To review, there are many structures in the lower back that can cause severe pain. These include muscles, ligaments, tendons, bones, joints and discs. The outer rim of the disc can be a source of significant back pain due to its rich nerve supply and tendency towards injury.

During our development, there is a great deal of overlap of nerve supply to all of these structures. This makes it nearly impossible for the brain to distinguish between injuries to one structure versus another. For example, a torn or herniated disc can feel identical to a bruised muscle or ligament injury. This is where an examination into the cause of the pain is important; each of these different structures may need a different type of treatment to resolve your pain.

Back pain can be divided into three large classifications. The most common condition is known as axial, or mechanical, back pain. This pain can run the gamut from very sharp, to a dull ache. It may occur all the time, or it may come and go. It also varies in intensity from very mild to extremely severe. One patient may report that his/her low back is only sore when having been seated for a time, or after working in the garden. Another patient may report severe, debilitating pain and need assistance to walk or stand, or even to get up from a sitting position. While one patient is perfectly straight, the other is bent over and locked in a crooked posture.

The one thing that is common in these conditions is that the pain is restricted to the lower back area. This most common type of problem, mechanical back pain, is completely nonspecific with regards to the injured structure or structures. Generally, the pain gets worse with certain activities or positions. It is usually relieved by rest or changing position. Note, extended bed rest may also aggravate this type of problem.

This condition responds extremely well to conservative care. At times, spinal manipulation alone is the “miracle” affording immediate relief. More often, the injury involves more than just a misalignment of a vertebra or of your pelvis. Nerves, muscles, tendons, ligaments and skin can all have an influence on the degree of discomfort.

Back pain can be divided into three large classifications – axial pain, referred pain and radicular pain.

And each ofthese may need to be addressed to attain relief. If you have multiple episodes of this type of pain, you will want to engage yourself in a rehabilitation program to help resolve the underlying causes of the problem.

Here, the diagnosis goes farther than just finding out what is causing the pain, but additionally centers on what weakness or restriction you have that ultimately cause you to have an episode. Here again, we function much like a "coach", finding the cause(s) and helping to direct you towards ways of avoiding and limiting future bouts with pain.

The next most common type of back pain is known as referred pain. Here, patients complain of having an achy, dull type of pain that seems to move around. The discomfort comes and goes and varies in intensity. This achy pain starts in the low back area and commonly spreads into the groin, buttock and upper thigh. The treatment options here are similar to those used in treating axial pain. Diagnostic and therapeutic measures are aimed at correcting abnormalities in the muscles, ligaments and small joints of the spine.

The last type of back pain is known as radicular pain. In this case, the pain is described as deep and usually constant. It follows the nerve down the leg and is often accompanied by numbness or tingling and muscle weakness. The most common example of this type of problem is the sciatic pain that radiates along the sciatic nerve - down the back of the thigh and calf into the foot. This type of pain is caused by injury to a spinal nerve. Some of the possible causes of this are a disc protrusion or bulge, arthritic changes, or a narrowing of the opening through which the nerve exits.

While a few of these cases will require surgery, most respond to conservative care. Here the care will consist of multiple therapies, all designed to reduce inflammation, balance your posture, strengthen supporting structures, attain normal motion and improve the health of the nerve that is involved.

In all of these types of back pain, your health habits play an important role. For example, there are certain foods that are high in the fats that cause more inflammation. Limiting intake of these animal fats and increasing your intake of the good fats that reduce inflammation may play an important role in your healing. Smoking is another health concern. Statistically, smokers are slow healers with respect to back pain.

An important part in prevention is
keeping these [back] muscles
active and in good tone.

One of the most important areas in chronic back pain management is the strength of your abdominal wall and your pelvic floor. There are three major abdominal muscles, each with small subdivisions. Any weakness in one of these sections can be the root cause of a chronic back problem. Weakness in these structures causes your back muscles to tighten and shorten. This adversely affects the lower back by causing compressive forces on the small joints and the discs.

An important part in prevention is keeping these muscles active and in good tone. If you are interested in helping to prevent, or at least limit, your chances of having any of these three types of back pain, talk to us about testing and setting up an exercise program for maintaining good support for your back.