Common low back pain, is it really a mystery?

Abstract

The pathophysiology of low back pain (LBP) is considered to be unknown. However, a strong pattern of biomechanical factors points us to the most likely cause of LBP. It is well known that the utmost majority of disc herniations, protrude posteriorly or posterolaterally, and it is widely accepted that this is caused by spinal flexion. It is also known that so-called neutrally lordotic spinal segments, i.e. the cervical and lumbosacral segments, are much more susceptible to these injuries, as up to 95% of disc pathology occur in the low cervical and lumbar levels. The literature also shows that reduced lumbosacral angles are a significant tendency in these patients. Further, many studies show atrophy of the extensor musculature in LBP sufferers. The intervertebral discs are richly innervated and may, like most other structures, yield warning signs which lead to pain generation when exposed to noxious stimulus such as anterior compressive forces, compatible with the above-mentioned factors. Based on the biomechanical evidence and the statistics, a postural cause of LBP, namely habitual lumbopelvic flexion (LPF), is very likely. Postural LPF is treatable, and a suggested approach for identification and intervention has been included in this paper.
Citation: Larsen K. Common low back pain, is it really a mystery? Anaesth Pain & Intensive Care 2018;22(1):125-130