Continuing our series on the main causes of low back pain, we will move away from discs and onto bony and soft-tissue structures.

A hypermobile joint is one in which excess movement is found. The ligamentous tissue between the joint surfaces ahs been stretched so much, the joint itself is unstable. The body responds by increasing the tonus (resting tension) of the muscles so the joint can not move properly. This can result in extreme pain when one tries to move into a previously stable range that is now unstable. The primary therapeutic response to a hypermobile joint is stabilization through proper muscle training. This will spread the required increased tension over several muscles and not cramp a single muscle causing pain. Untreated hypermobilities usually lead to disc problems. Minor hypermobilities are sometimes missed since the individual may not associate the minor backache with how ‘flexible’ they appear to be.

A hypomobile joint is one that doesn’t move enough. The articular surfaces are no longer congruent or the elasticity of the joint is less than optimal, causing an end of range effect earlier than is necessary. It is important in assessing a hypomobilty to determine if the origin is soft-tissue, arthritic, or some other reason. A soft-tissue hypomobiltiy can be cleared with specific stretching exercises while capsular ones can be treated with manual therapy applied directly to the joint. Even arthritic joints, caught early enough can be managed and the rate of degradation minimized for years.

Nerve impingement, commonly referred to as pinched nerve, occurs when a spinal nerve is trapped between two structures- generally a disc and a bone. This can cause symptoms all over the body depending on the nerves affected. A nerve in the neck for example can cause symptoms in the hand. Through manual therapy and specific rehabilitative exercises, most nerve impingements can be healed rather quickly. Even in cases of nerve entrapment (where the nerve is hypomobile within its own sheath), techniques to mobilize it and minimize symptoms exist and can be easily applied.

Sciatica is a general term for the symptoms caused by compression of nerve roots L4-S3 in the low back. These can be caused by spinal disc herniation,, spinal stenosis, piriformis syndrome, and poor posture/muscle use causing myofascial trigger points. In many cases, manual therapy with anti-inflammatories can minimize the pain and in some cases stop it completely.