Low Back Pain: Questions and Answers (Part 1)
Do you suffer from low back pain? Eighty-five percent of people do, at some point in their lives. Back pain is the second most common complaint prompting doctors’ visits, exceeded only by coughs and respiratory infections. Five percent of back pain is caused by a cause such as infection, tumor, arthritis or inflammation, but for the other ninety-five percent, the cause is difficult to determine. Because non-specific LBP (low back pain) is so common, and so mysterious, treatment has become a big business. Americans spend about $50 billion annually on prevention and treatment of LBP.
If you are seeking treatment for low back pain, it is wise to do your own research. Orthopedists, neurologists, surgeons, chiropractors, physical therapists, acupuncturists and other practitioners often disagree about causes and treatment. Some causes commonly cited are herniated (slipped) discs, poor posture, tight hamstrings or hip flexors, overweight, and lack of core strength. Before you commit to any treatment approach, question everything you are told.
Here are some common diagnoses, relevant research, and some “takeaways” on how to proceed:
Diagnosis #1: Bulging discs, vertebrae fracture, and stenosis:
Bulging discs – A study found that even when an MRI shows disc abnormalities, they may not result in pain. Conversely, you can have a bulging disc, and significant back pain, but the pain may not result from the disc abnormality.
Fractured vertebra – Two separate studies found that vertebroplasty, a high-risk procedure that injects an acrylic cement into bones in the spinal column to stabilize fractures caused by osteoporosis, does no more to relieve pain than a placebo.
Spinal stenosis – a 2006 study found that stenosis, a narrowed spinal canal, does not, by itself, cause back pain.
Takeaway: Regardless of any structural abnormalities that may appear on an MRI, do not be quick to accept surgery. Ask your doctor what other avenues you may be able to explore.
Diagnosis #2: Spinal curvatures, pelvic tilts, or leg length asymmetry
Spinal curves – a 2008 review looked at over 50 studies and determined there was no association between spinal curvature and pain.
Pelvic tilt – a 2004 study determined there is no relationship between lumbar lordosis and isometric strength of the trunk flexors, trunk extensors, and hip flexors and extensors. In other words, pelvic tilt does not cause back pain.
Leg length asymmetry – although some earlier studies indicated a correlation between differences in leg lengths and back problems, more recent research disproves that theory.
Takeaway – Many people with postural alignment or asymmetry have no pain, while others with better alignment experience chronic pain, so do not accept an opinion that a physical difference you may have is the root cause of your pain. Avoid sitting too much and do exercises to strengthen your glutes. Add barbell and dumbbell rowing variations to your regular workout, as well as squats and deadlifts, as long as you can do these without pain.
In Part 2 of this article, we will explore more common diagnoses for low back pain.