LOW BACK PAIN - ACUTE AND CHRONIC

Fifty million people are prone to back pain. The majority of our population will experience some form of back pain during their lifetime. A conservative estimate is that 20 to 30 % will experience a recurring or lingering bout of pain that will prevent them from working, sports or normal daily activities. This painful affliction can manifest itself in any area of the back. We will be discussing the low back area, the most common site for back pain.

The etiology (or the beginning) of our problems start from the time of our birth and habits we acquire during our early years, such as poor posture, trauma, etc. Occupation can be the major contributing factor in the predisposition for the onset of painful back conditions, generally after age 40. Following occupation, engaging in various sports activities, such as football, baseball, basketball, bowling, soccer, wrestling, tennis and golf will leave indelible marks or injuries to our spines. The more physical and violent the sport, and the frequency in which one engaged in it, made them more prone to injury, taking it’s toll in later years.

The lower back is the supporting structure bearing the brunt of supporting your upper body, making it an extremely vulnerable area for strain, sprain, and other injuries. Many other factors can contribute to the vulnerability to injury in addition to occupation and sports. Heredity, poor posture, and structural formation of the spine can predispose you to certain types of back conditions. Injuries to bones, ligaments, muscles, nerves, and discs will weaken the back so that even a slight trauma can precipitate the acute, severe onset of pain. And of course, there is the normal wear and tear of daily living that takes a toll. Any of the above factors can and will, in all probability lead to some degree of degeneration in the joints and osteoarthritis to some degree. This in turn will lead to inflammation of the joints; muscles and ligaments causing the pain and stiffness that can plague you for the rest of your life.

Volumes and volumes have been written about the Anatomy (structure), Myology (muscles), Neurology (nerves), and Kinesiology (movement of muscles) that comprise the structure of the back. Even a greater number of volumes have been written about the diagnosis of back pain, and the causes. As a Chiropractor in practice for over 48 years, I have treated hundreds of patients with these conditions. A quite common and frequent condition that will present in the office is one that can be attributed to an asymmetry (difference) in bones and joints, and a fixation that pervades the joints. In visualizing the lower back, there are the right and left hips (Ilii). Positioned between the hips is a large triangular bone called the "Sacrum". The Sacrum articulates (touches and acts as a joint) with the right and left hip bones. These joints are comprised of hills and valleys that dovetail with each other to form the Sacroiliac joints. When there is a discrepancy in the joining of these hills and valleys you have an unstable joint, that with any slight aggravation, an acute episode of pain is likely to be precipitated.

Immediately above the Sacrum are 5 lumbar vertebrae, 12 thoracic vertebrae, and 7 cervical vertebrae, on which the skull rests. The 5th lumbar vertebra is separated from the sacrum by a disc, as are all the other vertebrae that act as shock absorbers. From either side of the body of the 5th lumbar vertebra, are two projections (transverse processes) that are at times overgrown (anomaly), either on one or both sides. These projections can encroach (touch) the sacrum on one or both sides. Over an extended period of time they cause an irritation, or even a fusion to the sacrum. This irritation or fusion interferes with the normal movements that are normal to the low back and predisposes the individual to a great many types of back pain as a result.

Nature will try to stabilize these joints by causing muscles to tighten (spasms) which is a form of "splinting". This "splinting" generally increases the pain we experience, which can be very severe. When this occurs, the person is almost completely incapacitated (the acute phase). When left untreated the condition becomes a chronic stage and the back becomes unstable. The patient then becomes prone to recurring bouts of acute severe pain at anytime due to the slightest provocation.

When treating the condition, it is at this time that I feel the patient can use an orthopedic support to help the body with it’s "splinting" so that the muscles will be able to relax. The patient must rest as much as possible and refrain from any and all extreme physical activities until the acute phase is over. Daily hot showers and using a heating pad (preferably moist heat) can be of value. When the acute phase and the pain are brought under control, a return to normal activities is done gradually by taking precautions in not trying to over do in any work or sports related activity. This will also apply to gardening and our normal household activities.

Many patients will balk at wearing a support because they can be cumbersome and very uncomfortable. However, I will explain that they are not going to wear the support for the rest of their lives, only until they are free of pain. I do not believe wearing the belt constantly is of value to the patient because it will tend to weaken the muscles of the back and abdomen that are of primary importance in supporting the back structures. There are exceptions to the rule and that is when their occupation is involved with lifting, construction, driving, gardening, etc. Wearing the support on the job would then be advisable. After work the support is removed so that the muscles of the back and abdomen can react normally so as not to weaken. I advise them to keep the support handy (and when traveling) in the event they feel pain or spasm coming on, and, then, and only then wear the support for a few days until the condition calms down.

One support I have found to be effective when the condition is caused by the instability of the sacroiliac joints and/or the 5th lumbar vertebrae is called a "Trochanter" support. The support is only 3 inches wide, easy to wear, is very comfortable, and is unobtrusive under clothes. This support helps stabilize the sacral joints and further prevent irritation to these joints. It can be worn for longer periods when needed, and even worn during sleep. It will also allow the lumbar and abdominal muscles to react normally.

On returning to normal activities we must think of a program to keep these bouts from recurring. An ounce of prevention is worth a pound of cure. The best prevention is the strengthening of the back and abdominal muscles. Just by strengthening these muscles we can prevent a great deal of the pain and suffering that one goes through with a painful back condition. I advise the patient to start an exercise program. By starting this regime these frequent recurrences can likely be prevented. Select, a no impact, total body workout that won’t aggravate your condition, yet strengthen the back and abdominal muscles. Once starting on a program you must become dedicated to a daily regime. Hit and miss, just won’t do it. If you miss a session and you don’t feel guilty, "You are not dedicated".

BOTTOM LINE..EXERCISE..SAVE YOUR BACK