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Mechanical Low Back Pain - Strains, Discs, Arthritis, & Stenosis

Updated: Sep 9, 2023



Mechanical low back pain is a prevalent form of low back pain resulting from issues with the structures of the spine, including muscles, ligaments, discs, and joints. This type of pain is frequently referred to as "non-specific" low back pain because it lacks a specific identifiable cause.



Mechanical Low Back Pain can be caused by a variety of factors, including:

  1. Poor posture: Sitting or standing for prolonged periods in a slouched or hunched position can place excessive stress on the lower back muscles and lead to pain.

  2. Muscle strain: Overuse or sudden movements can cause strains or tears in the muscles of the lower back.

  3. Disc herniation: When the soft material inside a spinal disc pushes through the outer layer, it can irritate nearby nerves and cause pain.

  4. Arthritis: Osteoarthritis or other types of arthritis can cause inflammation and pain in the joints of the lower back.

  5. Spinal stenosis: Narrowing of the spinal canal can put pressure on the spinal cord or nerves and cause pain and other symptoms.

In most cases, Mechanical Low Back Pain can be effectively managed with conservative treatment and exercise.


 

Red Flags

In situations where you have sustained an injury or are experiencing severe pain, it's natural to feel as though you're in critical condition. However, the good news is that this is likely not the case. This conclusion is based on the lack of "Red Flags," which refer to indicators and symptoms that suggest a more serious underlying condition.

Every time we ask our patients questions about their condition we are always looking for Red Flags. Some of these questions would include (3):

  • Have you experienced a “recent onset of bowel or bladder incontinence”? We are not asking about minor changes in bowel movement, but are instead investigating a significant and recent lack of bladder and bowel control. This would be an indication that something more serious is going on, and that your condition may NOT be mechanical in nature.

  • Have you experienced “severe numbness around your pelvis”? This is known as Saddle Anesthesia – which is a complete loss of sensation in the area of the buttocks and perineum (the area between the anus and scrotum in males, and between the anus and vulva in females). We would also ask you if you are experiencing significant lower extremity weakness, in both legs or numbness. These symptoms can be an indication of Cauda Equina Syndrome – a neurosurgical emergency – caused by compression of the nerve roots below the level of the spinal cord, and sometimes as a result of a prolapsed disc. Cauda Equina Syndrome is A VERY RARE CONDITION.

  • Have you had a recent trauma? In these cases, we are looking to rule out fractures, or significant soft tissue damage.

  • Do you have a history of cancer? Have you experienced unexplained weight loss? Do you have a persistent fever, suffer from extreme fatigue, do you have sores that don't heal, and many other questions? Though not at the top of our list, cancer and tumours are on our list of differentials.

  • Have you had a persistent fever (over 100.4)? Recent spinal surgery history within the last year? We may ask you questions about being immuno-compromised. In these cases, we are looking for indications of possible infection.

  • We would also ask you questions about any progressive neurological deficits, such as major muscle weakness, major sensory weakness, and indications of significant muscle atrophy.

Fortunately, most cases of mechanical back DO NOT exhibit these symptoms.

 


Diagnosis


A thorough medical history is important in the diagnosis and treatment of Mechanical Low Back Pain because it can provide important clues about the underlying cause of the pain and help to guide appropriate treatment.


During a medical history, your healthcare provider should ask about the location, intensity, and duration of your pain, as well as any factors that worsen or improve the pain. They may also ask about any previous injuries or medical conditions that may be contributing to the pain.


In addition to the physical symptoms, your healthcare provider should also ask about your lifestyle and activities, including your occupation, exercise habits, and sleeping habits. This information can help to identify any activities or behaviours that may be contributing to the pain and guide recommendations for lifestyle modifications, treatment and exercise recommendations or even ergonomic adjustments.



Physical Assessment

Besides taking a complete history, doing a full orthopedic and neurological workup is critical. This gives the practitioner good objective data that you are just dealing with a mechanical injury and nothing more serious (something pathological).


The following videos are common orthopedic and neurological examination tests that we perform on our patients. This would be in addition to diagnostic imaging if required.


Low Back Examination

Effective Orthopaedic Testing - This video covers some of the common causes of low back pain and how to diagnose them using orthopedic examination procedures.



Lower Limb Neuro Examination

The lower limb neurological examination is part of the overall neurological examination process and is used to assess the motor and sensory neurons which supply the lower limbs. This assessment helps to detect any impairment of the nervous system. It is used both as a screening and an investigative tool.


Peripheral Vascular Examination - Key Points

A peripheral vascular examination is a valuable tool used for ruling out signs of vascular-related pathology. The detection and subsequent treatment of PVD can potentially mitigate cardiovascular and cerebrovascular complications. In this video we go over some of the common procedures we perform in daily clinical practice.


 

GET ASSESSED - THEN GET TREATED

It is important to get treated for Mechanical Low Back Pain for several reasons:

  1. Pain relief: Mechanical Low Back Pain can be extremely painful and can significantly impact quality of life. Treatment can help to reduce pain and improve overall comfort.

  2. Improved function: Mechanical Low Back Pain can limit mobility and interfere with activities of daily living, such as walking, sitting, and standing. Treatment can help to improve function and restore mobility.

  3. Prevention of further injury: Untreated Mechanical Low Back Pain can lead to further injury or complications, such as muscle weakness, nerve damage, or chronic pain. Early treatment can help to prevent these complications.

  4. Improved quality of life: Chronic Mechanical Low Back Pain can have a significant impact on quality of life, leading to depression, anxiety, and social isolation. Treatment can help to improve quality of life and overall mental and emotional wellbeing.

  5. Cost-effectiveness: Early treatment of Mechanical Low Back Pain can be more cost-effective than delaying treatment and allowing the condition to worsen. In some cases, conservative treatment measures, such as physical therapy and exercise, can be just as effective as more invasive treatments, such as surgery.


Manual Therapy

Below are some links to videos demonstrating manual therapy procedures that we have successfully used (for decades) in treating sprain-strain injuries. These videos include both joint manipulation/mobilization procedures and soft tissue techniques.


The Power of Chiropractic Adjustments

Chiropractic adjustments are powerful tools. When patients who suffer from chronic back pain receive care, at regularly pre-planned intervals, (Chiropractic Maintenance Care), then they do much better as compared to patients who only receive care during episodes of acute back pain.


The Gluteus Maximus Release - Motion Specific Release (MSR)

In this video, Dr. Abelson demonstrates how to use Motion Specific Release (MSR) to release restrictions in the Gluteus Maximus muscle. Strong, flexible, engaged gluteal muscles are critical to injury prevention and rehabilitation.


Thoracolumbar Fascial Release - Motion Specific Release

The thoracolumbar fascia (TLF) is a vital component in stabilizing the spine and transferring loads from the core. In this video, Dr. Abelson exhibits an exceptionally efficient procedure for releasing tension in the TFL.


 

Exercise is Critical

Regular exercise is essential for achieving full recovery from an injury. This recovery process is a collaborative effort between the patient and the practitioner. While it is the practitioner's responsibility to provide the best possible treatment, it is up to the patient to perform daily exercises in order to achieve full recovery. True recovery isn't just a matter of pain reduction. Full recovery can only be attained when the patient's body has achieved a level of stability that makes a future injury of the same type unlikely.


Exercise programs typically begin with recommendations for the acute stage of recovery, followed by a focus on mobility and flexibility, progressing to strength building, and then to functional exercises that emphasize balance and proprioception.


The following videos feature exercises that we may recommend to our patients. It's important to note that each exercise recommendation should be tailored to the individual's needs. The first video provides tips on avoiding exacerbating a back strain. It covers sleeping positions, core bracing, lifting techniques, and many other common activities that can worsen back pain.


Back Pain and Activities of Daily Living

In this video, we provide you with essential information regarding back pain and your daily activities. Performing daily actions in the correct manner can significantly impact your condition.



Stop Back Pain Fast! - Acute Low Back Pain Routine

The "Stop Back Pain Fast" routine is intended to alleviate your pain as soon as possible. If you are experiencing ACUTE LOWER BACK PAIN, it is crucial to halt it immediately. Back pain is one of the primary reasons people seek medical attention, and it can be excruciating. Back pain can vary from sharp, stabbing sensations to a persistent, dull ache. Regardless of the type of back pain you are experiencing, this video can aid in breaking the cycle of pain.


6 Minute Plank Routine – Intermediate Level

Individuals with a weak core are vulnerable to various issues, including poor posture, lower back pain, hip and knee injuries, among others. If you are looking to enhance your athletic performance, focusing on strengthening your core is an excellent starting point.


Improve Your Balance - Exercises for Beginners

In both rehabilitation and sports performance training, balance exercises are a critical component that should never be disregarded. Enhance your balance by following these straightforward exercises. By utilizing our progression techniques, you can confidently perform these exercises without an elevated risk of injury.

 

Conclusion


While mechanical low back pain is a common ailment, it can be debilitating. Nevertheless, with the right approach, it can be resolved relatively quickly. Take control of the situation and address the problem properly by:

  1. Seeking the advice of a professional for an assessment.

  2. Receiving appropriate treatment, which may involve both osseous and soft tissue therapy.

  3. Remembering that exercise is not optional, but a vital component of recovery, which should include elements of mobility, strength, balance, proprioception, and cardiovascular exercise.

An acute episode of low back pain does not have to become a chronic issue. Don't allow it to become one! Life is too short to be held back by injuries when you could be enjoying everything else. Take control of your back pain today!


 

DR. BRIAN ABELSON DC. - The Author


Dr. Abelson is committed to running an evidence-based practice (EBP) incorporating the most up-to-date research evidence. He combines his clinical expertise with each patient's specific values and needs to deliver effective, patient-centred personalized care.


As the Motion Specific Release (MSR) Treatment Systems developer, Dr. Abelson operates a clinical practice in Calgary, Alberta, under Kinetic Health. He has authored ten publications and continues offering online courses and his live programs to healthcare professionals seeking to expand their knowledge and skills in treating musculoskeletal conditions. By staying current with the latest research and offering innovative treatment options, Dr. Abelson is dedicated to helping his patients achieve optimal health and wellness.

 

References

  1. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Chou R, Quaseem A, Snow V, et al. Intern Med. 2007;147(7):478-491.

  2. Epidemiological features of chronic low-back pain. Andersson GB. Lancet. 1999;354(9178):581-585.

  3. Bigos SJ. United States Agency for Health Care Policy and Research. Acute low back problems in adults. Clinical practice guideline. Rockville, Md: US Dept. of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research. viii, 1994:160.

  4. Effective Functional Progressions in Sport Rehabilitation, Ellenbecker, Todd, Human Kinetics 2009


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