The two most common causes of chronic low back pain are

  1. Facet joint injury or osteoarthritis
  2. Sacroiliac joint dysfunction or osteoarthritis.

The facet joints are small joints in the spine which is where motion in the spine occurs. The discs are cushions in the front of the spine that do not move and are infrequent sources of pain. The facet joints are located on each side of the spine and occur in pairs at each level from C1-2 in the upper neck to L5S1 in the lower back. A number of factors can lead to damage or degeneration of the facet joints in the lower back resulting in pain. When discs in the front of the spine degenerate, they become narrower which changes the stress on the facet joints in the back of the spine at the same level. This stress can lead to degeneration in the cartilage of the joints which ultimately leads to osteoarthritis, similar to what occurs in the knees and the hips. This leads to pain that is often associated with bending, twisting and lifting. Activities that involve being bent forward for periods of time such as preparing meals, vacuuming, working at a bench, gardening, etc often cause or intensify the back pain. Activities that require bending backward also aggravate facet joint pain.

Facet joint pain often occurs as a sudden jab of pain on one or both sides of the back followed by intense spasm of the back muscles. These attacks of pain can last for seconds or can last for days, weeks or months. Many people experience these types of attacks that occur once per year and then gradually become more frequent and last longer until the pain is there all of the time. This type of pain often prevents people from golfing, gardening and other recreational activities and can impact a person’s ability to work. Determining which joints are the source of the pain and eliminating the pain can allow the person to return to normal activity.

The sacroiliac joints are located in the pelvis between the sacrum which is the bone that the spine sits on and the ilium which is your hip bone (not the hip joint). There are two sacroiliac joints, one on each side of the pelvis which is a common source of chronic low back pain. The pain can be on one side or on both sides. Pain from the sacroiliac joints is often aggravated by sitting and driving, crossing the legs and trying to put your socks on. Like facet joint pain it can be intermittent or can be constant. These joints are much less mobile than the facet joints. The common causes of sacroiliac joint pain are dysfunction or osteoarthritis. However, they often appear normal or x-rays, CT scans and MRI scans. Sacroiliac joint pain is common in people who wear tool belts or service belts, such as carpenters or police officers as the belts are often heavy and lop sided.


Sacroiliac Joint Pain

The best way to determine if the pain is arising from the facet joints or the sacroiliac joints is to inject local anesthetic onto the nerves that innervate the joints. This often results in almost immediate relief of the pain. Once the source of the pain is confirmed then there are different treatment options such as cortisone shots, rhizotomies (which cauterize the nerves to relieve pain) and sometimes fusion operations. The Welcome Back Clinic provides services that can determine if your chronic low back pain is from one or more of these joints and offers treatments that can provide long term pain relief.