Overcoming Low Back Pain – Part 1

Low Back Pain (LBP) is a monster! It can have a severe impact on people of all ages, genders, and backgrounds. Luckily, its not all doom and gloom! There are things you can do to help ease your symptoms and prevent them from getting worse, and hopefully from even occurring in the first place.

To effectively prevent and treat this problem, it is crucial to first understand what structures are involved regarding the anatomy of the lower back, and also what the causes and different types of LBP are. In this blog post series we will look at understanding LBP and providing some of the most effective ways to manage it and help you get back on the road to good health again!

Anatomy of the Lower Back

To avoid going into an in depth anatomy lecture, I'll keep this as basic as possible. Simply put, the lumbar spine or lower back is responsible for supporting the weight of the upper body and facilitating movement of the trunk and lower limbs. The elements comprising the lumbar spine are made up of:

• Muscles, Ligaments and Tendons - these help support and stabilise the spine. And just like any other soft tissues, these can sprain and strain which can lead to pain and stiffness.

• Vertebrae (bones) - 5 of them to be precise, which are actually the largest and strongest in the spine.

• Facet joints - These are the joints between the vertebrae that allow for movement and stability. These can become inflamed or irritate.

• Intervertebral discs - gel like cushions sit between each vertebrae. They are made up of a tough outer layer called the annulus fibrosus and a gel-like centre called the nucleus pulposus. If the outer layer tears, the gel-like centre can bulge or herniate out of the disc, potentially compressing nearby nerves and causing pain.

• Neurovascular structures - These nerves exit the spinal cord through small openings in the vertebrae and carry signals to and from the rest of the body. If a nerve is compressed or irritated, it can cause pain, tingling, or numbness in the lower back and legs.

Each of these structures are prone to different stressors, and alone or in combination, can contribute to low back pain.

How much of a problem is Low Back Pain?

According to the Global Burden of Disease Study, low back pain is the leading cause of disability worldwide. In the UK, staggeringly, it accounts for over 37% of all musculoskeletal-related consultations!🤯 Here, it is estimated that 12% of the population will be experiencing LBP at any given time, with an eye-watering 84% of people experiencing it at some point in their lives. It is the leading cause of work-related absence, with around 3 million working days lost each year due to low back pain.

Clearly, it’s a pretty big problem. But why might this be the case?

The incidence of low back pain varies depending on several factors, such as age, gender, occupation, and lifestyle. Older adults and women are more likely to experience low back pain than younger individuals and men. Studies have also shown that sedentary lifestyles, obesity, and smoking can increase the risk of developing low back pain.

When you think about it, we spend much more of our time now seated and sedentary. And with all this artificial intelligence around, I’m going to be the one to say we’ve got lazy!

What Type of Low Back Pain do I have?

Low back pain can be categorised into different types based on its duration, underlying cause, and associated symptoms. Understanding these different types are essential for effective treatment and management. The types of low back pain that we’re going to address are:

Mechanical - Mechanical low back pain is the most common type of low back pain. It can range from mild to severe and may be accompanied by stiffness, limited mobility, and muscle spasms. This is a type of pain caused by damage to body tissue. This usually feels sharp, aching or throbbing.

Chronic - Chronic low back pain is defined as pain that persists for more than 12 weeks. This type of pain can be challenging to manage and may require long-term treatment.

Neuropathic (Nerve-related) - Nerve-related low back pain is caused by compression or irritation of the spinal nerves. This can result in a sharp, shooting pain that radiates down the leg, known as sciatica. In some cases, nerve-related low back pain can be accompanied by numbness or weakness in the affected leg.

I understand both personally and through feedback from my patients that it can be difficult to know when to seek medical attention. Firstly, if you experience any form of LBP I would consider booking in with a Sports Therapist or Physiotherapist for an initial assessment so you can get to the root cause of your symptoms and have a better understanding of how to treat or prevent things getting worse.

Red flags in someone with low back pain refer to symptoms or signs that may indicate a serious underlying medical condition that requires urgent medical attention. I’ve listed these below for your attention:

1. Pain that is accompanied by fever, chills, or unexplained weight loss

2. Pain that is accompanied by numbness, tingling, or weakness in the legs or feet

3. Loss of bladder or bowel control

4. History of cancer, recent trauma, or drug use

5. Difficulty walking or standing up straight

6. A recent history of infection or surgery

If you or someone you know experiences any of these red flags, it is important to seek immediate medical attention.

So what has caused my Low Back Pain?

Honestly, unless there is a mechanical incident where you can pinpoint the precise moment it occurred, there are likely multiple factors that come together to cause it. The following are some common causes of low back pain:

Poor Posture

A bit of a pet hate of mine. I often get asked “whats the best posture”. Honestly, I don’t recommend being in any one posture/position for any length of time. And I don’t like fear mongering “bad postures”. There’s no evidence to suggest posture is the cause of low back pain (Slater et al, 2019). And actually, maintaining a “good” posture can require more effort and work which potentially leads to fatigue and pain (O’Sullivan et al, 2012). So, lets instead try to do what the body is designed to do - move! And lets get away from these increasingly common sedentary lifestyles where we’re sitting for prolonged periods.

Repetitive movements

Repetitive movements can cause low back pain, if the bodies not conditioned to perform those movements repetitively. Lets take gardening for instance. If I decide to build a pond in my garden and am repetitively digging over a weekend. There's a good chance I may have some back pain. But, a gardener who does this for a living will be conditioned to doing this activity and likely find it more comfortable.

Lifting heavy objects

Lifting heavy objects without proper form and technique can also lead to back pain, by potentially putting undue strain on the structures of the spine. I emphasise the words ‘can cause pain’ here. As my own argument to this is ‘what is proper form and technique’? The answer, whatever works well for you. As long as you condition the body to do what you want it to, you give it the best chance of performing injury free. Let's take the deadlift as an example. Do I see many patients injure themselves doing it, yes. But this doesn't mean I tell them not to do it. Quite the contrary. In fact, after treating the back pain, I get them deadlifting many different techniques with many different weights, to condition the body to do what they wish. This is because I'm here to help you reach your goals, not to dictate to you what your goals should be!

Underlying medical conditions

Such as osteoporosis and spinal stenosis. These conditions can cause pain and discomfort in the lower back and can limit an individual's ability to perform their daily activities.

I guess what I'm trying to say is yes there are certain factors that can cause low back pain. But, the human body is incredibly robust and malleable, if conditioned with the activity in mind. So let's treat issues when they arise, but let's also prepare the body for what we wish to do, by getting it moving and doing what it's designed to!

Conclusion

In conclusion, low back pain is a widespread health issue that affects people of all ages, genders, and backgrounds. It is the leading cause of disability worldwide, and its impact on society is significant, including work-related absence and healthcare costs. Whilst there are some medical conditions that attribute to low back pain, usually theres a variety of factors at play for its cause. But getting the body moving is always good! Hopefully the above has given you a bit more of an understanding around low back pain and has squashed some of the myths you may have heard.

References

• The Global Burden of Disease Study: https://www.thelancet.com/gbd

• National Institute for Health and Care Excellence (NICE) guidelines on low back pain: https://www.nice.org.uk/guidance/ng59

• Arthritis Research UK report on the impact of musculoskeletal conditions in the UK: https://www.versusarthritis.org/media/2295/impact-of-msk-conditions-in-the-uk-january-2018.pdf

• Systematic review published in the Annals of the Rheumatic Diseases: https://ard.bmj.com/content/73/6/968

• Slater, D., Korakakis, V., O'Sullivan, P., Nolan, D., & O'Sullivan, K. (2019). “Sit up straight”: Time to re-evaluate. journal of orthopaedic & sports physical therapy, 49(8), 562-564.

• O'Sullivan, K., O'Sullivan, P., O'Sullivan, L., & Dankaerts, W. (2012). What do physiotherapists consider to be the best sitting spinal posture?. Manual therapy, 17(5), 432-437.