Common Sources of Lower Back Pain
An overwhelming percentage of the population will experience pain/discomfort at the low back, or lumbar area, at some point in their lifetime. Pain is most often associated with disc changes, arthritis, or generalized degeneration of spinal structures due to “wear and tear”. Physical Therapists will often encounter patients seeking relief of lumbar area pain that may or may not include radiating symptoms to the lower extremities. Most common complaints include low back pain that will travel side to side, to the gluteal area, or down the back of the leg. Often times, symptoms can be related to a spinal condition and can be treated conservatively with spinal mobilization, stretching, core/low back and hip area strengthening. In more severe cases, surgery may be necessary to manage symptoms.
However, a sacroiliac joint dysfunction is often mistaken for a low back condition as it may produce similar symptoms. The sacroiliac joint is located at the end of the spinal column where it meets the pelvis, associated with the “dimples” located at the low back area. Dysfunction at this joint may include forward or backward rotation, upward/downward shift, instability, or joint irritation/inflammation. The most common cause of joint dysfunction in this area is trauma, typically a fall or step off of a curb, or pregnancy. In the case of pregnancy, hormonal changes will contribute to laxity at this joint which will contribute to joint irritation. Patients most often indicate increases in pain with long periods of standing/walking as well as sitting. Pain is generally reduced with lying down. Spinal movements are typically not problematic and pain is generally contained to the lowest area of the spine, however “sciatic” type symptoms may also be present and can extend throughout the leg to the foot. This pain is a referral of joint pain, much like a heart attack can refer to the left arm and neck. Generally these symptoms are unilateral, or one-sided, and may result in muscular guarding at the low back, gluteal or hip area. Severe tenderness is often present at the “dimple” on the affected side.
Despite the similar location and type of symptoms present, distinct differences in the conditions can be found during a comprehensive evaluation. It is important to note that many symptoms can be associated with several different conditions and proper evaluation techniques by a healthcare professional are necessary to determine the involved tissues or structures. An appropriate treatment program can then be developed. Without proper diagnosis of a sacroiliac dysfunction, symptoms can worsen and become quite severe. As for the low back, symptoms can be resolved conservatively with joint mobilization, lower extremity stretching, muscle release techniques, as well as stabilization exercises.
Outcomes are always most favorable in any condition if caught and treated early.
Dr. Stephen DiGiambattista is a Physical Therapist with North Pocono ProCare Physical Therapy located in Moscow. If there are questions, concerns or you have ideas for future columns please feel free to contact Stephen at firstname.lastname@example.org.