The Joint Ventures' Blog

Diagnosing lower back pain

Tuesday, September 06, 2016

A diagnosis of “low back pain” often indicates only the location of the pain, but does not give an accurate picture as to what may be causing the pain to present in this location. Pain in the low back area may in fact be originating from the lumbar spine, the sacroiliac joint, the hip joint, and/or the muscles in the surrounding area.  Thus pain in the low back and/or buttock may not always be stemming from the lumbar spine itself.

Physical therapists assess all of the above areas when a patient enters the clinic with a complaint of pain in the middle of his/her low back, or on one side of the low back, hip, buttock, or groin.  Furthermore, patients often present to a physical therapy office with an x-ray or MRI report.  While imaging plays a role in many diagnoses, and an MRI may show pathology such as “degenerative disc disease” or “bulging disc,” this is not always the source of the pain.   Such findings frequently show up on imaging of the spine of people without any symptoms at all.  In addition, often times there are multiple contributing factors to the onset of “low back pain.”

Clinical testing by a licensed physical therapist helps to identify which area(s) is contributing to symptoms in order to direct appropriate treatment.  Often multiple impairments (weakness, tightness, postural abnormalities, etc) of several areas are contributing to the pain and treatment focuses on these particular areas.  The role of the sacroiliac (SI) joint as a cause of pain is debated in the literature, however this joint cannot be overlooked.  The SI joint may be hypermobile (excessive movement) or hypomobile (limited movement), and muscle imbalances may be contributing to a joint malalignment, thus causing pain.   Because of the proximity of the SI joints to the lumbar spine and hip joint, and often the referral of pain from the lumbar spine to the buttock area, a thorough clinical exam by a licensed physical therapist is essential to determining the most effective conservative treatment approach.

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