More about Back Pain: Injury to an inter-vertebral disc, facet joint or the sacroiliac joint (SIJ)
Inter-vertebral disc injuries of a traumatic nature can be serious conditions to deal with and are frequently accompanied by several complications as described on the previous page.
But other conditions can arise from less traumatic origins which also lead to intense pain and muscle spasm affecting the lumbar spine.
Two of these conditions are irritations of the spinal nerves as a result of a lumbar disc injury and facet joint dysfunction; both of which can lead to pain and loss of mobility as a result of deep muscular spasm.
Protective muscle spasm of the lumbar spine often results from misalignment of the inter-vertebral disc, which causes it to slightly bulge. This can give the appearance of the top half of the body being misaligned from the waist upwards.
Known as a spinal 'shift', this altered position is caused by the intense muscle spasm pulling the spine to one side. This can often lead to pressure being placed on the spinal nerves.
The pain that results from a bulging or swollen intervertebral disc normally presents in the buttock or posterior thigh.
Sometimes this can mimic hamstring muscle pain or a feeling of tightness. Neural tension arising from a simple lumbar disc irritation can also present in this way. Often described as 'sciatic pain', this term covers a variety of presentations.
The spine is designed to be flexible; and injuries can occur to the intervertebral discs, associated nerves, or to the vertebrae themselves.
In cases of the latter, this usually affects the facet joints that interact with the adjacent vertebral bones, often leading to a feeling or locking or stiffness.
With physiotherapy treatment and appropriate exercises, any irritation caused by bulging of an intervertebral disc will gradually lessen as the disc returns to its normal position.
Although people often refer to “having a disc put back in place”, it is actually the release of deep muscle spasm as described above which in turn restores the correct alignment of the spinal column.
Similarly, the often-described treatment of “cracking everything back into place” is explained by the spine’s anatomy.
Because the facet joints articulate with each other, they can become very stiff and essentially appear to be ‘locked’, due to their close proximity to each other.
Basically, each individual vertebrae should be able to move independently without the involvement of the vertebrae above or below.
For example, when you bend over to lift something, one vertebrae should move first, followed by the next, and then the one after that etc., and this is known as good segmental movement.
When facet joint stiffness occurs, segmental movement is reduced; and the vertebrae appear to ‘lock'. Thus, the essential mobility required just isn't there.
Instead of having each individual vertebrae moving against the next, for example, you get two or three adjacent vertebrae moving together in a very rigid pattern without any individual segmental movements in between.
This ‘locking’ is usually the result of facet joint stiffness limiting the available movement ranges.
Facet joint dysfunction responds well to treatment consisting of heat applications, gentle mobilisations of the stiff vertebrae and specific exercises.
Additionally, temporary lifestyle and working modifications are often deemed appropriate until the injury resolves.
The combined treatment using heat and mobilisation techniques often gives excellent results with fewer recurrences of injury or adverse effects.
Dealing with sciatic pain
Sciatic pain is a nerve-related condition arising from the lower lumbar vertebrae and can be the result of a traumatic injury or gradual onset.
Of all the injuries that can be sustained, sciatic pain can strike anybody as I am sure most readers will know! It’s possibly one of the most painful and annoying injuries or conditions that anyone can suffer and often the cause is unknown.
The pain is usually felt as a constant, nagging, burning pain originating in the lower back, passing through the buttock and into the posterior thigh.
Although most injuries in this category often tend to stop at the level of the knee, true sciatic symptoms extend right down into the foot and ankle. The pain can be debilitating.
Causes are variable and can result from poor lifting techniques, maybe straining to lift a weight in the gym perhaps, or by picking an object up in the wrong way.
In other situations, adopting sustained postures such as when driving or sitting on a long flight in the same position for example, can have the same effect. So too can continually performing repetitive movements.
Sciatica can also occur as a result of poor posture, impact-related activities like playing squash, or running on hard surfaces like roads or treadmills as opposed to soft grass, and by over-training.
Sometimes, though, sciatic pain just comes on without any single specific incident or triggering factor and often these can be the most difficult presentations to get rid of.
The sciatic nerve originates in the lower back and as explained earlier, the pain usually results from pressure on the nerve root, often caused by a lumbar disc bulge.
This is quite common. The pain then follows the course of the nerve as it passes through the buttock area and radiates down the leg; often giving the ‘burning’ sensation earlier described.
It’s a horrible pain for us ordinary people and just as bad for athletes and footballers.
Sport-specific training is impossible with sciatic nerve irritation since anything that involves any degree of impact will hurt; and running is usually out of the question as a result.
Any exercise involving the ‘sit-up’ action can be extremely painful, (although exercises of the sit-up type are not recommended in any case) and will only make things worse.
Treatment normally consists of mobilising the area of the spine where the injury originates from in order to release the tension in the lower back and thus alleviate the leg pain.
Specific exercises to complement the physical treatment are vital and it’s important to do everything at the correct stages otherwise the injury will only become more painful.
Once the injury begins to settle, and physiotherapy treatment helps to reduce the pressure on the nerve, the pain usually eases as a result.
Avoiding known aggravating factors such as impact-running, sustained postures, and unnecessary lifting or loading of the spine are essential to the recovery process.
Related conditions: Sacro-iliac pain
The sacro-iliac joint links the lower spine to the pelvis and can become very stiff; leading to both acute and chronic pain.
Known as sacroiliitis, this can be an extremely painful condition which is often linked to non-specific lower back pain (LBP) and / or hip pain.
Any condition ending in ‘itis’ means that inflammation is present so sacroiliitis is basically an inflammation of the sacro-iliac joint (SIJ).
Sacroiliac pain comes in various guises but in an inflammatory form the main symptom is one of pain. Frequently this can be of that ‘nagging’ type that just won’t go away; similar to the sciatic pain described above.
No matter what you do or what position you try to get into, the symptoms are still present and you just cannot seem to be able to get rid of them.
Often constant, sacroiliitis comes in varying degrees of discomfort ranging from a minor irritation right through to downright excruciating pain.
As imagined, the term sacroiliitis is often used to cover a multitude of injuries and conditions affecting this region.
The terminology used can be confusing. Several diagnoses given for lower back or sacroiliac pain are global definitions such as lumbago for example; which basically means pain in the lumbar region aka lower back pain!
Sacroiliitis can be another example of this; with the term used to sometimes cover all bases pending a more specific diagnosis.
In medical terms, the lower part of the lumbar spine is called the sacrum, while the anatomical name for the pelvic bone is the ilium.
The area where the two meet is called the sacro-iliac joint (SIJ) and the SIJ is a joint where very little movement actually occurs.
When the human form walked on all fours the SIJ was active in helping to propel the rear legs; but now that we walk in the upright position the SIJ is no longer required to adopt this function and the body has adapted accordingly.
So movements in this region take place at the hip joint or in combination with the lumbar spine. True movement at the SIJ is minimal and limited to a few degrees only.
But like non-specific lower back pain, several factors can affect the SIJ including impact running, overuse injuries such as a result of repeated movements, or through excess bending and lifting etc.,
aeg length discrepancies where one leg is shorter than the other.
Biomechanical factors such a leg length discrepancies and muscular imbalances can affect the lower back, hip and SIJ.
Carrying an injury to another area in the body such as the knee for example can also lead to sacroiliitis or other related hip or lower back pain.
In female athletes, an increased ‘Q’ angle of the knee often leads to generalised lower back or sacroiliac pain as a result of the altered biomechanics specific to their gender. You can read how this affects the knee on the female athlete’s page.
Often, SIJ pain accompanies LBP and the causes can be insidious, frequently without single specific incident or injury leading to symptoms.
It’s also possible that a lot of LBP can occur through gradual onset and then compounded by previous injuries or incorrect exercise or lifting techniques added to poor posture (see the section on posture for more detail).
Either way, a short period of rest and specific exercises form part of the overall injury management package.
Some manual therapy such as joint mobilisations often help, together with self-applied heat treatments via a hot water bottle or a microwavable wheat-bag for example.
As stated above, the combination of rest, treatment and specific exercises will encourage most injuries in the area of the lower back, hip and SIJ to settle, hopefully things won’t take too long to settle.
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Photo credit Jeffrey F Lin