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What Causes Lower Back Pain?

when to be worried about lower back pain

Low back pain is one of the most common conditions worldwide. Some studies have even suggested that more than 80% of Americans will have experienced low back pain at least once in their life. Annually, anywhere between 15-45% of the population will experience low back pain. 

Not only does low back pain have a significant burden on your physical capabilities, but it can also affect numerous other parts of your life. Perhaps work becomes more difficult because of your limitations. Or maybe you stop going to your exercise classes altogether. Just one low back pain episode can impede various other areas of your life, including socially, psychologically, and even your work.

Although low back pain can be cumbersome, early management of the condition is vital to ensure a quick recovery. To help you keep well informed about low back pain. We have composed a comprehensive information sheet and useful tips. 

Low Back Pain Signs and Symptoms

Unlike other specific conditions such as an ACL-rupture of the knee or hip osteoarthritis, low back pain has a variety of symptoms. Due to the anatomical complexity of the low back (e.g. spinal cord, spine, muscles, nerves, etc.), people can experience different sensations and limitations.

However, many health professionals, including physical therapists, tend to group low back pain into three main classifications. These include:

Non-specific low back pain

The majority (up to 90%) of low back pain cases will fit in this category. Most people with non-specific pain often has no underlying structural deficits or contributing factors. Non-specific low back pain can present in many different demographics but particularly in more sedentary individuals. Fortunately, most people will recover within days to weeks.

Specific disorders with or without neurological symptoms

In 5-10% of low back cases, there may be a potential structural compromise to the spine, such as the disc or vertebrae. These specific disorders may include a herniated disc, spondylolisthesis, and sciatica. Depending on the severity of the injury, neurological symptoms can be present. Neurological symptoms are caused by nerve-related issues which can lead to symptoms down the leg.

Like non-specific low back pain, milder cases can happen during any activity, including sitting down for prolonged periods or awkward bending movements. Based on clinical experiences, those with severe neurological symptoms either live very sedentary lifestyles, have had trauma (e.g. motor vehicle accident) or perform high-risk activities (e.g. powerlifting, manual laborer, etc.)

Herniated disc which is pressing on the nerve. Source.

Serious Conditions

Although most low back pain problems are not severe, there are rare circumstances where it could be caused by something more complicated. These conditions include tumors, spinal fractures, autoimmune disorders, and even spinal infections. Typically, health professionals will use a panel of specific symptoms called “red flags” to help whether your low back pain is sinister or not. 

Low back pain classifications. Source.

What differentiates these low back pain classifications are the presenting symptoms, prognosis, and severity. Consequently, the signs and symptoms of low back pain will be arranged per these classifications.

Non-specific low back pain:

  • Muscular spasms along the spine
  • Difficulty bending the back
  • General backaches and tightness
  • Aggravated after specific movements (e.g. bending forward) or resting

Specific disorders with or without neurological symptoms:

  • Persisting focal low back pain that is non-resolving
  • Numbness and pins & needles down the leg
  • Burning pain
  • Worsening pain with specific positions such as standing or sitting

Serious conditions:

  • Sudden and unintentional weight loss
  • Difficulties with urination or excreting
  • High-impact mechanism of injury (e.g. motor vehicle accident)
  • Paralysis
  • Excruciating pain at nighttime
  • Coinciding fever

Causes of Low Back Pain

Different types of low back pain will have different causes. For example, spinal fractures will often be caused by high-impact forces such as car accidents or falling from extreme heights. Therefore, we will organize the causes of low back pain into these two categories:

1. Acute low back pain: Low back pain that has recently occurred and has persisted for <3 months

2. Chronic low back pain: Low back pain that has persisted for >3 months. All chronic low back pain starts as acute before becoming a long-term condition.

Acute Low Back Pain

  • Prolonged postures such as standing and/or sitting
  • Low impact trauma, such as sports and work-related injuries
  • Awkward and sudden movements, such as picking something up from the floor
  • Can come spontaneously without a particular event or incident
  • Muscular spasms

Chronic low back pain

  • High-impact trauma, such as dangerous car accidents and falling from high platforms
  • Significant spinal changes (e.g. degeneration)
  • Poor coping habits from acute injuries
  • Medical conditions (e.g. osteoporosis, kidney problems)
  • Delayed visits to healthcare professionals, such as physical therapists and doctors
  • Spinal deformities such as significant scoliosis

Secondary Consequences of Low back Pain

In some circumstances, your low back pain could be caused by other areas of the body, such as your organs and hips, and vice versa. This is called referred pain. Pain that is felt in one area but is caused by problems in a separate area. To simplify this complex concept, we have separated referred pain into three broad categories.

Somatic referral:

Somatic referral” is a term used to describe traveling pain from the musculoskeletal system. The musculoskeletal system typically refers to the structures which form the framework of our body, including bones, muscle, and ligaments. As our body is interconnected by these structures and our nerves, any disturbance (e.g. pinched nerve, muscular weakness, etc.) can cause pain in other areas.

One example is sciatica, where any pressure on the spine can cause down the hips, pelvis and legs. The reason this happens is that the sciatica nerve originates from the back and runs down the leg. If the origin of the nerve is impacted, this can shoot pain to areas that it connects to. See my article about the best treatments for sciatica.

Visceral referral

Viscera is a term used to describes the organs in the body such as the stomach, kidneys, and even genitalia. Although uncommon, there are instances where disturbances to these viscera such as inflammation can transmit pain to the back. Similarly, disruptions to the low back, such as cauda equina syndrome (compression of the spinal cord) affect areas such as the bladder and bowels. 

Visceral referral of low back pain. Source.

Movement and Exercise

One of the most important ways to manage your low back pain is to keep active and consistently perform specific exercises. The type of activities performed will depend on your back’s condition and what your symptoms are. To ensure that the exercises you are performing are safe and effective, you should always seek the guidance of a physical therapist. However, below are three simple ways that you can help reduce your back pain.

  1. Trigger Point Therapy

What if I told you that you could be getting treatment from a home masseuse for only $30? You’d probably say I was lying. However, by using a small massage ball and form roller, you can perform your own trigger point therapy on your back. Trigger point therapy is the act of releasing specific areas of muscular tension; you might hear people refer to these as “knots.” Now it does take a bit more effort on your behalf, but it can be very effective for relieving muscular tension and back pain.

  1. Bridge

The bridge is a fundamental movement that is incorporated with many exercise-based therapies including yoga, Clinical Pilates and even resistance training. When performed correctly, it’s very effective for activating and developing the posterior-chain muscles which include the hamstring, gluteal and low back muscles. These muscles help support the back in various dynamic and static positions. Not only does this strengthen the back but allows other neighboring muscles to take the stress off it. For those who experience pain when bending down, this movement can be very beneficial.

  1. Child’s Pose Stretch

The Child’s Pose stretch is an excellent way of stretching out the spine. While we are going about our daily activities such as working or walking, our spine is under constant compression from our body’s weight. By performing this stretch, you may feel that your whole body is being elongated and decompressed. We would recommend this stretch to those who experience pain from prolonged standing or walking,

Medications

Medications can be taken to help relieve low back pain. However, our recommendations would be to see a qualified physician for further advice and support. Unguided use of mediations can be harmful and lead to unintended effects. Below will be three types of over-the-counter medication and pain relief that may be beneficial.

  • Paracetamol: Paracetamol medications such as Panadol are commonly used for short-term pain relief. Although these have fewer side-effects than anti-inflammatories, they still present some risks, including those with chronic liver issues.
  • Anti-inflammatories: Medications such as Advil and Neurofen contain active ingredients that help reduce inflammation and pain. However, these have more risks and side-effects than paracetamol.
  • Topical creams: Although varied outcomes, some creams such as Fisiocream and Voltaren can be used to help alleviate localized muscle pains and aches. These are gels and creams with or without active ingredients that are applied to the skin.

Who Should I See for My Low Back Pain?

Despite the information and advice above, we would advise that you consult with a relevant health professional, especially if your back pain has not resolved.

For most cases of low back pain, having both a passive and active approach is crucial. To help guide you through this process, seeking the assistance of a physical therapist and/or physician will be beneficial.

A physician will assist you in the earlier stages of your low back pain. They will perform appropriate investigations, provide short-term pain relief, and clear out medical-related causes of your back pain.

Attending physical therapy should also be a priority at all stages of your recovery. In the initial phases, your physical therapist may deliver more of a passive approach such as manual therapy, electrotherapy, and dry needling. However, rehabilitation and exercises will be prescribed at ALL stages of your flare-up to accelerate and maintain your recovery.

Disclaimer: The purpose of this article is to provide general education and some recommended treatments for low back pain. If you are experiencing any of the above symptoms or problems, please consult your primary healthcare practitioners such as a medical doctor or physical therapist.

Written by Leon Mao, Doctor of Physiotherapy (DPT)

Leon is an Australian physiotherapist who specializes in working with musculoskeletal conditions. He graduated from the University of Melbourne with his Doctorate in Physiotherapy before entering the workforce. He is now consulting from Top to Toe Health as a clinical and telehealth physiotherapist and primarily works with office-based workers and athletes.

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