It is estimated that every adult will experience some form of back pain at least once in their lives. There’s a difference between mechanical and inflammatory back pain. With inflammatory back pain, movement tends to help it, while resting worsens the pain. For some individuals, relief from inflammatory back pain is something they could have to manage for some time. Fortunately, there are effective management and relief options available.

Inflammatory vs. Mechanical Pain

Chronic back pain has two major causes. These are Mechanical and Inflammatory. They have slightly different characteristics when presenting. Chiropractors know what to look for to tell the difference between the two. Then a decision can be made on how to proceed with treatment or management.

Inflammatory

Pain caused by inflammation can be described as:

• Not having a known definite cause.
• Characterized by stiffness, especially after waking up.
• Pain reduces with movement, activity, stretching, exercise.
• Is worst during the early hours of the morning.
• Is often accompanied by pain in the buttocks/sciatica symptoms.

Mechanical

Mechanical pain can be described as:

• Pain that becomes worse with activity, stretching, or exercise.
• Pain reduces with rest.
• There is no stiffness after sleeping.
• This pain is not constant but can become intense/severe for short periods.
• Pain in the buttocks/sciatica symptoms do not present.

Inflammatory and Non-Inflammatory

Non-inflammatory is the same as mechanical pain. Mechanical/non-inflammatory back pain has causation related to the mechanics of the back and can result from injury or trauma. The cause of non-inflammatory pain does not necessarily present right away. For example, poor posture that leads to back pain is a mechanical/non-inflammatory cause. However, non-inflammatory back pain can be accompanied by inflammation as a natural reaction to injury. But this inflammation is not the cause of the pain. Non-inflammatory back pain can be treated effectively with conservative treatments. This includes:

• Chiropractic adjusting
• Physical therapy
• Spinal decompression

Contributing Autoimmune Diseases

When inflammation is the cause of pain, it is considered inflammatory pain. Autoimmune disease/s can cause the body to attack different areas of the body mistakenly. Chronic pain can be caused by autoimmune diseases that include:

• Rheumatoid Arthritis

Arthritis causes the immune system to attack the joints throughout the body.

• Ankylosing Spondylitis

This is a rare type of arthritis that affects the spine. It is found more in men and usually begins in early adulthood.

• Multiple Sclerosis

This is a disease where the immune system attacks nerve fibers and can lead to back pain.

• Psoriatic Arthritis

This type of arthritis is characterized by patches of psoriasis along with joint pain and inflammation.

Inflammatory Pain Treatment

Individuals that think they might have inflammatory back pain should consult a doctor, spine specialist, and/or chiropractor. A general practitioner can misdiagnose inflammatory back pain as mechanical back pain. Many find relief from taking non-steroidal anti-inflammatory drugs or NSAIDs and following an exercise/physical activity regimen. However, sometimes this is not enough. This is where chiropractic treatment and physical therapy comes in.

Chiropractic and Physical Therapy

These medical professions complement each other well and can be beneficial as a part of an overall treatment plan. A chiropractor, with the help of a physical therapist, can bring significant relief. Management techniques involve:

• Chiropractic adjustments
• Flexion-distraction
• Posture correction
• Personalized exercises

Inflammation Night Pain

Inflammatory back pain tends to worsen at night. What happens is the inflammatory markers settle down when the body is not moving. A few simple practices can help you get better sleep.

• Stretch Before Bed and When Waking

Performing stretches before going to bed and after waking up helps keep the body limber.

• Inspect Pillows and Mattress

Sleeping with the spine out of alignment could exacerbate the problem. Using a too-soft mattress or a too-large pillow could be contributing to the pain. Sleeping on the side is recommended to use a pillow between the legs to keep the low back straight.

Exercises

Some exercises should be discussed with your doctor. Individuals have found that exercise and stretching are essential for relief.

Cardio

These exercises increase heart rate, boost mood, and release natural pain killers. Low-impact cardio exercises:

• Swimming
• Walking
• Cycling

Strength-Building

Strengthening the core muscles will help maintain posture and spine support. Some of these include yoga poses:

• Cat and cow
• Upward and downward dog
• Glute Press
• Plank
• Bridge
• Superman

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Body Composition

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Mediterranean Lifestyle

Sustainable and easy to follow three basic elements: following the diet, physical activity, and high levels of socializing. For individuals that want to change their diet and lifestyle to the Mediterranean, try the following:

• Add more vegetables to meals. This can be salads, stews, and pizzas. Kidney beans, lentils, and peas are common Mediterranean staples.
• Switch to whole grains as well as products made from whole grain flour. The high fiber content can improve heart health and can help lower blood pressure. Minimize refined carbohydrates like white bread and breakfast cereals.
• Balance rich desserts with fresh fruits like oranges and bananas that can include antioxidant fruits like blueberries and pomegranates.
• Treat meat as a side dish instead of the main course. Adding strips of chicken or beef into a vegetable saute/soup.
• Balance meat dishes with fish and seafood. This includes sardines, salmon, clams, and oysters.
• Go vegetarian for one day a week.
• Cut out processed meats with high levels of preservatives.
• Add healthy fats like avocados, sunflower seeds, nuts, and peanuts to meals.
• Add dairy like cheese and Greek or plain yogurt.
• Increase physical activity into a routine.
• Talk to friends and family.

References

Cornelson, Stacey M et al. “Chiropractic Care in the Management of Inactive Ankylosing Spondylitis: A Case Series.” Journal of chiropractic medicine vol. 16,4 (2017): 300-307. doi:10.1016/j.jcm.2017.10.002

Dahlhamer, James et al. “Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults – the United States, 2016.” MMWR. Morbidity and mortality weekly report vol. 67,36 1001-1006. 14 Sep. 2018, doi:10.15585/mmwr.mm6736a2

Riksman, Janine S et al. “Delineating inflammatory and mechanical sub-types of low back pain: a pilot survey of fifty low back pain patients in a chiropractic setting.” Chiropractic & manual therapies vol. 19,1 5. 7 Feb. 2011, doi:10.1186/2045-709X-19-5

Santilli, Valter et al. “Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized, double-blind clinical trial of active and simulated spinal manipulations.” The spine journal: official journal of the North American Spine Society vol. 6,2 (2006): 131-7. doi:10.1016/j.spinee.2005.08.001

Teodorczyk-Injeyan, Julita A et al. “Nonspecific Low Back Pain: Inflammatory Profiles of Patients With Acute and Chronic Pain.” The Clinical journal of pain vol. 35,10 (2019): 818-825. doi:10.1097/AJP.0000000000000745