Lower back pain is a common condition that affects roughly 80% of the population at some point in their lives. Not all lower back pain is due to the same causes though. It is common for people to relate their lower back pain to me as “sciatica” when in fact they do not have sciatica. Sciatica is defined by the Medical Dictionary as radiating pain from the back, down the leg, all the way to your foot. In fact, very few patients that I see actually have sciatica. There are many other reasons for lower back pain. Below are listed some of the more common lower back conditions.
- Mechanical Lower Back Pain – Is due to strains of muscles and/or sprains of ligaments. This type of lower back pain often occurs due to a traumatic event and results in pain across the lower back that may be focused on one side.
- Spondylolithesis – This is due to a bone, usually the 5th lumbar vertebrae developing a small break in the rear portion of the bone. The break allows for the vertebrae to slip forward which results in torque and pulling of the 5th lumbar ligaments. The patient will usually feel pain across the lower back.
- Piriformis Syndrome – This painful condition results in pain that radiates down into the gluteal region and some times down the patients hamstring as well. It is often misdiagnosed as sciatica and will result in the patient receiving treatment that is misdirected and inappropriate. The condition can be brought on by a variety of reasons including repetitive motion, weight gain, excessive sitting or trauma.
- Radiculopathy/Sciatica – Pinching of the L5-S1 nerve root on one side of the lumbar spine will result in radiating pain that goes from the back/gluteal region and can shoot/radiate all the way down to the foot. The patient may experience burning type pain or simply numbness. Long term nerve compression can result in weakness (foot-drop) and muscle atrophy. The compression is usually the result of a swollen or bulging disc.
- Disc Herniation – The most common lumbar discs to swell, bulge, protrude or herniated are the L4-L5 lumbar discs and the L5-S1 lumbar discs. Disc swelling can progress to a protrusion which can then progress to a lumbar disc herniation. Lumbar disc herniations are actually not that common. Lumbar disc herniations are a progression from the initial stage of lumbar disc swelling or disc bulge. If a lumbar disc bulge progresses it grows to a disc protrusion. If it worsens from there it becomes a lumbar disc herniation. The problem with a lumbar disc bulge or lumbar disc herniation is that it puts pressure on the nerve and can cause severe pain that radiates down the front or back of the leg depending which lumbar disc is involved.
There are many other causes of lower back pain that are more “sinister” but they are not that common. The above conditions are the most common that present to our office as well as other offices around San Diego. Once an accurate diagnosis is made the most important thing is how you treat your lower back pain.
Diagnosing Lower Back Pain
I can not speak for all clinics that treat lower back pain but in my experience diagnosing it accurately is straightforward. I perform a series of manual orthopedic tests that can differentiate between the most common conditions. These tests are sometimes referred to as “provocative” tests as they are intended to provoke the pain slightly which helps accurately diagnose the condition. These Orthopedic tests help to differentiate between the various conditions and arrive at an accurate diagnosis. Typically, neither X-rays nor MRI’s are necessary to accurately diagnose a patient’s condition. In the cases of trauma X-rays might be used to make sure the patient has not fractured their spine but if discs or soft tissue injury is suspected X-rays are of little use. If an MRI is warranted we either order the MRI through the patient’s insurance or send them to a facility that we have a cash plan with. Surprisingly MRI’s can be done for as little as $300!
Treating Lower Back Pain
Once an accurate diagnosis is reached a proper treatment protocol is recommended to the patient. It is not unusual to provide the patient with multiple treatment options ranging from the most conservative (do nothing) to the least conservative (have surgery). In fact, very few patients require back surgery except in the most serious of situations. Our job is to help you avoid back surgery and we are very good at that. We like to take an all-inclusive approach (“kitchen sink”) when treating someone with back pain. Treatments usually include:
- Therapeutic Ultrasound
- Electrical Stimulation
- Gentle Spinal Adjustments
- Corrective Exercises to restore muscle balance
- Correction of any asymmetries
- Home stretching and strengthening programs
- Home foam roller/self massage routine
We consider it both necessary and crucial to involve the patient not only in understanding their back condition but in participating in fixing it by doing as much work at home, on their own, as possible. By doing the home stretching and strengthening routines patients can often avoid numerous trips to the Chiropractor or Physical Therapist who will essentially watch them exercise. We feel most patients, if given the proper tools, do not need to be baby-sat and pay someone to watch them exercise.
We also employ the latest technology in the rehabilitation of lower back injuries by using Alter-G technology. The Alter-Gravity treadmill allows a patient with significant back pain during standing, walking or running to walk or run pain free due to the Altered Gravity decompression chamber. By getting the patient ambulatory without pain great strides are taken towards correcting their back pain quickly. Read more about the Alter-Gravity treadmill.
If you suffer from either acute or chronic lower back pain and would like to receive an accurate diagnosis and treatment options please call our clinic today. Our office number is 858-268-8525. If you prefer to get more information before calling you can email Dr. Runco directly at Drrunco@sdri.net. Feel free to ask any questions you have and allow for 1-2 days to receive his response.