LOW BACK PAIN (LBP)

     Let’s start our journey of LBP by understanding the anatomy of the spine.  The low back is comprised of vertebrae, ligaments, muscles, blood vessels, nerves and discs.  The vertebrae are the bones that make up the spine.  The ligaments help to hold the bones and other structures in place.  Muscles attach to the bones and help produce functional movements.  Blood vessels run throughout the body and deliver nutrients to tissues.  Nerves run throughout the spinal column to send and receive information.  The most notable part of the nervous system found in the spine is the spinal cord.  Lastly the most notorious anatomical structure in regards to LBP, are the intervertebral discs.  Discs are fibrous and gelatinous structures that sit between the vertebrae and provides cushion for weight bearing activities and movement.  Together these structures unite to form the low back, each having the ability to produce LBP.

The causes of LBP can be organized in 4 basic classifications, somatic, radicular, central and visceral.

  1) Somatic pain arises from musculoskeletal structures such as intervertebral discs, ligaments, muscles and joint capsules etc.  This type of pain can be felt locally, which is noticed by more superficial structures and as referred pain which is most commonly associated with deeper structure of the body.   Most somatic pain is referred pain.  Referred pain can be described by the brains inability to localize a structure because of neurons converging together from many different areas.  One of the most common types of referred pain we see in our office is discogenic.  Discogenic pain arises from irritation of the disc which can present locally (ie: in the center of the back) or distally (ie: in the glute, hamstring, knee or foot etc.).  The disc itself has nervous innervation, which means it can perceive pain.  When the disc is stressed, for example with the fault of low back flexion during deadlifts, it will tell you with a pain response. 

     Somatic pain can present as constant, intermittent, sharp, dull, vague, radiating, and localized or any other descriptor you may think of when you think LBP.  Biomechanics of the body also play an important role in how somatic structures are affected.  For instance poor posture or bending and twisting places undue stress on musculoskeletal structures creating pain and dysfunction.

  2) Radicular pain can be the result of nerve irritation from the pressure on a neurological structure.  This exists when the disc protrudes/bulges or when other anatomical structures place pressure on the nerve root creating radiating pain.  99% of the time, pressure on a nerve root produces shooting radiating pain, numbness, tingling and/or motor weakness.  It can be excruciating and is comprised of both a mechanical and chemical source.  Chemical sources mean inflammation and mechanical sources mean pressure on the nerve root.  Radicular and somatic pain CAN occur together.

  3) Visceral pain arises from organs.  Examples of this are cardiac pains felt in the jaw and down the left arm, or gallbladder pain felt between the shoulder blades.

  4) Central pain arises from cells in the central nervous system.  For example, herpetic neuralgia or phantom limb pain.

Presentations of LBP and relevancy of severity:

     LBP can present in a number of ways, below I will discuss the most common.  The most concerning forms of injury is when there are shooting pains, numbness, tingling and/or motor weakness and mechanical deformation, meaning stuck in one position or blocked motion.  Central low back pain or intermittent pain activated by poor mechanics is usually not as painful as the above examples of pain, however still concerning.

The most common questions we receive as docs are, “when do I know it is bad pain? And should I follow up with a doctor?”  Honestly, all back pain is bad, especially the shooting, radiating kind, but only you can make the determination whether it requires a doctor visit.  For all intents and purposes, if it is causing pain, don’t ignore it.  Pain signifies injury and it’s your body’s way of telling you something is wrong.  Prolonging correction of a problem can make the injury more severe than the initial onset.

The RED FLAGS that will require an immediate visit to the emergency room are any one or all of the follow symptoms: loss of bowel/bladder control, numbness along the inner thighs and uncontrollable pain.

What can you do to prevent LBP?

     Be diligent with your low back stabilization exercises and core exercises.  Including these exercises into a daily routine is the staple for LBP prevention and rehabilitation.  Make sure to talk to a licensed provider prior to starting and exercise or rehabilitation program to make sure it is designed right for you.

Key takeaway points for LBP prevention:

             1)  Avoid any type of flexion and rotation of the low back – it creates a sheering force on the discs

             2)  Avoid low back flexion with heavy weights

             3)  Watch your posture.  Sitting is not a natural position and continually places stress on the discs and tissues.  Reduce bad form and limit stress caused by sitting for multiple hours per day. 

This article was intended to give a brief overview of low back pain.  In no way does it describe all causes or types of low back pain or is the information intended for use of self-diagnosis.  Many times low back pain can be caused by biomechanical dysfunction of the musculoskeletal system.  This is why it is essential for you to follow up with a health care practitioner if you are experiencing low back pain, to determine the appropriate cause of the pain.