What is lower back pain?

To those who have or have had this long term nuisance condition it cannot be overemphasized in defining what lower back pain is. Lower back pain is pain that is felt in the "lower back". The lower back refers to the inferior end of the spine, particulary the lumbar region. Pain usually originates from L3/L4, L4/L5 or L5/S1 spinal segment. Looking at the movements that happen in this region and the amount of the load that it supports, it is very easy to implicate this region with pain.

Pain in the lower back can originate from any injury to the soft tissues or the bones. It can also originate from systemic infections or degenerative joint diseases. It is worthwhile to note that most of "bad backs" originate from structural impairments in the lower back. Apart from abnormal biomechanics in lifting, overuse is also a big contributing factor in LBP.

Causes of lower back pain?

Pain in the back can originate from different structures. It may come from the:

• Nerves
• Muscles
• Bones
• Discs
• Ligaments

Tight muscles, herniated discs, degenerated discs and muscle spasms can result into nerve compression and eventually lead to pain. The following is a list of the common causes of lower back pain:

• Trigger points (myofascial trigger points)
• Shifting of bones (spondylisthesis)
• Spondylosis
• Spondylitis
• Sciatica
• Tight paraspinal muscles
• Poor diet i.e. unbalanced diet, especially that which lacks in magnesium, calcium and potassium and other micronutrients
• Intake of inadequate water
• Weak back or abdominal muscles
• Weak core
• Weak hamstrings and glutes
• Degeneration of spinal disks
• Overweight
• Tumours of the spine
• Infllammatory diseases including HIV myelopathy
• Infection e.g. tuberculosis of the spine
• Abnormal lifting mechanism
• Abberant activation of the muscles

Symptoms of LBP

The most common and obvious symptom of LBP is the pain itself. The pain may be localized i.e. concentrated on a specific area or it may radiate (spread) over to other areas such as the glutes (buttocks) and the legs or to the hallux (big toe).

If your LBP is accompanied by night sweat and cough, weight loss and loss of muscle power in the lower extremities it may imply that you may have tuberculosis.

If your pain is radiating to the buttock it may mean that you may have trigger points. If the pain radiates to the big toe, it may mean that your nerve is being compressed (sciatica).

Management of lower back pain

Management of lower back pain depends on the careful assessment of the person holistically. Because causes of back pain are complex, two people may have the similar kind of pain but from different orgins and therefore one kind of treatment cannot fix all back pains

One form of back pain may resolve with corticosteroids while another cannot. One form of lower back pain may resolve with spinal manipulation while the other cannot.

Medical Management

This involves prescription of painkillers and steroids. Nonsteroid anti-inflammatory medicines are also commonly used to reduce the pain.

Surgical Management

Surgical management may be done to fix discs or bones which are out of place. Sometimes it may be done to remove tumours compressing the nerve. There are different forms of surgeries that may be done to fix lower back pain and each depends on what has to be fixed.

Conservative Physical Management

Different approaches ae used to deal with lower back pain. Electrical devices such as interferential current, transcutaneous electrical stimulators, infrared, ultrasound, and other electrophysical agents are commonly in use. Physiotherapists may also prescribe exercises that are done based on thorough assessment. Physiotherapists are very good at this and after a complete assessment, an individualized therapeutic exercise program can be prescribed to help the individual deal with his or her back pain. Physiotherapists teach people on how to manage their pain successfully and they also help in restoring health in the structures that have lost their respect in the body.

Exercises to relieve back pain

The following exercise can help relieve some forms off back pain but are not meant to substitute professional physiotherapy recommendations. Exercises on this page have been grouped in lower back stretches, mid back stretches and then neck stretches. You may do the the following sequence but make sure that you maintain a slow steady gentle breathing while performing these exercises:

Stretching the lower back

1. Single Knee to Chest:

   In this exercise, you lie on your back and take one knee to your chest untill you feel a gentle stretch under your back. This is just a stretch and it must never give you pain. Hold your bent knee for 30-60 seconds and then switch. Repeat this with the other leg.

2. Double Knee to Chest:

   In this exercise, you do like the single knee to chest only that both knees are taken to chest at the same time. Hold for 30 - 60 seconds and then repeat this 2 to 3 times.

3. Cat-camel exercise

   This involves arching your back up to the ceiling while bringing your chin toward your chest. Do not over arch your back amd make sure that you focus on moving every vertebra segment by segment. This exercise can be safely repeated about 8 to 10 times.

4. Bottom to Heels

   This exercise involves you being in four-point kneeling and then taking your bottoms to your heels. Hold for 30 - 60 seconds and then repeat this twice. Please remember to put a pillow in between your legs.

5. Sitting forwards stretch

   Slowly run your hands down the outside of your legs until you feel a comfortable stretch in your back. Hold for 30 - 60 seconds and repeat this 2 times.

6. Sitting fowards stretch with back straight

   Sit on the edge of a chair or a gym ball, keeping a small inward curve in your lower back. Now bend forwards from your hips, keeping the curve in your lower back. The movement will be small, but keeping it slow and controlled. Hold for 30 - 60 seconds and repeat 2 times. To reduce the stretch, bend your knees.

7. Crouching back stretch

   Holding onto a door handle or something stable, slowly lower your bottom down towards your heels. Only move as far as is comfortable, not into pain. Maintain slow, relaxed breathing throughout. hold for 30 - 60 seconds and repeat 2 times.

8. Side bend stretch

   While standing upright tall, slowly slide your hand down the outside of your thigh, feeling the stretch to the opposite side. Return to the starting position. Hold for 30 - 60 seconds and then repeat 2 times alternatively.

   To increase the stretch, raise your arm above your head. Keep upright throughout and do not bend forwards.

9. Back extension lying

   This is similar to McKenzie extension kind of stretch. Lie on your tummy and then lean on your forearms. Hold for as far as you can managed and then return your chest back to the floor. Repeat for 8 - 10 times.

Stretching the mid back

1. Knee rolls with arms on the side of the body

   Knees bent to 90 degrees and hold the stretch for one deep breath and then return to the starting position

2. Knee rolls with arms on the opposite side

   Repeat for about 8 - 10 times.

3. Sitting rotations

   Repeat for about 8 - 10 times.

4. Standing rotations with a gym ball

   Repeat for 8 - 10 times.