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.

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 Lower Back

Lumbar Vertebrae

lower-back-painThe 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.

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 subluxations – 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.”

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:

vertebral subluxations
faulty spinal biomechanics
deconditioned and weak spinal musculature
improper firing patterns of spinal musculature
poor postural habits
poor diet and nutritional practices
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:

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

Prescription drugs such as oral steroids, antidepressant medications and colchicine are not recommended for acute low back problems.
The risk of serious complications from lumbar spinal manipulation is rare
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.”

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.

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.

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 subluxations, 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 subluxations
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

Low Back Pain Related Articles and Research

The Manga Report

As the largest existing analysis of scientific literature on low back pain, the 1993 Ontario Ministry of Health commissioned study drew international attention when it recommended the management of low back pain be moved from medical doctors to chiropractic doctors.

Due to serious financial problems with the Canadian governments, the different types of treatments for low back conditions were evaluated in an effort to reduce and contain health care costs. Their findings showed chiropractic manipulation was the most cost effective and efficacious care for low back pain.

The researchers also stated that studies on the prevalence and incidence of low back pain suggest that it is the leading cause of disability and morbidity in middle-aged persons, and is by far the most expensive source of workers’ compensation costs North America.

The Canadian Government report concluded with the following findings:

On the evidence, particularly the most scientifically valid clinical studies, 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;

There is no clinical or case-control study that demonstrates or even implies that chiropractic spinal manipulation is unsafe in the treatment of low back pain. Some medical treatments are equally safe, but others are unsafe and generate iatrogenic (doctor-induced) complications for low back pain patients. Our reading of the literature suggests that chiropractic manipulation is safer than medical management of low back pain;

Indeed, several existing medical therapies of low back pain are generally contraindicated on the basis of the existing clinical trials. There is also some evidence in the literature to suggest that spinal manipulations are less safe and less effective when performed by nonchiropractic professionals;

There is an overwhelming body of evidence indicating that chiropractic management of low back pain is more cost-effective than medical management;

There would be highly significant cost savings if more management of low back pain was transferred from physicians to chiropractors. Evidence from Canada and other countries suggests potential savings of many hundreds of millions annually;

Workers’ compensation studies report that injured workers with the same specific diagnosis of low back pain returned to work much sooner when treated by chiropractors than by medical physicians;

There is good empirical evidence that patients are very satisfied with chiropractic management of low back pain and considerably less satisfied with medical physician management;

The use of chiropractic has grown steadily over the years and chiropractors are now accepted as a legitimate healing profession by the public and an increasing number of medical physicians;

In our view, the following offers an overwhelming case in favor of much greater use of chiropractic services in the management of low back pain:

the effectiveness and cost effectiveness of chiropractic management of low back pain
the untested, questionable or harmful nature of many current medical therapies
the economic efficiency of chiropractic care for low back pain compared with medical care
the safety of chiropractic care
the higher satisfaction levels expressed by patients of chiropractors.
The following recommendations were also included in the report:
There should be a shift in policy to encourage and prefer chiropractic services for most patients with low back pain;
Chiropractic services should be fully insured under the Ontario Health Insurance Plan;
Chiropractic services should be fully integrated into the health care system;
Chiropractors should be employed by tertiary hospitals in Ontario;
Hospital privileges should be extended to all chiropractors for the purposes of treatment of their own patients who have been hospitalized for other reasons, and for access to diagnostic facilities relevant to their scope of practice and patients’ needs;
Chiropractic should have access to all pertinent patient records and tests from hospitals, physicians, and other health care professionals upon the consent of their patients;
Since low back pain is of such significant concern to workers’ compensation, chiropractors should be engaged at a senior level by Workers’ Compensation Board to assess policy, procedures and treatment of workers with low back injuries;
A very good case can be made for making chiropractors the gatekeepers for management of low back pain in the workers’ compensation system in Ontario;
The government should make the requisite research funds and resources available for further clinical evaluations of chiropractic management of low back pain, and for further socioeconomic and policy research concerning the management of low back pain generally;
Chiropractic education in Ontario should be in the multidisciplinary atmosphere of a university with appropriate public finding;
Finally, the government should take all reasonable steps to actively encourage cooperation between providers, particularly the chiropractic, medical and physiotherapy professions.
The Effectiveness and Cost Effectiveness of Chiropractic Management of Low-Back Pain (The Manga Report). Pran Manga and Associates (1993) – University of Ottawa, Canada.

The Agency of Health Care Policy and Research Study

On December 8, 1994, the Agency for Health Care Policy and Research (AHCPR) of the US Department of Health and Human Services released Clinical Practice Guidelines for the management of acute low back pain. Their guidelines were developed after extensive study of diagnostic and treatment methods for acute low back pain.

The guidelines were created by the AHCPR panel to provide primary care clinicians with information and recommended strategies for the assessment and treatment of acute low back problems. The AHCPR panel was made up of 23 members consisting of medical doctors, chiropractic doctors, nurses, experts in spinal research, physical therapists, an occupational therapist, a psychologist, and a consumer representative.

The following conclusions were made in this landmark study:

Conservative treatment such as spinal manipulation should be pursued in most before cases considering surgical intervention;
Prescription drugs such as oral steroids, antidepressant medications and colchicine are not recommended for acute low back problems.
Other interesting finds included:
The risk of serious complications from lumbar spinal manipulation is rare;
There is currently no evidence supporting the use of trigger point, ligamentous and facet injections, needle acupuncture or dry needling as treatment for acute back problems;
The panel found no evidence of benefit from the application of physical agents and modalities such as ice, heat, massage, traction, ultrasound, cutaneous laser treatment, transcutaneous electrical nerve stimulation (T.E.N.S.) and biofeedback techniques.
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.

Chiropractic vs. Hospital Outpatient Management for Low Back Pain

Study Abstract
Objective – To compare the effectiveness over three years of chiropractic and hospital outpatient management for low back pain.

Design – Randomised allocation of patients to chiropractic or hospital outpatient management.

Setting – Chiropractic clinics and hospital outpatient departments within reasonable traveling distance of each other in 11 centres.

Subjects – 741 men and women aged 18-64 years with low back pain in whom manipulation was not contraindicated.

Outcome Measures – Change in total Oswestry questionnaire score and in score for pain and patient satisfaction with allocated treatment.

Results – According to total Oswestry scores improvement in all patients at three years was about 29% more in those treated by chiropractors than in those treated by the hospitals. The beneficial effect of chiropractic on pain was particularly clear. Those treated by chiropractors had more further treatments for back pain after the completion of trial treatment. Among both those initially referred from chiropractors and from hospitals more rated chiropractic helpful at three years than hospital management.

Conclusions – At three years the results confirm the findings of an earlier report that when chiropractic or hospital therapists treat patients with low back pain as they would in day to day practice those treated by chiropractic derive more benefit and long term satisfaction than those treated by hospitals.

90% Under Regular Medical Care Still Suffer Low Back Pain 1 Year Later

Study Overview

It is widely believed that 90% of episodes of low back pain seen in general practice resolve within one month
In a large population based study we examined the outcome of episodes of low back pain in general practice with respect to both consultation behaviour and self reported pain and disability
While 90% of subjects consulting general practice with low back pain ceased to consult about the symptoms within three months, most still had substantial low back pain and related disability
Only 25% of the patients who consulted about low back pain had fully recovered 12 months later
Since most consulters continue to have long term low back pain and disability, effective early treatment could reduce the burden of these symptoms and their social, economic, and medical impact

Study Abstract
Objectives – To investigate the claim that 90% of episodes of low back pain that present to general practice have resolved within one month.

Design – Prospective study of all adults consulting in general practice because of low back pain over 12 months with follow up at 1 week, 3 months, and 12 months after consultation.

Setting – Two general practices in south Manchester.

Subjects – 490 subjects (203 men, 287 women) aged 18-75 years.

Main Outcome Measures – Proportion of patients who have ceased to consult with low back pain after 3 months; proportion of patients who are free of pain and back related disability at 3 and 12 months.

Results – Annual cumulative consultation rate among adults in the practices was 6.4%. Of the 463 patients who consulted with a new episode of low back pain, 275 (59%) had only a single consultation, and 150 (32%) had repeat consultations confined to the 3 months after initial consultation. However, of those interviewed at 3 and 12 months follow up, only 39/188 (21%) and 42/170 (25%) respectively had completely recovered in terms of pain and disability.

Conclusions – The results are consistent with the interpretation that 90% of patients with low back pain in primary care will have stopped consulting with symptoms within three months. However most will still be experiencing low back pain and related disability one year after consultation.

Heavy Lifting Dries Out Vertebral Discs

Heavy lifting may trigger a range of physiological changes that can hasten damage to the discs that cushion the bones of the spine, eventually leading to back pain and disability, according to a study presented by California researchers at a meeting in Belgium on Friday. The study findings may lead to better treatments for back pain and new ways to prevent back injuries.

The report helps shed light on the changes that lead to disc degeneration, a condition in which the spongy cushions separating the vertebral bones in the back become dehydrated and damaged. A common condition, disc degeneration can be painful and debilitating.

“The findings should lead to improved treatments for one cause of low back pain, disc degeneration,” noted lead author, Dr. Jeffrey Lotz, of the University of California at San Francisco. The findings should also help researchers determine how much weight people can lift safely.

Lotz and colleagues examined the way compression affects the discs in the tails of mice. A mouse’s tail is an extension of its spine, and includes discs similar to those in the human back.

The researchers attached a device that exerted varying degrees of pressure on the discs in each mouse’s tail. They found that chronic compression triggered an array of changes in both the structure and biological activity of the discs.

Among other things, chronic compression killed cells in the discs. The greater the pressure, the greater the number of cells killed. Widespread cell death eventually limited the surviving cells’ ability to maintain and repair the discs, the authors found. Over time, this caused water loss inside the discs, leaving them dehydrated. Once dehydrated, the discs were less able to withstand pressure, and bulged outward.

Dehydration of the discs triggered other changes, including the release of chemicals that appeared to irritate surrounding nerves, the researchers found. The release of these chemicals, and the pressure that bulging discs might exert on nearby nerves, may cause the pain associated with disc degeneration, the researchers report.

In light of these findings, it may be possible to treat degeneration by injecting damaged discs with growth factors that stimulate cell repair, note the researchers, who are now testing this procedure. If the technique is successful, it could be an alternative to back surgery, the current treatment for disc degeneration.

Back Exercises Help Back Injuries

According to a new study, specific back stabilizing exercises are essential for preventing the recurrence of back injuries.

Following back injuries, the smaller stabilizing muscles of the back, such as the multifidus muscles, undergo atrophy. Because these smaller muscles play an important “stabilizing” role in the back, failing to rehabilitate them back to normal almost always results in reinjury.

In this study, researchers found that in patients who sustained back injuries, 29% experienced reinjury within one year if they had received treatment which included back stabilizing exercises. In the group of individuals who did not receive these exercises, an astonishing 80% experienced reinjury within 1 year.

This not only marks the importance of fully rehabilitating the spine following a back injury, but also shows the recurrent nature of back injuries in general. Therefore, individuals suffering from back injuries should seek treatment which addresses the health of their spine and involves the full rehabilitation of the spinal components. Treatments dealing with symptomatic relief only are highly ineffective and short-lived.

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