What Causes Lower Back Pain?

Low Back Pain is most commonly non-specific and mechanical in nature, however consider the following etiologies as a part of your thought process:

1

Urgent/Emergent

Ruptured Abdominal Aortic Aneurysm
Cauda Equina
Referred Pain
Prostate Cancer
UTI/Pyelonephritis
Uterolithiasis
2

Mechanical

Muscle Sprain/Strain- Piriformis Syndrome, Psoas syndrome (OMM is great first line treatment for these)
Trigger Points
Somatic Dysfunction- Diagnose and treat with OMT
Degenerative Changes- Spondylosis
Facet Arthritis
3

Radiculopathy

Usually from disc herniation or vertebral foramina stenosis
Pain is classically sharp and electric
Typically get neurologic deficits along that level and positive straight leg raise
4

Myelopathy (disturbance of the spinal cord)

Usually from narrowing around the cord from degenerative changes in the discs, vertebrae/facets, and ligaments
Symptoms are often bilateral and non-localized

How Can OMM Treat it?

Osteopathic Manipulation is an excellent first line treatment for most low back pain that isn’t due to fracture, neurologic process, or systemic illness.  It has been shown to be at least as effective as anti-inflammatory medicines and is a great first line treatment option in the absence of any red flag features.  The goal is to remove mechanical restrictions in the bones, fascias, muscles, and nerves related to the low back, sacrum, and pelvis.

Ideally, all osteopathic treatments will address the more dominant restrictions in the body to restore optimal function.  Additionally, one should consider evaluation and treatment of the sacrum, pelvis, lumbar spine, lower extremities, and the organs of the abdominopelvic cavity.

The combination of OMT and lifestyle modifications (exercises, stretches, and ergonomics) is often the most direct treatment approach to get to the cause of the patient’s lower back pain.

Resources

The following resources may be valuable to learning more about an osteopathic approach to low back pain.

  • Low Back Pain information
  • Low Back Pain narrated powerpoint
  • Watch this narrated powerpoint to learn more about sequencing your treatments using the Area of Greatest Restriction (AGR) model
  • Watch this video to see the general approach to screening with AGR
  • Watch this video to see the AGR approach to the body regions below T12
  • Here is a video on how to use Still Technique to treat the sacrum and pelvis
94
Additional training hours Dr. Seals has obtained regarding neck and back pain!