Lower Back Pain Sources
There are many causes of lower back and leg pain, which can create a similar clinical picture.
The disc is the most common source of lower back and leg pain. However, there are usually several different components that lead to the injury and the pain being generated.
Due to repetitive stresses or sudden trauma, the gel in the center of the disc can tear into the rings of ligament surrounding it. That tear becomes a weak spot in the disc that is more likely to become reinjured in the future. When the closer rings surrounding the gel are torn, local lower back pain is produced. As the tear progresses radially outward, the pain moves further into the hip and leg. This is commonly misdiagnosed as sciatia. The accurate diagnosis would be Internal Disc Derangement because the entire injury is contained within the disc.
Sciatica is caused when the spinal nerve exiting at the affected level is irritated or compressed. This occurs when the radial tear either begins to significantly deform the outer disc putting pressure on the nerve, or ruptures through the outer disc, compressing the adjacent spinal nerve.
Lumbar facet joints, the sacroiliac joints, and the hip joints can create local or referred pain patterns. Specific diagnosis is made by performing a detailed history, examination, and analyzing regional imaging. This diagnosis dictates the treatment approach, which can vary greatly depending on the cause. Below is a typical pain referral pattern related to the sacroiliac joint:
Muscular Trigger Points
According to the Academy of American Family Physicians, “Trigger points are discrete, focal, hyperirritable spots located in a taut band of skeletal muscle. They produce pain locally and/or in a referred pattern and often accompany chronic musculoskeletal disorders.” They go on to say, “These include muscles used to maintain body posture, such as those in the neck, shoulders, and pelvic girdle. Trigger points may also manifest as tension headache, tinnitus, temporomandibular joint pain, decreased range of motion in the legs, and low back pain.”
Determining if an individual’s pain is caused by trigger points can be very tricky. It is essential that the clinician have a detailed knowledge of all of the potential pain referral patterns. The example below of a trigger point in the gluteal medius muscle is commonly misdiagnosed as Sciatica involving the spinal nerve.
Clinicians must consider non-musculoskeletal sources in their list of possible diagnoses when evaluating their patients. Some examples of these include:
Solution to Lower Back Pain
These problems are shown to often times have many contributing factors.
These factors include such issues as spinal joint dysfunction (malfunctioning of the spinal joints), muscle imbalances, weakness of the supporting spinal musculature (Deconditioning Syndrome), improper movement patterns, poor posture/ergonomic habits, and chronic inflammation.
Because these problems tend to be complex, and the rate of disability is significant, a multi-specialty team approach is best.
At Palmetto Physical Medicine, not only are the specialists each doing what they are best at doing, but they are working together to provide the optimum benefit for the patient.
The primary goal initially is to return the individual to function as quickly as possible. This is followed up with patient education on spinal strengthening and physical fitness, skill training, and ergonomic modification to best prevent recurrences.
This approach has shown quicker recovery times, faster return to work, decreased re-injury rates, and less therapist dependence.
Call Palmetto Physical Medicine today at 864-437-8930 to schedule an appointment.