Lower Back Pain
Lower Back Pain
Eighty per cent (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 people miss work and see a doctor or physiotherapist. Fortunately, most back pain treatment for musculoskeletal disorders succeeds. Generally, you can avoid lower back pain with the added knowledge of some back education, back care strategies, and back exercises.
Please seek advice specific to your low back pain.
Back Pain Causes
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
Youth Spinal Pain
Teenager Neck & Back Pain
Teenagers can be particularly vulnerable to back pain, mainly due to a combination of high flexibility and low muscle strength and posture control.
The competitive athlete and most individuals who exercise regularly or maintain fitness and core stability control are less prone to spine injury and problems due to the strength and flexibility of supporting structures. Luckily, issues involving the lower lumbar spine are rare in athletes and account for less than 10% of sports-related injuries. Injuries do occur in contact sports and with repetitive strain sports. Your physiotherapist can assist in the resolution of any deficits in this area.
Sports such as gymnastics, cricket fast bowlers, and tennis have a higher incidence of associated lumbar spine problems related to repetitive twisting and hyper-bending motions.
Spondylolisthesis is a significant concern and needs to be appropriately treated by a physiotherapist interested in these types of injuries. Luckily, most injuries are minor, self-limited, and respond quickly to physiotherapy treatment.
Common Adolescent Spinal Injuries
Lower Back (Lumbar Spine)
Midback (Thoracic Spine)
Neck (Cervical Spine)
For specific advice regarding youth neck or back pain, please seek the professional advice of your trusted spinal physiotherapist or doctor.
Back Pain Info
What is Back Muscle Pain?
Back muscle pain or its aliases: pulled back muscle, back muscle spasm, torn back muscle or back muscle strain, is very common. Back muscle pain is the most common source of back pain. The good news is that it is also one of the quickest to heal and rehabilitate.
What Causes Back Muscle Pain?
Most causes of low back pain are muscle, ligament or joint-related. Commonly, these muscular strains, ligament sprains, and joint dysfunction arises suddenly during or following physical loading of your spine. Muscle fatigue, excessive loads, high speeds or poor lifting postures are the most common causes.
The causes of pure back pain are numerous but roughly fall into the following categories.
Back Muscle Strains
Muscle pain is the most common source of back pain. Muscle fatigue, excessive loads or poor lifting or sitting postures are the most common problems.
Inefficient, weak, or back muscles that lack endurance or expected contraction timing could lead to reduced joint stabilisation and subsequent injury to your back muscles, ligaments, joints or even spinal discs.
Poor posture when sitting, standing and lifting at work can place unnecessary stress upon your spine. With muscle fatigue or overstretching, your ligaments and discs can stretch, which puts spinal joint muscles and nerves under pain-causing pressure or strain, resulting in back 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, muscular spasm 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.
What are the Symptoms of Back Muscle Pain?
Back muscle pain symptoms may range from a mild ache to sudden debilitating back pain.
Typical back muscle pain symptoms include:
- Localised back pain, with no radiation into your buttock or leg.
- Back muscle tenderness and spasms.
- Protective back stiffness.
- Sudden back pain onset.
You will usually feel better when resting and may find a change of position painful, e.g. sit to stand, rolling in bed, walking or bending.
How is Back Muscle Pain Diagnosed?
Differentiating a back muscle strain from a ligament sprain can be difficult, as both injuries show similar symptoms. In general, it doesn't significantly matter what you call the problem because the treatment and prognosis for both back muscular strains and ligament sprains are similar. Most spinal practitioners refer to both injuries as a category called a "Back Strain" or "Musculoligamentous Strain".
X-rays and CT scans do not identify muscle or ligament injury. MRI scan is probably the best diagnostic test to determine the muscle or ligament structures injured.
What is Back Muscle Pain Treatment?
Seek a Professional Diagnosis!
A spinal healthcare practitioner, such as your physiotherapist, should thoroughly; examine you to exclude more severe sources of back pain.
Numerous injuries can cause back pain, and the treatment does vary significantly depending on your diagnosis. Physiotherapy treatment aims to protect your damaged tissue while hastening your muscle and ligament healing and then look at strategies to prevent a recurrence.
Your physiotherapist has some nifty tricks for quickly relieving your back pain so that you can enjoy life again as soon as possible.
Back Pain Info
How To Avoid Repeat Back Strain
While it is easier to understand that lifting a heavy load in an awkward position can cause back pain, it's harder to comprehend how a simple movement can hurt your back. Yes, it can happen by merely leaning forwards to pick up your teacup or when bending to brush your teeth! We know that some people are vulnerable to repeated lower back sprains and strains.
The reason is poor local joint control. The main reason for this is inadequate or non-existent muscle activation of the deep core stability muscles. These muscles are small but next to the joint to control excessive slides and glides. The joint can slide too far and strain its supporting ligaments when they don't work correctly. Ouch! That hurts.
The good news is You can quickly correct poor core stability to prevent back pain. Don't hesitate to contact your physio for more information or have your core activation accurately assessed.
High-risk factors of back pain include:
- sudden forceful movement
- lifting a heavy object
- twisting the back
- coughing or sneezing
- prolonged sitting with poor posture
- Lower Back Pain
- What Is The Best Treatment for Lower Back Pain?
- Deep Core Stability
- Recurring Back Pain
Back Pain Info
Suffering Back Pain. What Should You Do?
While lower back pain is commonplace, the diagnosis of the cause of your back pain is specific to you, and therefore, the treatment or investigation pathway varies for each case.
A spinal health care professional can assist you with a prompt diagnosis, early referral, acute and chronic back pain relief, plus long-term self-management or back pain prevention strategies specific to you. You should feel confident that your practitioner has screened you for particular pathologies that require urgent medical attention. They should assess you for neurological deficits such as:
- loss of bowel or bladder function,
- leg muscle weakness,
- loss of sensation,
- diminished reflexes,
- and day-to-day operation.
A thorough assessment will determine whether you have radiculopathy or stenosis. This diagnosis is essential since treatment usually differs from NSLBP or radicular pain.
Please consult a musculoskeletal physiotherapist or another spinal healthcare practitioner for specific recommendations.
You probably already know that back pain has a nasty habit of returning within a few months of the initial injury. Research has shown that you have an 80% chance of recurring back pain within 12 months of the first episode. The good news is that you can reduce your chances significantly if you do the right thing early.
What Should You Do When You Suffer Back Pain?
The latest research recommends that you only spend a day or two resting in bed. More extended periods cause muscle weakness, making repeat back pain more likely.
Ice or Heat?
We recommend ice treatment for 20 minutes every 2 or 3 hours for the first 48 hours. The ice should help reduce your pain, swelling and back spasms. After a few days, you are safe to use heat packs. We usually recommend avoiding heat (and heat rubs) in the first 48 hours. Heat packs encourage bleeding, which could be detrimental if used too early.
Should You Use a Back Brace?
A back brace can help you to get back on your feet or allow you to return to work sooner. We don't encourage long-term use because research has shown that your stomach and back muscles will weaken as you become reliant on the brace.
What Medication Should You Use?
Your Doctor or Pharmacist may recommend pain relief in the form of paracetamol or an anti-inflammatory. You are best seeking their advice as certain drugs can interfere with other health conditions.
When Should You Commence Physio?
In severe cases, when the slightest movement causes unbelievable pain or spasm, it may be best to wait a day or two to start treatment. This delay will allow the majority of swelling to settle. Slight niggles or "my back feels out" sufferers can usually commence treatment (and maybe fixed) on the day of injury. If you are not sure what to do, please call us for advice. We'll happily guide you in your time of need.
What About Core Stability Training?
The current physiotherapy and fitness training trend is 'core stability training' (back and abdominal muscle control).
What If You Do Nothing?
"Back pain is something you could be suffering needlessly". Research tells us 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 and the quicker you'll get back to living your life.
What Results Should You Expect from Physiotherapy?
Not only will your physio diagnose the cause of your pain and give you the "peace of mind" associated, but they'll also help you to:
- Relieve your pain quicker
- Cope better with your pain using proven strategies and tips
- Get you back to work and play faster through improved healing rates.
- Loosen and strengthen your back with individually prescribed exercises
- Prevent future bouts of back pain via our holistic back pain management approach
Think about it. Back Pain is Something You Could be Suffering Needlessly.
Please use our expert advice to guide you out of pain quicker and for a lot longer.
If you have any questions regarding your back pain (or any other condition), please call us now to discuss your situation. You'll find our friendly staff happy to point you in the right direction.
Back Pain Info
What Are The Most Common Back Injuries?
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 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.
Your spinal disc is a glycoprotein-filled jelly-like disc nucleus surrounded by a fibrocartilaginous wall, known as an annulus. Your annulus design contains the nucleus, allowing movement between the vertebrae. The annulus consists of several layers of multi-directional fibrocartilaginous fibres. The fibres are all densely packed, forming the outer section of the spinal disc.
A disc bulge (slipped disc) occurs when the annulus weakens and subsequently bulges to 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 (e.g. osteoporosis).
Poor posture when sitting, standing or lifting at work can place unnecessary stress on your spine. Muscles fatigue, ligaments overstretch, discs stretch, and spinal joints and nerves under pain-causing pressure.
More info: Poor Posture
Back Pain Info
What Is The Best Treatment for Lower Back Pain?
Don't you wish there was a magic formula to treat all back pain? But, we are all different and have different causes of our back pain and underlying genetics and general health conditions. All of these factors create potential complications that need to be considered by your healthcare practitioner. While lower back pain treatment will vary depending on your specific diagnosis, your physiotherapist will have the following aims.
Lower Back Pain Treatment Guidelines
PHASE I - Back Pain Relief & Protection
Managing your back pain is why 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 various treatment tools to reduce your pain and inflammation. These include ice, electrotherapy, acupuncture, de-loading taping, and 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. 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. Plus, they'll assess your muscle length and resting tension, muscle strength and endurance, proprioception, balance and gait (walking pattern).
Your physiotherapist may 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, 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 that will determine what specific treatment goals you 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 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 for repeat episodes s 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
Your physiotherapist will discuss many treatment options 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 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. Many of our PhysioWorks physiotherapists have acupuncture or dry needling training. Ask your physiotherapist for advice.
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 sound low back pain prevention strategy.
TENS machines are electronic pain-relieving devices that will reduce your pain and the 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 the nature of your injury and the treatment plan you develop with your physiotherapist.
Back Pain Treatment
The best treatment for lower back pain relies upon an accurate diagnosis to direct the primary treatment direction. Once the specific spinal pathologies have been excluded, your physiotherapist will deal primarily with radicular syndromes and non-specific lower back pain (NSLBP).
With an accurate assessment and early treatment, most lower back pain will respond extremely quickly to physiotherapy. We enable you to resume normal daily living activities without pain. Please ask your physiotherapist for their professional treatment advice.
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 help you and your back pain relief and prevention.
Back Pain: Frequently Asked Questions
Back Pain Causes FAQs
- What Are The Most Common Causes Of Back Pain?
- How Do You Know If Your Back Pain Is Serious?
- What Are The Highest Frequency Causes of Lower Back Pain?
- How Do You Know If Your Back Pain Is Muscular?
Repeat & Incidental Back Pain FAQs
- What Causes Repeat Low Back Strains & Sprains?
- What Causes Back Pain Out Of Nowhere?
- What Causes Back Pain?
Youth Back Pain FAQs
Back Pain Treatment FAQs
- What Is The Best Treatment for Lower Back Pain?
- What Can You Do To Relieve Your Lower Back Pain?
- Could Real-Time Ultrasound Physiotherapy Help You Beat Back Pain?
Back Pain Exercises FAQs
- What Exercises Help Back Pain?
- What Are The Best Core Exercises?
- How Can An Exercise Ball Help Your Lower Back Pain?
- Does Back Massage Help?
Back Pain Prevention FAQs
Is Your Back Pain Serious?
What Can Cause Severe Low Back Pain?
A sudden injury most often causes acute low back pain. The most common injury sources are 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.
Warning Signs of a More Serious Back Injury?
In these instances of neurological deficit, please urgently consult your nearest hospital, doctor or physiotherapist. The following neurological signs warrant prompt assessment:
- pins and needles (paraesthesia),
- numbness (anaesthesia),
- leg muscle weakness,
- altered reflexes,
- difficulty walking,
- loss of control of bladder or bowels.
Non-Musculoskeletal Causes of Low Back Pain
Although 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: e.g. rheumatoid arthritis, psoriatic arthritis.
- Female reproductive organs: e.g. pregnancy complications, ovarian cysts or cancer, endometriosis
Please seek the professional advice of your trusted and experienced healthcare practitioner to diagnose the cause of your lower back pain.
Back Pain Info
Nerve pain is pain caused by damage or disease that affects the nervous system of the body. It is also known as neuropathic pain or neuralgia. Nerve pain is a pain that comes from problems with signals from the nerves. It is different to the typical type of pain that is due to an injury. It is known as nociceptive pain.
What Causes Nerve Pain?
A problem with your nerves themselves, which sends pain messages to the brain, causes neuropathic pain.
What Are Nerve Pain Symptoms?
Nerve pain is often described as burning, stabbing, shooting, aching, or like an electric shock.
What Causes Nerve Pain?
Various conditions can affect your nerves and cause nerve pain. Familiar sources of nerve pain include:
- Shingles (post-herpetic neuralgia).
- Trigeminal neuralgia.
- Diabetic neuropathy.
- Phantom limb pain (post-amputation).
- Multiple sclerosis.
- HIV infection.
- Other nerve disorders.
Nerve Pain & Nociceptive Pain
You can suffer both nerve pain and nociceptive pain simultaneously. The same condition can cause both pain types.
Nerve Pain Treatment
Nerve pain is less likely than nociceptive pain to be helped by traditional painkillers. Paracetamol and anti-inflammatories seem less effective. However, other types of medicines often work well to ease the pain. Nerve pain is often relieved by anti-depressant or anti-epileptic medication. Please ask your doctor for more advice.
What is Pain?
Pain is the built-in alarm that informs you something is wrong!
Pain is your body's way of sending a warning to your brain. Your spinal cord and nerves provide the pathway for messages to travel to and from your brain and the other parts of your body. Pain travels along these nerve pathways as electrical signals to your brain for interpretation.
Receptor nerve cells in and beneath your skin sense heat, cold, light, touch, pressure, and pain. You have thousands of these receptor cells. Most cells sense pain. When there is an injury to your body, these tiny cells send messages along nerves into your spinal cord and then up to your brain.
In general, pain receptors are classified according to their location.
Receptors that respond to injury or noxious stimuli are termed nociceptors and are sensitive to thermal (heat), electrical, mechanical, chemical and painful stimuli. Each nociceptor is connected to a nerve that transmits an electrical impulse along its length towards the spinal cord and then, ultimately, your brain.
It is your brain that informs you whether or not you are experiencing pain. Plus, your pain can plays tricks - especially when you suffer chronic pain.
Pain messages travel slower than other nerve stimulation.
Nerves can also be categorised according to their diameter (width) and whether a myelin sheath is present.
Three types of nerves are concerned with the transmission of pain:
A-beta fibres, which have a large diameter and are myelinated
A-delta fibres, which has a small diameter and also have myelinated sheaths.
C fibres have small diameters, are non-myelinated (slowing their conduction rate), and are generally involved in the transmission of dull, aching sensations.
Nerves with large diameters conduct impulses faster than those with a small diameter. The presence of a myelin sheath also speeds up the nerve conduction rate.
One method of easing your pain is to provide your nervous system with high speed "good feelings", such as rubbing your injured area. This is the same principle that a tens machine (pain-relieving machine) utilises to provide pain relief.
What Causes Pins & Needles?
What is Paraesthesia?
A moderately pinched nerve is the most common cause of "pins and needles". Pins and needles are referred to as "paraesthesia" in the medical community. Did you know that feeling "pins and needles" can be a worse sign than having pain in your arm or leg? The reason is that you can't even feel pain anymore when you significantly squash the nerve.
Even worse than "pins and needles" is "numbness" or "anaesthesia", which is a total lack of sensation. You will experience anaesthesia when there is severe nerve compression. Anaesthesia or numbness that persists for more than a few hours can signify permanent nerve compression. Would you please seek prompt medical attention to prevent the nerve from permanent damage and the muscles it innervates to weaken drastically?
The majority of pinched nerves and nerve compressions are only transient and quickly reversed with early treatment. However, neglect can lead to permanent nerve compression injuries, which may never recover.
Common Causes of Pinched Nerves
The most common forms of nerve compression are in the spinal joints, where either a disc bulge or a bony arthritic spur can irritate and compress the nerve. Compressions can also occur as the nerve passes through or around muscles. Your physiotherapist will know where to look.
How Can You Fix "Pins and Needles"?
If you know of someone who is experiencing chronic or permanent "pins and needles", "numbness", or "muscle weakness", please encourage them to seek urgent professional advice. The secret to quick success is the correct diagnosis. A highly trained health practitioner such as your physiotherapist or doctor is your best port of call.