If you’re experiencing pain in your lower back, you’re not alone. Up to 80% of the population in the US has reported experiencing lower back pain at some point during their lives. Over the last 3 months, 25% of the US has experienced lower back pain. Just because low back pain is common, does not mean it’s normal.
After a long winter in Chicago, everyone has slipped on a patch of ice, hefted one too many shovels full of snow or succumbed to ten inevitable deconditioning from too many nights and weekends on the couch.
It seems likely Chicagoans experience more than their fair share of lower back pain. There are a million different ways your low back pain can start and once it’s started, it often becomes a persistent chronic part of your life, making it difficult to enjoy your down time, distracting you at work and limiting your ability to remain active.
Lower back pain can be classified into two basic groups: local or radicular pain (sciatica or sciatica-like).
Local pain is exactly that, confined to one area in your back. During the acute (short-term) after it starts, you may experience sharp pain localized to one specific area. As your low back pain becomes more chronic and persistent, the pain tends to become more diffuse and spread out. It may even change how it feels, giving you more of a dull sensation making it harder to pinpoint one specific area. The broad, diffuse pain results from irritation to facet joints, small joints along the back of your spinal bones (vertebra). This dull, diffuse pain (aka sclerotogenous pain) spreads along predictable patterns along your spine.
You may be able to control or manage this type of pain temporarily with heat, massage, ice, rest or NSAIDs. Unfortunately, the benefits of managing the pain are generally do not provide a solution for you even though you may feel much better. This type of pain tends to become persistent and returns like an unwanted houseguest, disrupting your routine, making life less enjoyable and it’s just plain annoying. Facet joints tend to become irritated with abnormal loading, overstress or overuse.
This irritation can result from poor posture. Posture is just an external expression of what’s happening internally. If your spine isn’t in the correct position, your joints will experience increased or abnormal loading. This “extra” wear and tear leads to irritation and irritation leads to inflammation and inflammation leads to pain.
If your problem is related to a postural issue, the posture must be addressed along with the irritated and painful muscles and joints. These types of issues tend to be ones that progress through your workday. You may start the day feeling “ok” but, by the end of the workday or work week, your lower back pain is much more noticeable and affecting your ability to function. The starting point of many of these problems originates with your daily life or lifestyle.
Work can be especially problematic because you may find yourself stuck in one position or in awkward positions for extended periods of time. Whether you’re an office worker working in downtown Chicago, a construction worker or something in between, you probably already recognize which part of your job is helping to cause the problem. The next step is finding out exactly what part of your body has been affected negatively and which changes need to be made to get you back to normal.
Your low back pain may have also gotten its start with a trauma. Most people don’t realize, you don’t always feel pain immediately after an incident that causes damage to your body and it isn’t always something memorably. Were you sliding into second base during a Chicago Sport and Social event or the high level Chicago Metropolitan baseball league and catch the bag funny as you went for two? Going up for a rebound and someone knocked your legs out and you took a hard fall? Running along the lake front path and hit an uneven section of road and jarred your lower back a little? Did you pick up your little one or lift them into a car seat out of balance? It could be any of these things or a thousand other ways; life has a way of sneaking up on us and wearing our bodies out!
There are some instances where the traumas can lead to the second type of lower back pain, radicular pain. This type of lower back pain travels from the lower back down your legs. It may even be you don’t feel any pain in your lower back and only pain, tingling or numbness down your legs, in your feet or in one spot where the sensation is no longer normal. With radicular or radiating pain, the cause is an injured intervertebral disc putting pressure directly on your spinal nerves.
Intervertebral discs are large circular-shaped pieces of cartilage acting to provide shock absorption and help create the shape of your spine from top to bottom composed of the annulus fibrosis and nucleus pulposus. The nucleus pulposus is a jelly-like substance/gel at the center of the disc. With sudden or extended abnormal loading, this gel-like material can migrate from the center. If it only moves slightly, the disc injury is called a bulge or protrusion where the bulge places pressure on the spinal nerve and the pressure may not always be constant but can come and go. These types of disc injury are the least severe type of disc injury and typically respond very well to physical therapy and chiropractic care.
Our office has found most of these cases respond very well to treatment and patients feel dramatically better over the course of 3-5 weeks. The next level of disc injury is called a prolapsed disc. In a prolapsed disc, the gel has migrated significantly and is only contained by the last layer of disc cartilage. Prolapsed disc injuries are more severe than a “regular” bulge and may take significantly longer to heal. Despite the severity of these injuries, the best course of action is still physical therapy and chiropractic because surgical interventions create permanent changes to your spine and its mechanics and should always be considered a last resort.
The last type of disc injury is when the disc punches through the cartilaginous layer. These are then divided into extruded or sequestered injuries. With an extrusion, the gel remains connected to the disc and hasn’t become completely disconnected yet. A sequestered disc fragment has been completely disconnected. With sequestered discs, the pain can move around and be very unpredictable.
In the most severe cases, the pressure on the nerves is so severe it can lead to a syndrome called “cauda equina.” In cauda equina, individuals lose control of their bladder, bowel and/or lower extremities. These cases are a MEDICAL EMERGENCY and surgery must be performed immediately to avoid permanent, irreparable long-term damage. We have been able to successfully treat over 93% of all other cases involving a disc injury and you should not wait until your low back pain gets this bad to take action. The longer you experience pain, the more time and effort it will take you to get back to feeling and functioning normally.
Standard of Care for Disc Injuries as reported in latest research
- 6 weeks of conservative care, if no progress escalate
- Identify problem causing the discal irritation
- Reduce pain
- Improve ROM
- Muscle memory/programming
- Strengthening/locking in gains
- Sequestered discs are surgical
- MD recommendations
- Muscle relaxers
- Cortisone injections
As you probably know, NSAIDs are not to be used more than 10 days in a row because they lead to a significant increase in stomach bleeds. Opioids have been in the news for a few years now and their side effects and addictive nature far outweigh any benefit they might provide. Muscle relaxers may provide temporary relief but as soon as the medication wears off, the pain and symptoms typically come right back.
Physical therapy and chiropractic pose minimal risk compared with medical interventions. Published research reports the effectiveness of physical medicine along with manual therapy in reducing/improving lower back pain. There is a secret weapon our office has at our disposal and it isn’t available to other healthcare providers … (drum roll please) … Our secret is access to and experience using specialized spinal structural analysis software which allows for a direct comparison between your spine and a “normal, neutral” spine. This tool greatly improves the focus of your treatment program AND allows for an extremely accurate means to track your improvements after your symptoms have disappeared.
As seen to the left, the green line indicates neutral/normal position of the spine and the red line shows where the actual position of the spine. Using a systematized program, to reduce pain, restore motion and re-train your body to maintain a normal position, the best possible long-term results can be achieved. You can be pain-free AND you can optimize your body at the same time and reduce the chance you have to suffer from low back pain in the future.
If you’re ready to be pain-free, let us know. We are ready to help you get back on track and forget all about your lower back pain.