Types of Low Back Pain
hip pain, sciatica, lumbar, trigger point, numbness, tingling, sacroiliac, bursitis, disc, disc degeneration protruding disc, herniated disc, pinched nerve, spinal nerve, nerve root, back pain, paralytic ileus, irritable bowel syndrome, constipation, sexual dysfunction, and dysmenorrhea are all examples of the various types of back pain and problems that can be experienced from having back pain.
60-80% of the American population will experience at least one episode of severe low back pain in their lifetime. Annually, over 60 billion people complain of having low back pain. It is the second most common reason that people missed work, behind only the common cold.
Doctors tend to oversimplify this condition, wanting to “see” the problem on an x-ray or MRI, and use a magic bullet for the treatment; which generally come in the form of steroid injections, medications or surgeries. This approach ignores the complexity of these cases, especially when they are a chronic occurrence. This will also lead to a common reoccurrence of the low back pain for the person.
Evidence of a disc herniation is noted in about 90% of individuals with the appropriate symptoms. Unfortunately, the same evidence of disc herniation is present in the imaging of 50% of non-symptomatic patients
One famous study examined 100 twenty-five-year-old men with no history of lower back pain and found 50 of them to have disc bulges and herniations on an MRI.
It is important to always remember that the source of the pain (pain generator) is not the same thing as the cause of the pain. A common example of a pain generator in the case of lower back and leg pain is the spinal disc. Either something has caused an acute injury to that structure or the structure is under enough stressful load to make pain receptors within it react. In most cases, the cause of the issue is a combination of joint dysfunction, muscular imbalance, poor muscular stability, and poor ergonomic habits that lead to a repetitive stress /strain injury over a period of time. Because of the complex nature of these problems, focusing on a singular assessment or treatment approach to address these issues is unwise, especially in recurrent and chronic cases, and the majority of the time it can lead to unsuccessful treatment efforts.
Symptoms of lower back pain can range from mild to incapacitating, occasional to constant, and local to radiating. It is common to feel lower back pain as a referred pain, going down into one or both hips and one or both legs. Although pain being generated from the disc is by far the most common cause, other structures can also cause back pain and refer pain into the hips and legs including joints, muscles or fascia (connective tissue), and organs.
Back pain and joint dysfunction can also cause problems with organ function such as paralytic ileus, irritable bowel syndrome, constipation, sexual
dysfunction, and dysmenorrhea through the compression of nerves exiting the spinal column that stimulate those areas.
There are many causes of lower back and leg pain, which can create a similar clinical picture. The intervertebral disc is the most common generator of lower back and leg pain. However, there are usually several different components that lead to the disc injury and the pain being generated.
In a normal disc, there are rings of ligaments (called the annulus) surrounding a gel like center (called the nucleus) that allows for movement and force distribution.
Due to repetitive stresses or sudden trauma, the gel in the center of the disc can tear into the rings of ligament surrounding it. That tear becomes a weak spot in the disc that is more likely to become reinjured in the future. When the closer rings surrounding the gel are torn, local lower back pain is produced. As the tear progresses radially outward, the pain moves further into the hip and leg. This is commonly misdiagnosed as sciatia. The accurate diagnosis would be Internal Disc Derangement because the entire injury is contained within the disc.
Sciatica is caused when the spinal nerve exiting at the affected level is irritated or compressed. This occurs when the radial tear either begins to
significantly deform the outer disc putting pressure on the nerve, or ruptures through the outer disc, compressing the adjacent spinal nerve.
Joint Pain: Lumbar facet joints, the sacroiliac joints, and the hip joints can create local or referred pain patterns. Specific diagnosis is made by performing a detailed history, examination, and analyzing regional imaging. This diagnosis dictates the treatment approach, which can vary greatly depending on the cause. Below is a typical pain referral pattern related to the sacroiliac joint:
MusAccording to the Academy of American Family Physicians, “Trigger points are discrete, focal, hyperirritable spots located in a taut band of skeletal muscle. They produce pain locally and/or in a referred pattern and often accompany chronic musculoskeletal disorders.” They go on to say, “These include muscles used to maintain body posture, such as those in the neck, shoulders, and pelvic girdle. Trigger points may also manifest as
tension headache, tinnitus, temporomandibular joint pain, decreased range of motion in the legs, and low back pain.”
Determining if an individual’s pain is caused by trigger points can be very tricky. It is essential that the clinician have a detailed knowledge of all of the potential pain referral patterns. The example below of a trigger point in the gluteal medius muscle is commonly misdiagnosed as Sciatica involving the spinal nerve.
These problems are shown to often times have many contributing factors.
These factors include such issues as spinal joint dysfunction (malfunctioning of the spinal joints), muscle imbalances, weakness of the supporting spinal musculature (Deconditioning Syndrome), improper movement patterns, poor posture/ergonomic habits, and chronic inflammation.
Because these problems tend to be complex, and the rate of disability is significant, a multi-specialty team approach is best.
In this model, not only are the specialists each doing what they are best at doing, but they are working together to provide the optimum benefit for the patient.
The primary goal initially is to return the individual to function as quickly as possible. This is followed up with patient education on spinal strengthening and physical fitness, skill training, and ergonomic modification to best prevent recurrences.
This approach has shown quicker recovery times, faster return to work, decreased re-injury rates, and less therapist dependence.