Worse sitting or bending
Pain that builds with sitting and bending and eases when you stand or walk often involves an irritated disc.
Low back pain
Low back pain most often comes from the muscles, joints and discs of the lower back, and it changes with position and activity. How it changes is one of the most useful parts of the history, because where the pain is felt does not by itself establish where it starts.
Three common patterns
Worse standing or arching
Pain that builds with standing or leaning back and eases when you sit often involves the facet joints or, later in life, narrowing of the spinal canal.
One side, into the buttock
One-sided pain that spreads into the buttock can come from the SI joint or the hip as much as the spine. Pain below the knee suggests a nerve root.
If this is a medical emergency, call 911.
Treating the lower back
The pattern guides the plan. Disc-related pain favors decompression and positions that unload the disc; joint-related pain favors adjustment and corrective exercise. The American College of Physicians' 2017 guideline lists spinal manipulation and heat among the first treatments for recent low back pain, and exercise and spinal manipulation for pain that has lasted more than three months.
Adjustments
For restricted joints of the lumbar spine and pelvis, by hand or on the drop table.
Spinal decompression
When the findings point to a disc, to take load off it.
Soft tissue and exercise
Graston and electric stimulation with heat for the muscle guarding the area, and a home program matched to the pattern.
Imaging is not usually needed at the start. Dr. Herner orders an X-ray or MRI after significant trauma, when there is leg weakness or numbness, or when pain does not respond to treatment as expected.