What Is The Source Of Your Back Pain?
80-90% of the population will experience low back pain (LBP) at some point in their lives. It is inevitable. Get over it!
So what’s causing my LBP? Where is it coming from? Why do I have LBP? These are all questions that people often and rightfully ask of their medical doctor, chiropractor, physiotherapist, massage therapist, or anyone else that may have an opinion or answer.
The truth of the matter is, LBP is a complex condition with multiple contributors to both the pain and associated disability. So the answers to these questions vary from individual to individual.
So what do we know?
- People who have had previous episodes of LBP are at increased risk of a new episode.
- People with other chronic conditions, including asthma, headache, and diabetes, are more likely to report LBP than people in good health.
- People with poor mental health are also at increased risk of LBP.
- Lifestyle factors such as smoking, obesity, and low levels of physical activity that relate to poorer general health are also associated with occurrence of LBP episodes or development of persistent LBP.
- Work exposures of lifting, bending, awkward postures, and tasks considered physically demanding are also associated with an increased risk of developing LBP.
So the questions that still remain are what is the source of your back pain? and why does it matter?
Let’s answer the second question first because it makes your therapists’ job easier and you happier. If we know what tissues are the pain generators, we are able to make the appropriate recommendations to get you feeling better and living stronger. So if we know where the pain is coming from we know what we need to do, and in some cases what not to do.
The answer to the first question follows. There are three things that have undergone extensive investigation as potential contributors of LBP.
These are the “shock absorbers” between the vertebrae and they have two parts similar to a jelly doughnut. The “jelly” or nucleus pulposus resides in the middle and the outer annulus fibrosus or “doughnut” which surrounds the jelly and is attached to the vertebrae above and below.
As life goes on and we bend, twist, sit and lift things the outer part starts to develop tears or breaks down and the jelly starts to make its way from the middle to the outside.
An interesting fact is that only the outer 1/3 of the annulus is sensitive to pain so you don’t even feel any pain until you get there!
As time goes on the disc begins to bulge which can then lead to a disc herniation, which is the equivalent of the jelly outside of the doughnut and this can irritate the neighbouring nerve root which can lead to leg pain.
To make things more interesting or complicated depending on whether you are the patient or clinician, 50% of 40 year olds are walking around with disc bulges and no back pain!
What you can do:
If you are dealing with discogenic low back pain laying on your stomach with your upper body slightly elevated in a relaxed position is one way of reducing your symptoms. Things you SHOULD NOT do are knee to chest stretches, especially first thing in the morning!
These are the “other” joints between the vertebrae that don’t get the attention or glory of the discs. Over time these joints can undergo wear and tear and can be the source of back pain for some individuals.
An interesting observation is that people with a history of discogenic pain and/or related surgeries will end up overloading these joints thereby leading to back pain later on in life that is facet joint in origin.
As the appearance of the joint changes it can start to irritate a nerve root, thereby leading to leg pain
What you can do:
If you are dealing with low back pain that is facet joint in origin knee to chest stretches or flexion based stretches are helpful in reducing your symptoms. Things you SHOULD NOT do include back bends or extension based exercises.
The endplates are what the discs are anchored to and they can undergo wear and tear or spinal degeneration as a part of aging or due to injury and/or disc herniations.
It is theorized that the inflammation caused by structural damage to the disc or endplate spreads into the bone which results in swelling and pain.
What you can do:
If you are dealing with back pain that is due to these endplate abnormalities the best thing you can do for yourself is staying active.
Simply put, lower back pain is complex. The chances of you experiencing it at some point in your life is high. However, it can be treated and managed. Most of the time it goes away on its own. The key is to stay active!