What’s Causing My Back Pain?
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.
Content Courtesy of Chiro-Trust.org. Used with Permission. All Rights Reserved.