Injury Report: Lower Back Pain

Low Back pain is the #1 most common complaint in patients I see as a Physical Therapist.  With that said, it is also one of the most complicated to treat because there are SO many different causes of low back pain. One treatment protocol can not be used for all the causes. 

Low back pain can be due to changes in the spine’s health, spine alignment, sacroiliac dysfunction, referred pain, muscular dysfunction, etc.

So where to begin…

#1 Let’s first take a look at the ANATOMY

• The lumbar spine is made up of 5 vertebrae, or bones (L1-5)
• They are separated by discs which act as cushions between each bony vertebrae
• The spinal cord runs in the middle of each vertebrae
• Spinal nerves then branch off of it and out at each level of the lumbar spine
• These nerves then run down into the legs to carry messages for sensation and muscle innervation (the most common being the Sciatic nerve)
• The lumbar spine is very stable due to its ligaments
• Stability is also provided by its muscles- back muscles and abdominal muscles

So the neural messages from the body to the brain are what tell us we are in pain. So we in turn will stop doing the painful movement and rest. And usually the pain goes away. However if it does not, then action should be taken to learn how to move pain free again. In section #3 we will discuss ways to work on the lower back by yourself. However, as always, if the pain is very high you should consult with your Physician. Physical therapy may be beneficial early on as we will treat YOU and how YOU are presenting.

#2 Let’s discuss the many possible CAUSES of back pain

• Muscle strain
• Muscle spasm
• Spinal stenosis
• Degenerative disc disease
• Disc bulge/herniation/protrusion
• Spondylolisthesis/Spondylosis
• Osteoarthritis
• Osteoporosis
• Arthritis
• Compression fracture
• Lumbar radiculopathy
• Sciatica
• Spine curvature
• Fibromyalgia
• Referred pain from underlying issues (i.e. tumors, infections, kidney stones, aneurysms)

#3 Finally, let’s cover some possible treatment options

• Determine the cause of the problem so you can avoid it from happening again and modify your activities
• Improve posture and body mechanics as that is often times a contributing factor
• Get moving with safe exercises like back stretches, leg stretches, and core strengthening (see below)
• Modalities like ice or heat. Use ice for new injuries that are associated with swelling. Use heat for older injuries that are associated with degenerative changes or muscle spasms.
• Physical Therapy may be recommend by your Physician. If so, some treatments there may include: spine manipulation, soft tissue massage, exercises, traction, electrical stimulation, ultrasound, and/or dry needling.

Below are some safe exercises to try at home if you are having lower back pain. Keep in mind these are very general. Skip one if it hurts you. Seeing a Physical Therapy who can personalize your program to your exact needs based on the cause of your pain would be ideal.