Lower Back pain - Part 1

Lower back pain

If you are experiencing lower back pain, you are not alone…

Did you know that 80% of people over the age of 35 experience lower back pain at some point in their lives? And 1 in 4 people will be suffering from it right now…

Lower back pain

About Back Pain

Lumber pain – lower back pain

Back pain is one of the most prevalent health conditions affecting at least one in ten Australians at any time. According to the Medical Journal of Australia, “up to eighty per cent of Australians will experience back pain at some point in their lives and 10% will experience significant disability as a result. Lifetime prevalence of low back pain is reported to be as high as 79.2% in Australian adults and 84% in adolescents”. One in four adults with back pain are reported to have fair to poor physical health, compared with one in nine of the general population. Back pain has been reported to double or even triple feelings such as sadness, worthlessness, hopelessness, as well as feeling like everything is an effort.

There is also a link between chronic pain and depression, and they commonly occur together. Depression is often associated with decreased function due to chronic pain, as people are unable to do the many things they would normally have been able to do without pain.

Back pain can refer to both upper and lower back pain. Upper back pain affects the mechanics of the lower back, so sometimes they will co-exist. This blog will focus on lower back pain.

What is Lower Back Pain?

Acute Back Pain vs Chronic Back Pain

Lower back pain can be experienced as pain or tension around the lower back area (lumbar spine) and can affect the spine, joints, ligaments and muscles as well as nerves.

Lower back pain

The causes of lower back pain are varied, from either irritation to a nerve or muscle, to tightening of the myofascia (connective tissue covering a muscle) to physical damage or dysfunction of the spine… it can be either an acute or chronic condition, with different types of pain of varied intensities.

Generally acute back pain is considered pain lasting a few days up to 6 weeks, sub-acute back pain lasts 6 weeks to 3 months, and chronic back pain lasts longer than three months.

Anatomy of lower back pain

Anatomy of lower back

Lower Back Pain – Lumbar Facet Joint

Your back (spine) provides you with support, mobility and protects the spinal cord. The vertebrae articulate with each other via the facet joints along the spine, and are also separated from each other by a “shock absorber” known as an intervertebral disc.

The vertebrae are held together by ligaments, and create the site of attachment of the back muscles. Spinal nerves exit at the side of each vertebrae, which send messages to the muscles, organs and the brain.

The lower back refers to the lumbar spine area. It is a complex structure composed of the vertebrae (the bones of the spine), muscles, nerves, ligaments, and other soft tissues. Lower back pain can result from either injury and damage to any of these structures, or can also be caused by the spine and body being in mis-alignment due to tension in some muscles as well as the connective tissue (myofascial tissue / fascia).

 Commonly, the muscles that are responsible for creating pain in the lower back area, include:

• Psoas
• Quads – particularly Rectus Femoris
• Quadratus Lumborum
• Latissimus Dorsi
• Adductors
• Rectus Abdominus
• Gluteals

Thoracolumbar Fascia

Sometimes, it is actually not just muscular tightness, but fascial tightness that is the problem. Fascia is a web of connective tissue throughout our body that literally connects everything. It covers muscles, creates tendons and ligaments, covers organs and connects muscle to bone. It is a highly adaptable tissue, with elastic properties. Deep fascia can contract and is affected by the stress response. Fascia tightens, which creates tension. After the period of stress has passed, the fascia and muscles may remain in a state of tension, which can lead to damage, trigger points, adhesions and even create scar tissue over time.

Thoracolumbar Fascia Can Contribute To Lower Back Pain

Fascia connects via Myofascial Lines or “Fascial Trains”, whereby muscle fibres that run the same direction connect via the fascia. Looking at the picture of the Superficial Back Line (one of 12 different Myofascial Lines”), you can see that fascia connects your head to your toes – literally! Fascial line tightness can contract not only the fascia covering the muscle, but can contract a whole line of fascia, creating overall tightness throughout the body, which creates musculoskeletal imbalances.

The thoracolumbar fascia is a diamond shape of connective tissue that is located directly over the lumbar spine area. It forms the attachment of the Latissimus Dorsi Gluteal muscles, and the Transverse abdominus muscle (core). This area can also become tight and contract, creating postural imbalances.

Causes

It’s sometimes hard to know exactly what causes back pain. It’s usually thought to be related to a muscle strain or mechanical dysfunction in one of the structures in your back, rather than just a nerve problem.

For many people with back pain, there isn’t any one specific underlying problem or condition that can be identified as the cause of the pain. Lower back pain can have many causes including:

• Weakness of core muscles can mean that more load is taken through the back, putting pressure on the lumbar spine
• Fascial tightness – increased tension in connective tissue, making it prone to injuries such as tears or strains
• Back muscle strain or sprain
• Disc injury or degeneration such as slipped disc, bulging disc, herniated disc
• Scoliosis
• Nerve-root pressure / nerve irritation / nerve impingement
• Spinal stenosis (a narrowing of the spinal canal through which the spinal cord passes)

Examples of Disc Problems

• Degenerative disease such as osteoarthritis or osteoporosis
• Rheumatoid arthritis
• Back or spinal injury
• Spondylolisthesis (vertebrae slips forward and out of position)
• Repetitive Movements
• Postural stress
• Abnormal bone structure e.g. short leg or asymmetrical pelvis

 
Back pain may also be caused by an infection or cancer, but these two causes are very rare. The most common causes are either injury or strained/sprained/tight muscles.

Symptoms of Lower Back Pain

Symptoms of lower back pain can depend on the cause. Some common symptoms include:

• Muscle spasm and tightness
• Muscle cramps
• Stiffness
• Pain around the back and buttock areas
• Numbness
• Tingling
• Aches
• Muscle Spasm
• Locking joints creating a limited range of movement (ROM)
• Weakness

If you are experiencing these symptoms, book in to see our Myotherapist today who can start treating you for your lower back pain.

In “Part 2″ our next blog will cover treatment options, self care and prevention of lower back pain, so stay tuned!