There are approximately 24 vertebrae (bones) stacked on top of each other from the bottom of the skull to the pelvis. In between each vertebra there is a soft cushioning disc (intervertebral disc). The disks are similar to a jelly doughnut because the outer part of the disc (annulus fibrosus) is like the dough and the inner portion (nucleus pulposus) is similar to the jelly. In a normal disc, the inner portion (jelly) of the disc remains inside the outer portion (dough). The annulus fibrosus is the outer shell of a disc that connect the bones and protects nucleus pulposus, which cushions the bones and absorbs the shock exposed to the spinal column. It also provides motion between the vertebrae of the spine so we can bend and move our neck and lower back.
Most episodes of lower back pain result from relatively harmless conditions such as pulled muscles, weak core muscles, degenerative discs, arthropathy, spinal instability, scoliosis, and a myriad of other less common conditions.
The most common cause of back pain is the normal aging process of discs in the lower back combined with the mechanical effects of absorbing weight and allowing motion to take place between the bones and the discs. Discs reach this critical level where they lose their ability to absorb shock efficiently.
Degenerative discs are common among older people. Below is a picture of what a normal disc, degenerative disc, bulging disc, herniated disc, thinning disc and disc degeneration with osteophyte formation looks like.
Discogenic pain is caused by damage to the intervertebral discs. Back pain is typically worse when sitting or standing. Walking short distances reduces the pain. Aerobic exercise improves the patient’s fitness level. Long-term aerobic activity does not cause permanent injury to the patient. For most patients, using anti-inflammatory medications will alleviate the pain. Physical therapy for strengthening and stretching can help those with more severe and persistent pains. Epidural Steroid Injections are reserved for those patients whose pain continues after physical therapy. Surgery is reserved for those patients who fail all other treatments.
A person with discogenic lower back pain should expect intermittent episodes (less than 3 weeks) of short-lasting back pain over many years. Each episode of back pain usually last less than 6 weeks, and no more than 12 weeks. If at any time the pain lasts longer than anticipated or the pattern of pain changes, it should be reevaluated by a physician. When more stress in put on the vertebrae means the disc is more likely to slip. Slipping causes narrowing of the spinal cord, and abnormal forces at the slip create bone spurs, disc herniation, and thickening of the lumbar ligaments. All of these factors contribute to the stenosis (narrowing). Treatment is determined by your symptoms, and depends on how much pain you’re having.
Degenerative facet joints can cause back pain. A scoliotic curve is a curved spine. Disc herniations occur when a full-thickness tear in the outer part (dough) of the disc allows the inner portion (jelly inside the donut) of the disc to leak out of the hole. Nerve roots lie very close to the disc, and when the disc leaks, pressure builds up on the nerves causing them to become irritated and inflamed. This causes pain, numbness, and tingling in the arms and legs. Sometimes, this irritation leads to muscle weakness and/or loss of bowel or bladder function. Patients with lower back pain who have been treated conservatively often need surgical intervention to relieve the pressure on the spinal nerves.
Different Types of Pain
First you need to know the types of pain – inflammatory pain, mechanical pain, musculoskeletal pain and neuropathic pain. Inflammatory pain (occurs due to inflammation of spinal joints) begins gradually, comes and goes, feels better with exercise, affects other areas of the body and lasts longer than three months. Mechanical pain (source of pain may be in the spinal joints, discs, vertebrae or soft tissues) begins suddenly, it is persistent, feels better with rest, stays in one area and lists for a few weeks.
With back pain, the pain is divided into categories: acute, chronic, and neuropathic. Acute lower back pain usually lasts less than three to six months. It is defined as pain directly associated with tissue damage such as: paper cut, needle prick, touching a hot stove, smashing a finger with a hammer, labor pains.
However, if pain persists, it can increase an individual’s risk of becoming chronic pain. Chronic pain is pain that lasts more than three to six months, beyond the point of tissue healing. Chronic pain can be due to identifiable cause or not. Chronic pain that does not have a clear determinable cause could be continued pain after surgery that has completely healed, and fibromyalgia is another example of chronic pain.
Musculoskeletal pain is pain that that affects: bones, joints, ligaments, muscles, and/or tendons. This pain can be either acute or chronic. It may also be in one area of the body or it may affect your entire body. The most common types of musculoskeletal pain are: bone pain, such as fractures; joint pain, which can be stiffness and inflammation; muscle pain this can include muscle spasms, cramps, some infections or tumors; tendon and ligament pain that includes sprains, strains and overuse injuries.
Neuropathic pain has no signs of the original injury remaining and the pain is not related to an observable injury or condition. What happens is that certain nerves keep sending pain messages to the brain even though there is no ongoing tissue damage. The pain is often described as severe, sharp, lightning-like, stabbing, burning, or cold. You may have ongoing numbness, tingling, or weakness. You may feel this pain along the nerve path from the spine down to the arms/hands or legs/feet.
Causes of Lower Back Pain
In some cases, lower back pain may be due to arthritis or other degenerative diseases. Lower back pain is a very common problem among adults over 30 years of age. Having a family history of osteoporosis increases your chances of developing lower back pain.
Most common causes of low back pain are mechanical issues, musculoskeletal injuries, and soft tissue injuries. Other causes of lower back pain are injuries to the intervertebral discs, nerve root compression, and irregular movement of spinal joint.
Low back sprains or strains can happen suddenly, or develop slowly over time from repetitive movements. Strains occur when a muscle is stretched too far and tears, damaging the muscles and ligaments. Sprains happen when ligaments, which connect bones together, are affected by over-stretching and tearing.
Common causes of sprain and strain include: lifting heavy objects, or twisting the spine while lifting; sudden movements, such as a fall, that places too much stress on the lower back; poor posture; sports injuries (i.e. golfing, hockey, football, tennis, gymnastics) that involve twisting or large forces of impact.
Causes of Chronic Lower Back Pain
A common cause of chronic pain in the lower back is a lumbar herniated disc. In this case, the jelly-like center of the disc breaks through the tough outer layer, causing irritation and inflammation of nearby nerves. This causes excruciating pain and makes movement difficult. Discs are filled with proteins that cause inflammation if they reach nearby nerves, and inflammation can be caused by inflammation of the muscles around the spine. Nerve roots receive many nutrients from the discs, and tears in the discs can cause inflammation of these nerves.
Degenerative disc disease. In the beginning of life, there isnot much degeneration in the discs. Over time, the discs begin to weaken. Eventually, the discs become too weak to support the body weight and the person feels pain. Facet joint dysfunction occurs when the discs are too weak to hold up the facet joints. This causes the facet joints to rub together and feel painful.
Sacroiliac joint dysfunction is an inflammation of the sacroiliac joints. There is too much pressure on the sacroiliac joint causing pain. Sacral stenosis is when your nerves are compressed by the bones in your spine. You may suffer severe pain in your buttocks and legs.
Facet joint dysfunction is two facet joints behind each disc at each motion segment in the lumbar spine. The joints have cartilage between the bones and are surrounded by a capsular ligament that Facet joint dysfunction. There are two facet joints behind each disc at each motion segment in the lumbar spine. These joints have cartilage between the bones and are surrounded by a capsular ligament that is greatly supplied by nerves. These joints can be painful by themselves, or in conjunction with disc pain.
Spinal stenosis causes pain through the narrowing of the spinal canal where the nerve roots are located. Narrowing of the spinal canal can be central, forminal, or both, and it can be at a single or multiple levels.
Spondylolisthesis is a condition where one vertebra slips over another. There are five different kinds of spondylolisthesis. Most commonly, it happens because of a defect or fracture of a joint between two bones. Mechanical instability of the joint causes back pain.
Osteoarthritis is a degenerative disease of the discs and joints. It usually affects people older than 50 years old.
Spinal osteoarthritis can be slow-moving and painful. It is usually associated with aging and can cause curvatures of the spine. Trauma can cause acute fractures or dislocations that can cause pain. It sometimes referred to as spondylosis or degenerative joint disease.
Compression fractures occur when the spinal column collapses inward.
Osteoporosis causes weak bones, and compression fractures are caused by weak bones. Older people have weaker bones than younger people. These types of fractures may be caused by osteoporosis, which is a condition that affects the bones. People who have osteoporosis usually get compression fractures.
Ankylosing spondylitis (AS), which is a type of arthritis that causes inflammation, pain and stiffness most often in the spine and joint above the tailbone. AS occurs when your immune system is overactive and attacks healthy joints and tissues, causing inflammation.
Deformity. Curvature of the spine can include scoliosis kyphosis. Deformity can be associated with lower back pain if it leads to malfunction of the discs, facet joints, sacroiliac joints or stenosis.
Trauma such as fractures or if the spine is dislocated can lead to pain.
Low back pain can be caused by less common factors, such as infections (osteomyelitis, which is a spinal infection), spinal tumors, or autoimmune disease.
How is Lower Back Pain Diagnosed?
Your health care provider, will ask you about your symptoms and complete a physical exam. He or she is checking for broken bones or other damage. Your health care provider might order imaging studies to help him or her determine if there is any damage to spine, vertebrae, discs, muscles, ligaments, tendons, nerves, blood vessels or organs.
Some of the tests that might be ordered are: Spine X-ray to get an image of the bones; MRI (Magnetic Resonance Imaging), which uses magnet and radio waves to create a picture of bones, muscles, tendons, and other soft tissues; CT scan that creates 3D images of bones and soft tissues by using X-rays and a computer; and/or a Electromyography (EMG) to test nerves and muscles to see if there is nerve damage, which can cause tingling or numbness in your legs. Your health care provider may also order blood and urine tests. The blood tests can detect genetic markers for come conditions and urine tests can check for kidney stones that can cause pain in the sides of the lower back.
Lower Back Pain Relief
Medical Care
Lower back pain usually gets better by resting, taking painkillers, icing and exercising. You should stay active to increase blood flow to the area and help you heal quicker.
Medical treatments might include medicationssuch as over-the-counter pain relievers, nonsteroidal anti-inflammatory drugs (NSAIDs), or prescription drugs (narcotics, opioids) for pain and other medication that relax the muscles and prevent back spasms. These medications are usually given for nonspecific pain.
Back braces. Back braces can help lumbar support.
Injections. Your health care provider uses a needle and x-ray to inject medication into the area that is causing pain.
Steroid injections can be used to relieve pain and reduce inflammation.
Physical therapy (PT) is another treatment that may be prescribed to strengthen muscles. It also can improve flexibility and to avoid another injury.
The last treatment from a medical doctor can include surgery.
Chiropractic Care
In chiropractic medicine, Doctors of Chiropractic (Chiropractors) use non-invasive, hands-on approach, manual spinal manipulation (chiropractic adjustment). A chiropractor makes physical adjustments to the spine using manual manipulation therapy with the goals of improving mobility and reducing stiffness, discomfort, or pain and restoring proper alignment. Cervical spinal manipulation therapy is hand thrusts of varying speed and force are applied to adjust the spinal structures and cervical spinal mobilization therapy that is a gentle and less forceful adjustment technique. Other types of treatment that Chiropractors might use include massage therapy to ease muscle tension and reduce pain. Massages also increase blood flow to the low back, which brings nutrients and oxygen to damaged muscles that speed up healing. Flexion-distraction technique (where the patient is facing down and flexing legs up and down through the use a specially designed table. When the chiropractor flexes the legs down, pressure is placed by the doctor’s other hand on the desired segment of the spine. Heat and cold therapy, rehabilitation therapy, exercise therapy, traction and/or spinal decompression and dietary management may be included in your treatment. Meditation to reduce the perception of pain, depression, anxiety and sleep problems. Your chiropractor will develop a treatment plan, including exercises that are best for your diagnosis.
At Health & Rehab Chiropractic, Dr. Czekaj will do a comprehensive (physical and mechanical) examination. This includes getting your medical history, gathering information about you by asking questions: How and when did your pain begin, what is the effect of your pain, what is the level of pain, do you have any other symptoms, is there anything that makes the pain worse or better. He will check your posture, alignment, muscle tone, nerve function, how your body moves, how well you can bend, turn, twist, and if any specific movement(s) reproduce your symptoms. Dr. Czekaj may order x-rays, order an MRI, or other testing.
After the complete examination, Dr. Czekaj go over the results and explain what he believes is happening to your spine, the effective treatment he would recommend and explain how he thinks it will help you. If he deems necessary, he may suggest and provide referrals to see a physical therapist, spine surgeon, or other provider. Dr. Czekaj believes that the body has natural recuperative abilities that promote healing so you can get back to your normal activity.
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