Low back pain is one of the most common causes of disability worldwide, responsible for BILLIONS of dollars spent on health care and lost time at work annually. If you have ever experienced low back pain, you know that it can not only impact your hobbies and ability to remain active, but it can make even the most common of daily activities challenging. Our goal with this series is to help you better understand the cause of your low back pain, provide real solutions to help you manage it, and show you that there are many care options out there, some you can do at home, that allow you to remain free of prescription drugs and surgery.
Back pain is not a one-size fits all problem, there are most commons, but your approach to care needs to be as individual as you. Without a proper and thorough assessment, it is hard to say which approach will work best for you, but through the experience of helping hundreds of people alleviate their low back pain every day, we can focus on a few of the most common causes and their proven strategies for relief.
HOW COMMON IS LOW BACK PAIN?
When we talk about low back pain and its prevalence, you are more like to experience low back pain multiple times in your life than to never experience it at all. That being said, the presentation can vary from stabbing, shooting, and radiating type pain to a more dull, achy, and feeling of tightness. However you choose to describe this feeling, the trust is that it can and will disrupt your sleep, daily routines, and your desired recreational activities. There is good news at the end of this rope, and this is that the majority of low back pain sufferers have pain related to posture, overtraining, muscle tightness and is usually our bodies protective response to something it does not like, meaning it is treatable and preventable!
To lay some foundation for our low back pain discussion, here are a few current statistics:
Low Back Pain is the leading cause of disability worldwide, costing nearly $100 Billion in heatlhcare cost and lost wages.
It is estimated that 80% of people will expereience back pain during their life with over 50% having an episode this year.
Over 90% of low back pain complaints are mechanical in nature and do NOT require drugs or surgery.
Of those who have back surgery, around 27% will require another surgery within 5 years.
It is estimated that 60-75% of back pain is preventable through exercise, education, and proper work ergonomics.
WHAT CAUSES LOW BACK PAIN?
Back pain, although extremely common, is a somewhat complicated complaint where one very important thing must be understood before we move forward...
…back pain is a SYMPTOM, not a diagnosis.
Back pain can be dibilitating, but the real goal here is to understand the cause of your back pain so that we can determine what factors need to be modified in your life to prevent future episodes.
To look at this through a simple analogy, lets say you go out to your car tomorrow and it doesn’t start. Now, if you called your spouse, friend, or a mechanic, you would tell them your car won’t start (I have back pain), but the real question is WHY doesn’t your car start? It could be from a dead battery, empty gas tank, or something more severe and deep within the engine. Regardless, your car still will not start. Using this analogy, would you treat each of the above mentioned problems the same? No! Now, does it make sense to take the same approach when treating low back pain?
Looking at back pain, we typically break it down into 3 categories: Functional, Structural, and Pathological.
Functional: Simply put, how you move, or don’t move at all, is causing repeated stress and now you are pain sensitive, stiff, and in frequent or constant pain. This is the most commmon group. Letting a condition in this category go unaddressed too long can cause it to spill over into our structural category.
Strutural: Strutural conditions include the things you can see on x-rays and MRI’s. This is the category that includes arthritis (we all get it, you’re not special), disc bulges and disc herniations. These can absolutely cause pain but are usually the result of some long term dysfunction. NOTE: As we will discuss later, just because something shows up on an x-ray or MRI, does not mean it is the cause of your pain!
Pathological: This is the least common of the group, making up about 1-1.4% of back pain complaints. This is often the result of bowel diseases, kidney stones, long term unhealthy habits, and cancer. These are very rare and should not get your attention at first. Dr. Google will lead you this way but he is very deceptive!
These groups interact with each other frequently. For example, lets say you sit at a desk 8 hours each and every day of the week. From here, you like to lift weights. It has been shown that repeatedly lifting heavy objets with a rounded spine (functional), can lead to disc bulges (structural).
IMPORTANT ANATOMICAL FEATURES OF THE LOW BACK
When we look at the structures of the low back, it is easy to get lost in what all is there. Once we take into account how the core and hip muscles interact and support the low back, it can get pretty complicated.
Most are familiar with the vertebrae, and even more with the disc between each vertebrae. Each of these form a pseudo-joint, and along with the pillars of facet joints down each side, we have the vertebral collumn. We know that muscles move and stabilize joints and restriction, tightness, or a strain/sprain type injury to these tissue can cause a cycle of pain, one caused by the other, and so on.
Looking at the muscles, there are too many to mention for our purposes here, but as mentioned above, when looking at low back pain, you must include the core and hip musculature in the conversation and not just the commonly blamed errector spinae and multifidi muscles of the low back. Honestly, there is so much more to low back pain than this, but to stay on track and address the most commons, understanding where the facet joints are, how the hip muscles and core muscles support the low back complex will suffice for our lesson.
LET’S REVIEW WHAT WE LEARNED HERE IN PART 1:
Low Back Pain is one of the most common reasons a person presents to a doctors office and results in over $100 Billion in healthcare costs and lost work time.
Of all the structurs associated with the low back, we can break most complaints down into 3 categories: Structural, Functional, Pathological.
Low Back Pain is NOT a diagnosis, it is a SYMPTOM!
Not that we have the basics down, look out for part 2 of our Low Back Pain series where we will cover the most common causes and basic self-treatment options. -> Part 2 <-
Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Cottonwood Heights Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.