In general there are 3 main causes of low back pain that are commonly related in a vicious cycle.
1) The most common cause is due to irritation of the facet joints. The small joints in the back of the spine are highly innervated and can produce significant pain when they jam together. The jamming can also cause periostitis (bone inflammation) of lamina in the vertebra above in cases of significant disc degeneration. Lumbar extension (leaning backward) tends to exacerbate the symptoms and flexion tends to relieve it. Symptoms include low back pain, muscle spasm, and/or inguinal pain, and/or buttock pain, and/or leg pain not extending below the knee. Self help remedies include:
A) Only ice for the 1st 72 hours, then alternating ice and heat 15 min each.
B) Lay on the floor and put your legs up on a chair/couch.
C) Knee to chest stretches
D) Anti-inflammatory (Aspirin, Ibuprofen, Naproxin)
2) Next we have tears in the annulus (disc) which is actually more pain sensitive then the facet joints. Annular tears are a common cause of low back pain and they produce more pain with each subsequent injury as nerves follow the tear growing deeper into the disc. Increasing the overall health of the disc with supplements like glucosamine sulfate and spinal decompression are the 1st place to start. Increasing core strength helps to reduce the possibility of repeated injury. Annular tears are the precursor to slipped discs and allowing adequate healing of the disc is important so the condition does not progress. Symptoms include low back pain, muscle spasm, and/or anterior, and/or thigh pain, and/or flank pain. Self help remedies include:
A) Only ice for the 1st 72 hours, then alternating ice and heat 15 min each.
B) Lay on the floor and put your legs up on a chair/couch.
C) Hanging from a pull-up bar to allow the low back to decompress.
D) Limiting sitting as much as possible. (Sitting compresses the disc and can increase symptoms and slow healing.
E) Anti-inflammatory (Aspirin, Ibuprofen, Naproxin)
3) Last there is a "slipped disc" or disc protrusion/herniation/bulge. This is where the disc bulges out and puts pressure on the nerves that make up the sciatic nerve that runs down the leg. This is the most serious and debilitating injury. Sitting tends to aggravate these conditions and in severe cases coughing and sneezing are far from pleasant. This is much more complicated then pressure on a nerve as the wrapping around the nerve being compressed also contains blood vessels. So a disc bulge not only can put pressure on the nerve but also the blood vessels around it creating an ischemic hypoxia and buildup of metabolic byproducts which complicated the symptoms further. Sometimes leg pain is the first symptom which tend to be the hardest patients to treat. The initial presentation of low back pain with leg pain presenting over the next few days has a better clinical outcome. Symptoms include: Low back pain, muscle spasm, and/or shooting/buring/numbing leg pain usually past the knee. Self help remedies include:
A) Only ice for the 1st 72 hours, then alternating ice and heat 15 min each.
B) Lay on the floor and put your legs up on a chair/couch.
C) Limiting sitting as much as possible. (Sitting compresses the disc and can increase symptoms and slow healing.
D) Spinal decompression is vital for disc injuries, but it needs to be a specific form of decompression as generalized forms will aggravate medical disc protrusions.
E) Anti-inflammatory (Aspirin, Ibuprofen, Naproxin)
These 3 events tend to create a cycle of low back pain. Injuries to the disc accelerate degeneration (loss of disc height) As the disc height reduces more weight is transferred from the disc to the facet joints and causes the facets to degenerate and jam together producing more pain. Progressive disc and facet degeneration can lead to stenosis and chronic ischemic hypoxia as the structures of the low back are slowing "choked off" due to a loss of size of the spinal canal and osseoligamentous canal. Keep in mind that the degenerative changes take years to progress.
Trying to diagnose which condition is causing your symptoms relies on the skill of your doctor. MRI is useful in confirming exam findings but can sometimes confuse the situation by showing asymptomatic findings. Most people have disc protrusions on MRI but they do not produce symptoms, so it really comes down to finding a doctor with excellent clinical skills in dealing with low back injuries. Any doctor that tells a patient "you just pulled something" either is not well versed in the mechanisms involved in low back pain or does not think the patient is able to comprehend the problem and "dumbs it down." All of the causes of LBP I listed result in some muscle spasm. Annular tears and disc bulges both have monosynaptic reflexes that result in muscle spasm and treating the muscle spasm only delays treatment for the actual cause of the symptoms. All of these conditions typically do respond well to Physical Therapy and Chiropractic care. Acute disc protrusions should not be treated by any high velocity manipulation as there is a risk or creating further injury. Gentile spinal decompression can be used in the acute stages, but acute disc injuries are best treated after 72 hours in the sub-acute phase.