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 mal-alignment 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 (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.
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.
Lower Back Pain Case Study
from Vlad Graham-Vilo, Remedial Massage Therapist.
The patient arrived for her massage appointment complaining of constant low back pain for the last 2 years.
The client was from the United States and thus only in Sydney for a week, and could only attend a short course of treatments.
Before assessing, she had informed me that she had been physically active with Pilates and had working with a physiotherapist, chiropractor, osteopaths and other massage therapists. But was still experiencing ongoing back pain, particularly at night and had all but given up on finding relief.
An assessment of the range of motion of the lower spine showed that there were no restrictions or pain in spinal flexion, extension, side-bending and rotation. However, assessing the range of motion of the hip demonstrated that there was a restriction in right hip internal and external rotation, hip flexion and abduction. After performing a Straight-Leg-Raise (SLR) it was evident that there was little flexibility of the hamstrings but no signs of sciatic nerve irritation were present. This was noted as a factor causing back pain, as the back must compensate for a lack of range of motion from the hips.
The main objective of the treatment was to restore the range of motion in the hips to reduce the tension in the lower back rather than just treating the back in isolation.
There was only time for three treatments before the patient had to return to the United States. The anterior hip musculature was assessed as a significant area to address as these muscles have been shortening for such a long period of time that it would have been inhibiting the hamstrings and glutes leading the back to compensate for the lack of movement in the hips.
From working on the TFL and iliacus, the client had noticed that these muscles were referring straight into the area of back pain and became the focal point of the treatments.
After the initial treatment, the patient noticed for the first time in 2 years that she had slept through the night with very minimal pain. The last two treatments were aimed at addressing the hip flexors and unloading the thoracic region, coupled with exercises that targeted hamstrings and glutes to help stabilize the pelvis to reduce back pain.
After her short course of treatments, there was already a significant reduction in back pain, and continuing treatment with the right practitioner could offer even better results
There are many causes of low back pain, but they can be grouped roughly as follows:
Trauma
Mechanical:
Muscular pain
Vertebral dysfunction
Prolapsed disc (slipped disk)
Narrowing of bony canals
Fibromyalgia: Generalised aches and pains
Incorrect bone positions and articulation
Inflammatory
Ineffective lesions of the spine
Ankylosing spondylitis/sacroileitis
Metabolic:
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
Depression