What Makes Low Back Pain So Common?

Low back pain (LBP) is one of the most common types of pain involving the musculoskeletal system. LBP sufferers may sometimes miss work or be unable participate in desired activities, social outings, and the like. It can be so disabling that out of desperation, they visit the ER.

There are many causes of LBP. Some of the obvious include over lifting/carrying, performing a task for too long or with too many repetitions, and sitting or standing in one position for too long. However, frequently LBP seems to occur for no apparent reason, or at least none that can be clearly identified. One of the most basic causes of LBP is simply standing on two, rather than four legs. When comparing a 4-legged to a 2-legged subject, arthritis of the spine and disc degeneration occurs much earlier in those of us with two legs. This is due partially because 2/3rds of our weight is supported by the low back and pelvis. In addition, vertical loading occurs in the 2-legged subject whereas the load is distributed between four legs in a horizontal fashion in the 4-legged species. Other less obvious causes of LBP include physical characteristics such as flat feet (fallen arches), a short leg resulting in a tipped pelvis, carrying too much weight, being out of shape/weak muscles, as well as hereditary factors. Non-physical characteristics include diet, exercise participation, lifestyle, stress and other psychological conditions such as depression, anxiety, bipolar disorders, and others. Hence, treatment must address the entire person, not just the low back since often, several of the characteristics mentioned here are present and often participating in the cause for LBP.

Because many of these characteristics are not properly attended to, LBP tends to be recurrent, where multiple episodes come and go over time. In years past, health care providers would focus the majority of their attention on the physical characteristics of LBP and when treatment results was ineffective, the blame was placed on the psychological aspects for which little, if any, treatment was offered. However, over the last 20 years, the shift towards treating the whole person or, adopting the biopsychosocial model (bio- = physical, psycho- = mental, and social = how LBP is perceived and affects daily social interaction) has been emphasized as the appropriate approach when managing patients with low back pain. No longer should the psychological aspect be ignored but rather, identified and treated so that this significant barrier to recovery can be properly managed.

Regarding treatment, unless someone presents with a “red-flag” which, for LBP sufferers include cancer, fracture (especially unstable fractures), cauda equine syndrome (spinal cord pinching resulting in bowel / bladder control loss), or infection, immediate/emergent care is not required. A careful health history followed by appropriate tests can usually identify these “red flags.” Otherwise, surgery for LBP is not recommended until at least 4-6 weeks of treatment with non-surgical approaches are first utilized and, an identifiable “lesion” can be identified that clearly is causing the presenting complaints and clinical findings. Chiropractic has an obvious advantage over specialty care when considering non-surgical treatment of LBP. Both physical and emotional issues are identified and a “team” approach with other health care providers when required is ordered. Moreover, all the international guidelines published for treating LBP recommend spinal manipulation BEFORE most of the other non-surgical approaches are tried due to medication side-effects and, the successes reported in many studies where spinal manipulation is performed.

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