Degenerative Low Back Pain
By Don Williams
B.Sc., M.Chiro., ICSSD., PG Dip. NMS Rehabilitation,
Cert. DNS. Memb: CAA. FICS, CEA.
Low back pain is an extremely common problem impacting on a huge proportion of our population.
Statistics suggest that 80% of society will suffer back pain in their lives and in any given year, almost 60% of the working population will miss at least 1 day of work due to back pain.
But what causes back pain and how do we address it?
There are many different structures within our back, neck and body which can cause pain, including; the intervertebral disc, muscles, ligaments and facet (or zygopophyseal) joints. These are simply the basic musculoskeletal structures, however, sometimes back pain can be referred from internal organs, some common culprits are; uterine fibroids in females, bowel obstructions, kidney infections, aortic aneurysms, gall stones, stomach ulcers and malignancies or cancers.
Obviously, it is important when you have back pain to have it thoroughly assessed to identify whether it is a musculoskeletal complaint or whether it is a referred problem or something more sinister.
If the problem is musculoskeletal then there may be a range of treatment options available; Including Acupuncture, Chiropractic, Remedial Massage, Exercise or Physiotherapy. Some people will find heat or ice may help and some people will respond to pharmaceuticals. In fact, if you believe some of the advertisements on Television (with celebrity swimmers posing as experts) you could be forgiven for thinking that drugs will in fact cure that back pain, rather than the reality of which they will mask the pain until the body has recovered.
Certain presentations or complaints seem to respond well to different intervention strategies.
What works for one person will not always work for the next person. Good practitioners should have a range of available strategies to apply based on the response of the patient.
We sometimes have patients present to our clinic who have been told that they have “Arthritis”, or a “Degenerative Back” and they will have to live with it, however rarely is back pain this simple. We know that in clinical presentations, the amount or level of degeneration is not well correlated with the amount of back pain people experience. This simply means, sometimes people have awful degeneration and no pain and sometimes people have great xrays with no degeneration and lots of pain. If you have been given a diagnosis of, “it is arthritis and you will have to live with it”, then seek a second opinion. You may be able to have treatment which will significantly reduce or even eliminate your pain.
Degenerative Spine Healthy Spine
There are a number of different types of arthritis which can influence or affect the spine, broadly categorised into inflammatory arthritis (such as Rheumatoid Arthritis) and Degenerative arthritis.
Inflammatory arthritis can be quite problematic. Although the disease process is not directly treatable my musculoskeletal practitioners, the normal mechanical pain and dysfunction can still be treated.
Degenerative arthritis is the process in which wear and tear over a period of time causes the joints to degenerate. This can result in stiffness or a reduction in the range of motion. This will often respond quite well to treatment. The biggest question generally surrounds the issue of whether the degeneration has actually been there for a period of time and the pain is as a result of an overload or injury which has triggered the reaction or whether the body has hit a tipping point in which the degeneration has built up to a degree that the body is not going to tolerate it anymore.
Everyone starts to degenerate when they reach adulthood. Essentially there is an age correlated expectation for the amount of degeneration that we have. Issue may arise when we degenerate more quickly than expected, or when this degenerative change starts to impact on the nerve and spinal cord. The interesting thing about degenerative compression of the nerves is that the signs and symptoms are somewhat different than those we see from an abrupt episode of compression or a disc injury. This is thought to be as a result of the body’s innate ability to adapt to change and degeneration.
Generally speaking, the more degeneration is present, the more conservative treatment is. Just because you have advanced degenerative change does not mean you cannot have conservative treatment. Skilled practitioners will always assess your presentation and will apply treatment that takes your history and presentation into account. People with significant degeneration may be contraindicated for certain treatment methods, which will normally be discussed at the time of treatment.
The unfortunate circumstance is that people who don’t respond well or not at all often face quite aggressive intervention and surgery, which is of course a last resort when all else has failed.
If you have been told that you have “arthritis”, or “spinal degeneration”, then all is not necessarily lost, they may still be conservative strategies that work for you.