There are several different subtypes of low back pain. Below is a description of some of the most common forms of low back pain and estimates of how long they typically take to heal. These estimates are based on our experience with the great majority of patients with these conditions. While every effort has been made to give you a realistic timeframe for the conditions, we cannot predict with absolute certainty that every patient’s progress will fall within the timeframes listed.
1) Acute Mild to Moderate Low Back Sprain Without Leg Pain Going Past The Knee: This sudden onset condition often follows lifting something too heavy or bending in an awkward position and suddenly “locking up”. This is usually the result of a sprain of a sacroiliac or facet joint, with the surrounding muscles going into spasm. If a patient goes to a medical doctor for this condition they are usually told it is “just a pulled muscle”. It is rare to injure a muscle in your back without also straining some of the ligaments which hold the spine and pelvis together.
The pain is typically in the lower back, gluteal region and/or the thigh. The pain usually does not go past the knee. The patient often has difficulty moving because their back feels “locked”. The pain can be excruciating. Sometimes patients in severe pain from this condition are of the mistaken belief that such severe pain is beyond the capabilities of a chiropractic approach. Nothing could be further from the truth. Chiropractic should be the first approach tried for this type of case. By gently, moving joints back to a neutral position, the abnormal stretch of the ligaments is relieved, setting the stage for a much quicker recovery. We have specialized equipment to treat patients with debilitating pain comfortably. The key thing to remember in this kind of case is that the severity of the pain does not correspond with the severity of this condition. Despite the fact that the pain can be severe, most lower back sprains are not serious and they usually respond very well to our treatment methods in 3-6 visits over a time period of 10 to 21 days. Without chiropractic treatment, it is common for the symptoms to last 6 weeks (42 days). Furthermore, without chiropractic treatment, when the inflammation finally subsides on its own, and with it your pain, you are left with sacroiliac or facet joints that still do not move normally, setting the stage for the next episode in the future. The next episode could be in the same place or somewhere else such as your neck, upper back or even down in a knee. While most case can be out of pain within 3 weeks, it is recommended that patients continue to take it easy for another 3 to 5 weeks as ligaments require 6 to 8 weeks to fully heal.
This is the kind of case where the cost effectiveness of chiropractic really shines in comparison to other approaches. The cost of chiropractic care in this kind of case is usually a fraction of the enormous expense of being hospitalized and having x-rays and/or an MRI performed.
2) Acute Flare Up Of Chronic Intermittent Low Back Pain Without Leg Pain Going Past The Knee: This type of case is similar to an acute low back sprain with the difference being, this type of sprain occurs repeatedly, sometimes every 2 to 3 months. Like an acute low back sprain, an acute episode of chronic low back pain can usually be resolved in 3 to 6 visits over 10 to 21 days, depending on the severity of the episode. While most cases can be out of pain within 3 weeks, it is recommended that patients continue to take it easy for another 3 to 5 weeks as ligaments require 6 to 8 weeks to fully heal.
The difference in this type of case is that we will make a more concerted effort to identify any underlying biomechanical problems which may be causing the sprain to keep coming back. This often requires additional investigations such as a new set of x-rays. While it may take additional visits to identify and correct these underlying problems, in the end, you have a much better chance of breaking the cycle of repeated sprains if we take the time to further investigate your problem and develop a long term strategy for you to follow at home to minimize your need for future professional care.
3) Severe Lumbar Sprain: This type of case usually involves some form of trauma. A classic example here in Thailand would be a slip and fall on a wet slippery tile floor. As we all know, non-slip flooring is all too often, overlooked in the local landscape. This type of sprain can usually be successfully treated in our clinic. If the pain is severe at the beginning of the case co-management with a medical doctor may be necessary for medications to control the severe pain. This type of sprain is usually seen 3 times the first week, twice a week the next 2 weeks, then once a week until it is resolved. This type of case can usually be resolved in 1 to 2 months. The speed at which one recovers from this condition is usually largely dependent on how well the patient is able to keep their appointments and follow our home instructions.
4) Acute Low Back Pain with Pain and or Numbness Radiating Down the Leg, Usually Past The Knee: In young and middle aged patients, this is usually, originating from a Herniated Disc. In elderly patients, this is usually caused by Spinal Stenosis,
An acute herniated disc can occur suddenly while performing some activity involving bending and/or lifting a heavy object, or gradually, from repeatedly lifting objects of light to moderate weight. A herniated disc typically can cause pain, numbness and/or tingling radiating down the leg, usually past the knee to the calf or foot. Based on the symptoms and simple tests performed in our office, a preliminary diagnosis of a herniated disc can be made and treatment initiated immediately. An MRI is not needed to start the treatment. If the patient fails to achieve significant improvement over 3 week of treatment, the patient is referred for an MRI.
Disc herniation’s are more serious and thus more difficult to treat than sprains, nonetheless, a chiropractic approach should be tried first before seeking care from other professionals unless there are red flag symptoms of a possible Cauda Equina Syndrome (see section on medical referrals). We incorporate procedures to quickly reduce the inflammation, decompress the herniated disc and rehabilitate the weakened structures.
It is important to note that if the symptoms remain in the back or only go to the thigh, even if you have a proven herniated disc from an MRI, your pain may not actually be coming from your herniated disc (see section on chronic herniated discs below). Furthermore, less than 10% of cases of herniated discs require surgery when treated properly. In most cases, a patient’s symptoms can be resolved in 4 to 12 weeks. The exact time and number of visits for this condition varies quite a bit from patient to patient, depending on the size of the herniation and other risk factors the patient may have. Most patients are treated 3 times the first week, then twice a week for 3 to 6 weeks, then once a week if necessary, for 1 to 5 weeks. Some mild herniation’s can be resolved in as little as 12 visits over 1 month. If you require more visits than the average case, we will work with you to keep the cost of treatment affordable. A trial of treatment is usually begun without an MRI because in the early phase of treatment having the MRI is not going to change the way we treat you. There are other neurological tests we can do in the clinic to pinpoint where the herniation is without the MRI, and thus, commence treatment. If less than 50 % improvement is reached after 4 weeks, an MRI is usually ordered in conjunction with a consultation with neurosurgeon for a second opinion. We only consult with surgeons who prefer to use surgery as a last resort. It is important to understand that even if pain relief is achieved in less than 12 weeks, it takes a disc at least 3 months to heal. Strenuous activities must be avoided until the disc fully heals. It is of paramount importance that during the healing phase you must continue to avoid bending, lifting heavy objects or twisting excessively. You should also limit the time spent sitting during this time as well; taking breaks every 20 to 30 minutes.
4) Chronic Continuous Low Back Pain
Here is a list of some of the most common causes of chronic continuous lower back pain.
a) Chronic Herniated Disc: A chronic herniated disc is a disc herniation that has not improved in 3 or more months since the onset of symptoms. This often occurs when an acute herniated disc has not been properly treated in a timely manner. A classic example of this is the case where a patient has only been “treated” with pain medications and possibly acupuncture, but without any procedures performed to physically decompress the disc. Most chronic herniated discs can still be treated successfully. The time frame is usually 8 to 12 weeks. The longer a condition has been present, the longer it will take to respond to treatment. In some cases of chronic herniated disc disease, some residual symptoms may be permanent. It is common in these cases for a patient’s pain level and function to dramatically improve while the numbness remains.
There are some important things that all patients who have been diagnosed with a herniated disc need to know and they are:
1) Not all herniated discs cause symptoms. Studies have been done where adults with no history of spinal pain and no history of leg pain or numbness are given MRI examinations. The researchers find that about one third of the subjects have evidence of some degree of disc herniation visible on the MRI. What this means is that just because a herniated disc has been identified on an MRI, it doesn’t necessarily mean that it is the cause, or the entire cause of your problem. It also doesn’t mean the opposite that it is not the cause. In the real world, the relevance of the MRI findings has to be sifted through on a case by case basis. Here are a few general rules to keep in mind about discs:
2) The more the symptoms radiate into the leg and foot, the more likely the herniated disc is a “symptomatic disc” and an important part of the patient’s pain syndrome. When a patient complains of low back pain, or low back pain that only radiates to the buttocks or thigh, it is less likely that a herniated disc is the exclusive cause of the pain, even if an MRI indicates the presence of a herniated disc. The sacroiliac and/or facet joints are likely to be either the entire cause or part of the cause of your pain. For more details, continue reading below.
3) While pain, tingling and numbness to the leg and foot are common symptoms of a herniated disc, they are less serious than muscle weakness. Muscle weakness is usually a sign of a more serious herniation. Atrophy (shrinking) of the muscles of the calf is the result of prolonged weakness and is typically indicative of prolonged nerve root compression.
4) Having a lumbar herniated disc does not automatically exclude the possibility that you have another problem that is also contributing to, or is entirely the cause of your pain syndrome. Low back pain that radiates into the leg can also come from other causes such as Piriformis Syndrome. In this syndrome, a tight piriformis muscle in the gluteal region can also pinch the sciatic nerve, causing pain, numbness and tingling radiating to the leg and foot. Articular Dysfunction of the Sacroiliac Joints is the most common cause of Piriformis Syndrome. The locking of one or both sacroiliac joints causes the piriformis muscle to shorten. Furthermore, Sacroiliac Joint Dysfunction can cause a local inflammatory response which also often refers symptoms to the thigh and groin. Articular Dysfunction of the facet joints in lower back also has a similar pain referral pattern. We have had many cases where a herniated disc was present on an MRI and we treated other abnormalities present such as articular dysfunctions and tight muscles, and the patient’s symptoms have disappeared.
As you can see, the diagnosis of a lumbar herniated disc and how it should be treated are not as straightforward as some would have you believe. In most cases where a herniated disc is identified on an MRI, it would be misleading to be told by a healthcare professional that the only option is to have an immediate operation before trying conservative treatment methods such as the methods used in our clinic. Most herniated lumbar discs can be successfully treated using a combination of chiropractic, physical therapy and acupuncture. We have state of the art equipment for the conservative treatment of disc herniation’s. Until you have tried chiropractic for your disc problem, you haven’t exhausted all conservative approaches to your problem.
b) Simple Degenerative Disc Disease (Spondylosis): This is when one or more of the discs in the lower back has worn out, becoming thinner, causing the lumbar vertebrae to become closer together which causes the facet joints to compress and become arthritic. This condition is similar to a herniated disc in the fact that many people have evidence of a degenerated disc visible on their X-Rays with absolutely no symptoms. Like a herniated disc, it would be wrong for any healthcare professional to take X-Rays of your lower back and recommend surgery based on the x-ray findings of a degenerated disc. Most degenerated discs will never require surgery. Degenerated discs often cause stiffness and pain in the lower back. Degenerated discs are almost always preceded by Articular Dysfunction of some of the lumbar vertebrae. Most patients with degenerated discs respond well to chiropractic manipulation, physiotherapy and the muscle work we perform at the clinic. Chiropractic care improves the mobility of the vertebrae. While it is not possible to turn degenerated discs back into normal discs, most patients with this condition experience substantial relief with our care. In most cases, the treatment schedule is twice a week for the first 2 or 3 weeks, then once a week for another 4 to 6 weeks. Because the degenerative changes are irreversible, many patients with this condition choose to maintain their improved function with maintenance visits, usually once a month.
c) Degenerative Disc Disease with Spinal Stenosis: In this variant of disc degeneration, the degenerative changes actually cause the holes in the vertebrae which all the nerves pass through, to become smaller, chronically compressing the nerves. What sets this condition apart from simple disc degeneration is the presence of chronic leg pain and or weakness and or numbness. This is one of the most challenging cases for any professional treating back pain. While surgery has a pretty good track record for simple disc herniations, the results for spinal stenosis are less predictable. Surgery should only be considered after all conservative methods of treatment have been tried first. Chiropractic treatment is similar to that for a simple degenerative disc however the treatment period is longer, usually twice a week for 4 to 6 weeks, then once a week for 4 to 6 weeks. Most patients will reach maximum improvement within this time frame. If the level of improvement is insufficient within this time frame, a medical referral is made.
d) Spondylolisthesis: This is a condition in which one of the lumbar vertebrae, usually the 4th or 5th, has slipped forward in relation to the vertebrae below. This usually occurs because the vertebrae fractured sometime in the past, usually in childhood. It usually is not discovered at the time of the injury, rather, it is usually discovered at a later date, often years later. Unfortunately, this fracture never heals. If the symptoms are limited to the lower back and gluteal region, the treatment schedule is typically twice a week for the first 3 or 4 weeks, then once a week for another 4 to 6 weeks. If the symptoms go all the way down the leg, the treatment period is longer, usually twice a week for 4 to 6 weeks, then once a week for 4 to 6 weeks to reach maximum improvement. As stated above, a spondylolisthesis never heals. While most fractures in the skeleton heal, with the 2 sides of a broken bone fusing back together, a spondylolisthesis never does. The goal of chiropractic treatment for this type of case is to improve the mobility above and below the spondylolisthesis. This is accomplished by improving the mobility of the hip joints and sacroiliac joints below the spondylolisthesis as well as improving the mobility of the thoracolumbar region above the spondylolisthesis. Ensuring maximum flexibility of these surrounding regions minimizes strain on the spondylolisthesis. The supportive musculature must also be strengthened for this type of patient. Surgery is usually the last options for this type of case as the surgical procedure is quite invasive, requiring metal rods to be placed in the back in an attempt to fix the bones together in a rigid position.
e) Lumbosacral Transitional Segment AKA: Lumbarization and Sacralization: This condition results from a birth defect in which the last lumbar or sacral bone is malformed, causing an extra joint to form usually on only one side of the spine. Like a spondylolisthesis, if you have a transitional segment you will have it for life. The goal of chiropractic treatment for this type of case is to improve the mobility above and below the transitional segment as well as the transitional segment itself. This is accomplished by improving the mobility of the hip joints and sacroiliac joints below the transitional segment as well as improving the mobility of the thoracolumbar region above the transitional segment. Ensuring maximum flexibility of these surrounding regions minimizes strain on the transitional segment. the treatment schedule is typically twice a week for the first 2 or 3 weeks, then once a week for another 4 to 6 weeks.