What is the tissue source in low back pain?

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As I speak with more clinicians, I get wider and wider views of what the tissue (soft tissue or inert) source in low back pain.  For sake of this post, let’s say chronic low back pain…dubbed non-specific low back pain. The most common answers are the:

1. Intervertebral disc

2. Facet joints

3. Myofascial

4. Sacroiliac joint

5. None (unless symptoms are acute, pain does not equal tissue damage)

Training, type of patients, treatment approaches, research, media, and beliefs all play a combined role in creating a bias.  Two of my mentors are on exact opposite ends of the spectrum.

For instance, here is an example of the diversity in ratio:

Clinician 1: Sacroiliac Joint (80%), Facet Joint (10%), Myofascial (10%)

Clinician 2: Intervertebral Disc (30%), Facet Joint (60%), Sacroiliac Joint (10%)

DePalma et al in 2011 estimated the prevalence rates of discogenic, facet and sacroiliac joint in chronic low back pain patients whom have been in motor vehicle accidents.  After having diagnostic procedures that are “criterion standard” for diagnosing either of the 3 conditions above, here are the results:

Of the 27 patients, 15/27 (56%) were diagnosed with discogenic pain, 7/27 (26%) with sacroiliac joint pain, and 5/27 (19%) with facet joint pain.

The author’s conclusions:

Our study is the first to demonstrate that diagnostic spinal injections can identify particular spinal structures, namely the intervertebral disc, facet joint, and sacroiliac joint, as the specific source of chronic low back pain due to inciting motor vehicle collisions. The most common source of motor vehicle collision-induced chronic low back pain appears to be the disc followed by the sacroiliac and facet joints.

Granted this is a subgroup of chronic low back pain patients (small n too), but based on this data…

Clinician 3: Intervertebral Disc (55%), Sacroiliac Joint (25%), Facet Joint (20%)

Quite the variability right?

I want to know what YOU think.

I have had success in the past with polls (EBP, pre-manipulation hold, and osteopractor word of the year), so I hope to get lots of engagement!

You know you see low back pain.

You know you have an opinion.

So let’s ALL engage to get a true sense of what clinicians think ALL over the world.

To participate, choose your TOP tissue choice of low back pain.  Then in comments, provide a ratio as I did above, your profession and explanation behind your rationale.

Filed under: Differential Diagnosis, Future of Physical Therapy, Lumbar Spine/SIJ http://intouchpt.wordpress.com/