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           Article Written by Rohini Prasannan  — Medically reviewed by Cosimo Simeone

Introduction:

Lower back pain is a very common condition. In fact, nearly 2 in every 3 people have lower back pain at some point in their lives. But the cause is not normally serious, and you can often manage the pain yourself. However, for some people, getting advice from a physiotherapist or doctor is important.

It is pain around your back from the bottom of your ribs to the top of your legs. Moreover, it can come from any of the many structures that make up your back. These  include bones, joints, muscles, ligaments, nerves and tendons.

Sometimes, it is difficult for doctors to say what exactly is causing back pain. This is because there are so many different parts to your back and tissues that surround it. Furthermore, even tests such as X-rays and magnetic resonance imaging (MRI) scans are not helpful in some cases.

What typically causes lower back pain?

The lower back is a complex structure consisting of bones, muscles, ligaments, and discs, all of which can be potential sources of pain. The causes of lower back pain can range from muscle strains and injuries to more serious conditions such as herniated discs or spinal stenosis.

Of course, understanding the underlying causes of lower back pain is crucial for proper diagnosis and treatment. Furthermore a healthcare professional should be consulted for an accurate assessment based on individual circumstances (1).

Specific back pain:

·   Muscle or ligament strain: This is the most common cause of lower back pain. It can occur due to lifting heavy objects, sudden movements, or overuse of the back muscles. In fact, strained muscles or ligaments can cause localized pain and discomfort.

·   Herniated or bulging discs: The spinal discs act as cushions between the vertebrae. When a disc’s inner core protrudes or bulges outward, it can irritate nearby nerves. So this can lead to lower back pain. This condition is often referred to as a herniated or slipped disc.

·   A fracture:  A crack or break in one of your vertebrae. This can happen after trauma to your spine, or if you have osteoporosis (a condition that weakens your bones).

·   Facet joint pain: Pain in one of the joints that link the bones in your spine together.

·   Inflammatory lower back pain: This can be caused by a condition such as ankylosing spondylitis, which causes inflammation in your spinal joints and ligaments.

Sometimes, when you have pain in your lower back, it can feel like it’s coming from other organs in your body, like your kidneys, pancreas, or bowel. But don’t worry, this doesn’t happen very often. In rare cases, a more serious problem like an infection or cancer can also cause lower back pain. 

Non-specific back pain:

When it comes to back pain, sometimes it’s difficult to pinpoint a specific cause. In fact, this type of back pain, known as non-specific back pain, is the most common. It often happens when you strain or overwork the muscles, tendons, or ligaments in your back. However, it can be challenging to determine the exact reason for the pain.

While the exact cause may be unclear, there are certain factors that can increase your chances of experiencing back pain. Some of these risk factors include:

·   lifting heavy or awkward objects

·   being obese

·   being inactive

·   having a demanding job, or being stressed due to work

·   standing for a long time

·   being depressed

Symptoms of lower back pain:

Pain in lower back can feel different for each person. Sometimes it happens suddenly, like when you lift something heavy or move in a way that hurts your back. Other times, it can start slowly over time or without a clear reason. For this reason people describe the pain in different ways. Some say it feels dull, while others say it’s like a tearing or burning sensation (2).

Certain activities or movements can make the pain worse, but there are also things that can help make it feel better. Also the pain can be with different intensity, mild, moderate or strong. Here are some common symptoms associated with lower back pain:

· Pain: You might feel discomfort or pain in your lower back. It can be a dull ache or a sharp, stabbing pain. The pain can stay in one spot or spread to your buttocks, hips, or legs.

· Stiffness: Your back muscles may feel stiff, making it hard to move or bend comfortably.

· Muscle spasms: Sometimes, your lower back pain can cause your back muscles to involuntarily tighten and contract, which can make the pain worse and limit your movement.

· Limited range of motion: It might restrict your ability to do certain movements or activities, such as bending forward, twisting, or standing for a long time.

· Radiating pain: If the pain is due to nerve compression or irritation, you may feel pain that travels down your buttocks, thighs, or legs. This is often called sciatica.

· Numbness or tingling: Lower back problems can cause strange sensations like numbness, tingling, or a “pins-and-needles” feeling in your lower back, buttocks, legs, or feet.

Red flags in lower back pain:

Red flags are warning signs that may indicate a more serious underlying condition when experiencing lower back pain. Here are some red flags to be aware of (3):

·   History of cancer

·   Severe or persistent pain

·   Bowel or bladder dysfunction

·   Progressive weakness

·   Numbness or tingling

·   Trauma or injury

·   Unexplained weight loss

·   Fever or infection

·   Pain at rest or during sleep

Remember, experiencing a red flag does not necessarily mean you have a serious condition, but it’s important to seek medical attention promptly to rule out any potential underlying issues.

Diagnosis of low back pain:

When you go to the doctor, they will ask you questions about how you’re feeling and examine your body. Sometimes, they may want to take special pictures of your back to see if anything is broken or damaged. These pictures, called imaging studies, help the doctor see clear pictures of your bones, disks, muscles, ligaments, and tendons in your back. Your provider may order:

·  Spine X-ray

·  MRI·  

·  CT scan

·  Electromyography (EMG)

It’s important to remember that diagnosing lower back pain can sometimes be challenging as it often doesn’t have a specific identifiable cause. Therefore, a thorough evaluation by a healthcare professional is crucial to determine the most appropriate course of treatment for your specific situation.

Treatment options for lower back pain:

If you have pain in your lower back and go to a physiotherapist or a doctor, they will likely suggest that you try some things to help yourself feel better. In addition, they might tell you exercises you can do for your back or suggest joining a group that exercises together. But if your pain doesn’t get better, they might suggest different things you can try. They could also send you to a special doctor if needed. 

Prevention of lower back pain:

To avoid back pain, it’s important to take care of your back by following these tips:

· Stay physically active 

· Be cautious when lifting and carrying heavy objects

· Maintain good posture: ·       

· Avoid prolonged sitting in one position

By following these guidelines, you can reduce the risk of developing back pain and maintain a healthy back.

Physical therapies:

Your doctor may recommend you to see a physiotherapist for your lower back pain, or you may be able to make an appointment yourself. Book your physiotherapist appointments here. Furthermore, a physiotherapist can assist you in several ways to help with your lower back pain. Here are some things they can do:

·  Advice on exercises specifically for your lower back to improve your ability to move, strengthen your muscles, correct your posture, and increase flexibility.

·  Helping you manage your pain by using different therapies like applying ice or heat, and using ultrasound.

·  Providing hands-on treatment, like massaging your back or adjusting your spine, which is called manual therapy.

Psychological therapy:

When you’ve been experiencing back pain for a long time, it can be tough to stay positive. However, maintaining a positive mindset and staying active can aid in your recovery and prevent the pain from becoming long-lasting.

If negative emotions are affecting your healing process, you might benefit from psychological support specifically for lower back pain. Your doctor might recommend a type of therapy called cognitive-behavioral therapy (CBT) along with exercise.

CBT can help you understand and modify how you respond to and manage pain. Additionally, practicing relaxation techniques like breathing exercises can be helpful. 

Exercise program for low back pain:

Here’s a simple exercise program designed to prevent and reduce low back pain. It incorporates a mix of strength exercises, stretching exercises, and mindfulness techniques. Remember to consult with a healthcare professional before starting any exercise program, especially if you have pre-existing conditions or injuries. 

1. Warm-up (5 minutes):

     2. Cat-Camel Stretch:

    3Bird Dog Exercise:

  • Video Link: Bird Dog Exercise
  • Repetitions: 8-10 per side/ Sets: 3-4
  • Rest: 15-30 seconds

   4. Pelvic Tilt:

  • Video Link: Pelvic Tilt
  • Repetitions: 10/ Sets: 2-3
  • Rest: None

   5. Standing Hamstring Stretch:

    6. Bridge Exercise:

  • Video Link: Bridge Exercise
  • Repetitions: 10/ Sets: 3-4 sets
  • Rest: Rest: 15-30 seconds

    7. Cool Down and Mindfulness (5 minutes):

Certainly this a general exercise program, so not based to any specific patient or needs. I recommend if you want to have something more specific to book an appointment with us.

Conclusions:

Back pain is common and can happen to anyone. Even Though the exact cause of lower back pain is often difficult to determine, it can be related to muscle strain, herniated discs, fractures, or inflammation.

If you experience persistent or severe pain, it’s important to seek medical advice. Certain symptoms, called red flags, should prompt immediate attention. These include neurological symptoms, unexplained weight loss, or a history of cancer.

Treatment options for lower back pain include exercises, physical therapies, medications, and psychological support. Taking care of your back through regular exercise, proper lifting techniques, and good posture can help prevent back pain.

Avoiding prolonged sitting and making ergonomic adjustments can also contribute to a healthy back. Consulting a healthcare professional is crucial for an accurate diagnosis and personalized treatment plan.

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