From a client this week –
…my husband finally went to see our internist about a nagging low back pain that just won’t go away. He’s 80 pounds or more overweight, sedentary, and thinks Ibuprofen is something we all just have to take constantly to get by. His doctor’s PA told him he had “mechanical low back pain” and that it would just go away with time, what does that mean?…
A Quick Primer on What “Mechanical Low Back” Pain Means
Before a quick overview of what the term mechanical low back pain might refer to, of course I have to remind you that I’m not providing medical advice here, simply reviewing key concepts related to the question above.
In the arena of spinal pain and symptoms, one way to describe discomfort (or symptoms) is to divide them into one of two types (though they can both occur at the same time) – mechanical symptoms versus what are described as radicular symptoms (you might hear the term radiculopathy used).
Radicular symptoms refer to those symptoms generated when a nerve is irritated, and usually occur somewhere along the specific nerve’s course through the body and limbs. Think of a herniated disc “pinching” a nerve; let’s use as an example a far lateral disc herniation at L5S1 (the lowermost disc in the entire spinal column between the 5th lumbar vertebra (backbone) and the sacrum, pushing on the exiting L5 nerve root at that level. There may be some back pain produced in this scenario, but symptoms (could be pain, numbness, tingling, weakness) would potentially show up in the hamstring region, the front of the lower leg, and maybe even the top of the foot (all areas involved with the L5 nerve root).
Mechanical pain, on the other hand, typical represents symptoms produced by irritation or dysfunction of any other structure that’s NOT nerve tissue.
The most likely suspects are muscle, ligament, bone, joint, and the discs themselves (they’re a type of joint actually between the backbones (vertebrae) – a jelly like center (the nucleus pulpous) surrounded by a very interesting, multilayered harder (and specialized) cartilage-like casing. Most spine gurus agree that at least the outer third of the disc shell is supplied by nerve tissue and can generate pain; for a time it was thought discs didn’t have a direct nerve supply.
By far and away the lion’s share of mechanical low back pain is generated by muscles and ligaments, though as we charge through life we all accumulate some “wear and tear” changes in these spinal structures, that can (at least now and again) get inflamed, generate pain, and limit our function.
The good news here is that almost all of us will have a spell of mechanical low back pain at some point in our lives, and the overwhelming majority of the time, symptoms go away pretty damned quickly, and without much attention or intervention. Consider those episodes a proverbial “shot across your bow” imploring you to optimize your health, nutrition, and fitness if you’re not living that way now.
On the other hand, mechanical low back (or other spinal) pain that won’t respond to rest or a brief period of decreased activity, perhaps a very short course of anti-inflammatories, and maybe simple local measures (icing/heat) – and that continues to impact daily function – probably needs to be looked into with more than a pat on the head and encouragement that “it’ll get better in a few days”.
We’ll be digging into the topic of spinal pain more deeply through the fall…
