Lower Back Pain
Lower Back Pain
Eighty percent (80%) of people will experience lower back pain at some stage of their life. Back pain is a symptom caused by numerous biopsychosocial conditions. It is one of the most common reasons for people missing work and seeing a doctor or physiotherapist. Fortunately, most back pain is caused by musculoskeletal conditions and can be readily treated with great success. Generally, lower back pain is something you can avoid with the added knowledge of some back education, back care strategies and back exercises. Please seek advice specific to your low back pain.
What Can Cause Severe Low Back Pain?
Acute low back pain is most often caused by a sudden injury to the muscles and ligaments supporting the back. The pain may be caused by muscle spasms or a strain or tear in the muscles and ligaments. But occasionally, it can have a more sinister cause.
Sudden Low Back Pain Causes
- Muscle Strain or Muscle Spasms
- Spinal Disc Injury
- Compression fractures eg Osteoporosis
- Spine Cancer
Non-Musculoskeletal Causes of Low Back Pain
Despite most low back pain is musculoskeletal in origin, other health conditions can cause low back pain.
- Abdominal aortic aneurysm
- Infection of the spine (osteomyelitis, discitis)
- Kidney infection or kidney stones
- Spondyloarthropathies: eg rheumatoid arthritis, psoriatic arthritis.
- Female reproductive organs: eg pregnancy complications, ovarian cysts or cancer, endometriosis
What Causes Lower Back Pain?
Lower Back Pain is categorised by researchers and spinal health care practitioners into the following categories:
1. Specific Spinal Pathologies (<1%)
2. Radicular Syndromes (5-10%)
3. Non-Specific Lower Back Pain (NSLBP) (Bardin et al., 2017)
Specific Spinal Pathologies
Some conditions that cause back pain do require urgent and specific referral and treatment. These can include spinal infections, cancer/malignancy, spinal arthropathies (eg rheumatoid arthritis or ankylosing spondylitis), cauda equina syndrome or spinal fractures. These conditions do require early diagnosis and prompt referral to the appropriate medical specialist. Luckily these conditions account for less than 1% of back pain sufferers, but you don't want them missed.
Some referrals should be IMMEDIATE!
Lower back pain can result from structural damage that can irritate or pinch a nerve. Researchers believe that radicular syndrome causes 5-10% of the presentations of back pain to general practitioners. The most common nerve that can be pinched in the lower back is your sciatic nerve. You may be diagnosed with sciatica if you are suffering radicular pain down your leg due to a back injury. While the sciatic nerve is the most common nerve that can be affected by a spinal injury any nerve can be affected eg femoral nerve.
Back injuries such as a herniated disc (slipped disc), facet joint sprain, spondylolisthesis, spondylolysis, degenerative disc disease, spondylosis, and back ligament sprain can all contribute to or cause radicular pain syndrome due to swelling or space occupying material adjacent to the spinal nerve. The nerve is either irritated (radicular pain) or pinched/compressed (radiculopathy).
Lumbar radiculopathy can result in functionally disabling conditions such as foot drop, foot slap or evertor muscle weakness that can affect your ability to walk. Spinal stenosis is slightly different condition and relates to compression of the spinal canal. Spinal stenosis is usually more prevalent as you age.
Non-Specific Lower Back Pain (NSLPB)
Non-Specific Lower Back Pain (NSLBP) is the diagnostic term used to classify sufferers of lower back pain where no specific structure has been injured. It is really a diagnosis of exclusion. In other words, your spinal health care practitioner has excluded specific spinal pathologies and any of the radicular syndromes mentioned above as the cause of your back pain or symptoms.
Fortunately, these conditions account for approximately 90-95% of the lower back pain causes and they can nearly always be successfully managed conservatively and without the need for surgery. Most improve within two to six weeks. They can be fast-tracked with pain relief and physiotherapy techniques such as manual therapy and back exercises.
Most lower back pain causes are musculoskeletal in origin and known as non-specific low back pain (NSLPB). The causes of lower back pain are numerous but roughly fall into either a sudden (traumatic) or sustained overstress injuries.
Most people can relate to traumatic injury such as bending awkwardly to lift a heavy load that tears or damages structures. However, sustained overstress injuries (eg poor posture) are probably more common but also easier to prevent. In these cases, normally positional stress or postural fatigue creates an accumulated microtrauma that overloads your lower back structures over an extended period of time to cause injury and back pain.
Most commonly, NSLBP is caused by back muscle strain, back ligament sprain. Other chronic back conditions such as degenerative disc disease may underly the acute conditions and predispose you to the acute pain.
The good news is that you can take measures to prevent or lessen most back pain episodes. Early diagnosis and specific individualised treatment is the easiest way to recover quickly from lower back pain and to prevent a recurrence.
Suffering Back Pain. What Should You Do?
As you can see while lower back pain is common, the diagnosis of the cause of your back pain is specific to you and therefore the treatment or investigation pathway does vary from case to case.
A spinal health care professional can assist you a prompt diagnosis, early referral, acute and chronic back pain relief, plus long-term self-management or back pain prevention strategies specific to your back pain. You should feel confident that your practitioner has screened you for specific pathologies that require urgent medical attention. Plus they should also assess you for any neurological deficits such as loss of bowel or bladder function, leg muscle weakness, loss of sensation, diminished reflexes and day-to-day function to determine whether you have a radiculopathy or stenosis, which may require different treatment options to NSLBP or radicular pain.
For specific guidance regarding your condition, please seek the individual assessment from a health practitioner with a special interest in back pain, such as a musculoskeletal physiotherapist.
Common Lower Back Pain Causes
The following conditions may cause lower back pain.
- Back Cramps
- Back Muscle Pain
- Core Stability Deficiency
- DOMS - Delayed Onset Muscle Soreness
- Side Strain
- Back Stress Fracture
- Scheuermann's Disease
- Spinal Stenosis
- Stress Fracture Spine (Cricket Bowlers)
Back Joint Injuries
Back Treatment Options
High-Frequency Causes of Lower Back Pain
Back Muscle Strains
Back muscle injuries are the most common form of back injury. Muscle fatigue, excessive loads or poor lifting postures are the most common problems. Inefficient back muscles can lead to poor joint stabilisation and subsequent injury.
More info: Back Muscle Pain
Ligaments are the strong fibrous bands that limit the amount of movement available at each spinal level. Stretching ligaments too far or too quickly will tear them with subsequent bleeding into the surrounding tissues, causing swelling and pain. Awkward lifting, sports injuries, and motor vehicle accidents are very common causes. Just as in other regions of the body, physiotherapy hastens ligament healing and relieves pain so that you can enjoy life again as soon as possible.
More info: Back Ligament Sprains
A bulging disc injury is a common spine injury sustained to your spine's intervertebral disc. Spinal discs are the shock-absorbing rings of fibrocartilage and glycoprotein that separate your bony vertebral bodies while allowing movement at each spinal level, and enough room for the major spinal nerves to exit from the spinal canal and travel to your limbs.
The annulus is the outer section of the spinal disc, consisting of several layers of multi-directional fibrocartilaginous fibres all densely packed to create a wall around the glycoprotein filled jelly-like disc nucleus. A disc bulge (commonly referred to as a slipped disc), can potentially press against or irritate the nerve where it exits from the spine. This nerve pinch can cause back pain, spasms, cramping, numbness, pins and needles, or pain in your legs.
More info: Bulging Discs
You can also fracture your spine if the force involved is highly traumatic or you have a low bone density (eg osteoporosis).
More info: Osteoporosis
Poor posture when sitting, standing and lifting at work can place unnecessary stress on your spine. Muscles fatigue, ligaments overstretch, discs stretch and this places spinal joints and nerves under pain-causing pressure.
More info: Poor Posture
What is the Best Treatment for Lower Back Pain?
The best treatment for lower back pain obviously relies upon an accurate diagnosis to direct the primary treatment direction. Once the specific spinal pathologies have been excluded or the patient referred to the relevant specialist we are dealing mostly with radicular syndromes and non-specific lower back pain (NSLBP).
With accurate assessment and early treatment, most NSLBP and radicular pain syndromes will respond extremely quickly to physiotherapy, allowing
you to quickly resume pain-free and normal activities of daily living. Please ask your physiotherapist for their professional treatment
advice. They can also advise you when a back brace is suitable or if you are better advised to perform
some specific back exercises.
Real-time ultrasound has been used by back pain research in recent years to assist the diagnosis and successful treatment of lower back pain. Real-time ultrasound is now available at leading physiotherapy clinics to assist you and your back pain relief and prevention.
While lower back pain treatment will vary depending on your specific diagnosis, your physiotherapist will have the following aims.
PHASE I - Back Pain Relief & Protection
Managing your back pain is the main reason that you seek treatment for lower back pain. In truth, it was actually the final symptom that you developed and should be the first symptom to improve.
Your physiotherapist will use an array of treatment tools to reduce your pain and inflammation. These include ice, electrotherapy, acupuncture, de-loading taping techniques, soft tissue massage. A course of non-steroidal anti-inflammatory drugs such as ibuprofen may also help in this phase.
PHASE II - Restoring Normal ROM and Strength. Early Back Exercises.
As your lower back pain and inflammation settles, your lower back pain may feel better but you are actually more vulnerable for re-injury during this honeymoon period when you don’t have pain but your muscles and ligaments are weak. During this phase your physiotherapist will turn their attention to restoring your normal lumbar spine motion, muscle length and resting tension, muscle strength and endurance, proprioception, balance and gait (walking pattern).
Your physiotherapist will commence you on a lower abdominal core stability program to facilitate your important muscles that dynamically control and stabilise your lower back and pelvis. Your physiotherapist will assess your muscle recruitment pattern and prescribe the best back exercises for your specific needs.
PHASE III - Restoring Full Function
Depending on your chosen work, sport or activities of daily living, your physiotherapist will aim to restore your back’s function to safely allow you to return to your desired activities. Everyone has different demands for their lower back that will determine what specific treatment goals you need to achieve. For some, it is simply to walk around the block. Others may wish to run a marathon or be a fast bowler. Your physiotherapist will tailor your back pain rehabilitation to help you achieve your own functional goals.
PHASE IV - Back Exercises - Preventing a Recurrence
Recurrence of lower back pain can occur. The main reason it is thought to recur is due to insufficient rehabilitation. In particular, poor compliance with deep abdominal core muscle exercises. You should continue a version of these back exercises routinely a few times per week. Your physiotherapist will assist you in identifying the best exercises for you to continue indefinitely.
Other Lower Back Pain Treatment Options
There are many treatment options that your physiotherapist will discuss with you in the treatment of your lower back pain. Treatment varies based on the source of your individual back pain symptoms. Fortunately, researchers report a 95% resolution of back pain within 12 months. This can be fast-tracked by physiotherapy and exercises, or in some severe cases, spinal surgery. Luckily less than 1% of back pain sufferers will require spinal surgery.
A back brace or corset can provide excellent relief for most lower back pain and sciatica sufferers. Those who gain the most benefit are those who find their pain eases when they wrap/bind a towel or sheet (folded-lengthwise) tightly around their stomach and lower back. If this simple test eases your back pain, you should use a back brace in the short-term. Back braces and strong deep core muscles help to avoid a recurrence in the future.
Back braces are available via the following web link: Back Braces
Acupuncture has been an effective source of pain relief for over 5000 years. While we do not fully understand how it works, acupuncture can assist you back pain relief. Ask your physiotherapist for advice as most of our PhysioWorks physiotherapists have acupuncture training.
More info: Acupuncture
Massage always feels wonderful, plus it has wonderful muscle relaxation benefits. Massage is particularly useful when back muscle spasm or chronic muscle tension is present. Regular remedial massage is also a very handy lower back pain prevention strategy.
More info: Massage
TENS machines are an electronic pain relieving device that will reduce your lower back pain and your need for pain-relieving drugs.
More info: Tens Machine
Poor sitting posture is a common cause of sciatica and lower back pain. To assist the support of your lower back many simple and effective products have been developed over time. These include lumbar D-roll, Bassett frames and kinesio tape.
More info: Posture Support
Your lower back needs to carry many extra kilos. Losing weight via an exercise program such as walking or swimming plus an improved diet have been shown to assist lower back pain sufferers. Changing your daily habits is the secret. If you require advice, please ask your physiotherapist for their recommended exercise guidelines to burn your fuel or consult a dietitian to help point you in the right direction when it comes to a simple and healthy calorie controlled diet.
More info: Dietitian
Lower Back Pain Exercises
With the correct lower back pain exercises and specific treatment guided by your physiotherapist, back pain relief is very achievable. Most severe lower back pain sufferers will recover within 4 to 6 weeks. However, this time can vary greatly as it depends on the nature of your back injury, the treatment plan that you develop with your physiotherapist, and how compliant you are with your treatment and lower back pain exercises.
Please ask your physiotherapist for their advice in what will help you most.
More Info: Back Pain Treatment
How to Prevent Lower Back Pain?
While there are no guarantees, it is well known that active individuals who regularly exercise to maintain normal flexibility and muscle strength to support their spine have the best chance of avoiding lower back pain.
Healthy spine postures and safe lifting techniques at home and at work also reduce your risk of developing lower back pain. Feel free to discuss with your physiotherapist the specific postures and activities that you perform on a daily basis. They will aim to help you to understand how to position yourself and move with the lowest risk of injury.
Lower Back Anatomy
Your lower back region (otherwise known as the lumbar spine) is made up of five vertebrae (L1-L5). In between these vertebrae lie fibrocartilage discs (intervertebral discs), which act as cushions between adjacent vertebrae, while at the same time protect the spinal cord.
Your lumbar spine articulates on your sacrum, which wedges into your pelvis. You will find that some authors describe "lower back pain" as pain arising from your lumbosacral spine.
Nerves stem from the spinal cord, which provides muscles with sensations and messages to produce movement. Stability of your spine is provided through ligaments and muscles of the back, lower back, and abdomen.
FAQs about Lower Back Pain
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