Lower Back Pain & Causes

Lower back pain is the most common condition suffered by adults and is becoming more prevalent due to our increasingly sedentary existence. It is defined as aches and/or sharp pains in and around the lumbar spine and posterior pelvis. It is often accompanied by stiffness and occasionally accompanied by numbness, tingling and/or weakness down the lower limb to the foot.

Your back is made up of many muscles that create movement and stabilisation of the spinal bones (vertebrae) and the ligaments that prevent excessive movement. Discs act as shock absorbers between your vertebrae, and nerves run from your brain to your body through holes between the vertebrae.

Patient with lower back pain

Each movement of your back requires: 

a) Dozens of muscles turning on and off at the right time,

b) Smooth movement of the facet joints,

c) The discs to support that movement.

d) Sensorimotor integration by the brain.

Prolonged stresses, repetitive tasks and accidents can cause injuries to the spine and its surrounding components. The most common contributing factors are an inactive lifestyle, poor posture and obesity.

Most lower back pain is mechanical which is defined as overuse, injury or deformity of a normal anatomic structure. Pathology is an uncommon cause, therefore a functional approach to your lower back pain is usually best.

Types of lower back pain:

The specific condition that you have can be determined by asking a series of questions and performing various tests and exams. The conditions below have very brief descriptions and should not be relied upon for a diagnosis: 

Lumbar sprain - excessive loading of lumbar ligaments causing stretching or tearing, associated with inflammation of the lumbar facet joints.

Sacroiliac joint dysfunction - dysfunction of the sacroiliac (S.I.) joint(s) that leads to lower back  and posterior pelvis pain and/or pain in the bum and back of thighs. Can involve inflammation of the S.I.’s.

Lower back strain (aka pulled muscle) - overuse, improper use or fatigue can lead to overstretching or tearing of a muscle.

Muscle spasms - involuntary contraction of one or more muscles, usually happens with a strain or sprain. 

Bulging disc - a tear in the outer part of your intervertebral disc. Can cause pain, especially if the associated inflammatory chemicals irritate the spinal nerve root. 

Herniated disc - the outer disc can deteriorate to the point that the inner gel-substance seeps out of the disc and can cause severe symptoms in the lower back and down the lower limb

Cauda equina syndrome - significant damage to the lower spinal nerves can lead to numbness around the anus, and loss of bowel or bladder habits. Rare but severe, requires immediate hospital admission. 

OA related lower back pain - osteoarthritis or degenerative joint disease is pain and stiffness, especially in the mornings, caused by the deterioration of your spine in areas of prolonged dysfunction. 

Inflammatory arthritis - conditions which typically affect the immune system and involve joint pain, stiffness and deformity, eg rheumatoid arthritis and ankylosing spondylitis.

Scoliosis - sideways curvature(s) of your spine leading to back pain, often starts just before puberty.

Spinal canal stenosis - the spinal canal can deteriorate as one ages, this can cause irritation to the spinal cord and nerves leading a myriad of symptoms including pain and numbness down the lower limbs. 

Spondylolisthesis - the body of the vertebrae (usually at the bottom of the spine) slips forward relative to the vertebrae below, causing lower back pain. Occurs with or without stress fracture of the vertebrae.

Fracture - a spinal bone can fracture (break) with direct impact or significant injury. A vertebral body can collapse in someone with osteoporosis (bone weakening). 

Organic causes - a variety of other things can cause lower back pain such as infection, kidney stones, abdominal aortic aneurysms or tumours. 


Treatment for lower back pain:

Painkillers can effectively reduce pain levels however, if one ignores the cause of the problem this can lead to a worse longer term outcome. Pain is like the tip of the iceberg. 

Anti-inflammatories can effectively reduce inflammation, however the inflammation is not the cause of their problem, it is an effect. Removing inflammation can interfere with your body’s normal healing efforts. 

Chiropractors are experts in diagnosing spinal conditions and because of their functional approach are often the best suited health professionals to provide treatment.

Studies have shown that the techniques chiropractors specialise in are effective for adults experiencing acute, sub-acute and chronic lower back pain. For example, researchers at the EMGO Institute for Health and Care Research found that spinal manipulative therapy (“SMT”) has a significant short-term effect on pain relief in the lower back.

Surgery is the last option and should only be contemplated in extreme situations:

  1. Significant trauma that leads to a complicated fracture

  2. When someone experiences cauda equina syndrome, which involves lower back pain, a loss of bowel/bladder control and/or perineal or saddle anaesthesia (numbness between your genitals and anus), requiring emergency surgery.

  3. Significant and prolonged pain, numbness and tingling in your lower back and down your limbs.


Self-Care

Many of the practices to maintain good spinal health are also the ways you can help to rehabilitate your spine. These should be done in consultation with a chiropractor, this advice should not be relied upon for your specific case.

Stretching - in 99% of cases it’s great for people to keep their spine moving frequently. This could be anything from simple stretches through to yoga classes. Although, don't push a joint past your pain threshold, this could do more harm than good.

Strengthening - this is not always necessary in the initial stages of lower back pain. However, once you are on the road to recovery your chiropractor should be giving you some strengthening exercises to help. Squats and deadlifts can be beneficial but you need to be very careful about your technique and progress. 

Sport and dance - moving your body as frequently as possible is the rule and when you play most sports or dance you are moving many of the lower back joints and engaging many lower back and pelvic muscles in a way that improves spinal stability. 

Rest - occasionally rest is required, for example when there is a significant disc herniation. However, for most conditions we do not prescribe rest. 

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