The Science of Low Back Pain

Mechanical low back pain typically involves dysfunction of the intervertebral discs, facet joints, sacroiliac joints, or surrounding musculature. The disc starts to lose its hydration and load distribution capabilities, which leads to increased stress on surrounding structures. The deep stabilizing muscles like multifidus and transverse abdominis often show delayed activation patterns, compromising segmental stability. Over time, this can lead to movement pattern changes that perpetuate the problem. When pain persists beyond 3 months, changes in the nervous system can amplify pain perception, making previously non-painful movements uncomfortable. When disc dysfunction progresses significantly, it may lead to disc herniation with potential nerve root compression (sciatica). Similarly, when facet joints become primary pain generators, this can develop into facet joint syndrome, while sacroiliac joint dysfunction may become a distinct condition requiring specific treatment approaches.