Understanding Lower Back Pain: Types, Causes, and Treatments, and the Role of Physiotherapy
▫️Written by John Keller
✅ Reviewed by Dr. Jenny Hynes on June 7, 2024
Lower back pain is a common issue that affects people of all ages and backgrounds. It can arise from a variety of causes, including muscle strain, poor posture, spinal abnormalities, and degenerative conditions. Understanding the underlying causes of lower back pain is essential for effective management and prevention.
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Lower back pain can significantly impact a person's daily life, leading to discomfort, reduced mobility, and even disability. It is one of the leading reasons for missed workdays and can affect overall quality of life. By addressing lower back pain promptly and appropriately, individuals can prevent it from becoming a chronic condition and maintain their overall health and well-being.
Research has shown that early intervention, including physiotherapy, exercise, and lifestyle modifications, can significantly improve outcomes for those suffering from lower back pain (Hartvigsen et al., 2018). By understanding the importance of lower back health and seeking timely treatment, individuals can reduce the risk of long-term complications and enhance their quality of life.
What is lower back pain?
Definition and general overview
Lower back pain refers to discomfort or pain located in the lower region of the spine, which includes the area from the bottom of the rib cage to the top of the legs. It can vary in intensity from a dull ache to a sharp, stabbing sensation and can be acute (lasting a few days to weeks) or chronic (persisting for more than three months). Causes of lower back pain can include muscle or ligament strain, herniated discs, arthritis, skeletal irregularities, and osteoporosis (Maher et al., 2017).
Prevalence and impact on daily life
Lower back pain is a widespread condition, affecting millions of people globally. It is the leading cause of disability worldwide and a common reason for individuals to seek medical care (Hartvigsen et al., 2018). The prevalence of lower back pain increases with age, but it can affect individuals of all ages and occupations.
The impact of lower back pain on daily life can be substantial. It can limit physicalactivity, reduce productivity at work, and lead to psychological stress due to chronicdiscomfort and potential disability. Activities such as lifting, bending, or even standingfor prolonged periods can exacerbate the pain, making it challenging to performeveryday tasks. Effective management of lower back pain is crucial to maintaining agood quality of life and preventing chronic health issues.
Types of lower back pain
Acute non-specific low back pain
Definition and characteristics. Acute non-specific low back pain refers to pain in the lower back that lasts less than six weeks. It is termed "non-specific" because it is not attributed to any specific underlying pathology (Maher et al., 2017).
Common causes and risk factors. Common causes include muscle or ligament strain, poor posture, and sudden movements. Risk factors include heavy lifting, sedentary lifestyle, and obesity (Hartvigsen et al., 2018).
Symptoms and duration. Symptoms include localized pain and stiffness in the lower back. The pain typically resolves within a few days to weeks with appropriate rest and treatment.
Axial spondyloarthritis (Inflamed spine)
Definition and characteristics. Axial spondyloarthritis is a type of inflammatory arthritis that primarily affects the spine and the sacroiliac joints. It can lead to chronic back pain and stiffness (Sieper et al., 2016).
Underlying causes and genetic factors. The exact cause is unknown, but genetic factors play a significant role, particularly the HLA-B27 gene (Sieper et al., 2016).
Key symptoms and diagnosis. Key symptoms include chronic back pain and stiffness, particularly in the morning and after periods of inactivity. Diagnosis is often based on clinical evaluation, imaging studies, and genetic testing.
Persistent non-specific low back pain
Definition and long-term nature. Persistent non-specific low back pain lasts for more than 12 weeks without a specific identifiable cause. It is often chronic and can fluctuate in intensity (Maher et al., 2017).
Potential triggers and lifestyle factors. Triggers include prolonged sitting, poor posture, and inadequate physical activity. Psychological factors like stress and depression can also contribute (Hartvigsen et al., 2018).
Symptoms and management. Chronic symptoms include continuous or intermittent pain, often accompanied by stiffness and reduced mobility. Management can be challenging and often requires a multidisciplinary approach including physiotherapy, medication, and lifestyle changes.
Radicular pain (Pain in your leg)
Explanation of radicular pain. Radicular pain occurs when a nerve root in the spine is compressed or irritated, causing pain to radiate along the path of the nerve, often into the leg (Deyo & Mirza, 2016).
Causes. A common cause is a herniated disc, where the disc material presses on a nerve root. Other causes include spinal stenosis and spondylolisthesis.
Symptoms. Symptoms include sharp, shooting pain, numbness, and tingling that travels down the leg, commonly referred to as sciatica.
Spinal canal stenosis (Narrow spinal canal)
Definition. Spinal canal stenosis is a narrowing of the spinal canal, which can compress the spinal cord and nerves. It commonly occurs in the lumbar spine (Kalichman et al., 2009).
Causes. Causes include degenerative changes due to aging, such as osteoarthritis, thickened ligaments, and herniated discs (Kalichman et al., 2009).
Symptoms. Symptoms include back pain, numbness, weakness, and cramping in the legs, which may worsen with prolonged standing or walking.
Causes of lower back pain
Overview of common causes
Lower back pain can arise from a variety of sources, each contributing to the discomfort and functional limitations experienced by individuals. Understanding these causes is essential for effective prevention and management.
Physical activities and injuries
Physical activities and injuries are among the most common causes of lower back pain. Overuse, muscle strains, and ligament sprains can result from heavy lifting, sudden movements, or prolonged repetitive motions. Sports injuries and accidents, such as falls or car accidents, can also lead to acute or chronic lower back pain (Maher et al., 2017).
Medical conditions and genetic predispositions
Certain medical conditions can predispose individuals to lower back pain. These include degenerative disc disease, herniated discs, osteoarthritis, and spinal stenosis. Genetic factors, such as a family history of these conditions, can increase the likelihood of developing lower back pain. Additionally, conditions like scoliosis or other structural abnormalities of the spine can contribute to chronic pain (Kalichman et al., 2009).
Lifestyle factors
Lifestyle factors play a significant role in the development of lower back pain. Poorposture, whether sitting, standing, or sleeping, can place undue stress on the lowerback muscles and spine. Obesity increases the mechanical load on the spine, leading toincreased wear and tear on the intervertebral discs and joints. A sedentary lifestyle,combined with weak core muscles, can exacerbate these issues, leading to persistentlower back pain (Hartvigsen et al., 2018).
Signs and symptoms of lower back pain
General signs to look out for
Lower back pain can present with various signs, including:
Persistent ache or stiffness along the spine
Sharp, localized pain in the lower back, especially after lifting heavy objects or sudden movements
Chronic ache in the lower back, particularly after sitting or standing for extended periods
Difficulty standing up straight without experiencing pain or muscle spasms
Specific Symptoms Associated with Each Type of Lower Back Pain
1. Acute non-specific low back pain
Sudden onset of pain
Localized pain in the lower back
Muscle stiffness and limited range of motion
Pain that improves with rest
2. Axial Spondyloarthritis (Inflamed Spine)
Chronic back pain and stiffness, especially in the morning
Pain that improves with exercise but not with rest
Limited spinal mobility
Potential inflammation in other joints
3. Persistent non-specific low back pain
Pain lasting more than 12 weeks
Pain that may worsen with certain activities or prolonged sitting
Stiffness and reduced flexibility
Psychological stress due to chronic pain
4. Radicular pain (pain in your leg)
Sharp, shooting pain radiating from the lower back down the leg (sciatica)
Numbness or tingling in the leg or foot
Muscle weakness in the affected leg
Pain that worsens with sitting or certain movements
5. Spinal Canal Stenosis (Narrow Spinal Canal)
Pain in the lower back and legs, especially when standing or walking
Numbness, weakness, or cramping in the legs
Symptoms that improve when bending forward or sitting
Difficulty walking long distances
When to seek medical attention
Seek medical attention if you experience any of the following:
● Severe pain that does not improve with rest or is accompanied by other symptoms like fever or unexplained weight loss
● Pain that extends down one or both legs, especially if it is accompanied by numbness, tingling, or weakness
● Difficulty controlling bowel or bladder function
● Sudden, severe pain following an injury
Prevention of lower back pain
Strategies for maintaining a healthy back
1. Importance of proper posture and ergonomics
Maintain good posture when sitting, standing, and sleeping
Use ergonomic furniture and equipment, such as chairs with proper lumbar support and adjustable desks
Avoid slouching and ensure that workstations are set up to promote good posture
2. Exercise and strengthening routines
Engage in regular physical activity, including exercises that strengthen the core muscles (abdominals and lower back)
Incorporate stretching routines to maintain flexibility
Practice exercises like yoga or Pilates that promote back health and overall fitness
3. Lifestyle modifications and weight management
Maintain a healthy weight to reduce the mechanical load on the spine
Follow a balanced diet rich in calcium and vitamin D to support bone health
Avoid smoking, as it can contribute to spinal degeneration and reduced blood flow to the spine
By incorporating these strategies, individuals can reduce their risk of developing lowerback pain and maintain a healthy, active lifestyle.
Diagnosis of lower back pain
Diagnostic procedures and tests
Diagnosing lower back pain involves a combination of patient history, physical examinations, and diagnostic tests. Physicians typically start with a detailed patient history to understand the nature, onset, and duration of the pain, along with any related symptoms and potential risk factors (Deyo & Weinstein, 2001).
Role of imaging studies (X-rays, MRIs)
Imaging studies are crucial in diagnosing lower back pain, especially when specific underlying conditions are suspected:
X-rays: Useful for detecting bone abnormalities, fractures, and degenerative changes in the spine (Jarvik & Deyo, 2002).
MRI (Magnetic Resonance Imaging): Provides detailed images of soft tissues, including discs, muscles, and nerves. It is particularly helpful in identifying herniated discs, spinal stenosis, and other soft tissue conditions (Deyo et al., 2009).
Physical examinations and patient history
Physical examinations help assess the range of motion, reflexes, muscle strength, andareas of tenderness. Common tests include the straight leg raise test for sciatica andassessments of flexibility and posture. Combining physical examination findings withpatient history provides a comprehensive understanding of the condition and helpsguide further diagnostic steps (Deyo & Weinstein, 2001).
Treatment options for lower back pain
Overview of treatment modalities
Treating lower back pain often requires a multifaceted approach, tailored to the underlying cause and severity of the pain. Common treatment modalities include medication, physical therapy, and sometimes surgical interventions (Chou et al., 2007).
Medication and pain management
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Often the first line of treatment to reduce pain and inflammation.
Muscle Relaxants: Used for short-term relief of severe pain and muscle spasms.
Opioids: Prescribed cautiously for severe pain that does not respond to other treatments, due to the risk of addiction and side effects (Chou et al., 2007).
Corticosteroid Injections: Can provide relief for inflammation-related pain, particularly in conditions like herniated discs and spinal stenosis (Benyamin et al., 2012).
Surgical interventions
Surgery is usually considered when conservative treatments fail, or when there are serious underlying conditions, such as:
Discectomy: Removal of a herniated disc that is pressing on a nerve.
Laminectomy: Removal of part of the vertebra to relieve pressure on the spinal cord or nerves.
Spinal Fusion: Joining two or more vertebrae to provide stability and reduce pain from movement (Deyo et al., 2009).
Alternative treatments
Acupuncture: May provide pain relief by stimulating specific points on the body (Cherkin et al., 2009).
Physical Therapy: Focuses on strengthening the muscles supporting the spine,improving flexibility, and promoting proper posture and movement patterns(Hayden et al., 2005).
Effectiveness of physiotherapy for lower back pain
Role of physiotherapy in managing and treating lower back pain
Physiotherapy plays a crucial role in managing and treating lower back pain by addressing both the symptoms and the underlying causes. It involves a variety of techniques aimed at reducing pain, improving function, and preventing recurrence. Physiotherapists assess each patient individually to create personalized treatment plans that may include manual therapy, exercises, and education on proper body mechanics .
Specific physiotherapy techniques
1. Manual therapy
Definition: Involves hands-on techniques such as mobilization and manipulation to reduce pain and improve mobility.
Effectiveness: Studies have shown that manual therapy can be effective in reducing pain and improving function in patients with lower back pain (Gross et al., 2015).
2. Exercises
Core Strengthening: Exercises that target the abdominal and back muscles to provide better support for the spine.
Stretching: Helps to improve flexibility and reduce muscle tension.
Aerobic Conditioning: Low-impact activities like walking or swimming to improve overall fitness and reduce pain.
Effectiveness: Exercise therapy is widely recognized as beneficial for reducing pain and improving function in patients with lower back pain (Hayden et al., 2005).
Benefits and success stories
Physiotherapy offers several benefits for individuals with lower back pain, including:
Pain Reduction: Techniques such as manual therapy and specific exercises can significantly reduce pain levels.
Improved Function: Physiotherapy helps restore normal movement and function, allowing patients to return to their daily activities.
Prevention of Recurrence: By strengthening the muscles that support the spine and educating patients on proper body mechanics, physiotherapy can help prevent future episodes of lower back pain.
Patient Success Stories: Many patients report significant improvements in pain and function after undergoing physiotherapy. For example, a study by Ferreira et al. (2013) found that patients who received tailored physiotherapy programs experienced greater improvements in pain and disability compared to those who did not.
Recommendations from certified physiotherapists
Certified physiotherapists recommend the following strategies for managing lower back pain:
Stay Active: Engage in regular physical activity and avoid prolonged bed rest.
Practice Good Posture: Maintain proper posture while sitting, standing, and sleeping to reduce strain on the back.
Strengthen Core Muscles: Incorporate exercises that target the core muscles to provide better support for the spine.
Seek Professional Help: Consult a physiotherapist for an accurate diagnosis anda personalized treatment plan.
Conclusion
Importance of understanding lower back pain
Understanding lower back pain is essential because it affects millions of people worldwide and can significantly impact daily life and overall well-being. By recognizing the different types of lower back pain, their causes, and symptoms, individuals can take proactive steps to manage and prevent this common condition. Knowledge about lower back pain empowers people to make informed decisions about their health and seek appropriate treatment when necessary.
Encouragement to seek professional help
If you experience persistent or severe lower back pain, it is crucial to seek professional help. A healthcare provider can accurately diagnose the cause of your pain and recommend an appropriate treatment plan. Early intervention can prevent the condition from worsening and help you return to your normal activities more quickly. Consulting with a certified physiotherapist can be particularly beneficial, as they specialize in the management and treatment of musculoskeletal conditions, including lower back pain.
Final thoughts on the significance of physiotherapy
Physiotherapy plays a vital role in managing and treating lower back pain. It offers a comprehensive approach that includes pain relief, improved function, and prevention of recurrence. Through personalized treatment plans that may include manual therapy, exercises, and education on proper body mechanics, physiotherapy helps individuals achieve long-term relief and better quality of life. By staying active, practicing good posture, and seeking professional guidance, you can effectively manage lower back pain and maintain a healthy back.
By understanding the importance of lower back health and taking proactive measures,you can significantly reduce the impact of lower back pain on your life. Remember,seeking professional help and following a tailored physiotherapy plan can lead tosuccessful outcomes and improved overall well-being.
References:
Benyamin, R. M., Manchikanti, L., Parr, A. T., Diwan, S., Singh, V., & Falco, F. J. (2012). The effectiveness of lumbar interlaminar epidural injections in managing chronic low back and lower extremity pain. Pain Physician, 15(4), E363-E404.
Cherkin, D. C., Sherman, K. J., Avins, A. L., Erro, J. H., Ichikawa, L., Barlow, W. E., ... & Kaptchuk, T. J. (2009). A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Archives of Internal Medicine, 169(9), 858-866.
Chou, R., Qaseem, A., Snow, V., Casey, D., Cross, J. T., Jr, Shekelle, P., & Owens, D. K. (2007). Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine, 147(7), 478-491.
Deyo, R. A., & Mirza, S. K. (2016). Clinical practice. Herniated lumbar intervertebral disk. The New England Journal of Medicine, 374(18), 1763-1772.
Ferreira, M. L., Maher, C. G., Herbert, R. D., Refshauge, K., & Latimer, J. (2013). A systematic review of the efficacy of conservative interventions for reducing pain and improving function in non-specific low back pain. European Spine Journal, 22(3), 564-580.
Gross, A., Miller, J., D'Sylva, J., Burnie, S. J., Goldsmith, C. H., Graham, N., ... & Haines, T. (2015). Manipulation or mobilisation for neck pain. Cochrane Database of Systematic Reviews, 2015(9), CD004249.
Hartvigsen, J., Hancock, M. J., Kongsted, A., Louw, Q., Ferreira, M. L., Genevay, S., ... & Woolf, A. D. (2018). What low back pain is and why we need to pay attention. The Lancet, 391(10137), 2356-2367.
Hayden, J. A., van Tulder, M. W., Malmivaara, A., & Koes, B. W. (2005). Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews, 2005(3), CD000335.
Jarvik, J. G., & Deyo, R. A. (2002). Diagnostic evaluation of low back pain with emphasis on imaging. Annals of Internal Medicine, 137(7), 586-59
Kalichman, L., Cole, R., Kim, D. H., Li, L., Suri, P., Guermazi, A., ... & Hunter, D. J. (2009). Spinal stenosis prevalence and association with symptoms: the Framingham Study. Spine, 34(4), 319-325.
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Article by
John Keller
Clinical Director | Sports & Musculoskeletal Physiotherapist
John graduated as a Physiotherapist from the Auckland University of Technology with the John Morris memorial prize for outstanding clinical practise in 2003. John has since completed Post Graduate Diplomas in both Sports Medicine and Musculoskeletal Physiotherapy with distinction, also collecting the Searle Shield for excellence in Musculoskeletal Physiotherapy.
Reviewed by
Dr. Jenny Hynes FACP
Clinical Director | Specialist Musculoskeletal Physiotherapist
Jenny sat extensive examinations to be inducted as a fellow into the Australian College of Physiotherapy in 2009 and gain the title of Specialist Musculoskeletal Physiotherapist, one of only a few physiotherapists in the state to have done so.