Where the pain is matters
“Back pain” covers three quite different regions, and they tend to fail in different ways.
- Lower back. The most common by a distance, and the region that carries the most load. Covered in detail below.
- Mid back (thoracic). Often stiffness rather than sharp pain, frequently related to sustained desk posture, and a common hidden driver of neck and shoulder problems. When the mid back stops rotating, the neck and shoulder do more than their share.
- Upper back and between the shoulder blades. Commonly a combination of thoracic joint restriction and the muscular load of holding the head forward for hours a day.
Low back pain that seems to come from nothing
The classic story: you bent to pick up a sock, or reached into the boot, and your back went. Something that trivial cannot really have caused an injury, and it did not. It was the last repetition of a movement pattern that had been loading that segment poorly for a long time.
Joints adapt to how they are loaded. Load them well and they hold up. Load them poorly, awkwardly, repeatedly, for years, and they change shape in response. That process is gradual and usually quiet, which is why the first sign of it is often pain that seems to arrive out of nowhere after a decade of nothing.
What is generating low back pain
Low back pain is not one diagnosis. The structures that commonly produce it include:
- The facet joints: the small paired joints at the back of each segment. Typically worse with extension and rotation, often eased by sitting forward.
- The discs: often worse with sustained flexion and sitting, and sometimes referring into the leg. See disc herniation and bulging discs.
- The sacroiliac joints: usually felt lower and to one side, around the dimple of the pelvis.
- Muscular and myofascial structures: frequently secondary to one of the above rather than the primary problem.
Where pain travels down the leg past the knee, or comes with pins and needles or weakness, nerve involvement is likely: see sciatica.
Why it often is not where you think
The spot that hurts is frequently the structure that has been compensating, not the one that stopped working.
A stiff mid back asks the low back and the neck to make up the difference. A hip that does not extend asks the lumbar spine to. Neither compensation hurts at first: it just quietly loads a structure beyond what it is built for, until that structure complains. Treat only the complaining structure and you get relief, then recurrence.
That is why the examination looks at the whole spine and how it moves as a chain, rather than at the sore segment alone.
Seek urgent medical care if you have
Loss of bladder or bowel control, numbness around the groin or inner thighs, progressive limb weakness, severe pain after significant trauma, or back pain with unexplained weight loss, fever, or night pain that does not change with position.
How we assess it
A first visit takes about 30 minutes: a full history (what it is stopping you doing, what makes it better and worse, what you have already tried), a physical examination of movement and load through the whole spine and pelvis, and relevant neurological and orthopaedic testing. Then a clear explanation of what we found and what we would recommend, including whether we are the right people to help.
Where the picture is unclear or the findings warrant it, we have digital imaging on-site, including objective range of motion measurement so progress can be compared against a number rather than a memory.
What care might involve
- Adjustment where segmental movement has been lost
- Rehabilitation and PowerPlate for the loading and strengthening side: the part that holds the change
- Cold laser therapy where the region is irritable
- Spinal decompression for particular persistent presentations where offloading a segment is appropriate: assessed first, and reviewed against baseline scores at four weeks
Not everyone needs all of it: most people need one or two.
What we can honestly promise
Not a guaranteed outcome. What you will get is a proper examination, a clear explanation of what we found, a recommendation with a review point attached, and an honest answer if chiropractic is not the right approach for what is going on.
Related
If pain is travelling into a leg see sciatica; if into an arm, see neck pain. For disc-related presentations see disc herniation and bulging discs. For desk-driven strain see posture correction.