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Low back pain is becoming increasingly common, with up to 80% of people experiencing low back pain at some point in their life. This is particularly true in large centres like downtown Toronto, where sedentary desk work, poor postural habits, and decreased overall activity, have all combined to increase the stress and strain on the lower back and the incidence of injury. The degree of pain ranges from mild discomfort to acute and debilitating chronic pain, with low back pain now the number one cause of disability worldwide.
Back pain that is not appropriately treated in the early stages may lead to more chronic pain conditions over time, with frequent reoccurrences and flare ups. Because the nerves in the lumbar spine control sensation and muscle strength in the lower back and legs, down to the feet, a progression in the condition can lead to pain in the buttock area, radiating and referred pain into the legs, and eventually sciatica pain. This may be further complicated by lumbar disc issues (degenerative disc disease, disc bulges or herniated discs) and conditions like spinal stenosis.
Taking proactive steps to avoid this progression is one of the most common reasons people consult with a back pain chiropractor. In the majority of cases, with early intervention, back episodes will improve with chiropractic care treatments after only a few days, while more complicated clinical presentations where the pain persists may require advanced diagnostic imaging and more comprehensive treatment strategies for complete recovery.
A proper diagnosis of the underlying cause of your back pain or neck pain is critical for proper treatment, and for your successful long-term recovery.
The first step is a detailed patient history and consultation, looking at the any lifestyle factors, occupational stresses and traumas, which may be contributing to your low back pain. This is followed by an assessment, to examine the movement of your low back and any restrictions, your posture, and to conduct orthopedic and neurological testing.
If warranted, based on your assessment findings and any neurological or lumbar disc concerns, your doctor of chiropractic may recommend advanced diagnostic imaging, such as an MRI or X-ray, to better understand your condition.
There are many causes and risk factors for low back pain and neck pain, but some of the most common include: chronic postural strain and stress from prolonged sitting, poor overall posture, poor sleeping posture, general inactivity and de-conditioning of postural and spinal muscles, sprain strain sports injuries, occupational stress from repetitive bending and lifting, heavy lifting and other acute injuries. Additional causes include:
Due to occupational stress injuries, chronic postural stress, sports injuries and trauma, associated muscles, ligaments and joints of the lower back can be strained and injured, resulting in an inflammatory response and pain. A proper assessment to identify the injured tissues, with appropriate treatment, stretches and exercises, can greatly improve the symptoms, and help to prevent future occurrences of both back pain and neck pain.
The facet joints, or zygapophyseal joints, are located in the back of the spine. These joints are particularly vulnerable to repeated extension of the lower back, such as prolonged leaning backwards or arching of the back. This may compress and potentially damage these joints, resulting in localized pain.
Chronic postural stress, prolonged sitting, and repeated bending and twisting and heavy lifting over time can lead to osteoarthritis, often referred to as “wear tear” arthritis. This stress and compression on the low back leads to joint surfaces and cartilage wearing down over time, including intervertebral discs, often resulting in inflammation and associated pain. This condition is often referred to as degenerative disc disease or lumbar spondylosis. Improving posture, restoring proper movement and mobility, and stretching can greatly improve the symptoms of osteoarthritis and disc degeneration over time.
Lumbar intervertebral discs are vulnerable to injury over time, commonly referred to as a slipped disc, potentially progressing from a mild disc bulge, to a disc herniation, eventually progressing to a sequestered disc in the spinal canal. Disc injuries in the lower back often compress the nerve root as it exits the spinal cord, often resulting in severe low back pain and in some cases associated leg pain. If the disc herniation is of sufficient size and severity, direct spinal cord compression may result ,with severe and serious neurological compromise.
Lumbar discs are most often injured through a combination of chronically forward flexed posture (such as from prolonged sitting), combined with movements that forward flex and rotate the lower back area, such as bending forward and twisting to pick up a very heavy object.
Common symptoms of a herniated lumbar disc is immediate sharp pain in the lower back, potentially travelling down the leg, that makes movement almost impossible. This pain is often worsened by any type of forward bending (putting on your shoes or socks, getting out of bed in the morning), and can be aggravated by sneezing or coughing.
Proper assessment and treatment by a back pain chiropractor is essential early on with any lumbar disc injury, to help improve symptoms and function, but to also prevent any worsening of the disc herniation over time and worsening of the symptoms into a chronic pain condition.
Spinal stenosis is a condition where the spinal canal inside the spine, or the openings where the nerves exit from the spinal canal (called foramen) narrow in size. This narrowing is often the result of advanced arthritis over many years, resulting in bone spurs/osteophytes or herniated discs encroaching into the spinal canal or foramen, narrowing them. This condition is often diagnosed with advanced imaging, such as an x-ray or MRI. This narrowing may result in compression of the exiting nerve roots from the spinal cord, often resulting in back pain, numbness, or tingling travelling down the legs, similar to sciatic pain.
This is a condition where one vertebra in the lumbar spine moves forwards on the adjacent vertebra. This may occur from an acute traumatic injury to the lower back or from repetitive stress and strain, most commonly related to repeated extension or arching of the lower back, such as in gymnastics. This forward slippage of the vertebra compromises the integrity of the spine, potentially irritating spinal joints, and compressing exiting nerve roots. Conservative chiropractic care is often successful with grade 1-2 slippage, while surgical management may be required for grade 3-4 spondylolisthesis.
Scoliosis refers to a sideways curvature of the spine, combined with a rotational component. Scoliosis can be congenital in nature, starting in childhood, can develop due to trauma or spinal fracture, or can be acquired over time due to occupational or postural habits. Scoliosis can range from very mild in nature, with only a slight sideways deviation, to a severe sideways curve, causing significant pain and symptoms. Proper scoliosis management requires accurate diagnosis, including x-rays, and appropriate treatment, often combining specific structural chiropractic care with customized exercises and stretches. In severe scoliosis, bracing of the spine or spinal surgery may be required.
The sciatic nerve is the largest nerve in the body, and exits through the lumbar spine, travelling through the buttock, and down the backs of the leg to the feet. Compression and irritation of the sciatic nerve often results in back pain accompanied by burning, numbness or tingling travelling down the back and side of the leg. Several structures can compress the sciatic nerve: a herniated disc/bulging disc, degenerative disc disease, spinal stenosis, spondylolisthesis, or tight gluteal, hamstring and piriformis muscles.
Radiculopathy refers to compression of a nerve root as it exits the lumbar spine, often associated with symptoms similar to sciatica: pain, burning, tingling, numbness and even weakness in the leg and foot. Conservative care can be successful in many of these cases, requiring a thorough assessment, often with advanced imaging (X-ray/MRI) for a complete clinical picture.
Chiropractic treatment for low back pain has been repeatedly demonstrated to be highly effective for patients looking for back pain relief.
A chiropractor is a primary care provider and spinal specialist who incorporates multiple approaches to effectively treat neck pain and back pain: chiropractic spinal adjustments, specific lower back stretches and mobilization techniques, soft tissue therapy, and lumbar and core stabilization exercises.
Our Toronto back pain clinic uses multiple techniques for chiropractic adjustments, depending on the preferences and the needs of the individual patient. These include traditional manual chiropractic adjustments, drop-table adjustments, and the use of activator instrument assisted adjustments.
This multimodal approach focuses on improving movement and alignment of the lumbar spine, decreasing muscle spasm and overall stiffness, increasing lower back stability, providing comprehensive low back pain treatment, effectively relieving pain for best results.
The length of time it takes to recover from neck pain and back pain depends on several factors: your age, the overall condition of your spine, the underlying cause and severity of the pain, how quickly you begin treatment, and your consistency with treatment and recommended home care procedures. Recovery time will vary based on the severity of the condition, and can range from a few days, or in the case of a complicated disc injury or spinal stenosis, several months. Consistency of back pain treatment is critical to a successful long term outcome.
After having worked with thousands of patients in our back pain clinic suffering from neck pain and back pain, we know that an important part of any low back pain recovery plan to reduce pain is strengthening of the lower back and core stabilization muscles. Best results are achieved by combining these back exercises with low back stretches, and beginning gradually, without forcing any of the movements and staying only within the pain-free ranges of motion.
The common muscle groups contributing to a weak lumbar spine and poor core stabilization are: quadratus lumborum, multifidus, lumbar extensors, and the gluteal muscles (including piriformis).
Exercise prescription should be individualized for each patient, depending on their underlying issues and chronic pain tolerance. The following low back exercises are appropriate for many patients due to their focus on slow, controlled movements, with several being isometric in nature.
For lower back exercises and movements in general, stability and proper form is key. Twisting movements, and any exercise requiring extreme flexion of forward bending of the lower back should be avoided, particularly early in the recovery phase. If an exercise is acutely painful, please stop. All exercises and movements should stay in the pain free range.
For a more detailed explanation and video demonstrating each, please refer to the “exercise” tab of our website, under lowback.
Caution should be employed when looking to stretch lower back muscles, particularly in the symptomatic painful stage of recovery. Extreme motions and spinal positions are generally not tolerated well by the lumbar spine, and should generally be avoided early on in any treatment process. Once patients are through the acutely painful stage, gentle stretches can be introduced. These would be based on the specific biomechanical faults of the patient, and the specific postural challenges they face. Most commonly in our back pain clinic in Toronto, these would be: tight psoas hip flexors, tight hamstrings, and tight gluteal/piriformis muscles.
For a safe general lower back mobilization exercise, consider beginning slowly with a cat camel stretch/mobilization. Begin slowly, and don’t force any of the movements. For a detailed description and video, please refer to the exercise tab of our website, under lowback:
If your back pain is accompanied by pain or numbness, tingling, or weakness travelling down your lower back into your leg, please consult with a spinal care professional. This likely indicates a more complicated spinal condition, often either a lumbar disc herniation or bulge, or possibly spinal stenosis.
If you’ve suffered a serious accident, fall or trauma, and are experiencing severe lower back pain and are unable to move, please visit your family doctor or nearest hospital.
If at any point you experience back pain accompanied by numbness in the buttock area or groin (termed saddle anesthesia), along with bowel or bladder problems (difficulties with urination or bowel movements), this may indicate an immediate medical emergency (termed cauda equina syndrome), and warrants an immediate trip to your local hospital emergency room.
If you are not certain, but are experiencing any bladder or bowel issues, and any numbness or abnormal sensation in the pelvic area, go immediately to your nearest hospital and have it assessed properly.
If you are searching for a back pain chiropractor in Toronto, our clinic has been helping patients overcome their back pain for over 20 years, and has helped thousands of people find back pain relief in that time.
While the recommendations given throughout this article are all well researched, everyones clinical presentation of back pain is unique. Specific clinical recommendations will vary based on your history and examination findings.
In spite of your efforts, if you continue to be frustrated with your back pain, and are unsure of your next step, please consider consulting with a spinal specialist for a detailed assessment.
If we can be of assistance to you, or if you’d like more information or have questions, please feel free to contact our chiropractic clinic.
Dr. Byron Mackay
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