This article goes over the 4 most common lower back pain causes and the some of the different diagnoses that fall under those causes. Lower back pain is one of the leading causes of disability worldwide and in the United States. While this is a multifactorial problem, it has been found that education is a great way to battle back against this epidemic. This article’s goal is to educate the public on the most common lower back pain causes. The 4 most common causes of lower back pain are disc derangement, joint dysfunction, radiculopathy, and myofascial pain. Once you better understand the most common causes of low back pain you will hopefully have a better understanding of what is going on with your own back.
Disc derangement is the label applied to the cause of low back pain that comes from the intervertebral disc. Disc derangement is the most common cause of low back pain. This is different than the pain that one may experience from a disc herniation. Although when one has a disc herniation they may also experience pain from disc derangement. To understand disc derangement one must first understand the anatomy of the disc. The disc is a cartilaginous structure that separates the vertebrae in the spine. The discs have two main parts to them. There is an inner part called the nucleus pulposus, that forms a compact circular shape, and then there is the outer part called the annulus fibrosis which completely surrounds the nucleus. One could imagine this is similar to a cream filled donut. The nucleus of the disc does not have any nerve endings in it and it is the main weight bearing part of the disc. The annulus, however does have nerve endings and for the most part is non weight bearing. Disc derangement is thought to develop when small tears in the annulus fibrosis develop and nuclear material leaks into the outer annulus causing a mixing of the two parts of the disc. It has been hypothesized that the pain presents because the nuclear material either causes an inflammatory response in the annulus or the nuclear material becomes innervated after these parts of the disc start mixing.
Disc derangement is most commonly caused by repetitive flexion. Compression and possibly torsion during the repetitive flexion may contribute to the derangement occurring. As you can imagine flexion is a very common part of everyday life. Pretty much any time you bend over you are flexing the spine. Throughout one’s life they flex there spine literally thousands of times. For some people this never causes an issue, for others disc derangement develops and causes them to experience severe lower back pain.
Disc derangement can happen suddenly or be a long drawn out process. When it happens suddenly it can present as severe lower back pain. This severe lower back pain can cause someone to be in so much pain that they are barely able to move. Other times this pain will come on slowly and one might notice that there symptoms start in the low back and then, as time goes on, the pain proceeds to go down one or both legs. This is usually a sign that the disc derangement is progressively getting worse.
The good news is that disc derangement is very treatable with conservative options such as end range loading exercises, spinal manipulation, and an at home exercise plan.
Joint dysfunction is another common cause of lower back pain. Joint dysfunction presents as restricted range of motion, or “restrictions” as we call them, and are believed to occur after injury to tissues. After an area becomes injured it will become inflamed, and often muscles in the area will contract to protect this area from excessive movement that could potentially worsen the injury. During and after the injuries resolution these muscles may not relax. This causes what we call a nociceptive input. In other words, it irritates the area and causes pain.
The exact cause of low back pain from joint dysfunction is believed to be caused by dysafferentation. According to the theory of dysafferentation an abnormality in the movement of a joint causes there to be unequal input from mechanoreceptors (nerve endings that relay joint position) and nociceptors (nerve endings that relay pain). Normally the signals from mechanoreceptors overrides the signals from nociceptors, causing one to only receive the input from the mechanoreceptors. When there are abnormalities in the joint’s movement the nociceptor’s signals override the mechanoreceptors signals causing one to instead experience pain.
Spinal manipulation is one of the most effective ways to restore motion to joints and their surrounding areas.
Radiculopathy is pain that comes from a nerve root. While radiculopathy of the low back often causes pain to radiate into the legs, not all pain that radiates into the legs is caused by radiculopathy. When people talk about the term sciatica or sciatic nerve pain they are truly talking about radiculopathy. Patients often are misdiagnosed with sciatica when they do not truly have it. Since disc derangement is the most common cause of low back pain and can cause pain that is very similar to sciatica in presentation it is often misdiagnosed as sciatica. True sciatica requires there to be actual compression of, pressure on, or irritation of the sciatic nerve. That said radiculopathy can also happen to nerves besides the sciatic nerve. In some cases patients with radiculopathy in the low back will experience pain down the femoral nerve or another nerve altogether. Either way when one truly has radiculopathy it is because there is irritation of a nerve root. There are two common types of conditions that cause irritation of a nerve root, and therefore radiculopathy, they are disc herniations and spinal stenosis.
It is important to recognize that not all disc bulges or herniations result in radiculopathy or pain. Unfortunately, the people who are experiencing pain often describe it as severe low back pain that radiates into the legs. The type of pain that is experienced due to a disc herniation depends on the type and position of the herniation. If the damaged disc is irritating a surrounding nerve, shooting pain and weakness into the legs may develop. The discomfort is often described as stabbing and lightning-like. Disc herniations develop in a similar fashion to disc derangement. The inner part of the disc protrudes through small tears in the outer part of the disc. When this results in a herniation the inner part of the disc protrudes so far as to actually start to come out of the outer part of the disc. This causes intense inflammation in the area which can irritate the nerve root, or the protruding part of the disc can directly compress the nerve root. Both of these mechanisms can cause you to suffer from radiculopathy.
Spinal stenosis is more common in older individuals, however it can develop or be a congenital condition in the younger population as well. Spinal stenosis is essentially a narrowing of the pathway that the spinal cord or nerve roots pass through. Spinal stenosis is most often due to degenerative changes in the vertebral bodies. Over time, for a multitude of reasons, bony or ligamentous encroachment can occur either in the vertebral canal or in the lateral canals. When stenosis happens in the central vertebral canal this can be a more serious condition and affect multiple organ systems. When stenosis happens in the lateral canals it usually has a similar presentation to disc herniation. The good news is that both types of stenosis can be treated and managed with conservative care.
Conservative care such as therapeutic exercises can often effectively treat radiculopathy regardless of what condition it comes from. Although a lot of people get stressed out and worry that they are going to have to have surgery when they have a disc herniation or stenosis the first line of treatment for radiculopathy is actually conservative care. Conservative care has been shown to be an effective treatment and the majority of patients with radiculopathy never require surgery or any invasive treatments.
Myofascial pain is pain that is muscular in origin. It can present as a back spasm, the feeling of tightness, tenderness of the back, or in some rare cases it can cause radiating pain. Myofascial pain can be due to trigger points, strains, or possibly even sprains. Trigger points are hyperirritable spots in the muscle that results in a tender irritable spot. Most people refer to these trigger points as knots. These trigger points can cause back spasms. Sprains and strains are tears in ligaments and musculature respectively. They can also result in the surrounding muscles spasming and causing severe back pain. Strains and sprains can occur in anyone, but they typically occur in people who begin tasks and work these structures in ways they are not used too. For example, a person who attempts to run a marathon during their first outing in the summer is likely to overwork these structures causing damage. Ligament sprains are typically caused by stretching the involved ligament past its limits, creating tears. Muscular strains are commonly caused by lifting too heavy of an object and twisting motions. Strains of muscles and sprains of ligaments in the back can be extremely painful and are often accompanied by swelling and bruising of the surrounding area. Chiropractic care and rehabilitation are effect at treating sprains and strains of the low back and can help you get better sooner.
Now That You Are Familiar With The 4 Most Common Lower Back Pain Causes:
You should try and take this information and determine if it applies to your situation. While it is still advisable to consult with a medical professional, having a better idea of what is causing your pain can help you on the road to recovery. Hopefully you can now do some more targeted research on the cause of and the best way to treat your low back pain.
If you would like professional help with your low back pain please contact me. We can discuss on the phone or in person what is going on with your pain and I can give you my opinion on what is going on and what the best treatment options are. Please feel free to reach me at 412-517-8124.