Lower back pain
The lower back is the area bellow your ribcage and just above your buttocks, this area of the spine is called your lumbar spine. Your lumbar spine is made up of 5 vertebrae (bony discs) and intravertebral discs (the spongy discs in between the bony ones). There are also other structures that make up the lumbar spine such as; Ligaments, muscles, tendons, spinal cord, nerves and fascia (a thin fibrous connective tissue).
Near enough everyone will experience lower back pain in their life and you can see why when there are so many structures that are involved. You are yet to consider organs that can also refer pain to the lower back such as the genitourinary and gastrointestinal system, this referral of pain from organs to the body wall is called Viscerosomatic referral. Even though there’s a lot of structures to consider with lower back pain, it is our job as Healthcare professionals to find out what the culprit could be then help you resolve it. According to the National Institute of Neurological Disorders and Stroke, around 80% of adults will have lower back pain at some point during their lives.
Pain can be felt in very different ways that vary from person to person, some people describe it as a sharp stabbing pain whereas others will describe a dull ache, although there are many other descriptions such as cutting, stinging, burning, boring, splitting, crushing, gnawing, nagging, gripping, scalding, shooting, or throbbing. Even though most of us are not big fans of pain. Nevertheless, it is one of the body’s most important communication tools and its there for a reason, to tell you somethings not right.
There are several ways to categorize pain. One is to split it into acute pain and chronic pain. Acute pain typically comes on suddenly and has a limited duration. It’s frequently caused by damage to tissue such as bone, muscle, ligaments or even organs. Chronic pain lasts longer than acute pain and is generally more resistant to treatment. It’s usually associated with a long-term issue, such as osteoarthritis, damage to a disc, long term muscle strain or even systemic illness. However, most low back pain is the result of an injury, such as muscle sprains or discogenic referral (pain caused by damage to a intravertebral disc) due to sudden movements or poor body mechanics while lifting objects.
So what exactly are the common causes of lower back pain?
A muscle strain, or sometimes known as a “pulled muscle”, happens when your muscle is overstretched or overworked. This usually occurs as a result of overuse, or improper use of that muscle. Strains can happen in any muscle, but one of the most common sights is in your lower back.
When talking about disc I am referring to an intervertebral disc as mentioned earlier. I know this sounds weird but think of a disc like an onion with jam in the middle. It’s is made of two parts: the elastic layers of the onion (annulus fibrosis) and the jam-like contents (nucleus pulposis) that sits in the middle. It can handle quite a lot of pressure without damage, but specific types of pressure and torsion can damage the outer layers and push the jam- like content (nucleus pulposis) outwards through the different layers of the onion (annulus fibrosis). This in turn can cause a disc bulge, herniation or even a prolapse where the nucleus pulposis leaks out.
the spinal cord runs down a canal within the spine once it leaves the brain, the canal that it runs down is called the spinal canal, it is like a gutter for the spinal cord to go down while its protected by the bones which form the vertebral column (spine). Sometimes the spinal canal can become narrower which then compresses the spinal cord that runs through it or even the nerve roots that then run out but that’s called foraminal stenosis.
We have natural curves in our spine where if you was to look at someone from the side the spine would look like an S shape and from behind would be a straight line. However, there are some abnormalities where the spinal curves can be more prominent, these are called Lordosis, Kyphosis and Scoliosis. These can be congenital conditions that are usually diagnosed during childhood or adolescence.
There are a lot of other conditions that can contribute to lower back pain. These include:
Spondylosis is a disrepair of the spinal joints which causes the joint spaces to thin. Ageing is the primary cause of this condition
Fibromyalgia is long-term pain and tenderness multiple joints, muscles, and tendons of the body. The reason behind this is not yet known.
Spondylitis is inflammation of the joints between the bones of the spine.
Kidney and bladder referral this is normally due to an infection or a kidney stone
Pregnancy due to the different stresses on the body as the foetus grows in size and release of hormones such as Relaxin which allows ligaments and bones to move easier.
Endometriosis is when the endometrial cells start to grow outside of the uterus causing inflammation. Normally found in young females.
Ovarian cysts scar tissue that builds up on the Ovaries usually due to the release of eggs.
Uterine fibroids growth of tissue that forms around or inside the wall of the uterus that can press or inflame surrounding structures
What to do
Well depending on your condition depends on how you are treated. Please note that if for any reason you have changes in your bladder or bowel habits such as the Inability to control your urine or Inability to control bowel movements, are experiencing sexual dysfunction and/or pain and weakness in the legs you should seek immediate medical attention as these can be signs of a serious condition. However, Pain and weakness in the legs alongside lower back pain can be quite common and might be related to one of the musculoskeletal conditions mentioned earlier that is effecting the nerve supply to your legs.
Most of the time people feel like they should stretch their lower back but this sometimes can make the pain worse as it depends on what body tissue is causing the pain governs the way you should be stretching. For example when you bend forward to touch your toes, this action stretches some of the muscles and fascia in your lower back but it can result in increasing load onto the discs within the spine.
The National Institute for Health and Care Excellence (NICE) advises exercise for lower back pain. Although you may feel like you should rest, moving is good for your back as it is designed to move 3 dimensionally, so try to get moving as best you can even if that means going for a walk or moving in a chair. Exercises for lower back pain can strengthen the back, core, and leg muscles. This in turn can increase stability, lead to pain reduction and prevention of reinjury. Here are some stability exercises that can help with lower back pain:
The McGill’s “Big Three”
- The Curl-up
Lie down on your back. Extend one leg and bend the knee of the other leg.
Put your hands under the lower back to maintain the natural arch of your spine.
Pull your head, shoulders and chest off the floor, as though they were all locked together. Lift them up as one unit. Keep your back in neutral position. Don’t tuck your chin or let your head tilt back. Hold for 10 seconds.
Slowly lower yourself down. Do half of the repetitions with your left leg bent and half with your right leg bent.
- The Side Bridge
Lie on your side, with your forearm on the floor and elbow underneath your shoulder. Place your hand on the opposing shoulder to stabilize your torso. Pull your feet back so the knees are at a 90-degree angle.
Lift the hips off of the floor and hold for 10 seconds. Try to maintain a straight line from your head down to your knees. Make sure that your hips are in line with the rest of your body. When completed turn over to other side.
Optional: to make it slightly harder, straighten the legs instead of bending them.
- The Bird Dog
Assume a hands-and-knees position on the floor.
Raise the left arm forward while simultaneously extending your right leg back until both are parallel to the floor. Ensure that hips are aligned with the torso and not tilted to one side. Hold for 10 seconds. Repeat on the other side.
Try to keep good posture
Especially when lifting. Make sure your back is always straight, bend at the waist and knees. Let the power come from the legs, they are a lot stronger combined than the muscles of the lower back. One thing I see a lot of people doing is arching their lower back when told to keep their back straight, there is no need to arch your lower back to the point that you look like Beyoncé, just try to keep it straight when lifting. You should naturally have an arch in your lower back so most of the time there is no need to enhance it.
If back pain is something you are suffering with or worried about why not see one of our highly trained Osteopaths, at Correct Osteo Clinic we conduct free consultations that consist of taking your medical history, posture and movement analysis and give advice on exercise and lifestyle changes that is right for you to ultimately prolong your healthcare.