It is commonly thought that roughly 80% of people will suffer from low back pain at some point in their lives. Because such a large number of people suffer from it many doctors erroneously believe that lower back pain is “normal” and will simply go away on its own. Research has shown this to be an absurd notion and points out that there are many different reasons for lower back pain and that in fact lower back pain does not usually go away on its own. What the research tells us is that most doctors THINK their patients back pain went away because their patient never came back to see them. When asked why they never went back to see their doctor patients responded that the doctor was not helpful the first time so they did not see the point in going back a second time.
Another inaccurate notion about lower back pain is that it is usually muscular. This assumption is typically due to laziness on the doctors part because they did not either know how to or did not care to perform a proper physical examination. We know this is true because the average time most doctors spend with patients is roughly seven minutes. In my clinic we spend an hour! I am not sure how an insurance company can expect a doctor do anything more than a cursory exam in seven minutes. Research has shown that the vast majority of medical doctors are in inept in the world of orthopedic testing and diagnosing lower back pain accurately. Incompetence combined with a hastened exam can only lead to a lack of a realistic diagnosis. For this reason many physicians simply diagnose the patient with muscular lower back pain or what is known as “mechanical” lower back pain when in fact there is a more serious underlying cause.
The following list of The 10 Most Common Lower Back Pain Conditions is based on all of my 15 years in practice and my extensive review of the published medical research on the topic. This list is not statistically accurate for those that will try to compare it to the National Institute of Health statistics. The reason for the discrepancy is that the NIH can only report what is reported to them. Since we know from the published research that as many as 95% of medical doctors can not accurately diagnose (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2739498/) orthopedic conditions then we know that what they are reporting is invalid. Instead I am reporting the 10 most common conditions that I myself have seen and these numbers are only reflective my experience. It has been my experience that most patients with lower back pain conditions have been previously misdiagnosed and therefore incorrectly treated resulting in the condition worsening or at the very least becoming chronic. Usually after taking a meticulous history it is obvious that the patient is suffering from a condition that was not diagnosed accurately. Following the history I perform a comprehensive biomechanical and orthopedic examination which then reveals the true nature of their lower back pain. Once a correct diagnosis is achieved the proper treatment protocol and recommendations can be implemented.
- Disc Bulge – The term disc bulge is often used synonymously with disc herniation although they are not the same thing. A disc bulge describes swelling of the lumbar disc also called the Intervertebral Disc or IVD. Swelling of an IVD is easily treated and can be fixed although most patients with this condition get diagnosed with either muscular or mechanical lower back pain. The principal reason for the misdiagnosis is that the patient often describes the pain as muscular. When lumbar discs swell they cause the muscles that surround it to spasm. This muscle spasm which is in response to the disc swelling is known as muscle splinting. Muscles in your body will “splint” in response to joint injury. In the early stages of lumbar disc injury the disc will swell resulting in the lumbar muscles splinting and the patient describing the pain as going across their lower back. Because the patient does not describe the pain as radiating down their leg the doctor assumes it is muscular in spite of the fact that there may not have been a mechanism to cause muscular or mechanical lower back pain.
Disc bulges, although related, are not comparable to disc herniations. A lumbar disc herniation is a much more severe IVD condition in which the lumbar disc has been permanently damaged and the disc is putting direct pressure on your nerves. This lower back condition is often minimized by doctors in spite of the fact that the patient is in significant pain and displays all of the signs of someone in severe distress. One of these signs is called an Antalgic Lean (http://bodyspace.bodybuilding.com/photos/view-user-photo/29092731). This posture causes the patient to assume a bent and twisted stance in an attempt to take pressure off of their nerves. This “textbook” appearance is often misunderstood by the doctor to be poor posture. The doctor then blames their poor posture for causing their lower back pain when in fact their lumbar disc herniation is actually causing their poor posture or antalgic lean.
Another sign of a lumbar disc herniation is pain that radiated down the patients leg from either lower back or their gluteal region all the way to their knee of or even all the way to their foot. This radiating pain is known as Radiculopathy or in layperson terms “Sciatica”. It is concerning to me how many patients present with this sign but it was overlooked by the doctor! Pain that radiates from the lower back or Glute should always be a “Red Flag” and a cause for concern. With proper Orthopedic testing a disc herniation is easy to diagnose and once diagnosed accurately can usually be treated effectively without surgery. However, if left untreated or if treated incorrectly lumbar disc herniations can progress to what is called Lumbar Disc Extrusions. Lumbar Disc Extrusions are a serious condition that typically necessitate surgery and cannot be fixed with conservative methods. I have seen lumbar disc herniations misdiagnosed as bursitis, Piriformis syndrome and even hamstring strains when simple orthopedic testing could have easily diagnosed the condition correctly and saved the patient months of needless pain and suffering.
- Piriformis Syndrome – This condition is commonly misdiagnosed surprisingly most often as a disc bulge. Piriformis Syndrome causes pain in the patients Gluteal region that will often radiate down the back of their thigh. This condition is easily treated and fixed if diagnosed accurately. Because it is often overlooked or misdiagnosed patients are left to their own devices and the condition worsens. Piriformis Syndrome is easily distinguished from a Lumbar Disc Bulge or Lumbar Disc Herniation with proper Orthopedic testing. Patients will often report that it hurts worse while sitting or driving and point to their gluteal region as the point of origin for the pain. Piriformis Syndrome will not usually be evident on MRI and cannot be seen with normal Lumbar MRI’s. For this reason MRI is ineffectual for helping diagnose Piriformis Syndrome. Most Chiropractors misdiagnose this condition as a sacroiliac joint dysfunction or SI joint Dysfunction. While the sacroiliac joint may be involved it is important to understand that the Piriformis muscle is responsible for movement of the SI joint and that it may be causing the SI joint dysfunction. While taking a patients history I often hear about repeated trips to the Chiropractor that never seems to fix their condition. They will sometimes say that it seemed to help temporarily but the pain always returned. This is because the underlying problem was either not addressed or not addressed effectively. By treating the underlying cause, in this case the Piriformis muscle the SI joint will normally stabilize on its own sometimes with the addition of a few simple stabilization and stretching exercises.
- Anatomical Leg Length Inequality/Discrepancy – This condition is known to be present in roughly 75% of the population and can be a primary cause or contributor to lower back pain conditions. Although extremely common leg length inequality is somewhat controversial in the traditional medical system. The reason for this has to do with a few older studies that reported leg length inequality is so common that it is considered a normal human variant. The words common and normal were used in such a way that it was interpreted to mean leg length inequality is normal and does not need to be treated. This could not be farther from the truth. It is common to die of a stroke but it is not normal. It is due to an