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What is low back pain?

Low back pain is a common condition that affects a significant portion of the population. Most people will experience low back pain during their lives, and for some, it can present significant challenges.

Low back pain is uncommon in children under 10 years old but becomes increasingly prevalent with age. Around 40% of 9–18-year-olds experience back pain, and most adults will encounter it at some point in their lives.

Low back pain often limits activity and impacts the ability to work, enjoy daily activities, and maintain overall well-being. While many cases resolve on their own, recurring episodes can lead to chronic low back pain, affecting mental health, daily life, and productivity. Prevention of low back pain is important throughout life.

As a rule of thumb, it is advisable to seek help from a musculoskeletal healthcare professional such as a doctor of Chiropractic if your back pain persists beyond a few weeks, or if you experience acute pain. Early intervention improves the chances of recovery before the condition becomes chronic (lasting over 3 months). 

People who suffer from recurrent or chronic low back pain often find that they can maintain good low back health by receiving treatment from a chiropractor occasionally throughout the year as well as complementing with massage therapy and dry needling or acupuncture. It is additionally recommended to look after your health at home by performing regular exercises, taking supplements and eating nutritious food, and reducing stress levels.

Chiropractors see a wide range of patients. Some are chronic and find relief from chiropractic treatments, some only come in when their backs are acute, and some are wellness patients or athletes who want their spine to function optimally and feel strong and pain-free every day. 

Although this clinic does not enforce regular treatments onto our patients or sell treatment packages, a form of maintenance care is the best way to avoid future low back pain and maintaining optimal strength, especially in people that are prone to pain or injuries.

By investing in your spinal health, you can continue to enjoy a pain-free and active lifestyle!

The World Health Organization
recommends spinal manipulation in combination with other therapies such as exercises, massage therapy and needle therapy for the prevention and treatment of chronic low back pain in their low back pain guidelines from 2023.

What causes low back pain?

Research show that clinical tests can often not accurately pinpoint the tissue source of low back pain, although several innervated structures can cause pain when stimulated such as:

  • Discogenic Pain: The intervertebral disc is the cushion that is located between the spinal vertebrae, which can be a cause of pain due to disc degeneration or bulging of the disc, which can be seen on MRI. It is important to note that these findings also can be seen in asymptomatic people. Despite some imaging and clinical findings suggesting a link between disc issues and pain, no reliable method exists to identify discogenic pain.

  • Facet Joint: The facet joints are located between the vertebraes to create stability of the back, and there is potential no association between facet joint osteoarthritis and low back pain, and making a clinical identification of facet joint-related not reliable.

  • Vertebral Endplates (Modic Changes): Modic changes are vertebral endplate abnormalities visible on MRI and can be classified into types 1, 2, and 3. These changes might result from structural damage leading to inflammation or infection. Modic type 1 changes are linked to low back pain, while type 2 changes are associated with disability but not pain. However, identifying individuals whose pain is due to Modic changes is not currently possible. 

Neurological Symptoms Associated with Low Back Pain

  • Radicular pain: (commonly known as sciatica) occurs due to nerve-root involvement and presents as dermatomal leg pain, often worsened by coughing, sneezing, or straining.

  • Radiculopathy: involves weakness, loss of sensation, or reflexes linked to a specific nerve root and can coexist with radicular pain. The primary cause is often disc herniation with local inflammation, although herniations are also common in asymptomatic people and may resolve independently of pain resolution.

  • Lumbar Spinal Stenosis: Lumbar spinal stenosis is characterised by pain or discomfort in the lower limbs during walking or standing, which is relieved by rest or bending forward. It is typically caused by narrowing of the spinal nerve roots or vertebral structures due to degenerative changes such as osteoarthritis, or bulging discs. 

Medical Imaging 

 (such as X-ray, CT or MRI)

Imaging findings of degeneration or herniations are common findings in people with low back pain, but they are also common finings in people without pain, creating diagnostic challenges. Some MRI abnormalities, such as Modic type-1 changes, disc bulge, disc extrusion, and spondylolysis, are more commonly associated with low back pain, particularly in individuals under 50.

However, MRI findings are not useful for predicting future onset or course of low back pain.

Routine imaging does not improve patient outcomes and is not recommended by guidelines.

Reference List

  1. Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., Halabi, S., Turner, J. A., Avins, A. L., James, K., Wald, J. T., Kallmes, D. F., & Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811-816.

  2. Elma, Ö., Brain, K., & Dong, H.-J. (2022). The importance of nutrition as a lifestyle factor in chronic pain management: A narrative review. Journal of Clinical Medicine, 11(19), 5950.

  3. Hartvigsen, J., Hancock, M. J., Kongsted, A., Louw, Q., Ferreira, M. L., Genevay, S., Hoy, D., Karppinen, J., Pransky, G., Sieper, J., Smeets, R. J., & Underwood, M. (2018). Low back pain 1: What low back pain is and why we need to pay attention. The Lancet, 391(10137), 2356-2367.

  4. International Association for the Study of Pain. (2021, July 9). Nutrition and chronic pain.

  5. World Health Organization. (2023). WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings. World Health Organization.

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