Back Pain

Lower Back / Lumbar Pain

As you probably already know, back pain is a very common complaint. About three in four adults will experience back pain during their lifetime—and that number may very well rise, given our aging population and recent trend of obesity.

Low back pain (pain in your lumbar spine) is the most common. Most back pain comes from sprains and strains caused by stressful movements: lifting something without using proper techniques or a sudden twisting motion are just two examples of how you can hurt your back.

If your back pain is caused by a muscle sprain or strain, the rate of healing depending on how severe the sprain or strain is. Sometimes scar tissue and fibro-adhesions will develop after injury making this region more succeptable to re-injury. Your recovery can also be helped along by modest medical attention such as over the counter anti-inflammatory medication and pain management if necessary. Furthermore, chiropractic care is the best conservative treatment for low back pain. Other treatments that are beneficial include: stretching, exercise, ice packs, and massage.

Sometimes, though, back pain is caused by a more severe spinal condition, such as a herniated disc or spondylosis. Chiropractic care in 90% of these cases can help resolve these symptoms and manage the patient’s chronic condition. Depending on the severity of your pain and its cause, you may require more involved medical help, such as pain management in addition to chiropractic care; and in severe cases surgery.

But please keep this in mind: just because you have back pain doesn’t mean you’ll need serious medical attention or surgery. It does mean that you’re in good company and that you have an array of treatment options to get you feeling better.

As you can see from the image below, your back, or spine, is made up of many parts. First, we’re going to look at the bone structures. Your backbone, also called your vertebral column, helps support a lot of your body weight, and it protects your spinal cord. You have 33 vertebrae (bones) that make up the vertebral column. In the image, they’re labeled as “Vertebral Body.”

Parts of the Spine

Your spine is divided into regions: there’s your neck (cervical spine), mid-back (thoracic spine), and low back (lumbar spine). At the bottom of your spine, you also have the sacrum and the coccyx, which is commonly called your tailbone. Your iliums or hips then attach to the sacrum.

The vertebrae in your neck are labeled C1-C7, meaning that you have seven vertebrae in that region. Most adults have 12 vertebrae in the thoracic spine (T1-T12), which goes from your shoulders to your waist. Then there are five vertebrae in your low back (L1-L5), and below that, your sacrum is made up of five vertebrae between the hipbones. By the time you’re an adult, these five bones have fused into one bone. The coccyx is made of small fused bones at the very tail of your spine (hence the tailbone).

Your spine also has facet joints, which are on the posterior side (back) of your vertebrae. These joints (like all joints in your body) help facilitate movement and are very important to your flexibility. They are surrounded by a ligamentous capsule that can become inflamed and become a cause of low back pain know as facet syndrome. Patients who wear high heels or place their back into extension will aggravate this condition.

Another vertebral bone structure that’s labeled in the image is the pedicle. These are on either side of your vertebrae, and they are part of the “walls” for your spinal canal.

In between your vertebrae, you have intervertebral discs (also labeled on the image). These act like pads or shock absorbers for your spine as it moves. Each disc is made up of a tire-like outer band called the annulus fibrosus and a gel-like inner substance called the nucleus pulposus.

Together, the vertebrae and the discs provide a protective tunnel (the spinal canal) to house the spinal cord and spinal nerves. The spinal cord gives off branches or pairs of nerves at each level of the back. These nerves exit neural foramens and extend into various parts of the body, where they help you feel and move.

Your back also has muscles, ligaments, tendons, and blood vessels. Muscles are strands of tissues that act as the source of power for movement. Ligaments are the strong, flexible bands of fibrous tissue that link the bones together, and tendons connect muscles to bones and discs. Blood vessels provide nourishment. These parts all work together to help you move.

Back pain may be a result of injury to any or all of these body parts. Injury to the muscles, ligaments, tendons can result in sprains or strains. Injury to bones, nerves, or blood vessels may be more serious. Also, the outer layers of the intervertebral discs can get tears or cracks, allowing the annulus fibrosus or nucleus pulposus to bulge out. Any of these injuries can cause inflammation and pain.

Back pain is its own symptom. However, there are various ways to feel back pain, and your symptoms depend on what is causing your pain and where it is affecting your spine.
Your back pain may be acute or chronic. Acute pain lasts four to six weeks, but chronic pain is persistent, long-term pain—sometimes lasting throughout life. At times, people with chronic pain can aggravate or exacerbate their condition resulting in acute pain.
Back pain may be sudden and sharp—or it may be dull. Pain may occur with movement, and it may even occur with coughing and sneezing. You may also have numbness in your arms or legs. (Leg symptoms are often referred to as sciatica caused by a pressured or impinged nerve.)
It’s important to treat your back pain properly. Contact your physician or chiropractor—and seek immediate attention if you have back pain with any of the following emergency signs:

• Pain is increasing in intensity and getting worse
• Pain affects every day activities
• Moderate symptoms
• Groin or leg weakness or numbness
• Arm or hand weakness, tingling, or numbness
• Loss of bowel or bladder control
• Because there are a variety of causes of back pain, it’s vital to know the exact cause of your pain, and your doctor will help figure that out.

It is not uncommon for individuals to hurt their back and not realize how they did it—but your back certainly does, and the pain is trying to tell you something. Or you may not know that something is wrong with your spine until a stressful movement aggravates the condition. Some common causes of back pain include:

Aging

Ligaments thicken, shorten, and discs dry out with age—that’s just part of what happens to us as we grow older. These age-related changes in the spine may lead to disorders that create pressure on your spinal nerves—meaning that you’ll have symptoms such as pain, numbness, or weakness. Degenerative disc disease is an example of an age-related spinal disorder. Over time, your discs can lose their normal structure and function. That is just wear and tear, but it can result in a bulging disc or a herniated disc and pain. Sometimes, the bulging or herniated disc can pressure a nerve, causing pain that travels to another part of your body. For example, a herniated disc could push on a nerve in your low back and send a shooting pain down your leg (also known as sciatica). Pain that travels from the origin to another part of your body is called radiculopathy. You can experience cervical radiculopathy, which affects your arms mainly, or lumbar radiculopathy, which affects your legs.

Daily Life

Just getting through every day takes its toll on your body. Stress and emotional tension can cause muscles to tighten and contract, resulting in pain and stiffness. Since we carry most of our weight in our backs, that’s where we can feel the end result of tense daily living: tight muscles and painful movements. Also, the way you’re getting through your day could be the cause of your back pain. Poor posture—standing for long periods of time or sitting incorrectly—can cause back pain (so watch out while you’re at the office). Low back pain is often associated with heavy physical work, lifting or forceful movement, bending or twisting, or awkward positions. If you don’t use proper lifting techniques while hefting a box of books, for example, you can really hurt your back. Even healthy, normal activities can cause muscle sprains and strains, which can lead to back pain. Gardening, tennis, horseback riding, biking, and even golf can all potentially hurt your back.

Injuries and Accidents

You can fracture a spinal bone in a fall or a car accident. If you have osteoporosis, a condition that weakens your bones, you’re much more prone to fracturing a bone. You can have a sports-related injury, such as pain caused by being tackled too many times in football. These are the sudden, unexpected causes of back pain that most likely require immediate medical attention.

Obesity

Being overweight puts pressure and stress on the back, especially the low back. In addition, carrying excess weight aggravates other health conditions such as osteoporosis (weak bones), osteoarthritis (joint pain), rheumatoid arthritis (an autoimmune disease), degenerative disc disease (described above in the aging section), spinal stenosis, and spondylolisthesis.

Secondary Metastatic Cancer

Unfortunately, cancer that has spread from another organ can affect the spine. In males usually prostate cancer affects the lower back; in females ovarian, breast, or uterine cancer may affect the spine. There are other organs that may spread to the spine but these are the most common. In these situations most treatment consists of palliative care for which a pain management physician would be helpful. In these instances injections or vertebralplasty / kyphoplasty will be helpful as the spine is fragile when cancer is involved. Chiropractic care is not an option.

Why Consult a Chiropractor

Chiropractic offers gentle, effective, and time-saving approaches to treat your low back pain. Chiropractic is a drugless, non-surgical system of health care. One important principle of chiropractic involves returning motion to the spine. Restricted spinal motion—when the spine doesn’t move as well as it should—can cause back pain.

Chiropractors emphasize spinal manipulation (or adjusting the spine) as a means of correcting spinal joint restrictions and relieving pain, treating disc injuries, improving alignment and posture, and promoting health and wellness.

Chiropractic has developed a number of treatment approaches in addition to traditional spinal adjustments. These treatment approaches help chiropractors address a wide range of back pain conditions.

Low back conditions that respond to chiropractic care include:

• back sprain or strain injuries
• spinal joint restriction syndromes
• facet joint sprain
• sacroiliac sprain
• lumbar disc injuries that don’t require surgery
• radicular pain or symptoms of numbness in the lower limbs
• spinal stenosis
• various types of chronic low back pain

Before deciding which approach or approaches are for your pain, the chiropractor will do a thorough examination to diagnose the specific cause of your pain.

How a Chiropractor Diagnoses Back Pain

Even if you go to the chiropractor complaining of low back pain, he or she will evaluate your spine as a whole. The chiropractor will check your neck (cervical spine), mid-back (thoracic spine), and low back (lumbar spine). It’s important to examine the entire spine because even though it’s just your low back that hurts, other regions of the spine may be affected.

Your chiropractor will determine areas of restricted joint motion, disc injury, muscle spasm, and ligament injury. One way the chiropractor does that is through motion and static palpation of each unit of motion in the spine. These diagnostic techniques are unique to chiropractic. Motion and static palpation is an examination by means of movement and touch. The chiropractor will feel for tenderness and tightness, and then he or she will examine the spine to see how well each spinal joint moves.

The chiropractor will also analyze how you walk and look at your overall posture and spinal alignment. Those details will help your chiropractor understand your body mechanics and how well your spine is working and moving.

The chiropractic examination includes standard physical and neurological exams. You’ll also go through your past medical history with the chiropractor. The chiropractor may have you get imaging tests (such as x-rays or MRIs) and laboratory tests in order to help him or her diagnose the cause of your back pain.

After the examination, the chiropractor will be better able to create an effective treatment plan for your back pain.

Possible Chiropractic Treatment Approaches for Back Pain

The exact treatment plan depends on your diagnosis. Your chiropractor may use a combination of spinal manipulation, manual techniques, and therapy instruments.

Some possible spinal manipulation treatment approaches are:

Specific spinal manipulation:

Sometimes called spinal adjusting, spinal manipulation is an active, hands-on care that returns motion to the spine. With a return of normal spinal mechanics, muscles relax and pain is resolved. In specific spinal manipulation, the chiropractor identifies the joints that are restricted or show abnormal motion (also called subluxations). He or she then returns motion to the joint with a gentle thrusting technique.

Flexion-distraction technique:

This is a gentle, non-thrusting type of spinal manipulation. This treatment is still hands-on, utilizing a specialized table to assist the chiropractor. It’s especially useful in treating bulging discs and ruptured (herniated) discs.

Thompson Technique:

This utilizes tables with drop mechanisms that enable the doctor to use a hand on thrust that mobilizes the joints when the mechanism hits its resting or normal position. This is highly helpful with pelvic and sacral torsion or a pelvis that is torqued.

Instrument-assisted manipulation:

This is another non-thrusting technique. Using a hand-held instrument, the chiropractor can apply force without thrusting into the spine. This is especially appropriate in older patients with degenerative joint syndrome.

To treat your back pain, the chiropractor may also use various manual therapies. These are used to treat soft tissue (ligaments and muscles, for example) injuries. Some possible manual therapies are:

Trigger point therapy:

The chiropractor identifies specific hypertonic (tight), painful points on a muscle (these spots or areas are pockets of inflammation). Then he or she puts direct pressure (using the fingers) on these points to relieve the tension and / or break up the inflammation.

Stretching:

Here are some important things to keep in mind as you do these low back stretches:

Manual joint stretching and resistance techniques or post isometric stretching: this technique enables the practitioner to fool our body’s defense mechanisms / stretch receptors. By doing so we are better able to further lengthen tight muscles.

Therapeutic massage:

Myofascial release in simple terms is passive shortening and lengthening of the muscle while placing direct pressure over trigger points.

Instrument-assisted soft tissue therapy:

The chiropractor uses instruments to perform repeated strokes over the area(s) of restriction. Research has shown that instrument-assisted soft tissue therapy increases the number of fibroblasts in the area. Fibroblasts are special cells that help heal injuries, including muscle injuries. If there are more fibroblasts, then the strained muscle, for example, can heal faster.

In addition to spinal manipulation and manual techniques, the chiropractor may use various instruments to treat muscle inflammation. These modalities are used to relax the muscles. Some examples are:

Ultrasound:

By increasing blood circulation, an ultrasound helps reduce muscle spasms, cramping, swelling, stiffness, and pain. It does this by sending sound waves deep into your muscle tissues, creating a gentle heat that enhances circulation and healing.

Interferential electrical stimulation:

This uses a low frequency electrical current to stimulate your muscles and pain fibers.

Exercise:

reinforce the improved joint mechanics (return of normal spinal motion); your chiropractor will prescribe therapeutic exercises.

Prevention and Whole Person Care Chiropractors are “whole person” doctors who view back pain as unique to each patient. Therefore, they don’t focus on just your back pain. Chiropractic care includes nutrition, stress management, and lifestyle goals (because all of those can add to back pain, so you need to address them if you really want to relieve your pain).

Chiropractors emphasize prevention as the key to long-term health—another example of chiropractors looking at the whole person, not just the painful problem. Preventing low back pain is vital to the chiropractic approach to care.

If you have back pain, you have many treatment options to choose from, including alternative treatments. Your doctor may even suggest treatments such as acupuncture, herbs, or massage as part of your treatment plan. These options are called “alternative” because they’re an alternative to “traditional” medicine, which generally means medications, injections, and surgery.

Many patients have reported that alternative treatments and nutrition have helped relieve their back pain. You may want to try:

Acupuncture or Acupressure:

These alternative treatments developed in China. Practitioners believe that you have an energy force called your Chi (it can also be spelled Qi, but both forms are pronounced “chee”). When this force is blocked, you can develop physical illness, such as back pain. Therefore, you need to free up your body’s Chi channels, which practitioners call your meridians. Acupuncture and acupressure work to restore a healthy, energetic flow of Chi. Acupuncture uses very fine needles, and practitioners insert them into precise points in your body’s meridians—exactly where is determined by your symptoms. The needles, which contain no medication, are left in for 20-40 minutes. Research has shown that the presence of the needles causes your body to release certain neurochemicals, such as endorphins, and they help in the healing process. Acupressure works along the same principles as acupuncture, except practitioners use their thumbs, fingers, and elbows to target the specific Chi points.

Herbal Remedies:

Before trying any herbal remedies, do your research and talk to your doctor. There may be side effects that you’re unaware of—an herbal remedy could interfere with a prescribed medicine you’re taking, for example. Some herbal remedies you may want to consider for your back pain are:

Anti-inflammatory:

natural supplements and diets are very helpful for reducing inflammation. For example, bromelain when taken in-between meals is a great proteolytic enzyme to decrease inflammation. Products that we carry in the office include bromelain and several other ingredients known to decrease inflammation. Omega 3, 6 are very helpful for not only improving good cholesterol, but, for decreasing arthritic inflammation in general. A product made by Metagenics known as UltraInflammX, is powerful for acute situations and general whole body inflammation. In addition to foods that are anthocyanoside-rich such as cherries and blueberries. Some individuals have food allergies that contribute to inflammation, identifying these foods and eliminating them is the key to reduce whole body inflammation.

Capsaicin Cream:

Capsaicin is what makes chili peppers hot, and it can also relieve your pain. It just temporarily reduces your pain, though, so you’ll need to keep re-applying, probably around 4-5 times a day. It may take several weeks for you to feel significant relief from capsaicin cream, so just because it doesn’t work right away, don’t give up.

Devil’s Claw:

Devil’s claw comes from southern Africa, where it has been used for centuries to treat fever, arthritis, and gastrointestinal problems. It works as an anti-inflammatory. Today, it’s used for conditions that cause inflammation and pain, like osteoarthritis. You can take it in a capsule.

White Willow Bark:

The white willow led to the development of aspirin in Europe. If you don’t want to take the synthetic version (aspirin can irritate the stomach), use white willow bark. It’s for conditions that cause pain or inflammation, like osteoarthritis. It also provides relief for acute back pain.

Massage:

A Spine Universe survey in early 2008 showed that back pain patients are very satisfied with massage as a treatment option. It actually had the second highest patient satisfaction rating. Considering that many cases of back pain are caused by muscle strain and overuse, it’s wonderful news that massage is a worthwhile treatment option. A massage can help release muscle tension and relieve muscle inflammation and pain.

General Back Health:

Let’s face it: even if you don’t have back pain right now, you probably have had it at some point—and you’ll probably have it again. To keep your back healthy, you should try to keep it strong, mobile, and flexible. Going through these easy stretches will help you do just that. Consider incorporating them into your normal exercise routine or making them something you do when you first get up every day. Seeing your chiropractor on a maintenance basis is preventative in avoiding exacerbations or aggravations of a new or chronic condition.

Back Surgery:

You may be fearful of back surgery, but in fact, only 5% of people need surgery to treat back problems. Your pain may be severe, but most conditions do not require surgery. Surgery is reserved for the most severe cases of back pain (spinal cord impingement, structural deformity, severe cases of spinal stenosis).

Surgery should be considered only after you’ve tried several months of non-surgical treatment. Many surgical procedures can be performed using minimally invasive techniques—meaning less “cutting” or entering the body. These techniques result in smaller incisions, shorter hospital stays, less pain after surgery, and a faster recovery.

Some typical spinal surgeries include:

Facetectomy: A procedure that removes a part of the facet (a bony structure in the spinal canal) to increase the space.

Foraminotomy: A procedure that removes the foramina (the area where the nerve roots exit the spinal canal) to increase the size of the nerve pathway. This surgery can be done alone or with a laminotomy.

Laminoplasty: A procedure that reaches the cervical spine (neck) from the back of the neck, which is then reconstructed to make more room for the spinal canal.

Laminotomy: A procedure that removes only a small portion of the lamina (a part of the vertebra) to relieve pressure on the nerve roots.

Micro-discectomy: A procedure that removes a disc through a very small incision using a microscope.

Spinal Laminectomy: A procedure for treating spinal stenosis by relieving pressure on the spinal cord. A part of the lamina (a part of the vertebra) is removed or trimmed to widen the spinal canal and create more space for the spinal nerves.

If your doctor recommends surgery, always ask the purpose of the operation, results you can expect, and possible complications. Feel free to ask for a second opinion if back surgery is suggested; this is your right. Your doctor will be happy to refer you to a specialist to re-evaluate your condition.

Posture and Proper Lifting

Tips to Minimize Stress at the Desk

• Don’t lean over the desk for prolonged periods of time.
• Don’t sit too far from the work and/or with the back unsupported.
• Raise or lower the chair to the proper height so the knees are bent at a 90-degree angle.
• Keep the elbows bent at a 90-degree angle. The elbows may rest on the work surface.
• Don’t bend or twist the neck to cradle the phone against the shoulder.

How to Maintain a Neutral Spine While Standing: The feet should be placed slightly apart with the knees straight and chin tucked in to maintain a neutral spine. Do not stand in one position for a prolonged period of time; shift the weight from one foot to the other frequently. Using a footstool to elevate each foot from time to time may be helpful.

Proper Posture Proper posture means maintaining the natural curve of the spine (neutral spine). Not only should proper posture be used when standing or sitting, but also it should be incorporated into all activities of daily living—thereby minimizing the amount of harmful stress the spine must bear. Proper posture is so important that it may be one of the first things the physical therapist teaches the patient.

What does proper posture look like? Imagine a plumb line hanging from the ear lobe. When proper posture is assumed, the plumb line will drop straight down the middle of the arm to the ankle.

Why is this so important? Poor posture and incorrect body mechanics are two of the leading causes of neck and back pain.

Spine Safety: Carrying

First take a look at the object to be moved. If it appears to be too heavy or cumbersome, find help!

Consider where the object is going. Are there obstacles along the way? If so, move them out of the pathway.

Depending on the shape of the object, try to hold it at the side and bottom while keeping it close to the body. Remember to keep the back straight. Carry the object with the elbows slightly bent. An extra tip…Carry a balanced amount of weight in each hand. For example, when carrying multiple shopping bags or luggage pieces, split the load in two.

The shoulders should be held slightly back and level.

Each ear should line up with the shoulders.

The chin is slightly tucked and the pelvis is shifted forward so the hips are aligned with the ankles.

Spine Safety: Lifting

First take a look at the object to be moved. If it appears to be too heavy or cumbersome, find help!

If there are obstacles in the way, move them before lifting the object.

Maintain good posture and keep the head properly aligned. Try to get as close to the object as possible and bend at the knees.

Spine Safety: Reaching

Consider the size, weight, and location of the object. Use a sturdy stool or ladder if necessary. Don’t even think about standing on tiptoe!

Next, directly face the object and get as close to it as possible. One hand could be used for additional support. Try not to look overhead for prolonged periods of time. This could cause unnecessary stress to the neck. An extra tip…Store items that are used often within easy reach. This may mean rearranging shelves and/or closets.

Don’t lift yet! Make sure the feet are slightly apart and flat on the floor. To turn, instead of twisting the body, pivot with the feet. This will help to provide a stable base of support.

Keep breathing and tighten the stomach muscles. Smoothly lift the object using the arms and legs…not the back!

And remember: Poor posture and incorrect body mechanics are two of the leading causes of neck and back pain.

Different Types of Lumbar Conditions:

Spondylosis: also known as spinal osteoarthritis, can be considered another part of getting older. It means degeneration of the spine from wear and tear, but not everyone will have symptoms as a result of spondylosis. The Spine Universe Spondylosis Center thoroughly explains this disorder, from symptoms and causes to the most common treatments.

Degenerative disc disease (DDD) affects people usually 30 and over because it is caused by the effects of aging on the spine. The intervertebral discs can become stiff and rigid, causing pain and other symptoms. However, there are many treatments, including physical therapy, medications, exercise, and surgery.

Spondylolisthesis is when one vertebra slips forward slip over the one beneath. Here in the Spine Universe Spondylolisthesis Center, you’ll learn about the spondylolisthesis grades, the difference between degenerative and isthmic spondylolisthesis, and why some people don’t have back pain with this condition.

Spinal stenosis: is a condition that the canal that houses the spine cord becomes narrow pressuring the cord which can cause moderate and severe neck and lower back pain. The most common cause of spinal stenosis is aging. Obviously we can not prevent this, but spinal stenosis “prevention” is about practicing certain habits to extend the health of your back. If you already have spinal stenosis, getting regular exercise and using proper body mechanics may help reduce the chances of your spinal stenosis from getting worse. Contact your chiropractor who will be well versed in tailoring these exercises to your needs.

Diagnostic Imaging

You may need to have imaging tests done to help your doctor diagnose the cause of your lower back pain.

You may have an x-ray, which can show the narrowed disc space, fractures, bone spurs (osteophytes), or osteoarthritis. A computerized axial tomography scan (a CT or CAT scan) or a magnetic resonance imaging test (an MRI) can show a bulging disc or a herniated disc. MRI is the gold standard for detecting impinged or pressure against a nerve root that eventually joins other nerves making up the sciatic nerve.

Bone scan: This will help your doctor detect spinal problems such as osteoarthritis, fractures, or infections. You will have a very small amount of radioactive material injected into a blood vessel. That will travel through your blood stream and be absorbed by your bones. More radioactive material will be absorbed by an area where there is abnormal activity-—like an inflammation. A scanner can detect the amount of radiation in all your bones and show the “hot spots” (the areas with more radioactive material) to help your doctor figure out where the problem is.

CT myelogram: In this test, you’ll have a special dye injected into the spinal fluid around your spinal cord and nerves. (Before that happens, the area will be numbed.) Then you’ll have a CT scan done. The image will provide a detailed anatomic picture of your spine, especially of the nerves and the surrounding bone. The doctor will look for areas of compression, or pressure, on the nerves