Low back pain is one of the most common musculoskeletal conditions affecting Australians.

Statistics show that over 80% of the population will be affected by low back pain at some point in their lifetime.

Low back pain is a symptom, it’s a not a diagnosis. There is usually a specific condition that is responsible for causing your low back, hip or even sciatica type pain.

Chiropractors treat these common conditions that could be responsible for causing low back pain.

Sacroiliac Joint Dysfunction

Lumbar Strains & Sprains

Facet Joint Syndrome

Intervertebral Disk Disorders

Sacroiliac Joint Dysfunction

Pain referral from one of the sacroiliac joints usually presents as low back or deep buttock pain.

Sometimes there may be pain referral into the groin or hamstring area on the side of the affected joint. The sacroiliac joints are formed between the sacrum and the left and right iliac bones (pelvis).

Sacroiliac Joint dysfunction can cause:

  • Low back pain when going up and down stairs.

  • Difficulty rolling over in bed.

  • Leg pain that might feel like sciatica.

man with sacroiliac joint dysfunction
Anatomical model with sacroiliac joint pain

Causes of sacroiliac joint pain

  • Compression and twisting of the spine. E.g. lifting a heavy object

  • Contact sports

  • Prolonged sitting

  • Differences in leg length

  • Muscle imbalances between hip flexors and extensors

  • Pregnancy and child birth

  • Ankylosing spondylitis

Treatment

Sacroiliac joint dysfunction responds well to manual hands-on therapy including mobilisation and manipulation. Stretching of over-active hip flexors and surrounding soft tissues can also be beneficial.

Exercises will also be prescribed to improve muscular control in the lumbar spine (low back) and pelvis.

Lumbar Strains & Sprains

A lumbar strain is when a muscle in the low back has been injured. A Strain is when a ligament or joint has been injured.

Strains and sprains are often are often traumatic injuries that present with similar pain patterns. Pain can cause the body to compensate, resulting in dysfunctional movement patterns and spinal instability.

Patients with a lumbar strain or sprain might:

  • Feel low back discomfort while sitting or standing.

  • Be unable to exercise at a high intensity.

  • Have swelling around the affected muscle in the low back.

runner with lumbar sprain strain low back pain
anatomical model with low back strain

Causes of lumbar strains & sprains

  • Overexertion at work or sport

  • Aggressive stretching of the low back

  • Whiplash or motor vehicle accidents

  • Heavy lifting with poor lifting technique

  • Poor posture and muscle imbalances

Treatment

Soft tissue therapy including massage, taping and stretching can be used to control the inflammation and swelling. Dry needling can help decrease muscle spasms and pain.

Rehabilitation exercises focus on retraining muscular control in the hips and low back, which helps prevent these kinds of injuries from reoccurring. Postural muscle imbalances will also need to be corrected with stretching and exercises.

Facet Joint Syndrome

Facet joint syndrome is one of the most common causes of low back pain. They can cause referred pain into your buttock or leg that may mimic a nerve entrapment or intervertebral disk injury.

The facet joints are found between your vertebrae that make up your spine. They allow for certain movements in the lumbar spine such as flexion, extension and a small amount of rotation Facet joints provide some stability in the lumbar spine by limiting side-to-side movements.

A patient with facet joint syndrome might experience:

  • Pain when moving from a sitting to a standing position.

  • Severe muscle spasm. The body is trying to protect the painful facet joint.

  • Discomfort when bending forwards then standing upright again.

  • Sharp low back pain when hyperextending your spine.

facet joint dysfunction pain referral pattern
anatomical model with lumbar facet syndrome and low back pain

Causes of Facet Joint Dysfunction

  • Overexertion & fatigue when performing physical tasks

  • Sports that require hyperextension and rotation of the spine

  • Poor posture, muscle imbalances & compensation

  • Lumbar spine instability

  • Prolonged sitting

Treatment

Pain relief is the primary goal. Hands-on treatment of the joints in the spine can help promote normal movement and decrease pain and muscle spasm.

Stretching and exercise rehabilitation will focus on improving any muscular imbalances.

Sport specific biomechanics need to be considered if you have sport related low back pain. Incorrect technique or equipment could be aggravating your condition.

Intervertebral Disk Disorders

The intervertebral disks function as shock absorbers between the vertebrae. Herniated disks can compress the nerves that run into our legs and feet causing numbness, tingling and/or weakness.

As we age our disks lose fluid, this is a normal part of ageing. The outer part of the intervertebral disk (annulus fibrosis) loses elasticity and degenerates, allowing the inner core (nucleus pulposus) to herniate or bulge outwards which can compress nerves.

The term “slipped disk” is often used to describe the condition but is incorrect as disks do not actually slip or move, they herniate.

Symptoms of intervertebral disk disease include:

  • Constant or intermittent low back

  • Sciatica

  • Numbness or tingling in the legs and/or feet.

  • Weakness in the legs and/or feet

  • Bowel or bladder control issues.

intervertebral disk herniation low back pain
intervertebral disk buldge

Risk factors for Intervertebral Disk Disease

  • Age & gender. Men between 30 – 50 years old are at the highest risk.

  • Smoking decreases oxygen supply to the disks, increasing the rate of degeneration.

  • Sedentary lifestyle. Intervertebral disks require movement to stay healthy.

  • Incorrect lifting technique. Lifting with your back in a rounded posture puts far more pressure on the disks.

  • Poor posture. A flat low back means there is increased pressure on the disks.

  • Repetitive manual tasks. Bending, twisting and heavy lifting can cause micro-trauma to the disks.

  • Being overweight puts increased strain on the disks.

The onset of pain from a damaged or herniated disk may be sudden or gradual after an injury.

Sometimes patients may not recall a previous injury or exactly when the injury may have occurred. They might have experienced less severe or intermittent low back pain that resolved on its own.

A single incident of heavy lifting and twisting may be enough to herniate a disk.

The pain usually feels sharp or like an electric shock that is worse when coughing, sneezing or prolonged sitting or standing. Lying down may provide temporary relief for patients with a herniated disk.

Recovery time for a herniated disk can take anywhere from 6 weeks up to 6 months.

Conservative treatment should always be attempted before considering surgery.

Sometimes surgery may be necessary if you fail to respond to conservative care or if you experience severe neurological loss. Factors such as your age, clinical presentation and overall health needs to be considered. But it’s usually advisable to attempt conservative treatment first.

The first few days of treatment focus on reducing (centralising) leg pain, decreasing inflammation and the compression on the nerves. Joint mobilisation is used to promote normal movement in the spine which helps reduce muscle spasm and pain.

Treatment

Intervertebral disk treatment and rehabilitation will consist of hands-on treatment in the practice to help improve movement and give you pain relief.

You will also be shown how to protect your back, what activities are safe and what should be avoided while you recover.

Home care for intervertebral disk herniations will consist of repetitive movements into a pain-free zone, specific stretches and core stabilising exercises.

Bed rest is not recommended, however it can provide temporary relief if necessary. But it is important to continue to stay active so that the stabilising muscles of the spine don’t become weak as this could delay recovery.

Muscle imbalances and movement issues will continue to be monitored throughout your recovery. The goal is to restore proper biomechanics and core strength with rehabilitation exercises.

sports chiropractor performing dry needling on a patient

Exercises used for treating or preventing low back pain

The exercises shown below can be used as part of a low back pain rehabilitation program.

The Plank

Side Plank

Bird Dog / Quadruped Reach

McGill Curl-Up

Single-Leg Glute Bridge