Wednesday, March 6, 2013

7 Common Cause of Low Back Pain

Low back pain is one of the most common complaints at the doctor's office. It is estimated that over 80% of the population will experience at least one episode of severe LBP (low back pain) that will debilitate them for at least one week. That is significant! You are also more likely to experience periodic exacerbation of LBP following an injury to the lumbar spine. Chronic LBP tends to be episodic and generally comes on without warning.

This blog post is to identify the most common causes of low back pain.

1. Injury or Sprain/Strain of the lumbar spine: this is a common cause of LBP, especially in the workplace and following a motor vehicle accident. If treated within a short amount of time, this type of condition generally resolves in 8-12 weeks. However, other variables such as obesity, diabetes, pre-existing LBP, degenerative arthritis, deconditioning etc...may cause the lumbar sprain injury to take longer to resolve.

2. Degenerative Disc Disease, Osteoarthritis, Spinal Stenosis: I have lumped the degenerative arthritic conditions together, with spinal stenosis being the most severe and progressive condition of them all. Degeneration of the spine is caused by "wear and tear" and/or history of trauma. The "degenerative cascade" proposed by the famous orthopedist Dr. Kirkaldy-Willis starts with spinal dysfunction/fixation and/or injury of the spine. This leads to intervertebral disc cellular changes, tears, bulges, herniations and eventually leading to instability. The body then attempts to stabilize (the final phase) by stiffening up as the joints, discs and spine becomes arthritic with calcium deposits. End stage lumbar spondylosis is spinal fusion.

3. Disc herniation: there are several categories of intervertebral disc herniations. The most common is a circumferential bulge. Studies demonstrate that about 80% of the population have minor disc bulges and are generally asymptomatic. Another type of disc herniation is a protrusion. This is when the outer annular fibrocartilage weakens or tears and the inner "jelly-like" nucleus protrudes out from the spine. This will commonly compress or irritate a spinal nerve root. The other type of herniation is the disc extrusion. This is when the outer annulus fibers tear completely and the inner nucleus pulposus herniates out from the spine. This may compress a spinal nerve above or below the vertebra and usually requires surgery.

4. Facet syndrome: This is a very common cause of LBP and a condition that I treat frequently in my office. The facets, also called the posterior joints, are interlocking joints of the spine that are highly innervated with nerves and receptors and are covered by a joint capsule. This is why they are common pain producing structures of the spine. The facet joint capsules are often sprained during flexion and torsional movements. The facet joints frequently become "impinged" or "locked up" and is commonly referred to as facet imbrication or facet impingement. Chiropractic manipulation is effective for this type of problem.
5. Scoliosis: This is a condition in which right or left (lateral) curves of the spine are present and are generally more than 10 degrees. Any curve below 10 degrees is considered a minor "curvature" and is generally a functional curve. Adolescent idiopathic scoliosis is the most common type of scoliosis and starts between ages 10-16. Scoliosis management ranges from conservative chiropractic care, postural exercises, to bracing and in more severe cases surgery.

6. Sacroiliac Syndrome: This is another very common cause of low back pain. It is commonly mistaken as hip pain. The sacroiliac joints are found in the pelvis between the ilium and the sacrum at the bottom of the spine. Some people have small little dimples in the region of the SI joints. The SI joints are synovial joints and are connected by strong ligaments. The SI joints can also become sprained. Sacroiliac syndrome usually presents as localized joint and buttock pain, but can refer to the groin or posterior thigh. The gluteal muscles are almost always involved and are tender and/or weak. (specifically the gluteus medius and minimus)

 7. Postural syndromes: This is another common cause of low back pain and is almost always, to some extent, involved in all of the above conditions. Lower crossed syndrome is a common postural imbalance in the lower body which involves having tight low back muscles and hip flexors and weak glutes and abdominal (core) muscles. This will cause anterior (forward) pelvic tilting, causing dysfunction in the lower lumbar spine and sacroiliac joints. This is another condition that I see everyday in my office and it responds well to chiropractic manipulation and exercise/postural re-training.
For more information Dr. Brent Moyer can be contacted at Brant Arts Chiropractic 905-637-6100. Twitter @BrantArtsChiro Facebook: Brant Arts Chiropractic.