Mechanical lower back pain

Posted On: October 31, 2011

My name is Dr. David A. Johnson and I am both a chiropractic physician and a doctor of physical therapy. I have been practicing for over twenty years after starting my practice in Lake Forest, Illinois in 1988.

In this blog I would like to explore lifestyle modifications that can help people who are managing lumbar disc injuries. My experience in this area is extensive, as I have helped hundreds if not thousands of individuals with discogenic lower back pain.

First some definitions, a disc bulge, a common term, is really nothing more than an early disc herniation. A disc herniation is the inner disc material called the nucleus breaks through its ligamentous containment, a structure called the annulus. The annulus has layers and if the inner layers only are compromised you will likely have a bulge. If more layers are compromised a herniation will result. If all the layers are compromised you will have an extravasation of the nucleus.

If the herniation gets close to nerve roots or spills inflammatory chemicals on a nerve root it will result in a radiculopathy or a radiculitis. The most common nerve roots involved are those of the sciatic nerve leading to sciatic pain or sciatica. This results in pain being experienced down ones lower extremity.

Not all cases of lower back pain are from disc herniation and more often than not the offending structures include other tissue that has been strained mechanically. This leads many physicians to diagnose mechanical lower back pain, nonspecific lower back pain or simply lumbago (a Latin word for lower back pain).

After years of practice and extensive studying it is my opinion that a lot of the cases of mechanical lower back pain have a discogenic component. I have found that if you treat the patient with mechanical lower back pain, with strategies that address the mechanics of the disc, there is a high degree of success.

These strategies include the following:

1. Avoiding lifting by bending and rotating at the waist
2. Avoid repetitive lifting tasks
3. Do not sit slouched
4. Bolster the curve in the small of your back with a paper towel roll
5. Avoid prolonged sitting
6. Take frequent micro-breaks from sitting, standing to stretch every 30 minutes
7. Walk for aerobic conditioning

At North Shore Spinal and Sports Rehabilitation we use a mechanical based approach to figure out which direction we should start the patient moving to help them heal. This approach was first popularized by a physical therapist named Robin McKenzie.

McKenzie identified that there were certain movements that further injured patients causing their pain to spread further from the injured site in a phenomenon called peripheralization. He also discovered that the opposite movement typically centralized the complaint to the spine. The movement that centralizes the patient’s complaint is the direction that will more often than not help the patient manage their complaint.

As someone who has examined thousands of spines I can often rapidly identify which movement the patient needs to focus on to help their healing process. I typically start the patients doing these restorative movements the day of their initial examination. The ability to identify the proper movement pattern, getting patients to perform the pattern and giving them advise on lifestyle modifications is one of the keys to my success in managing patients with mechanical lower back pain. If you have lower back pain and are looking for solutions to manage your problem, please contact my clinics for an examination.

To schedule an appointment, please call our Lake Forest, Lake Bluff office at 847.295.0920, or our Highland Park office at 847.432.4077. You may also use our online Request an Appointment form.