The Multiple Causes of Low Back Pain

Today, I will focus on one specific presentation of low back problems. But before we turn our attention to only one, I would like for the reader to understand that every low back is different. Truly examining the function of the system and being able to pick out where it breaks down and for what reason is the beginning of the road to recovery. Find a practitioner with the knowledge and skill to repair it once they've found it and you're set. Since every case is different, the treatment should be unique to every patient. Dr. Terry Elder said it perfectly, "never make a patient fit your style of treating; make your treatment fit the patient." 

One common cause of low back pain is facet syndrome. The facets are synovial joints, just like the knuckles of your fingers, that slide along each other and both allow for movement and limit it, and they are innervated, which means that they can feel pain. The person with "facet syndrome" overloads these structures too much of the time and creates injury and an inflammatory process within these joints. The natural load of gravity should be shared by the disc, the front of the vertebra, and facet joints, at the back. This person carries a much larger percentage of the load on the facet joints due to their posture. They have a deep curve in their spine when standing naturally, and the situation gets worse when walking or participating in other activities. Why? Because, this person has tight muscles that are pulling their pelvis and spine into extension while other weak muscles are not stopping it. Why? Maybe because they had a small injury that has altered which muscles the brain picks to accomplish certain tasks for avoiding pain, or maybe this person sits all day and shortens/tightens those muscles and inhibits the others, or there could be a lot of reasons. Why? Don't worry about it, because we know what it is, how to fix it, and the main ingredient….how to avoid it. 

Muscles that get too tight in this case are usually the hip flexors (psoas, rectus femoris, or tensor fascia lata) and the erector spinae (simply the erectors). The former pull the pelvis and lumbar spine into extension and the latter crunches the low back into extension and compression. The tension in these muscles must be manually released.

The weak muscle is the gluteus maximus (according to Body by Jake, the "butticimo"). It should be the main extensor of the hips, but in this case cannot be isolated from the overactive erectors. This muscle must be trained to work in isolation, not strengthened but woken up.

And finally, going right to the source, the chiropractic portion of the story, tension must be released from those facet joints. The adjustment should be careful to avoid extension and provide flexion to the spine. For this person, nothing is better than the right adjustment.

Exercises should focus on lengthening the hip flexors, isolating the glutes, and bracing the low back by addressing the core musculature. Teaching this patient how to maintain a neutral spine is also very helpful.

This is only one out of so many causes of low back pain, and even this type of low back must be treated uniquely from another person with the same type. There is never a cookie cutter answer to fixing low back problems. To speak with someone about this or other topics, please contact In Motion Spine and Joint Center at (615) 302-4747.