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 your low back

Low back typically refers to the joints and tissues of your lumbar spine. This area represents the bottom 5 spinal vertebra (bones) between the thoracic spine (mid back) and your sacrum (triangular bone in the pelvis). Your vertebra are connected by the intervertebral discs. The back side of your vertebra are connected by symmetrical joints on either side, which are known as the zygoapophyseal (z-joints or more commonly known as facet joints).   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. A good analogy for your low back configuration 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 your spine there are many ligaments that guide and limit your movements.  Further movement control occurs actively through the coordinated contraction of your trunk muscles. In some cases this contraction will occur before any movement has occurred.  These muscles include some of the muscles of the abdominals and the muscles of the back more commonly known as your 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 a number of pain sources causing your 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.  In some cases this may have been caused by one activity, such as when lifting a heavy object, or may have occurred after doing a repetitive task like gardening or playing a sport.  Pain from your muscles is usually felt when your muscles are either contracted or stretched.

Low back pain from your nerves

Neurogenic pain refers to a pain due to an injury to the nerve or nervous system of the low back.  If you're having this pain, you probably are describing it as as electrical. It may also 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 your leg or foot.  Since your nerve root supplies the muscles of the leg then you may also be noticing that certain muscles are giving out. Your affected area can be further away from the source of pain and is generally felt when pressure is put on your nerve with standing postures, twisting or in some cases with prolonged sitting or stretching.

Low back pain from your facet Joint

Pain symptoms elicited from the joints of the spine is commonly known as facet pain.  The pain often is at your low back but can also radiate to the back of your thighs. This pain if often aggravated by compression of your joints. This  can be as extreme as carrying heavy weight on your shoulders or as mild as standing upright for long periods of time.  This pain source is often negatively affected by stiffness of your shoulders, hips and knees. Usually your position of ease is typically sitting down or leaning on your arms.  There is often an associated muscle weaknesses of the hip which is often felt when you're getting out of a chair.

Low back pain from your disc

Your lumbar disc provides restraints to excessive amounts of bending and twisting. Younger spines have discs with a high water content and are more vulnerable to injuries that involve sustained bending of especially if twisting is involved.  Disc injuries are often described as herniations, bulges or protrusions.  If your injury is large enough there can be pressure placed on the exiting nerve root. This can cause nerve pain to radiate into your low back and different parts of your leg.  Pain is usually aggravated with bent forward positions which includes sitting or putting on your shoes.  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 but can increase your pain awareness of your injured disc.  This phenomenon is know as centralization of pain and needs to occur for your disc to heal.

Other causes of your 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 your first few steps
• Hip or knee pain when you're 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 your low back pain

If you're 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 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 your physiotherapist should include a detailed history including your previous injuries medical condition and changes in your activity or office setup in the months preceding the pain.  Your physiotherapist will show you simple movements of your spine that you can do 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.

How can I reduce the chance of it happening again?

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 your 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

Muscle imbalances, lost mobility and strength deficits are most easily addressed and at a much lower cost if you are not currently in pain.  The proactive approach is to check out your problem areas before your next flare-up hits.  Don't limit your daily routines and activities because of past pain.