So, the lower back and lower back pain. This is probably the most common reason someone will call the chiropractor for help. Its definitely what we see most often in our clinic.
Anatomy
The lower back or lumbar spine is made up of 5 vertebrae, (Bones) with intervertebral discs (the shock absorbers) and many ligaments for stability and muscles which allow it to move, bend and twist in different directions. I like to lump it all together with the pelvis too, so I would generally call it lumbosacral pain. Which includes everything from the 1st lumbar vertebrae to the sacroiliac joints and buttock muscles. I won’t bore you with all the anatomy, because there is a lot of it. The different parts of the anatomy can cause different symptoms and experiences of pain. Disc herniations in the lower back can be quite clearly observed in the clinic. When the disc touches on the nerve, that nerve supplies a different part of the leg. These nerves supply a reflex, a muscle and a patch of skin. So you may see a decreased or absent reflex, a weaker muscle and altered sensation (pins and needles or numbness or pain) to an area of the leg. Each part has a different healing time too. For example, muscles heal quickly because they have a very good blood supply. This means the body can send all its healing cells quickly and abundantly to the area. Ligaments have a lesser blood supply, so will take a little longer to heal. But here’s the kicker, you don’t have to have a physical injury to these to have pain. To tear a muscle or ligament takes a heck of a force. (That’s for another day too or this blog will be three days long).
So, who gets lower back pain?
According to the World Health Organisation (WHO), in 2020, LBP affected 619 million people globally and this is expected to increase to 843 million cases by 2050. This is likely because of the population growing and people living longer. (1)
LBP is the single leading cause of disability worldwide. It can be experienced at any age and most people experience LBP at least once in their lives.
The prevalence of LBP increases with age and the highest number of cases occur around the age of 50-55 and is more common in women (2).
LBP can make it hard to move around, sleep well and affect your quality of life. It can end up affecting your mental wellbeing, cause difficulties around work and social interactions.
Acute and Chronic Pain
You may have heard it be described as acute or chronic. This essentially describes how long the pain has been there for. Acute lower back pain has been there for less than 12 weeks and chronic lower back pain has been there for over 12 weeks. Either way, it can be really debilitating for the person experiencing it, whether acute or chronic.
We approach your pain slightly differently depending on how long you have had it. This is following the evidence and research and clinical experience in dealing with them. If you injured your back yesterday, tripping over while running, the treatment and advice given is going to be different to if you have had lower back pain for 6 years and there was no mechanism of injury.
Is it serious?
Approximately 90% of lower back pain is not serious. Meaning, that it isn’t caused by something sinister like a fracture, cancer, referred pain from internal organs or inflammatory arthritis. (Not to be confused with osteoarthritis which I will go through another time).
This is why it is important that everyone has a consultation and examination before having any treatment done to their back. Without a case history and without the examination that follows, you haven’t had these “red flags” ruled out and therefore you do not know if the treatment is safe for you to have done. Or if you really need to be sent to someone else to have imaging (X-rays/MRI/Ultrasound) or blood tests etc. Chiropractors receive extensive training on taking a case history in order to rule out the nasties.
This is the part of the consultation where you might think, why in the world do they want to know if my bowels and bladder are working normally? Or what medication I am on, what bones I have broken in the past, what my diet is like and my family medical history? Well, this all puts together a picture in our head of what is going on in your lower back. Ruling out those red flags and making sure it is just your lower back playing up.
Can you really work out exactly what is wrong with me?
Because there are so many muscles, joints, ligaments etc, it’s very difficult to narrow it down to one specific joint or muscle causing someone’s pain. Not to mention that when we have a pain or injury, everything else around it will get involved. If you irritate a joint, that joint is surrounded by ligaments, it is moved by a muscle, which is attached to a tendon. (Think of the song, the hip bone’s connected to the….knee bone). Those muscles can be long and they can cross several joints of the back. As long as we have ruled out the red flags, we are happy, but that doesn’t mean we don’t have a pretty good idea of what is going on in there. The treatment we provide and the exercises we give don’t need to be super specific to have a beneficial effect. We also need to take into account what aggravates the pain and what makes it feel better. This allows us to pick treatment modalities and exercises that will be good for you and hopefully not make you feel worse. We also want to pick a treatment you are most likely to respond to with the least amount of risk involved. There are risks involved in all aspects of treatment, which I will touch on another time.
All these structures can cause pain, but we can also have changes in these structures as a normal part of aging and not experience a lot of pain. (You can see now that there is a lot more to lower back pain than something being simply injured. It’s a massive topic and complicated, but we will pick through this with you over the coming months).
Why does something feels ‘out’ in my back.
Thankfully, that is just a sensation. This is a really old myth of back pain I like to try and dispel quickly.
Your back pain isn’t caused by bones slipping out of place and so we don’t pop them back into place during a treatment. Our spines are designed to give us lots of movement in different directions and are held securely in place by ligaments, by the angles of the joints themselves and the muscles surrounding them. This means it is very, very difficult to move joints in and out of place. We’re talking MAJOR trauma for this to happen. If we could slip joints out of place so easily, I don’t think the human race would have lasted this long. We would be weak, unable to stand up and move around easily and not mention likely paralysed by these joints pressing on nerves and spinal cords. Think of the joints as not working as well as they were. They can become stiff and sore, restricting the movement in that joint. The muscles around the joints can then tighten up, essentially a protective mechanism of the body, and these muscles can then become sore too. When these structures become restricted, they don’t allow our usual free flowing movement and they can get aggravated by movements we once didn’t even think twice about doing.
Treatment options for lower back pain.
Pain is a very individual experience and therefore treatment varies greatly between each individual case. Luckily, there are lots of different interventions we can choose from that we have learned over our time in practice.
Chiropractors are best known for their “adjustments” or joint manipulations, which can result in the cracking and popping noises you hear when having this done. The popping noises are just gases in the joint and not bones moving in or out of place. Note that the audible release (the crack or pop) sometimes associated with joint manipulation is characterised by rapid separation of joint surfaces with subsequent cavity formation or ‘cavitation’. Any particular therapeutic benefit of audible release is not fully established (3).
Treatment may also include
· Soft tissue work, which can be massage, trigger point therapy and stretching techniques.
· Dry needling. This is like acupuncture, using needles, but slightly different to the traditional Chinese medicine. For example, we might like to put them into really tight muscles and help them relax down, providing some short term muscle relaxation and pain relief.
· Basic stretches are given to every single patient who comes in for an appointment. These stretches are to help get the joints and muscles moving better and show your brain that these movements are OK and non threatening. Helping them relax and stop overprotecting us.
· We like to encourage you to hit your weekly physical activity levels which are shown in the diagram below.
· Rehab. Strengthening your muscles and create flexibility in your back. This rehab, will increase your “adaptive range”. Or how much your body can adapt to and tolerate the stresses of life, which can lead to back pain. The better you adapt, the more stress your body can tolerate, the less pain you are likely to experience. Or the less the pain will affect you.
· Encouraging healthy living and promoting public health issues with regards to smoking cessation, nutrition, meditation and relaxation techniques (You’ll be surprised what can affect your pain and likelihood of injury). There is a proven link between smoking and MSK health with cigarette smoking having harmful effects on the musculo-skeletal system. It results in a loss of bone mineral content and increases incidence of fractures. There is an established link between smoking and back pain and evidence that smokers have a poorer therapeutic response to treatment for MSK complaints.
· We discuss posture, mattresses, tapes/straps/belts and braces, hot, cold, topical creams, pain medication and things of that nature. Helping you decide what is best for you.
· We work closely with other practitioners and businesses around the county and are able to recommend personal trainers, sports therapists, physiotherapists, counsellors, massage therapists of all sorts (sports massage, relaxation massage, pregnancy massages).
· We can also refer you back to your GP for further investigation
· We can also refer for private MRI, X-ray and Ultrasound if indicated.
In short, back pain is common, its rarely serious and in most cases, seeing a chiropractor will help. Our aim at Pembroke Chiropractic Clinic is to get you out of pain and back to the things you enjoy as quickly as possible, for as long as possible.
You can book an appointment online using this link or call us on 01646 686856.
Feel free to send us an Email or give us a ring. You can even pop into the clinic and catch us on a break if you would like to talk about anything before booking in. We’re more than happy to have a chat to see if it sounds like we could help you before you commit to an appointment.
References
1. GBD 2021 Low Back Pain Collaborators. Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol 2023: 5: e316-29
2. GBD 2019: Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. https://vizhub.healthdata.org/gbd-results/.
3. Kawchuck et al, 2015
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