Lower Back Pain
The lower back is a complex structure composed of the vertebrae (the back bones), the nerves which leave the spinal cord at that level, ligaments, muscles and other soft tissues. The back provides support, movement and protects important structures such as the spinal cord. The vertebrae (the lumbar ones at that level) articulate with each other via the facet joints at the back, and are also separated from each other by a cushion, or shock absorber called the intervertebral disc. They are held together by various ligaments, and form the site of attachment of the back muscles. Nerves exit at the side of the backbone at every level.
Lower back pain means a back pain roughly between the bottom of the ribs and the top of the legs at the back. Importantly, the pain often radiates to the buttocks, and sometimes further down the leg and even to the foot. When back pain is combined with pain into the leg, travelling down below the knee, it is referred to as sciatica, because the nerve roots of the sciatic nerve at the back are being irritated by pressure on it.
There are many mechanisms of back pain, but the most common one is called 'mechanical' back pain or vertebral dysfunction. Vertebral dysfunction occurs due to malalignment between the lumbar vertebrae at the facet joints and/or intervertebral discs. The small degrees of disarticulation are not gross enough to be seen on an x-ray but cause painful muscle spasms and sometimes nerve impingements which contribute to symptoms.
Men and women are equally affected by lower back pain but the underlying causes of the pain may differ. For example, women suffer back pain during pregnancy and menstruation or from conditions such as osteoporosis f(bone thinning) or osteoarthritis (joint destruction) which are correspondingly more common in females. Men may be more likely to suffer lower back pain secondary to trauma from sporting or labour-intensive work activities.
There are many causes of low back pain, but they can be grouped roughly as follows:
- Muscular pain;
- Vertebral dysfunction;
- Prolapsed disc (slipped disk);
- Narrowing of bony canals;
- Fibromyalgia: Generalised aches and pains;
- Incorrect bone positions and articulation;
- Infective lesions of the spine;
- Ankylosing spondylitis/ sacroileitis;
- Osteoporosis, fracture particularly in elderly, post-menopausal women;
- Paget's disease;
- Neoplastic (tumours/cancer):
- Metastases from tumours of other organs;
- Primary bone tumours;
- Multiple myeloma;
- Vascular: Disruption of the blood supply to the spinal cord (spinal claudication);
- Referred pain: Pain spreads to the back from somewhere else, for example to urinary tract. More common in elderly men;
What can I do for relief when I've hurt my lower back?
The best position for relief when your back hurts is to lie on your back on the floor with pillows under your knees, with your hips and knees bent and your feet on a chair, or just with your hips and knees bent. This takes the pressure and weight off your back.
You may need 1 to 2 days of this sort of rest for a hurt back. Resting longer than this can cause your muscles to weaken, which can slow your recovery. Even if it hurts, walk around for a few minutes every hour to help keep your back muscles strong.
Heating pads can help to relax painful muscle spasms. Use heat for 20 to 30 minutes at a time. Ice packs and massages may also give relief.
Sydney Essential Health is situated in Sydney's Eastern Suburbs, 5 minutes walk from the centre of Bondi Junction and close to Woollahra, Double Bay, Rose Bay, Bellevue Hill, Paddington, Edgecliff, Randwick, Coogee and Bondi. Also only a quick train or bus ride from the city of Sydney and Sydney CBD. Click here for map and contact details.