Low Back Pain- a multimodal phenomenon

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 causes 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 grand-children 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:

1. Disc injury- the discs are in between the 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 intravertebral 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- 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 join joints that are bone to bone in your body. These 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 pregnancy the ligaments in one's pelvis begin to relax in order to prepare for birth. This laxity in combination with the added forward weight from the baby can cause some soreness. Click here to see our pregnancy page for more information. 
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 back soreness with specific activities they can experience phycological low back pain. This is where the brain has such strong pain pathways that even when pain is not necessary, pain signals from the brain will be activated. 
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 for low back soreness

Treatments and management for low back pain vary 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 herniations 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. 

Management Strategies

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 can temporarily give some relief it is always better to get a diagnosis from a health professional. Then 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. 

Further reading/ Facts about low back discomfort:

• 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.