Simplifying Low Back Pain - Darrin Schober, MS, PT

Posted: January 1, 2019

Understanding the source of your Low Back Pain is often complicated and medical treatment and tests are expensive .  The medical literature tells us that everyone will experience some episode of low back pain in their lifetime, typically this occurs in our early to mid thirties and into our later forties in life.  The pain will commonly last 6-8 weeks before resolving on its own.   

As a physical therapist who exams individuals with low back pain complaints weekly it is very important that our clients understand the source of their pain as this will impact our treatment choice and support our reasoning for recommended changes in posture, movement or necessary exercise to regain postural support and endurance for activities that we face in life.

When simplifying the sources of back pain we need to break the spine into three sections; front third, middle third and back third.  

Front third represents the vertebral body of the vertebra and  the intervertebral disc.  Commonly the vertebral body or bone is not the source of pain unless a fracture or trauma is present.  Elderly patients can suffer weakness/collapse in the boney vertebral body which commonly presents as a compression fracture.  The only other structure in the front third is the intervertebral disc.  Which can cause disc related pain, commonly referred to as discogenic pain.  Symptomatically pain coming from the disc will manifest in sitting as pressure increases inside the disc.  Clients will often say sitting at a dinner or on bleachers is very difficulty after 10-15 minutes of time. 

Middle third pain is represented by the nerves exiting the spinal column.  This pain will be best described as numbness and tingling that travels typically into the legs and often below the knee.  It will follow a very consistent pattern maybe intermittent or more constant.  A client may experience local weakness like foot drop on one side or a dullness in sensation local to a specific area.  These are all key indications of a nerve that is experiencing some problems exiting the bony spine.  Pain from the nerves is referred to as neurogenic pain.

The back third is most commonly referred to as mechanical low back pain as this involves your facet or movement joints in your back and pelvis.   Sometimes your movement joints get caught or locked into a specific position limiting full motion.   Locally  you will experience muscle stiffness and spasm in the region.  The quality and ease of your regular daily movement will be altered and pain will be present in the region.  If this goes unchecked for some time your body will begin to compensate in other joints only making the original problem worse.

Rarely is discogenic , neurogenic or mechanical pain isolated to a single pain source.  Meaning it is common to have a primary pain source and suffer secondary sources of pain that become involved as symptoms.   As physical therapist we often sort out the primary pain source while educating on other secondary sources.  By understanding the source of your pain and what will provoke or improve it, the client becomes better engaged in the recovery process and ensure in the long term this won’t be a lasting issue throughout their lifespan.

Are you suffering from low back pain?  Tell us how low back pain has affected your life.

Best Regards,

Darrin Schober, MS, PT

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