Troubleshooting Low Back Pain – A guide to why it hurts and how to fight the hurt
Low back pain is one of the most frequently occurring musculoskeletal problems within the United Kingdom. It is estimated that the burden it causes leads to approximately 4% of the UK population taking time off work (which works out at around 90 million working days lost per year) and between 8-12 million GP consultations per year1. So why is it such a problem?
So, what is Pain?
Let’s take a step back and understand what pain actually is. Here is the official definition of the word pain, as outlined by the International Association for the Study of Pain (IASP 2016):
“An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”
In easier terms, this highlights that pain has very strong links with our emotions and how we are actively interpreting the pain. Individuals can be reporting pain when there hasn’t been any tissue damage; equally we learn to apply the word pain based on our experiences through life. Of course, when actual tissue damage has occurred (for example a fractured bone) pain occurs following the cascade of chemical events that occur within our damaged tissues and the neural feedback to the brain
Causes of Low Back Pain
There are a whole number of different causes and origins of low back pain, so we have decided just to list the most common ones below:
Nestled between each vertebra, your discs are designed to transmit load, absorb shock and improve fluidity of movement. Discs can become inflamed and irritated (discitis) and unfortunately for some can also bulge or even herniated.
This is the irritation of nerves, usually in the part of your anatomy where the nerve exits the spinal canal through a small hole either side of the spine to feed out to its target area of the body.
This is inevitable and a normal part of ageing and the lifestyles we choose to lead. Degenerative changes can range from osteoarthritis to loss of height in discs as examples.
Either side of each vertebra exists a joint called the “facet” joint. These provide further stability and facilitate better control of movement in rotation and side bending. Facets can become stiff (hypomobile), arthritic and/or inflamed.
Prolonged poor posture or repetitive poor positioning with and without load will ultimately place strain upon your back. These tend to have an accumulative effect before presenting as symptoms.
Muscular imbalance and weakness
Our muscles tend to work in pairs to create movement over a joint; for global posture and dynamic movement our muscles operate in patterns called “slings”. Our general day to day activities as well as injuries can upset these harmonious working patterns which can lead to imbalance and eventually pain. For example, the iliopsoas helps to flex your hip and the gluteals extend your hip. One example of an imbalance; if the hip flexors become tight and overactive, the gluteals will become weaker (we call this reciprocal inhibition.) The result of this will be compensation from other muscle groups which try to do the work of the weaker muscles (e.g your back extensors, hamstrings.)
Will My Lower Back Pain Ever Go Away?
Our Physiotherapists say “yes”. We always advise to be proactive and address your back pain when it first occurs, rather than leaving it and hoping it will just go away. Approximately 80-90% of sufferers will get better over a 6-week period, with only 5-10% developing more chronic problems which last over 3 months duration2. We work on the principle that the longer it is there the longer it will take to work on all the contributing factors.
How Can I help My Lower Back Pain?
- The most important thing is not to panic. If your pain has just come on, it is advisable to find an ice pack to apply, wrapped in a small towel, to the painful area for 15minutes. Repeat this every 2-3 hours for the first 24-36 hours initially. We get a lot of people saying: “I don’t like taking tablets if I can help it”. It is of our opinion that if you can create a scenario to help your pain settle you will feel better, and this may mean taking basic analgesia to help with pain and inflammation in the interim. If you aren’t sure, a quick call to your GP surgery or pharmacist for advice over the phone is best.
- Next is keep mobile– we are designed to move, and rest has been proven to be detrimental long term. We would then advise making an appointment to see a Chartered Physiotherapist as soon as possible – typically we find patients are too sore to treat hands on, on the same day as the onset of the pain, however some people like to come in for reassurance and to understand how to best manage it in the first instance. We are always happy to discuss symptoms and provide appropriate advice to patients to ensure they are following correct methods to feel better.
Ultimately, gradual graded exercises can help to mobilise your lower back, encourage relaxation in tight muscles and improve symptoms of pain and stiffness. Getting started on appropriate exercises, as prescribed by a Physiotherapist, helps to ensure you don’t develop imbalances as previously discussed, and also works to try and prevent the problem from occurring again.
- Dunn KM, Croft PR: Epidemiology and natural history of low back pain. Eura Medicophys. 2004, 40 (1): 9-13.
- Manchikanti L, Singh V, Falco FJE, Benyamin RM, Hirsch JA: Epidemiology of Low back Pain in Adults, International Neuromodulation Society. 2014, 17 (52): 3-10.