back pain

Low Back Pain and Sciatica: Only Two Diagnoses – Surely Not?

There are many medical diagnoses attributed to low back pain and sciatica, yet how relevant are they?

When it comes to conservative treatment, I would suggest that it is not really that important, as these medical diagnoses identify the source of the pain, but not necessarily the cause of it.

For arguments sake, let’s say you have a herniated disc/slipped disc. While I accept that this may well be the source of your pain, it is not really going to help us if we are to set out a treatment strategy to resolve your pain, We need to find out why the disc herniated in the first place i.e. what caused the disc to herniate in the first place.

Non-Specific Low Back Pain

It is widely accepted throughout the health profession that nearly all low back pain suffered by the general population is non-specific low back pain (NSLBP), where no single structure can be truly identified as the source of pain.

Therefore, I believe we should concentrate on a functional diagnosis as opposed to a medical one, as it is typically our functional day-to-day activities which lead to NSLBP.

I believe we need only concern ourselves with two diagnoses:

Flexion Dominated Pain (FDP)

Extension Dominated Pain (EDP)

FDP refers to pain which is aggravated by the movement of leaning forward (flexion) or any movement or posture which has a similar influence on the spine.

EDP refers to pain which is aggravated by the movement of leaning backwards (extension) or any movement or posture which has a similar influence on the spine.

So are you suffering with FDP or EDP?

If a position such as lying on your stomach helps ease your pain (maybe place a pillow or two under your stomach, because if your pain is quite sensitive laying on your stomach alone may aggravate your pain a little) it is likely you are suffering with FDP.

Alternatively, if sitting down and leaning forward to rest your forearms on your knees or maybe lying on your back and gently hugging one or both knees to your chest eases your pain, your functional diagnosis is probably EDP.

NB. If your pain is still quite acutely inflamed, then it is likely that most positions and postures will increase your pain. Under these circumstances, the first thing to do is to settle the inflammation present.

As always with the human body, it is not quite as black and white as this and some postures of flexion or extension can be quite subtle and not always that easy to identify straight way. Nevertheless, nearly all NSLBP can be given a functional diagnosis which will allow you to specifically treat the cause of your problem and consequently resolve the pain you are suffering with.

You will also need to take note of your aggravating and easing factors, but that’s for another article…

Paul Boxcer – Bsc (Hons) Physiotherapist, has over 14 years experience of treating people with low back pain & sciatica. With careful analysis of this experience, Paul has developed his unique Personalised Treatment Approach to treating both of these painful conditions. Visit his website at to find out more about Paul’s unique approach to treating both sciatica and low back pain.

Paul’s book“Low Back Pain & Sciatica – A Personalised Treatment Approach” not only explains everything you need to know in order to allow you to cure yourself of the pain you may be suffering with, but by addressing the cause of the problem, it ensures the risk of subsequent episodes is also eliminated. Visit Paul on his Facebook page for further information or maybe ask him a question or two!

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