By Dr. Robert Woelkers, PT, DPT, CSCS
Lower back pain is a condition that effects millions of people worldwide each year. It is the number one cause of people calling off work in the United States. It can manifest overnight or can come on very quickly. Once it presents itself, the pain can interfere with activities such as sitting, standing, driving, lifting, sleeping, running, jumping, negotiating steps, gardening, playing with children, work, sports and other recreational activities. Almost all individuals will have at least one episode of acute back pain sometime in their life, and certain individuals will develop chronic lumbar pain that will effect their quality of life. In this article we will dig into the three common causes of lower back pain and how to identify them.
This first cause is a herniated disc that can put pressure on the nerve resulting in sciatica. A disc is a structure located between two vertebrae and it is named based on the above and below vertebrae. A disc works to provide compression throughout the spine in order to absorb shock and force during daily activities. Individuals 55 and younger and more likely to get a herniation. When a disc starts to bulge out of position or the inside nucleus herniates it will push on the nerve root. This will result in radiating pain down the leg, weakness and even incontinence.
Sitting, driving, bending, and lifting objects, which are considered flexion based exercises cause pain. Individuals with a herniated disc respond well to extension based exercises also known as McKenzie Method. I use the “Garden Hose” analogy when describing a herniated disc. Pretend the spinal cord and nerve roots is the spigot that turns the water on and the nerve is the hose. Water flow will decrease if the hose is impinged. In other words if a disc or another structure puts pressure on the nerve/nerve root it won’t be able to send or receive important signals as quickly as the body needs.
Degenerative Disc Disease (DDD), Arthritis, Stenosis
Stenosis occurs in individuals > 65 years old and it is a condition in which the spinal column starts to narrow around the spinal cord. Narrowing occurs because discs and joints begin to degenerate, ligaments become inflamed, and arthritis sets in. Stenosis results in pain when standing, walking, negotiating steps and lying prone on ones stomach. These are extension based activities and many individuals respond well to flexion based exercises (we will go over these in another post). In order to better understand stenosis imagine you are on a four lane highway.. After a few miles into your road trip you start to see signs of a tunnel ahead. Four lanes are squeezed into one as the tunnel approaches. Same thing occurs overtime with stenosis. You start off with a healthy vertebrae and surrounding structures, and overtime the structures breakdown and you are now down to one lane.
SI Joint Dysfunction
Back pain caused by Sacro-iliac Joint Dysfunction is the most underrated and missed diagnosed condition of all three. This is because pain is hard to pin point, it does not show up on an X-Ray and MRI and mechanism of injury may be unknown. SI Joint dysfunction can occur when one of the joints becomes fixed and the opposite joint starts to become more mobile, also numerous ligaments surrounding the joint can become inflamed. This results in severe pain and muscle imbalances throughout the lower back and legs. Many of our patients have gone years with chronic lower back pain without much relief. Once we identify the root cause, correct it, and start strengthening the region they start seeing amazing results.