LOW BACK PAIN
More than 80% of North Americans will suffer from lower back pain at some point in their lives, which makes it one of the most common reasons adults seek care for a musculoskeletal problem.
According to experts, lower back pain is the number one disability culprit in workers’ compensation claims and accounts for more than $50 billion annually in the US through medical care and lost production.
In addition, the latest research shows most lower back problems which cause low back pain do not fully resolve without extensive treatment and proper rehabilitation, contrary to previous beliefs.
Identifying the true source of lower back pain takes a focused spine evaluation, including a detailed history, hands-on orthopedic and neurological testing, and imaging reviewed specifically for disc, joint, and nerve involvement. That is why TriMed Spine & Joint pairs chiropractic physicians with orthopedic surgeons and interventional pain management specialists under one roof, so the examination, the diagnosis, and the treatment plan all come from the same spine-focused team in Boca Raton.
ANATOMY OF LOWER BACK
The lower back is built from five lumbar vertebrae, the discs between them, the facet joints at the back of each level, the nerve roots that exit between the vertebrae, the paraspinal muscles, and the sacroiliac joints where the spine meets the pelvis. Any one of those structures can generate lower back pain, which is why identifying the source changes the treatment.
Lumbar Vertebrae
The lumbar spine contains 5 moderately large vertebrae which sit atop the sacrum. These bony segments act as attachments for muscles and ligaments in the lumbar spine and also encase and protect the lower spinal cord and lumbar nerve roots.
Because the lumbar vertebrae are located between the pelvis and upper torso, the degree of stress endured by the lumbar spine is great. These abnormally high degrees of stress result in frequent lumbar vertebral subluxations – misalignments and improper motion patterns of the lumbar vertebrae. If left uncorrected, these misalignments and faulty biomechanics of the lower spine can result in spinal injury and irreversible degenerative changes.
Lumbar Intervertebral Discs
The lumbar discs connect adjacent lumbar vertebrae to one another and cushion the spine as well as permit motion between the individual vertebrae. As stated above, the lumbar spine is a “transitional” area between the pelvis and upper torso, thus, resulting in high degrees of spinal stress. This results in the 4th and 5th lumbar discs suffering more injuries than all other spinal discs combined.
Disc herniations in the lumbar spine are the most common causes of “sciatica”, meaning pain running down the back of the leg in the area of the sciatic nerve. Possible symptoms include pain, numbness, tingling, or weakness in the legs and/or feet.
In rare cases, a lumbar disc herniation can compress the spinal nerves which provide motor control to the bowel and bladder. Although rare, if you’re having back pain and experience a loss of bowel and/or bladder control, immediate medical intervention is required. Without immediate decompression, the loss may become permanent.
Lumbar Facet Joints
The facet joints in the lumbar spine allow for considerable amounts of flexion but a much lesser degree of extension and rotation. These joints must withstand large amounts of stress from the body and as a result, are prone to acute and repetitive injuries and degenerative arthritis.
Facet joints are most commonly injured during movements involving a rotational or twisting component. When injured, pain is often sharp and localized to the area of the affected facet joint. Later in life, if spinal problems have been allowed to linger without appropriate rehabilitation, arthritis will likely be present. If severe enough, as is commonly the case, bony arthritic enlargement of the joint can impinge upon spinal nerve roots and produce symptoms of pain, numbness, and tingling down the leg, as well as leg weakness, in addition to back pain.
Lumbar Spinal Nerves
The lumbar spinal nerve roots exit openings formed between adjacent lumbar vertebrae termed the intervertebral foramina or IVF. The weakest aspect of the spinal disc is unfortunately in close proximity to the IVF. Thus, disc injuries commonly result in discal materials compressing, stretching, or irritating the nerve roots exiting the IVF’s.
Because the nerve roots exiting the lumbar spine innervate structures in the lower extremities, any compression, stretching, or other irritation will result in numbness, tingling, pain, or weakness in the leg(s) and/or feet. This may result from vertebral malpositions, disc herniations, arthritic changes to the vertebrae and facet joints, or even abnormalities within the muscles (piriformis syndrome).
Lumbar Spinal Musculature
The paraspinal muscles in the lumbar spine attach to the spinal vertebrae and pelvis to provide the torso with movement. These muscles must be strong to control the upper torso about the pelvis and thus are frequently overworked and injured. The pain associated with paraspinal muscle injury is generally a dull, boring, generalized ache in the area of the lower back.
Sacroiliac Joint
The sacroiliac joints are located between the sacrum and the ilium bones of the pelvis. These joints may also become irritated or injured resulting in lower back pain, buttock pain, and occasionally leg pain.
This condition tends to be more common in women, especially during pregnancy when hormonal changes and pressure from the forming fetus increase the stress on these joints.
CAUSES OF LOW BACK PAIN
Low back pain most often originates in the lumbar discs, the lumbar facet joints and their capsules, the lumbar and pelvic muscles and ligaments, the lumbar and sacral spinal nerves, or the sacroiliac joints. Research shows the exact tissue responsible cannot be specifically identified in up to 80% of individuals, and those patients are said to suffer from “nonspecific low back pain.”
Although the specific tissues causing low back pain are difficult to identify, chiropractic doctors have found a number of factors consistently present in low back pain patients. These factors include vertebral subluxations, faulty spinal biomechanics, deconditioned spinal musculature, and the practice of poor postural habits and techniques. By addressing these factors – the actual causes of the tissue injury – chiropractic doctors are able to obtain extraordinary results in low back pain sufferers.
Common events leading or contributing to the development of lower back pain include:
- Incomplete rehabilitation of past injuries
- Lack of proper and periodic lumbar spinal alignments
- Presence of lumbar spine subluxations
- Improper lifting techniques
- Auto accidents
- Improper workstation setup
- Poor posture
- Prolonged sitting
- Prolonged use of non-ergonomically designed equipment
- Excessive repetitive torsal motions
- Exposure to vibratory forces (truck drivers, jackhammer operators)
- Scoliosis (lateral deviation of the spine)
- Fallen foot arches and other foot abnormalities
- Physical inactivity
- Poor diet and nutritional practices
- Smoking
Structures that are often the source of lower back pain include:
- Lumbar intervertebral discs
- Lumbar facet joints and joint capsules
- Lumbar and pelvic muscles and ligaments
- Lumbar and sacral spinal nerves
- Sacroiliac joints
Non-Surgical Option: DRX9000 Spinal Decompression Therapy
Lower back pain caused by a lumbar disc problem may respond to DRX9000 spinal decompression therapy, a non-surgical treatment performed on a computerized decompression table. Call 1 (855) 487-4633 to schedule an evaluation with Steven Cantor DC. Published outcomes for non-surgical spinal decompression are collected in our DRX9000 clinical research summary, including a 2025 Military Medicine chart review of 267 patient records in which 90.5% reported pain reduction and average pain scores fell from 6.9 to 2.5. Individual outcomes vary. Decompression is one tier among several, and TriMed reviews the full range of alternatives to back surgery before any surgical referral is considered.
Lower back pain care at TriMed is delivered through the complete TriMed Protocol — decompression sequenced with the supporting therapies your recovery needs.
Related Conditions and Treatment
Lower back pain overlaps with several specific spine diagnoses, and the related TriMed pages cover general and mid-back pain, herniated discs, sciatica, lumbar spinal stenosis and DRX9000 spinal decompression.
- Back Pain – an overview of upper, mid and lower back pain.
- Mid-Back Pain – thoracic spine pain and its causes.
- Herniated Disc – the complete guide to herniated disc symptoms, causes and treatment.
- Sciatica – leg pain caused by pressure on the sciatic nerve.
- Lumbar Spinal Stenosis – canal narrowing in the lower back.
- DRX9000 Spinal Decompression – our non-surgical treatment for disc conditions.
Ready to Get Started?
Lower back pain treatment in Boca Raton starts with an evaluation that separates a disc or nerve problem from a joint or muscle problem, because that is what determines whether chiropractic care, non-surgical spinal decompression or an interventional pain management procedure comes first. Patients travel to TriMed Spine & Joint from across Palm Beach County for that evaluation.
Common Questions About Low Back Pain
These are the questions patients ask most often about how long low back pain lasts, when it needs urgent care, whether to rest or stay active, and when imaging or non-surgical decompression is worthwhile, answered by the team at TriMed Spine & Joint in Boca Raton.
How long does low back pain usually take to settle?
Most episodes of simple mechanical low back pain improve substantially within two to six weeks. Pain that is not improving after a few weeks, or that keeps coming back, is worth having examined rather than waiting out.
When is low back pain an emergency?
Seek immediate medical attention if you have progressive weakness in a leg, numbness in the groin or inner thighs, or any loss of bowel or bladder control. Severe pain after a significant fall or accident, or pain with fever or unexplained weight loss, also needs prompt evaluation.
Should I rest in bed or stay active?
Extended bed rest generally slows recovery. Most people do better staying gently active within comfortable limits while avoiding the specific movements that clearly aggravate the pain.
What is the difference between low back pain and sciatica?
Low back pain stays in the back. Sciatica describes pain that travels along the sciatic nerve into the buttock and down the leg, which suggests a nerve is being irritated rather than the back alone.
Do I need an X-ray or an MRI?
Not for most first episodes. Imaging is ordered when there are nerve symptoms, a history of trauma, or a lack of progress with conservative care, because many findings on scans are also present in people with no pain at all.
Can non-surgical spinal decompression help my low back?
DRX9000 spinal decompression is one option considered when a herniated, bulging or degenerative disc is the source of the pain. DRX9000 spinal decompression is FDA-cleared for those conditions and is performed at our Boca Raton office; whether it suits your case is decided after an examination and a review of your imaging.