Low back pain

Low back pain can be either an acute or chronic disabling condition. It will affect most people at some stage in their life and accounts for more sick leave taken than any other single condition.

An acute lower back injury may be caused by a traumatic event, like a car accident or a fall. It occurs suddenly and its victims will usually be able to pinpoint exactly when it happened. In acute cases, the structures damaged will more than likely be soft tissue like muscles, ligaments and tendons. With a serious accident, vertebral fractures in the lumbar spine may also occur.

Chronic lower back pain usually has a more insidious onset, occurring over a long period of time. Physical causes may include osteoarthritis, rheumatoid arthritis, degeneration of the discs between the vertebrae or a spinal disc herniation, or tumors (including cancer). However, some causes are psychological or emotional, and have been diagnosed as TMS or tension myositis syndrome.

Causes
Possible causes of low back pain:


 * Mechanical:
 * Apophyseal osteoarthritis
 * Ankylosing hyperostosis
 * Scheuerman's osteochondritis
 * Spinal disc herniation
 * Spinal stenosis
 * Spondylolisthesis and other congenital abnormalities
 * Fractures
 * Non-specific
 * Leg Length Difference
 * Restricted internal hip rotation
 * Misaligned coxis (Pelvic Girdle)


 * Inflammatory:
 * Seronegative spondylarthritides (e.g. ankylosing spondylitis)
 * Rheumatoid arthritis
 * Infection


 * Neoplastic:
 * Bone tumors (primary or metastatic)
 * Spinal tumors


 * Metabolic:
 * Osteoporotic fractures
 * Osteomalacia
 * Ochronosis
 * Chondrocalcinosis


 * Paget's disease


 * Referred pain:
 * Pelvic/abdominal disease
 * Posture


 * Tension myositis syndrome


 * Depression

Diagnosis
Often, getting a diagnosis of the underlying cause of low back pain and/or related symptoms, such as sciatica, is quite complex. A complete diagnosis is usually made through a combination of a patient's medical history, physical examination, and, when necessary, diagnostic testing, such as an MRI scan or x-ray.

Diagnosis of leg length difference is quite easy. Just stand in front of a mirror in your underwear on a flat, level floor in front of a mirror (a bathroom is usually good). Look at your hips to see if they are level. If one seems higher, put a magazine under the short leg. Keep adding magazines until your hips look level. Measure the height of the magazines. This is the difference in the length of your two legs. 90% of the population has a leg length difference; the same percentage that experiences lower back pain during their lifetime. A difference of only 1% would be 1/3rd inch or more.

Diagnosis of restricted internal hip rotation is also easy. Lie on your stomach with your legs together. Bend your knees 90 degrees so that the soles of your feet point up toward the ceiling. Keeping your knees together, move your feet apart. Your lower legs will form a V. Have someone measure the angle of each lower leg in relation to a vertical line. The angle should be the same for both legs. Each leg should be a minumum of 45 degrees; 60 degrees if you play golf or tennis. Vad, et al, found restricted internal hip rotation on the lead hip associated with lower back pain in professional golfers.

Treatments
The course of treatment for low back pain will usually be dictated by the diagnosis of the underlying cause of the pain. Rarely, low back pain will require surgery. For the vast majority of patients, low back pain can be treated with non-surgical care. Typical non-surgical treatments for low back pain includes:


 * Chiropractic manipulation
 * Acupuncture treatment
 * Physical therapy and exercise
 * Pain medications, such as NSAIDs or acetaminophen
 * Ice and/or heat application (or moist heat)
 * Education and attitude adjustment (TMS)
 * Correcting leg length difference
 * Increasing internal hip rotation
 * Muscle Energy Technique (MET) and massage therapy

If the pain is severe and does not respond to non-surgical treatments, patients may elect to have surgery to correct the problem causing the pain (e.g. a lumbar disc pressing on a nerve).

To correct leg length difference, insert a hard rubber or cork heel pad into the shoe of the short leg if the difference between the two legs is 3/8ths inch or less. If more, have a shoe repairman build up the sole and heel. Taper the toe to avoid tripping. If more than 3/4 inch, start with 1/2 of what you need so that your body can adjust.

Increase internal hip rotation with stretching or connective tissue massage. Hatha Yoga is an excellent adjunct to professional treatment.