Lower Back Pain
Eighty percent (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 medical doctor or physiotherapist.
Lower Back Pain Causes
Lower back pain has many causes. Most lower back pain causes are musculoskeletal in origin and known as non-specific low back pain. Most commonly, these back injuries are caused by muscular strains, ligament sprains and joint dysfunction, particularly 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 is the easiest way to recover quickly from lower back pain and to prevent a recurrence.
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 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.
Common Lower Back Pain Causes
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
Ligaments are the strong fibrous bands that limit the amount of movement at 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.
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 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 into your legs.
You can also fracture your spine if the force involved is highly traumatic or you have low bone density (eg osteoporosis).
Poor posture when sitting, standing and lifting at work can place unnecessary stress upon your spine. Muscles fatigue, ligaments overstretch, discs stretch and this places spinal joints and nerves under pain-causing pressure.
Lower Back Pain Treatment
With accurate assessment and early treatment, most lower back pain injuries will respond extremely quickly to physiotherapy allowing you to quickly resume pain-free and normal activities of daily living.
Please ask you physiotherapist for their professional treatment advice.
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 be simply to walk around the block. Others may wish to run a marathon or be 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.