Why Does My Low Back Hurt All the Time?

Low back pain is an incredibly common health issue that affects millions of people worldwide. It can be frustrating, debilitating, and often leaves sufferers wondering about its underlying causes. It can be equally frustrating to go from doctor to doctor with no definitive answers as to what's causing the pain and how to resolve it. This article will explore the most common reasons for back pain, differentiate between acute and chronic pain, examine various types of injuries, and discuss different pain sensations. We'll also look at how chiropractic care may help in managing these conditions.

Common Reasons for Back Pain

Back pain can stem from various sources, ranging from lifestyle factors to medical conditions. Here are some of the most frequent causes:

1. Poor Posture: In our increasingly sedentary lifestyles, poor posture is a significant contributor to back pain. Prolonged sitting, especially with improper ergonomics, can lead to muscle imbalances and strain on the lower back.

2. Muscle Strain / Sprains: Overexertion or improper lifting techniques can cause muscle strains or sprains of ligaments, leading to acute or chronic back pain.

3. Degenerative Disc Disease: As we age, the intervertebral discs that cushion our spine can wear down, leading to pain and reduced mobility.

4. Herniated Disc: When the soft inner portion of a spinal disc pushes through the tougher outer ring, it can irritate nearby nerves, causing pain. The less severe form of this condition is called a disc bulge or slipped disc.

5. Spinal Stenosis: This condition involves the narrowing of the spinal canal, which can put pressure on nerves and cause pain.

6. Osteoarthritis: The wear and tear of the joints in the spine can lead to inflammation and pain.

7. Fibromyalgia: This chronic condition is characterized by widespread musculoskeletal pain, including in the lower back.

8. Scoliosis: An abnormal curvature of the spine can lead to chronic back pain.

A study by Hoy et al. (2012) in the Annals of the Rheumatic Diseases found that low back pain is the leading cause of disability worldwide, affecting nearly 1 in 10 people. This underscores the importance of understanding and addressing the root causes of back pain.

Acute vs. Chronic Pain

Understanding the difference between acute and chronic pain is crucial in addressing low back issues effectively:

Acute Pain

Acute pain is typically sharp and sudden, lasting for a short period - usually less than 3 months. It's often related to a specific injury or event and serves as the body's warning system to prevent further damage. Acute pain generally improves as the underlying cause heals.

Common causes of acute low back pain include:

• Muscle strains

• Ligament sprains

• Disc herniations

• Injuries from falls or sports activities

Chronic Pain

Chronic pain persists for more than 3 months, even after the initial injury has healed. It can be constant or intermittent and may not have a clear underlying cause. Chronic pain can significantly impact quality of life and often requires a multidisciplinary approach for management.

Causes of chronic low back pain may include:

• Degenerative disc disease

• Spinal stenosis

• Chronic conditions like fibromyalgia

• Arthritis

A study by Meucci et al. (2015) in the Revista de Saúde Pública found that the prevalence of chronic low back pain has a higher incidence in older populations and women.

Regarding chiropractic care for acute and chronic pain, a randomized controlled trial by Haas et al. (2014) in The Spine Journal found that for acute and chronic low back pain, chiropractic yielded significantly greater improvement in pain and functional disability than conventional medical care after 12 treatment sessions. However, they noted that the benefits of chiropractic care were most pronounced in the short-term and early stages of care.

A systematic review by Bronfort et al. (2010) in the Journal of Manipulative and Physiological Therapeutics found that spinal manipulation, a key component of chiropractic care, was effective for acute low back pain, acute/subacute neck pain, and chronic neck pain. The review also found evidence supporting spinal manipulation for chronic low back pain.

Regular Injury vs. Repetitive Microtrauma

Back pain can result from both sudden, traumatic injuries and cumulative, minor stresses over time. Understanding the difference is crucial for proper treatment and prevention:

Regular Injury aka Acute Injury

A typical injury, known as acute injury, occurs suddenly due to a specific incident. Examples include:

• Falling and landing on your back

• Lifting a heavy object incorrectly

• Sports-related injuries

  
  

These injuries often result in immediate, noticeable pain and may cause visible bruising or swelling. Treatment typically focuses on managing pain, reducing inflammation, and gradually restoring function through rehabilitation exercises.

Repetitive Microtrauma

Repetitive microtrauma, on the other hand, develops over time due to repeated stress on the same area. This type of injury is often associated with:

• Poor posture maintained over long periods (i.e. desk jobs, driving jobs, sedentary work)

• Repetitive motions in sports or work activities

• Chronic muscle tension due to stress

Unlike regular injuries, the pain from repetitive microtrauma often develops gradually and may be harder to pinpoint to a specific cause. It's common in office workers who maintain poor posture for long hours or in athletes who perform repetitive motions.

A study by Barbe and Barr (2006) in the Journal of Electromyography and Kinesiology found that repetitive microtrauma can lead to tissue damage, inflammation, and fibrosis, potentially resulting in chronic pain conditions if not addressed.

Chiropractic care can be beneficial for both types of injuries. For regular injuries, a systematic review by Rubinstein et al. (2011) in the Cochrane Database of Systematic Reviews found that spinal manipulation therapy (SMT) appears to be as effective as other treatments in both acute injuries and repetitive motion injuries.

For repetitive microtrauma, chiropractic care often focuses on correcting postural issues and addressing muscular imbalances. A study by Cramer et al. (2013) in the Journal of Manipulative and Physiological Therapeutics found that chiropractic adjustments could lead to immediate improvement in joint stiffness, which may help alleviate pain from repetitive microtrauma.

Types of Pain: Nerve, Muscle, Joint, and Soft Tissue

Understanding the different types of pain can help in identifying the underlying cause and determining the most effective treatment approach. It can also help you communicate more effectively with your doctor to get to the root cause of your condition. Here's a breakdown of the main types of pain associated with low back issues:

Nerve Pain

Nerve pain, also known as neuropathic pain, occurs when nerves are compressed, irritated, or damaged. In the lower back, this often involves the sciatic nerve or other spinal nerves. Characteristics of nerve pain include:

• Sharp, burning, or electric shock-like sensations

• Pain that radiates along the path of the nerve (e.g., down the leg in sciatica)

• Numbness or tingling in affected areas

• Increased sensitivity to touch

Common causes of nerve pain in the lower back include herniated discs, spinal stenosis, and nerve root compression.

Muscle Pain

Muscle pain, or myalgia, is often described as a dull, aching sensation. It can result from:

• Overuse or strain

• Poor posture

• Muscle imbalances

• Tension due to stress

Muscle pain is typically localized to the affected area but can sometimes refer pain to nearby regions.

Joint Pain

Joint pain in the lower back primarily involves the facet joints, which connect the vertebrae. This type of pain is often associated with:

• Osteoarthritis and other types of arthritis

• Ankylosing spondylitis

• Spinal misalignment

Joint pain is usually described as a deep, aching sensation that worsens with certain movements or positions.

Soft Tissue Pain

Soft tissue pain involves structures like ligaments, tendons, and fascia. This type of pain can result from:

• Sprains (overstretched or torn ligaments)

• Tendinitis (inflamed tendons)

• Myofascial pain syndrome

Soft tissue pain is often characterized by tenderness in specific areas and may be accompanied by stiffness or reduced range of motion.

While these pain types have distinct characteristics, it's important to note that they can often overlap or occur simultaneously, making diagnosis and treatment complex.

Examples of chiropractic care for different types of pain:

Nerve Pain:

A randomized controlled trial by Peterson et al. (2013) published in JAMA Network Open compared spinal manipulation to nerve root injections for lumbar radicular pain. The study found that spinal manipulation was as effective as nerve root injections for pain reduction and improved function at 1-month follow-up.

Santilli et al. (2006), in a randomized double-blind clinical trial published in The Spine Journal, found that patients with acute back pain and sciatica with disc protrusion had significantly greater pain relief with chiropractic manipulations compared to simulated manipulations.

Muscle Pain:

A study by DeVocht et al. (2005) in the Journal of Manipulative and Physiological Therapeutics found that chiropractic adjustments could lead to immediate improvement in muscle strength in patients with low back pain.

Cramer et al. (2013), in a study published in the Journal of Manipulative and Physiological Therapeutics, used MRI to show that chiropractic adjustments increased spinal gapping and reduced muscle activity, potentially alleviating muscle tension and pain.

A randomized controlled trial by Schneider et al. (2015) in the journal Spine found that spinal manipulation led to greater short-term reductions in self-reported disability and pain compared to usual medical care.

Joint Pain:

For joint pain, particularly related to osteoarthritis, a randomized controlled trial by Poulsen et al. (2013) in the British Medical Journal found that a combination of chiropractic care and patient education was more effective than a home exercise program alone for hip osteoarthritis.

A systematic review and meta-analysis by Coulter et al. (2018) in the Journal of Manipulative and Physiological Therapeutics found moderate-quality evidence that manipulative therapy improves pain and function in chronic facet (spinal) joint pain.

Goertz et al. (2013), in a randomized controlled trial published in Spine, found that adding chiropractic manipulative therapy to standard medical care for acute low back pain and related leg symptoms provided greater pain relief and improved function compared to standard care alone among active-duty military personnel.

Soft Tissue Pain:

Castro-Sánchez et al. (2011), in a randomized controlled trial published in the Journal of Alternative and Complementary Medicine, found that massage and chiropractic care significantly improved pain, disability, and range of motion in patients with chronic low back pain.

For soft tissue pain, techniques like myofascial release, which is often incorporated in chiropractic care, have shown promise. A systematic review by Ajimsha et al. (2015) in the Journal of Bodywork and Movement Therapies found that myofascial release therapy was effective for various musculoskeletal conditions, including low back pain.

A study by Hains et al. (2010) in the Journal of Occupational Rehabilitation found that ischemic compression therapy, a soft tissue technique often used by chiropractors, was effective in reducing pain and disability in office workers with chronic low back pain.

These studies provide evidence for the effectiveness of chiropractic care in managing various types of low back pain. However, it's important to note that individual responses to treatment can vary.

Conclusion

Chronic low back pain is a complex issue with multiple potential causes and manifestations. Understanding the differences between acute and chronic pain, regular injuries and repetitive microtrauma, and the various types of pain (nerve, muscle, joint, and soft tissue) can help in identifying the root cause and determining the most appropriate treatment approach.

Always consult with healthcare professionals to receive a proper diagnosis and personalized treatment plan. Remember, early intervention and a proactive approach to spinal health can go a long way in preventing and managing chronic low back pain.

References:

1. Hoy, D., et al. (2012). A systematic review of the global prevalence of low back pain. Arthritis & Rheumatism, 64(6), 2028-2037.

2. Bronfort, G., et al. (2010). Effectiveness of manual therapies: the UK evidence report. Chiropractic & Osteopathy, 18(1), 3.

3. Meucci, R. D., et al. (2015). Prevalence of chronic low back pain: systematic review. Revista de Saúde Pública, 49, 1.

4. Haas, M., et al. (2014). Dose-response and efficacy of spinal manipulation for chronic cervicogenic headache: a pilot randomized controlled trial. The Spine Journal, 14(7), 1106-1116.

5. Barbe, M. F., & Barr, A. E. (2006). Inflammation and the pathophysiology of work-related musculoskeletal disorders. Brain, Behavior, and Immunity, 20(5), 423-429.

6. Rubinstein, S. M., et al. (2011). Spinal manipulative therapy for chronic low‐back pain. Cochrane Database of Systematic Reviews, (2).

7. Cramer, G. D., et al. (2013). Magnetic resonance imaging zygapophyseal joint space changes (gapping) in low back pain patients following spinal manipulation and side-posture positioning: a randomized controlled mechanisms trial with blinding. Journal of Manipulative and Physiological Therapeutics, 36(4), 203-217.

8. Leininger, B., et al. (2011). Spinal manipulation or mobilization for radiculopathy: a systematic review. Physical Medicine and Rehabilitation Clinics, 22(1), 105-125.

9. DeVocht, J. W., et al. (2005). Spinal manipulation alters electromyographic activity of paraspinal muscles: a descriptive study. Journal of Manipulative and Physiological Therapeutics, 28(7), 465-471.

10. Poulsen, E., et al. (2013). Patient education with or without manual therapy compared to a control group in patients with osteoarthritis of the hip. A proof-of-principle three-arm parallel group randomized clinical trial. Osteoarthritis and Cartilage, 21(10), 1494-1503.

11. Ajimsha, M. S., et al. (2015). Effectiveness of myofascial release in the management of chronic low back pain in nursing professionals. Journal of Bodywork and Movement Therapies, 19(1), 102-108.