Dear Tserenchimed Purevsuren,

Pain in lower back is a very common problem affecting almost 93% of all people. Though majority recover in 6-12 weeks, about 10-15% might carry on having persistent or intermittent low back ache episodes over years.  Less than 1% of all low back aches have a serious cause like TB spine, metastasis etc. 

All the structures that you mentioned are pain sensitive. Add to it the nerve roots that are often compressed in Prolapsed intervertebral disc. The origin of most pains is biomechanical in nature. The spine was designed for the quadrupeds to give springiness while running and the act of the quadrupeds becoming bipeds during the evolutionary process a million or so years ago made us inherit a poorly designed spine, not the best model for carrying our body weight. Hence the high prevalence of low back ache.

Considering the fact that

a. So many pain sensitive structures exist so close to each other in the spine,

b. Low back ache is so common and

c. In patients with long standing pain, a vicious pain cycle sets in,

I believe that it might be very difficult to pinpoint the exact origin of pain. It is likely to be a combination of multiple sites. Especially amongst patients with chronic/persistent pain, central sensitisation occurs, i.e previously subthreshold synaptic inputs to nociceptive neurons now generate an augmented action potential output. In simpler words, patients continue to perceive pain without any significant sensory inputs.

Your imaging like MRI most often may not be of much help in identifying the source of pain. An MRI abnormality does not necessarily have a clinical correlation with pain origin.

Looked at another way, in acute pain, most patients will recover anyway and in presence of multiple pain sensitive structures, it would be tough to localise. 

In chronic pain, as central sensitisation takes over, it becomes more and more difficult to say which part is the source of stimuli.

regards

thank you very much

Low back pain is caused by a commonly overlooked subluxation of the sacral axis in anterior rotation. If you have seen the relief from a dislocation of the shoulder or knee from a proper reduction,  a reduction of the subluxated sacral axis will give the same kind of relief for those with low back pain.  Please see.

32.  DonTigny, RL:  A detailed and critical biomechanical analysis of the sacroiliac joints and relevant kinesiology: the implications for lumbopelvic function and dysfunction.  In Vleeming A, Mooney V, Stoeckart R (eds): Movement, Stability & Lumbopelvic Pain: Integration of research and therapy.

Churchill Livingstone (Elsevier). Edinburgh, 2007, pp 265-279

33.  DonTigny, RL: Sacroiliac 101; Form and Function; A biomechanical study.

Journal of Prolotherapy  3:561-567, 2011 

34.  DonTigny, RL: Sacroiliac 201; Dysfunction and Management: A biomechanical solution.  Journal of Prolotherapy 3:644-652, 2011

 36.  Quick, Effective SI Joint/Low Back Pain Assessment and Treatment: The DonTigny Manual Therapy Approach. The DonTigny Manual Manipulation Approach

http://www.greatseminarsonline.com   Corrections on actual patents with immediate relief of pain.  Five CEUs

Richard L. DonTigny, PT

Independent Investigator

81 North Shore Drive #10

Belgrade, Montana 59714

USA

(406) 219-3416

[email protected]

www.thelowback.com