If you’re one of the millions of people who suffer from low back pain, you know that it can be a real pain in the neck. Literally. Low back pain is one of the most common types of chronic pain, and it can take on many different forms. In this post, we’ll take a look at some of the most common types of low back pain, and we’ll discuss what appropriate treatments could be applied for it. Read on to learn more about low back pain and how to manage it.
Generally, when people think of back pain, they perceive it as just the same. They would all think: “Oh I have sciatica. I’ve got low back pain.” There are a lot of different things to consider when discussing low back pain. Let’s break it down into just four basic categories: muscles and tendons, ligaments and joints, nerves, and discs.
Categories and Presentations of LBP
These four categories of low back pain have very different presentations. As you’re reading about this, think of your back pain and which category it might fall into.
Muscles and Tendons
Most back injuries start with a movement. For example, you might bend down to pick something up and then suddenly feel pain in your back. This pain might not go away. Often, this is because a muscle or tendon has gone wrong or is adjusting to some kind of change within the anatomy of the body. Whether it’s a ligament giving out or a muscle coordination issue, it will put one muscle group at risk.
But because every part of your spine is controlled by a group of muscles, it’s common to put yourself in a position where the muscle or tendon is asked to do more than it can. Anytime there’s even a small tear within the body, there’s this neurological reaction that causes the muscles and tendons to just collapse and tighten down because they’re trying to protect the body from further injury.
In those situations, people would report: “I just bent over to pick up a piece of paper, and all of a sudden my back caught up.” These issues will typically last for a few days, linger for maybe a couple of weeks and then completely go away.
Nevertheless, it’s a good indication that there’s some muscle weakness in the body. Core strengthening exercises would make a big difference for that individual.
In medical school, the ligaments are not something we’re focused on in Anatomy. People may have a basic understanding of what their role is, but ligaments are truly the foundation of our body’s stability.
Every joint has a motion to it. The joints are not designed to move. Ligaments are what prevent it from moving in directions. For instance, the knee is good for bending and flexing. It also rotates a little bit, but that’s not its main purpose. The knee is supposed to bend one way and that’s why it has ligaments to keep it in place.
The same thing happens to the spine. We have ligaments that prevent the spinal segments from sliding forward, backward, and side to side. And that’s by design. However, as we age, we develop skin wrinkles. The joints develop wrinkles too.
In other words, the ligaments start to lose their elasticity and tensile strength. As a result, it gets a little bit of wiggle motion to it. This wiggle can put the muscles and tendon tendons at risk. Moreover, it can put the ligaments themselves at risk as well.
The way you can tell you have a ligament issue is if every time you move in a certain position, it feels like your muscles are doing all the work. The muscles will eventually start to get tired and then you will feel a dull achiness or burning sensation. They’re compensating for instability in the ligaments. People will often describe this as: “I’m standing at the kitchen sink, brushing my teeth. And after a few minutes, I feel like they can’t continue to stand there.” This is a good indication that there’s a ligament dysfunction that warrants attention.
The feeling of being completely worn out and not knowing what’s going on is a great place for rehabilitation. If you do it right, this could kick your body into action in ways that will make all those hours worth every single minute. Discover more about this in a future post.
People are scared about nerves and nerve pain. Most people will say, “I’ve got sciatica”, “I’ve got a pinched nerve”, or “I’ve got a slipped disc.” People often feel a shooting pain in their lower back when they move, but it’s not just there. The problem may be coming from somewhere else too and extending into your legs as well. It’s prevalent to think this is a result of a nerve being problematic.
If you ever had your finger got stuck in a door, when you pull the door open, it’s not the finger that hurts. Instead, the whole hand is throbbing. You might feel it to your elbow. This is because the nerve signal coming out of the injury is so loud that it overloads the system at the relay centers of the spinal cord. This means that it can’t tell where it’s coming from. What happens is, that it sends an alarm bell for that whole region.
The same thing can happen to your spine. If you’ve got an injured ligament, a tendon, or even a joint, it will be something that would and could generate such a loud pain signal. You could feel it elsewhere and it’s called referred pain.
A referred pain is not the same as a pinched nerve. A pinched or compressed nerve is usually one of two states. It can either be an acute injury that’s caused a radical change in the spine, creating a compression around the nerve. This can feel like an all of a sudden feeling of pain in a specific nerve highway into the leg.
Or, it is a chronic condition that changes over time. This happens because of things like arthritis, which can make the joint swell, or disc changes, which can make the disc lose its strength and push outwards into the nerve canal. These situations are more of a chronic evolution. People feel this sensation in their legs that gets worse when they stand up or walk. We call it neurogenic claudication. There’s congestion of blood vessels around that nerve. It’s the congestion of blood vessels that causes that sensation down the leg rather than an actual compressed nerve.
These are mendable. There are treatment options outside of surgery for it. It is critical to tease apart nerve root pain or radicular pain from all the other categories of pain, which can mimic each other.
Discs (and Joints)
We’ll talk about discs and joints as a pair because there are two sides to a tripod. Imagine the front leg as the disc and the back two legs are the two joints of your spine. Oftentimes, they go hand in hand because you don’t develop arthritis in isolation and you don’t develop disc issues in isolation. They’re stabilizing each other.
As we age and we develop those joint wrinkles, our joints become mobile. So it puts stress on the disc, for which it wasn’t designed. Discs are great compressive springs. They’re not very good at shear stress, going forward, backward side to side. As that disc breaks down, it puts more pressure on the joints. Therefore they can start to become arthritic and problematic.
All of these issues will feel very similar. Whether it’s disc pain or joint pain, you can have a very similar feeling of pain in your back that gets worse when you stand, walk around, or are in a stationary position. Teasing these things apart is a nuanced job and is crucial to do before you commit to something life-altering, like surgery or, something that has a radical change in your anatomy.
“It’s not enough to just look at an image and decide, ‘Okay, that’s what needs to happen.’” – Dr. Danesh
That is why it’s important that whenever you’re going to see your provider, they’re not just telling you how you need an MRI scan, try to explain to you what the results (and, or the problems look like) and say, “You need surgery. I need to implant something into there.” There’s a lot that goes on with it. If they’re only looking at an MRI, they’re just looking to find a place to do surgery. You need to look at somebody who’s going to be doing a very thorough workup to try to do the minimal amount, to have the maximum outcome for you.
Not everything that shows up on the MRI is important. If you cut yourself and there is a scar, that scar is healed. It’s not the reason your hand hurts. The same thing applies if your MRI is showing changes. These might be old scars from old injuries that have healed and are no longer a problem but put stress on other structures. Those now may be the cause of the pain.
It’s not enough to just look at an image and decide, “Okay, that’s what needs to happen.” It really does take this integrated thorough workup to figure out what’s relevant and what’s not.
Though it may seem daunting, taking the time to understand the different forms that low back pain can take is crucial to providing an accurate diagnosis and treatment plan. By breaking down low back pain into its categories and presentations, we hope that you feel more empowered to discuss your symptoms with your doctor and work together towards finding a solution. If you have any questions about how we can help you specifically, please don’t hesitate to reach out for a discovery call. We’re here to support you on your journey to better health.
If you’re experiencing low back pain and would like help getting to the bottom of it, we’d be happy to schedule a discovery call with you. During this call, we can discuss your symptoms in more detail and come up with a plan tailored specifically for you.
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DISCLAIMER: The information in this email is not intended nor implied to be a substitute for professional medical advice, diagnosis, or treatment. All content is for general informational purposes only and does not replace a consultation with your own doctor/health professional