According to the National Institute of Neurological Disorders and Stroke, approximately 80% of adults will experience low back pain at one point in their lives and it often tends to recur¹. Moreover, low back pain is the leading cause of activity limitation and work absence, contributing to significant economic burden². This may all seem daunting, but I am here to reassure you that after reading this article, you’ll have a better understanding of what low back pain is and how to properly manage it.
First and foremost, a large proportion of low back pain episodes are non-specific, which means that they are not attributable to a specific, known pathology such as an infection, tumor, fracture, inflammatory disorder, cauda equina syndrome, radicular syndrome, etc. Most episodes of low back pain are self-limiting and unrelated to serious diseases³. However, a medical consultation is still necessary to eliminate any serious pathology.
On the contrary, it is extremely important that a health professional such as a doctor or physiotherapist perform a comprehensive evaluation to identify the small portion of patients who could potentially have a more serious underlying condition. In addition, a medical consultation will also provide you with the necessary tools to better manage your pain (i.e. a doctor would prescribe pain medication and a physiotherapist would treat your low back pain, as well as prescribe certain exercises/stretches to help manage the condition). Before we take a look at common causes of low back pain, let’s go over the anatomy of the low back, also known as the lumbar spine.
Anatomy of the Lumbar Spine
The low back is made up of 5 vertebra (L1 to L5). Between each vertebra are intervertebral discs. The intervertebral discs consist of an inner gelatinous fluid, referred to as the annulus pulposus, which is responsible for attenuating shock. This is facilitated by the outer fibrous layer, referred to as the annulus fibrosis⁴.
Causes of Non-Specific Low Back Pain
Before a patient is classified as having non-specific low back pain, serious spinal pathology must be ruled out. Any innervated structure in the lumbar spine (i.e. muscles, ligaments, dura mater, nerve roots, zygapophyseal joints, annulus fibrosis, thoracolumbar fascia, vertebrae, etc.) can cause symptoms of low back and referred pain into the extremity or extremities. According to previous research and international guidelines, it is not necessary, nor is it possible, to identify the specific tissue source of pain in order to effectively manage patients with non-specific low back pain because as the name suggests, there is no identifiable pathoanatomical source⁵ ⁶ ⁷.
Specific Causes of Low Back Pain
Certain episodes of low back pain may be due to an injury and/or pathology. One common cause of more specific low back pain is a disc herniation. The disc between the vertebrae is pushed outward. This can compress the spinal cord or nerve root, which can cause pain that radiates down into the leg⁴. Similarly, narrowing of the joint spaces between vertebrae or the spinal canal (termed spinal stenosis) can also lead to compression of the spinal cord or a nerve root⁸.
Lastly, disc protrusion prevalence increased with age. They can be the source of your pain, but they can also be completely unrelated. The evidence suggests that certain imaging-based degenerative features are likely part of normal aging and unassociated with pain. Positive imaging findings must be taken with a grain of salt.
When is Low Back Pain An Emergency?
If you have a history of any of the following, please consult a doctor immediately¹¹:
- Recent trauma
- Prolonged use of steroids
- Previous history of cancer or current cancer
If you are experiencing any of the following symptoms, please consult a doctor immediately¹¹:
- Numbness/loss or sensation between the thighs and around the
- Bladder/bowel dysfunction (incontinence)
- Sudden/severe weakness in one or both legs
- Erectile dysfunction
- Increasing low back pain
- Low back pain not relieved by rest
- Unexplained sudden and significant weight loss
How To Manage Your Low Back Pain Right Now
Stay Active: Limit bed rest and begin a gradual return to your daily activities. However, refrain from activities that increase your pain. Avoid prolonged sitting, as well as repetitive bending, lifting and twisting movements.
Cold packs/ice: Place a cold pack on your lower back for 15-20 minutes at a time, every 2 hours, as needed. The cold pack will help relieve your pain, reduce muscle spasms and reduce any inflammation caused by the injury. Avoid heat within the first 48 hours after injury.
Proper posture: Modify your sleeping, sitting and standing postures to minimize the stress on your low back.
Consult your doctor: Please consult your doctor to inquire about any medications you can take to help relieve your low back pain, as well as to inquire whether any further medical investigation is required for your low back pain.
Consult a physiotherapist: Physiotherapists are highly trained health professionals who can perform a comprehensive evaluation to determine whether or not there is an underlying serious pathology present. In addition, a physiotherapist can treat your low back pain through the use of various techniques. These include manual therapy and muscle release, provide you with a home exercise program comprised of strengthening and stretching exercises.
How To Prevent Low Back Pain
Examples of risk factors identified for a first occurrence of low back pain include¹²:
- Standing or walking > 2 hours per day,
- Frequent moving or lifting > 25 lbs
- Increased driving time
- Poor mental health
Repetitive movements soliciting the spine (i.e. bending forward to pick up objects repeatedly) are not well tolerated. Proper posture when performing daily activities and/or work is crucial for the prevention of low back injuries. For instance, when lifting heavy objects, keep them close to you, bend your knees and hips, and avoid twisting movements. Most importantly, don’t forget to take breaks.
In addition, depression or increased anxiety are sources of mental distress. These are crucial to address, as they can often be involved in the persistence of low back pain. Lastly, obesity is an important risk factor for developing low back pain. Did you know that being overweight and obesity have the strongest association with seeking care for low back pain¹³? This is why it is so important to address this early on.
Anthony Teoli MScPT