Low back pain is extremely common with up to 80% of people experiencing it at some point in their life. The prevalence of low back pain in the adult population is 30% with the most common form being designated as mechanical or nonspecific. This name is given to low back pain that lacks specific tissue damage. Thankfully, this type of back pain is self-limiting and usually resolves in 4 to 6 weeks. However, more than 2/3 of people with low back pain experience a recurrent episode within 12 months and complete relief takes some time to achieve. Lastly, the economic costs related to the small minority of individuals with persistent, disabling occupational low back pain are an enormous problem for society.
The good news is that the majority of back pain improves rapidly and most of the causes are not serious or life threatening. A minority of people will experience chronic, unremitting low back pain while disability persists in a small percentage of people. Most individuals do not seek care from a medical professional but when they do, the pain does not last as long. Satisfaction is particularly good with chiropractic care.
Anatomy of the Low Back
There are 4 structures that make up the majority of the pain generators of the low back. There are other possible causes but the 4 structures often causing pain are:
- The intervertebral disc: small circular tissue found between each bony spinal segment, known as a vertebral body
- The facet joints: located on the back side of the spine, these connect one vertebral body to another vertebral body and allow for motion
- The nerve root: the initial branch of a nerve as it leave the spine
- The musculature: tissue that has the ability to contract and allows for spinal stability and motion
The following figure shows some of these structures
Patterns of Back Pain
There are 4 patterns of low back pain, each with their own type of pain presentation, symptoms, and aggravating factors
Flexion Intolerant Low Back Pain
This is the most common pattern of low back pain because it is aggravated in a position we often place ourselves in: forward flexed position (ex:sitting). This pain pattern involves the intervertebral disc that can develop small tears over a period of time. The pain itself is often intermittent and can worsen with flexion activities such as sitting, as well as bending and twisting. The pain may also increase from coughing, sneezing and straining.
Extension Intolerant Low Back Pain
This pain is typically developed when stress is put on the posterior elements of the spine, such as the facet joints. This pain is often intermittent, feels sharp or stabbing, and is localized to the low back. The symptoms often worsen with extension type activities such as bending backwards, walking or simply standing.
Radiculopathy
This is another word for a nerve root irritation. It can be irritated or inflamed by the intervertebral disc so exhibits the disc-type pattern as previously discussed. This is your sciatica-type back pain, which happens more often in individuals under the age of 50 years old. The pain is typically constant and described as shooting, burning or electrical. A defining feature of this pattern of low back pain is that you can experience numbness and tingling down the back of ONE leg and you may also experience weakness.
Spinal Stenosis
This pattern of back pain occurs more commonly in older individuals and is a progressive degenerative condition. The pain is typically intermittent, and aggravated by extension type activities such as standing and walking. You can experience numbness, tingling, or gluteal pain in BOTH legs and symptoms are often relieved by sitting or other flexion-type exercises.
All of the previously described patterns of back pain have something in common: a directional preference. In other words, the spine does not like moving in certain directions since they aggravate symptoms, and prefers to move in the directions that relieve symptoms. This is important in your recovery as movement will help your back heal as fast as possible. The goal is to find the best direction to do it in. Rest is sometimes necessary but it is important to remember that resting is because of the pain NOT FOR the pain. Prolonged rest can actually delay recovery so getup and move as soon as you can!
What About the Musculature?
Myofascial pain is unique from the previously discussed patterns of back pain. This is because muscles, on their own, rarely are a primary source of pain. Myofascial pain typically occurs with any of the above patterns of low back pain due to guarding, spasm, or irritation. It is also important to remember that some of these conditions can occur together, which is why you should see someone who is familiar with differentiating these types of back pain.
Check out the table below for a quick summary of the 4 patterns of back pain.
Interested in learning more how nutrition plays a role in recovery? Check out our blog post HERE!
Looking to meet with one of our chiropractors? Click the link HERE to book an appointment!
