Most Low Back Pain (LBP) are induced mechanically, meaning they are caused by abnormal distribution of force to our spinal structures including joints, discs, ligaments or tendons…the abnormal forces could be caused by poor posture, muscle imbalances, and single or repeated micro and Macro traumas to the spine.
Most mechanical LBP respond very well to rehab specially if the potential contributing structures to pain are identified early on and treated. The goal in rehab is to restore postural symmetries in spine, thus decreasing wear and tear resulting from uneven stresses on the intervertebral joints, discs and surrounding soft tissue structures such as ligaments, muscles and tendons.
There are four types of mechanical LBP
LBP is defined as acute when pain is presented for up to six weeks. The intensity can range from mild to severe and may fluctuate. The pain may radiate into one or both buttocks or even into the thigh/hip area. Acute Low back pain could be self-limited and if it persists beyond three to six weeks appropriate physical therapy approach could be very helpful.
LBP is defined as recurrent when there are episodes of back pain similar to first episode with subsequent episodes increasing in pain intensity, distribution, frequency and duration. Recurrent LBP needs to be treated properly so it won’t lead to more chronic condition. Most Recurrent LBP respond effectively to Physical therapy.
LBP is defined as chronic when pain is presented for longer than three to six months. Chronic LBP may originate from an injury, disease or stresses on different structures of the body. The type of pain may vary greatly and may be felt as bone pain, nerve pain or muscle pain. Sometimes there is an identifiable source of pain such as structural issues for example; Degenerative Disc Disease (DDD) or Spinal Stenosis. In these conditions, physical therapy still could be very helpful in reducing pain. These patients will be required to stay active, do appropriate exercises and make some modifications in their activities and life style to sustain their gains in rehab. If the pain persists then injections or spine surgery may be considered as a treatment option.
Sometimes chronic LBP continues beyond 6 months and the point of tissue healing and there is no identifiable cause or source of pain. In these cases, it appears that pain can set up a pathway in the nervous system and, in some cases, this becomes the problem by itself. Chronic LBP is influenced by many factors, such as ongoing pain signal input to the nervous system even without tissue damage, physical deconditioning due to lack of exercise, a person’s thoughts about the pain, as well as emotional states such as depression and anxiety. These types of chronic LBP so called “chronic pain syndrome” requires a more comprehensive treatment approach such as “multidisciplinary pain management program” to help patients to manage their pain.
Since most LBP can respond effectively to physical therapy treatment it is crucial to receive therapy from a clinician, who is skillful and knowledgeable about the functional anatomy of the spine and knows how to implement an effective treatment program. I think those patients who do not respond to the first course of physical therapy treatment should seek further consultation with a physical therapist that is more specialized in treating back pain before they pursue more invasive procedures such as injections or surgery.