Low Back Pain – Causes and Management – part 1

What is Low Back Pain?

Lower-back-pain

Back pain is a very common condition. 85% of the UK population experiences back pain at least once in their lives.

Before I jump right in the middle of things by telling you causes and management, let me first explain what low back pain is and how it is categorised.

Low back pain can be defined as pain, muscle tension or stiffness localised below the costal margin and above the gluteal folds, with or without leg pain. According to the duration of the pain, low back pain can be categorised, either acute or chronic.  When the pain persists for less than 12 weeks, we call that acute low back pain and in the case, when the pain persists for longer than 12 weeks, it considered being chronic pain.

 

Low back pain is also categorised by the cause of pain

Specific Spinal Pathology

arthritis

In this category, back pain is caused by arthritis. The most common form of arthritis is osteoarthritis but ankylosing spondylitis (bony fusion of the spine) and rheumatoid arthritis (see photos) would also be included here. The pain in this category could also be caused due to fractures, infections, tumours and other bone disorders. This is the rarest cause of back pain and accounts for less than 1 in 100 cases.

 

 

ankylosing spondylitis

 

Nerve Root Pain / Radicular Pain (“Trapped Nerve”)

This is also a relatively rare category of low back pain, causing less than 5% of cases.

spinal cordIn this category back pain is caused by the spinal cord. The spinal cord runs down our spine and when it becomes trapped, causes all kind of neurological symptoms, like pins and needles, numbness and weakness, in the leg.

 

 

 

sciatic nerveThe most common nerve root pain is sciatica or sciatic pain, resulting from the compression of the sciatic nerve. When the nerve gets trapped, it result of shock like or burning pain in the low back combined with pain in the buttocks and down one leg.

Possible causes of the compression could be due to a bulging or a prolapsed disc in the lumbar spine.

 

 

Simple / Non-Specific Low Back Pain (NSLBP)

Low back pain in this category is not attributable to any underlying pathology. NSLBP is the most common form of low back pain. About 19 in every 20 cases can be placed in here. In many cases, the cause may be a simple sprain to the ligament or a strain of a muscle, alternatively there might be a minor irritation of an intervertebral disc or facet joint. However in these cases it is almost impossible to accurately distinguish the main source of pain.

Possible Risk Factors that can Contribute to Low Back Pain

So now that you know the possible causes of low back pain, let me explain some of the risk factors that can contribute to developing back pain

 Modifiable Risk Factors

  • Lack of fitness / physical inactivity
  • Smoking
  • Obesityprolonged sittingsmokingobesityStress
  • Trauma
  • Awkward posture at work
  • Frequent bending and twisting
  • Heavy and repetitive lifting
  • Jarring, gripping, vibration or repetitive actions
  • Prolonged sitting and prolonged standing

 

scoliosisNon – Modifiable Risk Factors 

  • Increasing age
  • Number of pregnanciespregnancy
  • Previous episodes of low back pain
  • Major scoliosis
  • Occupational risks (work related)

 

 

From this moment on, I will only be referring to non-specific low back pain (NSLBP).

Management of NSLBP

medication

As we earlier discussed in this blog, NSLBP is mechanical in nature and it is likely caused by sprains, strains or inflammations and irritations. Therefore the first choice of treatment to manage low back pain and to keep the person active, is usually in the form of analgesic medications or non-steroidal anti-inflammatory drugs, like ibuprofen, aspirin, paracetamol or diclofenac/voltarol. Your doctor may prescribe stronger medication if you suffer from chronic pain where the pain is severe.

*Please, always consult with your doctor when taking any medications. 

There are a few very important things that you know when it comes to low back pain and the management of low back pain

  • There is nothing to worry, backache is very common

Back pain or ache is not usually due to any serious disease. It is simply the body signalling that there is an ongoing tissue damage, like inflammation. Your spine is one of your strongest parts of your body.

  • Avoid too much rest

Most back pain settles quickly, at least enough for you to get on with your normal life.

  • Stay as active as possible and continue normal daily activity

Back pain need not cripple you, unless you let it.

  • If working, stay at work or return to work as soon as possible

Be positive and stay active; you will get better more quickly and have less trouble later.

  • Hurting does not mean harm 

It is simply the body signalling that there is an ongoing tissue damage, like an inflammation.

 

So we now understand that keeping physically active is very important and you are probably wondering what are the benefits of physical activity and what are the effects of inactivity.

The Benefits of Physical Activity

physically activeBeing physically active helps with weight loss and weight management and joint tension, it also increases the feeling of well-being and helps with general stabilisation.
Other benefits are: reduced risk of a heart attack, lower the risk of type 2 diabetes, helps to lower blood pressure, have stronger bones, muscles and joints and lower the risk of osteoporosis, it gives the person more energy, better mood and a person will generally feel more relaxed and sleep better.
Physical activity reduces disability, pain, time spent off work compared to bed rest.
Being physically active promotes an early return to work. Tailored exercise programmes can help to feel less pain and move around and get on with normal activities.

The Effects of Physical Inactivity

physical inactivityBeing physically inactive is associated with worse low back pain than remaining active. It results in delayed recovery, higher risk for chronicity and longer time spent off work.
In fact staying in bed results in joint stiffness, loss of bone mineral density, venous thromboembolism and decreased general health. Bed rest can also lead to chronic disability and negatively effect rehabilitation strategies.
Inactivity also effects the brain, which results in bad mood and could create pshycosocial issues. Being physically inactive results in lowered immune system, muscle imbalances and poor posture.

Summary

In this part we have discussed some key points of what low back pain is, what can cause back pain and what the risk factors are. We have also briefly covered some of the managements of back pain and looked into the benefits of physical activity.

Most of us will experience low back pain at least once in our lives. What you need to keep reminding yourself is that, back pain usually does not mean that there is a serious underlying issue with your back. It’s important to stay positive and as active as possible. Try to avoid bed rest.

*If in any doubt please consult with your doctor. You can also find useful credible information regarding low back pain on the following website:

 

This is the end of Part 1 but I will be back soon with the next part where I will talk more about different postures, exercises and more!

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