What is Lower Back Pain?
Lower back pain has many causes. Eighty per cent (80%) of people will experience lower back pain at some stage of their life. It is one of the most common reasons for people missing work and seeing a doctor or physiotherapist.
Your lower back region (otherwise known as the lumbar spine) consists of five vertebrae (L1-L5). Between your vertebrae lie fibrocartilage discs, known as intervertebral discs. Your discs act as cushions between your 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 that arises from your lumbosacral spine.
Nerves stem from the spinal cord, which provides muscles with sensations and messages to move. Your spinal stability is through ligaments and muscles of the back, lower back and abdomen.
What Causes Lower Back Pain?
Most causes of low back pain are musculoskeletal in origin and known as non-specific low back pain. These back injuries are most commonly from muscular strains, ligament sprains, and joint dysfunction, mainly when pain arises suddenly during or following physical loading of the spine.
The good news is that you can take measures to prevent or lessen most back pain episodes. Your physiotherapist is an expert who treats and can help you to prevent low back pain.
Early diagnosis and treatment are the easiest way to recover quickly from lower back pain and prevent a recurrence.
The causes of lower back pain are numerous but roughly fall into either sudden (traumatic) or sustained overstress injuries.
Most people can relate to traumatic injuries, such as bending awkwardly to lift a heavy load that tears or damages structures. However, sustained overstress injuries are probably more common but also more natural to prevent.
In these cases, ordinarily positional stress or postural fatigue creates an accumulated microtrauma that overloads your lower back structures over an extended period to cause injury and back pain.
Common Causes of Lower Back Pain
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 reduced joint stabilisation and subsequent damage.
More info: Back Muscle Pain
Ligaments are the durable, 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 prevalent 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. Your disc is mostly several multidirectional fibrocartilaginous layers. The layers are all densely packed create a wall around the glycoprotein filled jelly-like disc nucleus. A disc bulge (commonly referred to as slipped disc) can potentially press against or irritate the nerve where it exits 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 (e.g. osteoporosis).
More info: Osteoporosis
When sitting, standing, and lifting at work, poor posture can place unnecessary stress upon your spine. Muscles fatigue, ligaments overstretch, discs stretch, which puts spinal joints and nerves under pain-causing pressure.
More info: Poor Posture
How Can You Prevent Lower Back Pain?
While there are no guarantees, it is well known that active individuals who regularly exercise to maintain reasonable 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 work also reduce your risk of developing lower back pain. Feel free to discuss with your physiotherapist the specific work-postures and activities that you perform daily. They will help you understand how to position yourself and move with the lowest risk of injury.
Lower Back Pain Treatment
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 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, Strength
As your back pain and inflammation settles, your lower back pain may feel better. Still, you are more vulnerable to 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. They’ll then add 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 exercises for you, specific to your 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 allow you to return to your desired activities safely. Everyone has different demands for their lower back to determine what specific treatment goals they need to achieve. For some, it is merely to walk around the block. Others may wish to run a marathon or be a fast bowler. Your physiotherapist will tailor your rehabilitation to help you achieve your own functional goals.
PHASE IV – Preventing a Recurrence
Recurrence of low back pain can occur. The main reason is recurrence 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 activities for you to continue indefinitely.
Other Back Pain Treatment Options
There are many treatment options that your physiotherapist will discuss with you to treat your back pain. Treatment varies based upon the source of your symptoms.
A back brace or corset can provide excellent relief for most sciatica sufferers. Those who gain the most benefit find their pain eases when they wrap/bind a towel or sheet (folded-lengthwise) tightly around their stomach and back. If this simple test relieves your 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.
Acupuncture has been a useful source of pain relief for over 5000 years. While we do not fully understand how it works, acupuncture can assist you with pain relief. Ask your physiotherapist for advice as most of our PhysioWorks physiotherapists have acupuncture or dry needling training.
Massage always feels lovely, plus it has terrific muscle relaxation benefits. Massage is beneficial when muscle spasm or chronic muscle tension is present. Regular remedial massage is also a useful low back pain prevention strategy.
TENS machines are electronic pain-relieving devices that will reduce your pain and your need for pain-relieving drugs.
Poor sitting posture is a common cause of sciatica. Many simple and effective products developed over time to passively assist your back support. These include lumbar D-Roll, Bassett frames and kinesio tape.
Your lower back needs to carry any extra kilos. Losing weight via an exercise program such as walking or swimming, plus an improved diet, has to assist lower back pain sufferers. Changing your daily habits is a 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 healthy and straightforward calorie-controlled diet.
More info: Dietitians
What Back Pain Treatment Results Can You Expect?
Most sufferers of lower back pain will recover within 4 to 6 weeks. However, this time can vary. It depends on both the nature of your injury and the treatment plan that you develop with your physiotherapist.
Acute Injury Signs
Acute Injury Management.
Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.
For detailed information on specific injuries, check out the injury by body part section.
Don't Ignore these Injury Warning Signs
Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.
If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.
Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.
Reduced Range of Motion
If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.
Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.
Immediate Injury Treatment: Step-by-Step Guidelines
- Stop the activity immediately.
- Wrap the injured part in a compression bandage.
- Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
- Elevate the injured part to reduce swelling.
- Consult your health practitioner for a proper diagnosis of any serious injury.
- Rehabilitate your injury under professional guidance.
- Seek a second opinion if you are not improving.
Article by John Miller
Elite Sports Injury Management
You probably already know that a sports injury can affect not only your performance but also your lifestyle. The latest research continues to change sports injury management considerably. Our challenge is to keep up to date with the latest research and put them to work for you.
How we treated you last year could vary significantly from how we treat you this year. The good news is that you can benefit considerably from our professional knowledge.
What Should You Do When You Suffer a Sports Injury?
Rest from painful exercise or a movement is essential in the early injury stage. "No pain. No gain." does not apply in most cases. The rule of thumb is - don't do anything that reproduces your pain for the initial two or three days. After that, you need to get it moving, or other problems will develop.
Ice or Heat?
We usually recommend avoiding heat (and heat rubs) in the first 48 hours of injury. The heat encourages bleeding, which could be detrimental if used too early. In traumatic injuries, such as ligament sprains, muscle tears or bruising, ice should help reduce your pain and swelling.
Once the "heat" has come out of your injury, you can use heat packs. We recommend 20-minute applications a few times a day to increase the blood flow and hasten your healing rate. The heat will also help your muscles relax and ease your pain. If you're not sure what to do, please call us to discuss your situation specifically.
Should You Use a Compressive Bandage?
Yes. A compressive bandage will help to control swelling and bleeding in the first few days. In most cases, the compressive dressing will also help support the injury as you lay down the new scar tissue. This early healing should help to reduce your pain. Some injuries will benefit from more rigid support, such as a brace or strapping tape. Would you please ask us if you are uncertain about what to do next?
Gravity will encourage swelling to settle at the lowest point. Elevation of an injury in the first few days is beneficial, especially for ankle or hand injuries. Think where your damage is and where your heart is. Try to rest your injury above your heart.
What Medication Should You Use?
Your Doctor or Pharmacist may recommend pain killers or an anti-inflammatory drug. It is best to seek professional advice as certain medications can interfere with other health conditions, especially asthmatics.
When Should You Commence Physio?
In most cases, "the early bird gets the worm". Researchers have found that the intervention of physiotherapy treatment within a few days has many benefits. These include:
- Relieving your pain quicker via joint mobility techniques, massage and electrotherapy
- Improving your scar tissue using techniques to guide the direction it forms
- Getting you back to sport or work quicker through faster healing rates
- Loosening or strengthening of your injured region with individually prescribed exercises
- Improving your performance when you return to sport - we'll detect and help you correct any biomechanical faults that may affect your technique or predispose you to injury.
What If You Do Nothing?
Research tells us that injuries left untreated take longer to heal and have lingering pain. They are also more likely to recur and leave you with either joint stiffness or muscle weakness. It's important to remember that symptoms lasting longer than three months become habitual and are much harder to solve. The sooner you get on top of your symptoms, the better your outcome.
What About Arthritis?
Previously injured joints can prematurely become arthritic through neglect. Generally, there are four main reasons why you develop arthritis:
- An inappropriately treated previous injury (e.g. old joint or ligament sprains)
- Poor joint positioning (biomechanical faults)
- Stiff joints (lack of movement diminishes joint nutrition)
- Loose joints (excessive sloppiness causes joint damage through poor control)
What About Your Return to Sport?
Your physiotherapist will guide you safely back to the level of sport at which you wish to participate. If you need guidance, ask us.
What If You Need Surgery or X-rays?
Not only will your physio diagnose your sports injury and give you the "peace of mind" associated, but they'll also refer you elsewhere if that's what's best for you. Think about it. You could be suffering needlessly from a sports injury. Would you please use our advice to guide you out of pain quicker? And for a lot longer.
If you have any questions regarding your sports injury (or any other condition), don't hesitate to get in touch with your physiotherapist to discuss. You'll find our friendly staff happy to point you in the right direction.