Back Pain

What is it?

While changes in our boney anatomy throughout the lifespan are normal, in some cases close proximity of the joints of our spine can cause irritation to a variety of structures.  Degenerative Disc Disease (or DDD) is a description for the decrease in hydration of the discs in our spine, which may increase the proximity of the bones within our joints.  This proximity can often be interpreted as arthritis, which is the medical term for irritation and inflammation (itis) of a joint (arthro).  Spacial narrowing within the areas where nerves normally travel through, either centrally where the spinal cord travels, or laterally where nerve roots exit to the rest of the body from the spinal cord, is known as stenosis.  Often this three diagnoses are interrelated, and may contribute to your pain if progressed to a certain point.

Treatment

As with most joints of the body, arthritis can often be treated by decreasing strain along a joint by increasing the stability and strength of active contractile tissues within the regions that support the joint.  In this case, the musculature of the back and legs which support the pelvis and spine, is a key area of focus in order to improve this support if proximity of the tissues themselves is causing the affected irritation.  If, as in the case of stenosis, the proximity of these tissues is causing nerve impingement, changes in posture can often provide a change in available travel space for the nerves, and retraining of posture may provide a great deal of alleviation.

Important Facts to Know

Diagnosis of these conditions has actually become significantly more complicated with newer research that shows that our ability to diagnosis via imaging like x-rays and MRI appears somewhat limited as asymptomatic  “normal” spines present with very similar images to those experiencing this kind of pain, meaning that image findings of these conditions do not necessarily mean they are the cause of symptoms.  A thorough physical exam including testing of neurological findings, functional stenosis testing like the two stage treadmill test, and thorough testing for postural endurance should be combined with a specific subjective screen before a diagnosis of these conditions is finalized.

What is it?

Lumbago is a catch all term for low back pain without a specific confirmed diagnosis, meaning “pain in the lumbar region.”  Similar to sciatica, there are many possible causes, including any of the listed diagnoses in these sections, or a separate cause known as central sensitization, commonly a source of pain in patients with chronic pain.  This is a particular diagnosis that presents when the neurological system has gotten so used to the sensation of pain and danger because of an initial injury, that even if the tissue itself is no longer a source of pain, the nervous system perceives all input to the region as noxious, dangerous, and therefor painful.

Treatment 

Treatment of lumbago as an whole involves determining a correct diagnosis!  For those with central sensitization, treatment may involve progressive expose programs to decrease the nervous system’s perception of the dangers of load, position, pressure, and activity and reset the system to a more normal level.

Important Fact to Know

Because things like central sensitization and non-specific low back pain do not present with distinct findings on imaging, other causes described in this list of diagnoses may be initially diagnosed as the cause of pain.  However, given that each diagnosis on this list has a very specific presentation of pain patterns normally associated with it, it is always important that your healthcare team is correlating all findings of tests with your reports of how and where your pain presents specifically.

What is it?
This term is used to describe any referral of symptoms down the length of the sciatic nerve, which begins as several nerve roots from the lumbar and sacral regions join into one nerve near the buttock.  This nerve then travels down the back of your leg and into your foot.  If impinged by a variety of structures, from muscle, bone, or disc, pain may begin to travel down the length of the nerve.  This can usually be easily diagnosed with a slump or straight leg test by a physical therapist, physician, or chiropractor, who will then perform further tests to determine which of the above structures are causing the issue.

Treatment
Thankfully the majority of sciatica appears to be caused by muscular restrictions in the hips, and exercise and manual therapy techniques can help alleviate these causes!

Important Facts to Know
Sciatica, while uncomfortable, is generally not the result of acute damage, however there are key signs to watch for.  Sudden loss of weakness or feeling along the affected distribution is generally a sign that a neurologist should be monitoring your condition.

What is it?

This condition involves one of your vertebrae, most commonly part of your lower lumbar region, actually translating either anteriorly or posteriorly in comparison to the rest of the spine.  A bony translation like this can be an adaptive change of your body to load, or from a traumatic incident.  While not all cases result in pain, in certain degrees this condition can create a “kink” in the central canal where the spinal cord travels, resulting in nerve impingement.  The most common symptoms of this condition are numbness and tingling or loss of muscular control along the nerves of the impinged region, and presentation with these symptoms indicates a referral to a neurologist.

Treatment

For those without neurological symptoms or who have a stable presentation, postural retraining can often help alleviate symptoms, and muscular support of this region can be highly important!

Important Facts to Know

A spondylolisthesis can in some cases impinge on a very specific set of nerves that innervate your bladder and bowel region.  If you ever develop symptoms of this condition including sudden changes in control of your bowel and bladder, or numbness in this region, immediately contact your physician for an emergency referral!

What is it? 

Between each boney vertebra of your spine is a soft, flexible disc made of a tough outer layer with a more gelatinous inner nucleus.  These discs regularly deform throughout all movement to allow flexibility of the spine, and can be affected by a variety of factors including hydration, compression throughout the day by gravity, nutrition, and adaptive changes to exercise.  While these deformations are generally normal and non painful, in some cases the discs may push further toward the spinal cord than normal, which in some cases can cause sciatic symptoms.  If the nucleus of a disc exudes through the outer layer, a disc is known as herniated, otherwise it is known as bulging.  The term “slipped disc” is a non medical catch all term which either of the above conditions may fall under.

Treatment

Thankfully, recent studies have shown that between 60 to 90% of herniated and bulging discs actually resolve without need for any medical intervention!  However, because of the pain caused by initial injury, we have found that often local muscle tissue can become extremely irritable and guarded, and a combination of manual therapy and exercise is often needed to help “reset” the body’s perception of this region. In cases where symptoms do not resolve with progressive activity and time, medical procedures like injections or surgery may be necessary to alleviate pressure on a nerve if the disc does not resolve on its own like normal.

Important Facts to Know

Diagnostic imaging like MRI is actually no longer considered the gold standard for these conditions!  Because of the normalcy of disc changes throughout the day and inability to differentiate between pathological and normal changes in discs from images alone according to recent studies on diagnostic accuracy, further studies like physical examination of affected symptoms, neurological signs, and neurological testing is usually necessary to determine of this is the cause of your pain.

What is it? 

The joints of your body are surrounded by both ligaments, a connective tissue that passively connects one bone to another to affect stability, and muscles, our contractile tissues that allow movement.  As with any other joint, these tissues can become overworked either through repetitive use, or through a single instance of high load.  Both contractile and non-contractile tissues have specific nerve endings designed to detect this overload, which is sent to the brain as a message of pain, limiting movement in the area both in how much range your brain will let you move through, and how much force it will allow local muscles to output.  This family of pain may include small facet joint irritation (sometimes known as Facet Syndome) as these joints are surrounded by some of these affected tissues, up to large muscular strains of the erector spinae or quadratics lumborum.

Treatment

As with any other joint sprain or strain, the goal of therapy here is to regain both the range of motion and force production lost because of this nervous system response by respecting the warning messages being put out.  This means that while it is important to gradually move and load through these regions to stimulate release and tissue synthesis, we want to do so in a manner that respects how far the body is willing to go.  You should participate in active movements and activities only within your symptom tolerance, and good communication with your therapist is key!  Adjunct therapies like manual therapy and modalities may be used to help calm and relax your nervous system to prevent growth of a protective response afterward depending on how your individual case responds.

Important Facts to Know

New research has shown that the amount of pain we have with this type of injury is thankfully not correlated with amount or existence of tissue damage.  In fact, in many cases MRIs do not detect any tissue damage in patients in severe pain in muscular strains, so a lack of tissue findings on imaging does not invalidate your pain, or mean that there is nothing wrong.  Because the nervous system response is mediated not by damage but by levels of load through the tissues, damage is not necessary to feel intense pain, but thankfully that usually means surgery is not necessary!