Chronic Lower Back Pain (CLBP)

Human beings, with the possible exception of bigfoot (Gigantopithecus blacki), are the only mammals that walk upright on two legs. To accommodate this upright position, our human spines have evolved into a vertical position, which enables us to stand upright, for long periods of time, without becoming fatigued or uncomfortable. This vertical position of the spine and torso provides us many evolutionary advantages, and it also has some unique challenges for our body. For animals that walk on all fours, the intrinsic weight of the body is dispersed throughout the spine, unlike human spines where the majority of the weights and pressures are concentrated towards the lower back.

For us, the weights and pressures associated with gravity gets concentrated into the lower back, which may cause strain and increased aging to the spine, muscle, and soft tissue structures of the lumbar spine. The increased pressures may be present in any body positions other than the supine position. These increased pressures on the lower spine apply to all people, though some people may be at more risk for lower back pain than others , due to workplace conditions, weight, lifestyle factors, and disease. Due to increased pressure on the lower back, people may be at risk for minor injuries that cause lower back pain, or major injuries that involve chronic lower back pain (CLEP). Let's take a look at some of the causes, symptoms, and treatments for pain conditions involving the lumbar spine.

Most degenerative conditions that occur in the lumbar spine can also occur in the other regions, though the lumbar spine is at the most risk because of its location at the bottom of the spine. There are several anatomical structures around and at the base of the lumbar spine to protect it and draw energy away from the ligaments and discs of the lower back, but degenerative problems may develop nonetheless. The two most common degenerative conditions associated are lumbar herniated discs and degenerative disc disease. Both of these conditions involve the deterioration of the discs. There are two layers of the discs: the inner annulus fibrosis, which is the tough outer layer, and the nucleus pulposus, which is a thick jelly material that includes large concentrations of water, glycoproteins, chondrocyte like cells, and chondroitin sulfate.
In many cases, these discs degenerate without patients ever experiencing any back pain at all. In other cases, people may experience acute back pain while these degenerative changes to the discs are taking place, but who recover rather well once the structure has stabilized. In much more rare cases, a patient experiences chronic lower back pain (CLBP) that won't go away without some sort of medical intervention. Degenerative disc disease may involve the deterioration of either layer of the intervertebral disc. A lumbar herniated disc specifically involves one or more tears in the annulus which causes material from the inside of the disc to leak out. If this material from the nucleus leaks into the spinal nerves or nerve roots, the person may experience moderate to severe lower back pain and discomfort.

Conditions other than degenerative disc disease associated with chronic lower back pain include spinal deformities such as lordosis and kyphosis, spinal stenosis, spondylolisthesis, neoplastic tumors, and arachnoiditis.

Treatments: Treatments for chronic lower back pain may involve the strengthening of the muscles that protect and move the lumbar spine. The muscles most commonly associated with the maintenance and health of the lower back include the side muscles (obliques and rotators), flexion of the torso (iliopsoas and abdominal muscles), and extension of the back (gluteal and back muscles).