Classifying Low Back Pain

Back pain is the most common musculoskeletal injury in the United States, affecting ~80% of Americans at some point in their lives. The causes of back pain are widespread. ​

​Many patients walk through our doors with an x-ray or MRI in hand that shows disc degeneration, arthritis, stenosis, a bulging disc, herniated disc, or a spondy. Sounds terrible, right?

Wrong! First off, this diagnostic information is empowering! Your PT will be able to educate you in certain postures that should be modified and activities to perform that will decrease load through the irritated area. Secondly, just because you have one or more of these diagnoses does NOT mean you have to be in pain! There are millions of people walking around with these diagnoses and NO LOWER BACK PAIN.

While imaging studies such as MRI’s and x-ray’s can be useful for your doctor to visualize structures within your low back, a skilled physical therapist can identify the components of the tasks and activities that are triggering your pain.

There are three major triggers that are associated with low back pain: load sensitivity, neural tension, and directional preference. At CMPT we work to determine which of these categories you fall into. This information is crucial in adequate treatment!

Load Sensitivity

Loading the spine can be as simple as the load of gravity when sitting or standing in addition to the load of an external force, such as carrying a bag of groceries. Loading the low back is perfectly fine at the proper dosage, but some individuals who are experiencing low back pain may have increased sensitivity to load. Did you know that the load on your spine when sitting with poor posture can be equal to nearly double your body weight?

Neural Tension

When nerves become irritated they can cause pain, numbness, and tingling that radiates down from your back into your leg. It is important for patients with neural tension to decrease postures that place the nerve in a stretched position. Some classic aggravating activities for patients with neural tension include sitting on the couch with their legs stretched out on an ottoman, prolonged driving, and bending down to put on socks and shoes.

Directional Preference

Some conditions contribute to increased pain when either flexing the spine (bending forward) or extending the spine (bending backward). Someone who has pain extending the spine may need exercises to improve abdominal strength, which helps to decrease an extension tendency in the spine when standing. Someone who has pain flexing the spine may need to sit on a wedge to make this posture less provocative.

If you have back pain, do you know which of these categories you fall into? More importantly, do you understand what postures to avoid, what modifications to make during daily activities, and what exercises to perform? Do you understand what you are doing to resolve the underlying impairments? If you answered no to these questions then I can say for certain that you have not done PT at Central Mass PT.

No two patients are the same and at CMPT we do not believe in cookie-cutter care because it simply does not make sense. If you have back pain call today to schedule an appointment.


  2. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816. doi:10.3174/ajnr.A4173.

#backpain #physicaltherapy #spine #neuraltension

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