If you are like most people, you have had low back pain at some time in your life. It is rare for anyone to have never experienced lumbago. For what it’s worth, statistics say that one in every twelve people walking this earth is suffering from some degree of low back pain every day. And one out of every six people has had an incidence of low back pain within the last month—that’s a lot of sore backs. Here’s the kicker: If you have been lucky enough to escape low back pain, then just know your chances of experiencing some form of it in your lifetime are an astounding eighty percent! Think it won’t be you?
So what do you do when that moment of excruciation and anxiety strikes? Nothing but simply wait it out? Should you seek help, and if so, where will you go? These are the questions I will attempt to answer within the next few paragraphs, because, if you are like most people, you are probably reading this in pain right now: You’ve got low back pain, you’ve hoped it would go away on its own, but it hasn’t; and now you’re desperate for relief. Read on.
What Causes Low Back Pain?
There are many causes of low back pain—far too many to go over all here. However, for all intents and purposes, we can categorize them into three groups: organic, mechanical, and neurological causes. Each type requires different treatments, and has varying degrees of clinical immediacy—that is, how quickly it needs to be addressed. The most pressing emergencies are generally organic, but a few neurological problems are bad enough to require prompt attention.
Organic Causes of Low Back Pain
I will not go over every organic cause of low back pain here. What I will do is describe emergencies and provide you with some key things to look out for. It is essential that you understand that the conditions I discuss here may require you to seek immediate medical attention. If you are experiencing these signs and symptoms, don’t play around—get to the emergency room right away.
Cardiovascular problems can cause low back pain. That’s right, your heart and blood vessels might be the reason your lower back hurts, particularly if you are in the throes of an abdominal aortic aneurysm (AAA). AAA is the swelling of the aorta. Tears in the interior of this massive artery can lead to blood filling in between the tissue layers of the vessel walls. As the tissue swells, it can eventually burst, causing death. AAA is a medical emergency. Although many people with AAA have no symptoms at the time the aneurysm is discovered, some do develop symptoms, including low back pain, abdominal pain, and groin pain. The most unsettling sign of AAA is a throbbing, pulsating mass in the abdomen. If you have low back pain and a palpable pulsation in the abdomen, get to the ER immediately.
Digestive problems can also cause low back pain. Gas and bloating are common ailments affecting the lower back. Less common is cramping caused by diarrhea, but it can be painful. Cramping can be due to food sensitivities (lactose intolerance, Celiac disease, and Crohn’s disease), intestinal infection, or parasites. None of these are medical emergencies, though. The one digestive issue that can have immediacy, however, is appendicitis. Appendicitis is an inflammation of the appendix, and it is typically painful. I’ve had it, and I can attest that it’s no fun.
Genitourinary problems can also cause low back pain. The one we hear about most often is kidney stones. These tiny little uric acid crystals form in the kidneys and can be passed into the ureters, the tubes that carry wastes from the kidneys to the urinary bladder. As small as kidney stones can be, the lumen or opening of the ureters is much smaller. You don’t have to be a physicist to guess what happens when a larger object tries to pass forcefully through a smaller tube. What isn’t so obvious is where the pain is felt when kidney stones pass. But I bet you’ve guessed it—the low back. Low back pain associated with kidney stones is excruciating.
Nephrolithiasis (kidney stones) is a medical emergency, as the stones can create a complete obstruction, which can ultimately lead to infection or kidney damage. Another sign to look out for is waves of pain. These waves are called renal colic, and they are the body’s way of trying to dislodge the obstruction. The body is intelligent, yes indeed; and so are you—so get to the emergency room, pronto.
Finally, a urinary tract infection (UTI) can cause low back pain. If you feel like having to pee all the time but cannot; if you are urinating fire; if you feel bloated; if you are cramping in the low back or pelvis; if you have foul smelling, cloudy, or bloody urine; if you have fever—then you may have a UTI. With a urinary tract infection, you may have one of these symptoms, or you may have them all. Go to your doctor or the emergency room right away.
There are some basics that you should know, which will help you determine whether to run to the ER or wait to see your chiropractor. When evaluating your low back pain, it is important to observe the following. If you experience:
- Severe pain that is constant and unrelieved by position (lying flat on your back, sitting, lying on your side with a pillow between your legs, etc.),
- Fever and/or vomiting along with back pain,
- Pain that wakes you up, and keeps you up, at night,
- or bowel or bladder problems, such as losing control of going to the bathroom,
These all require emergency room visits right away.
Mechanical Causes of Low Back Pain
Hopefully, you are not in the throes of an organic bout of low back pain. If your pain is mechanical—that is, it involves the joints, muscles, or tendons—then it will likely change with changes in position or movement. In other words, mechanical causes of low back pain generally increase or decrease in intensity as you alter your activities. For instance, the pain may be worse upon waking up and getting out of bed, but it improves as you walk around a bit; it may also worsen with prolonged sitting. Bending forward can aggravate low back pain, and some may need to stay flat on their backs with very little movement. Whatever the case may be, mechanical causes of low back pain usually need mechanical solutions.
Subluxations
The first mechanical cause of low back pain is a non-moving, stuck joint. My Los Angeles and Palm Desert chiropractic clients know exactly what this condition is called—subluxation. Subluxations are stuck joints. They prevent proper movement, while causing muscle spasms, inflammation, and irritating sensitive nerves.
Subluxations are painful. Many cases of chronic low back pain are due to unaddressed subluxations. Chronic subluxations can lead to the development of degenerative arthritis—a painful inflammatory condition where the spinal disks wear away and ultimately cause spinal fusion.
Because chiropractors are the only doctors who detect and correct subluxations, you pretty much have to see one to get fixed up. Some common attributes of low back subluxations are pain when sitting, pain on bending forward or backward, pain when going from lying to sitting and from sitting to standing, and pain not relieved by non-steroidal anti-inflammatories (NSAIDS).
Subluxations rarely, if ever, open up on their own. As I have said, they are the cause of many long-standing episodes of low back pain. An interesting phenomenon regarding chiropractic and low back pain is that chiropractors have historically been the last resort doctors in a patient’s repertoire. So, it’s not uncommon for people to come to chiropractors after they have already tried everything else, and to no avail. That’s quite all right—as long as people come eventually. Once again, chiropractors are the only doctors who actually correct subluxations.
Muscular Causes of Low Back Pain
Many muscular conditions can cause low back pain. Muscle strains happen…but not as much as people think. Spasms often accompany subluxations, but they can persist long after the subluxation has resolved. Trigger points are also dreadful players in low back pain. However, by far the most common muscular issues associated with low back pain are muscular imbalances.
Muscular imbalances occur when one muscle (or group of muscles) becomes excessively tight, while another muscle (or group of muscles) becomes excessively weak. The muscles involved are usually antagonists, meaning they perform the opposite actions of one another. A perfect example is tight hip flexors (iliopsoas) along with weak glutes (gluteus maximus). When the glutes get weak, the lower back becomes unstable. Throw in a strong, extremely tight muscle that throws the back into an arch, and what you have is a recipe for disaster. Take a look in the mirror: if you see an excessive arch in your lower back—then a muscular imbalance is at least one of your lower back problems.
Tight muscles can be easily remedied through stretching. In fact, my chiropractic patients in West Hollywood and Palm Springs are well aware that I’m a strong advocate of stretching. Although a yoga class can do wonders for opening up tight areas (as well as strengthening weak ones), if you are experiencing a low back pain episode, you will probably need to get your problems evaluated and treated as soon as possible. In other words, who’s got the energy for a yoga class when you’re writhing in pain? I understand this, and you can be assured that your muscular imbalances will be assessed while you receive treatment for your back in my Rancho Mirage sports chiropractic practice.
Low Back Pain Can Come From the Feet
So, the mechanical causes of low back pain resulting from joint and muscle problems may be obvious, but less obvious is that some people have issues with their feet that can also be a source of low back pain. The feet, being the foundation of our mechanical locomotor system (our wheels), have an enormous impact on our movement, and ultimately, on how we feel. Foot dysfunctions, like over-pronation or over-supination, are usually the turning inward or outward of the feet when one walks. Other names for these dysfunctions are flat feet and duck walking.
When the feet lack stability, causing them to move excessively as we walk (particularly when stepping down and pushing off), it can lead to mechanical dysfunction in the low back and pelvis. Excessively firm feet are also undesirable, and both conditions—instability and inflexibility—can lead to low back pain, as well as other issues. In these cases, it is essential to have your feet checked by a professional. Podiatrists can do it, and so can orthopedists. But the best place to go for a comprehensive foot examination is your local neighborhood chiropractor. Chiropractic offices are well-suited for assessing foot dysfunction and gait (how you walk) because they can also help relieve back pain, identify muscular imbalances, and provide custom orthotics if necessary.
Orthotics are custom-made inserts that fit into the shoes. A chiropractor will cast you in plaster or have you step into foam slippers. In my West Hollywood and Rancho Mirage chiropractic sports offices, I choose plaster casting because I know it makes the best orthotic. Casting in plaster allows for the correction of foot dysfunction in the neutral position, and it doesn’t recreate the flatness or overarch when stepping down in the foam.
Orthotics are miraculous devices that can end chronic back pain within days. You will still need to have your subluxations adjusted and your muscular imbalances corrected, but orthotics are incredibly effective at supporting chiropractic care. I am a flat-footed over-turner when I walk, and I also had chronic low back pain until I started wearing orthotics regularly. I highly recommend any low back pain sufferer to get their feet checked, as orthotics have changed my life.
One other thing orthotics are great at is helping prevent a disastrous condition, which is, without a doubt, the toughest condition I see in my Los Angeles and Palm Desert chiropractic offices—the herniated disc.
Herniated Discs
The spinal bones (vertebrae) are separated from each other by a firm yet spongy disc. The intervertebral disk is made up of fibrocartilaginous material. The outer annular rings are fibrous and tough, while the inner nucleus is soft and spongy. The nucleus moves within the annular fibers as we move. If the annular fibers weaken, they can tear. A torn annular fiber no longer holds the nucleus in the center, and the nucleus can then push outward from the disk, compromising the spinal nerves. Bulging disks are called herniations. Disc bulges are painful in and of themselves, but when the bulge presses up against a nerve, it can be unbearable.
A typical symptom of a herniated disc is severe low back pain with all movements, which may cause the sufferer to be bent over and unable to stand on his or her own. I’ve had people carried into my office when suffering from a bulging disk. If the herniation is bad enough, the sufferer can lose control of his or her bladder or bowels. If this happens, it’s a medical emergency, and a trip to the ER is warranted.
If a nerve is involved (a pinched nerve), the person can experience sharp, electrical pain in the lower back, buttocks, or down the leg. This is called sciatica. Sciatica can prevent the sufferer from walking, can cause a limp, or can make sitting in one position impossible. If you have low back pain that feels centrally located on the spine, press lightly into the area; if you want to scream or your legs buckle, then you may have a herniated disc. Getting to a chiropractor immediately is essential. Herniated discs are the one true chiropractic emergency—don’t hesitate.
Neurological Causes of Low Back Pain
We have discussed how disc herniations can press upon or pinch a nerve. Nerves can be irritated in other ways as well. For instance, spinal subluxations can irritate nerve tissue in the absence of a herniation. Tight muscles can also impinge on nerves in the lower back region, the front of the groin and thigh area, and the buttocks. A painful condition known as piriformis syndrome is characterized by a spasm of the piriformis muscle, which sits directly on top of the sciatic nerve. Pregnant women are familiar with this sensation as it’s quite common among expecting mothers. Piriformis syndrome is no fun, but it’s treatable. I treat many people suffering from piriformis syndrome in my Beverly Hills and Coachella Valley chiropractic offices.
Another condition that can irritate nerve tissue as it exits the spine is spinal stenosis. Stenosis is the narrowing of an opening, so spinal stenosis is the closing off of the foramen or openings from which the nerves exit. Central canal stenosis is a type of spinal stenosis in which the central opening for the spinal cord narrows. This is a critical situation that requires the expertise of a neurosurgeon.
One final note on sciatica: If a disc herniates such that the nucleus squirts out of tissue completely, this is a serious condition. Typically, there is no low back pain, but an excruciating pain in the leg. The pain can be almost anywhere, but it is typically felt down the front of the shin, near the ankle. This is a painful and unnerving situation. A neurologist can give you a steroidal injection to deaden the immediate pain, but it is imperative that chiropractic and physiotherapy be taken up immediately following the shot to correct the actual problem. The effects of the shot won’t last forever, but it should give you enough time to work on the problem. I’ve treated several people in this situation, and we have had great success. A small minority of these patients will need surgery, and for this, a neurosurgeon will be necessary.
Treatment Options for Low Back Pain Sufferers
If you’re experiencing low back pain, what should you do? The first piece of advice is to take action. Doing nothing and hoping the pain will go away on its own, despite some current medical advice to that effect, is not only foolish, it’s masochistic. I have encountered people in my Los Angeles and Palm Springs chiropractic practices who have lived with their low back pain for twenty or more years. Believe me—the pain will not go away on its own.
If you do seek the care of a professional, you have the following options: If you see a medical doctor, you will be in the best position to evaluate whether you have an organic condition. This is important if, in fact, your low back pain is coming from your cardiovascular, digestive, or urinary systems. If, however, your low back pain is due to mechanical causes, then the medical approach is rather limiting.
The modern medical approach to mechanical low back pain is often quite simple. Most low back pain sufferers are given the medicinal triad of pain killers, anti-inflammatories, and muscle relaxants. Although in some cases, this regimen can help reduce the pain for the short term, many people report little to no improvement with that selection of treatment. Returning to the medical doctor at that point might get you a referral to a physical therapist, which is definitely a better long-term option, but it can also be limiting.
A physical therapist (PT) will likely do therapeutic modalities, like heat, electric stimulation, some muscle work (if you are lucky and find the right practice), and give you exercises (which is the right thing to do). Treatment may go weeks or months, and I’ve even heard some patients speak of PT care lasting six months or longer.
Chiropractic Care to Relieve Low Back Pain
If you choose a chiropractic office—and if you are in Los Angeles, Beverly Hills, West Hollywood, Palm Deserst, Rancho Mirage, or La Quinta then you should check out my cranial and sports chiropractic offices—you will get your spinal subluxations adjusted, your muscles relieved through deep tissue massage, stretches, and exercises; and you can get your feet checked and be cast for orthotics if that is indicated. In a chiropractic office, you will have the greatest chance of getting the full spectrum of care necessary to give your lower back some relief. Chiropractors can do therapy and rehabilitation—a big plus when dealing with acute or chronic low back pain. I have been in the sports chiropractic field, helping people recover from low back injuries, for twenty-five years. I have had thousands of people walk through my doors (some have crawled) and get long-term solutions to their low back pain problems. I have also had my fair share of low back pain (hey, chiropractors have low backs, too), and for my money, the quickest, most effective way to deal with low back pain is through safe, effective chiropractic care. Don’t hesitate, call your chiropractor today.
-originally posted on March 31, 2009
