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Ole Mehrfeld
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25002 Lleida
Tel. 973 281 840
Roderick A. King
Bisbe Lorenzana,33 bis. 1r-1a.
17002 Girona
Tel. 972 220 787

 

Disorders of the lumbar region

Low back pain has reached epidemic proportions, so much so that most people will suffer from it, to a lesser or greater extent, at some point in their lives. 

So what is low back pain really all about? The simplest way to view it is as an adaptive process in which five major factors are at play, Posture, loss of flexibility, Muscle weakness or wasting, repetitive strain and trauma.

  • Posture

  • Human beings are land mammals. There are numerous kinds of land mammal but we are the only ones who walk fully upright and sit in chairs or sofas. Our spine, which is similar to all the others, is a wonderful load bearer when in the horizontal position. Imagine for a moment that you are on all fours, supporting your weight on hands and knees. In this position, our spine is like a bridge slung between the four pillars of our arms and legs and with our abdominal muscles below to provide support. If we wanted to give someone a piggyback in this position, even someone heavy, we could do so easily. Now imagine standing upright or even sitting down and having the same person sit on your shoulders. Obviously the weight would be far harder to handle and may even be painful. So, the human spine is not well adapted to upright stance but it would manage a lot better if it didn’t have to cope with Loss of flexibility and muscle weakness or wasting as well. 

  • An observable truth about life is that we lose flexibility as time goes by. That is why kids are bendy and grandparents aren’t. Strength is similar; it tends to wane over time. Unless we are prepared to do flexibility and strength exercises and especially if we live a sedentary life, we will inevitably see a decline in both.

    So, what we are saying is that a spine that is better adapted to a quadruped stance, not only has to withstand the non-stop downward pressure of gravity in an upright position but that it has to do so with tissues that are getting stiffer and weaker as the years pass by. Add to this the repetitive strain that our jobs and leisure activities demand of us, as well as the inevitable trauma involved in the falls and twists that have occurred to us all and it becomes clear that back pain is going to result.

    Ok, so that is how we end up with back pain but when we have it, what is it that actually hurts?

    The principal pain producing tissues in cases of back pain are the muscles, joints and discs. If the problem goes far enough it can also affect the nerves as in sciatica.

    In the following section we list a number of conditions, all of which stem from the process described above. They follow on one from the other in progressing levels of severity.

    Let’s start with the least severe and work forwards.

    Please remember that many conditions have multiple names which I have tried to include in the headings. Better a cumbersome heading than a lack of information but I don’t want you to get 

1.Muscle pain

Pain which arises in the muscles is sometimes described as myofascial pain or myofascial pain syndrome. Many of our muscles tighten and shorten over time, producing the loss of flexibility described earlier. This situation can produce painful spots in the muscles called trigger points. The pain may radiate from the point of origin into more distant areas and the tightening and shortening of the muscles can produce postural distortions and thereby other pain syndromes. This kind of back pain is a first stage condition, destined to worsen over time if not treated properly and responds rapidly to chiropractic care.

2.Lumbago

Lumbago is an outdated term which simply means pain in the lumbar region but does not specify its origin. It usually describes either the muscle pain above or the facet pain below. 

3. Facet syndrome

Facet syndrome refers to pain which arises in the small joints between the vertebrae of the spine. These joints are susceptible to restriction and or postural distortion as the muscles which surround them shorten and tighten.

Chiropractic spinal manipulation is a highly effective means of restoring position and function to these important vertebral joints. Relief is usually quick.

4. Disc pain, degenerative disc disease, spondylosis, arthritis, arthrosis

As we stand and sit upright or even worse slump, the discs between our vertebrae, which act as cushion like shock absorbers, come under a lot of compressive strain. If in addition we suffer from the same joint restriction described in the previous paragraph, the discs begin to dehydrate. Disc dehydration is the first phase of disc degeneration. As the discs degenerate, they lose height and the vertebrae become closer. The facet joints described above have to take more strain and both disc and joints begin to wear out. This wearing out process is called degenerative disc disease, arthritis, arthrosis or spondylosis and is the cause of much back pain. This is a stage further than the previously described disorders but nonetheless responds very well to chiropractic care. If left untreated however it may well lead on to the next disorder.

5.Disc hernia

The disc is composed of two distinct parts: the annulus fibrosus which forms a donut like ring and the nucleus pulposus which is a jelly like substance in the middle. The dehydration and subsequent degeneration previously described, leads to a weakening of the outer ring which, as a result can tear, thereby allowing the jelly like nucleus to escape forming a hernia. Tearing of the outer ring with escape of the jelly like nucleus is associated with acute low back pain. Most patients suffering from such an episode present with very limited movement and an out of line posture (antalgia) which the body automatically adopts to avoid further pain and injury. Once a patient has reached this stage, it is very important to not only provide adequate treatment but also to prescribe specific exercises designed to re-strengthen vital spinal muscles so that they can properly support the disc in its recovery and subsequent return to everyday activities. As with the previous stage, this is a more advanced condition and usually requires more treatment. It does however respond well and if left unresolved may progress to the next level.

6.Sciatica

Sciatica occurs when the sciatic nerve, which arises from beside the lumbar discs, is irritated by a disc hernia, swollen joint capsule or a bone spur, also known as an osteophyte which rubs on it producing pain and often numbness or tingling down the affected leg. In advanced cases, patients experience not only severe pain and limitation but often loss of sensation and/or weakness in certain groups of muscles in the leg. This debilitating condition often leads to surgery although nowadays research evidence points towards better long term results with conservative care such as chiropractic manual techniques and carefully designed spinal exercise programs. In the “Centre Quiropráctic” we have seen several hundred such cases over the last 16 years and ca confidently say that even though it would have been quicker and easier to resolve patients in an earlier stage, the vast majority have been able to resume a normal, pain free life, without surgery. Obviously there are cases where surgery is the only option and in such cases we would not hesitate to refer the patient to the most appropriate medical specialist.

7.Pelvic pain, Sacro-illiac pain, Sacro-illiac syndrome

Thus far we have described those conditions affecting the lumbar spine but the lumbar spine is not the only culprit in the low back pain story. The sacro-illiac joints are also a common source of local and radiating low back and/ or leg pain. These important pelvic joints lend a degree of flexibility to the pelvis. They can however jam either in a neutral or not so neutral position. This condition is painful and debilitating but responds excellently to chiropractic manipulation. If one or both of the joints have become unstable, then an appropriate belt can be used to provide support whilst the tissues recover