Lower Back Pain Conditions and Treatment
The 10 Most Common Lower Back Pain Conditions
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 underlying cause such as excess plaque in the arteries. An anatomical leg length inequality can result in excess stress on one side of your body and cause lower back pain. Most doctors are simply not skilled enough or equipped to accurately measure your leg length so they do not bother to do it and will simply dismiss your questions regarding it by stating that leg length inequality is normal. Leg length inequality can also be functional instead of structural or anatomical. Functional leg length inequalities can result from overpronation of the foot-ankle complex and various muscle imbalances. Anatomical leg length differences can be easily distinguished from functional leg length differences by performing a thorough orthopedic and biomechanical exam. By measuring a patients feet (often a person with one foot larger than the other has one leg longer than the other), measuring their right vs. left weight distribution, evaluating their posture looking for one hip or shoulder higher than the other and then physically using a tape measure to measure the length of their bones will reveal whether or not they have one leg longer than the other. Once diagnosed an anatomical leg length discrepancy is easily treated.
It is not unusual for doctors to prescribe a heel lift for those with a short leg. While this may at first seem to make sense if we think about it more closely it does not. A heel lift will transfer weight from the rear of the foot to the forefoot (think about a woman wearing high heels). The thicker the heel lift is the more the weight is transferred to the forefoot. Instead a full length lift should be constructed out of flexible material so that the entire short side is evenly elevated and weight is distributed evenly. If the difference is too great to allow a full length lift the shoe itself can be modified and elevated to offset the difference.
If the difference is due to a functional leg length inequality then the proper intervention would need to be prescribed to offset the difference. Examples of this would be making custom orthotics if one arch was lower than the other or muscle balancing exercises to establish symmetry and balance.
- Scoliosis – Is a spinal curvature that causes increased stresses on the patient’s spine. Technically to be classified as scoliosis the curvature must be measured to be ten degrees or more on x-ray. It has been my experience that many people who think they have scoliosis actually do not although they might have a slight curvature of their spine. When a spinal curvature is noticed on examination it is essential to measure the person for a leg length inequality. It is my experience that many patients have been to multiple chiropractors who yank on their leg or crack their back and tell them they fixed their leg length difference. That is blatant stupidity in my opinion as it is clearly impossible to cause a person’s femur or tibia bones to grow with such a procedure. I also have seen many patients who are told by a therapist that their hips are rotated which then causes their spine to be curved. This notion is also blatantly ridiculous. If you compare the human body to any other architecture it is evident that in order for a structure to be stable it must have a level foundation. Since you do not stand on your hips it stands to reason that if your hip is rotated then something below the hips is affecting it and causing the rotation. Consider this analogy, if you saw a building that was leaning over (think leaning tower of Pisa) you would not try to level it by addressing the 10th No, you would go to the foundation and level it thus in effect leveling the 10th floor and all other floors. Anyone with a spinal curvature, whether it is measured at 10 degrees or not, has to be evaluated from the ground up. It is imperative to measure both of their feet, arch height, hip height, shoulder height, weight distribution and physically measure their leg length so that they can be balanced thus removing the stress on their spine and vertebra.
- Spondylolisthesis – Describes a condition where a vertebrae slides forward or subluxates on the vertebrae below it. This can happen with age or can happen due to trauma that causes a fracture. As the vertebrae slide forward and subluxates the ligaments and muscles that are connected to it are pulled taught and can strain or tear. This condition is easily diagnosed by x-ray and can usually be corrected through postural awareness and stabilization exercises. Chiropractic adjustments can also help to realign the spine and reduce pain.
- Spinal Stenosis – Is a broad category that describes narrowing of the holes (foramen) that your nerves pass through. The narrowing is typically due to bone spurs (arthritis) and can cause pinched nerves and pain that is felt in a very specific and reproducible pattern. For example if the nerves in your L5-S1 are pinched on your right side you will experience radiating pain, possibly numbness and maybe even weakness. The pain will travel down the back of your butt and thigh and may reach all the way to your foot. Doctors who know what they are doing can perform a test called slumps test or seated leg raise test which stretches your sciatic nerve. If this test reproduces your symptoms the doctor will know you have a pinched nerve in your back located on the involved side at L5-S1. While x-rays might be useful to some extent a MRI is necessary to distinguish between stenosis or a disc bulge/herniation.
- Osteoarthritis – Is a degenerative condition that can affect the bones and joints throughout our body. Osteoarthritis is deterioration of our cartilage and/or bone spur formation. Without adequate cartilage our joints can be painful with specific movements while bone spurs can impede the passage of our nerves on their path to our muscles, joints, tendons and ligaments.
- Osteoporosis – Is a degenerative condition that results in less bone density. With lessening bone density comes compression fractures of your spine which will cause pain. Osteoporosis is easily diagnosed with x-ray and the good news is….it can be reversed! We have used the Altered Gravity (AlterG) effectively to allow patients to walk and/or run at a lower body weight than could otherwise be possible. How do we lower your body weight? Watch Nancy explain to Dr. Runco exactly how she used the AlterG to reverse her Osteoporosis. http://www.sdri.net/services/how-to-cure-osteoporosis-with-the-alterg/
- Referred Pain – Your organs are known to refer pain to your lower back when they are not healthy. The two most common are the kidney and bladder. Kidney stones and bladder infections are common reasons why these organs would cause your back to hurt. The pain from the kidneys or kidney stones will typically occur in the lower right or left quadrant of your back near the top of your pelvis. Referred pain from your bladder will usually occur near your tailbone and/or groin. Usually with both of these conditions you will experience other symptoms such as cloudy or bloody urine and pain while urinating. These conditions will require a visit to a medical physician as soon as you recognize them as non-mechanical lower back pain causes. If you know you have kidney stones and seem to get them frequently try this home remedy courtesy of us. It will usually begin to work within 24 hours and in many instances has allowed for painless passage of kidney stones. ¼ cup lemon juice, 2 tablespoons olive oil, 2 tablespoons apple cider vinegar and as much warm water as you want to dilute the mixture. Drink 2-3 times daily….it tastes like salad dressing by the way.
- Postural Lower back pain – Do you sit at a desk all day? Did you know there is more pressure on your lower back while sitting versus standing? Try purchasing or have your company purchase stand up desks. http://www.standupdeskstore.com/standing-desks I am a fan of desks that can be adjusted so that if I choose I can sit or stand. The notion that there is a correct way to stand or sit is ridiculous as we are commonly forced into various positions throughout the day. The best position is the next position. By constantly moving and changing positions we are distributing stress throughout the body instead of loading specific muscles and joints for hours at a time.