Mechanical low back pain is a phenomenon that affects eighty five percent of us at least once in our life time and for approximately one fifth of us, it affects us to some degree once every year. It is defined as local lower back pain caused by strain of the muscles along the spine of the lower back or of a sprain of the ligaments or joints between the individual vertebrae of the lower back. The symptoms are quite consistent: local lower back pain especially when changing positions that is also aggravated by exertional activity (lifting, forward or back bending, twisting ) or when assuming static positions such as lying or sitting for an extended period of time. In addition to the local pain, there is also associated muscular tension in the affected area of the lower back. The end result is an episode of low back pain and stiffness that can range from being mild but noticeable to disabling for a period of time.
The danger of experiencing a bout of this type of lower back pain is that it may become chronic or long lasting in duration causing an extended time of pain and disability. This is generally the case when patients experiencing mechanical low back pain do not properly take the right steps to rectify the cause or causes of the discomfort. This happens commonly when either the pain is misdiagnosed and therefore not managed properly from the health care practitioner side, or if the patient is not compliant with the prescribed plan of management. In either case, the mismanagement or the non compliance leads to greater pain and greater disability.
Managing mechanical low back pain from the health care practitioner side involves first and foremost arriving at the correct diagnosis and then implementing the proper plan of management to alleviate and prevent further the cause of the disorder. The correct diagnosis of lower back pain of mechanical origin is arrived at by taking a thorough patient history and regional physical examination. The diagnosis is correctly then made when both of these procedures point to the cause of the lower back pain resulting from excess strain placed on the muscles, ligaments or intervertebral joints of the lower back. In addition, the symptom pattern as well as regional physical examination findings must also rule out any other significant diagnoses. A common mistake that is made by practitioners upon arriving at the correct diagnosis of mechanical low back pain is oversimplifying the structural cause of the pain and discomfort. That is, the assumption is made in these cases that only one “part” of the anatomy of the lower back is affected when experiencing such pain. For example, the over-abundantly diagnosed “pulled muscle” as the sole cause of one’s mechanical lower back pain. The fact is that individual structures that make up the spine are not mutually exclusive. They are intimately connected both structurally and functionally. As a result, when one part is injured or irritated, the other parts are directly impacted and thus also need to be addressed in both diagnosis and treatment.
The Common Lower Back Pain Case: In our clinics we see these cases each and every day. The patient arrives with some degree of local lower back pain with stiffness. The patient lacks mobility in that the range of motion of the lower back is significantly reduced with pain experienced when entertaining any type of movement. In most cases they also exhibit some degree of antalgia generally in forward flexion (they are posturally bent slightly forward) or in lateral flexion (bent to one side left or right) which relieves some of the pain. Otherwise there are no other neurological signs or symptoms.
Properly Treating Mechanical Low Back Pain: In this case in order to effectively treat this ailment, we simply need to address all of the components that are causing the dysfunction. Proper treatment/management involves:
- Reducing any inflammation that is present at the intervertebral joint level or in the surrounding soft tissues which is the primary cause of the pain. *Treatment: moist ice therapy, natural anti inflammatory supplementation.
- Reducing spasm or tightness in the paraspinal muscles therefore increasing the pliability of these soft tissues. *Treatment: acupressure, massage, electrotherapy, active release techniques, active and passive stretching.
- Reducing any vertebral misalignments/subluxations to restore the range of motion in the affected joints of the spine. *Treatment: spinal adjustments
If these 3 components are effectively addressed with the addition of a sound educated home patient self -care regimen, the resolution of symptoms and duration of disability are significantly reduced and the cause of the low back pain is corrected properly.
Dr. Raminder Badyal
