Low Back Pain

Low Back Pain: a common, painful condition affecting the lower portion of the spine. This is one of the most common musculoskeletal disorders that plagues the population and is said to be the second most common complaint doctors hear from patients.

What can cause lower back pain?

Most acute low back pain is mechanical in nature, meaning that there is a disruption in the way the components of the back (the spine, muscle, intervertebral discs, and nerves) fit together and move. Some examples of mechanical causes of low back pain include:

Congenital Differences:

• Skeletal irregularities such as scoliosis (a curvature of the spine), lordosis (an abnormally exaggerated arch in the lower back), kyphosis (excessive outward arch of the spine), and other congenital anomalies of the spine.
• Spina bifida which involves the incomplete development of the spinal cord and/or its protective covering and can cause problems involving malformation of vertebrae and abnormal sensations and even paralysis.

Injuries:

• Sprains (overstretched or torn ligaments), strains (tears in tendons or muscle), and spasms (sudden contraction of a muscle or group of muscles)
• Traumatic Injury such as from playing sports, car accidents, or a fall that can injure tendons, ligaments, or muscle causing the pain, as well as compress the spine and cause discs to rupture or herniate.

Degenerative Problems:

• Intervertebral disc degeneration which occurs when the usually rubbery discs wear down as a normal process of aging and lose their cushioning ability.
• Spondylosis the general degeneration of the spine associated with normal wear and tear that occurs in the joints, discs, and bones of the spine as people get older.
• Arthritis or other inflammatory disease in the spine, including osteoarthritis and rheumatoid arthritis as well as spondylitis, an inflammation of the vertebrae.

Nerve and spinal cord problems:

• Spinal nerve compression, inflammation and/or injury
• Sciatica (also called radiculopathy), caused by something pressing on the sciatic nerve that travels through the buttocks and extends down the back of the leg. People with sciatica may feel shock-like or burning low back pain combined with pain through the buttocks and down one leg.
• Spinal stenosis, the narrowing of the spinal column that puts pressure on the spinal cord and nerves
• Spondylolisthesis, which happens when a vertebra of the lower spine slips out of place, pinching the nerves exiting the spinal column
• Herniated or ruptured discs can occur when the intervertebral discs become compressed and bulge outward
• Osteoporosis (a progressive decrease in bone density and strength that can lead to painful fractures of the vertebrae)

Non-spine sources:

• Kidney infection and stones can cause sharp pain in the lower back, usually on one side
• Endometriosis (the buildup of uterine tissue in places outside the uterus)
• Fibromyalgia (a chronic pain syndrome involving widespread muscle pain and fatigue)
• Tumors that press on or destroy the bony spine or spinal cord and nerves or outside the spine elsewhere in the back
• Pregnancy (back symptoms almost always completely go away after giving birth)

What are the symptoms of lower back pain?

• Stiffness: It may be tough to move or straighten your back.
• Posture problems: Many people with back pain find it hard to stand up straight.
• Muscle spasms: After a strain, muscles in the lower back can spasm or contract uncontrollably.

Back pain can range in intensity from a dull, constant ache to a sudden, sharp or shooting pain. It can begin suddenly because of an accident or by lifting something heavy, or it can develop over time as we age. Getting too little exercise followed by a strenuous workout also can cause back pain.

There are two types of back pain:

1. Acute, or short-term back pain lasts a few days to a few weeks. Most low back pain is acute. It tends to resolve on its own within a few days with self-care and there is no residual loss of function. In some cases a few months are required for the symptoms to disappear.
2. Chronic back pain is defined as pain that continues for 12 weeks or longer, even after an initial injury or underlying cause of acute low back pain has been treated. About 20 percent of people affected by acute low back pain develop chronic low back pain with persistent symptoms at one year. Even if pain persists, it does not always mean there is a medically serious underlying cause or one that can be easily identified and treated. In some cases, treatment successfully relieves chronic low back pain, but in other cases pain continues despite medical and surgical treatment.

Alleviating Low Back Pain

In some instances, completely eradicating low back pain may not be feasible, so the focus should be on improving function and reducing pain. It is important to inform your client that pain reduction and improved function may not be immediate and may take several months to become evident.

Avoid the following movements so as not to exacerbate pain in the low back:

• Rapid twisting, forward flexion or hyperextension
• Unsupported forward flexion
• Simultaneously lifting legs while lying prone or supine
• Twisting at the waist with feet turned

In physical training:

• Be aware of proper posture and alignment
• learn how to adopt and maintain a neutral spine
• learn to be aware of lumbar spine, abdominal bracing and glute activation
• Monitor discomfort and regress or cease exercise, if necessary

Exercises to Strengthen the Core and Alleviate Back Pain

Start with one set and increase to two to three sets as tolerated and as function improves the recommended range for muscular endurance is 12-16 reps depending on your fitness level and low back pain. Start with fewer repetitions when inexperienced until you can work up to the muscular endurance repetition range.

1. Wall Roll: Improves torsional control and encourages abdominal bracing through co-contraction. Assume plank position with both elbows planted on a wall. Abdominals are braced. While on the balls of the feet, pivot, pulling one elbow off the wall. Avoid any motion at the spine while the movement occurs. Work up to approximately 10 repetitions.
2. Clamshell Exercise: Retrains the gluteals, which is important for improving back health. Lie on the side, and anchor the thumb on the anterior superior iliac spine. Reach around with the fingertips and position them to land on the gluteus medius. Keeping the heels together, open the knees like a clamshell. The position of the fingertips on the gluteus medius should allow the client to feel glute activation.
3. Side Bridge: Targets lateral muscles, which are important for optimum spinal stability. On the side of the body, place elbows under the shoulder. Elevate hips and knees off the ground. Perform regression with knees on the ground if this is too much for your client. Hold for 20 seconds
4. Bird Dog: Safely and effectively develops spinal extensors. Begin on all fours, hands under shoulders and knees under hips. Extend opposite arm and leg (hold position as tolerated by client). Work up to holding extended position for seven to eight seconds on each side.
5. Glute Bridge: Improves core stability via glute activation. Lie supine, elevate hips off the ground. Activate glutes as hips are elevated. Hold for three to five seconds.