Lower Back Pain Treatment

What Causes Lower Back Pain

The lumbar spine carries the weight of everything above it and does most of the bending. It is built for that, but it is not built for ten hours of sitting followed by one hour of lifting. Most lower back pain we see at 201 Broadway is mechanical, which means it comes from a muscle, joint, disc or ligament that has been overloaded, and it can be found on examination.

• Lumbar strain. Muscles and ligaments pulled past what they were ready for. Shoveling out a car in January, moving apartments on September first, carrying a toddler on one hip up the stairs. It hurts across the low back, usually both sides, and is often worse the next morning than it was at the time.
• Facet joint irritation. The small joints at the back of each lumbar segment. Pain is usually one-sided, worse with standing, arching backward and twisting, and better sitting or bending forward. Common after a sudden twist and in patients over fifty.
• Disc bulge or herniation. Pain that is worse sitting, bending forward, coughing and sneezing, often with pain into the buttock or down the leg. The bike commute may feel fine while the office chair does not. See disc injuries.
• Sacroiliac joint dysfunction. The joint where the spine meets the pelvis. Pain just below the belt line on one side, worse rolling over in bed, getting out of a car or standing on one leg. Common in pregnancy and after a fall onto the buttock. More in our SI joint post.
• Degenerative disc disease and spinal stenosis. Discs thin and joints thicken with age, and most of it is painless. When the canal or the nerve openings narrow, you get aching and heaviness in the legs after walking a few blocks that eases when you sit or lean forward on a cart. Covered in spinal stenosis and degenerative disc disease.
• Sitting. Not a diagnosis, but the most common contributor in our patients. Kendall Square runs on laptops and lab stools. The lumbar curve flattens in a chair, the discs take more load than they do standing, and the hip flexors shorten. Add the Red Line in both directions and it is a long day of flexion. Our desk worker guide covers the fixes.

Two or more of these often overlap. A desk worker with a mildly degenerative disc who then shovels wet snow has a strain on top of a disc on top of a sitting habit, and the plan has to address all three.

How We Diagnose It at 201 Broadway

Dr. Bromberg takes the history himself, and it is the most important part of the visit. Every question has a purpose. Worse sitting or worse standing separates disc from facet. One side or both. Whether the pain travels below the knee, which raises the question of a nerve root. Whether it wakes you, whether you have had it before and what helped last time. Prior imaging, prior treatment, current medications.

The exam:

• Standing and walking. Whether you stand shifted to one side, whether the lumbar curve is flattened or exaggerated, how you get from sitting to standing and whether you need your hands to do it.
• Movement testing. Bending forward, backward, to each side and in rotation. Repeated movements matter. If bending backward ten times moves leg pain back toward the spine, that is diagnostic, and it shapes the home exercises from day one.
• Palpation. Each lumbar segment, both sacroiliac joints, the gluteal and hip muscles. Facet and SI problems are tender at a specific spot; strain is tender across a region.
• Orthopedic tests. Straight leg raise and related tests for nerve root tension, compression and distraction tests for the SI joint, extension with rotation for the facets, and hip range of motion to rule the hip joint in or out as the real source.
• Neurological screen. Knee and ankle reflexes, strength at the hip, knee, ankle and big toe, and sensation down the leg. Done whenever pain goes below the buttock, and repeated at follow-ups if anything was abnormal.

Imaging is not needed for most new lower back pain and can be misleading, because disc bulges and degeneration show up on the scans of plenty of people with no pain at all. Dr. Bromberg orders an X-ray after trauma, when there is a history that raises concern, or when the exam suggests instability or significant arthritis. He orders an MRI when there are neurological findings, when pain has not responded to a reasonable trial of care, or when decompression or a referral is being considered and the disc level needs to be confirmed. Films are done at area centers through our imaging referral process and he reviews the report with you rather than handing it over.

How We Treat Lower Back Pain

Clinical guidelines from the American College of Physicians list spinal manipulation among the first-line, non-drug options for both acute and chronic low back pain. That is the foundation of what we do, with the rest built around your specific finding.

Adjustments. A restricted lumbar or sacroiliac segment is restored to motion with a specific manual adjustment. For acute disc cases, pregnant patients and older patients with thinning bone there are low-force options, including positioning and gentle mobilization, that reach the same goal without a thrust. Described on the chiropractic care page.

Disc-specific care. When the disc is the source, the direction of treatment matters. Movements that centralize the pain, positioning that unloads the disc, and a hard look at the flexed sitting that provoked it. See disc injury treatment.

Spinal decompression. For herniated or degenerative discs, and for some stenosis cases, Dr. Bromberg uses a computer-controlled intermittent traction table that gently separates the lumbar segments in 15 to 30 minute sessions. A typical course runs 12 to 20 sessions over about six weeks, two to three a week and tapering, billed per session. It is not for every lower back case; strain, facet and SI pain do not need it. Details and the pricing note are on the spinal decompression page and in this explanation.

Soft tissue work. Active Release Technique for the gluteals, hip flexors, quadratus lumborum and the lumbar erectors that have shortened or spasmed. Muscle that stays tight after the joint is freed pulls the joint back toward restriction, which is why adjusting alone sometimes does not hold. See muscle therapy.

Exercise and habits. A few directional movements early, then endurance work for the trunk, then hip mobility, in that order. Plus the practical changes: a standing break every half hour or so, a lumbar roll in the office chair, how to lift the bike onto the rack, how to get out of bed without loading the disc. These are what keep the problem from coming back after the visits stop.

What Your Visits Look Like

First visit. History, exam, an explanation of what Dr. Bromberg found and what he thinks is driving it, and in most cases a first treatment the same day. If you arrive in acute pain and cannot sit, say so at the desk; you can stand or lie down while you wait. Walk-ins are welcome during office hours and same-day slots are held for patients in pain. More on what to bring and what the first visit involves.

Follow-ups. Dr. Bromberg rechecks the movements that were limited and the tests that were positive, treats, and progresses the home program. In the acute phase visits are usually two or three a week for the first week or two, then weekly, then further apart as you hold the gains. A decompression course has its own schedule, described above.

Usual visit count and span. An uncomplicated strain or facet episode commonly settles in a handful of visits over two to four weeks. A disc case or a long-standing problem usually runs six to twelve weeks. Stenosis is managed over a longer arc with the goal of walking farther, not a cure. No prepaid packages. The plan is reassessed on real progress at a point Dr. Bromberg names at the start, and our post on how often to see a chiropractor explains the logic.

How progress is measured. Sitting tolerance in minutes, straight leg raise angle, how far you can bend before pain, how far you can walk (for stenosis), whether leg pain has moved closer to the spine, and the things you want back: the commute, the gym, picking up a child. Most major insurance plans are accepted and your benefits are verified before treatment; see insurance.

What to Expect: Outcomes and Timelines

Most acute lower back pain improves substantially within a few weeks, and most of it improves faster with treatment and movement than with rest. Facet and SI episodes often change noticeably in the first few visits. Disc-related pain is slower and more variable; leg symptoms usually improve before the back itself does, and numbness is the last thing to clear. Stenosis does not reverse, but walking distance and comfort can improve meaningfully. The realistic timeline is on the blog.

What slows recovery: bed rest beyond a day or two, which stiffens everything and weakens the trunk; sitting through the workday without breaks; lifting too early because the first good day felt like the end of it; fear of movement, which is common and understandable but keeps the muscles guarding; smoking, which impairs disc healing; and poor sleep. A long delay between onset and the first evaluation also lengthens the course, because the compensations have had time to set.

When the plan changes: if the expected improvement is not there at the checkpoint, Dr. Bromberg changes something. Different technique, decompression added or stopped, the exercise direction reversed, or imaging ordered to look for what the exam could not find. Repeating the same visit and hoping is not a plan.

When he refers out: weakness that is progressing, pain that does not fit a mechanical pattern, a suspected fracture, or a patient who has had a fair trial of conservative care and may benefit from an epidural injection or a surgical consultation. He will say so and coordinate with your physician. He also sees patients after surgery; our post on chiropractic after back surgery covers when that is appropriate.

When to See Someone Else First

A small number of lower back problems need an emergency department or urgent care first, not a chiropractor. Go now if you have:

• Numbness in the groin, inner thighs or the area that would touch a saddle
• New trouble controlling your bladder or bowel, or difficulty starting to urinate
• Weakness in a leg or foot that is getting worse over hours or days, or a foot that slaps or drags when you walk
• Back pain with fever, chills or unexplained weight loss
• A history of cancer with new back pain, especially at night or at rest
• Pain after a significant fall or a car crash, or any fall in a person with osteoporosis
• Severe pain that came on suddenly with abdominal pain, especially in older adults

The reasons behind each item are in back pain red flags. If none of these apply, you do not need a referral. Massachusetts allows direct access to chiropractic care. Call (617) 494-1166 or walk in during hours; the office is at 201 Broadway, First Floor, a 6-minute walk from the Kendall/MIT Red Line station, with free and metered parking on Broadway and the side streets.