Lower back pain is one of the most common reasons to seek care from a medical provider. It is estimated that 75% – 85% of people will have some sort of lower back pain in their life with most symptoms resolving themselves without surgical need (learn more).
Being a chiropractor, I obviously see a lot of lower back pain. The cause of the pain can range anywhere from an athletic injury to pain as result of inactivity. One of the first things to determine is whether or not the individual has a disc herniation, a disc bulge, or mechanical back pain.
A disc herniation is when the gelatinous material from inside the disc leaks into the area where the spinal cord is housed. This type of pain is typically the worst and can result in pain down both legs, pain down one leg, numbness, tingling and even loss of foot strength. The cause of this type of injury is usually some sort of trauma like picking up a heavy box.
The second type of injury, a disc bulge, can be a little trickier to diagnose. There is often a musculoskeletal component that may be the reason for the pain. Patients will present with pain in the lower back, butt, down the leg or any combination of the symptoms listed. A good physical diagnosis consisting of an orthopedic evaluation to determine the source of the pain is warranted. People typically choose to try NSAIDs to try and calm the inflammation and pain. Others will attempt stretching, lite exercise and activities such as yoga if the pain is not too bad. Others will seek chiropractic or physical therapy in an attempt to find the source of the pain, alleviate the pain, and learn what they can do at home to help prevent further symptoms. X-rays an/or MRI’s are typically ordered as well.
After a diagnosis is reached, a person will choose treatment that best fits their needs. A lot of people will find relief in the short and long term by combining approaches from different professions. While I cannot prescribe medication, I find that patients respond best when they see their primary physician first to determine if medication is warranted. Following that, soft tissue treatment, chiropractic care, rehab exercises and passive modalities can help decrease the amount of time it will take to get better. Chiropractors and Physical Therapist will typically give you at home care with the goal of helping you maintain your results and to prevent further injury.
The pain here can be diagnosed as L5-S1 pain or sacroiliac pain. Either way, we are typically looking at an active individual who has good strength in his prime movers, AKA – glutes, hamstrings, quads, iliopsoas. The problem typically lies in the smaller, stabilization muscles. Athletes have no problem working out through pain, but that doesn’t mean it is the right thing to do. Intuitively we all know this, but who has time to address the issue when you want to get your workout done. This is why I either see people for the same condition from time to time, or someone walks into my office completely unable to work out. Once either of these scenarios occur, the following approach should be taken:
- Assess for source of pain
- Treat soft tissue
- Use range of motion, stretching or adjust to improve movement
- When ready, begin corrective exercise aimed at improving joint stability
- Use passive modalities such as electric muscle stimulation, ultrasound, ice and/or heat
The corrective exercise portion is always the most boring for an athlete and the most fun for someone who is less active. The reason for that is the exercise typically produces faster gains in an inactive person versus an athlete because we are re-correcting strong muscles in the athlete but building new ones in a less active person.
Athletes give up on their corrective exercises too early because they can’t see their value. Corrective exercises such as planks, bird dogs, dead bugs, clamshells, step-ups, etc. are geared to create fatigue resistance stabilizing muscles. Once these muscles have been properly conditioned, the strong prime moving muscle can focus on solely moving the body rather than trying to aide in stability while trying to move the body at the same time. When you have weak stabilizing muscles, your joint bounces around like a pinball because very little support is available for the joint in the form of a strong stabilization muscle. As in the pain example above, active people tend to have tight hip flexors, tight hamstrings, uncoordinated glutes medius and tight IT-Bands. Most of this is due to sitting at work all day and jumping into activity.
Athletes give up on their corrective exercises too early because they can’t see their value.
How to fix this:
Focus on lengthening your hamstrings and iliopsoas while foam rolling the IT-Band and improving strength in your gluteus medius via exercises such as the clamshell and bridging. Look at my facebook page for a great video on building gluteal strength.