Conditions We Treat

Lower Back Pain

While there are many causes of lower back pain, most cases of low back pain can typically be linked to either a general cause - such as muscle strain - or a specific and diagnosable condition, such as degenerative disc disease or a lumbar herniated disc.

In the United States, lower back pain is one of the most common conditions and one of the leading causes of physician visits. In fact, at least four out of five adults will experience it at some point in their lives.

Ironically, the severity of the pain is often unrelated to the extent of physical damage. For example, lower back spasms from a simple back strain can cause excruciating lower back pain that can make it difficult to walk or even stand, whereas a large herniated disc or completely degenerated disc can actually be completely painless.

Types of Lower Back Pain

Low back pain is typically classified as either acute or chronic:
Acute lower back pain is short term, generally lasting from a few days to a few weeks. Some acute pain syndromes can become more serious if left untreated.

Chronic lower back pain is generally defined as pain that persists for more than three months. The pain may be progressive, or may occasionally flare up and then return to a lower level of pain. With chronic pain, the exact cause of the pain can sometimes be difficult to determine.

The causes of low back pain can be very complex, and there are many structures in the spine that can cause pain. Any of the following parts of spinal anatomy are typical sources of low back pain:

  • The large nerve roots in the low back that go to the legs and arms may be irritated.
  • The smaller nerves that innervate the spine in the low back may be irritated.
  • The large paired lower back muscles (erector spinae) may be strained.
  • The bones, ligaments or joints may be damaged.
  • The intervertebral disc may be damaged.

Sometimes there is a neurological component, such as leg or foot weakness or numbness, as well. It is important to note that many types of low back pain actually have no known anatomical cause; but this doesn't mean that the pain doesn't exist. The patient's pain generator may not be identifiable, but this does not necessarily signify that the pain is all psychosomatic. Actually, an estimated 90% of patients with pain will not have an identifiable cause of their pain.

Typically, younger individuals (30 to 60 year olds) are more likely to experience back pain from a lower back muscle strain or from within the disc space itself (e.g. lumbar disc herniation or degenerative disc disease).

Common Lower Back Pain - Symptoms and Causes in Younger Adults

Symptoms:  Severe or aching pain in the lower back after activity, sudden movement or lifting a heavy object. These lower back pain symptoms include any combination of the following:

  • Difficulty moving that can be severe enough to prevent walking or standing.
  • Pain that does not radiate down leg or pain that also moves around to the groin, buttock or upper thigh, but rarely travels below the knee.
  • Pain that tends to be achy and dull.
  • Muscle spasms, which can be severe.
  • Local soreness upon touch.

Possible causes:  Back Muscle Strain

A back muscle strain or ligament strain is one of the most common causes of acute lower back pain. Lifting a heavy object, twisting, or a sudden movement can cause muscles or ligaments stretch or develop microscopic tears. With a lower back strain, the severity of the pain ranges from mild discomfort to severe, disabling pain, depending on the extent of strain and the lower back muscle spasms that result from the injury. Back strains often heal on their own with the help of some combination or rest, ice and/or heat application, anti-inflammatory medications, and/or gradual and gentle stretching and lower back exercises.

Symptoms:  Low back pain that travels to the buttock, leg and foot (sciatica). Sciatica includes any combination of the following symptoms:

  • Pain typically is ongoing (as opposed to flaring up for a few days or weeks and then subsiding).
  • Pain may be worse in the leg and foot than in the lower back.
  • Typically felt on one side the buttock or leg only.
  • Pain that is usually worse after long periods of standing still or sitting: relieved somewhat when walking.
  • More severe (burning, tingling) vs. dull, aching pain.
  • May be accompanied by weakness, numbness or difficulty moving the leg or foot.

Frequent causes:  Lumbar herniated disc

Sciatica describes the symptoms caused when a nerve root in the lower spine is compressed, causing pain and numbness to travel along the large sciatic nerve that serves the buttocks, legs and feet. In younger adults, sciatica can be caused by a wide range of conditions, most commonly a lumbar herniated disc (may also be causes by degenerative disc disease, isthmic spondylolisthesis, and other conditions).

Symptoms:  Chronic lower back pain worsened by certain positions and movements. Symptoms may include any combination of the following:

  • Low-level of constant lower back pain punctuated by episodes of severe pain/muscle spasms lasting a few days to a few months.
  • Chronic pain can range from nagging to severe.
  • Back pain worsened by sitting.
  • Walking, even running, may feel better than sitting/standing.
  • Changing positions frequently relieves pain.

Frequent cause:  Degenerative disc disease

Lumbar degenerative disc disease can affect patients as young as 20. When the lumbar discs between the vertebrae begin to break down, the damaged disc can cause both inflammation and slight instability in the lower back, bringing about pain, muscle spasms, and sometimes sciatica. Degenerative disc disease is common and is often successfully treated.

While older adults can experience pain related to any of the conditions that also affect younger adults, individuals over age 60 are more likely to suffer from pain related to degeneration of the joints in the spine. Two of the most common causes of lower back pain in older adults include osteoarthritis and spinal stenosis.

Symptoms:  Lower back pain and stiffness that is the most pronounced in the morning and in the evening. Includes any combination of the below symptoms:

  • Pain that interrupts sleep.
  • Pain that is most pronounced first thing in the morning and again toward the end of the day.
  • Localized tenderness when the affected area of the spine is pressed.
  • Aching, steady or intermittent pain in the lower back that is aggravated by extended activity.
  • Stiffness or loss of flexibility in the back (for example, unable to bend comfortably at the waist).

Possible causes:  Facet joint osteoarthritis
Facet joint osteoarthritis, also called degenerative arthritis or osteoarthritis of the spine, is a degenerative condition that develops gradually over time. The pain is caused by the breakdown of the cartilage between the facet joints in the spine. At first the symptoms may only be intermittent, but can later develop into steadier pain in the lower back, and may eventually cause sciatica in addition to lower back pain.

Symptoms:  Leg pain that occurs primarily when walking and standing upright. Includes any combination of the following:

  • Unable to walk far without developing leg pain.
  • Lower back pain relief is achieved quickly after sitting down.
  • Symptoms fluctuate between severe and mild/none.
  • Symptoms develop gradually over time.
  • Weakness, numbness and tingling that radiates from the low back into the buttocks and legs (sciatica).

Likely causes:  Lumbar spinal stenosis or degenerative pondylolisthesis

Both spinal stenosis and degenerative spondylolisthesis can place pressure on the nerves at the point where they exit the spine. Standing upright, such as in normal walking, increases pressure on the nerve and results in leg pain

Common Lower Back Pain - Symptoms and Causes in Older Adults

While older adults can experience pain related to any of the conditions that also affect younger adults, individuals over age 60 are more likely to suffer from pain related to degeneration of the joints in the spine. Two of the most common causes of lower back pain in older adults include osteoarthritis and spinal stenosis.

Symptoms:  Lower back pain and stiffness that is the most pronounced in the morning and in the evening. Includes any combination of the below symptoms:

  • Pain that interrupts sleep.
  • Pain that is most pronounced first thing in the morning and again toward the end of the day.
  • Localized tenderness when the affected area of the spine is pressed.
  • Aching, steady or intermittent pain in the lower back that is aggravated by extended activity.
  • Stiffness or loss of flexibility in the back (for example, unable to bend comfortably at the waist).

Possible causes:  Facet joint osteoarthritis

Facet joint osteoarthritis, also called degenerative arthritis or osteoarthritis of the spine, is a degenerative condition that develops gradually over time. The pain is caused by the breakdown of the cartilage between the facet joints in the spine. At first the symptoms may only be intermittent, but can later develop into steadier pain in the lower back, and may eventually cause sciatica in addition to lower back pain.

Symptoms:  Sudden onset of back pain, limited flexibility, height loss
Includes any of the following:

  • Sudden onset of back pain.
  • Standing or walking will usually make the pain worse.
  • Lying on one's back makes the pain less intense.
  • Height loss.
  • Limited spinal flexibility.
  • Deformity and disability

    .

Possible causes:  Compression fracture (e.g. from osteoporosis)

As a general rule, the possibility of compression fracture should be considered after any sudden onset of back pain in adults over age 50, especially in post-menopausal women with osteoporosis and in men or women after long-term corticosteroid use. In a person with osteoporosis, even a small amount of force put on the spine, as from a sneeze, may cause a compression fracture.

Benefits of Chiropractic Manipulation

Objective effects of a Chiropractic adjustment have been investigated and reported. More specifically, a single chiropractic adjustment produces both sensory and motor effects as well as sympathetic nervous system effects.

The sensory and motor effects of a Chiropractic manipulation include:

  • Increased joint ROM in all 3 planes and reduction of pain.
  • Increased skin pain tolerance level.
  • Increased paraspinal muscle pressure pain tolerance.
  • Reduced muscle electrical activity and tension.

Sympathetic nervous system effects of a Chiropractic manipulation include:

  • Increased blood flow and distal skin temperature (fingertips).
  • Blood pressure reduction.
  • Differences in distal skin temperature in the fingertips. Blood flow in the fingertips may rise or fall with specific chiropractic adjustments to the spine. For example, the distal skin temperature has been shown to rise (signifying increased blood flow) following a chiropractic adjustment to C1-C7 and/or L4-L5 while the temperature fell (less blood flow) when the chiropractic adjustment was made to the area between T1-L3.

Blood chemistry changes after a Chiropractic manipulation include:

  • Increased secretion of melatonin. Secreted by the pineal gland in the brain, melatonin helps regulate other hormones and maintain circadian rhythm (the 24-hour cycle that determines when people fall asleep and wake up).
  • Increased plasma beta endorphin levels. Endorphins are the body's natural pain killers; when increased, they help humans manage pain.
  • Elevation of Substance P and enhanced neutrophil respiratory burst. Referring to the rapid release of oxygen species, respiratory burst is an important reaction in the degradation of internalized cells and bacteria.
  • Pupillary diameter changes. Changes in diameter of the pupil (which range from 2-8mm) are often associated with different levels of fatigue and mental workload.

If you have any questions or concerns about your condition please call us at (720) 851-2475 to set up a complimentary consultation.

 

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