There are common issues that bring people to physical therapy. From earlier posts, we shared that musculoskeletal injuries make up 24% of all self-reported medical conditions, the highest of all conditions. We also shared that Low Back Pain (or LBP for short) affects patients most from age 44 onwards (age 65-74 being the highest prevalence). But there are many types of LBP, and it is often difficult for patients to understand their pain, especially in light of the breadth of information available on the internet. The spine is an amazing piece of architecture, so we wanted to have a general discussion on the different types of injury that fall into the LBP bucket.
The lumbar spine is defined as the segment of the lowest 5 vertebrae of the spine, what we generally call our “low back”. There are discs separating each vertebrae, and nerves from the spinal cord exit through spaces between each vertebrae. The lumbar spine sits on top of the sacrum, or tailbone, and is also in very close proximity to either half of our pelvis.
The low back gets used so much in our daily life. It is the bony architecture along the back side of our “core” (more on that later!). It is not until we sustain a low back injury that we truly discover how much we use, and abuse, it in everyday activities. During acute injury we find that lifting, sitting, walking, standing, sleeping, sports, and yes, sex, are painful and difficult. The lumbar spine is designed to flex and extend, and has very limited rotation (about 3-5 degrees per segment). It is also used as a shock absorber via the discs and natural curve.
All LBPs are not the same. So how do we know the difference? Many times, you will tell me which type you have.
HNP: The most common type of LBP we see is from a herniated, or bulging, lumbar disc. The disc material can get “squished out” and press on a nearby nerve. The pain can often be intense and travel from your low back and glutes down to your thigh, calf or even heel and toes. Radiculopathy, or "sciatic pain", is a large cause of disability and time lost from work. Patients often report pain after an increase in their sitting for work or travel, lifting something heavy, or shoveling dirt or snow. Numbness, tingling and/or weakness may be present.
DDD: Over time, the disc material between the vertebrae can lose fluid, elasticity and eventually, their thickness. Degenerative Disc Disease is diagnosed with an x-ray, which reveals a decrease in the disc height. Patients often report a gradual or sudden onset without trauma, a low grade aching across the low back, muscle tightness, stiffness, and no radiating.
Stenosis: Spinal stenosis is a gradual change in the bony architecture of the spine. It is classified as central stenosis or foraminal stenosis, depending upon the location of the bony changes. The onset is also usually gradual, with stiffness and aching. Patients often describe the pain as “burning” which may be generalized across the low back, or travel slightly down the legs, and feels worse with walking.
Spondylosis: Spondylosis is the degeneration, or arthritis, of the joints between one vertebrae and the next. Pain is usually described as dull and achy, and may get worse over time, like at the end of the day.
Treatment for each diagnosis is slightly different, and depends largely on the deficits and dysfunctions of the patient. At the very least, you can expect treatments to consist of manual therapy, therapeutic exercises, functional training and postural re-education. Much of our functional training will focus on lifting techniques and body mechanics.
If you have low back pain, you should not self-diagnose. Instead, seek medical treatment by visiting your physician, orthopedist or physical therapist. These professionals are trained to evaluate your condition and develop a proper diagnosis and treatment
plan to help address your pain. You may need to have an x-ray or MRI to further hone in on the diagnosis, at the discretion of your MD. But early diagnosis and treatment is key to getting you better, faster. The longer you wait (and compensate), the longer and more challenging it is to get you out of compensatory habits and restore your full function. Come in, and let’s get “back” to feeling better!
Source: Salter, Robert B. Textbook of disorders and injuries of the musculoskeletal system: an introduction to orthopaedics, fractures, and joint injuries, rheumatology, metabolic bone disease, and rehabilitation. Baltimore: Williams & Wilkins, 1999. Print.