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back pain

Introduction

Low back pain is a common cause of pain and disability. It can be secondary to other diseases or conditions. Chronic low back pain lasts longer than acute back pain, which resolves quickly.

Low back pain is one of the leading contributors to missed workdays.

The spine comprises 33 vertebrae; 24 are attached by joints allowing for movement in all directions. The remaining nine are designed to stabilize the spine but provide minimal movement. Our spines are very durable, but since they are so complex, there are risks of injury.

Lower back pain is a catch-all phrase that encompasses many symptoms and injuries. Lower back pain is the second most common reason for doctor visits in Canada, with 50% of all adults experiencing low back symptoms yearly. In most cases, lower back pain sufferers experience some pain relief after one week. However, if it is not managed well, it could become chronic.

According to The National Institute of Health, 80% of all adults will experience lower back pain at some point in their lives. Lower back injury is the most common cause of missed workdays, impacting up to 5 percent of the population (about 2 million people) each year.

Treatment options include physiotherapy, home exercise programs, acupuncture, or massage. These treatments may help, but if your low back pain does not improve, consult with your family doctor. Please see a health care professional to determine which treatment is best for you.

What Causes Low Back Pain?

spine back

The cause of low back pain can be divided into two main groups: traumatic and non-traumatic. Traumatic conditions are usually the result of an accident injuring ligaments, muscles, bones, or discs, while non-traumatic conditions include infections, tumours, and degenerative conditions. Other causes of low back pain include fractures, ruptured discs, or severe muscle strain.

Ligaments are fibrous tissues connecting bones to keep them from moving out of position. They protect the spine during side-to-side, front-to-back, and rotational movements. A ligament can be damaged during a tear or sprain, which is how many people injure their backs; these injuries can be acute (short term) or chronic (long term).

Muscles that support the lower back include erector spinae, multifidus and transvers spinalis muscles. These muscles extend, rotate, and help flex the spine and can be strained through several activities from the improper lifting of objects, work-related accidents, and sports injuries.

Infections in the spine can vary from bacterial infections to more severe and rare tuberculosis cases.

Tumours in the back can either be benign or malignant, but the result for the patient can often be a pain. Cancers that metastasize (spread) could also end up in the spine’s vertebrae.

Spondylitis, or spondylarthritis, is a condition that affects the spine and causes stiffness and pain. This affliction occurs because of ageing-related arthritis owing to joint wear and tear.

Common Types of Low Back Pain

Two common types of low back pain are sciatica and inflammation of the discs in the spine. Sciatica is caused when a bulging disc compresses one of the nerve roots that branch from your lumbar spine, which is the lower part of your spine. The results can be pain, numbness, or weakness in the lower body. Inflammation of a disc occurs when it is weakened by injury. The soft inner material pushes out through a tear in its outer wall and presses on nearby nerves, resulting in sciatica-like symptoms.

Lumbar strain is another common cause of low back pain. A muscle or tendon is overstretched and wholly or partially torn. The result can be sharp pain, muscle spasms and a loss of power and mobility.

Many other conditions may cause low back pain. Ankylosing spondylitis is an inflammatory condition in your spine and sacroiliac joints. Osteoporosis is when your bones are weakened. Rheumatoid arthritis is an inflammatory condition affecting joints in the body.

A herniated disc refers to the protrusion of the inner material of an intervertebral disc. Although a herniated disc can occur anywhere in your spine, herniated discs are most common in your lower back affecting your sciatic nerve. Compression of the sciatic nerve can cause radiating pain into your hip and buttocks and sometimes down your leg.

Diagnosing Low Back Pain

Doctors, physiotherapists, and chiropractors rely on the patient’s description of their symptoms, medical background, and a physical exam to make a diagnosis.

The practitioner determines whether any red flags need further testing or referral during this assessment.

If the practitioner rules out all red flags, they will continue with a physical examination of your back to determine which tissues are irritated. The physical examination will include functional movement, range of motion, strength, and special tests to develop the diagnosis.

Imaging tests such as x-rays, magnetic resonance images (MRI) or computed tomography (CT) scans can help diagnose injuries but are not always necessary.

X-rays can show bone changes such as fractures and abnormal growths such as tumours and arthritis. MRIs and CT scans provide more detailed images of the bones, muscles, and organs.

Symptoms of lower back pain

Sharp or stabbing pain in the low back, buttocks, or down your leg.

Pain that gets worse with coughing, laughing, sneezing, or exercising,

A dull ache in the lower back that makes it uncomfortable to sit or stand for prolonged periods.

Difficulty walking or standing up straight due to pain.

If you are experiencing any symptoms of lower back pain, you may wish to see your GP or a physiotherapist. Your GP may refer you to a physiotherapist for advice on the best ways to ease the pain.

In Canada, you no longer need to have a doctor’s referral to see a physiotherapist.

Chronic Low Back Pain

Chronic lower back pain is pain lasting for more than 12 weeks. Acute back pain is pain that lasts less than 12 weeks. Back pain can be caused by many things, including muscle strains, ligament sprains, herniated discs, and spinal stenosis.

One of the problems with chronic low back pain is that it can be challenging to determine its cause. Not knowing can lead to frustration for the patient.

Chronic lower back pain can also lead to other problems. These problems can include:

  • changes in mood
  • decreased function and mobility
  • problems with sleep
  • pain that spreads to the hips, legs, or feet
  • nerve symptoms such as numbness and tingling
  • trouble with urination or bowel movements (which may be a medical emergency, see a doctor immediately)
  • financial concerns if unable to work
  • compensation injuries or pain

Often people who suffer from chronic lower back pain are forced to deal with other problems as well as the pain. These problems can take away from the quality of their life and can be frustrating. It is essential to acknowledge these issues when treating chronic low back pain.

Treatment should be tailored to the individual and address as many of these problems as possible. Treatments can include interventions from various professionals.

Chronic low back pain can be a complex problem to deal with, but with the proper treatment, it can be managed. Seeking help if you struggle with this type of pain is essential. Many resources are available to help you get on the road to recovery.

Treatment for Low Back Pain

The treatment recommended depends on the underlying cause of your low back pain. The focus is on relieving symptoms to allow you to return to activities of daily living and leisure activities you enjoy.

The first goal of your treatment is to reduce the inflammation and pain associated with your condition. You can work with your health care practitioner to devise the best strategy to relieve pain caused by inflammation.

Your physiotherapist will determine which exercises will be safe for you to do to help you reach your goals. Exercises may help improve mobility and strength in your back. The goal is to gradually progress exercises that will help you reach your specific goals.

Tips on Living with Low Back Pain

The most important thing to remember if you are suffering from low back pain is that you can still perform many activities with minimal discomfort by following a few simple guidelines. The key is to build up your core abdominal muscles and then learn how to use them effectively while performing everyday tasks, which will help prevent future problems. Below are some helpful tips on living with low back pain.

7 Tips for Low Back Pain

Here are a few tips to get you started if you are experiencing low back pain.

1) Seek Appropriate Treatment to Prevent Further Damage

It is essential to seek help from a health care provider who can help diagnose and treat your low back pain. Early intervention can improve the results of your rehabilitation.

2) Posture can make a big difference

Standing and sitting posture can positively or negatively affect low back pain. If a particular position aggravates your low back pain, try switching positions. For example, if you have a sit/stand desk, try rotating between sitting and standing throughout your day. A physiotherapist can help you determine how to sit or stand best to avoid aggravation.

3) Sleeping With Low Back Pain Is Difficult

Some people who experience low back pain have difficulty sleeping. It is helpful to explore different positions to find the most relieving position. Often using pillows will help support your body and relieve pain.

4) Exercising with Low Back Pain

Consult your physiotherapist to determine which exercises are most appropriate for you to do. Incorporating strengthening and mobility rehab exercises specific to your injury is essential.

5) Driving With Low Back Pain

If sitting is an aggravating position for you, it may be challenging to tolerate driving. Take breaks from driving, especially if it is a long drive. Try adjusting your seat, raising or straightening it to find a more comfortable and relieving position.

6) Be Gentle and Patient with Yourself

Injuries can be frustrating. Every injury is different, and recovery timelines are difficult to predict as they vary for every person. It is crucial to develop a treatment plan with your physiotherapist to address your pain and rehabilitation.

7) Maintain good nutrition

Your body needs sufficient nutrients to support healing. Ensure you are eating healthy, and if you need help, please seek advice from a registered dietitian or nutritionist.

For additional tips on living with low back pain, speak to your doctor or physiotherapist.

Tips For Recovering from Low Back Pain

One of the most important things to incorporate into your rehab is exercises, including mobility, stability, and strengthening. Your physiotherapist will help you design a program specific to you that will address your injury and consider your goals.

Your physiotherapist will also teach you to perform functional movements with good technique to avoid aggravating your low back pain. These functional movements might include things like squatting or lifting.

Incorporating pacing strategies and rest might be essential components of your recovery. Taking appropriate rest breaks during activities and getting good sleep will help your body recover. Pacing could involve breaking workouts into smaller tasks, reducing activity duration, or adjusting intensity.

If you have any pre-existing health conditions, please seek advice from your doctor before beginning an exercise routine.

Stretching for Low Back Pain

Stretching may be a helpful strategy to address your low back pain. Discuss with your physiotherapist whether a stretching program is appropriate for you. Here are a few benefits of stretching:

  • Increased mobility and reduced stiffness
  • Desensitizing tissues to tolerate movements
  • Improved range of motion and flexibility to help with daily activities like sitting, getting out of a car, and standing up from a seated position
hamstring stretch

Examples of Stretches

These are examples of stretches for the spine and related areas. Do not perform these stretches without consulting your physiotherapist or health care practitioner. 

  1. Neck Stretch – Sit up straight with your shoulders straight and chin level. Then slowly drop your left ear towards your left shoulder as far as you comfortably can. Repeat with your right side.
  2. Side Stretch – Standing up straight with your arms extended, bend to one side until you feel a gentle stretch in the side and underarm. Repeat with your other side.
  3. Lower Back Stretch – Lying face up on the floor with your knees bent and feet flat, tighten your stomach muscles, gently pull one knee towards your chest until you feel a gentle stretch in your lower back. Repeat with the other knee.
  4. Lower Back Stretch – Lie on your back on the floor with your knees bent and feet flat, then pull both knees up to your chest until you feel a gentle stretch in the lower part of your back.
  5. Hip Stretch – Lie on your back, cross one foot across the opposite knee, and gently pull that knee towards your chest. Repeat with your other knee.
  6. Hamstring Stretch – Lie on your back with one leg flat on the floor and the other bent at the knee with your foot flat on the floor. Loop a towel around your foot or ankle, then gently pull the towel towards you until you feel a stretch through your hamstring (the muscles at the back of the thigh).
  7. Calf Stretch – Stand facing a wall with your hands flat on the wall at about eye level. Step back with one leg and lean your body towards the wall while keeping your heel on the ground to feel a stretch in your calf.
  8. Hip flexors stretch– In a half kneel, with your front foot on the ground and back knee on the ground, engage your lower abdominal muscles. Slowly lean your body forward, feeling the stretch in the front of your hip. To increase the intensity of this stretch, raise the arm on the side of your knee that is down.
  9. Lumbar stretch– Lay on your back with your knees bent and feet on the floor. Gently let your knees fall to one side while staying together.
  10. Cat Stretch – Get into all fours, then slowly allow your stomach to drop towards the floor while raising your upper body and pushing your hips up towards the ceiling. Hold for a few seconds, then go back to the starting position. Repeat ten times.

Strengthening Exercises

Those with lower back pain often benefit from strengthening exercises to support the lower back. Consult your physiotherapist before performing any activities to ensure they are appropriate for you. Here are some examples of common exercises for lower back pain:

  1. Bridge – Lie on your back with your knees bent and feet flat on the floor. Tighten your stomach muscles and slowly push your hips up towards the ceiling.
  2. Single-Leg Bridge – From the bridge position (see above), tighten your stomach muscles and lift one leg until it is level with your hips, then hold it there. Lower the leg back down and repeat on the other side.
  3. Chair Squats – Stand in front of a chair with feet hip-width apart and hands on your hips. Pull in your abdominal muscles, bend your knees, and lower yourself until your thighs touch the chair.
  4. Side Lying Leg Raises – Lay on your side with your legs straight. Raise your top leg in the air, then slowly lower it back down.
  5. Pelvic Tilt- Laying on your back with your knees bent and your feet on the floor. Gently engage your lower abdominals and think about pulling your belt line towards your chin. Reverse the motion by moving your pelvis in the opposite direction.
  6. Superman – Lie on your stomach with your arms over your head. Simultaneously lift your arms and legs off the ground. Ensure you are lifting from your hips rather than your back.
  7. Plank– Lay on your stomach and lift your body off the ground, keeping your elbows and toes on the floor. Avoid raising your hips high in the air or sagging your low back. Imagine pulling your toes towards your elbows. Hold this position. If it is difficult to maintain this position, drop down to your knees instead of on your toes.

Prevention is Key!

One way to prevent low back pain is by maintaining mobility and strength. Practicing functional movements can increase resiliency and strength in your tissues. If you are looking for ways to prevent low back pain, talk to your physiotherapist about what exercises are right for you.

What You Can Do to Live with Low Back Pain

People with low back pain may find it challenging to do everyday things, such as standing up from a sitting position or going up and downstairs. The following suggestions may help you manage the pain:

Ask your physiotherapist how to lift correctly to avoid aggravating your low back pain. If you can, try to change your posture, when possible, throughout the day. For example, if you are sitting at a desk or in front of the TV for extended periods, take frequent breaks to get up and stretch.

Your Mother Was Right

We all grew up with parents telling us to sit up straight. We tended to slouch on the couch watching television or sitting at a computer. Our parents often harped on the fact that we needed to sit up straight. Our parents were right. Sit straight, shoulders back with you chin tucked in and you could lessen or eliminate some of your back pain.

See Your Doctor

See your doctor if you have numbness, tingling, weakness in your legs and discomfort. Also, go to the doctor if you have severe pain that does not ease. Doctors can order diagnostic imaging if there is no precise diagnosis from the physical examination.

It is also essential to seek immediate medical attention if you are experiencing bowel or bladder changes.

If your low back pain is due to a traumatic incident, such as a car accident, it is advisable to see a doctor to rule out any fractures.

See a Physiotherapist!

Physiotherapy can help treat low back pain and improve overall strength and flexibility to help prevent future pain. A physiotherapist can teach you exercises to improve your strength and mobility and pain relief strategies.

Physiotherapy Treatments to Ease Low Back Pain

physiotherapist at Bergin Motion

Physiotherapy treatments for back pain may involve one or more of the following:

  • Muscle-strengthening exercises increase the strength of the muscles that help support the spine. These are called “core” muscles (such as abdominal, back extensor and gluteal muscle groups) and “global” muscles (e.g., hamstring).
  • Mobility exercises increase the range of motion of muscles supporting the spine and other joints.
  • Manual therapy helps to reduce pain, spasms, and muscle tightness.
  • Modalities such as acupuncture, laser, and muscle stim can promote healing and help manage pain.
  • Advice regarding lumbar supports, braces and other tools can help to manage pain throughout your day.
  • Practical advice for people with low back pain will include ensuring good postural habits, especially at work or home, where you spend a lot of time sitting or standing.

Frequently Asked Questions about Low Back Pain

Q: Is back pain common?

A: 80% of people will suffer from lower back pain at least once in their lifetime.

Q: How long does it take for low back pain to go away?

A: Everybody’s experience is different. Low back pain can last only a few days but could persist for much longer if not managed effectively.

Q: Is there anything I can do to prevent low back pain in the future?

A: Maintain a healthy lifestyle, including a healthy diet and regular exercise.

In your exercise routine, include core exercises and general strengthening exercises.

Use proper lifting technique if you have a physically demanding profession or frequently lift heavy objects. Training functional movements in your exercise program will help create resiliency and strength for your everyday activities.

Q: How can I tell if my back is getting better?

A: Improvement will be indicated by lower pain levels, increased exercise tolerance, and improved mobility.

Q: Should I exercise if I have low back pain?

A: Exercise can be safe and helpful during your rehabilitation. Consult your physiotherapist regarding which exercises are appropriate for you to perform.

Q: How can I prevent my back pain from coming back?

A: It is vital to continue a regular exercise routine designed by your physiotherapist. Try to identify your triggers with your physiotherapist and develop a plan to train those movements or move more effectively.

Q: How can I help my back?

A: It is essential to identify aggravating movements or positions. This will help dictate your limitations and guide your healthcare practitioner’s assessment and treatment. Consider rest and pacing strategies to avoid fatiguing or aggravating your back.

Maintain good posture and movement patterns to avoid re-aggravating your low back pain. Also, consider different sleeping positions to relieve your low back pain. Your physiotherapist can help you determine the best positions for you.

Consult your health care practitioner before starting a new exercise program. 

Conclusion

This article has described how important it is for people with low back pain to exercise and learn good movement patterns. Knowing which exercises can help ease your pain will improve your overall health while getting through your day-to-day activities less complicated.

A variety of factors can cause low back pain. They can be classified as traumatic (falls, motor vehicle accidents, overexertion injuries) or non-traumatic (postural, degenerative, or mechanical). Specific injuries causing low back pain can vary from sprains and strains to fractures, to disc injuries, to arthritis, to unspecified low back pain (sensitivity in the tissues around the low back).

We have discussed a variety of exercises that can help ease back pain. Still, seek advice from your physiotherapist before attempting any new movements if you experience low back pain. If you have questions about low back pain or exercises, contact a health care provider who can discuss this with you.