Difficult Low Back Pain

Low back pain can be a frustrating condition to diagnose for both the doctor and the patient suffering this common human malady. Some low back pain sufferers only experience this misfortune occasionally but each episode may be debilitating precluding sitting or standing without pain. Sometimes these episodes are so severe that lying down is excruciating, which rules out getting a restful night of sleep. Unfortunately, each successive episode is often worse than the last.

Even for sufferers of low back pain that is extremely severe, it can be very difficult for doctors to diagnose the exact tissues from which the problem is originating. This is because many episodes of low back pain are multi-factorial meaning they are comprised of many concurrently occurring factors contributing to the pain syndrome, none of which are easy to diagnose by themselves because of the overwhelming and overlying presentation of symptoms.

One group of low back pain sufferers that can be particularly difficult to diagnose are those people who are unable to tolerate lumbar flexion. Lumbar flexion is the movement or body position that places the trunk of the body (belly and chest) closer to the thighs. Such a body position may be seen when bending forward while in the standing position (commonly referred to as the Adam’s position) or while seated. In both of these instances there is lumbar flexion involved.

In such cases the lumbar (low back) discs may be involved though diagnosis of their involvement may be difficult to prove leading to inconclusive diagnoses. Why should this be difficult to diagnose? Can’t a bulging or herniated disc be seen on MRI?

Yes, a bulging or herniated disc can be seen on MRI (usually) but what may not be so evident is the degeneration, injury to internal disc structures, and inflammation that may be taking place within the disc. These aggravating factors can be irritating pain receptors within the disc and causing excruciating pain while leaving the nerve roots untouched. In cases such as these, low back pain without leg pain can be the major presenting symptom. However, trigger points in the muscles which are reacting to the pain from internal disc structures may refer pain into the buttock and/or down the leg. Pain from muscular trigger points is commonly one sided.

How can the low back muscles contribute to low back pain? There are a number of ways.

Trigger points within the muscles can become generators of pain by themselves. Additionally, pain signals from the low back (such as that occurring from within the disc) may inhibit the deeper core muscles contributing to the loss of their ability to perform at optimum capacity and/or anticipate bodily movements. These deficiencies can lead to pain.

Many of the deeper core muscles provide stability that prevents uncontrolled movements. An increase in uncontrolled bodily movement caused by reduced stability due to decreased function in these compromised muscles augments further degeneration and loss of function in low back structures thereby increasing the potential for additional low back pain in the future.

Can’t imaging techniques such as x-rays, MRI, or CAT scan show where the pain is coming from in low back pain syndromes? Often these techniques are not helpful due to the amount of damage and degeneration contained in the area of lumbar discs including disc degeneration, disc bulging, or even ruptured discs which may be present but not cause pain. However, disc involvement can be inferred by the presenting nature of pain.

If pain is most evident upon rising in the morning or even if pain awakens a person from sleep it may be due to the disc swelling during sleep, which is a natural occurrence. Pain produced by exiting an automobile or rolling over in bed can be indicative of disc involvement because of the stress placed upon the disc by these maneuvers. Does the pain present while sitting or while rising from the seated position? These are all signs the disc is involved.

The bottom line is that your local Doctor of Chiropractic is well versed in diagnosing, identifying the irritated structures, and treating low back pain regardless of which tissues are causing you agony.