Low Back Pain & Sciatica
Low back pain is the single most common reason to consult a chiropractor and can be extremely debilitating, either as a one off sudden acute episode or as long lasting chronic pain. Approximately 80% of people will experience back pain at some time in their lives and at any one point in time 28% of the population will be suffering with it (1). Damage to the low back can be felt as pain anywhere in the lower limb, most commonly the buttock, or thighs but can extend as far as the toes. There may also be some associated pins and needles, numbness and weakness.
The low back is made up of several regions; these include the lumbar spine, sacrum, sacroiliac joints and coccyx. The Lumbar spine is composed of 5 moveable bones called vertebrae and these are linked by facet joints on both the right and left sides, lying in between the vertebrae are the discs which act as shock absorbers cushioning one bone from another. Just below the lumbar spine sits the scarum bone, and this on either side meets the iliac bone of the pelvis to form the sacroiliac joints. The coccyx makes up the lower most point of the spine and is found just below the sacrum. Large muscles and strong ligaments overlie and attach to the bony structures of the spine, hips and legs allowing for both movement and support of the trunk and hips. Any one of the above structures is a possible pain generator and it is more than likely that it will be a combination of at least two or three of these. It is common that there is a loss in the normal movement of the joints which can result in the tightening of the surrounding muscles, leading to irritation of the surrounding nerves and thus pain.
Chronic Back Pain
It is common for chronic back pain to gradually develop and progress over time without a specific known onset. It often occurs when the structures of the low back are exposed to prolonged stresses which accumulate over time such as poor sitting, sleeping or standing posture, repetitive lifting and carrying and prolonged driving. The resultant outcome is overloading of the spinal tissues leading to dysfunction, fatigue and pain.
Acute Back Pain
Often acute back pain develops after the smallest of movements such as bending over to pick up a pen or sneezing. This sometimes follows a hard day at work especially if this has involved a prolonged time in a sustained posture for example bending over to do the gardening. It can be suggestive that there is a weakness within the deep stabilizing core muscles.
Some patients may recollect a specific event or activity where they felt a pull or twinge in the back, this is often not especially sore at the time, but then hours after as both inflammation and muscle spasm begin to occur the pain becomes more severe.
Sciatica is used to describe pain into the buttocks or legs. Commonly it is due to irritation of the nerves which supply these areas as they leave the lower lumbar spine. True sciatica is due to irritation of the sciatic nerve and can present with pain, pins and needles, numbness or weakness down the back of the leg, into sole of the foot and to the big toe. The most frequent cause of this is a prolapsed (slipped) disc, this is where the disc bulges and the resultant effect is irritation of the sciatic nerve as it leaves the spine at this level. However this is not the only low back complaint which causes in symptoms into the lower limb, other structures capable of this include the lumbar facet joints, sacroiliac joints and the muscles.
Chiropractic Treatment for Low Back Pain
Our chiropractors treat low back pain using a tailored package of care which is determined by your presentation, case history and individual requirements. It is based on years of clinical experience, as well as current research and guidelines (2, 3). Treatment may include gentle specific manipulation of the joints in the low back, known as spinal manipulative therapy (SMT), to increase the movement at any restricted joints and help reduce local nerve irritation. Massage, myofascial release techniques, trigger point therapy and cross friction may also be used to ease out any fibrous adhesions (knots) and tension in the surrounding musculature.
Most importantly home rehabilitation, postural and ergonomic advice to address any imbalances and possible attributing factors will be provided to you by your chiropractor.
1. Macfarlane GJ, Beasley M, Jones EA, Prescott GJ, Docking R, Keeley P, McBeth J, Jones GT; (2012).The prevalence and management of low back pain across adulthood: results from a population-based cross-sectional study. Pain. Jan;153(1):27-32
2. European Guidelines for management of acute non specific low back pain in primary care. (2006).
3. National Institute for Health and clinical Excellence. Early management of persistent non-specific low back pain. (2009)