Low Back Pain

George S. Pellegrino, LMT, CMTPT, RMTI, CLT and

Victoria L. Magown, CMTPT, LMT, RMTI, CLT

Have you ever suffered with low back pain? If you have you’re not alone. At some point in our lives, every one of us will experience back pain. It will interfere with work, recreation, daily activities and more.

Americans spend approximately $50 billion each year to relieve back pain. It is the most common cause of work-related disability and a leading cause of missed work. After headache, back pain is the second most common pain complaint in the United States. For many, back pain resolves within a few days. For others, pain is persistent, lasting for years.

Acute or short-term back pain can persist for a few days to several weeks. This is usually the result of muscle overload or a minor sprain. Acute back pain usually follows a sports injury, unaccustomed work around the house, or a sudden jolt resulting from a car accident, fall or near fall. Symptoms often include muscle pain, limited range of motion bending forward or turning at the waist, or inability to stand upright. Pain may radiate (or be referred) from the low back to another area of the body. If left untreated, acute back pain will become chronic.

Back pain illustration Chronic back pain is defined as pain persisting for more than 3 months. At this stage, if the source is not identified and properly treated, degenerative processes begin to develop including arthritis, bulging or herniated disks and depression. Clearly, the longer pain persists, the worse it becomes. Acute back pain often becomes chronic when we hold the belief, “It’ll just go away on its own.” We mask the problem with over-the-counter pain remedies or prescription medication while waiting for the pain to just “disappear.” By the time we realize the pain hasn’t resolved, it has exceeded three months duration, transitioning to the chronic stage. Sound familiar? Another cause of transitioning acute back pain to chronic is ineffective treatments targeting symptoms, usually just the pain site, while failing to properly identify the root cause. Such is often the case with pain produced by Myofascial Trigger Points (Trigger Points for short) resulting from soft tissue injuries.

Trigger Points are hypersensitive, selfsustained contraction knots that develop in muscle. They cause a shortening in the length of the muscle called a taut band which in turn restricts range of motion. When these knots (or taut bands that harbor them) are stimulated by contracting or stretching, pain is produced and referred in predictable patterns away from the Trigger Point.

More than 85% of the time, Trigger Points are not found at the site of the pain! And, they don’t show up on x-rays or an MRI. Ineffective treatments usually result from treating the site of the pain when the source is actually elsewhere.

Take a moment to look at the illustration; the ‘X’ identifies the location of the Trigger Point while the red area defines the resulting referred pain. Note the vertical back pain shown in illustration ‘A’. The pain is being referred from a Trigger Point at the front of the spine found in the psoas muscle (pronounced “so-as”).

In illustration ‘B’, the horizontal pain across the mid and low back is referred from a Trigger Point in the rectus abdominis also at the front of the body. In both cases, patients with pain patterns such as these are typically treated at the back where the pain is and not at the source, the Trigger Point at the front of the body. While treating the back for back pain makes sense for temporary relief, treating the source of pain always provides permanent pain relief. Consider the case of a typical patient; Chris, a realtor with no history of trauma suffered unrelenting low back pain while driving and low back and buttock pain while seated at her computer. She managed her pain for years with a popular pain reliever and various treatments aimed at her low back which never provided lasting relief. Variations of her pain only contributed to the pain mystery.

At MyoRehab, our team approach employing postural analysis and orthopedic tests provided a very clear understanding of the problem. For our certified therapists, the variations of her pain patterns told the rest of the story.

Muscles close to the spine (Illustration C) holding her upright in her chair harbored Trigger Points producing pain at the low back and buttocks. While seated in her car, her abdominal muscles were shortened, stimulating Trigger Points that produced horizontal low back pain (Illustration B). After years of needless suffering and considerable expense, treatment of the source of her pain finally provided permanent relief. A specific home exercise routine will prevent her pain from ever returning. For Chris, temporary relief was no longer an option. Are you being treated at your low back for low back pain that hasn’t gone away yet? If temporary relief is no longer an option for you, give us a call at 505-872-3100 and set up an appointment.

Come to MyoRehab and find out how our “Team Approach” can work for you.