Categorization of low back pain
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Low back pain is something that many people struggle with, and is often painful and limiting enough that many will eventually seek treatment. For a long time, many clinicians simply picked a low back treatment and gave it a try, hoping for the best. The likelihood of a successful outcome, due to this approach, was more of a toss up, as the treatment didn’t always match the cause and presentation of symptoms for the lower back pain.
It’s no surprise that as more and more research was done, it was discovered that there are actually several categorizations of lower back pain, with variations in ideal treatments for each category. Matching the correct treatment plan to the correct categorization is pivotal for making a full recovery. This might sound like a basic idea, giving the right treatment to the right person, but it's a relatively new concept. Furthermore, there are plenty of people who just throw the kitchen sink at someone who is suffering from low back pain, hoping something might help. Let’s take a look at the four main categorizations of low back pain, and how the successful treatment for each varies.
1) Low Back Pain with Leg Pain and a Pattern
This categorization is marked by two distinct factors. Number one, this back pain is accompanied by leg pain, and number two the leg pain can be changed with specific low back movements. Think of this as a pattern of movement that will make the leg pain better or worse. An example of this is if someone was to be standing and tried to touch their toes, there would be a distinct change in leg pain (better or worse or pain in a different area). If a certain movement is known to trigger some particular symptoms, while other movements alleviate symptoms in the leg, that person would fall into this category.
This treatment begins with finding the positive pattern, and staying in that pattern as often as possible.
Another barrier is that most clinics are not structured in order to have the time to be able to evaluate the little details of patterns. Working with a clinician that has the time to do this is crucial.
The leg symptoms are more important than the back symptoms.
The leg symptoms can represent an irritated nerve, and awareness of the movements that irritate that nerve is important.
Essentially, the goal is to calm down the nerve from being irritable by utilizing specific movements of the spine.
We need to focus on “calming the bear.” I.e., think of this in terms of a bear that has awoken from hibernation in the middle of winter. We wouldn’t poke the bear to go back to sleep, we would ease it back to sleep.
2) Low Back Pain with Leg Pain without a Pattern
Similar to number one, this categorization is marked by leg pain. The differentiating marker for this categorization, however, is that the leg pain has no distinguishable pattern of relief with specific low back movement. Essentially, every movement in every position even if gravity is eliminated, makes the leg pain worse. When looking for a pattern of relief, it can sometimes take little details of change in order to find it. Working with a clinician who can make these small adjustments, within a clinic that gives enough time to workout the details, is key.
After a complete trial of patterning that still comes up with no relief, a patient in this categorization of low back pain then needs to get mechanical traction. Traction is usually a machine that will pull on the back to help open up space for that nerve to “calm down”.
The number of people who fit into this category is actually quite small, and yet some clinics give everyone traction if they have low back pain. It might feel good but if you don’t fall into the category, then it's a waste of time.
No pattern of low back movement can be found to alleviate leg pain.
This category benefits from mechanical traction
With time, this person will soon develop a pattern of leg pain alleviation.
When the traction is effective at producing a pattern of alleviation, they no longer fit into this category but fall into the category number one.
3) Low Back Pain with No Leg Symptoms, Stiffness
This categorization presents with zero leg pain. It is marked by pain and stiffness in the low back. It can be accompanied with symptoms into the SI joint or butt, but not the leg.
This type benefits from hands-on treatment, such as manipulation, cupping, dry needling, and a handful of other techniques to reduce the stiffness.
This patient needs hands on care to help turn off their brain from protection mode in order to allow their body to regain full range of motion
The goal with this type is to get the patient moving better, and then strengthen the back to avoid a recurring injury
Don’t think of this as being out of “alignment.” This term is used a lot which can be misleading. Once you get moving better, it’s really because your brain is less protective, not because you’re aligned better.
4) Low Back Pain with No Leg Symptoms, Instability in Joint/Ligaments
This categorization is the most rare type, and is most commonly found in young female
athletes in sports like cheerleading or gymnastics. It is marked by weakness, or instability, in the joints and ligaments. Most of the time, people in this category of low back pain will experience symptoms when they bend backwards. This category can be a bit of a trap because we don’t really have a great tool to determine whether it's just weakness or actual joint instability. Sometimes, people even present with instability of the back without back pain at all.
At The Health Lab, we hear a lot of clients say that they have been told that they have instability, but don’t present within this category. Unfortunately, the term “instability” is used a lot without much basis. This causes more problems because it makes people feel vulnerable to injury. This, in turn, leads to avoidance, which then really sets them up for injury.
This treatment is primarily strength focussed, utilizing strength to provide the lacking stability in the athlete.
Plenty of people have been told they have an “instability” issue, but really don’t.
You can have a true instability without any symptoms of back pain.
Commonalities in Treatment
Despite their differences, in the end, all category treatments lead to the same road. All four categorizations need back, glute, and abdominal strength for stabilization. Things like deadlifts, reverse planks, and a reverse hyper machine will all result in body resiliency and aid in your healing and continued health as you recover from your low back pain and beyond.
How The Health Lab is Changing Low Back Pain for the Better
At The Health Lab, we want to see you better, faster. We do our best to navigate the road of getting you stronger without causing any setbacks, either physically or emotionally. After a careful movement based examination, we will treat you based on the categorization from the very beginning. Rather than relieving your symptoms and sending you on your way (as is the standard mode of therapy), we will relieve your symptoms and then work with you to build the needed strength to build resiliency. We don’t want you to continue having flare-ups, and we want you to have the education and knowledge required to lead a healthy, pain free life. If you are ready to take the first step in healing your low back pain, give us a call or visit our website to schedule your free 30 minute discovery visit.