A significant amount of chronic pain patients deal with chronic low back pain. This is a massive topic that we begin to cover in this introductory article and will dive deeper in future articles. In this article we will discuss mechanical back pain which is separate from discogenic back pain. The two main types of mechanical (axial) back pain are Sacroiliac Joint Dysfunction (SI Dysfunction) and Lumbar Spondylosis.
The Sacroiliac Joints are a pair of joints as the iliac crest attaches on either side of the sacrum, which is the bone just above your tailbone. Patients with SI pain can have bilateral or unilateral pain. SI joint patients typically have trouble walking up inclines, getting up from a seated position and the pain is a complex combination of instability in the SI joint, inflammation and many times associated piriformis tendon involvement. There are physical therapists that spend their entire careers focused on treating SI joint pain and the therapy for SI dysfunction is completely different than physical therapy for common low back pain. When patients plateau with physical therapy we have found tremendous success in targeted interventional injections to the SI region. We will typically begin worth a combination of cortisone and anesthetic to work as both a diagnostic as well as therapeutic treatment. Patients who experience only limited benefits from this treatment are then likely candidates for prolotherapy to the region which is a specific series of injections designed to harness our body’s own natural healing process. This is particularly helpful in patients who have an underlying instability in their SI joint.
Lumbar Spondylosis is medical terminology for pain emanating from the facet joints in the vertebrae. The facet joints run on the back portion of the spine and we describe them as the ‘knuckle’ joints of the spine. They allow the spine to twist and move and are classic causes of back pain anywhere along the spine but a very common cause of low back pain. Classically, patients with facetogenic back pain describe pain with extension or rotation activities, standing to wash dishes and lifting activities. Many time patients will describe a catching sensation or will describe back pain that runs from the spine out along the belt line. As always we recommend a trial of physical therapy and various other modalities we have discussed in previous articles. If patients fail all more conservative treatment we will consider facet joint injections. If the facet joints injections help but are only temporary we will then consider Radiofrequency Ablation injection to the affected facets. RF injections have a typical period of relief from 6-12 months.
The goal of these treatments are to improve function, decrease pain and hopefully avoid surgery. As always, diet, exercise, weight management, stress reduction are all integral in helping to improve any treatments.