Symptomatology: The Lumbar and Sacral Areas
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This is Chapter 12 from RC’s best-selling book:
“Symptomatology and Differential Diagnosis”
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Chapter 12: THE LUMBAR AND SACRAL AREASLow Back Pain
Low back pain has been the second most frequent health complaint in the United States for many years, second only to headaches. More lost working hours are attributed to this affliction than any other factor, and the vast majority of these complaints find their cause in biomechanical failures. These failures are often complex, accumulative, and subtly hidden by the body’s marvelous adaptive mechanisms –a diagnostic challenge when pain is solely referred.
BASIC INVESTIGATIVE APPROACH
Because of its prevalence, backache requires a meticulous consideration of all possibilities, a comprehensive case history, and a systematic examination associated with necessary laboratory data and x-ray findings. In addition, emotional factors must be considered. In eliciting the case history, the manner of onset, location and nature of pain and spasm, aggravating and relieving factors, and a thorough systems review are almost mandatory if professional justice to the patient is to be achieved.
The Lumbar Nociceptive Receptor System. The lumbar ligaments and fascia are richly innervated by nociceptive receptors. When the lumbar spine is in a relaxed neutral position, its nociceptive receptor system is relatively inactive. However, any mechanical force that will stress or deform receptors, with or without overt damage, or any irritating chemical of sufficient concentration will depolarize unmyelinated fibers and enhance afferent activity. Thus, the pain experienced after either intrinsic or extrinsic trauma can be the result of mechanical factors, chemical factors, or both.
Mechanical Pain. Normal mechanical force applied to normal tissue does not produce pain. However, abnormal mechanical deformation occurs whenever:
(1) abnormal stress is applied to normal tissues (eg, postural pain),
(2) abnormal stress is applied to abnormal tissues, or
(3) normal stress is applied to abnormal tissues (eg, soft-tissue shortening).