Back Pain Is The Single Leading Cause Of Disability Worldwide!

Back pain can affect people of all ages, from adolescents to the elderly.

The terms "Low Back Pain," "Chronic Low Back Pain," and "Acute Low Back Pain," do not comprise a formal diagnosis by theirselves. Instead these terms are a description of the symptoms caused by a structural diagnosis.

These are some of the most common low back complaints we see in our office.

Keep reading to learn the differences between each condition.
low back pain, low back sprain, low back strain

Lumbar Sprain/Strains

Disc herniation, disc bulge, disc pain, low back pain

Lumbar Disc Disorders

spinal stenosis, arthritic pain, arthritis

Lumbar Spinal Stenosis

low back pain, facet pain

Facet Syndrome

Lumbar Spine Anatomy

The lumbar spine is made up of five vertebra and five intervertebral discs. These disc act as shock absorbers to cushion your movements under load.

The intervertebral discs consist of two components, a tough outer ring of fibrous tissue, similar to the rings of an onion or tree,  called the annulus fibrosis, and a jelly-like center inside the annulus fibrosis called the nucleus pulposus. This structure is then held together by ligaments on the front and the back of the vertebrae and additional support is provided by muscles of the back and spine.

Lumbar Strain/Sprain

The lumbar spine is subject to tremendous loads.

Excessive stress placed on the supporting soft tissue can lead to ligamentous "sprains" and muscular "strains." These injuries frequently co-exist as a result of a single insult and are referred to commonly as "musculoligamentous injuries." The L4-5 and L5-S1 segments are subject to the greatest ranges of motion with the highest loads and not surprisingly, are the most often injured.

Lumbar Disc Disorders

Pain coming from a disc injury can present suddenly or have a gradual onset.

Common risk factors of disc injuries include:

  • Age and Gender – the highest prevalance occurs in men between the ages of 30 and 50 years old.
  • Sedentary lifestyle – the lack of exercise and poor core body strength increases the risk of disc injuries.
  • Improper lifting – using your back muscles instead of your legs to lift heavy objects. Twisting while lifting or lifting with an unstable base.
  • Repetitive activities that strain your spine – jobs that require constant lifting, bending, pulling, or twisting.
  • Posture – hyperlordotic lumbar curvature/sway back, anterior pelvic tilt (as seen in lower cross syndrome).
  • Frequent driving – staying seated for long periods and the vibration from the car/truck can put undue pressure on your discs.
  • Smoking – Smoking reduces the oxygen supply to the discs causing more rapid degeneration.
  • Obesity – being overweight puts added stress on lumbar discs.

 

 

Did you Know Lumbar Disc Degeneration Is A Normal Part Of Aging?

As we age, our skin gets wrinkles. A similar process occurs in the disc. The disc begins to lose fluid and becomes dried out causing the disc to compress.

With repeatative movement and increase demands on our spine, this can lead to the breakdown and degeneration of the outer ring of the disc (annulus fibrosis). When this happens it allows the inner core (nucleus pulposus), to bulge out. We know this as a bulging disc. This puts pressure on the outer ring of the disc, which may cause low back pain by causing pressure on the surrounding nerves and soft-tissue.

Over 90% of disc lesions occur at L4/5 or L5/S1, with L5-S1 being the most common.

Mechanical risk factors related to the development of LDL include:

  • Sedentary lifestyle or occupation
  • Driving motorized vehicles
  • Vibration
  • Smoking
  • Previous full-term pregnancy
  • Increased BMI
  • Increased sacral base angle
  • Having a tall stature

Making sense of you MRI findings

What do these words mean?

Disc problems may be classified by location/ zone as central, subarticular (lateral recess), foraminal, or extraforaminal.

  • The most language used for disc lesions is the use of the term "protrusion,"
    • This is used to describe bulging of an intact annulus (the thick outer rings of the disc)
  • "Extrusion" is used to describe connecting nuclear material (jelly-like middle) that has herniated through the annulus
  • "Sequestration" to describe a detached nuclear fragment
    • Part of the jelly-like core has broken off from the main part of the disc
  • The ratio of the bulge "waist" to mass may also help define protrusion vs. extrusion
    • protrusions have a wider annular base and extrusions have a narrower "stalk".

What The Research Shows

Age-specific prevalence estimates of degenerative spine imaging in asymptomatic patients

Imaging Findings        20 yr  30yr    40yr   50yr    60yr  70yr   80yr    

Disc degeneration      37%    52%   68%    80%   88%  93%   96%

Disc height loss         24%    34%   45%    56%   67%  76%   84%

Disc Bulge                 30%   40%   50%    60%   69%   77%   84%

Disc Protrusion          29%   31%   33%    36%   38%   40%   43%

Facet degeneration    4%      9%   18%     32%   50%   69%   83%

Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816. doi:10.3174/ajnr.A4173

Lumbar Stenosis

Degeneration of the spine and spinal column is inevitable with aging and may reflect normal changes in an aging spine.

While degeneration of the spine and disc occur with normal aging, this does not always cause spinal stenosis. However, it is the most common contributing factor. Lumbar spine stenosis describes narrowing of the central spinal canal, lateral recess, neural foramina or any combination of these sites.

Lumbar Spinal Stenosis Is The Leading Cause Of Pain, Disability And Loss Of Independence In Older Adults

Until recently, effective non-surgical treatments for lumbar spinal stenosis had not been established.

There are some habits, tips and exercise programs we  use to reduce the symptoms and limitations presented by lumbar stenosis. In our clinic we use directional preference exercises and the Spinemobility's 6-week lumbar stenosis boot camp to restore function, independence, and to reduce your pain.

Facet Syndrome

The facet joint is thought to be the source of pain in 15-45% of patients with chronic low back pain.

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At Restoration Spine and Sport, depending on your specific low back pain diagnosis, we create a patient-centered short-term treatment plan, that targets the cause and helps mitigate your pain.

Many of our low back pain patient are treated with a combination of gentle Chiropractic adjustmentsSoft Tissue TherapyCorrective Exercises and much more. Our goal is to provide a long-term solution for your pain, in a short amount of time.

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