Mechanical Low Back Pain

Definition :

Low back pain originating from the disc, vertebral body, or posterior elements or might be unrelated to the spine.

Causes :

Mechanical low back pain has been reported to arise from trauma (either chronic or sudden) such as a fall, a motor vehicle accident, twisting, prolonged poor postures, mental stress, fatigue, disc extrusion (also known as a slipped disc, rupture, or disc herniation), sometimes painful degenerative disc disease(also called arthritis), aging, congenital defects, poor flexibility, etc. Causes such as infection, hormonal problems, broken bones, systemic disease, and tumors require serious medical intervention but are very rare and are beyond the realm of this discussion.

Acute low back pain is defined as activity intolerance due to lower back or back-related leg symptoms of less than 3 months' duration. Chronic low back pain, therefore, is defined as pain/problems lasting greater than 3 months. Regardless of the cause or duration of mechanical low back pain, the result is likely to be damaged soft tissue(s) which can stimulate nerves and produce pain.

It is important to understand that it is next to impossible to determine exactly which tissue(s) are the cause of the low back pain. Someone like yourself may be experiencing pain and quite frankly, the cause is unknown. It could be muscle(s), ligament(s), disc(s), tendon(s), joint(s), and/or other connective tissue. They all can produce similar symptoms which commonly present as pain on one side of the back or across the back. It may radiate into the buttock or into the thigh. Quite often it will be accompanied by painful cramping of the muscles called a muscle spasm. Furthermore, medical research has shown that x-rays are of little help in determining the cause of low back pain except in rare cases such as severe trauma. Magnetic resonance imaging (MRI) is also ineffective at determining the cause of low back pain. For example 2 out of 3 people have positive findings for disc abnormalities on an MRI but are painless. As many as 1 in 3 people have disc bulges and are completely painless. Health care professionals often call low back pain a "pain in search of a pathology." This means that a patient’s medical tests will be negative or a test will produce a false positive. The cause could be any number of structures.

Treating Low Back Pain :

So how do we treat something if we don't know what exactly is wrong. We do know that mechanical low back pain is caused by damaged soft tissue. The damage stimulates pain nerves called nociceptors. The goal then is to promote healing of the damaged soft tissue which will eliminate the pain, not just treat the pain itself. This is done with a program that is customized to your individual needs.

Here are the steps :

Protecting the damaged soft tissue to prevent further breakdown. The area of damaged soft tissue is protected with rest and positioning. Activities that cause the pain should be avoided while the low back heals. Pain management techniques should be used and your physical therapist will discuss these with you. Bed rest is usually only necessary for 1-3 days (longer periods of bed rest have not been proven to be beneficial).

Increasing the circulation and mobility. This will deliver the proper building blocks (proteins, repair cells called fibroblasts, oxygen, proteins, etc.), remove inflammatory and waste products that build up in painful tissue(s), and prevent tissue atrophy. Increasing circulation is accomplished by walking and performing painless range of motion, stretching, and strengthening exercises.

Correcting the dysfunctions (weakness, poor posture, poor flexibility) that caused the problem in the first place. Progressive strengthening exercises, flexibility exercise, and postural/body mechanics education will help reduce the stress on your low back and promote proper repair.

The Key : Your physical therapist will give you the tools to treat your dysfunctions and create your own customized treatment program. That's not all. Anyone who has suffered from low back pain must understand that the problem is not corrected when the pain ends. Muscles must be stronger than before the pain started (that takes 12+ weeks), many weeks are needed to improve flexibility, and repeated practice is necessary to incorporate proper posture and body mechanics into your daily activities