Low Back Pain – The Facts
November 22, 2018

Back pain costs, through loss of work, the price of treatment and medication our economy about 9 billion dollars a year.  Statistically there is a high chance that you may suffer from a bad back at some time in your life and it is one the main reasons people go to healthcare practitioners in Australia.

Australian research on the 24th July 2014 in ‘The Lancet’; one of the world’s most respected medical journals questioned the management of back pain.

In the past, medical management usually included advice to take Paracetamol and wait for the pain to go away.  Now, the findings of a randomised controlled trial (RCT); the so called ‘gold standard’ of clinical evidence, has found Paracetamol, the most commonly recommended medication for back pain is as helpful as using a placebo sugar tablet!

New research in the American Medical Association Journal

Spinal manipulative therapy (SMT), the treatment used by the majority of chiropractors, has once again been shown to be evidence based and effective.  Published (2013) in the prestigious journal ‘spine’.  As a result of the new findings the journal of the American Medical Association (JAMA) recently included advice for people with acute low back pain to consider consulting a chiropractor.

The Pain and Problem are Unlikely to Just Go Away

Additionally, spinal pain was thought to “Go away by itself” and commonly advice was to take drugs in for form of anti-inflammatory medication and take a wait and see approach.  Evidence suggests this is often not the case.  Around 25% of Australians who experience lower back pain continue to have persistent of recurrent episodic back pain.

With the outdated traditional approach to treatment recovery is often non-existent or slower than anticipated with nearly one on three patients not recovering.

Incorrect diagnosis, lead to incorrect treatment and a lack of results

A major concern when it comes to treatment of backpain is that backpain is ‘just a’ muscle strain.  By definition, a muscle strain involves “torn muscle fibres” This can occur in the spine following physical trauma it is completely rare.  Muscle spasm or contraction, along with inflammation is most often a side effect from the actual underlying cause.

Let’s Look at what the Research States

  • DISC INJURIES account for approximately 40% of Lower Back Pain
  • JOINT (FACET) PROBLEMS account for 15-40% of cases (31% in other studies)
  • SACROILIAC (HIP) MISALIGNMENTS account for 13-18%

Other causes 12-20% account for all other causes of lower back pain, including degeneration, joint disease, ligament sprain, muscle strain, tumours, infection, autoimmune disorders and other such as fracture or spondylolisthesis (spinal abnormalities). 

Let’s Look at the ‘Slipped Disc’ and Sciatica

The term slipped disc is incorrect however convenient term used historically.  A disc slipping is actually impossible without destroying the bones they support.  Unfortunately, the term is used in medical circles as it gives a quick and easy name to a problem and saves having to spend time ‘educating’ the patient.

The intervertebral disc is incredibly strong and can bear substantial weight over time.  However, once the disc has begun to lose water content the process of degeneration or decay begins.  The degeneration process starts near the centre of the disc, so you’re not going to see it on a plain film x-ray or CT scan most of the time.  An MRI scan will show a dehydrated disc, which always accompanies internal disc degeneration.  The disc has a centre, a nucleus.  The nucleus is surrounded by concentric rings of fibrous material called the Annulus Fibrosis.  These annular rings contain the constantly moving nucleus during its function of shock absorption, and movement of the spinal segments.  Internal disc damage including disc herniations have to start somewhere and in most cases, they begin with what is known as an annular tear.  This can allow the nuclear material to work its way through the rings towards the outside of the disc.  Annular tears only become painful when they extend into the outer one third of the disc.

Eventually, the nucleus can create a bulge of the outer rings of the annulus reducing the space for the nerves as they exit the spine or as they descend in the spinal canal.  Further damage may cause the disc nucleus to protrude and cause direct pressure and/or chemical irritation on a nerve.  This commonly results in sciatica, which is the ‘nerve like pain’, which runs down the back of the thigh and into the lower leg.  If the discs if the upper lumbar vertebra are involved, you may notice this ‘nerve like’ pain int eh front of the thigh.  A trained healthcare professional such as a chiropractor, should be able to diagnose which nerve is involved and advise or treat accordingly. This would involve a number or orthopaedic and neurological tests and in some cases imaging such as an MRI or CT scan is very helpful.  It should be noted that not all disc protrusions cause symptoms and many people can lead a normal life with disc protrusions present.  It is however, very wise to manage the integrity of the damaged area on an ongoing basis.

Referred pain down the leg is caused by a number of other conditions, which do not involve protrusion compromising the nerve. These would need to be differentiated by a trained healthcare professional.  A chiropractor has a five-year degree with the purpose of these five years focused on being specialised in these conditions.

What Now?

With 25-30% of acute low back pain episodes converting to chronic ongoing pain, it makes good sense to see a chiropractor who has the training and experience to help.  If you wait and see evidence suggests further deterioration and an inability to live the life you want to live.

When you’re ready why not come in and check us out – you have nothing to lose….. except pain!