The prevalence of facet joint (FJ) pain in patients with LBP has been reported at 25% according to Manchikanti et al. (2004). Eubanks, Lee, Cassinelli and Ahn (2007) in their study found that facet arthrosis was present in 100% of those over 60 years of age and that in 79% L4-L5 level was involved.
Nachemson (1960), states that within a healthy spine up to 25% of the segmental load is transmitted through the FJ. Where a degenerative facet occurs this percentage increases up to to 47%. In severe cases of spondylosis Gellhorn, Katz and Suri (2012) attributes a significant 70% of load bearing on the facet joint. Yang, King (1984) also suggests that excessive facet load results in rotation towards the back of the inferior facet and therefore stretches the joint capsule which causes LBP.
The most affected by osteoarthritis joints are the L & R knee. Even though studies have not directly examined the role of heredity in facet joint osteoarthritis (FJOA) Gellhorn, Katz and Suri (2012) suggest that hand, knee and hip OA all show a genetic predisposition in prevalence of FJOA and frequency coexist.
FJOA most often affects L4-L5 according to Gellhorn, Katz and Suri (2012). The same study states that overweight (MBI 25-30 kg/m2) individual are three times more likely to suffer from FJOA than normal-weight reference group (BMI <25 kg/m2).
According to Rinaldo et al. (2017) type 2 diabetes is linked to chronic back pain due to hyperinsulinemia which has been associated with higher levels of proteoglycan chondroitin sulphate within the intervertebral discs in weaning rats. Disc degeneration has been associated with disturbance to composition of proteoglycans within the disc matrix which may predispose to CBP. The results of that study also suggest that the increased levels of A1C can cause a stress-induced senescence in nucleus pulposus cells and disc autophagy due to hyperglycemia. This in turn may cause a disc prolapse and the on-set of a mechanical back pain. The pathophysiology of this occurrence involves avascular nature of the intervertebral discs receiving nutrients through the cartilaginous endplates of the vertebral bodies via diffusion and that the microvessel diameter within the endplates of diabetic rats decreases causing disc degeneration.
An average compressive force during the driving phase in rowing is between 3000 - 4000N (Caldwell, McNair and Williams, 2003) with the peak compressive forces in men exceeding 6000N according to Hosea and Hannafin (2012). Reid (2000) states that compressing force of only 4000N alongside the repetitive nature of the rowing stroke, and lumbar flexion (Caldwell, McNair and Williams, 2003) constitutes a high risk factor for vertebrae damage.
The study has shown that rowing trial impacts multifidus, longissimus thoracis and lumborum muscles the most in the middle of the drive phase (Graph 1). During rowing trial the lumbo-sacral flexion progressively increased which in part may be due to muscle fatigue in erector spinae muscles (Caldwell, McNair and Williams, 2003). Bull and McGregor (2000) points out that fatigue deteriorates rotatory control of the pelvis on the femur which potentially may cause an injury.
SIJ DYSFUNCTION
Jans et al. (2014) in their study show that the prevalence of SIJ dysfunction of non-inflammatory aetiology is mostly caused by spine (44.1%) or disc degeneration (32.1%).
DISC HERNIATION
The compressive forces combined with cyclic flexion and extension motion of the lumbar segments has been found to be the most likely cause of disc herniation (Caldwell, McNair and Williams, 2003). According to Jordan, Konstantinou and O’Dowd (2009) 19-27% people with disc herniation have no symptoms.
LOW-GRADE TYPE III SPONDYLOLISTHESIS
Wang, Káplár, Deng and Leung (2017) found that spondylolisthesis is highly age and gender related. Even though women are more likely to suffer from DS, both men and women > 50 y.o. are being affected . Further in their research Wang, Káplár, Deng and Leung (2017) points out that the majority of DS rarely progresses further than Grade I ensuring a normal quality of life. According to Gellhorn, Katz and Suri, (2012) spondylolisthesis most often occurs at L4-L5, the same level as FJOA with higher prevalence in those who suffer from diabetes.
KIDNEY STONES
According to Alelign and Petros (2018) kidney stones can cause sharp pain in the lower back, usually on one side. White background exposure to stress makes it more likely to develop kidney stones. Also high BMI can contribute to formation of kidney stones (Poore et al., 2020). A low urinary pH, hyperuricosuria and low urinary volume has been associated with formation of kidney stones (Poore et al., 2020). Increased temperatures due to climate change may cause more frequent dehydration and blood hyperosmolarity (Johnson et al., 2019) Too high concentration of calcium in urine due to dehydration promotes kidney stone formation.
VERTEBRAL METASTASES
Benjamin (2002) points to spinal metastasis can affect as many as 7% prostatic cancer patients in which 90%-95% experience localised back pain. The study also highlights that the lumbar spine is three times more affected by the prostatic metastases than the cervical spine and it should be considered as the cause of spinal compression in case of present radicular symptoms. According to Fervaha et al. (2019) 1 in every 6 men with prostate cancer suffers from depression or suicidal thoughts. The impact it has on self esteem and general quality of life is therefore significant. According to Savard J. et al. (2011), as many as 12-15% of men with prostate cancer suffer from insomnia.
ABDOMINAL AORTIC ANEURYSM (AAA)
According to Shaw, Loree and Gibbons (2021), trauma, age, gender, caucasian race, hypercholesterolemia amongst others, can cause AAA. Iliac arteries are found to be the most affected. The same study shows that people with AAA experience LBP.
FIBROMYALGIA (FM)
FMS is a chronic nonarticular rheumatic pain disorder of centrally amplified and maintained musculoskeletal pain. According to McBeth, Silman and Macfarlane, (2003) widespread body pain, which is a cardinal sign of FMS, is more likely to develop in patients with prostate cancer. Crofford (2018) highlights that the patients with other rheumatoid diseases have a higher prevalence of FMS (OA at 10.1%) which is confirmed by Haliloglu et al. (2014).
In case of centralised sensitisation a referral to GP would be appropriate to rule out other rheumatic diseases, depression, MS, MG. In terms of osteopathic approach A study by Gamber et al. (2002) found that patients suffering from FM show a higher pain threshold, are more relaxed, satisfied, less strained and confused when receiving osteopathic manipulative treatment. Due to the chronic character of the disorder the osteopathic treatment is mainly focused on improving quality of life, mental health and pain relief.
PYOGENIC SPONDYLITIS
Pyogenic spondylitis is a term that includes epidural abscess, pyogenic spondylodiscitis, vertebral osteomyelitis and septic discitis (Cheung and Luk, 2011). Each of these conditions is caused by an infection of the spine which can involve intervertebral disc, vertebrae itself, paraspinal soft tissue or epidural space. Staphylococcus aureus, Streptococcus spp. E.coli, Proteus spp., Pseudomonas aeruginosa and Klebsiella pneumoniae are the most common causative organisms. Males are affected twice as often in comparison to females. Patients are typically presented with back pain, fever (less than 20%) with possible nerve root or spinal cord compression (29%) according to Tee Yu Jin (2021) and Cheung and Luk (2011).
Pyogenic spondylitis is a life threatening condition, the patient is to be referred to A&E.
Symptoms include back pain alongside possible nausea, vomiting, anorexia, weight loss, lethargy and confusion. The diagnostics involve ESR (43-87 mm/h), CRP, WBC, urinalysis, urine for cultures, blood cultures, chest X-ray, sputum cultures.
GRAPH 1:
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