Why Does My Back Still Hurt?
by Eric Winder, DC
John experienced daily lower back pain for years. Sitting in my office, he recounted a story of x-rays and MRIs that revealed spinal arthritis and disc bulges. He was prescribed therapy with stretches and exercises, spinal manipulations and massages. He even had tried steroid injections and a nerve-killing procedure called RFA. Some interventions helped for a while, but others, not at all. In the end, however, he was still in pain after years of seeking treatment. This is the story of how he finally achieved some lasting relief.
To understand John’s lack of success—and why he finally was able to find relief—we need to take a deeper look at the causes of lower back pain. First, it is important to debunk a common misunderstanding. At least two large studies have shown there is a low correlation between the severity of lower back pain and how much spinal degenerative change (arthritis, spurs, disc bulges or misalignments) a person has.
In other words, your spine can be painful but look healthy on an MRI, or it can feel normal, but show advanced arthritis. Therefore, It should be no surprise that the advent of MRI has not improved outcomes for treating lower back pain, except in specific cases. But if arthritis and degeneration are not the main factors in lower back pain, then where can we look? In my clinical experience,there are three main factors which contribute to chronic lower back pain. Most cases have some combination of muscular imbalance, joint instability and stiffening of the connective tissue called fascia. Let’s examine how these factors can result in pain.
Three Little Problems
Muscular balance means there is adequate muscle tone, so that joint positions are correct, and movement is smooth and strong.The muscles can be imbalanced if they are either too tight (possibly to the point of spasm) or too loose, both resulting in muscle weakness. Such imbalances are usually present with lower back pain, and can be a source of persistent nerve irritation because of stress on tight muscles or strain experienced by weak muscles.
Joint stability means that a joint should move only in the directions it is supposed to—not more to one side or the other. If a joint has excess motion, this means the tissues which hold it in place will repeatedly be over stressed which can result in pain. Not surprisingly, one of the most common reasons for joint instability is muscular imbalance, as mentioned above.
The third common factor, which I see in almost all cases of lower back pain, is stiffening of the fascia. This sheet-like connective tissue covers muscles, bones, joints and other tissues to serve as the structural fabric of our bodies. Fascia also holds the nerve endings that are responsible for position sense by identifying pressure and stretch in our tissues. Generally caused by prior injuries or trauma, abnormal stiffening of the fascia can confuse the nervous system’s feedback of position sense.
The Perception of Injury
A glitch in position sense can cause several different problems. The disruption of position sense is one way the nervous system recognizes an injury such as a broken bone or torn ligament. Stiffened fascia can cause distorted perception which makes the nervous system think there is an injury, even if there is not. Therefore, someone with perfect-looking spinal health on an MRI could still have intense lower back pain from that “invisible”misperception. Position sense from fascia is also what makes proper muscular balance and joint stability possible.
When either muscle imbalance and joint instability are involved in lower back pain, it is often due to restricted or stiff fascia. The nerve endings in fascia that create position sense are the primary source of information the nervous system uses to control muscular balance and make the joints stable. Our bodies want joint and muscle tension to be not too loose and not too tight— rather, this needs to be exactly right. Fascia stiffening and distortion can impair that.
Changing the Misperceptions
In John’s case, I found intense stiffening and restriction of fascia around his left knee and hip, throughout his lumbar spine area, and in his rib cage and upper neck. With a series of treatments to release their restrictions, his muscle spasms relaxed, and the slackened or inhibited muscles gained tone. Joint instabilities in the lower lumbar spine and left pelvic joint became firm, while still mobile in the right ways.
Early in his recovery, the relief lasted only hours or a few days after treatment. But eventually, as we neared the completion of treatment, John’s average pain had decreased from eight (on a scale from one to 10) down to three. By the time he was released from treatment, he was able to be more active and began to lose weight as a result. His spouse remarked on the improvement in his mood, and his final pain scale averaged two out often after years of much higher levels of pain.
If we took another MRI of John’s lower back today, it would probably look just the same as it did in years past, with the same disc bulges and arthritis. We did not change any structure that would be visible in medical images. We did, however, improve his muscular balance, joint stability and stiffening of the fascia. I find treating these three elements is crucial to helping most cases of lower back pain.
With the COVID-19 crisis, our evening programs have moved online. You are invited to attend a Zoom webinar on Low Back Pain, September 29, 6:30 p.m. You will learn in-depth about causes and treatments for lower back pain including important home care. Also find out more about fascia,why it is important and how fascia problems are involved with lower back pain. Dr. Eric Winder will discuss case examples and hold a Q&A session following the presentation. Visit GentleBay.com to register for the webinar.
John experienced daily lower back pain for years. Sitting in my office, he recounted a story of x-rays and MRIs that revealed spinal arthritis and disc bulges. He was prescribed therapy with stretches and exercises, spinal manipulations and massages. He even had tried steroid injections and a nerve-killing procedure called RFA. Some interventions helped for a while, but others, not at all. In the end, however, he was still in pain after years of seeking treatment. This is the story of how he finally achieved some lasting relief.
To understand John’s lack of success—and why he finally was able to find relief—we need to take a deeper look at the causes of lower back pain. First, it is important to debunk a common misunderstanding. At least two large studies have shown there is a low correlation between the severity of lower back pain and how much spinal degenerative change (arthritis, spurs, disc bulges or misalignments) a person has.
In other words, your spine can be painful but look healthy on an MRI, or it can feel normal, but show advanced arthritis. Therefore, It should be no surprise that the advent of MRI has not improved outcomes for treating lower back pain, except in specific cases. But if arthritis and degeneration are not the main factors in lower back pain, then where can we look? In my clinical experience,there are three main factors which contribute to chronic lower back pain. Most cases have some combination of muscular imbalance, joint instability and stiffening of the connective tissue called fascia. Let’s examine how these factors can result in pain.
Three Little Problems
Muscular balance means there is adequate muscle tone, so that joint positions are correct, and movement is smooth and strong.The muscles can be imbalanced if they are either too tight (possibly to the point of spasm) or too loose, both resulting in muscle weakness. Such imbalances are usually present with lower back pain, and can be a source of persistent nerve irritation because of stress on tight muscles or strain experienced by weak muscles.
Joint stability means that a joint should move only in the directions it is supposed to—not more to one side or the other. If a joint has excess motion, this means the tissues which hold it in place will repeatedly be over stressed which can result in pain. Not surprisingly, one of the most common reasons for joint instability is muscular imbalance, as mentioned above.
The third common factor, which I see in almost all cases of lower back pain, is stiffening of the fascia. This sheet-like connective tissue covers muscles, bones, joints and other tissues to serve as the structural fabric of our bodies. Fascia also holds the nerve endings that are responsible for position sense by identifying pressure and stretch in our tissues. Generally caused by prior injuries or trauma, abnormal stiffening of the fascia can confuse the nervous system’s feedback of position sense.
The Perception of Injury
A glitch in position sense can cause several different problems. The disruption of position sense is one way the nervous system recognizes an injury such as a broken bone or torn ligament. Stiffened fascia can cause distorted perception which makes the nervous system think there is an injury, even if there is not. Therefore, someone with perfect-looking spinal health on an MRI could still have intense lower back pain from that “invisible”misperception. Position sense from fascia is also what makes proper muscular balance and joint stability possible.
When either muscle imbalance and joint instability are involved in lower back pain, it is often due to restricted or stiff fascia. The nerve endings in fascia that create position sense are the primary source of information the nervous system uses to control muscular balance and make the joints stable. Our bodies want joint and muscle tension to be not too loose and not too tight— rather, this needs to be exactly right. Fascia stiffening and distortion can impair that.
Changing the Misperceptions
In John’s case, I found intense stiffening and restriction of fascia around his left knee and hip, throughout his lumbar spine area, and in his rib cage and upper neck. With a series of treatments to release their restrictions, his muscle spasms relaxed, and the slackened or inhibited muscles gained tone. Joint instabilities in the lower lumbar spine and left pelvic joint became firm, while still mobile in the right ways.
Early in his recovery, the relief lasted only hours or a few days after treatment. But eventually, as we neared the completion of treatment, John’s average pain had decreased from eight (on a scale from one to 10) down to three. By the time he was released from treatment, he was able to be more active and began to lose weight as a result. His spouse remarked on the improvement in his mood, and his final pain scale averaged two out often after years of much higher levels of pain.
If we took another MRI of John’s lower back today, it would probably look just the same as it did in years past, with the same disc bulges and arthritis. We did not change any structure that would be visible in medical images. We did, however, improve his muscular balance, joint stability and stiffening of the fascia. I find treating these three elements is crucial to helping most cases of lower back pain.
With the COVID-19 crisis, our evening programs have moved online. You are invited to attend a Zoom webinar on Low Back Pain, September 29, 6:30 p.m. You will learn in-depth about causes and treatments for lower back pain including important home care. Also find out more about fascia,why it is important and how fascia problems are involved with lower back pain. Dr. Eric Winder will discuss case examples and hold a Q&A session following the presentation. Visit GentleBay.com to register for the webinar.
