Low back pain is a pervasive complaint that affects a significant portion of the population at some point in their lives, making it one of the most common reasons for medical consultations and a major cause of disability worldwide. Its prevalence means that many individuals find themselves seeking relief from a variety of healthcare professionals, including physiotherapists, chiropractors, and osteopaths, each offering different approaches to treatment and management. The journey to find effective relief can be daunting, especially amidst stories of individuals who have transitioned from acute to chronic pain or those experiencing frequent recurrences of their symptoms. This reality underscores the importance of understanding low back pain's underlying causes and the various pathways to recovery.
What are the Main Causes of Low Back Pain?
The root cause of low back pain remains a widely discussed topic. Currently, the prevailing view is that it results from an imbalance between the physical demands placed on the body and its capacity to absorb those stresses.
This concept of imbalance is increasingly recognised as a central theme in many musculoskeletal complaints.When the strain exerted on the back—be it from poor posture, incorrect lifting techniques, or sudden, awkward movements—exceeds the body's resilience and strength, the tissues in the lumbar region can fail. This failure isn't about a catastrophic break but rather a breakdown in the ability of muscles, ligaments, or discs to handle stress, leading to inflammation, irritation, and pain in the affected area. It's essential to acknowledge that this explanation comes into play assuming more serious or 'sinister' pathologies, such as fractures, tumors, infections, or systemic diseases, have been thoroughly investigated and ruled out by healthcare professionals.
Understanding this mechanism is crucial for both preventing and treating low back pain, emphasising the importance of balancing physical activity with the body's limits and the role of targeted interventions to strengthen and protect the back.
What is the Source of my Pain?
This understanding of low back pain as a consequence of tissue strain sets the stage for exploring specific structures that might be responsible for the discomfort. Intervertebral discs are frequently perceived as the primary cause of back pain, though this is not always the case. These discs, acting as cushions between the vertebrae, are crucial for the spine's flexibility and shock absorption. However, they are also susceptible to damage and degeneration, leading to conditions like disc bulges or herniations that can exert pressure on nearby nerves. Other potential pain sources include:
Joints: These play a key role in the spine's movement and can be a source of pain if they become inflamed or degenerate.
Ligaments: Strong bands that link bones together, ligaments provide essential stability to the spine.
Muscles: Muscles support joint movement and can contribute to pain when strained or overused.
Referred Pain: Pain may also stem from organs or arteries near the spine, reflecting issues not directly related to the spinal structure itself.
Stress: An important but often overlooked factor, stress can exacerbate pain from current or previous injuries by making nerves more sensitive.
Identifying Your Pain Source
Understanding the origin of your pain can help with management in some cases, but it's important to acknowledge that clinical assessments and discussing your symptoms can only provide indications of the possible cause. No diagnostic method is infallible; even advanced imaging techniques may not always pinpoint the exact source of your discomfort. Certain symptoms and factors relating to how you injured your back however, might suggest a disc-related issue. These include:
Experiencing pain after engaging in activities that involve bending, twisting, or lifting heavy objects.
Feeling pain while bending forward.
Noticing discomfort during prolonged periods of sitting.
Developing pain in response to coughing or sneezing, which increases intra-abdominal pressure.
Pain that radiates down your leg but 'centralises'—or moves toward the midline of your back—during specific movements or exercises
Other symptoms, such as pain that worsens with standing or walking and improves with sitting, or pain which is worse when arching your spine backwards rather than bending forwards might suggest an alternative pain source, such as the near-by intervertebral joints.
Myth Busting: Not All Disc Bulges Cause Pain
Physiotherapy assessments are valuable, but imaging tests like MRIs or CT scans can accurately detect the presence of disc bulges. It's crucial to understand, however, that not all disc bulges or herniations cause symptoms. This brings up an important discussion about the necessity of scans, a conversation best had with a knowledgeable physiotherapist. To illustrate this point, consider a study by Boden et al. in 1990, which found that among 67 individuals with no history of low back pain or sciatica, about one-third showed significant MRI abnormalities, such as disc bulges and herniations, without any pain.
A great study was done by Wasserman and colleagues in 2017 investigating the lower backs of 100 athletes at the 2016 Beijing Olympics. MRI scans showed 52% had moderate to severe 'spinal disease' including moderate to severe degenerative disc changes with varying degrees of disc bulges and herniations. Weightlifting and aquatic diving had the highest incidence of low back pathology on MRI amongst competing athletes. This further demonstrates that not all disc bulges are symptomatic and it is possible to perform at the highest level with disc bulges and herniations!
Does the Source of My Low Back Pain Even Matter?
In some instances, pinpointing the exact source of your pain is crucial, particularly if more invasive treatments, like injections, are being considered, or if there's a suspicion of a more serious underlying condition. Identifying the root cause in such scenarios ensures that any interventions are precisely targeted and necessary, especially when dealing with potential sinister pathologies that require immediate and specific attention. However, for many common types of back pain, the treatment approach might not differ substantially based on the exact pain source. Non-invasive treatments such as physical therapy, lifestyle adjustments, and pain management strategies often focus on symptom relief and functional improvement, which can be effective across a variety of conditions. While understanding the specific cause of pain can provide valuable insights and guide certain treatment decisions, in many cases, the focus remains on alleviating pain and enhancing quality of life rather than on pinpointing the pain's origin.
If your disc IS the source of your pain, will it heal?
A common concern, disc bulges or herniations are indeed significant pain sources, especially when impacting a nerve, often leading to 'sciatica' symptoms such as pain, tingling, numbness, and weakness extending to the foot. The question then arises: can a disc bulge or herniation heal? Zhong and colleagues' 2017 research gave us valuable insight into this, finding that two-thirds of disc herniations can naturally heal and be reabsorbed by the disc. Moreover, a disc bulge or herniation may still appear on scans yet become asymptomatic, indicating that with proper conservative (non-surgical) treatment, the potential for recovery extends beyond two-thirds of cases. This suggests that the body has a remarkable capacity to heal disc injuries over time, highlighting the effectiveness of conservative management for many individuals.
How Can You Relieve Low Back Pain (with or without a symptomatic disc injury)?
Regardless of the pain source, there are many things you can do to help reduce pain and encourage healing if you have a symptomatic disc injury, or any other low back injury. These include:
Finding and modifying any potentially aggravating activity such as repetitive lifting with poor posture (e.g. repetitive bending and twisting)
Staying active. Appropriate, pain free movement and light physical activity will help with your recovery
Avoiding sustained postures, especially sitting! Sitting in one position, regardless of if your posture is perfect, for a long period of time (>20 minutes) without getting up and moving will be detrimental to your recovery
Improving the flexibility of tight and short muscles around your hips, legs and lower back
Improving the strength of weak muscles around your lower back/core, hips and legs, Read out blog post about core strength.
Improving your lower back control and awareness. Read our blog post about finding your neutral pelvis and spline
How do I know if my lower back pain is serious?
Understanding whether your lower back pain demands urgent attention is crucial. Here are some key points, often called 'red-flags' to consider:
Presence of additional symptoms like numbness, tingling, or weakness in the legs, especially if these symptoms are worsening over time.
Loss of bladder or bowel control alongside back pain.
Recent traumatic events such as a fall or car accident preceding your pain.
Duration and severity of the pain: severe pain that frequently wakes you at night or pain that doesn't improve over time with appropriate rest
Consulting a healthcare professional, such as an experienced sports physiotherapist for proper diagnosis and management is always advisable when in doubt. You can call to speak to directly to one of our experienced sports physiotherapists, or book online.
Should I see a Physiotherapist?
In many instances, an episode of low back pain will subside in time with appropriate rest, however if you have any of the 'red flags' mentioned above, are experiencing your first ever episode of back pain, or you have had repeated episodes and have never been assessed by an experienced physiotherapist to address the above mentioned factors, an assessment is recommended. This will help to rule out any sinister pathology, speed up your recovery and reduce the risk of recurrence! An assessment will typically look to explore the cause of your pain and possible solutions.
If you would like to speak to our experienced team at ProSport physio to organise an assessment, or to ask questions and discuss your particular problem, you can call us at 0415 889 903, send us an email at hello@prosportphysio.com.au or book online. We are happy to have a no-obligation free discussion about your problem and how we can help you!
