Low back pain (LBP) is one of the
most common reasons patients seek out Chiropractic care, and they appreciate
being told what is causing their back pain. This is why doctors gather a
careful and complete history from new patients and perform a physical examination. Once the "pain generator" is
determined, a doctor can discuss various treatment options and develop a plan
for managing the patient. Let’s review some causes of LBP!
If we divide the various conditions
into three categories, it significantly improves diagnostic accuracy. These
include: 1) Mechanical LBP; 2) Nerve root pain; and 3) “Red Flags” (serious
conditions). The most common conditions are those belonging to the first group.
The following is a partial list of conditions that belong to each category:
1) Mechanical LBP: Causes
of mechanical LBP include Lumbar and sacroiliac (SI) sprains, lumbar muscle
strains, facet syndrome, degenerative disk disease (DDD) and/or injury to the
disk without nerve pinch, osteoarthritis (this can affect different parts of
the spine), spinal instability, spondylolysis and/or spondylolisthesis, and
more. The pain pattern is usually localized to the low back and may spread into
the buttocks, hips, thighs, but rarely extends past the knee. Usually, there is
NO numbness or weakness in the leg or foot because that symptom suggests a
spinal nerve pinch.
2) Nerve root pain can
result from herniated disk (from either direct nerve pinching and/or chemical
irritation inflaming the nerve), central or lateral spinal stenosis (usually
caused by a combination of things including DDD), arthritis, and/or
calcification of ligaments near the nerve. These can be managed very
successfully without surgery but the careful monitoring of numbness, muscle
weakness, and treatment satisfaction is important!
3) Red Flags: These are
the potentially dangerous conditions such as cancer, fracture, infections,
cauda equina syndrome (spinal cord pinch creating bowel and/or bladder
weakness). Referred pain from organs may be included here as well. As you can
see, these carry potentially lethal consequences and require immediate referral
and specialty management.
The majority of patients suffering
from LBP fall into the first two categories, and the HISTORY can tell us a lot!
If the patient complains of pain that stays mostly in the low back but may
spread into the buttocks or thigh without numbness/weakness in the leg and
feels better with leaning forwards or curling up in a ball, it probably is a
Group 1 (mechanical) diagnosis. If there is numbness, tingling, and/or weakness
in the leg to the foot and bending over hurts, it’s most likely disk
derangement (bulge, herniated, etc.) with a nerve pinch. If there is
unexplained weight loss, a past history of cancer, non-responding LBP to
treatment, sleep interruptions, and age >50 years old, we may now be in
category three and further tests are needed!
The IMPORTANT point is that spinal
manipulation (chiropractic) can manage the most common causes of LBP as a
non-surgical, low-risk form of care.
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