joint degeneration and biomechanical stress of the facet joints. A physical examination may show pain on extension and lateral-bending movements.
Discogenic pain is a result of intervertebral disc disruption, which is primarily caused by degradation of the disc and its nuclear components. A physical examination may show that symptoms improve with standing and lying prone and worsen with lumbar flexion or forward bending and twisting.
Spinal stenosis is a condition in which degenerative changes of the lumbar spine lead to a decrease in available space for neural and vascular elements. You may experience gluteal and lower extremity pain, and/or fatigue that may or may not occur in conjunction with lower back pain. Upright exercise such as walking and positional changes such as lumbar extension may reproduce neurogenic claudication symptoms which can include pain, tingling, cramping and feelings of heaviness in the lower back and one or both legs. These symptoms may also be relieved with rest, sitting and lumbar flexion or forward bending.
Sacroiliac joint pain typically occurs in the lower back or upper portion of the buttock overlying the sacral joint. A physical exam may show pain that is reproduced when there is palpation or compression/distraction of the sacroiliac joint. A series of tests are also usually applied by your practitioner to clinically reproduce the pain to help aid in a strong diagnosis.
Some other conditions that are less common may mimic similar symptoms to those above, such as fibromyalgia, osteoarthritis, tumour and various infections. However, these causes do present with a variety of other symptoms that would not be present in a musculoskeletal based problem such as fever, unexplained weight loss, waking with pain and gastrointestinal, bowel or urinary issues.
General Treatment for Low Back Pain
Given the variability of causes and contributing factors to low back pain, management varies from person to person. A standard course of care includes pharmacological treatments, psychological treatments, physical and rehabilitation treatments, complementary and alternative medicine approaches, and minimally invasive surgical procedures. The aims of treatment is to relieve pain, improve function and develop coping strategies/self-management options to drive self-efficacy.
Chiropractic Treatment for Low Back Pain
Chiropractic treatment can encompass a large range of interventions; however, the focus of the consultation is usually the same. An extensive history will be taken followed by a physical examination to form a diagnosis. Once a diagnosis is established, and if no red flags or ‘things to be worried about’ are present, treatment can be provided. Treatment entails a combination of soft tissue and joint-based manual therapies, which can include things like dry needling and spinal manipulation or mobilisation. Most likely, a series of exercises or rehabilitative measures will also be provided alongside other appropriate self-management strategies. These can include movements, stretches or strengthening based exercises as well as ergonomic advice and general education around your condition.
Lachlan Fisher
BHS/AppSc (chiropractor)
References
(1) Buchbinder R, Underwood M, Hartvigsen J, Maher CG. The Lancet Series call to action to reduce low value care for low back pain: an update. PAIN. Published online September 2020:S57-S64. doi:10.1097/j.pain.0000000000001869
(2) Bogduk N. On the definitions and physiology of back pain, referred pain, and radicular pain. Pain. Published online December 2009:17-19. doi:10.1016/j.pain.2009.08.020
(3) Cooper G. Clinical Anatomy of the Lumbosacral Spine. In: Non-Operative Treatment of the Lumbar Spine. Springer International Publishing; 2015:3-10. doi:10.1007/978-3-319-21443-6_1
(4) Urits I, Burshtein A, Sharma M, et al. Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis, and Treatment. Curr Pain Headache Rep. Published online March 2019. doi:10.1007/s11916-019-0757-1
(5) Chou R. Low back pain (chronic). BMJ Clin Evid. 2010;2010. https://www.ncbi.nlm.nih.gov/pubmed/21418678