Lower back pain can be a really debilitating injury that affects people of all ages, fitness levels and walks of life. Unfortunatley once you’ve had lower back issues the risk of it happening again is high. Making sure that you know what you can do about it and how to manage and prevent flare ups in the future is key.

Definition

Low back pain (LBP) affects 80% of people throughout their lifetime (1). LBP is categorized based on its duration. An episode of LBP that has been present for less than six weeks is classed as acute LBP(2). This information sheet will focus on acute LBP, lower back anatomy, potential reason’s for the acute episode and effective management strategies.

ANATOMY

The lumbar spine is comprised of 5 vertebrae. These vertebrae are the largest of the whole vertebral column that begins up at your skull. Each two adjacent vertebral bodies are connected by an intervertebral disc. The primary function of the disc is to absorb load. Between each of these vertebrae a nerve exits. These nerves innervate different muscles and areas of skin in the lower limbs. These areas are called myotomes and dermatomes.

Potential Reason’s for Lower Back Pain

Symptoms of lower back pain and referred pain into the limbs can be caused by any innervated structure in the lumbar spine. This long list includes muscles, ligaments, nerve roots, the joints between each vertebrae (facet joints) and intervertebral discs.

To identify the impairments that may have contributed to the onset of pain a Physiotherapist can perform an assessment. This assessment will also be able to flag any more sinister pathology and identify the need of further scans or investigations.

LUMBAR FACET JOINT SYNDROME

Some Signs and Symptoms:

  • Pain with twisting and bending back.
  • Referred pain into buttock or thigh.
  • Pain after prolonged periods of sitting/standing. Changing position often helps improve pain.

Potential Causes (3,4)

  • Excessive twisting or bending can result in degenerative changes to the joint cartilage.
  • Like any other joint the lumbar facets can be sprained if you bend back too far or too quickly.
  • Changes to lumbar disc height can put more load through these joints and cause degeneration or irritation.

LUMBAR DISCOGENIC PAIN

Some Signs and Symptoms:

  • May be associated with pain radiating into buttock and leg.
  • Pain may increase with sitting and bending forward.
  • If there is a disc bulge present coughing or sneezing can bring on pain.

Potential Causes:

  • Too much load through the lower back i.e. heavy deadlift
  • Degeneration due to repetitive overloading
  • Poor mobility

PREVENTION AND MANAGEMENT STRATEGIES

  1. “No slumping” – be aware of your sitting posture; sit up on your ‘sit bones’ and don’t slump!
  2. Gain or maintain upper back mobility – Thoracic mobility can influence lower back pain.
  3. Move! – Try to get up and move/change position every 20 minutes.
  4. Develop a strong core – trunk strength, endurance and control are essential to providing lower back support.
  5. Stretch à important muscle groups to stretch for prevention/relief are hip flexors, hamstrings, erector spinae and quadratus lumborum.
  6. Don’t lock your knees when standing.
  7. Wear supportive shoes.
  8. Don’t forget the glutes! – Without good glute strength/control more load will be put through the lower back.
  9. Modify movements that aggravate your back pain.
  10. Develop safer movement patterns – see a professional – your Physiotherapist!
  11. Learn safe lifting techniques
  12. When standing don’t “stick your bum out” instead tuck under/posteriorly pelvic tilt.
  13. Don’t brace through your abdominals.
  14. If there is pain see a Physiotherapist! It’s not normal to have pain and it’s not “just because you’re old” à You don’t need to live with this pain.

REFERENCES

  1. Balagué, F., Mannion, A. F., Pellisé, F., & Cedraschi, C. (2012). Non-specific low back pain. The lancet379(9814), 482-491.
  2. Burton, A. K., Balagué, F., Cardon, G., Eriksen, H. R., Henrotin, Y., Lahad, A., … & Van Der Beek, A. J. (2004). European guidelines for prevention in low back pain.
  3. Safran, M., Zachazewski, J. E., & Stone, D. A. (2011). Instructions for sports medicine patients. Elsevier Health Sciences.
  4. Schütz, U., Cakir, B., Dreinhöfer, K., Richter, M., & Koepp, H. (2011). Diagnostic value of lumbar facet joint injection: a prospective triple cross-over study. PloS one6(11), e27991.