Jack Rogers, Chiropractor | Pinnacle Spine & Sports, Concord West, Sydney

By Jack Rogers | BChiroSc, MChiroprac

If there’s one question we hear on a daily basis, this is it. The conundrum of low back pain is one that has plagued doctors of all types for centuries – just what is going on with low back pain?

Consider this staggering statistic – chronic pain (including low back pain) costs our healthcare system more than cancer, heart disease and diabetes….COMBINED.

Back pain is a complex issue, and there’s much that can be said about its causes. But for the sake of brevity and for the purpose of this post, we’ll narrow it down to what the evidence says about the location of low back pain, and how you might be able to tell what structure is responsible for your condition.

Over 92% of all low back pain episodes are caused by three structures:

  • The intervertebral disc (40%)
  • The facet Joints (30%)
  • The sacroiliac joints (22.5%)

The anatomy of these 3 structures can be seen below:

Each of these structures present several key clinical signs that allow us to diagnose your back pain. It’s not always a black & white case, but the following key features are fairly characteristic of pain being generated by these areas:

FACET JOINT PAIN

  • Best on walking and sitting
  • Pain is distributed wide of the spine
  • Not worsened by sit-to-standing
  • Increased likelihood >50yrs old

DISC PAIN

  • Pain located centrally on the spine
  • Worsened by sit-to-standing
  • Increased likelihood <50yrs old
  • May be associated with lower limb symptoms if nerve involvement occurs

SIJ PAIN

  • Pain at pelvic level (below spine) and wide
  • No spinal pain
  • Worsened by sit-to-stand

As the picture below shows, disc-mediated pain is central in nature, whilst facet joint pain is wide of the spine. Sacroiliac joint pain is below the level of the spine.

Clinical Development International (2019). Dr A. Nicholson, Dr M. Long.

Regardless of where your pain is currently coming from, paramount to your care is determining what movement patterns have broken down to cause this in the first place. Our goal is to remove the pain-generating stimuli, then work with you to fix the faulty motor patterns and mechanical dysfunction that was probably there for a lot longer than the injury itself.

If you’re suffering low back pain, you can trust us to determine the cause and work with you to get back to everything you love doing as quickly as possible.

References:

Young S, Aprill C, Laslett M. Correlation of clinical examination characteristics with three sources of chronic low back pain. The Spine Journal, 2003;3(6):460–465

Schwarzer AC, Aprill CN, Derby R, et al. Clinical features of patients with pain stemming from the lumbar zygapophysial joints. Is the lumbar facet syndrome a clinical entity? Spine. 1994;19(10):1132–1137

Laupacis, A., Sekar, N., & Stiell, I. G. (1997). Clinical prediction rules. A review and suggested modifications of methodological standards. JAMA, 277(6), 488–494