This is the first in a 3-part series
Written by Michael J. Musacchio, Jr., M.D.
Low back pain is an exceptionally common condition in which an estimated half to three-quarters of the adult population will experience at least one memorable episode of back pain per year and up to 1 in 10 will develop chronic back pain. Acute back pain, which resolves within weeks, is typically attributed to the soft connective tissues. Once pain goes beyond three months, it is considered chronic and the physiology of this pain can become quite complex. Chronic back pain is typically attributed to traumatic or degenerative conditions, and may include a variety of physiologic, psychological, and social influences. Most patients with chronic back pain will respond to conservative treatments as anti-inflammatory medications, physical therapies, and therapeutic injections become more widespread and better understood. Others won’t, and in some cases surgical options exist and have become more common due to the popularization of minimally invasive techniques.
There are several potential sources of low back pain which can generally be categorized into one of three categories:
Myofascial pain is that which is attributable to a primarily muscular of ligamentous origin, facetogenic pain is mediated by the facet joints of the spine and discogenic pain emanates from the intervertebral discs.
Myofascial pain occurs when muscles and their associated tendons become shortened and contracted. This is typically a result of repetitive stress and strain and the muscles become susceptible to injury. These contracted muscles are often tender and palpable “trigger points” may be palpable to touch as small tender knots. Myofascial pain is most commonly associated with poor conditioning, poor posture, and poor spinal mechanics. It is arguably the most common cause of centralized low back pain and the treatment in always non-operative. There are no diagnostic tests to detect myofascial pain and it cannot be seen on MRI or X-ray. Treatment options include manual and physical therapies and possibly trigger point injections.
I’ll delve into other sources of back pain in my next blog post which will be part two of this 3-part series.Michael J. Musacchio, Jr., M.D. is a Center for Spine Care minimally invasive neurosurgeon specializing in the spine.
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