A man, whom I’ll refer to as John, experienced chronic low back pain for years. Sitting in my office, he talked about x-rays and MRIs, stretches and exercises, spinal manipulations and massage treatments—none of which could ease his pain long-term. 

He had even undergone steroid injections and a nerve-killing procedure called RFA.  Some interventions seemed to work for a while, and some not at all.  But after years of seeking help, the pain continued to resurface. This is the story of how John found lasting relief.   

To understand John’s initial lack of success, we’ll need to explore the causes of low back pain. However, it’s important to first debunk a common misconception. At least two studies have shown there is not much correlation between the severity of low back pain and how much spinal degeneration (arthritis, spurs, disc bulges, misalignments) a person has.   

In other words, your spine can hurt, but look normal on an MRI. Likewise, you might not feel any pain, but have serious arthritis. MRI has not necessarily improved the outcomes for treating low back pain, except in a few specific cases. So, if arthritis and spinal degeneration are not the main factors in low back pain, where can we look? 

In my clinical experience, there are three factors in chronic low back pain. Most cases have some combination of muscular imbalance, joint instability, and stiffening of the connective tissue called fascia. Let’s discuss how these factors contribute to pain.   

Three Little Problems 

Muscular balance means that your muscles have the right amount of strength and tension to protect a joint in motion. Muscles can be imbalanced if they are either too tight (possibly to the point of spasm) or too loose. Often, a painful joint has both tight and slack muscles. Such imbalances are almost always present with low back pain.  

Joint stability means that a joint moves only in the directions it’s meant to—not, for example, more to one side than the other. If a joint has even a small degree of excess motion, this means the tissues holding it in place are repeatedly overstressed, which can result in pain. One of the main causes of joint instability is muscular imbalance. 

The third common factor which I see in almost all low back pain cases is stiffening of the fascia. This sheet-like connective tissue covers muscles, bones, joints, and other tissues, serving as the structural fabric of our bodies. Fascia also holds the nerve endings responsible for our position sense, by sensing pressure and tension in the issues.  

Position sense, or proprioception, is what enables coordinated movement and upright posture. Stiffening of the fascia, often caused by prior injuries or trauma, can cause problems. This restricted fascia doesn’t stretch and flex the way it should, which interferes with its ability to send correct signals to the nervous system for position sense.   

The Perception of Injury 

A glitch in position sense can cause several different issues. A disruption in this position sense is one way that our nervous systems recognize injuries such as a broken bone or a torn ligament.  Stiffened fascia can cause perception distortion, which makes our nervous systems think there’s an injury, even when there isn’t. In other words, someone with a healthy spinal health might still feel intense low back pain from that invisible misperception. Position sense from fascia is also what makes muscular balance and joint stability possible.   

When muscle imbalance and joint instability contribute to low back pain, it’s usually due to stiff or restricted fascia. The nerve endings in fascia are the primary source of information our nervous systems use to control muscular balance and stabilize joints. Our bodies want joint and muscle tension to be not too loose and not too tight—rather, it must be exactly right. Fascia stiffening and distortion can make us lose that even balance.   

Changing the Misperceptions 

In John’s case, I found intense stiffening of fascia in his left knee and hip, lumbar spine area, ribcage, and upper neck. With a series of treatments to release these restrictions, his muscle spasms relaxed, and the slack muscles gained more tone. Joint instabilities in the lower lumbar spine and left pelvic joint became firm and mobile in all the right ways.   

Early in these treatments, John’s pain relief lasted for only a few hours or days at a time.  But eventually, as we neared the treatment’s completion, his average pain lowered from eight (on a scale from one to 10) down to three. Upon finishing treatment, he became more active and began to lose weight as a result. His spouse also remarked on the improvement in his mood, and his final pain rating was two out of 10. 

If we took another MRI scan of John’s low back today, it might not look much different as it had in years past, with the same disc bulges and arthritis. Fascia treatments do not change any structure that would be visible on a medical image. However, we significantly improved his muscular balance, joint stability, and stiffening of the fascia.  I find that treating these three elements is crucial for alleviating most cases of low back pain.  

Dr. Eric Winder has been practicing chiropractic for 27 years, with a focus on treating fascia and soft tissue for the past 24 years. Dr. Winder’s practice focuses on relieving pain and restoring alignment and motion through gentle therapies. For more information, call 941-957-8390 or visit https://gentlebay.com/