Low back pain is the second most common reason for primary care doctor visits in the United States. Studies indicate that up to 80% of the population will experience some form of back pain at some point in their lives, and not just middle-aged or older adults.
Onset of low back pain occurs frequently to individuals of all ages and puts them at risk for chronic back pain throughout their lifespan. Everyone’s health can be affected, which in turn can contribute to missed days at work and the inability to participate in the activities you love.
The solution to low back pain is NOT to stop moving.
I have heard so many patients tell me, “I no longer run/ski/go on long hikes due to my back pain,” and every time it makes me want to scale Boulder’s 2nd flatiron and shout at the top of my lungs: “It doesn’t have to be this way!” Most back pain is highly treatable with proper exercise and targeted physical therapy!
With the onset of low back pain comes the age-old question: What is causing this? Could it be a slipped disc, arthritis, or sciatica? The good news is that roughly 80% of low back pain is mechanical driven. This means that, from a structural perspective, nothing is broken, protruding, damaged, or otherwise requires invasive surgery to fix.
Mechanical pain stems from muscle imbalances in our spine, hips, and lower body or a lack of mobility in certain areas that lead to what physical therapists refer to as aberrant movement patterns. An aberrant movement pattern is any movement that is abnormal due to imbalances in the body that then contributes to pain.
If you experience pain while lifting, an aberrant movement pattern that commonly leads to this discomfort is the rounding of your back, lifting with your back first instead of your legs, or leaning more to one side.
So, what about an MRI for low back pain?
Another misconception I hear from patients is: “Well Dr. Charlotte, I’ve had an MRI and it showed degenerative disc disease and arthritis- that that HAS to be contributing to my pain, right?!” Not exactly!
*Key take-a-way*
There is a mountain of research that indicates people without low back pain have the same MRI findings as people with low back pain. Studies have proven that if you were to MRI 100 people aged 40 with no back pain, 68% would have degenerative disc disease and 50% would have a bulging disc. These percentages increase as we increase the age of the population.
So what does this mean? An MRI is only a snapshot, in a non-loaded and stationary position, of what is occurring in your spine. There is very poor correlation between pain and MRI findings. On the other hand, a good correlation is a patient’s subjective history, symptoms and a biomechanical physical therapy examination where movement and strength in the spine and surrounding structures are assessed.
Another thing that MRIs fail to accurately take into account is somatic pain. Somatic pain is the pain that stems from the pain receptors of muscles, joints, ligaments, tendons, and joint capsules. Somatic pain and mechanical pain go hand in hand because aberrant movements lead to irritation of these structures (muscles, joints, ligaments, etc.) contributing to somatic pain.
For example, let’s consider a facet joint, otherwise known as a zygapophyseal joint. These are the joints formed as vertebrae stack on top of one another and allow for flexion, extension, and rotational range of motion in the spine. Facet joints receive sensory innervation from the nerve root that exits through that joint. If this joint becomes inflamed because of lack of range of motion or muscle imbalances causing this joint to move in a way that irritates it, the result is somatic pain. The somatic pain stemming from this irritated lumbar facet joint can either stay localized or it can radiate down into the lower extremities depending on how much local irritation there is.
How can you prevent low back pain?
The most impactful thing you can do to prevent mechanical low back pain is make sure you have full mobility and stability in your spine, hips, and core. You want to ensure that your back and hips have full range of motion and can move appropriately and not cause stress on other surrounding structures. If you lack mobility in one area of your spine, another area will always try to make up for this and will often move more than it’s supposed to, which leads to pain.
It’s important that once you have full mobility, you stabilize the joint to make sure it’s moving appropriately within its range of motion to prevent aberrant movement patterns that can contribute to irritation of structures as well. Below are some exercises that can promote these things and keep your back healthy and pain free.
