Low Back Pain

Low back pain is one of the most common reasons to ever visit a doctor. About 80% of us will develop significant low back pain at some time in our life that will cause some degree of disability. Some will improve, and some will not.

The cost of basic treatment of low back was estimated to be around 100 Billion dollars per year in North America in the year 1991. This number has likely greatly increased since then.  5% of back pain sufferers contributed to 75% of the cost.

Men taller than 6 feet have roughly three times the risk of low back pain versus those less than 6 feet.   Males and females have about the same risk of general low back pain, but males have a higher incidence of low back pain from disk herniation radiating into the legs. The greatest incidence for low back pain ranges between the ages of 30 to 50 years of age but the age range of 40 to 45 years is highest for low back disk herniation.

Leg length discrepancy ranging from 0.5 to 1.5 cm is not associated with an increased risk of low back pain, but leg discrepancy of over 2.5 cm is associated with some increase risk of low back pain.

Increased risks of low back injury were seen in firefighters lifting more than 18 pounds, nurses who lift frequently and by those exposed to whole body vibration as seen in helicopter pilots. Sitting in a car seat for more than 50% of work time is associated with increased risk of low back disk herniation.

In sports, some of the highest risks of low back pain are seen in gymnasts, football players, wrestlers, female equestrian riders and golfers. (from the Low Back Pain Handbook, second edition, Cole, Herring, 2003)

Clearly we understand considerable amounts of information about low back pain, but still some aspects are still quite complicated and mysterious.

I approach low back pain from a muscle perspective. Let’s consider how so few children experience any form of pain. The fact is that the young, growing body has little muscle shortening or scarring in the spine or limbs. However, as we grow into adulthood, our body’s muscles develop the tendency to shorten and scar, and this property increases with age, trauma, repetitive work and stress.

These properties of muscle shortening apply to all our body’s muscles, especially the spine. Interestingly, the spine is special in that all along the deep spine, on both sides, are the deep intrinsic spinal muscles. These muscles have a rather unique tendency to shorten and scar with great veracity as a result of injury. As they shorten and scar, they apply persistent compressive forces at specific levels along the spine including the low back. This spinal muscle shortening causes vertebral and spinal compression that, over time, leads to disk wear, bulging and sometimes disk herniation.  The articulating surfaces of the spine, the facet joints, will also compress, inflame, swell and degenerate causing facet joint arthritis and swelling. The disk bulge and herniation may compress the spinal cord or nerve root causing a variety of referred pains, numbness and tingling down the leg(s). The facet joint may do the same to the nerve root, resulting in a condition known as spinal stenosis. But the arthritic facet joint may also cause local spinal compression pain and referred pain of a different nature; a vague referred dull ache or even burning into the low back, hip or even parts of legs and feet.

Imaging of the spine with x-rays can help assess alignment and give a general sense of disk and facet joint wear. MRI is very helpful for assessing the disk wear and herniation, but studies suggest as much as a 40% miss rate in standard MRI versus an upright MRI. In complicated cases, imaging technologies plus the opinion of an experienced spinal rehabilitation specialist may be required.