Your back provides support to your pelvis, legs, ribcage, arms and skull, hence it is the ‘backbone’ of your body. The back’s musculoskeletal system is made up of bones called vertebrae, where these bones are cushioned by spongy tissue called intervertebral discs (these are your back shock absorbers).
The vertebrae are also joined by pairs of small joints, the ‘facet’ joints. Covering all of these bones and joints are your paraspinal muscles which play the role of producing movement.
All of these structures within your spine need to work in unison – when they do not or when one or more component/s is compromised, this can be when lower back pain arises.
SPINAL ANATOMY 101
It is more common than you might think. Generally speaking, 80% of people will experience lower back pain at some stage of their life. Fortunately lower back pain (or lumbar pain) is commonly caused by musculoskeletal imbalances & conditions, meaning it can be easily treated.
The causes of lower back pain are numerous but roughly fall into either sudden (traumatic) or sustained overstress injuries. These can be further categorised into acute, chronic or acute on chronic.
A traumatic injury occurs during a particular movement or incident which suddenly overloads the structures in the back beyond their capability i.e. heavy lifting, twisting - golf, or motor vehicle accidents.
Sustained overstress injuries are more common to the majority of the population and is usually a result of positional stress i.e sitting, sleeping, repetitive lifting or sport.
With these injuries, the structures of the back suffer from accumulated microtrauma over an extended period of time with 'the final straw' eventually causing symptoms of pain.
COMMON LOW BACK PAIN CONDITIONS
These types of injuries can result from muscle fatigue & weakness, repetitive overuse, poor lifting postures or excessive force and load being transferred through the spine. Inadequate back muscle strength can lead to poor spinal stability, which can result in secondary issues such as bulging discs, sprained lumbar joints or even muscular & ligament tears.
This is commonly caused when the back muscles have failed to do their job and support the spine (and therefore more force is applied to a disc due to a lack of support) or degenerative disc changes (usually associated with age). A bulging disc can press against the nerve from where it exits the spine. This nerve pinch can cause back pain, spasms, cramping, numbness, pins and needles, or pain in your legs.
Develops when: 1) the nerve that runs from the lower back into the leg is compressed or ‘pinched’ by a bulging disc, or 2) a mechanical trauma/direct blow is sustained to the area, such as falling onto your back or hip, resulting in sciatic nerve irritation. The symptoms would include: pain at the local site (most likely the back or buttock), a burning pain typically down the back of the leg, calf and into the foot. It can also cause a loss of neural strength, resulting in a loss of strength to the lower limb.
This condition produces sciatic like symptoms, but the site of nerve compression is at the piriformis muscle. Overuse, tightness and weakness in this muscle can cause compression of the sciatic nerve, usually sending symptoms into the lower limbs.
This can include osteoporosis, arthritis and ankylosing spondylitis. The loss of bone density and strength can cause weakening of these structures, compromising the bony structural integrity of your spine.
This is a serious condition where degenerative changes (commonly age related) in the spine has resulted in the compression of the spinal cord in the spinal canal that it sits in. This condition can produce sciatic like symptoms as well as loss of sensation and sometimes even muscle strength.
Conditions such as kyphosis (rounding of the upper back/neck) or scoliosis (which produces a sideways spinal curve) will mean that the spine’s physical asymmetry will place pressure on different areas. This can cause tightness, muscular imbalances and pain to arise.
Modern day lifestyle which includes a lot of sitting, standing and lifting at work and during daily life can place unnecessary stress on your spine. For example, if you are hunched over at your desk with a rounded spine, your lower back has to work even HARDER to support the poor posture of your upper body which usually results in muscular fatigue, tightness and lumbar back & neck pain.
This one might not seem so obvious, but stress can commonly cause tightness/tension in the neck, shoulders and back as well as make you more sensitive to pain.
LOWER BACK PAIN PREVENTION
Exercising & stretching regularly – a good target would be 30 minutes daily of aerobic activity. Focusing on also a stretching routine to keep your body mobile and flexible will decrease the chance of tightness and stiffness accumulating.
Develop good postures – improving this will engage your ‘postural muscles’ in the upper spine & therefore will not require as much stability and effort from the lower back to support the upper.
Learn how to lift correctly – learning how to use your legs to take the weight off your body when doing the groceries, cleaning the house or picking up your children can give your lower back a much better chance of staying injury and strain free.
Invest in your mattress and pillow – we spend 1/3rd of our day sleeping, so sleeping on a medium to firm mattress is best for preventing back pain. It should support your shoulders, hips, and back (without sagging) to keep the spine straight. Use a pillow that doesn’t poke your neck forward or into a forward tilted position.
Managing your weight – this will cause less strain on your body & back.
LOWER BACK PAIN PHYSIOTHERAPY TREATMENT
Try the above preventative strategies, otherwise if symptoms and pain persists, a trip to your physio could help fix the problem. The key is for an accurate assessment and early treatment by a trained practitioner who will advise you on how to avoid worsening the problem and how to maximise healing potential.
Here at Infinite Health, our highly trained physiotherapists will assist you through the healing process, on to resuming pain-free activities, return to day to day normal activities and most of all reduce the risk of recurrence in the future.
Physios are highly skilled with diagnosing and providing back pain treatment. Initially taking a thorough subjective examination (understanding the history and behaviour of your back pain) combined with what is found in the physical examination will allow the clinician to establish an accurate diagnosis.
In the second part of the assessment, a Physiotherapist will physically assess how your body moves, via assessing the movement & function of joints, muscles, ligaments and overall movement patterns/restrictions to understand how your body is functioning.
Determining the CAUSE of your back pain, and then working to effectively treat this and prevent reoccurrence is the MOST important factor to understand. It is important to continue to keep active and engage in your normal activities as best you can whilst avoiding any aggravating factors whilst this occurs. Though if your pain has not eased in a few days, or in more chronic conditions which are long standing, it is greatly advised to seek the intervention of a physiotherapist.
Every lower back treatment plan is different and specific to each individual but should have the following aims and checkpoints.
Pain relief is what your Physiotherapist can help you with. This is achieved through soft tissue therapy and mobilisation, helping to alleviate muscular tension, spasm and pain. You will also be prescribed with gentle stretches initially to unload the tight or stiff structures in your back, which are contributing to your pain.
To prevent reoccurrence, the prescription of strength & stability based exercises will be developed in a tailored program to ensure your body is resilient and not at risk of the same issue! Additionally, developing strategies to reduce the risk of its recurrence is important, which include: work ergonomic set up, and/or sleeping/sitting positions causing back pain.
Physiotherapists will also provide you with education and understanding of your spine so the individual is able to self manage their back issues, ultimately providing YOU with the understanding of how to keep your lower back healthy and prevent reoccurrence.
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