Is my back pain just muscular?

One of the common statements we hear from patients is, “My back pain is just muscular”. And by this they mean a strain, like what might happen if you over stretched your hamstring or calf. Well, let’s explore this further.

How common is low back pain?

Firstly, about 1 in 6 Australians live with low back pain (LBP). Most of these cases are described as Non-specific back pain. In other words, most of the time, no single structure can be blamed.

Common structures that can cause low back pain?

MUSCLES: There are many muscles that move the spine – both deep core muscles that control stability and big superficial muscles that give shape to the body and move large sections of the spine.

DISCS: These are weight absorbing shock pads that also create space for spinal nerves to exit. Discs can bulge and herniate. In doing so they can compress the spinal cord or spinal nerves. Only the outermost portion of a disc has a nerve supply. Therefore, you can only feel disc pain if the outer disc is damaged. Hence why many bulges do not produce pain.

FACET JOINTS:  These are small joints that sit at the back of the spine and guide spinal movement. These joints can become locked, irritated or inflamed. Injury to facet joints are very common and typically respond very well to chiropractic care.

SACRO-ILIAC JOINTS (SIJs): These are large joints on the left the right side of the pelvis that transfer weight through the lower limbs into the spine. Although they have very little movement (only 1-4deg), they can lock up, become degenerative or unstable. An unstable pelvis is often seen in pregnant women.

The master controller

And of course you have the brain, spinal cord and entire nervous system, that work like the conductor to keep this magnificent machine humming along nicely. When a chiropractor works with your body, it is ultimately your nervous system they are thinking about.

Diagnosis matters

So, an exact diagnosis is sometimes a little tricky. Understanding that there is significant overlap with LBP, the ultimate diagnosis may involve multiple structures.

The difference between Muscular and Disc low back pain

There are clues that distinguish between LBP from muscular strain versus disc damage. This is important because the treatment and prognosis for these conditions are quite different.

Disc

  • Onset may be related to bending, twisting, overstraining, but there is often a build up over time
  • Pain is sharp, deep and catching
  • In addition to LBP, sciatica may also be present
  • Worse with sitting and bending forward
  • Better with bending back – hence extension exercises work better
  • May be aggravated by a cough or sneeze
  • May be associated with antalgia – bent to side or can’t straighten up
  • On testing may have abnormal sensation or reflexes in the lower limb

Best exercise might be standing low back extension – be sure to squeeze buttocks.

Muscular

  • Onset may be related to bending, twisting, overstraining, but not necessarily with a history pain
  • Pain achy and dull
  • Low back pain may refer into buttocks, but not below knee.
  • Also worse bending forward, but less aggravated by sitting than disc problems
  • Better with bending back, but may also benefit from slow and gentle forward stretching to tolerance
  • Not aggravated by cough or sneeze
  • Unlikely to have antalgia
  • Normal sensation and reflexes in the lower limb

As low back pain settles, you can often progress quickly to slow and gentle flexion stretches such as Prayer Stretch or Pose of the Child.

Chiropractic care

So, there you have it. Now you have some clues to distinguish between muscular and disc problems. But whatever the problem, remember nothing helps more than professional care.