Lower back pain is one of the most common injuries we treat as chiropractors. It is estimated that 80% of the population will experience low back pain at some point in their life.
There are many things that cause low back pain, and hardly ever is it one singular event that blows your back out. The spine, discs, and tissue surrounding the spine are quite resilent to stresses. But, microtrauma over time by sustained posture, impairment movement strategies or compensation patterns can lead to low back symptoms.
There are several areas of the low back that an cause pain. The discs, the facets, and the muscles can all create and elicit pain.
Disc bulges, or herniations, are more common than people think. And if you have one its porbably been there for longer than you'd expect.
It is estimated that ~60% of the population has a disc herniation but no symptoms related to low back pain. This should ecite you! That means that just because something is seen on an MRI or x-ray doesn't mean that it is causing your symptoms.
Disc herniation can be caused by a number of issues. The disc itself is actually incredibly designed to distribute compressive forces through the vertebrae and evenly distribute these forces. However, the disc isn't as resilient to shear forces or excessive compressive forces when the spine is not in proper alignment (i.e. neutral position).
We can determine what forces are acting on the spine to cause the disc injury and counteract them.
The facets are what attach each vertebrae in the spine to the one above and below it. Certain areas of the spine have different orientation of the facets depending on the movements associated with that area. For instance the facets of the lumbar spine are oriented more in the vertical plane, meaning that they are very good at movements in the sagittal plan (i.e. flexion and extension).
However, excessive movement or disc injury can lead to more stress being put on the facets than they would like...and you. The facets are not meant to create stability or take on above average forces. But when there is a disc injury the disc can no longer properly distribute forces evenly across the vertebrae so the facets take more of a beating.
These increased forces placed on the facets can lead to pain and early arthritic changes in the spine. Now, you need to understand that arhritis doesn't equal pain, but if the facets are overloaded it can lead to less efficient stabilty and movement causing certain muscles to overwork while others underperform.
Degeneration is a normal part of aging. As one of my mentors used to say, "We are all slowly turning into a pile of dust."
Makes you feel good, right?
Degenerative changes have no correlation to pain directly. However, it can be a contributing factor to movement impairments and instability.
When the disc starts to lose its height (or degenerate) it can no longer be the shock absorber it was meant to be. And as the disc gets closer together the ligaments that run from vertebrae to vertebrae becomes less taut.
This places stress on other parts of the spine. Now that the discs can not properly dissipate forces through the vertebrae and the ligaments for stability aren't as tight anymore, the body must compensate to find stability so that it can still be as efficient as possible with movement.
Degenretative change are a normal occurance and should not be seen as "painful" or "causative", they are simply a symtpom of the bigger picture. Once you are taught to properly stabilize your spine and use your extremties with your new found stability the pain will go away!