WHAT YOU NEED TO KNOW ABOUT LOWER BACK PAIN – PART 1

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Lower back pain affects 80% of Australians during their lifetime, with many of us suffering from issues that affect our daily lives. Over the next few weeks I’m going to deliver my thoughts on back issues.

First, let’s start with a few myths:

  • Back pain is hereditary – Back pain is not your destiny nor a life sentence. Yes, genetics make some people more susceptible to back issues than others, but it does not resign you to a life of back problems.
  • MRIs and CT scans give us all the information – Imaging is very limiting, most lower back issues stem from functional problems such as poor movement patterns, repeated over and over.
  • Back pain is linked to my tight hamstrings – research has indicated tight hamstrings are a symptom of back issues rather than a cause.
  • Lying in bed is good for my back pain – FALSE, lying in bed for excessive periods can cause lower back pain.
  • Stretching is good for back pain – There is no such thing as a good stretch for all back-pain sufferers. Often stretches are prescribed to improve the mobility of the spine, when most back-pain sufferers don’t need mobility to improve their back pain. Physiologically, pulling your knees to your chest, trigger the ‘stretch reflex’ – This is a neurological phenomenon that reduces pain sensitivity and provides some relief in the short term. By doing this you begin a cycle for someone who thinks they need to stretch out their lower back pain, instead they should stabilise and control their spine.

Common questions?

  • Why do I have low back pain and stiffness in the morning?

Well this is because overnight the discs between each of our vertebrae are filled with a protein that loves water. When we lie flat, the discs fill with fluid and gently push the vertebra away from each other, lengthening the spine – This is why we are taller in morning than we are before we go to bed each night! So, the reason our backs are so stiff in the morning is because the discs are so full of fluid, and when we get up each morning the excess of fluid begins to seep out, after an hour or so we return to our normal height.

  • Will daily workouts at the gym get rid of my back pain?

Incorrect, do the right workouts that will preserve your back instead of injuring it. Repetitive bending of the spine in the gym, followed by sitting all day, with poorly executed daily tasks could cause delamination of some of your disc fibres. The key is – Don’t stop working out, change your movement patterns so that you can enjoy fitness training without compromising your back.

  • Will stronger muscles will cure my back pain?

Nope, back injuries are the result of putting the spine under load then breaking form. Maintaining proper movement patterns requires endurance, therefore, we must place endurance as a priority.

  • Do sit ups strengthen my lower back? 

No, in most cases sit ups damage the backs of most people, and they do not increase back health

  • Where is my lower back pain coming from?

Now we have answered some common myths, lets look at the structure of the spine and where your lower back pain might be coming from.

Bones and Joints

The spinal column is made up of bones, called vertebrae, which are stacked on each other in a natural S-curve from your neck to your tailbone. On the sides of your vertebrae are bony protrusions called processes that can be felt all the way down your back and are anchor points for muscles and ligaments, which provide support to the spine. Between each vertebrae are discs, little gel spheres that cushion the bones of the vertebrae so they don’t rub together. Lastly, the joints of the spine are found behind the discs. These are called facet joints and determine how much we can bend, twist and turn.

What can cause pain here?

  • FRACTURE: Like any bone, your vertebrae can fracture, and usually results from high-energy trauma such as a car crash or sports accident, or a pre-existing condition like osteoporosis where bones are weaker than normal.
  • DISC HERNIATION: The bones of your lower back near your pelvis bear the most weight and move more than the other sections of your spine. This makes them more prone to disc herniation or degeneration leading to lower back pain that may radiate down your legs.
  • FACET JOINT PAIN: The joints behind the discs can become stiff, hypermobile, or locked causing pain and changing your normal range of motion.

Nerves

The spine protects the spinal cord, which runs from the brain down the spine. The spinal cord itself, consists of millions of nerve fibres which carry information to and from the limbs, trunk and organs of the body, back to and from the brain. There are 31 pairs of spinal nerves, which branch off and exit at each spinal level. These nerves sense pain, control movement and function of organs.

What can cause pain here?

  • NERVE DAMAGE: If spinal nerves are damaged, or pinched, sufferers may experience back pain that radiates down the leg or into the foot as a result of irritation.

Muscles

The muscles of the back include the spinal erectors, quadratus lumborum, rhomboids, the lats, the traps and many others closer to the spine itself. In addition to supporting the spine, these muscles are involved in many other movements, such as bending or twisting.

What can cause pain here?

  • STRAIN: The single most common cause of lower back pain is a strained muscle, which occurs when a muscle is stretched too far. This can happen from lifting a heavy object, twisting under load, poor posture, or sports injuries.
  • OTHER STRUCTURES: It’s also important to consider other muscles around the pelvis and hips including the psoas, iliacus, hamstring, glutes and quadriceps. These muscles have attachment points within the abdominal or lower back region and can cause pain or dysfunction in the lower back.

Connective Tissues

Ligaments, joint capsules and fascia make up the connective tissues. Their job is to limit end of range motion, hold bones together, and provide support and protection. 

What causes pain here?

  • SPRAIN: These structures can become irritated with repetitive activity or when overstretched resulting in a sprain injury. Usually this pain is local and has a slow onset. 

Understanding the structures and associated symptoms listed above may give insight as to what’s causing your lower back pain. However, the treatment plan for each diagnosis will be different, so if you are experiencing ongoing discomfort it’s important to seek help.

Self-Assessment for Lower Back Pain

In this next section we’ll be looking at a simple self-assessment you can do for your lower back pain. By answering the questions below you’ll begin to understand your back pain triggers. The additional information will also help your physiotherapist pinpoint the issue and put together a treatment plan to reduce discomfort and get you moving again. So grab a pen and paper (or write some notes in your phone) and let’s get started!

1. Does the pain change in intensity?

Things to think about: at it’s worst, how would you rate the pain out of 10? Does the type of pain change? For example it goes from a dull ache to a sharp stabbing pain?

What this could mean: a change in intensity can suggest the cause of the pain. For example is the pain worse in the morning when you wake up and improves as the day progresses? This can suggest discogenic issues. Or is the pain worse with certain exercises, worse sitting in a chair for prolonged periods?

2. When you roll in bed do you suffer painful catches?

Things to think about: is it only when you roll from the right to the left or vice versa? Or are both sides affected?

What this could mean: pain when rolling in bed can suggest rotational instability in the facet joints. These joints are involved in rotational movements of the spine, and respond best to strengthening exercises prescribed by your physiotherapist.

3. What makes your pain worse? 

Things to think about: note down the causes of your pain as they happen. Is it scenarios such as:

  • Tying your shoelaces?
  • After brushing your teeth? 
  • Sitting in a chair? How long for? 
  • Exercise? If so what exercises and when does it start?
  • After stretching or yoga? What direction were you leaning into the stretch?

What this could mean: all this information helps us identify your triggers. By knowing the directions and movements that lead to an increase in symptoms we can pinpoint the problem faster. It also helps your physiotherapist identify the types of exercises needed to strengthen supporting structures and provides the starting point for most graded exercise therapy programs.

4. Was the initial cause traumatic? 

Things to think about: was it after a car accident, high impact playing sport, or a traumatic fall?

What this could mean: there is a higher risk of fracture to the spine from high velocity or significant impact injuries. If this is the case imaging such as X-rays or an MRI may be requested to assist with diagnosis.

5. Do you have a history of medical conditions?

Things to think about: although rare, there are certain types of cancer, illnesses, and other diseases that present with lower back pain symptoms. Because of this your physiotherapist will take a full health history, and may refer you back to your GP for further tests if necessary. Additionally, chronic stress, anxiety and depression can trigger or exacerbate symptoms, so questions regarding your mental health are quite common. 

What this could mean: you may need further investigation to find the root cause of your lower back pain. Best not to trust Dr. Google with your symptoms and leave diagnoses to the professionals!

6. Is the pain at its worst first thing in the morning? 

What this can mean: pain that presents first thing in the morning, but eases throughout the day is normal. After lying in one position for several hours the joints around the spine may become stiff, but with movement this can ease as the fluid within the discs redistributes and muscles supporting the spine warm-up. 

7. Does the pain increase throughout the day? 

What this can mean: pain that increases and peaks at night may indicate poor sitting or standing posture, or a lack of strength or conditioning

8. Is the pain concentrated in your middle back? 

What this can mean: this can give us a clue as to the cause of your pain. The middle of the back can sometimes be referred pain from organs or it can be a sign of musculoskeletal back pain.

9. Does your back pain radiate into your buttock and feet?

What this can mean: this can be caused by nerve irritation and indicate disc pathology. Alternatively, tight muscles and trigger points in your buttocks can cause this type of pain. For symptoms below the knee, it is most likely nerve structures that are impacted.

10. Does the pain increase with fast walking or does it decrease? 

What this can mean: an underlying stenosis (narrowing of the spinal cord) or lateral broadbased disc bulge can be worsened by walking. However, a narrow bulge will generally improve with walking.

Whatever answers you have to the above questions, know that there is an appropriate treatment plan for you! Lower back pain doesn’t have to be lifelong or debilitating. It’s simply about finding the root cause and putting together the right treatment plan for you.

How do I help my back pain?

1. Understand your back

The most important thing to help back pain is to understand what pain is and to understand what sets off your episodes. Unfortunately there isn’t a one size fits all and it for many back pain sufferers they need a dedicated individual plan. As you can see above there are many things that may contribute to your injury or ongoing concern. A good plan will cover the whole picture rather than focusing on just the physical injury site. They will include the total body and environmental factors. 

2. Get moving

Add in as little as 20-30 minutes of gentle exercise a day and you will amazed at how much of a difference this makes. If you want a bigger bang for your buck, schedule the exercise an hour before you normally get sore. Get up and get moving as frequently possible throughout the day.

3. Start training 

I am a big fan of having a strong and mobile body. There are many benefits to adding strength training into your program. This can be as simple as 2-3 sessions a week with a program that covers the whole body. If you are already doing strength work then I would look at focusing on specific areas to firstly increase mobility and then build strength around the trunk in a progressively overloaded program. A place where people get in trouble is when they go from doing not a lot to training 5 days a week. This isn’t sustainable and you should focus on slowly building up your training load both session numbers and what you do during the session. 

If you need any advice on how this looks, I am always happy to review your current training program and see if there are areas we can adjust.

In summary:

Lower back pain isn’t the norm and just because you have been in pan previously doesn’t mean you have to be in pain in the future. It shouldn’t limit your ability to play with your kids, do the house work, exercise with friends or play sport. There are a multiple of reasons why you can be experiencing back pain but the most important thing is to understand what is causing your pain and develop a plan on how to overcome it.

As always, reach out if you want to chat about your specific injury.

Nick and The LIFT Team.

Nick Hunter

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