About Back Pain

Low back pain significantly affects 80% of adults in the Western World today and is the most common cause of limited activity in persons 45 years old and under. In less developed societies, low back pain is significantly less common. We could conclude that the lifestyle in the Western World may be a factor in low back pain. Unfortunately, low back pain is poorly understood; the wide variety of treatment approaches is a testimony to this fact. Low back pain affects men more often than women. Office workers and sedentary people are just as much affected by low back pain as manual laborers.

90% of low back pain is recurrent and 35% of these develop into Sciatica which can become increasingly treatment resistant. Sciatica (pain involving the sciatic nerve) is often felt in the lower back, buttock, along the back of the thigh and into the calf. Sciatica can present itself in different degrees, although we do not speak of true sciatica unless you have symptoms below the knee.

Sciatica often starts as low back pain, progresses to buttock pain and then moves into the thigh and eventually into the calf and foot. Once you have symptoms below the knee, you may also experience numbness, tingling and weakness. Besides experiencing leg pain, patients describe the pain as a continuous or intermittent throbbing.

BackTherapist.com has good news for you! While you are surfing the Net to figure out how you are going to manage low back pain or different degrees of sciatica, you can start self-treating immediately! Make a homemade "lumbar roll" (for a professional roll, please see Products Index page):

1. Roll up a towel so that when compressed it measures about 1½ inches in diameter.
2. Move all the way back in your chair until your buttocks touches the chair.
3. Place the rolled towel horizontally across your back (just above the belt line).

Your back should arch naturally and should feel comfortable.

Clinically, a majority of low back pain patients experience relief with the use of a lumbar roll [see Figure 1]. In fact, a well-supported sitting posture and regular interruption of sitting are cornerstones of your recovery process.

Figure 1 - Example of good sitting posture with the use of a "lumbar roll"

A small percentage of low back pain (referred hereafter as LBP) is trauma or incident-related. In other words, as much as 70% of the patients cannot pinpoint a specific cause of their LBP. Only a few people may recall a specific incident or maneuver that caused their pain. People who come for consultation often times do not recognize that prolonged sitting can be the "straw that broke the camel's back" in a situation where unsupported sitting followed frequent bending, stooping or lifting.

Unsupported sitting (slouch sitting) after bending, lifting or stooping can be a major factor in the development of low back problems. How can this be explained? How is it possible that one move or simple sitting can cause trouble after years of pain-free function, performing the same activities over and over? To answer these questions, we have to take a look at how we live our daily lives. Simply put, we have to look at how we move our backs and the positions we adopt in every day life. During the course of an average day, we bend our backs thousands of times. In addition, we assume positions, especially sitting, that force our backs in sustained bending. Modern life with computers and lots of traveling has been hard on us!

Every day sitting can cause problems. Even though we may appear to be sitting upright, the sharp observer will notice that after a few minutes, the back relaxes and assumes a position of bending. Please do not think that bending is bad in itself. Our back is well equipped to handle bending. It is the lack of interruption of bending and unsupported sitting that, with time, create problems. Interrupted stress to the back is harmless, but sustained stretching of the back sets the wheel in motion for degenerative processes [see Figures 3 and 4].

Figure 2. Red depicts the gel [nucleus] inside your disc
and yellow depicts the spinal nerve exiting the spine directly behind the disc.

During forward bending of the back [Figure 2, upper left drawing], the gel migrates towards the back of the disc [Figure 2, upper right drawing]. The opposite movement occurs with backward bending [Figure 2, lower left drawing]. The gel migrates forward [Figure 2, lower right drawing]. The strong retaining wall consists of rings of cartilage [similar to growth rings in a tree] that keep the gel in a more or less centered position. Sustained stress to the back as caused by "slouch sitting" and prolonged stooping will slowly damage the rings of the retaining wall and allow the gel to seep through the cracks [see Figure 3].

Initially, progressive degenerative processes all take place unnoticed because the tissue first affected lacks the nerve endings to give you any obvious warning signs. Once the tissue that adheres your disc to the neighboring bone (vertebral body) is damaged, the "retaining wall" of the disc develops cracks (fissures). These cracks allow the center material of the disc (the nucleus which is a gel-like tissue) to occupy an abnormal position within the disc. With further weakening of the retaining wall, the wall will distort or bulge and eventually breach or herniate [see Figure 3]. Most people, including health care professionals, recognize the signs and symptoms of a herniated disc (sciatica) when it is often too late for effective conservative management, but often do not readily recognize the early stages of disc degeneration. The first signs and symptoms are easily managed with proper education and a knowledge of how to counter these symptoms with posture and simple exercises.

Figure 3. Progressive stages of disc degeneration. From left to right: early cracks or fissures in the disc allow the gel to occupy an abnormal position within the disc [second from left], which leads to bulging of the retaining wall and eventual herniation [far right]. The cracks may be straight, diagonal, L-shaped, T-shaped or any combination.

Back pain will often not be felt until the bulge is large enough to cause pressure on the thick ligament in the middle directly behind the disc [Figure 3, depicted by the thickened black line], or pressure on the spinal nerve [Figure 3, third and fourth from left]. When the gel is shifted to the side [Figure 3, third from left], pain will first be felt on one side of the back and later in the buttock and thigh. The tissue damaged can start inflammation which may be the main cause of back pain. Only a herniation can cause symptoms below the knee.

The good news is that natural history is in your favor (i.e. time is on your side). Most episodes of low back pain improve dramatically within two to four weeks. Unfortunately, a first episode tends to become a recurrent problem (90% of all LBP is recurrent), increasing in severity and duration. Approximately 35% of all LBP sufferers develop sciatica, which can become increasingly treatment resistant. Early intervention is of paramount importance if one is to successfully manage and prevent LBP. People with LBP can self-treat their condition effectively once they have an understanding of their condition and obtain proper tools to self-treat. Your understanding of the causes is a critical step in the right direction. Learn everything you need to overcome your current condition by selecting the Program appropriate for your pain location.

Figure 4. The top row presents examples of a normal disc when viewed from the top [left], and from the side [right]. The bottom row depicts a degenerated disc. Notice the loss of disc height [right], compared to a healthy disc [top right].

General degeneration follows the different stages depicted in Figure 3. Degeneration leads to the formation of bone spurs and eventual spinal stenosis, which is a bony encroachment on the spinal nerve either on the side or center.

The majority of back-related problems are reversible with non-surgical, simple measures. Only a small percentage of people actually require surgery. Take the appropriate action now and check out BackTherapist.com's Programs, Kits, Products, and Question and Answer pages to find what has worked for thousands of low back pain patients.