If you have lower back pain, you are not alone. About 80% of adults experience low back pain at some point in their lifetimes.
Men and women are equally affected by low back pain, which can range in intensity from a dull, constant ache to a sudden, sharp sensation that leaves the person incapacitated.
The lumbar spine, or low back, is a remarkably well-engineered structure of interconnecting bones, joints, nerves, ligaments, and muscles all working together to provide support, strength and flexibility.
The low back (lumbar spine) is made up of 5 strong bones (vertebra L1-L5) stacked on top of each other. Between each of these bones, there is a shock-absorbing intervertebral disc which helps to distribute day to day forces evenly throughout your back. The job of ligaments and muscles is to support and offload the joints in your spine, while facilitating each movement that your back can provide.
Back pain triggers
However, this complex structure also leaves the low back susceptible to injury and pain.
Back pain can be ‘triggered’ by everyday activities either at home or at work. Sometimes it is caused by an injury to a joint, for example from doing sport or falling.
Pain can also develop over time as a result of sitting, standing or lifting badly. Common triggers that can cause back pain include:
bending awkwardly
lifting, carrying, pushing or pulling incorrectly
repetitive bending, lifting or sitting a lot at work
slouching in chairs
twisting
overstretching
Symptoms and Signs
Pain in the lumbosacral area (lower part of the back) is the primary symptom of low back pain.
The pain may radiate down the front, side, or back of your leg, or it may be confined to the low back. The pain may become worse with activity. Occasionally, the pain may be worse at night or with prolonged sitting such as on a long car trip. You may have numbness or weakness in the part of the leg that receives its nerve supply from a compressed nerve.
There are many reasons for having lower back pain, the good news is that it can often be treated effectively. If you have been told that you have degenerative disc disease or bulging discs, this does not mean that you will suffer from persistent back pain, have to stop daily activities, or have to stop participating in sport.
Treatment
Treatment choice for lower back pain generally depends on whether the pain is acute or chronic. Most episodes of lower back pain will respond favourably to a course of physiotherapy treatment. Early and accurate assessment and diagnosis is essential in order to prevent a worsening of symptoms. A physiotherapist can provide a variety of treatments that help you understand your problem and help you get back to your normal activities of daily living pain-free.
There is considerable evidence to support that spinal manipulative therapy (SMT) including passive mobilisation and manipulation, McKenzie therapy and the encouragement of early active movement, rather than bed rest, is effective in the short-term management of low back pain.
In chronic pain, studies have shown a benefit from the strengthening exercises. It will improve your posture and increase muscle support of the spine. Exercise is key to a healthy back.
There is no simple cure for back pain. The spine itself is such a complex part of our anatomy that there’s rarely one fix for the wide range of aches and pains that bring patients to my practice.
In addition to the treatments for acute and chronic back and neck pain, I offer my patients advice and instruction on using the McKenzie Method for controlling back pain and developing long-term spine health.
The McKenzie Method
In the early 1960s Robin McKenzie began developing his method of Mechanical Diagnosis and Therapy (MDT), as a complete physiotherapy philosophy for diagnosis and self-treatment to eradicate pain for his patients. His goal was to teach patients how to manage and treat their own pain.
The McKenzie assessment method uses a step-by-step process to evaluate the patient’s problem quickly and allows for a clear diagnosis and understanding of the complaint. From this understanding, a management program can be created for the individual. This plan focuses not only on manual therapy but also importantly on self-management exercises, posture education, lifestyle changes that allow the problem to heal without aggravation and not re-occur.
McKenzie’s exercises are designed to reposition any displaced intervertebral discs. This is initially done by using gravity to draw the discs back into the spine and then actively to consolidate the effect of gravity. To facilitate disc movement, you must relax as much as possible when performing the exercises and maintain relaxed and even breathing for the duration of the exercise.
Below I provide examples of some basic McKenzie exercises that can be done to help allay and prevent pain symptoms.
1. Lying on the stomach.
Lie down on your stomach. You can place your arms by your side or raise them up to your head. Make sure you are comfortable, if you are not you can place a small pillow under your chest. Keep this position for 3-5 minutes.
2. Lying prone on the elbow.
While lying on your stomach, place your elbow under your shoulders so that you are resting on your forearms. Take a deep breath and relax for 10-20 seconds, repeat 10x
3. Press up.
While lying on your stomach, place your hand under the shoulder and slowly straighten your elbow. Keep the lower part of the body relaxed while raising them upwards as far as possible. Then relaxed and return to the starting position. Only raise the back as far as the pain will allow. Repeat 10x
4. Back extension.
While standing, place your hand on the lower back. Slowly bend backwards as far as possible, then relaxed and returned to the starting position. Repeat 10x
If you have sciatica-type condition, if symptoms intensify in either or both legs (increased pain, numbness or tingling) discontinue that exercises until you speak with your physiotherapist or your primary care provided. If symptoms dimnish in the leg, continue the exercises, even if this is accompanied by a temporary increase in lower back pain.
Please be sure to discuss your individual symptoms as well as the suggested treatments with your health-care professional to determine the appropriate diagnostic and treatment plan for your circumstances.
References:
1. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations
www.ncbi.nlm.nih.gov/pmc/articles/PMC4464797
2. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials
www.ncbi.nlm.nih.gov/pmc/articles/PMC6396088
3. Effects of McKenzie and stabilization exercises in reducing pain intensity and functional disability in individuals with nonspecific chronic low back pain: a systematic review
www.ncbi.nlm.nih.gov/pmc/articles/PMC6642883
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