Low back problems are progressive in nature. Most low back problems are unrelated to any major injury. The majority of low back pain I have seen in my clinic is either caused by long-term postural strains or minor injuries from the past that never healed properly and have progressed into muscular imbalances. On occasion I do see patients who have major injuries that caused an acute problem but for the most part low back pain is the result of minor daily events resulting in pain.
Our low back is constructed of more than just five lumbar vertebrae we also have a pelvis which contains three large bones and two major joints. This joint of the pelvis called the sacroiliac joint is commonly a problematic area overlooked by most physicians. Many people with lower back pain suffer from strain of the sacroiliac joint of the pelvis. In my view this is the first stage in the progression of low back pain, which I call the sacroiliac stage.
When a person has had minor injuries to the spine or long term postural imbalances they are suffering from muscle imbalances as a result of neurologic changes in muscular postural reflexes. These neurologic changes are described in great detail in the new chiropractic theories section, which I suggest reading to understand the muscle imbalances I am going to describe, and how chiropractic care corrects them.
In the lower body the tendency is for the muscles of the low back and hamstrings to increase in tone and the muscles abdominal region and front of the thigh to decrease in tone. Since these muscle insert into the pelvis change in there tones will allow the pelvic bones to shift out of alignment causing strain on the ligaments of the sacroiliac joint. This strain of the sacroiliac ligaments is usually the most common cause of early low back pain. People describe this pain at or below the beltline, worse in the morning, worse after sitting, and it feels better once they have been up and moving. Chiropractic care is driven towards correcting the pelvic misalignment by proper manipulation techniques that target the muscle imbalance that created the imbalance.
The second stage of progression I call the disc stage. This stage results from long term pelvic misalignments. When the pelvis is out of alignment the spine, which rests on it, starts to compensate with minor a scoliosis or a lumbar lean.
When the disc herniates it is painful and causes just low back pain, but if it herniates in just the wrong place it can put pressure on the spinal nerves or the spinal cord. When the disc is pushing on a neurologic structure it results in pain/numbness/burning down the leg and if left untreated even results in weakness of the muscles of the leg.
At this stage of treatment the recovery time is much longer than sacroiliac phase. The therapy is driven toward taking away pelvic misalignments to relieve uneven pressure on the disc and physical therapy modalities (hot packs, acupuncture, and electrical stimulation) to relieve inflammation of the disc.
Many people get through this stage with the use of medication or cortisone injection by a medical doctor. The problem still exists and progresses to the last stage, which can never be completely corrected with any care. This stage is called stenosis of the spine. Stenosis is defined as narrowing of the canals where nerves or the spinal cord travel by extreme arthritis of the facet joints and complete loss of the disc. When someone is at this stage it is usually later in life and is very debilitating. Chiropractic care, physical therapy modalities, and spinal rehabilitation via exercise may take away pain but the pain will usually return again and again. Symptoms of stenosis are wide and never consistent but usually the person has low back pain with leg pain/numbness and weakness in the legs.
When a person has suffered a major back injury any structure within the spinal unit or the pelvis can be involved. In these cases a wide variety of diagnostic tests most be run to pin point the site of injury for recovery to be timely and full. If properly treated with the aid of medical professionals and chiropractic care to stop the progression of postural imbalances as a result of the injuries a person can return to a highly functional state again. When left unresolved these injuries have a tendency to progress rapidly through the stages just described.