Low back pain
Incidence of low back pain
Low back pain is a common complaint. A recent study has shown that the incidence of low back pain in the population ranges from 38% to 70% of an adult population.
Anatomy of the low back
The low back typically refers to the joints and tissues of the lumbar spine. This area represents the bottom 5 spinal vertebra (bones) between the thoracic spine and the sacrum (triangular bone in the pelvis). The vertebra are connected by the intervertebral discs. The back side of the vertebra are connected by symmetrical joints on either side, which are known as the zygoapophyseal (z-joints or facet joints more commonly). A good analogy is to think of a tricycle. The front tire represents the bone and disc while the back tires represent the joints.
Between the bones of the spine there are situated many ligaments that guide and restrict movements. Further control of movement occurs actively through the coordinated contraction of the trunk muscles, in some cases before movement has occurred. These muscles include some of the muscles of the abdominals and the muscles of the back more commonly known as the paraspinal muscles.
Between the bones of the back there are also nerve roots that exit to supply the muscles and tissues of the low back, hips, legs and feet.
What is the source of low back pain
There can be numerous causes of low back pain.
Low back pain from muscle strains
One of the most common sources of low back pain is local pain from one of the many muscles of the low back or muscles that refer pain to the low back. The pain may have been caused by one activity such as occurs when lifting a heavy object or may have occurred after doing a repetitive task such or playing a sport. Muscle pain is generally felt when the muscles are either contracted or stretched.
Low back pain from Nerves
Neurogenic pain refers to a pain due to an injury to the nerve or nervous system of the low back. The pain can often be described as electrical and may shoot or jump to a different area. Significant compression of a nerve root can result in the loss of sensation to further away regions of the body including the leg or foot. If the nerve root supplies the muscles of the leg then one of the symptoms may include a giving out of the muscles when stress is placed on the nerve. The affected area can be further away from the source of pain is generally felt when pressure is put on the nerve with standing postures, twisting or in some cases with prolonged sitting or stretching.
Low back pain from the Facet Joint
Pain symptoms elicited from the joints of the spine is commonly known as facet pain. The pain often is at the low back but can radiate to the back of the thighs as well. Postures that create compression of the region can elicit symptoms, this can be as extreme as carrying heavy weight on the shoulders or as mild as standing upright for long periods of time. This area is often negatively affected by restrictions of movement in the shoulders, hips and knees. The common position of ease is typically sitting down or leaning on the arms. There is often an associated muscle weakness of the hip which is often felt when getting out of a chair.
Low back pain from the Disc
The lumbar disc provides restraints to excessive amounts of bending and twisting. In younger spines the disc has a high water content and is vulnerable to injuries that involve sustained bending of the spine with or without twisting. Injures to discs are often described as herniations or protrusions. If the injury is large enough there can be pressure placed on the exiting nerve root which can result in nerve pain radiating into the low back and different parts of the leg. Symptoms usually worsen in bent forward positions which can include sustained sitting. With irritation of disc pain pain often radiates, or peripheralizes, away from the injured structure. Often people with disc pain need to stand up to make the pain reduce. This is often felt as a reduction of peripheral symptoms making you more aware of pain at the injured disc. This phenomenon is know as centralization of pain and needs to occur for the disc to heal.
Other causes of low back pain
- Soft tissue strains due to poor posture and muscle imbalances
- Spondylolysis and spondylolisthesis
- Trauma to the tissues or joints
- Bone pain from loss of bone density
- Joint pain from abnormal loading of the joint
- Organ pain referral to the low back such as occurs with kidney stones
- Emotional or psychogenic pain
Risk factors for low back pain
Some episodes of low back can’t be avoided. However there are some factors that can increase your likelihood of having an episode of low back pain. In one study these were found to include:
- limping during the first few steps
- hip/knee pain during sitting
- overall widespread pain were associated with the first incident low back pain
- having had a prior low back pain
- having another current other musculoskeletal complaints
- Men and women with prior low back pain were more inclined to report incident low back pain
- Individuals older than 70 years with strength that was more than 50% within the same population
What can be done about low back pain
If you are experiencing low back pain the first step is identifying how to reduce your pain. In some cases you will instinctively move or adopt positions to reduce the pain, but if there are multiple causes of low back pain then the easing position is not always apparent. Often professional advice by on the proper way to move or sustain a position of the spine will help to reduce the pain that you are experiencing. This should be done by a physiotherapist with training in spinal pain and conditions. Part of the assessment by your physiotherapist should include a detailed history including previous injuries and medical condition, changes in activity or office setup in the months preceding the pain. Often a series of movements of the spine can be given to help to continue to reduce the pain that you are experiencing. For most low back pain a comprehensive physiotherapy assessment will be able to determine the cause and appropriate treatment for pain. In most cases X-Rays and MRIs are not required unless back pain symptoms have been resistant to appropriate conservative treatment including core retraining and a flexibility program.
As your symptoms reduce in intensity the next step becomes to identify areas of restricted mobility, strength or poor posture that may have led to the development of the pain in the first place. These can include simple body weight or weighted exercises or may involve flexibility or ergonomic advice. If your goal is to return to sport or higher level activities there should be a transition to more sport related exercises and flexibility programs.
Prehab for low back pain
Whether you are starting a new exercise program, trying to be more active or if you are tired of the impact that persistent low back pain have been having on your life, the proactive approach is to check it out before the next flare-up hits. Muscle imbalances, lost mobility and strength deficits are most easily addressed and at a much lower cost if you are not currently in pain.
Not Sure Where to Start?
Our team of physiotherapists, massage therapists and naturopathic doctors have training and experience to help get you get your symptoms under control and to prevent recurrence. Call or email us for more information!
Family Physiotherapy, assessing and treating sports injuries for the residents of Thornhill, Markham and Vaughan
The physiotherapists at Family Physiotherapy have been providing high quality assessment and treatment techniques using safe and evidence based techniques to the residents of Thornhill, Markham, Richmond Hill, Woodbridge, Vaughan and Toronto. Our therapists are continually upgrading their skills and take the time to provide you with the one on one care necessary to quickly get you back to the activities you love doing. Comprehensive assessment and treatment techniques are always one on one without the use of assistants or double booking patients to make sure that you achieve your functional and sports goals as soon as possible. Our therapists would be happy to help you to achieve your goals, call the clinic to schedule a consultation to get you back on track. Don’t let pain ruin your day!
Incidence and risk factors for first-time incident low back pain: a systematic review and meta-analysis Jeffrey B. Taylor, DPTa, *, Adam P. Goode, DPT, PhDb , Steven Z. George, PT, PhDc , Chad E. Cook, PT, PhD, MBAd The Spine Journal 14 (2014) 2299–2319
Manual Therapy 18 (2013) 165e168 Pathoanatomy and classification of low back disorders Jon Joseph Ford a,*, Andrew John Hahne b,1