Low back pain

Over 70% of people will experience low back pain at some point in their life. It presents as anything from a tweak to completely thrown out and its causes can be simple or serious. The low back is an exceptionally complicated region of the body and despite containing the 5 largest vertebrae of the spine, the low back is still quite susceptible to injury. Similar to injuries in other areas back pain can develop rapidly after a fall, quick twist or strenuous lift or develop slowly after many years. 

Causes of low back pain

The main generators of pain in the low back are the joints of the spine, its inter-vertebral discs, ligaments and surrounding muscles. These can all be injured quickly or slowly over time. The following list will highlight some of the more common injuries.

  • Muscle strain: this has a very simple cause effect relationship, your muscles were asked to do more work than they were capable of doing. As a result the muscle develops small tears which decrease its strength, activate pain receptors and leave the muscle susceptible to further injury. Most of those suffering muscle strains will feel increased tension and fatigue in the affected muscle, pain when contracting or stretching that muscle or its surrounding muscles.
  • Joint sprain: this has a similar cause effect relationship in that the joint has either been compressed or taken beyond its normal movement range. As a result the surface of the joint can become damaged and the ligament like capsule around the joint can become stretched. Both structures send strong pain signals, especially with further compression or stretch. Here those suffering joint sprains often feel sharp pains near the end of the normal movement ranges. 
  • Disc injury: The intervertbral disc exists between every vertebrae in your spine and act to facilitate and also limit many of the motions of your back. It is made up of two key parts; a jelly like center that acts to distribute forces which is surrounded by a ring of elastic fibres that control the motion of its vertebrae. With prolonged poor posture, especially during strenuous activity the inner jelly begins breaking outwards through the ring of fibres. These fibres are very strong pain generators and can render a person quite disabled when injured. As tearing continues the outer ring can then deform creating a disc buldge, and then finally break through the ring resulting in a disc herniation. Those with disc injuries often experience severe low back or buttock pain and often have pain shooting down their leg like an electric current.
  • Dynamic lumbar spine instability: this is a relatively new concept in low back pain where the normal biomechanics of the low back are altered, often at just one vertebrae, during normal motion. This results in a vertebrae being just a couple millimetres out of sync with its neighbours but causing significant joint and muscle stresses. Those with instability often experience a catching sensation with particular movements.
Care for low back pain
Self-care is an important component in low back pain. As early as 10 years ago many back pain sufferers were told to lay down for a few days until it improves, this may be the worst course of action and is no longer a recommendation. Remaining active is an important part of recovery as long as that activity is with minimal to no pain. During your activity keeping good low back posture and a lightly contract abdomen can help protect your back. The application of ice over an injured region can help reduce the pain intensity and also slow the development of scar tissue from the injury. Positions of relief are also important for low back pain, these should rarely require extreme position and could be as simple as small side bends or slight back extensions. These positions can be held for several seconds to help reduce pain levels or provide relief, do not hold positions that generate pain.
The most important component of self-care is recognizing that self-care may not be adequate. If you are uncertain or concerned about your low back consult with your family doctor or chiropractor. If your back pain does not improve with self-care this should be a strong indication to visit your primary care provider.
As one of the most common injuries there are many guidelines for the management of various types of low back pain. The American College of Physicians and the American Pain Society worked together to create a clinical practice guideline for low back pain. They recommend spinal manipulation for recent onset low back pain and a combination of spinal manipulation, massage therapy, exercise therapy, acupuncture, yoga, cognitive-therapy and progressive-relaxation for long standing low back pain (a month or more)1.
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The above recommendation of self-care for low back pain should not replace recommendations from your health care provider or your own judgement regarding your low back pain. If you feel your back pain warrants immediate care you should seek immediate care. The above information is meant to provide general information and not a specific directions to treat your low back pain.

1. Chou R, Qaseem A, Snow V, Casey D, Cross JT Jr, Shekelle P, Owens DK, Clinical Efficacy Assessment Subcommittee of the American College of Physicians, American College of Physicians, American Pain Society Low Back Pain Guidelines Panel. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med 2007 Oct 2;147(7):478-91.View this paper

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