COMMON SOURCES OF LOW BACK PAIN

Low back pain is one of the common reasons people see a Doctor of Chiropractic. It is also a common reason for missed work. Fortunately, there are just a few common sources of low back pain that can be pinpointed by skillful examination.

Three of the most common sources of low back pain include problems with the DISC, FACET JOINTS AND SACROILIAC JOINTS. Base on age, the location of the pain, and what movements or positions either aggravate the pain or not, help direct us to the cause of the low back pain.

When it comes to the common causes of low back pain, the documented frequency of each of the three is part of the beginning of our diagnosis. Statistical evidence shows us that the source of low back pain 40% of the time is the spinal disc, the facet joints are responsible 30% of the time and the sacroiliac joint is the cause 22.5% of the time.

Age can play a factor in separating the common causes of low back pain. If someone is over 50, it is more likely the facets causing pain. This is typically due to degenerative changes in the joints. If they are under 50, the spinal disc is more likely the cause of the pain.

Location

The location of the pain is the next indicator to help us find the cause of the low back pain.

* Facet pain is more often to the side of the spineback of man indicating common sources of low back pain
* Disc pain is more central, directly in line with the spine in
* Sacroiliac pain is characteristically on one side, and below the level of L5 or the bottom vertebra

Sitting or Walking

An important clue to help diagnose the cause of low back pain related to how the pain responds with sitting or walking

    •     * Facet pain is usually best on walking or sitting
    •     * Disc pain is aggravated by sitting and relieved by walking
    •     * Sacroiliac pain is characteristically aggravated by static standing and walking

When inquiring about sitting, another key in figuring out the cause of the pain relates to how does it feel to get up from a sitting position?

  •     * Facet pain is typically NOT aggravated by getting up from a sitting position
  •     * Disc pain or SI pain is commonly made worse when getting up from sitting

Skin Sensitivity

Another interesting finding to help us determine which one of the common causes of low back pain is: how sensitive is the skin over the area of pain.

  •     * Painful facet joint tissue typically causes an over sensitization of the skin over the affected joints.
  •     * Disc pain sources are less likely to cause any tenderness of the skin and superficial layers of muscles of the lower back.

EXAMINATION

While there are specific characteristics of the 3 common causes of low back pain, there are also subtle nuances of each that can result in an overlapping. It is also possible to have a couple of these causes going on at once.

While this post is intended to provide information about 3 of the most common sources of low back pain, it does not substitute for professional help. In rarer instances there are other conditions that must be ruled out. These include:

  • * Spondylolisthesis – a forward slippage of a vertebra
  • * Spinal stenosis – a narrowing of the spinal canal, compressing the cord
  • * Pars fracture
  • * Myofascial pain – muscle and soft tissue
  • * Central Sensitization

A proper diagnostic examination is neccessary to determine the source of pain.

If you are suffering from low back pain, seek the help of a qualified Doctor of Chiropractic. You can call our office at (314) 731-4383 or CLICK TO CALL AND MAKE AN APPOINTMENT

In his ongoing efforts to provide the best care possible, Dr. Schmaltz had gone back to school! He is currently Enrolled in Advanced Clinical Training and Post-doctrinal program in Chiropractic Orthopedics and Neuromuscular Medicine. Sponsored by the University of Bridgeport, Health Sciences Postgraduate Education Department.

References 
  1. Donelson R, Aprill C, Medcalf R, Grant W. A prospective study of centralization of lumbar and referred pain. A predictor of symptomatic discs and annular competence. Spine. 1997;22(10):1115–1122


2. Fortin, J. D., & Falco, F. J. (1997). The Fortin finger test: an indicator of sacroiliac pain. American Journal of Orthopedics (Belle Mead, N.J.), 26(7), 477–480

3. Laslett, M., McDonald, B., Aprill, C. N., Tropp, H., & Oberg, B. (2006). Clinical predictors of screening lumbar zygapophyseal joint blocks: development of clinical prediction rules. The Spine Journal, 6(4), 370–379. doi:10.1016/j.spinee.2006.01.004

4. Laupacis, A., Sekar, N., & Stiell, I. G. (1997). Clinical prediction rules. A review and suggested modifications of methodological standards. JAMA, 277(6), 488–494

5. Majlesi, J., Togay, H., Unalan, H., & Toprak, S. (2008). The sensitivity and specificity of the Slump and the Straight Leg Raising tests in patients with lumbar disc herniation. Journal of Clinical Rheumatology: Practical Reports on Rheumatic & Musculoskeletal Diseases, 14(2), 87–91. doi:10.1097/RHU.0b013e31816b2f99

6. McKenzie RA. The lumbar spine: Mechanical diagnosis and therapy. Waikanae, New Zealand: Spinal Publications, 1981


7. Schwarzer AC, Aprill CN, Derby R, et al. Clinical features of patients with pain stemming from the lumbar zygapophysial joints. Is the lumbar facet syndrome a clinical entity? Spine. 1994;19(10):1132–1137

8. Young S, Aprill C, Laslett M. Correlation of clinical examination characteristics with three sources of chronic low back pain. The Spine Journal, 2003;3(6):460–465

9. DePalma, M. J. (2015). Diagnostic Nihilism Toward Low Back Pain: What Once Was Accepted, Should No Longer Be. Pain Medicine (Malden, Mass), 16(8), 1453–1454. http://doi.org/10.1111/pme.12850

10. DePalma, M. J., Ketchum, J. M., & Saullo, T. (2011). What is the source of chronic low back pain and does age play a role? Pain Medicine (Malden, Mass), 12(2), 224–233. http://doi.org/10.1111/j.1526-4637.2010.01045.x

11. DePalma, M. J., Ketchum, J. M., Trussell, B. S., Saullo, T. R., & Slipman, C. W. (2011). Does the Location of Low Back Pain Predict Its Source? Pm&R, 3(1), 33–39. http://doi.org/10.1016/j.pmrj.2010.09.006