Low Back Pain Treatment- Longmont, CO

What causes lower back pain?

Amongst the most common causes of people seeking medical intervention is for low back pain (lumbago). It is also one of the leading causes of adult disability.

Proper treatment of low back pain requires properly assessing the cause. So what causes low back pain? Amongst the most common reasons people suffer from low back pain is due to repetitive, mechanical strain. In short, repeatedly inflaming and injuring the tissues of the lower back from poor posture or improper moving or lifting techniques. This is very common from the jobs we work and can be either from sitting at a desk (poor posture and lack of movement) or from improper mechanics (poor moving/lifting techniques).

Overtime, these chronic "micro-injuries" lead to repeated damage and inflammation to the structures of the lower back (muscles, tendons, ligaments, and joints). This, in turn, leads to chronic aching, stiffness, and soreness in the lower back, which will tend to get worse over time (a product of peripheral and central sensitization). 

Direct traumatic injury to the lower back, such as with lifting something too heavy or from engaging in competition is also a big player in low back pain, though not as common. Frequently, this type of injury will lead to chronic pain (sometimes years later) if proper treatment is not performed to heal soft tissue and reinstate inhibited muscles.

Some other common causes of low back pain include internal medicine conditions such as menstrual disorders (endometriosis for example). Kidney stones can also be a major cause of low back pain, specifically right or left sided low back pain (specific to the location of the kidney stone). These causes require treatment of the underlying condition in order to resolve the pain.

Internal inflammatory conditions, such as polymyalgia rheumatica or ankylosing spondylitis are also known causes of lower back pain. In these conditions, there is an autoimmune disorder which is leading to repeated inflammation on the tissues of the lower back. Treatment, in this case, needs to be geared not only toward the pain but also calming the immune response which is causing it. 

Disc pathology (herniated or bulging discs) are commonly believed to be a primary cause of low back pain; however, MRI studies show that many people have these issues but experience no lower back pain whatsoever. Having a disc bulge or herniation does NOT automatically mean that that is the cause of a person's low back pain. The only way to really confirm this is with a combination of MRI confirmation and a matching clinical presentation.

Low back pain with associated structures

Acupuncture being performed in the lower back

Acupuncture for low back pain

What to do for lower back pain?

To truly treat lower back pain effectively, it is important to properly assess and understand the processes involved in creating the pain. Without a proper understanding, treatments will at best give temporary relief or worse, can actually cause an increase in pain.

There are 3 key factors to take into consideration when looking into treating any type of low back pain issue: motor inhibition, peripheral sensitization and central sensitization. With an appropriate assessment, we can understand which of these issues is occurring and WHERE to begin the treatment process.

So what is motor inhibition? Motor inhibition is a distinct decrease in the function (strength) of a muscle. This can be caused by pain, trauma, or changes to a joint. 

In low back pain, the oblique muscles and the transverse abdominal muscles are almost ALWAYS inhibited. This is EXTREMELY important because these muscles directly support the lower back. If they are not working properly, repeated injury and inflammation to the lower back will continue.

The gluteus muscles are also extremely important and often inhibited in low back pain. Ever notice how some people have a foot (or maybe both feet) that splays out to the side? This is often a product of an inhibited gluteus medius muscle. This means that with every step you take, your body is receiving the impact of movement in a way that it was not designed to take. So even just simple walking or jogging causes undue stress on the body (not to mention being a big player in lower back pain).

Peripheral and central sensitization. When you experience some kind of injury (trauma or more likely, repetitive strain), there is an "ouch" signal that goes to your brain. The longer this pain signal remains, the more the tissues around this area will feel begin to get sensitive. This is called peripheral sensitization. It's the reason why a pain may have started at a single spot but now can be felt over a whole area, such as across your lower back.

As this process continues to occur, the pain signals being sent to the brain get amplified and eventually the entire body can become more sensitive. This is called central sensitization and represents increased sensitivity in the brain itself. We will often see this when a pain has been lingering for many months or even years. Because the brain is so sensitive, patients will often present with chronic pains in numerous other areas and can lead to widespread chronic pain conditions such as fibromyalgia.

At this point, it becomes important to cautiously proceed with treatment. When a body is in the grips of peripheral and central sensitization, local stimulus such as massage, chiropractic, or acupuncture can actually make the problem worse if it is done too aggressively. This will just further the central sensitization and perpetuate the chronic pain. This issue is likely why so many low back surgeries fail to relieve chronic pain. Rather than addressing the sensitization, the surgery creates further trauma and inflammation and additional pain signals, which just perpetuates the sensitivity already present in the brain.

So when we treat someone in this condition, it is important to address the sensitivity that is occurring at the brain level FIRST! By doing this, we can decrease the pain amplification and shift the nervous system into a more restful state (parasympathetic state). This will allow us to proceed further with addressing issues of motor inhibition and local tissue problems without worsening the patient's condition.

Acupuncture for low back pain

So what does acupuncture for lower back pain look like? First, your practitioner should make an appropriate assessment. This includes a detailed history of the issue and also a physical assessment looking for inhibited muscles associated with low back pain issues. Part of this process will be in determining the presence of peripheral or central sensitization. 

Once a proper assessment has been made, treatment will proceed based on which factors are present. In some cases, this may begin by using methods to decrease peripheral and central sensitization. Often this looks like acupuncture and electric stimulation on areas that may be no where close to the lower back. The benefit of proceeding in this way is that we avoid worsening sensitivity and often this type of treatment can help to relieve lower back pain fast.

Treatment of motor inhibition is also a major aspect of eliminating lower back pain. This may begin on a first treatment or it might be important to wait until sensitization has decreased. This will involve simulating motor points in the inhibited muscles and then retesting these muscles to ensure that strength has returned. In many cases, patients will notice an immediate improvement in the strength of these muscles.

As these issues are corrected, your practitioner can proceed further with applying proper treatment to affected tissues in the lower back (muscles, tendons, joints, etc.). This may also include the use of internal medicines or topical medicines to aid in addressing pain and inflammation. By proceeding in this way, we can treat all aspects contributing to chronic lower back pain, which means long term relief or even total elimination of the pain.

Fortunately, the research for the use of acupuncture for low back pain is extremely positive. Many large scale trials have been done demonstrating not only that acupuncture is an effective treatment method, but that it may actually be one of the best ways of treating chronic lower back pain. 

Acupuncture on the lower back
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