Pain, soreness or stiffness in the lower portion of your back can be debilitating. It causes people to miss work, take medications and even be admitted to the hospital. It also results in emotional stress as it causes fear in activities that might cause more pain.
Examples of these activities can be as simple as riding a bike, going for a run, playing with grandchildren or just being able to complete chores to keep your household running.The causes of low back pain are complicated and numerous.
Here is a list of 11 potential causes of low back pain:
1. Disc injury- the discs are in between the vertebrae (bones) in your spine. They provide space for your nerves to travel. When you damage a disc there is a potential to damage the nerves associated with that disc, which causes pain in predictable areas. Sciatica is a common presentation for these problems.
2. Nerve compression– the intervertebral space is where the nerves from your back travel through. Anything that causes these spaces to narrow can compress the nerves and cause pain in specific locations.
3. Mechanical– this term encompasses joints, muscles, ligaments, soft tissue, discs and vertebrae.
4. Non–Specific– where the physical cause cannot be confirmed. This is the most common type of low back pain.
5. Functional– Low back pain caused by faulty movement patterns or using muscles that aren’t designed for activity eg) using your low back rather than your hips when lifting a heavy object.
6. Ligaments– these connect joints that are bone to bone in your body, like your shin bone to your thigh bone. These ligaments are very strong and difficult to stretch. However, when they are stretched and damage is caused they are slow to repair, as minimal blood flow occurs to ligaments. During pregnancythe ligaments in one’s pelvis begin to relax in order to prepare for birth, this in combination with the added forward weight from the baby can cause some soreness.
7. Muscles– they can be strained causing low back pain, but this is rarely the case. Usually, muscles are overworked, inefficient or in need of relative rest.
8. Lactic Acid – build up of lactic acid is that burning sensation you feel in your legs when you go for a run or ride a bike or have a big gym work out. While usually temporary, the lactic acid can build up and irritate nerves, having a longer lasting effect.
9. Psychological/Learned pain– in some cases when people have experienced low back pain for a large portion of their life, or begin to associate low back soreness with specific activities. These people can then experience psychological low back pain. This is where the brain has such strong pain pathways that even when pain is not coming from the back, pain signals from the brain will be activated so it feels like it is from the back.
10. Cancer/ tumours/ Cauda Equina – these are extremely rare. However, any health professional should be ruling these out initially as causes of low back discomfort. The pain felt here is deep, aching, constant and not relieved by rest. It also can cause symptoms such as loss of bowel and bladder control, flank pain, blood in the urine or stool and other symptoms that arise from organ involvement.
11. Arthritis/Diffuse Idiopathic Skeletal Hyperostosis/ Ankylosing Spondylitis– Systemic inflammation caused by arthritis can be difficult to diagnose and manage. Most people with arthritic conditions can be managed but in many cases will continue to deteriorate.
Treatment and management
Treatment and management for low back pain varies due to the numerous causes, and there is no one size fits all. Back pain is an individualised experience by the person experiencing it. The level of intensity may be changed through stressful situations or lack of sleep. In some instances, two people whom both have disc herniation at the same level can have completely different levels of pain.
One may be in debilitating pain and the other in no pain at all. This shows how complicated pain really is, and there is still a long way to go in understanding the complexities surrounding low back pain.Currently, the guidelines for care for low back pain is 6 weeks of conservative management. This means treatment by a qualified healthcare practitioner. If the treatment is not successful the patient shoulder be sent for an MRI. With these guidelines it is important to note that previous history of cancer and other ‘red flags’ may require urgent referral for imaging. What the health practitioner should do is monitor progress of the pain and dysfunction over the course of treatment. That may be by monitoring pain levels or the ability for the individual to function properly eg) the patient has improved strength or movement outcomes. The guidelines for treatment come from scientific studies conducted on a variety of patients suffering low back pain.
What do the scientists say?
In 2016, a review of all relevant studies for low back pain and paracetamol use was conducted. They found that paracetamol, which is “recommended as the first choice medication” for low back pain “does not produce better outcomes than placebo for people with acute LBP (low back pain)”. The word ‘acute’ in this situation means pain that has lasted less than 12 weeks. A ‘placebo’ is this case was a fake tablet given to test the paracetamol vs someone who believes they are taking paracetamol, but is actually taking a sugar tablet. This data is based on 1785 patients and is the best available study to access the effectiveness of paracetamol vs placebo.
While many of us may reach straight for our drug cabinet every time we suffer from low back pain, it is important to consider the aforementioned information, and consider treatment by a qualified health professional. (Saragiotto BT, Machado GC, Ferreira ML, Pinheiro MB, Abdel Shaheed C, Maher CG. Paracetamol for low back pain. Cochrane Database of Systematic Reviews 2016, Issue 6. Art. No.: CD012230. DOI: 10.1002/14651858.CD012230.)
How to make it feel better
Some ways to manage low back pain without help from a chiropractor, physiotherapist, osteopath or general practitioner include being more active, eating healthier, losing weight, quitting smoking, medications, rest, heat/ice and changing posture. (Bauer UE, Briss PA, Goodman RA& Bowman BA 2014. Prevention of chronic disease in the 21st century: elimination of the leading preventable causes of premature death and disability in the USA. Lancet 384:45–52. ). While these strategies can temporarily give some relief it is always better to get a diagnosis from a health professional so they can properly guide you in how to most effectively find relief from pain in the short term and keep the pain away in the long term.
According to trusted evidence from the Cochrane Review library, one of the best techniques for relief from acute low back pain comes from “intensive patient education”. This means the practitioner giving information to the patient based on their specific presentation of low back pain. Education that includes telling the patient to remain active and in the fastest time possible to return to their normal activity levels, to avoid anxiety over their back pain, to learn coping strategies to deal with their pain and ways to avoid further stress and future injuries to the low back. (EngersAJ, JellemaP, WensingM, van der Windt DAWM, Gro lR, van Tulder MW. Individual patient education for low back pain. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD004057. DOI: 10.1002/14651858.CD004057.pub3.)
Other studies show that Chiropractic, pilates and massage all help in minor ways for low back pain. The best approach is to utilise all these techniques, along with being educated about your pain.
Docklands Health Top 3 Tips for Relief From Low Back Pain!
These exercises are only suggested to people who have sought the attention of a medical practitioner first.
1. Prone Lumbar Extension- lying face down on the ground prop yourself up onto your elbows. In this position it is important to keep your pelvis relaxed so that the low back can remain in a relaxed position. Hold this position for 30 seconds.
2. Child position- go down onto your knees and then sit on your heels. Lean forward so that your forehead is on the ground and place your arms extended behind you with your hands next to your ankles. Again we suggest you hold this position for 30 seconds.
3. Thread the needle- Finally come up onto all fours. With your hands underneath your shoulder and knees under your hips bring one of your arms across your body through the gap between your other arm and leg, then return to the starting position. Repeat this on the opposite side. We recommend doing this 10 times on each side.
Further reading/ Information:
- 1/6 Australians will experience back pain this year (https://www.healthdirect.gov.au/back-pain). That’s 3.7 million people!
- 28% of the population with a disability is due to back pain. (https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/impacts-of-chronic-back-problems/contents/summary)
- In 2011 it was found that low back pain was the 3rd leading cause of total disease burden and injuries in Australia. (https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/impacts-of-chronic-back-problems/contents/summary)
- Smoking, being overweight and, being inactive are all risk factors for low back pain. (https://www.webmd.com/back-pain/guide/back-pain-overview-facts)
- The most common way to help manage low back pain is through medications. These are Non-Steroidal Anti-Inflammatory, Paracetamol and opioid pain relievers. (https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/back-problems/contents/what-medications-are-used-to-manage-back-problems)
- Of the number of people in Australia with back pain, most of them will also suffer a chronic illness such as asthma, heart disease, diabetes, lung disease, mental health problems or unrelated cancer. (https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/back-problems/contents/back-problems-and-associated-comorbidities-the-numbers)Manek NJ & MacGregor AJ 2005.
- Epidemiology of back disorders: prevalence, risk factors, and prognosis. Current Opinion in Rheumatology 17:134–140.Bauer UE, Briss PA, Goodman RA& Bowman BA 2014.
- Prevention of chronic disease in the 21st century: elimination of the leading preventable causes of premature death and disability in the USA. Lancet 384:45–52.Tavee JO, Levin KH.Continuum (Minneap Minn). 2017 Apr;23(2, Selected Topics in Outpatient Neurology):467-486. doi: 10.1212/CON.0000000000000449 Low Back Pain.
- Maher C, Underwood M, Buchbinder R. Non-specific low back pain.Lancet.2017;389:736–747. doi: 10.1016/S0140-6736(16)30970-9.Rubinstein SM, Terwee CB, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low‐back pain.
- Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD008880. DOI: 10.1002/14651858.CD008880.pub2.
- Rubinstein SM, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for chronic low‐back pain. Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No.: CD008112. DOI: 10.1002/14651858.CD008112.pub2.
- Furlan AD, Giraldo M, Baskwill A, Irvin E, Imamura M. Massage for low‐back pain. Cochrane Database of Systematic Reviews 2015, Issue 9. Art. No.: CD001929. DOI: 10.1002/14651858.CD001929.pub3.
- Yamato TP, Maher CG, Saragiotto BT, Hancock MJ, Ostelo RWJG, Cabral CMN, Menezes Costa LC, CostaLOP. Pilates for low back pain. Cochrane Database of Systematic Reviews 2015, Issue 7. Art. No.: CD010265. DOI: 10.1002/14651858.CD010265.pub2.