Finding Relief: The Why’s of Lower Back Pain and the How’s of Physical Therapy

Are you suffering from a low back ache? Have you been experiencing persistent lower back pain? Are you seeking to uncover the underlying cause of this discomfort? Do you yearn to liberate yourself from the confines of lower back pain? Nowadays, many people are suffering from low back aches.

Introduction

Low backache, also known as lower back pain, is a common condition characterized by discomfort or pain in the area of the lower back, specifically between the ribcage and the pelvis. The pain can vary in intensity, duration, and location and may range from mild and achy to severe and sharp. Low back ache can be acute, meaning it lasts for a short duration, usually a few days to a few weeks, or it can be chronic, persisting for more than three months. It can affect people of all ages and is one of the leading causes of disability worldwide.

The pain may be localized in the lower back, but it can also radiate into the buttocks, hips, and legs, depending on the underlying cause. Some common symptoms associated with low back ache include stiffness, limited range of motion, muscle spasms, loss of sensation, and difficulty standing or walking for prolonged periods. Various factors can contribute to low back aches, including muscle strain, injuries, herniated discs, degenerative conditions, poor posture, obesity, and sedentary lifestyles. Psychological factors such as stress and anxiety can also play a role in exacerbating the pain.

Understanding Lower Back Pain

The Anatomy of the Lower Back

Before delving into the causes of lower back pain, it’s essential to understand the intricate anatomy of this region. The lower back, also known as the lumbar spine, consists of five vertebrae (L1 to L5) that support the weight of the upper body and provide flexibility and movement. The lower back also comprises intervertebral discs, spinal nerves, muscles, and ligaments, all working together to maintain stability and allow various activities.

Anatomy & Biomechanics

1. The lumbar spine consists of five vertebrae (L1 to L5) that support the upper body and provide flexibility. These vertebrae are the largest and strongest of all vertebrae as they have to transmit body weight from the upper body to the lower body. The most susceptible area is L5-S1 and S1-S2 as the LOG (line of gravity) passes in front of it and COG (center of gravity) lies in the vicinity of S2.
2. The Intervertebral discs (IV disc) separate the 2 vertebrae, transmit the load, and act as shock absorbers between the vertebrae. It provides flexibility to the spine.
3. The spinal cord runs through the spinal canal, while nerve roots extend from the cord and exit the spine through small openings.
4. The muscles, ligaments, and tendons support and stabilize the spine during movement. The lumbar spine is supported by surrounding muscles and ligaments, which aid movement and stability. The complexity and interconnectedness of these structures make the lumbar spine a vital component of the body’s overall movement and function.

5. Major ligaments of the lumbar spine are:

• Anterior longitudinal ligament
• Posterior longitudinal ligament
• Ligamentum flavum
• Supraspinous ligament
• Interspinous ligament
• Iliolumbar ligament

6. Muscles of the spine: Paraspinal muscles, erector spinae, quadratus lumborum, longissimus dorsi, paravertebral muscles (semispinalis, multifidus, and rotators).

7. Joints of the spine:

• Cartilaginous joint – The joint between the vertebral body and Intervertebral discs.
• Synovial joint – The joint between facets of superior and inferior facets of adjacent vertebrae.

8. The movements or kinematics in coordination with the pelvis involve:

• Flexion (bending) – Anterior tilting and gliding of superior vertebrae.
• Lateral flexion (lateral bending) & rotation (twisting) – lateral tilting, rotation, and translation of superior vertebrae.
• Extension (lifting) – Posterior tilting and gliding of superior vertebrae.

9. The kinetics involves axial compression, tension, bending, torsion, and shear stress.
10. The amount of movement depends on the size of the discs.
11. The direction of motion depends on the orientation of facets.
12. The pathology of the spine can lead to debilitating outcomes on the quality of life.

Functions of the vertebral column

1. The protection of spinal cord and spinal nerves.
2. It provides structural support to the body for weight-bearing.
3. It provides structure and flexibility to the body.
4. The IV discs provide cushioning between the vertebrae.

Common Causes of Lower Back Pain

1. Sedentary Lifestyle

Leading a sedentary lifestyle, such as prolonged sitting at a desk or in front of a computer, weakens the muscles supporting the lower back, leading to pain and discomfort.

2. Strain and Sprain

The overuse or improper use of back muscles can lead to strain and discomfort. Straining or spraining the muscles or ligaments in your lower back can cause pain. This can happen due to poor mechanics or sudden movements like twisting the back. When the lower back muscles are overworked or overstretched, they can become inflamed and painful.

3. Poor Posture

When a person has to maintain a posture for a prolonged time, they may develop a comfortable posture leading to poor posture that can strain the back muscles and ligaments. Poor posture is a common cause of lumbar pain, as it places the lower back in a position of constant stress. People who spend a lot of time sitting or standing in the same position or who use poor lifting techniques may develop postural abnormalities that lead to pain and discomfort.

4. SPINAL CONDITIONS

• Lumbar Disc Herniation: When the soft cushioning discs (intervertebral disc) between the 2 vertebrae bulge or rupture, they can compress nearby nerves, a condition also known as prolapsed intervertebral disc (PIVD).
• Degenerative Disc Diseases (Spondylolysis): The wear and tear of the intervertebral discs over a period of time can cause pain.
• Spinal Stenosis: The narrowing of the spinal canal puts pressure on the spinal cord and nerves
• Scoliosis: It is a condition in which there is an abnormal lateral curvature of the spine, which leads to back pain. It can be traumatic, congenital, or due to some underlying condition.
• Spondylosis: It is basically osteoarthritis of the spine. Other forms of arthritis that affect the spine can cause pain.
• Spondylolisthesis: The translation of one vertebra over another.

5. Overcompensation

Overcompensation can occur when one part of the body is injured or weak, causing healthy muscles to work harder to compensate. This can lead to additional stress on the lower back and result in pain and discomfort.

6. Poor Mechanics

Poor mechanics, such as bending over at the waist instead of the knees while lifting any object from the ground, can also contribute to lumbar pain. This places additional stress on the lower back muscles and can lead to injury.

7. Injury or Trauma

Accidents falls, or sports injuries may damage the structures in the back.

8. Obesity

Excess weight can stress the back and contribute to pain. The bulging out of the belly leads to additional stress on the spine and an increase in lumbar lordosis (curvature) of the spine.

9. Psychological Factors

Stress, anxiety, and depression can exacerbate back pain.

10. Spinal Stenosis

Spinal stenosis occurs when the spinal canal narrows, putting pressure on the spinal cord and nerves, leading to lower back pain and leg discomfort.

11. Arthritis

Osteoarthritis or other forms of arthritis can affect the spine’s joints, causing pain, inflammation, and reduced mobility.

The Impact of Lower Back Pain

Living with lower back pain can significantly affect an individual’s quality of life. It can interfere with daily activities, work productivity, sleep patterns, and even mental well-being. Chronic lower back pain can lead to feelings of frustration, depression, and anxiety, making it essential to find effective relief.

Treatment:

1. Rest: Short-term rest can help reduce acute pain and inflammation.
2. Physical Therapy: Strengthening and stretching exercises can improve flexibility and muscle support.
3. Pain Relief: Over-the-counter (OTC) pain medications or prescription drugs may alleviate pain and inflammation.
4. Heat and Ice Therapy: The application of heat or ice packs can help reduce pain and swelling.
5. Posture Improvement: Practicing good posture and ergonomics can reduce strain on the back.
6. Weight Management: Maintaining a healthy weight can reduce stress on the lumbar spine.
7. Epidural Steroid Injections: For severe pain, corticosteroid injections can provide temporary relief.
8. Massage Therapy: Helps relax muscles and relieve tension in the back.
9. Acupuncture: Some individuals find relief through acupuncture sessions.
10. Surgery: In severe cases or when conservative treatments fail, surgery may be considered (e.g., discectomy, spinal fusion).

PHYSIOTHERAPEUTIC MANAGEMENT

Physiotherapy is a practical approach for managing low back aches and promoting recovery.

Assessment:

A thorough evaluation is conducted by the physiotherapist to identify the underlying cause and severity of the low back ache. It involves pain assessment, joint ROM, muscle strength, dermatome and myotome, NCV, EMG, X-ray, and MRI investigations are also to be referred.

Individualized Treatment Plan:

Based on the assessment, a personalized treatment plan is developed to address the specific needs and goals of the patient.

Pain Management:

Physiotherapists use various techniques to manage pain, including heat and cold therapy, TENS (Transcutaneous Electrical Nerve Stimulation), and ultrasound.

Manual Therapy:

Hands-on techniques such as joint mobilization, soft tissue massage, and manipulation are used to improve joint mobility and reduce muscle tension.

Strengthening Exercises:

Targeted exercises are prescribed to strengthen the core, back, and supporting muscles. Strengthening the muscles can provide better support to the spine and reduce strain.

Stretching Exercises:

Flexibility exercises help improve the range of motion, reduce muscle tightness, and enhance flexibility in the lower back and surrounding areas.

Posture Correction:

Physiotherapists educate patients on proper posture and body mechanics during daily activities to prevent further strain on the back.

Ergonomic Advice:

Patients receive guidance on proper ergonomics at work and home to create a back-friendly environment.

Core Stability Training:

Training the deep core muscles (transversus abdominis, multifidus) helps improve stability and support for the spine.

Education:

Patients are educated about their condition, potential triggers, and strategies to manage and prevent future episodes of low back aches.

Home Exercise Program:

Physiotherapists design a tailored home exercise program to encourage continuity of care and long-term management.

Gradual Return to Activities:

Patients are guided on how to gradually resume daily activities and exercise routines to prevent re-injury.

Aquatic Therapy or Hydrotherapy:

In some cases, aquatic exercises in a pool may be recommended as buoyancy reduces stress on the spine while providing a gentle workout.

Biofeedback:

Biofeedback techniques may be used to teach patients how to control and relax specific muscles to alleviate pain.

Progress Monitoring:

The physiotherapist tracks progress, adjusts the treatment plan as needed, and provides ongoing support throughout the recovery process.

Remember, each person’s condition is unique, and the physiotherapy approach will be tailored accordingly. It’s essential to follow the therapist’s instructions and adhere to the prescribed exercises for the best results.

Lower back pain can be a challenging condition to endure, but it doesn’t have to be a lifelong burden. Understanding the root causes of lower back pain and embracing the benefits of physical therapy can pave the way to lasting relief and improved well-being. By adopting a comprehensive approach that includes strengthening the core, improving flexibility, and receiving expert guidance from a physical therapist, individuals can find the relief they seek and reclaim an active, pain-free life.

FAQs

[faq question=” Q: Is physical therapy suitable for all types of lower back pain?”]
A: Physical therapy is generally considered beneficial for various types of lower back pain. However, it’s essential to consult with a healthcare professional or physical therapist to determine the most appropriate treatment plan based on individual needs.[/faq]

[faq question=” Q: How long does it take to see results from physical therapy?”]
A: The time to see results from physical therapy can vary depending on the severity of the condition and the individual’s commitment to the treatment plan. Some may experience relief after a few sessions, while others may need more time and consistent effort.[/faq]

[faq question=” Q: Can physical therapy prevent lower back pain in the future?”]
A: Yes, physical therapy can be preventive by strengthening the core muscles and promoting proper posture and body mechanics. It can reduce the risk of future lower back pain episodes.[/faq]

[faq question=”Q: Are there any alternatives to physical therapy for treating lower back pain?”]
While physical therapy is highly effective, other treatment options may include medication, chiropractic care, acupuncture, or in severe cases, surgery. However, it’s best to explore non-invasive options first before considering more invasive procedures.[/faq]

[faq question=”Q: Can I continue physical therapy exercises at home?”]
A: Absolutely! Physical therapists often provide patients with exercises and stretches they can perform at home to complement the in-clinic sessions. Consistent practice can enhance the benefits of physical therapy and aid in faster recovery.[/faq]