Lower back pain

Lower back pain is the single most common reason people book an appointment here. It arrives as a dull ache that builds through a day of sitting, as a sudden spasm bending to pick something up, or as sharp pain that stops you mid-movement, and it affects work, sleep and mood well out of proportion to how it looks from outside.

Not all back pain is the same thing. It can come from the joints, the discs, the nerves or the muscles, and more than one is often involved at once. That is why the assessment is the part that matters: two people describing an identical ache can need quite different approaches.

What causes lower back pain

The presentations that come through this clinic most often are:

• Disc-related irritation, a bulging, herniated or degenerative disc, which is the presentation most likely to send symptoms into the leg
• Sacroiliac joint problems, pain low down and off to one side, at the base of the spine where it meets the pelvis
• Facet joint strain, typically worse bending backwards or twisting, and often easier when sitting
• Muscle spasm and soft tissue strain, which can be the original problem or the body’s guarding response to one
• Sciatica, nerve-related pain travelling down the leg, covered in more detail on its own page
• Postural loading from long periods sitting or standing in one position
• Pelvic and movement asymmetry, where one side is doing more work than the other

Even when pain arrives suddenly, tension has often been building for weeks. The moment it “went” is frequently the last straw rather than the cause.

When to see a chiropractor

Earlier is easier. A back that has been sore for a fortnight is a simpler problem than one that has been guarded and avoided for two years, because by then the movement patterns built around the original problem have become part of it.

Some presentations need emergency care rather than a chiropractic appointment. Go to a doctor or an emergency department now, ahead of contacting the clinic, if lower back pain comes with any of:

• Numbness around the saddle area: the inner thighs, groin or genitals
• New difficulty controlling your bladder or bowel
• Weakness in both legs, or rapidly worsening weakness in one
• Back pain following significant trauma, or with fever and feeling unwell

These can indicate cauda equina syndrome or another condition needing immediate assessment. They are uncommon, but they are the ones worth knowing. If you contact the clinic with any of them you will be told the same thing and helped to get seen, the chiropractors screen for them before every appointment and will decline to treat rather than proceed.

What the assessment covers

Your first appointment runs about 30 minutes:

• A full history, what happened, what makes it worse, what you have already tried, and anything relevant in your general health
• A physical assessment, posture, how you move, and muscle and joint testing through the lower back, pelvis and hips
• An orthopaedic and neurological screen, including reflexes, strength and sensation where symptoms travel into a leg
• An explanation of what was found, in plain language, before any treatment happens

You will not be asked to commit to a plan before you understand what the chiropractor thinks is going on.

What treatment involves

Chosen from the assessment rather than from a formula. Depending on what is found, it may draw on:

• Chiropractic adjustment, a controlled movement applied by hand to a specific joint
• Specific technique for disc presentations, which is hands-on and adjusted during the appointment rather than run on a machine, there is no decompression table here
• Massage therapy for the muscular guarding that builds around an irritated joint
• Dry needling, where the presentation suits it
• Rehabilitation exercises to take home
• Posture correction and practical changes to how you sit, lift and work

Between appointments

What changes a long-standing back is mostly what happens outside the clinic, how long you sit before moving, how you get out of a car, what you do with a heavy load, and whether the exercises get done. The chiropractor will give you specific changes rather than a generic list, because useful advice depends on what your days actually look like.

If chiropractic is not the right answer, you will hear that at the assessment. Where specialist care is the next step, you will get a detailed letter outlining the findings and recommendations, including the specialist we believe is best suited to your needs.

If you are weighing the two professions before booking anything, chiropractor or physio for back pain sets out what actually separates them.