Low Back Pain
Low back pain is one of the most common types of back pain among back pain sufferers. It is the second most common reason for a missed day of work, behind the common cold. This condition rarely becomes life threatening. However, it can be debilitating if left untreated.
The low back contains the spinal column, which is made up of small bones called vertebrae. In between these vertebrae are discs of cartilage that act as cushions. Their function is to support and cushion the weight of the body while assisting in the movement of the body.
In addition to these structures, there are also muscles which run the length of the spine and aid in the movement and stability of the body. Lastly, there are ligaments which link bone, cartilage, and other structures together. Within the spinal column are nerves that connect with other nerves throughout the body.
When different types of back pain occur, the nerves are often at risk of being damaged since they can be easily pinched or constricted. The lower back is responsible for turning, twisting, and bending. It is important for nearly all movement, which is why it is so important to address all issues related to the low back.
-Pain (sudden or chronic): Acute (sudden) pain is usually a result of trauma or flare-up and Chronic pain is experienced for a very long time (3 months or more)
-Weakness in low back or legs, which might make it difficult to perform everyday activities properly
-Strong pain in low back, buttocks, and/or legs
-Stiff muscles waking up in the morning
-Sudden tightness in low back, buttocks, or legs
-Numbness of muscles or lower extremities
-Radicular pain (including pain, numbness, tingling) travelling to the lower extremities
-Increased pain with coughing, laughing, or sneezing
-Abnormalities in the muscles, bone, or joints
-Trauma (repetitive or acute)
-Poor posture (including poor ergonomics and sleep habits)
-Degenerative diseases (arthritis, degenerative disc disease, etc.)
-Disc injuries in the lower back
-Obesity or excessive weight gain
-Excessive or no exercise
*The most common causes of low back pain are soft-tissue abnormalities due to injury or prolonged wear and tear. In rare instances, infection or tumors may cause back pain. In some people, low back pain may be the cause of lower extremity pain.
For Sudden (Acute) Low Back Pain place a cold pack over painful muscles and avoid things that may increase swelling (i.e. hot showers, hot tubs, hot packs, alcoholic beverages) for 48 to 72 hours. In addition, providing gentle massage to the affected areas allows increased blood-flow, which will help the affected tissues heal faster.
Studies show exercise and manual therapy (i.e. chiropractic, acupuncture, massage therapy), used either separately or together, are beneficial in the treatment of uncomplicated low back pain and allow quicker recovery periods. In more severe cases, injections and/or surgery may be necessary following appropriate diagnostic imaging (such as x-rays or MRIs).
For Long-Lasting (Chronic) Lower Back Pain the same protocol for acute low back pain can be utilized for chronic low back pain. In addition, the presence of a longstanding condition warrants additional care. Manual therapies, such as chiropractic, acupuncture, massage therapy, physical therapy, and structured exercise programs are extremely effective in decreasing pain and preventing future injury.
In addition, it is important to identify what factors in your daily life that could be the cause of low back pain (i.e. poor posture at work, poor sleeping habits, etc.). Maintaining good health habits are also integral for long-term relief of low back pain. If possible, reduce stress and tension at work and home. Stop smoking. Smoking slows healing because it decreases blood supply and delays tissue repair. Exercise regularly, including aerobic exercise such as walking and eat a healthy diet to maintain an overall balanced body.
“Patients with chronic low-back pain treated by chiropractors showed greater improvement and satisfaction at one month than patients treated by family physicians. Satisfaction scores were higher for chiropractic patients. A higher proportion of chiropractic patients (56 percent vs. 13 percent) reported that their low-back pain was better or much better, whereas nearly one-third of medical patients reported their low-back pain was worse or much worse.”
– Nyiendo et al (2000), Journal of Manipulative and Physiological Therapeutics
-Participate in a wellness program (i.e. acupuncture, massage therapy, personal training program, etc.), to maintain correct bio-mechanical balance, promote healthy whole body functioning, and increase strength of musculature to prevent injury
-Perform exercises to strengthen/stretch low back and leg muscles, especially prior to activity
-Learn proper posture, ergonomics, and sleep habits
-When lifting, always get close to the object, bend your knees and grasp the object firmly, lift straight up (don't twist!) in one fluid motion, hold the object close to your body, move close to where you want to place the object, and bend your knees when lowering the object
-Maintain proper back & neck support for your car/bed/sofa/chair
-Perform regular exercise, eat right, don’t smoke, and stay hydrated
Common Low Back Conditions
Strains and sprains of the low back are the most common cause of low back pain. Strains/Sprains are often caused by overuse of a muscle or overloading a muscle. When a muscle is stressed beyond its limits, injury occurs.
A muscle strain (or pulled muscle) is an overstretched or torn muscle. With injury comes inflammation, which is part of the healing process. Inflammation causes pain and can also trigger muscle spasms. The severity of a muscle strain can range from mild to severe.
These types of injuries occur due to overuse-type injuries (i.e. poor posture while working at the computer), sports injuries (overexertion of upper back ligaments/muscles), and poor posture (sleeping and work station).
Common symptoms of lumbar strains/sprains include: pain in the upper back that increases with movement, pain in buttocks, delayed onset back pain that shows up 24 to 48 hours after a neck injury, muscle spasms or pain in the regions of the low back/buttocks, and stiffness/decreased range of motion in the lower back.
Treatment for this condition is similar to other soft tissue injuries to reduce muscle spasms and inflammation. Faster recovery can be achieved while initiating treatment at Green Health Acupuncture such as acupuncture, physical therapy modalities (including cold laser, therapeutic ultrasound, electrical stimulation, and heat/ice therapy), and massage therapy.
“Massage is beneficial for patients with subacute and chronic nonspecific low back pain, especially when combined with exercises and education.”
--Furlan et al (2009), Spine Journal
Herniated Lumbar Disc
Herniated discs in the spine occur 90% of the time in the lumbar spine (low back). A herniated thoracic disc occurs when a nerve root is irritated and/or compressed as a result of a thoracic disc’s inner core extruding through the outer core.
This extrusion can then come into contact with the nerve root and cause interference within the nerve. Activity, stress or mechanical problems often cause herniated discs. A herniated disc may even be caused by a single excessive strain. A herniated disc may also occur suddenly in an event such as a fall or an accident, or may occur gradually with repetitive straining of the spine.
Often people who experience a herniated disc already have spinal stenosis, a problem that causes narrowing of the space around the spinal cord and spinal nerves. When a herniated disc occurs, the space for the nerves is further diminished, and irritation of the nerve results. The compression and sharp pain a person feels down the leg because of the herniated disc is called sciatica.
Common symptoms of a herniated disc include: Electric shock pain (when the compression is in the lumbar (low back) region, the shocks go down your leg(s)), tingling and numbness (abnormal sensations such as tingling, numbness, or pins and needles, these symptoms may be experienced in the same region as painful electric shock sensations), muscle weakness (because of the nerve irritation, signals from the brain may be interrupted causing muscle weakness, and in serious cases, bowel or bladder problems. An MRI is commonly used to aid in making the diagnosis of a herniated disc.
At Green Health Acupuncture, the focus is on non-surgical treatment such as acupuncture, chiropractic (traction/distraction), and physical therapy modalities which often provide relief of lumbar disc symptoms within 6-12 weeks.
In serious cases when relief is not achieved, orthopedic referral may be necessary to determine if more invasive measures are needed. Injections to the low back and surgery can be performed by a spinal surgeon that removes the pressure on the irritated nerve(s) and creates more room for it to heal and function.
Lumbar Degeneration (Bone Spurs and Osteoarthritis) aka Low-Back Arthritis or Spondylosis
The lumbar spine is a common location for osteoarthritis. Lumbar osteoarthritis is a degenerative disorder that may cause loss of normal spinal structure and function. Although aging is the primary cause, the location and rate of degeneration is individual to each person affected.
A bone spur (known as an osteophyte) is an enlargement of the joints stabilizing the lumbar spine. Bone spurs are smooth structures that can grow on lumbar vertebrae and tend to occur in adults over 50 years of age. Bone spurs can biomechanically impede function of the lumbar spine.
Symptoms of lumbar degeneration include pain in the back or spine, stiffness of the spine, and loss of flexibility in the spine. Advanced cases of spinal osteoarthriits may result in spinal stenosis. Spinal stenosis is a compression of the spinal cord and/or nerve roots due to narrowing of the spinal canal.
Lumbar osteoarthritis is typically treated via chiropractic, traction, strengthening, and physical therapy modalities. Low-impact or non-weight-bearing activities, such as walking, stationary training, and light weight training work best for patients with osteoarthritis.
In addition, use of strengthening exercises are important and if you are overweight, start exercising to decrease added weight on the spinal structures (stair climbing, water aerobics, Theraband workouts, and similar exercises will help to keep the joints mobile without straining them). Green Health Acupuncture will evaluate your specific needs and develop a customized exercise program to maximize your body’s potential and strengthen body structures to reduce pain and prevent further injury.
Lumbar stenosis is a degenerative condition that narrows the spinal canal and may affect the spinal cord and lead to compromised coordination of the lower extremities. Some patients are born with this narrowing, but most often spinal stenosis is seen in patients over the age of 50.
In these patients, stenosis is the gradual result of aging and “wear and tear” on the spine during everyday activities. As people age, the ligaments of the spine can thicken and harden, bones and joints may also enlarge, and bone spurs (called osteophytes) may form.
Additionally, bulging or herniated discs are also common and spondylolisthesis (the slipping of one vertebra onto another) also occurs and leads to compression. When these conditions occur in the spinal area, they can cause the spinal canal to narrow, creating pressure on the spinal nerve.
The narrowing of the spinal canal itself does not usually cause any symptoms. It is when inflammation of the nerves occurs at the level of increased pressure that patients begin to experience problems.
Lumbar spinal stenosis may cause radicular symptoms (numbness, tingling, burning) in the buttocks, thighs, legs, and feet (also called sciatica). In addition, weakness of the legs (or “foot drop”), and decreased pain with leaning forward or sitting (this is due to increasing the size of the spinal canal and reducing pressure on the affected nerves). In severe cases, the pain can be constant. Although rare, severe cases of stenosis can cause paraplegia or significant loss of function.
When diagnosing lumbar stenosis, doctors must determine whether progressive dysfunction (myelopathy) is present as a result of the spinal cord compression.
While extremely rare, progressive cases of lumbar stenosis with myelopathy may result in weakness and paralysis, thus making accurate diagnosis and treatment especially important.
Treatment of spinal stenosis can be treated conservatively at our clinic with chiropractic, acupuncture, massage therapy, and physical therapy modalities. In more severe cases, spinal surgery consultation may be required.
Sciatica is the medical term used to describe pain traveling in the distribution of the sciatic nerve. Sciatica is a symptom caused by a disorder occurring in the lumbar spine.
The most common causes of sciatica include: lumbar bulging/herniated disc (the extruding disc pushes on the nerve), lumbar spinal stenosis (encroachment of the spinal canal can put pressure on the affected nerves), spondylolisthesis (vertebral slippage can place pressure on the nerves), trauma, piriformis syndrome (tightness of muscle overlying sciatic nerve can put pressure on the sciatic nerve), and spinal tumors (in rare instances).
The sciatic nerve is the largest nerve in the human body, travelling from your low back down to your feet. Patients suffering from sciatica usually are between the ages of 30 and 50 years. It may happen as a result of the general wear and tear of aging, or any sudden pressure on the disks that cushion the bones (vertebrae) of your lower spine.
Sciatica is generally caused by sciatic nerve compression, resulting from mechanical dysfunction of the spinal column or direst pressure from tight muscles.
Treatments such as acupuncture, massage therapy, and specific exercises allow the tight muscles to relax and reduce pressure on the sciatic nerve. Green Health Acupuncture can specialize a treatment plan specifically for you to maximize results and reduce painful symptoms.