What causes Chronic Low Back Pain?

If you asked people what causes chronic low back pain (pain lasting > 3 months) – most people would answer disc, joint, and muscles problems – and this would be mostly correct. Now acute low back pain and chronic low back pain are two separate animals in how they respond to treatment, so here we will discuss chronic low back pain (CLBP).

Medical literature tells us that chronic low back pain is caused by:

40% – disc

30% – facet joint (joints in your spine)

20% – sacroiliac joints

10% – undifferentiated low back pain

But, what causes these tissues to become damaged, painful, and start to degenerate? How does this happen? 

Research is pointing towards hypermobile joint segments, proprioceptive deficits, and instability in the spine as the beginning of this degenerative and painful cascade. (Proprioception is the awareness of self movement and body position in relation to its surroundings) .

So what causes this hypermobility and instability?

The answer to this is both physical and neurological. 

CLBP patients show deficits in spinal sensation, a decreased ability to accurately position their trunk/torso, and Multifidus muscle wasting. CLBP patients also show reorganization of the motor cortex and postural control deficits. (Lumbar multifidus is the main segmental stabilizer of the low back and is primary proprioceptive apparatus).

This all leads to limited awareness of trunk movements and position.

Basically – your back can’t sense it’s position well, can’t respond to changes in movement or forces applied to the body fast enough to prevent injury, and the muscles that are largely responsible for this are typically weak.

Imagine playing dodgeball, and you have slow reflexes… probably isn’t going to work out very well, you are going to be hit because you can’t react fast enough to get out of the way. Same with your back, it sustains damage to the tissue – muscles (specifically Multifidus), joint, and disc. 

According to O’Sullivan et al (1), “Proprioceptive deficit may lead to delayed neuromuscular protective reflexes and coordination such that muscle contraction occurs too late to protect the joint from excessive joint movement. It has been hypothesized that this may lead to abnormal loading transmitted repetitively across joint surfaces, resulting in pain and articular damage.”

The takeaway here is that proprioception plays a key role in chronic back pain.

I mentioned the multifidus muscle as an important player in this whole process of strength, instability and chronic low back pain.

The good news is we can address this? 

Two ways to address this are:

1 – mechanical and neurological stimulation to the central nervous system through mechanical manipulation of the facet joints (adjustments/joint manipulation). This increases signalling to the brain so your brain and back communicate better. This also affects the size and strength of the Multifidus muscle.

2 – targeted strengthening of the lumbar Multifidus with pelvic stabilization on the Medx lumbar rehab equipment which is proven in research to be the best way to strengthen the low back.

I will dive into the neurological aspects of the adjustment and what it does in regards to the Multifidus muscle and how the nervous system responds to it, as well as how to target the Multifidus with strengthening on the Medx lumbar rehab machine in posts to follow.

If you have low back pain that does not want to go away – we may have a solution!

References:

1. O’Sullivan PB, Burnett A, Floyd AN, Gadsdon K, Logiudice J, Miller D, Quirke H. Lumbar repositioning deficit in a specific low back pain population. SPINE 2003; 28 (1): 1074-1079

2. Tsao H, Galea MP, Hodges PW. Reorganization of the motor cortex is associated with postural control deficits in recurrent low back pain. Brain 2008; 131: 2161-2171

3. Brumagne S, Cordo P, Lysens R, Verschueren S, Swinnen S. The role of paraspinal muscle spindles in lumbosacral position sense in individuals with and without low back pain. Spine 2000. 25 (8) 989-94

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