Back Pain

One of the most common forms of musculoskeletal issues affecting not only the U.S. population but he entire world

  • Global prevalence increased by 17% from 2005-2015 
  • Statistically speaking regarding global population: 
    • 18% will experience back pain at any one time 
    • 30% experience back pain in any one month 
    • 38% will experience back pain in any one year 
    • 40-80% will experience back pain in their lifetime. 

Is commonly experienced as a persistent or fluctuating low to medium pain intensityACute, with more than 2/3 experiencing a recurrence within the first year after recovery

Ranked 6th globally in terms of the number years lost due to ill-health, disability, or early death10. Thus, it is one of the leading causes of working disability

Two major lifestyle factors appear to affect LBP: 

  • Sitting  
    • 48% reported as a Functional Limitation 
    • 62% reported as an Aggravating factor 
    • 61% stated they had difficulty rising from a seated position 
  • Frequency of Flexion 
    • 65% reported as a Functional Limitation 
    • 63% reported as an Aggravating Factor

Listed below are common forms of Low Back Pain treated in this office: 

Please click the link for more detailed information 

1. Lumbar Disc Disorders

The lumbar spine consists of 5 vertebral bony segments with a soft and flexible intervertebral disc situated between each segment. These disc act as shock absorbers for the spinal column 

  • The intervertebral disc is made of two components: 1) the tough, outer annular fibrosis; 2) a soft, jelly-like center called the nucleus pulposus 
  • The structures of the disc are held together by ligaments with further support be provided by the core musculature

Spinal degeneration occurs naturally as we age 

  • This results in the disc losing fluid and drying out leading to compression on the disc 
  • Continued breakdown or degeneration can lead to the inner nucleus pulposus to bulge out putting more pressure on the outer annular ring and leading to pain, i.e., a Disc Bulge

If further degeneration of the disc is allowed to continue or with abnormal stresses placed on the lumbar spine the inner jelly-like core can break through the outer ring and lead to a herniated disc 

  • This can lead to abnormal pressure on the nerve roots of the lower back causing sciatica pain, weakening, numbness or changes in sensation down into one or both legs 
  • Most disc herniations occur in the lower part of the lumbar spine 
  • Severe trauma can lead to spontaneous rupture of a healthy disc or worsen an already herniated disc

Risk Factors/Causes 

  • Age and Gender – highest incidence occurs in men ages 30-50 
  • Improper lifting – using your back instead of your legs or twisting while lifting 
  • Repetitive activities – especially those that include lots of bending, lifting and twisting 
  • Frequent driving or sitting posture – especially without proper support 
  • Sedentary Lifestyle – lack of exercise and poor core musculature strength combined with excessive sitting 
  • Smoking – decreases oxygen supply to the discs leading to more rapid degeneration 
  • Severe Trauma

Onset of Pain 

  • Can be sudden with severe trauma or immediately following lifting and twisting activities or repetitive stress injuries 
  • Is typically of slow onset as patient may not recall the exact mechanism of injury or the precise moment the pain started - It is often preceded by less severe episodes of low back pain that resolve on their own 
  • Typically characterized by sharp, shooting pains as well as numbness and tingling into the legs that are influenced by movement, changing positions, coughing, sneezing, forceful bowel movements 
  • Furthermore, Weakness in leg and/or foot, decreased reflexes of knee and ankle as well as change in bowel and bladder function are also possible symptoms of a lumbar disc herniation 
    • Certain positions can make it better or worse depending on the nature of the disc injury


  • Initially, conservative care should be the first choice in care 
    • Focus will be on reducing any leg pain, controlling inflammation and preventing any further neurological deficits by removing the pressure from the nerve root 
    • Adjustments and soft tissue therapies are utilized as tolerated 
  • Treatment is dependent upon clinical presentation, age, overall health, lifestyle factors and tolerance to certain therapies 
  • Additionally, a home exercise program consisting positional and stabilization exercises will be recommended
    • Further education will consist of strategies to further protect your low back by safely returning to activity as well as positions and movements to avoid 
    • Home exercises further instill proper movement patterns and allows the body to slowly develop better movement tendencies as well as proper core activation and strength for long term wellness 
  • A referral for surgical consultation will be recommended if there is failure to respond to conservative methods or in the event of severe neurological loss

2. Sciatica

The sciatic nerve is the largest nerve in the human body and is made up of 5 nerve roots from the lumbosacral spine. It passes through the buttocks, down the back of the leg, around the heel and into the sole of the foot.

  • One of the most common reasons for patients to seek treatment 
  • Also, one of the most self-diagnosed conditions by patients  

Basic LBP can often progress to sciatica if left untreated 

Sciatica symptoms are typically felt in the lower back, buttocks, posterior leg and foot. The symptoms are described as: 

  • Pain ranging from mild and achy to sharp and burning 
  • Numbness 
  • Tingling 
  • Weakness of the affected leg


  • Most commonly from compression of the nerve roots from a bulged/herniated discs 
  • Trauma 
  • Direct pressure to the nerve:
    • Piriformis syndrome 
    • Sitting on a wallet  


  • A thorough evaluation helps to direct the nature of the treatment 
  • Initially treatments are designed to reduce pain symptoms related to sciatica. This includes:
    • Chiropractic adjustments 
    • Physiotherapy treatments like Traction/Flexion-distraction, E-stim, Cryotherapy (Ice) and specific home exercises aimed at reducing pain and inflammation around the nerve root(s)
  • Once pain is under control focus can be shifted to preventing recurrence by performing stabilization exercises for the low back and improving mechanics of the lower spine and lower extremities
    • Strategies to avoid or overcome triggers is necessary for long-term relief  

3. Facet Syndrome

The facet joints are the small joints located on the back of the spine. 

The orientation of these joints change in each region of the spine, thus, they are responsible for how much rotational movement occurs in each region of the spine 

Facet Syndrome is a very common condition that contributes to lower back pain 

Pain is often worst when changing positions, such as when going from a seated to standing position or when straightening up from a bent-over position 

  • Often described as dull, stiff and achy with occasional sharpness on certain movements

Common Causes 

  • Overuse 
  • Trauma/Motor Vehicle Accidents 
  • Excessive weight 
  • Pre-existing arthritis 
  • Prolonged sitting 
    • Desk jobs that involve sitting for most of the day is a major contributor to this condition


  • Mobilization of the fixated segments is addressed through spinal adjustments. 
    • This is supported by core stabilization exercises to strengthen the erector spinae musculature 
  • Proper education will have the most profound effect as it is usually that patient’s lifestyle habits that creates the problem in the first place 
    • Strategies to avoid and/or exacerbations to help the patient protect themselves is extremely valuable.

4. Lumbar Sprain/Strain

Sprains and strains of the lower back are very common 

  • A Sprain refers to an injury to the ligaments of a particular joint – think PASSIVE movement 
  • A Strain refers to an injury that occurs in the muscle – think ACTIVE movement

Can contribute to destabilization and, eventually, pain in the lower back 

Pain is common when attempting mundane activities such as sitting, standing, walking, exercise or even while sleeping 

Common Causes 

  • Traumatic injuries or injuries sustained in athletic events are the most prevalent 
  • However, Repetitive Movements, Poor Mechanics and Poor Posture are the most common causes especially as they relate to heavier lifting 
    • Furthermore, these types have a higher probability of becoming chronic due to the gradual onset and not being able to “pin-point” the initial cause


  • Reduction of pain and inflammation is the most important step – especially from a traumatic injury 
  • However, the primary sufferers of this condition, especially chronic cases, often are in poor physical condition with weak stabilizing muscles of the spine. 
    • Much like those with facet syndrome, desk jobs are a co-morbidity to this problem so stabilization exercises to improve the function of the core musculature and support the spinal adjustment(s) are essential 
  • Proper education for resolution and prevention cannot be overstated

5. Lumbar Stenosis

Caused by narrowing of the spinal canal in the lumbar region of the spine resulting in compression of the spinal cord 

  • Causes a variety of symptoms, including: localized or radicular pain, burning, numbness, tingling and muscle weakness in the back, buttocks or legs as well as loss of bowel/bladder control or loss of control of the reproductive organs 
  • Neurogenic Claudication is typically associated with Lumbar Spinal Stenosis and refers to changing leg symptoms as they related to different spinal positions

Symptoms are typically felts when standing or walking for a short period of time 

  • Results in a less active lifestyle 
  • Often feel the need to hunch over for relief; called the “Shopping Cart Sign”

One of the most common causes of disability in older adults and can lead to the reliance on others to function 


  • Advanced Osteoarthritis (OA) is far and away the most common cause. However, it is important to remember that degene ration of the spine is inevitable with age and may reflect normal changes in an aging spine. Thus, OA doesn’t ALWAYS cause stenosis 
  • Lumbar disc herniations 
  • Osteoporosis 
  • Tumor 
  • Congenital factors such as Dwarfism or congenitally short pedicles

It is important to note that degenerative changes of the spine are common and often are the result of the normal aging process 

  • Not all degeneration causes pain 
  • Not all arthritis leads to stenosis 


  • Chiropractic adjustments are necessary initially; however, the most benefit will come from specific, structured exercise 
    • We understand that certain movements will be uncomfortable thus exercise modifications will be necessary. This can completely change how it’s felt and allow you to achieve the results needed to progress forward.

Understanding that there is no “cure” for this is necessary. The best course for long term relief is management and changing some key lifestyle activities that are driving the problem 

  • Steroid injections and surgery are certainly available options, but results are typically inconsistent and always more expensive

Ultimately, it is next to impossible to combat the normal aging of the spine. However, there are some habits and tips one could use to reduce low back conditions, especially as they are related to other causes.

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