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Low Back Pain

If you're suffering from lower back pain you're not alone. More than 80% of North Americans will at some time in their life suffer from the disabling confines of lower back pain.According to experts, lower back pain is the number one disability culprit in workers' compensation claims and accounts for more than $50 billion annually in the US through medical care and lost production. In addition, the latest research shows most lower back problems which cause low back pain do not fully resolve without extensive treatment and proper rehabilitation, contrary to previous beliefs.
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The chiropractic doctor is unique in the health care field in that much of the training in chiropractic colleges is specifically aimed at identifying and successfully treating and managing lower back conditions. General medical practitioners generally lack adequate training in this area and have not learned the skills necessary to most effectively identify and treat most back conditions.

Anatomy of the Low back

Lumbar Vertebrae
The lumbar spine contains 5 moderately large vertebrae which sit atop the sacrum. These bony segments act as attachments for muscles and ligaments in the lumbar spine and also encase and protect the lower spinal cord and lumbar nerve roots.
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Because the lumbar vertebrae are located between the pelvis and upper torso, the degree of stresses endured by the lumbar spine are great. These abnormally high degrees of stress result in frequent lumbar vertebral restrictions - misalignments and improper motion patterns of the lumbar vertebrae. If left uncorrected, these misalignments and faulty biomechanics of the lower spine can result in spinal injury and irreversible degenerative changes.


Lumbar Intervertebral Discs
The lumbar discs connect adjacent lumbar vertebrae to one another and cushion the spine as well as permit motion between the individual vertebrae. As stated above, the lumbar spine is a "transitional" area between the pelvis and upper torso, thus, resulting in high degrees of spinal stress. This results in the 4th and 5th lumbar discs suffering more injuries than all other spinal discs combined.

Disc herniations in the lumbar spine are the most common causes of "sciatica", meaning pain running down the back of the leg in the area of the sciatic nerve. Possible symptoms include pain, numbness, tingling or weakness in the legs and/or feet.


In rare cases, a lumbar disc herniation can compress the spinal nerves which provide motor control to the bowel and bladder. Although rare, if you're having back pain and experience a loss of bowel and/or bladder control, immediate medical intervention is required. Without immediate decompression the loss may become permanent.


Lumbar Facet Joints
The facet joints in the lumbar spine allow for considerable amounts of flexion but a much lesser degree of extension and rotation. These joints must withstand large amounts of stress from the body and as a result are prone to acute and repetitive injuries and degenerative arthritis.

Facet joints are most commonly injured during movements involving a rotational or twisting component. When injured, pain is often sharp and localized to the area of the affected facet joint. Later in life, if spinal problems have been allowed to linger without appropriate rehabilitation, arthritis will likely be present. If severe enough, as is commonly the case, bony arthritic enlargement of the joint can impinge upon spinal nerve roots and produce symptoms pain, numbness, and tingling down the leg, as well as leg weakness, in addition to back pain.


Lumbar Spinal Nerves
The lumbar spinal nerve roots exit openings formed between adjacent lumbar vertebrae termed the intervertebral foramina or IVF. The weakest aspect of the spinal disc is unfortunately in close proximity to the IVF. Thus, disc injuries commonly result in discal materials compressing, stretching or irritating the nerve roots exiting the IVF's.
Because the nerve roots exiting the lumbar spine innervate structures in the lower extremities, any compression, stretching or other irritation will result in numbness, tingling, pain or weakness in the leg(s) and/or feet. This may result from vertebral malpositions, disc herniations, arthritic changes to the vertebrae and facet joints, or even abnormalities within the muscles (piriformis syndrome).


Lumbar Spinal Musculature
The paraspinal muscles in the lumbar spine attach to the spinal vertebrae and pelvis to provide the torso with movement. These muscles must be strong to control the upper torso about the pelvis and thus are frequently overworked and injured. The pain associated with paraspinal muscle injury is generally a dull, boring, generalized ache in the area of the lower back.


Sacroiliac Joint
The sacroiliac joints are located between the sacrum and the ilium bones of the pelvis. These joints may also become irritated or injured resulting in lower back pain, buttock pain, and occasionally leg pain.

This condition tends to be more common in women, especially during pregnancy when hormonal changes and pressure from the forming fetus increase the stress on these joints.

Treatments for Low Back Pain

Doctors of chiropractic are the health care leaders in the treatment of low back pain as well as other spinal conditions. Treatments are gentle, safe, natural, noninvasive and highly effective. Also, the treatments are designed to correct the root cause of your problem and not simply cover up the symptoms you experience. In fact, a Canadian government commissioned study on the effectiveness and cost effectiveness of chiropractic management of low back pain concluded,
"Chiropractic manipulation is safer than medical management of low back pain. Chiropractic management is greatly superior to medical management in terms of scientific validity, safety, cost-effectiveness and patient satisfaction."
- The Manga Report


Identifying The Cause
The first step in treating low back pain is to determine what has and is causing the low back pain. Once the causes and contributing factors are identified, a successful treatment plan can be structured to eliminate the pain and achieve the goals of the patient.
Most individuals experiencing low back pain have a combination of:

  1. vertebral fixations

  2. faulty spinal biomechanics

  3. deconditioned and weak spinal musculature

  4. improper firing patterns of spinal musculature

  5. poor postural habits

  6. poor diet and nutritional practices

  7. a history of activities (work or play) generating high levels of spinal stress



The Treatment
Chiropractic doctors have successfully treated low back pain for over 100 years. Through the use of natural and safe procedures, chiropractors correct the underlying problems which cause and contribute to the majority of low back pain cases.

The main treatment employed by the chiropractor is the chiropractic spinal adjustment. This noninvasive therapy consists of a gentle, manually or mechanically applied force into the segments of the spinal column. Spinal adjustments have been shown to decrease pain, increase spinal range of motion, decrease muscle spasm, reduce inflammation, optimize spinal biomechanics, and reduce the recurrence of old injuries.

Clinical practice guidelines for the management of acute low back pain released by the US Department of Health and Human Services (AHCPR) stated:

  1. Conservative treatment such as spinal manipulation should be pursued in most cases before considering surgical intervention;

  2. Prescription drugs such as oral steroids, antidepressant medications and colchicine are not recommended for acute low back problems.

  3. The risk of serious complications from lumbar spinal manipulation is rare

  4. Acute Low Back Problems in Adults. Clinical Practice Guidelines. Bigos S, et al. Agency for Health Care Policy and Research Publication No. 950642 (1994) - U.S. Department of Health and Human Services.


According to researcher Pran Manga, PhD,
"Spinal manipulation applied by chiropractors is shown to be more effective than alternative treatments for low back pain. Many medical therapies are of questionable validity or are clearly inadequate."

  1. The Effectiveness and Cost Effectiveness of Chiropractic Management of Low-Back Pain (The Manga Report). Pran Manga and Associates (1993) - University of Ottawa, Canada.



Proper Habits and Techniques
Another key ingredient to a successful low back pain treatment plan includes the learning of proper postural habits and other techniques. Proper posture is a significant factor in the health of the back and proper posture should always be practiced. Techniques common to daily living and work also play a major role in the development or lack of development of low back pain. This includes proper lifting techniques, avoidance of repetitive motions, avoidance of prolonged sitting, and much more. We can teach you correct habits and techniques which will protect your back from discomfort and injury.


Other Therapies
Other manual therapies such as massage, trigger point therapy, proprioceptive neuromuscular facilitation, and acupressure therapy may be utilized to assist in the relaxation of lumbar muscles and increase lumbar spine mobility.

Low back stabilization exercises are commonly prescribed to patients suffering from low back pain. These exercises are designed to teach the patient a "neutral spine" position as well as subconsciously enhance the muscles ability to stabilize and protect the spine from injury. Exercises and stretches are unique in that they can be performed outside the office without the assistance of the doctor.
Physical therapies may also be employed and include hot and cold applications, muscle stimulation, interferential therapy, therapeutic ultrasound, and diathermy.

Diet and nutrition also play a key role in the health of the spine. Without the proper nutrients, the lumbar spine and rest of the body are less able to remain healthy and heal once injured. If your diet and nutritional status is poor, we can help get you on track.


How To Maintain A Healthy Lower Back
Regular spinal checkups. Maintaining proper alignment and functioning of the lower back through periodic spinal adjustments minimizes the stresses to structures of the lower back. Also, keeping the nervous system free from interference ensures proper communication between the various structures of the lower back.

Proper lifting and ergonomics. Practicing proper lifting techniques and ergonomics are key in preventing lower back injury at work and preventing future recurrences of old injuries.

Regular exercise. Routine physical activity keeps the heart healthy and keeps the spine and the rest of the body strong and healthy. A minimum of 3 times per week for 40 minutes should be your goal. Involve friends and family, mix up the activities, keep it fun and stay consistent!

Proper diet and nutrition. Providing your body with the proper fuel increases performance, reduces the likelihood of injury and sickness, speeds recovery after injury, and keeps you feeling good. If, like the rest of us, you're finding it difficult to get all the nutrients your body needs, it's probably time to supplement.
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If you're suffering from low back pain, join the millions of other individuals who have benefited from gentle, safe and natural chiropractic care. Our treatments provide fast, effective relief which not only eliminates pain, but can help increase the performance and health of the entire body.

Causes of Low Back Pain

Many tissues can generate low back pain. Unfortunately, research shows that the exact tissues causing low back pain cannot be specifically identified in up to 80% of individuals. In other words, we cannot single out the tissue(s) responsible for the pain. These patients are said to suffer from "nonspecific low back pain"; the specific cause of the pain cannot be determined.
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Although the specific tissues causing low back pain are difficult to identify, chiropractic doctors have found a number of factors consistently present in low back pain patients. These factors include vertebral restrictions, faulty spinal biomechanics, deconditioned spinal musculature and the practice of poor postural habits and techniques. By addressing these factors - the actual causes of the tissue injury - chiropractic doctors are able to obtain extraordinary results in low back pain sufferers.

Common events leading or contributing to the development of lower back pain include:

  • incomplete rehabilitation of past injuries

  • lack of proper and periodic lumbar spinal alignments

  • presence of lumbar spine restrictions

  • improper lifting techniques

  • auto accidents

  • improper workstation setup

  • poor posture

  • prolonged sitting

  • prolonged use of non-ergonomically designed equipment

  • excessive repetitive torsal motions

  • exposure to vibratory forces (truck drivers, jack hammer operators)

  • scoliosis (lateral deviation of the spine)

  • fallen foot arches and other foot abnormalities

  • physical inactivity

  • poor diet and nutritional practices

  • smoking


Structures which are often the source of lower back pain include:

  • lumbar intervertebral discs

  • lumbar facet joints and joint capsules

  • lumbar and pelvic muscles and ligaments

  • lumbar and sacral spinal nerves

  • sacroiliac joints

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