SEGMENTAL JOINT DYSFUNCTION IN THE LOW BACK
Very simply, it is an area of the spine that is not moving properly. We may say the joint is fixated, stuck, or “locked up”. Segmental joint dysfunction is an extremely common diagnosis in the office and is a component of almost all mechanical lower back pain. It can also commonly present with other types of mechanical dysfunction in the lower back such as disc lesions, degeneration, and stenosis (1).
It is characterized by an achy pain near the base of the spine, typically favoring one side. There can be some irritation into the buttock or back of the thigh (4). A person with joint dysfunction in their low back might notice that their back feels worse with long periods of standing or sitting. They may also get sore when bending far forward or far backwards (3). These patients usually feel more comfortable when they change positions or walk. Lying down may also provide temporary relief (2).
Testing in the office might reproduce your pain during extension and forward bending of your low back. There may be some reduced movement in side bending, and a decrease in the arch of your low back (called a lordosis) (5,6). An area with joint dysfunction is often painful when the area is pressed on (5). Patients with joint dysfunction typically have some postural imbalances, or muscle imbalances such as lower crossed syndrome.
Do I need an x-ray?
According to the American College of Physicians, patients who present with this type of issue do not initially require x-ray imaging unless there are signs or symptoms of red flags (7,8). This saves patients time, money, and radiation exposure. If a patient is not responding (improving) with treatment, or there are other factors involved, then we consider imaging.
Treatment options shown to have benefit:
- There is significant data to suggest that chiropractic spinal manipulation therapy (SMT) is an effective treatment for LBP (11-18). A doctor shouldaddress restrictions in the thoracic, lumbar, sacroiliac, and pelvic regions. The sole dose-response efficacy study of SMT for LBP suggested that 12 visits over 6 weeks provided the most favorable outcomes (22).
- Myofascial release or Active Release Technique to surrounding muscles: particularly tight or hypertonic lumbar erector muscles, hip flexors (iliopsoas), piriformis, quadriceps, and ilio-lumbar ligaments (19).
- Kinesiology taping of the low back can potentially be helpful in some cases.
- Alternating of heat and ice can help. Recommendations for this type of issue include 20 minutes with ice on, 20 minutes off, then 20 minutes with heat applied to the area.
- Massage therapy has been shown to help temporarily decrease symptoms associated with joint dysfunction by reducing muscle tension around the joints (21)
- Electrical stimulation in early phases of treatment (9)
- Flexibility stretches that focus on hamstring and psoas flexibility (20)
- Spine stabilization exercises such as planks, side planks, and bird dogs (26).
Treatments that are not typically helpful:
- Lumbar support belt (9)
- TENS units (27)
- NSAIDs such as aspirin, ibuprofen, or naproxen (28)
There are many things you can do to help yourself with this condition. You need to remove or modify the activity that causes you pain. Next, proper lifting and bending mechanics, posture, ergonomics, sleep position, and shoe support are important. You need to minimize prolonged sitting. Weight loss is an important part of feeling better-obese patients are less likely to show improvement in their back pain (23). Yoga has been shown to be beneficial, as well as walking (24). Walking for 30 minutes 3x/week has shown a 33 percent decreased risk of low back pain (25).
At Creekside Performance Center, we are highly trained to treat each of these conditions. We are the only inter-disciplinary clinic providing services to Sheboygan, Sheboygan Falls, Plymouth, and Oostburg including chiropractic, manual therapy, myofascial release, ART (Active Release Technique), massage therapy, acupuncture, physiotherapy, rehabilitative exercise, nutritional counseling, personal training, and golf performance training under one roof. Utilizing these different services, we can help patients and clients reach the best outcomes and the best versions of themselves.
Evidence Based-Patient Centered-Outcome Focused
- Elsevier. https://www.clinicalkey.com/to... June 2013
- Wheeler AH, Murrey DB. Spinal pain: pathogenesis, evolutionary mechanisms, and management, in Pappagallo M (ed). The neurological basis of pain. New York: McGraw-Hill; 2005:421-52.
- Delitto A, George SZ, Van Dillen LR, Whitman JM, Sowa G, Shekelle P, Denninger TR. Low back pain. J Orthop Sports Phys Ther. 2012 Apr;42(4):A1-A57.
- Argoff CE, Wheeler AH. Backonja MM, ed. Spinal and radicular pain syndromes. Philadelphia, WB Saunders: Neurologic Clinics; 1998:833-45.
- Schneider M, Erhard R, Brach J, Tellin W, Imbarlina F, Delitto A. Spinal palpation for lumbar segmental mobility and pain provocation: an interexaminer reliability study. J Manipulative Physiol Ther. 2008 Jul-Aug;31(6):465-73.
- Sadler SG, Spink MJ, Ho A, De Jonge XJ, Chuter VH. Restriction in lateral bending range of motion, lumbar lordosis, and hamstring flexibility predicts the development of low back pain: a systematic review of prospective cohort studies. BMC Musculoskeletal Disorders. 2017;18:179.
- Chou R, Fu R, Carrino JA, Deyo RA. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet. 2009;373:463.-72
- Chou, R, Qaseem, A, Snow, V et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007; 147: 478–491
- Globe G, Farabaugh R, Hawk C, Morris CE, et al. Clinical Practice Guideline: Chiropractic Care for Low Back Pain. JMPT Jan 2016 Volume 39, Issue 1, Pages 1–22
- Chou R, Qaseem A, Snow V, et al. (October 2007). “Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society”. Ann. Intern. Med. 147 (7): 478–91.
- Haldeman S, Dagenais S. What we have learned about the evidence-informed management of chronic low back pain? The Spine Journal. 2008(8): 266-277
- Roger Chou, MD; Amir Qaseem, MD, PhD, MHA; Vincenza Snow, MD; Donald Casey, MD, MPH, MBA; J. Thomas Cross Jr., MD, MPH; Paul Shekelle, MD, PhD; and Douglas K. Owens, MD, MS, for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians and the American College of Physicians/American Pain Society Low Back Pain Guidelines Panel*. Diagnosis and Treatment of Low Back Pain: A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:478-491.
- Bigos S, Bowyer O, et al. Acute Low Back Problems in Adults. Clinical Practice Guideline, Number 14, Rockville, Maryland: U.S. Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, AHCPR Pub. No. 95-0642, December 1994.
- Shekelle PG, Adams A. et al. The Appropriateness of Spinal Manipulation for Low-Back Pain: Indications and Ratings by a Multidisciplinary Expert Panel. RAND Corporation, Santa Monica, California, 1991.
- Paige NM, Miake-Lye IM, Booth MS, et al. Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain; Systematic Review and Meta-analysis. JAMA. 2017;317(14):1451-1460.
- Qaseem A, Wilt TJ, McLean RM, Forciea MA, for the Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. Ann Intern Med. 2017;166(7):514-530.
- Coulter, Ian D. et al. Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis. The Spine Journal , Volume 18 , Issue 5 , 866 - 879
- Goertz CM, et al. Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone on Pain and Disability Among US Service Members With Low Back PainA Comparative Effectiveness Clinical Trial. JAMA Network Open. 2018;1(1):e180105.
- Kameda M, Tanimae H. Effectiveness of active soft tissue release and trigger point block for the diagnosis and treatment of low back and leg pain of predominantly gluteus medius origin: a report of 115 cases. J Phys Ther Sci. 2019;31(2):141-148.
- Long A, Donelson R, Fung T. Does it matter which exercise? A randomized control trial of exercise for low back pain. Spine. Dec 1 2004;29(23):2593-602.
- Massage for low-back pain. Furlan AD, et al. Cochrane Database Syst Rev. 2015 Sep 1;9:CD001929.
- Haas M, Vavrek D, Peterson D, Polissar N, Neradilek M. Dose=response and efficacy of spinal manipulation for care of chronic low back pain: a randomized clinical trial. The Spine Journal (2013)
- Ewald SC, Hurwitz EL, Kizhakkeveettil A. The effect of obesity on treatment outcomes for low back pain. Chiropr Man Therap. 2016 Dec 12;24:48
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- Park SM et al. Walking more than 90 minutes/week was associated with a lower risk of self-reported low back pain in persons over 50 years of age: A cross-sectional study using the Korean National Health and Nutrition Examination Surveys. Spine J. 2018 2018 Nov 15. pii: S1529-9430(18)31226-9. doi: 10.1016/j.spinee.2018.11.007. [Epub ahead of print]
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- Enthoven WT, et al. Non-steroidal anti-inflammatory drugs for chronic low back pain. Cochrane Database Syst Rev. 2016 Feb 10;2
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