Lower back pain is one of the most common pain most of us have experienced at work, at home or during a sports activity. Even children that are still attending school can experience lower back pain.
In general, back pain can range from a dull, constant ache to a sudden, sharp pain that can cause a shooting sensation to the lower extremities. We can experience this pain in the lower lumbar region by sudden movement, accident, heavy lifting, muscle imbalance such as weak core and glute muscles, herniated disc, sciatica, spinal stenosis, ankylosing spondylitis or due to ageing and more. At our clinic in North Vancouver, we do see many patients who are experiencing lower back so here is some information about why we suffer from pain in our lower back, how to treat it and what is the best prevention.
Types of lower back pain
Lower back pain can be categorized by time (acute/chronic), type of pain as mentioned before (sharp, dull, constant, throbbing, on and off) mechanical (from the muscles, ligaments, joints – facet joints, sacroiliac joints and radicular (from spinal nerve root ).
What can be causing lower back pain?
Lower back pain can be exposed to various forces throughout the whole day – heavy lifting, twisting, poor posture when prolong sitting or by sudden jolts. From an anatomical point of view, back pain can be caused by large muscles that are supporting the spine, nerves that are exiting from the spinal canal and can refer pain down the knee or ankle, facet joints that connect vertebrae and intervertebral discs that work as a shock absorber for our spine.
How can be lower back pain diagnosed?
For successful recovery, it is important to schedule an appointment with medical doctors or health care practitioners who are trained in an assessment like Osteopathic practitioners, Naturopathic Doctors, Registered Massage Therapists or Physiotherapists. With questions regarding the location of the pain, intensity, time (morning, end of the day, at night) can be narrowed down to the reason for the ache. Healthcare providers also use palpation to locate muscle spasms, tenderness or any joint abnormalities. Range of motion test helps to find a position that can worsen or recreate pain and reflex test that can evaluate weak reflexes and decrease muscle strength.
Symptoms of lower back problems
Back pain can range from a muscle aching to a shooting, burning or stabbing sensation. Pain may also radiate down your leg or get worse when bending, rotating, lifting heavy stuff, standing or walking.
Aching or Dull pain
Pain that remains within the low back is usually described as dull and aching rather than burning, stinging, or sharp. This type of sensation can be accompanied by muscle spasms, limited mobility, and discomfort in the hips.
Shooting pain down the legs and feet
Sometimes low back pain includes a sharp, stinging, tingling or numb sensation that moves down the thighs, knees and into the feet. This type of pain is usually caused by a nerve called sciatica. Sciatica pain is caused by irritation of a sciatic nerve. Sciatica most commonly occurs when a herniated disk, narrowing of the spine (spinal stenosis) compresses part of the nerve. This causes inflammation, pain and often some numbness in the affected leg. Sciatica pain can be a mistake for Piriformis Syndrome.
What is Piriformis Syndrome?
Piriformis syndrome is a condition in which the piriformis muscle, located in the buttock region, spasms and causes buttock pain. Tension and inflammation of the piriformis muscle can sometimes irritate the sciatica nerve, which runs underneath of piriformis muscle and cause pain, numbness and tingling along the back of the leg and into the foot (very similar to sciatic pain).
Increased pain after prolonged sitting
Sitting can increase pressure on vertebral discs. Walking and stretching can alleviate low back pain, but once we return to a sitting position, symptoms may return.
Increased pain when lying in the bed
Amongst the most common reason for pain during lying down are disc degeneration, muscle sprain, spine conditions such as scoliosis or lordosis, spinal stenosis or arthritis. Other conditions causing pain when lying can be kidneys or fibromyalgia.
Why does my back hurt in the morning and gets better after moving?
If you experience more pain in the morning, most likely it is because of stiffness caused by long periods of rest, poor sleeping position, decreased blood flow with sleep or possibly the quality of mattress and pillows you have been using. Other factors that are stressing your back while you are sleeping can be disc degeneration, herniated disc, spinal stenosis or fibromyalgia.
What are the main risk factors for developing lower back pain?
Back problems are among the most common chronic conditions in Canada and four out of five adults will experience at least one episode of back pain in their lives.
Age is definitely one of the main factors that can develop your back pain. Loss of bone strength from osteoporosis and decrease of muscle elasticity and tone plays a main part starting around the age of 30 and 40.
2. Excess Weight / Obesity
Being overweight and / or sudden weight gain can put stress on the back and lead to low back pain.
Back pain is more common among people who are not physically fit. Weak back and abdominal muscles can cause a lack of support for the spine.
Inherited conditions can cause lower back pain such as Ankylosing spondylitis.
5. Psychological conditions
Anxiety and depression can have an influence on how we perceive our pain. Pain that becomes chronic also can contribute to the development of such psychological factors. Stress can affect our body by tensing up muscles.
Is it possible to prevent lower back pain?
This is a question I hear almost daily. Recurring back pain resulting from bad body mechanics can be prevented. If we manage to avoid movements that are straining our back, maintain correct posture and stretch and strengthen muscles that are causing muscle imbalances in our body, we can achieve a positive effect. These are a few examples of what we can do to treat back pain or prevent it:
1. Regular exercise
Regular exercising will keep muscles flexible and maintain proper tonus and strength. Ideal exercises are low-impact aerobic exercises.
2. Increasing muscle strength and flexibility
If you never heard of the upper and lower cross syndrome, it is worth finding more information. In general, strengthening core muscles such as abdominal muscles and Glut Medius muscle can support your lower back muscles that are most of the time overworked. Opposite these muscles are hip flexors that in most cases need to be stretch. Here I suggest seeing a health care professional who has knowledge and experience to provide a proper assessment of weak and tight muscles. In some conditions like for example lordosis, where our pelvis tends to rotate more anteriorly are hip flexors are tight and need to be stretch. But with excessive posterior pelvic tilt, which causes almost no lower back curvature (straight back), hip flexors need to be strengthened. Both Osteopathy and Rolfing Structural Integration can be very beneficial in helping with muscle imbalance resulting in chronic pain.
3. Prolonged sitting/standing
Regular position switching and quick walk and stretch can help to relieve the back pain as the muscles are being stretched and used. Also supporting the lower back by small pillow can provide some lumbar support hence preventing pain from prolonged sitting.
4. Managing healthy weight
Proper nutrition, diet and regular exercise not only reduces existing back pain but can also help prevent certain types of back problems in the future such as osteoarthritis. For people whose Body Mass Index (BMI) is too high, excessive weight increase the risk of developing osteoarthritis. According to the National Institute of Health, a BMI of 30 or higher is typically considered to be obese, while a measure of 25 to 29.9 is typically considered to be overweight.
5. Lifting heavy objects
If you do have to pick up something heavy, lift from the knees, pull the stomach muscles in, and try to keep your back straight. Remember not to rotate your upper body when lifting.
National Institutes of Health. National Institute of Diabetes & Digestive & Kidney Diseases. “Understanding adult obesity.” 2001. http://win.niddk.nih.gov.