Back Pain

Low back pain is a leading cause of disability at work and following motor vehicle accidents. Most of us will experience some form of back pain at some time in our lives. Not all pain can be cured, but usually it can be helped in some way, whether it is in the low back (lumbar region) or higher up.

Back pain has many causes.

Most often the cause is a soft tissue injury. This is often quite apparent by considering the circumstances. But it may be important to exclude more serious conditions. The U.S. Department of Health and Human Services published an excellent little booklet on acute low back problems in adults (Bigos, et al, 1994) which can be ordered from the Superintendent of Documents, P.O. Box 371954, Pittsburgh, PA, 15250, and by phone (202) 512 1800 or, if in the USA, (800) 358 9295. Ask for Publication No. 95-0643. Table 1 in that publication gives the following as "red flags" for potentially serious conditions. They are quoted verbatim with permission.

• Possible fracture.

  Major trauma, such as a vehicle accident or fall from a height.

  Minor trauma or even strenuous lifting (in older or potentially osteoporotic patient).

• Possible tumour or infection.

  Age over 50 or under 20.

  History of cancer.

  Constitutional symptoms, such as recent fever or chills or unexplained weight loss.

  Risk factors for spinal infection: recent bacterial infection (e.g., urinary tract infection); IV drug abuse or immune suppression (from steroids, transplant or HIV).

  Pain that worsens when supine [Comment: This should not be confused with difficulty finding a comfortable position]; severe nightime pain.

• Possible cauda equina syndrome.

  Saddle anesthesia.

  Recent onset of bladder dysfunction, such as urinary retention, increased frequency, or overflow incontinence.

  Severe or progressive neurological deficit in the lower extremity.

Once these conditions have been excluded there are three types of problems to consider that require three different treatment approaches.

• Pain due to disc pathology is often helped by back extension exercises.
• Pain in the back made worse by back extension probably relates to facet joint irritation and can be helped by flexion exercises.
• Pain related to muscle tightness, whatever the cause, can be helped by muscle stretching exercises.

An important principle to CONSIDER AT ALL TIMES is that any information found on the internet should be thought of as possibly having some educational value, but never as advice on how to treat your own personal problem. But with this information in your possession you can visit your health practitioner and better understand what that person says about your condition. The health visit then becomes a two-way dialoque in which you become an important and informed participant in the decision-making process.

A personal friend and long-time associate of mine has developed a backstretching device that works through gravity, the INVERCHAIR. All his life he has been a professional wrestler, winning numerous titles in the 60s and 70s. He won the title of World Wrestling Champion in 1971 and again in 1972. He devised the Inverchair to relieve his own back pain. It has been used successfully on many of my own patients as well as in many other clinics and sport centres throughout the world. In the wrestling world he is known as Waldo von Erich.

Recently he developed a new device that is light weight and portable. It is so inexpensive to manufacture that everyone could afford to buy one--and store it under the bed. He called it "ThePost". Unfortunately my good friend Waldo died July 5, 2009, before he could put it on the market.

If soft tissue injury pain persists there may be important psychosicial factors causing the pain to persist. Alternatively there may be signifiant ligament disruption causing Loss of Motion Segment Integrity (LMSI). This is a similar problem to what we see more frequently in the neck, following motor vehicle accidents. Here is some information on Loss of Motion Segment Integrity.

Back to the pain page

Created by: Don Ranney 2002/04/22.

Revised by: Don Ranney 2010/03/11.