Why does my back hurt?

Back Pain Defined: It’s as easy as 1, 2, 3…

Back pain can be very troubling. It is often mysterious, showing up without any traumatic incident, and fluctuating unpredictably. Fortunately, most back pain is not serious and can heal without major intervention such as injections or surgery.  Below are the 3 main causes of back pain. 

Back pain typically has 3 causes:

1. Disc Herniation, or disc bulge. Referred to by non-medical professionals as “slipped disc”
2. SI Joint Dysfunction, or problems in the pelvis
3. Stenosis, or arthritis of the spine

Disc herniation

A disc herniation, or disc bulge, is typically caused by bending, lifting, and/or twisting, with or without weight. It can also crop up due to long term sitting or standing with bad posture. The number one sign of a disc bulge is pain radiating into the buttocks and down the leg. This symptom is termed sciatica, named for the sciatic nerve. This nerve runs down both sides of the body from the low back, through the buttock, and down into the calf. Sciatic pain can be accompanied by weakness, numbness, and tingling. It often gets worse with bending forward and sitting, and better with standing up and walking.

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Most of the time, sciatic symptoms improve and dissipate over a period of one to three months. Conservative management of a disc bulge is successful the majority of the time. This consists of physical therapy to address inflammation, spine alignment, disc compression, muscle spasm and weakness. If you have loss of bowel or bladder control or weakness so severe that your leg is “giving out”, then it would be wise to consult a physician. In very rare cases you may need a surgical consult. The most common surgical procedures are laminectomy, discectomy, and/or fusion. Surgery is truly your last resort and should only be considered if conservative management has failed, or if the bulge is so severe that weakness progresses at a rapid rate.

SI joint dysfunction

The second common cause of back pain is SI joint dysfunction. You have two SI joints, one on each side of the low back, located where the top, flat part of your tail bone, as opposed to the bottom curvy part, meets your pelvic bones. People often have little indentations, or dimples, over the area of the SI joint in the very low part of their back.

SI joint pain is often located right over the SI joint on one or both sides of the body, but can also radiate into the buttock, groin, and down the thigh, similar to sciatica. The development of SI joint dysfunction is most often associated with pregnancy, but can also develop after a fall onto the buttock, a misstep off of a curb, or any other asymmetrical movement or weakness in the pelvic, abdominal, or leg regions. Functionally, people with SI joint issues may complain of difficulty performing movements that are one-sided, such as climbing stairs or stepping up onto a curb. They may feel a general malaise or dull ache throughout the buttock, hip, and groin region that is hard to define or explain. Often these people feel imbalanced, as though one leg is longer than the other, or they may notice that one leg turns out or in further than the other when standing, walking, or lying down.

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SI joint issues resolve readily with conservative management including physical therapy and strengthening. Physical Therapists are experts at regaining alignment in the pelvis, addressing muscle strength imbalance, and improving functional mechanics to restore balance between the two sides of the body. Many people with SI joint pain feel great relief just after one visit to a physical therapist, due to some specific manual techniques that can restore alignment to the pelvis almost immediately.

Spinal stenosis

The third common cause of back pain is spinal stenosis, or arthritis of the spine. Stenosis occurs when there is a narrowing of the holes through which the spinal cord and nerves pass, and this narrowing causes impingement or pressure on the nerves, similar to how a disc bulge causes pressure on a nerve. The difference between stenosis and a disc bulge is that spinal stenosis is a diagnosis associated with aging and general wear-and-tear of the spine vs. bending/lifting/twisting trauma. Most people with stenosis are over the age of 50. Another differentiating factor between stenosis and a disc bulge is that people with stenosis tend to feel better sitting or standing in a hunched forward position. This relieves the pressure that the bones themselves are putting on the nerves and, therefore, decreases symptoms. Common symptoms related to stenosis in the low back are pain, cramping, weakness, numbness, and tingling which occur in either one, or both legs.

Spinal stenosis is a little trickier to treat than the other 2 diagnoses. You can’t stop the aging process; it is a part of life and, unfortunately, some people have more of a propensity for osteoarthritis than others. What is possible, though, is regaining mobility in the spine and decreasing pain in the legs with mobilization, stretching, and functional movement. Physical therapists understand how to safely move the body of someone with stenosis, without causing an increase in pain and irritation. Treating stenosis is really about maintenance of the mobility and space that remains in your spine in order to delay further progression of immobility. Occasionally people do opt for surgical intervention to remove excess bone from the nerve impingement site. If conservative management is not successful, pharmaceutical or surgical intervention are likely necessary to maintain a good quality of life.

See the experts

So that’s back pain: Easy as 1,2,3. If you are suffering from any of the symptoms discussed in this post, you should come in and see us at MoveMend! You can easily schedule your initial physical therapy examination online here. 

 Also, it is no longer required for you to have a referral from your physician to see a physical therapist in the state of Washington.

Written by Dr. Ryan Simmons

Director of Physical Therapy at MoveMend