Low Back Pain

By Dr. Kenneth R. Van Dyken, D.C. · Updated October 2026

Reviewed by: Dr. Jack Choate, D.C., Dr. Paula DiMaio, D.C.

Introduction

If I were to ask you what medical condition costs more than heart disease or diabetes, what would you pick? Probably not lower back or neck pain! While it sounds a bit crazy, facts are facts. Researchers published a paper in the Journal of the American Medical Association in 2020, covering more than twenty years of data.¹

As a chiropractic and massage clinic that specializes in spinal disorders, Spinal and Sports Care sees lower back and neck pain cases on a daily basis. If you are someone who struggles with a sore low back, chronic low back pain, low back and leg pain (sciatica), this article is a great starting point. We’re going to cover lower back pain in general but also touch on common types of lower back pain, including lumbar spinal stenosis, herniated discs, sciatica and nerve pain. We’ll also do an overview of therapies that work for each condition.

Why does lower back pain cost more than diabetes or heart disease? We don’t have all the answers but the data does give us some ideas. One of the biggest problems with lower back pain is that when it hits, it can be disabling. In fact, there is more disability associated with lower back pain than any other health problem.² If you’ve suffered from a bad episode of low back pain before, you’ve experienced how disruptive it is. If you are unable to sit, or stand, or bend over and pick up objects, life gets difficult. This is one reason that low back pain is so impactful. Another reason is that back pain is not very easy to diagnose. This might seem confusing, but this is because low back pain is notorious for being difficult to diagnose. Back pain is often dubbed as “non-specific”, meaning, it’s hard to figure out where it’s coming from. This is because there are many structures in your spine which can cause pain. This makes back pain what we call “heterogenous” which means mixed or varied, or not of all one type.

The downside to this label is that we have become too general in our treatments. This may be one reason why when we study treatment methods, the results are all over the board. One study says ibuprofen works and the next says to stay away. All of this adds up to unnecessary care, MRI’s that shouldn’t be ordered and lots of bouncing around in the medical system.

Why is low back pain so hard to diagnose?

What tends to work best is to try to do our best to classify the pain. That is, we’ll do what we can to put the pain into a bucket. From anatomy studies, we know that discs, joints and the nerve roots are often a main source of pain. Ligaments and muscles can also cause pain, but they don’t seem to be the primary source as much. From there, we can do various tests and look for clues in the history to figure out what is most likely to be the main culprit. I say “main” for a reason – it’s often not just one structure but maybe a combination. From there, we decide to treat the back pain with the tool that is best suited for the pattern or classification. You wouldn’t use a screwdriver to hammer a nail – you might get a little ways but not far. The right tool makes a very significant difference.

All this is to help you understand why back pain is such a sticky problem. So, now let’s talk about a few very common causes and what we can do about them. Each of these will have their own separate page if you want to read more.

What causes sciatica and leg pain?

Sciatica is a bit of a garbage word. What I mean is that it’s not specific. It can mean pain in the leg, in the buttock or in the lower back. Either way, it’s not a very helpful term. So, let’s talk about leg pain and where it can come from.

Leg pain can come from a few different sources.

1. Leg pain can come from a nerve root when it is irritated or inflamed. This is called “Radiculopathy”.
2. Leg pain can be “referred”, that is, coming from another structure. The most common is the spine (sometimes pelvis) referring pain into the buttock, hip, thigh or the entire leg.
3. Leg pain can come from the spinal cord being compressed and losing blood flow. This is called “spinal stenosis”.
4. Leg pain can also arise from the hip joint if it is irritated, causing referred pain. The most common cause would be osteoarthritis in the hip.

You can see that proper diagnosis is really important. You wouldn’t expect the same treatment to work just as good for all four of these options. Once we have the best option forward, we begin to treat. The response to treatment is sort of like a test. If it works, it confirms our diagnosis. If it doesn’t, we reevaluate and try again.

What is a herniated disc, and does it need surgery?

This is probably the diagnosis that scares everyone the most. And that makes sense, given that we all know someone who had a ‘disc slip’ and likely we’ve heard about surgery and other treatments. You might also be a patient who had a disc herniation and you still remember how much it hurt. Let’s do a brief overview of a disc herniation.

A spinal disc is a bit of a unique structure. Here’s a couple of factoids to help you get a better understanding.

1. It is made up of a stiff fluid like center called a nucleus pulposus
2. This is surrounded by a wall, thicker in the front and thinner in the back corners, called an annulus.
3. It is avascular. That means minimal to no blood supply. Nutrients come from the bones above and below when we move and walk, pumped from bone to disc.
4. it has no nerves past the first ⅓ of the disc except in chronic disc problems.

Simply put, a disc herniation is when the center squishes out the back, usually in one of the thinner back corners, pushing through the wall. It could be big, small, really painful and sometimes….not as painful. Yes, believe it or not, sometimes patients have existing disc injuries and… not much pain. That’s a story for another day.

In general, most patients do NOT need surgery for a disc herniation unless it is causing big problems with the nerves. This is called radiculopathy, compressing the nerve and interrupting the nerve signal to the muscles and skin. If this persists or rapidly worsens, permanent nerve damage can occur. This is where a surgical referral could happen.

What is lumbar spinal stenosis?

Stenosis is the medical term for narrowing. What this means is that there isn’t enough room for the nerves in the spinal column, specifically in the central canal where they travel. The narrowing compresses the nerves and often leads to symptoms in the legs, usually both legs at the same time. The reason the narrowing occurs is usually a combination of degenerative changes in the spinal column – where the discs and the joints have broken down and this has led to narrowing in the canal. This applies pressure to nervous tissue, which often leads to less blood flow, which we call ischemia. This can cause what is known as neurogenic claudication where as the blood-flow is cut off to the nerves, you start to experience leg pain, tingling or numbness in the legs.

These symptoms are almost always aggravated by:

• Standing and walking
• Bending backwards

And they are relieved by sitting down or leaning forward. Clumsiness and loss of balance are also symptoms, and patients may walk with a wider step because of it.

So why does it get better with sitting down and worse with walking? This is because when we stand, our spinal canal is naturally a bit more narrow. That is, if you imagine a pipe, the diameter of the pipe is smaller when standing. When we sit, it opens up the canal, which provides “breathing room” for the nerves, restoring blood supply.

This condition is most likely to affect patients at the age of 50 and above, and is fairly common in patients who are 65 or older.

What causes facet (joint) back pain?

The joints in the lumbar spine are known as “facets” and every joint in the lumbar spine has a nerve going to it called the medial branch nerve, which gives the joint sensation and supplies power to some of your back muscles (called multifidi). What a mouthful! Don’t worry, there’s no test, but this is important to know, for reasons you’ll see later. Now, the joint can cause pain in a variety of ways.

1. The joint can become irritated – we call this facet syndrome.
2. The joint can become restricted in its movement, causing intermittent pain and dysfunction. We call this a joint restriction.
3. The joint can become degenerated – we call this spondylosis. This is a sort of breakdown or wearing out of the joint which comes with some inflammation, joint stiffness and bony changes.

All of these conditions can cause significant low back pain and sometimes leg pain. The leg pain occurs because the wiring and nervous system is such that pain can be sent from the joint down into the glutes, into the thigh or sometimes the groin.

What are the treatment options for low back pain?

If we’ve learned anything from the research it’s that treating low back pain like it’s all the same is a recipe for failure. The best results come from making sure that our tools fit the job at hand. A screwdriver doesn’t work real well for hammering nails. With that in mind, here are some of our tools that we use. Each tool can be used for more than one problem, so there is some overlap. We might combine these tools as well to create even better results.

• Manipulation – our old, trusty standby. Manipulation is any sort of focused “adjustment” to the lumbar spine. We have a variety of techniques to administer this, and we’ll make sure it suits your scenario. This is great for lumbar facet irritation or joint restrictions.
• Myofascial release – this is targeted muscle therapy used to release tight muscles and relieve pain. It can be very helpful for muscle spasms.
• Manual Therapies – this is a big category – this would include “neurodynamic” treatments, where we target the nerve through stretches and glides. This is very useful for sciatica.
• Lumbar Decompression Therapies – this is non-surgical decompression designed to decompress the lumbar spine. This is specifically used for lumbar spinal stenosis and disc herniations. It has helped many people avoid spinal surgery.
• High Intensity Laser Therapy – this utilizes a dual wavelength laser to accelerate inflammation and relieve pain. This is particularly useful in injuries in the lumbar spine.
• Mechanical Diagnosis and Treatment – this is a special mention because it is both a tool for discovering what KIND of low back pain you have and treating it at the same time. This is a fantastic tool for disc irritation and for classifying low back pain.
• Homecare and advice – this might be one of the most useful things we do. We encourage our patients to move again, to build strength in their spine and body and to move towards a healthier lifestyle when appropriate. This might take the form of home-care, exercises, stretches, diet changes, supplements or whatever else might be appropriate. This approach is useful for every condition we treat.

Any or all of these tools might be used and in varying combinations. One size certainly does not fit all. This is especially true of low back pain!

Frequently Asked Questions

Conclusion

Low back pain is a huge, worldwide problem. It costs billions of dollars and causes an incredible amount of pain, lost work, disability and depression. There is no simple fix but there are options to find relief, regain mobility and get back to doing all the things you desire.

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1. Dieleman JL, Cao J, Chapin A, et al. US health care spending by payer and health condition, 1996-2016. JAMA. 2020;323(9):863-884. doi:10.1001/jama.2020.0734 ↩︎
2. Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, Hoy D, Karppinen J, Pransky G, Sieper J, Smeets RJ, Underwood M; Lancet Low Back Pain Series Working Group. What low back pain is and why we need to pay attention. Lancet. 2018 Jun 9;391(10137):2356-2367. doi: 10.1016/S0140-6736(18)30480-X. Epub 2018 Mar 21. PMID: 29573870. ↩︎