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According to the World Health Organization, 70% of people world wide will experience lower back pain. That's an amazing statistic. Now then, once someone has LBP, their concern is twofold; what is causing it and how to get rid of it. In my experience the pain is caused by 3 things: nerve pain, facet pain and muscle spasm. Nerve pain is classic in that it runs down a particular nerve, like the sciatic. More on that in a bit. Facet pain is caused by inflammation in the facet joints, which are the joints in the back of the spine that connect one vertebra to the next. Then we have muscle spasm pain. That's a tricky one particularly because it usually happens as a result of one of the first two.
There is a difference between shooting pain (nerve) and referred pain. Its important in that it usually determines how long it will take to get some relief. As I mentioned above, nerve pain follows a particular nerve, either completely or just partially. In the case of sciatic pain, it begins in the lower back and travels thru the glute and down the back of the leg into the foot. Where as referred pain, usually caused by an irritated facet, gives the same similar "radiating" sensation, but over a general area as opposed to down a nerve root. For example, when someone has LBP radiating kind of all around the glute and a bit into the upper leg over a large area, I know it is referred pain, usually from a facet. Again, there will usually be the addition of muscle spasm pain associated with both.
There are so many ways to proceed to fix the problem, and I do all of these on a daily basis in the office. It begins with a case history. What were you doing when it happened? How long has it been going on? Is the pain dull or sharp? Is there numbness or tingling sensations? You get the idea. Then I do an examination to include spinal ranges of motion. Often times there is so much spasm, there is no motion at all. Then we check reflexes. This gives me info on what nerves may be involved. We check sensations and compare right to left. Again, this helps me pinpoint which nerves are involved. We will test the muscles to, again, narrow down which nerves are the culprit. If the situation warrants, we can always do an x-ray or an MRI scan, but usually the exam gives all the required information.
Once we have identified the cause of the problem we can begin fixing it. With all three causes of LBP I typically begin extremely conservatively, then get more dynamic. For example, on a hot sciatic case, I would use ice packs on the area for 15 minutes and then do a scan with the Ultralign and proceed to do a very gentle correction. I would do this for the first couple of visits and then reassess. After a couple of visits, there should be a positive change noted. Even if the patient is still sore, we can begin to see some of the positive indicators we found in the initial exam going away.
Once we are improving and stable, I like to begin a stretching program. I'll do another article on stretching, but we are all too tight. We all sit too much. I train daily, and I sit too much. It is what it is. After a few stretching sessions and the condition is improving, I strongly suggest a regimen of core strengthening exercises. I don't give you a paper of stuff to do at home, that's dumb. I take you into the office gym and teach you the proper exercises and I train you how to do the workouts properly and safely. The key is to get rid of the lower back pain and prevent it from returning. The adjustments, the stretching and the strengthening are, in my opinion, the best way to achieve those goals.