Human, Injury Management

Lower Back Pain

At some point in everyones life they will likely suffer back pain of various degrees, some people more than others. Why this is, is not fully understood. Continued research allows us to gradually develop a better understanding. For instance 15 yrs ago the advice for back pain was to lie flat with a hot water bottle, but this is seen as detrimental and that movement does help back pain.

Causes

Back pain can be caused by many things such as a direct trauma, chronic overuse or an underlying illness where the pain is being referred from elsewhere. It is really important to seek professional help to rule out any more serious health issues if the pain is constant, non-mechanical and there is unexplained weight loss.

Causes of lower back pain can include the following

  • Fractures to the vertebra can occur due to direct trauma such as a fall or stress fractures brought on by overuse
  • Nerve root compression can occur due to disc herniation
  • Spondylolysis caused by repeated hyperextension and rotation
  • Spondylolisthesis which is the slipping of one vertebra on another
  • Spinal stenosis is the narrowing of the spinal canal due to bony changes
  • Labral tears and rim lesions in the hip joint can refer into the back

The above conditions can be diagnosed with relative ease and treated accordingly however the following structures can also cause back pain and are harder to diagnose

  • Muscle
  • Fascia
  • Nerves
  • Vertebral disk
  • Ligaments
  • Joints (capsule and cartilage)

In many cases lower back pain can be caused by more than one of the above structure. Sometimes the body can over react to pain and injury by causing muscles too spasm to protect the area, which does have it benefits as it prevents further injury of that area, however this increased tension can also cause discomfort and will need treating. Due to the involvement of multiple structures and the fact that these structures are more difficult to pinpoint in assessment does mean that when being treated there is sometimes a need to try a treatment and see if it works. It may take several alternatives before something is found so don’t be disheartened if your therapist takes some time to pinpoint the best treatment method.

Treatment

There are many treatments that a qualified professional can employ and here is a list of possibilities

  • Pain medication- in the early stages anti-inflammatories can be useful in helping to reduce muscle spasm and inflammation but after sometime it is thought that they can hinder the healing process. As a result caution should be taken when taking medication. A chat to a doctor can often help to decide what would be best for you. Something that is cheap and has relatively few side affects is ice. Ice in the early stages can reduce inflammation and relieve pain. Don’t use heat in the early stages.
  • Rest- this may be advised depending on the injury. A fracture for example, may require complete rest. In other cases reduction in volume, intensity or avoiding aggravating activities may be advised during early recovery with a plan to increase activity levels gradually.
  • Massage- a deep tissue massage and trigger point work can often elevate tension, reduce pain, encourage healing and increase mobility.
  • Mobilisations- these are gentle oscillations to a joint which can help elevate pain and reduce tension, which can help decompress and loosen joints.
  • Manipulation- is a high velocity manuaver performed to a vertebral joint to achieve the same effect as a mobilisation but often at a faster rate. This should be performed by a chiropractor/osteopath.
  • Dry needling/acupuncture- Needling is thought to help reduce tension and relieve pain. Acupuncture can also help with well being and energy levels.
  • Taping- Taping is not a sole treatment but something used to complement others. It is good with helping posture and proprioception. It can help with swelling reduction and relieve some pain. However research is mixed on the effectiveness of tape. Tape should not be something a patient becomes reliant on but a part of the whole process.
  • Cupping- this is a treatment method that needs further research but has a potential to help towards decompressing soft tissue such as fasciae and muscle. Using cups with movement could potentially be the most effective way to use cups. While there is not much research don’t be put off if your therapists suggests this as an option as you might find it effective. It does leave marks that look like bruises but the skin has not experienced a trauma like a bruise so they do not hurt.
  • Stretching- a therapist can apply some passive stretches or use muscle energy techniques which require participation from you. It encourages a muscle contraction and then relaxation to encourage lengthening. Stretches may also be prescribed to you as homework.
  • Exercises- This is probably the most important element of recovering from a lower back injury. This also requires commitment from you as an individual and is probably the area that therapist find the hardest to get clients to perform. I can’t stress how important it is to get your exercises done. You will recover quicker, stronger and are less likely to have it recurring. So please do your exercises to help strengthen muscles and mobilise joints.

Exercises

Some simple back friendly exercises to mobilise and strengthen

Shoulder bridge

The shoulder bridge is a good basic exercise to start with. Below is a link to an entry level version which is a good place to start. There are many variations that are progressively harder but start basic and gradually build. https://www.youtube.com/watch?v=d2I8_VBJPGM

Key points to remember when doing a shoulder bridge

  • Engage your gluteal muscles (butt muscles) and deep core muscles before beginning the movement
  • Keep your pelvis level by pushing through your heels evenly
  • Don’t over extend through your back at the top of the movement
  • Remember to breath
  • When progressing onto leg lifts or heel lifts maintain a level pelvis and don’t let it dip

Hip twist

Is a great way to mobilise and stretch through the lower back. This exercise can be performed as a continuous movement or held at the end of your range to get a bit more of a stretch. This link shows the movement pattern https://www.youtube.com/watch?v=ONB4d84SXRc

Things to remember when doing a hip twist

  • Keep both shoulders on the floor and look the opposite direction to your knees
  • Move within your pain range.
  • Breath and take it slow, relax into the movement