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A Bit About Low Back Pain
Low back pain is very common! Most people have either had it, or know someone who has. Among adult populations it is the leading cause of disability and activity limitation world-wide!(1) It is estimated that every year approximately 15-20% of all adults will experience an episode of low back pain. While up to 80% of adults will experience an episode low back pain in their lifetime. Back pain does not discriminate, affecting people of all ages, sometimes even children, although it is most common between the ages of 30-65. (1,7)
It is estimated that every year approximately 15-20% of all adults will experience an episode of low back pain. While up to 80% of adults will experience an episode low back pain in their lifetime. (1,7)
In this article, you will learn about the basic structures that makes up the low back region, different types of low back pain, the stages of low back pain, when you should go to the doctor, common signs & symptoms, how the physio can help and what to do about it if you have it!
Basic Anatomy & Structures of the Low Back Region
Despite pervading narratives that the spine is fragile and easily becomes unstable, in order to protect the spinal cord, the vertebral column has to be very strong, resilient and have multiple fail-safe methods, which it does!
The low back, or the lumbar spine region is one of the most commonly affected regions of the body when it comes to pain. The lumbar region of your spine is so-called because this is where the lumbar vertebrae or the lower spinal bones are situated. There are 5 lumbar vertebrae which are referred to as L1-L5. They are the largest vertebrae of the spine with very thick and wide vertebral bodies. In between each vertebrae are inter-vertebral discs. The inter-vertebral discs are very strong but flexible structures, made up of collagen with a kind of gel in the middle. The purpose of the discs are to connect the vertebrae and to act as a shock-absorption system for load that is coming through the spine. The spine and it’s discs make up the vertebral column and together are very strong and robust. One major purpose of this structure is to protect our spinal cord which is housed within the spinal column and runs through vertebral foramina (a hole in the middle-) of all the spinal bones. Despite pervading narratives that the spine is fragile and easily becomes unstable, in order to protect the spinal cord, the vertebral column has to be very strong, resilient and have multiple fail-safe methods, which it does!
The rest of the vertebral column is made up of the mid-upper back, and neck, or the thoracic and cervical regions. These are made up of 12 and 8 vertebral bones respectively. These spinal bones are smaller in size than those in the lumbar region and have slightly different shapes in order to best accommodate movement for those areas. Surrounding the lumbar vertebrae there are ligaments, muscles, capsules, fascia, nerves, blood vessels, not to mention internal organs, such as the kidneys and spleen. So needless to say, there is a lot going on in there.
In research we see sometimes that the definition of the low back region extends beyond the lumbar spine reaching to the bottom of the gluteal muscles (ie. Just under your bum). If you are experiencing symptoms in your bum region this can sometimes be considered a low-back pain.
Types of Low Back Pain
There a many different pathologies that can occur in the low back region however I’m not going to get into that here. I will write another blog on that topic soon. Subscribe to my newsletter to stay up-to-date with blogs, tips & advice! Sign up here!
Basically there are two umbrella terms for low-back pain; specific or non-specific. We call it specific, when we know the specific cause and can confirm it, usually with some form of imaging or blood testing. We call it a-specific, when we can’t say with certainty what structures might be hurt or damaged, or there may even be no damage at all!
Shocking, I know, but it is true that pain does not always mean there is damage! We can experience pain, even when nothing is torn, twisted, or broken.
This is one of the great complexities of the body and there are many scientists still researching to find out exactly why and what the real purpose of pain is in our experience as a living human. This is a wonderfully complex and interesting field of study, with which there is much to learn. We are still not sure what the purpose of pain actually is. Some believe that it is a protection mechanism, that pain is experienced in order to protect the organism. This is certainly true in many cases, like when we sprain our ankle and cannot tolerate load for a while while the tissues are still healing, but is does not explain all pain. Why would someone experience pain in a phantom limb, if there is no actual tissue that can be damaged? One thing we do know, is that pain is contextual. This means that the context with which we experience pain can have a modulating affect on it, or it can be modified based on the context. But, more on this in another blog!
When there is a specific structure, injury, or pathology that we can diagnose and confirm, we call this “specific” low-back pain. Some examples of a specific low back pain would be a fracture in one of the vertebrae, a radiculopathy (nerve issues), osteoarthritis (damage to the bone/cartilage), or a spinal stenosis (narrowing of one of the canals) for example. Now it is definitely worth noting here that out of all the low back pain, only 10% (8) usually falls into the category of “specific” pain, which includes some of those pathologies mentioned above. The chance that your low-back pain is coming from something even more serious like a tumour, which would still fall under the “specific” category is less that 1 percent. So the chances that your back pain is something more serious that needs swift medical intervention are seriously low. These are good odds. Let's even re-frame that: 90% of low back pain is nothing specific or something that need serious medical intervention. So yes, you many now breath a sigh of relief!
Of course if you're seeing a healthcare practitioner becuase of your back pain, they 100% need to be on the look out for these more serious conditions. Physiotherapists and most allied health care practitioners are trained to look for signs & symptoms of serious cases, but luckily for the most part, back pain is not serious. I know that it can be frustrating to hear that most cases are non-specific, since you might want to know what is causing your pain. I get that. It seems logical to need to know that. But the good news most of the time, we actually don’t. More on that below.
The odds are in your favour since 90% of low back pain is nothing specific or something that need serious medical intervention.
When we don’t know with certainty what might be the exact cause of pain we call it “non-specific” low back pain. Non-specific pain does not mean that there is absolutely no damage at all. We just can’t say with certainty where that damage might be. But it also doesn’t mean that there definitely is damage. Sometimes we roll our ankles and we have pain, but we haven’t actually damaged anything. The same can happen in your back.
Pain is more of a signal, that something is not right, and that something needs to change. This can be inflammation, overuse, irritation, overload, under-load, stress, and of course also a damage to the tissues. Many times it’s a combination of factors.
One thing we do know, is that pain is contextual. This means that the context with which we experience pain can have a modulating affect on it, or it can be modified based on the context.
Stages of Low-Back Pain
This non-specific type of low back pain can technically be divided into three categories; acute, sub-acute, and chronic. Acute low back pain is when someone is experiencing a sudden increase in pain symptoms. Acute symptoms can last up to 6 weeks. Technically a “flare-up” of back pain is also considered acute pain as it is a sudden increase of symptoms and can last from a few hours up to 6 weeks (sometimes more) and that is still considered to be a normal time-frame of acute symptoms. Sub-acute symptoms are defined as lasting from 6-12 weeks and chronic or persistent symptoms are defined as lasting beyond 3 months. But really anything beyond 3 months we should be calling persistent pain. There’s not really anything wrong with calling it chronic, as chronic is a technical term, but what it implies to many people is that the pain is never going away, or something that you have to live with forever, or possibly even something that gets worse over time. The term persistent instead says, the pain is here and it’s been here for a while, but it really doesn’t say anything about the future. Conceptually speaking this is a concept that you much prefer to deliver to the patient as it’s more positive and insinuates a more hopeful prognosis. There is nothing to say that back pain once “caught” is around forever. This is simply not true.
There is nothing to say that back pain once “caught” is around forever. This is simply not true.
I think it’s important to note that pain is a normal part of life. Although pain is sometimes signalling us to be careful or to change our behaviours that is not necessarily a bad thing. A lot of the time pain is protective (not always), but a lot of the time it is. Think about when you have broken your ankle and you want to start walking again, the pain helps you load your ankle appropriately, slowly over time, so that you don’t do too much too soon. This is helpful. Pain also signals to you if you’re too close to a fire or stepped on something sharp. The pain provokes a protective measure in you, to take action and move away from the fire or check your foot for a wound. This is a very valuable system in our body that we should never wish away. However, pain is not only protective. Pain is complex, complicated and not fully understood. Pain cannot only be a protective mechanism because there are many times we feel pain and it’s not protecting us or we feel no pain when we should. But this is a discussion for another time!
When should I got to the Dr?
Chances are that if you are experiencing a sudden increase in low back pain for the first or second time in your life, and it’s the only symptom that you are experiencing the pain will likely go away on it’s own within 6 weeks of onset. Sometimes it may only take a few days (8). Low back pain has a great natural recovery, meaning that without treatment of any kind it can and most likely will get better. However, sometimes pain persists and sometimes there are other things going on
Generally speaking, you don’t need to go see a Dr. just because you are experiencing low back pain. However, there may be other reasons why you might want to go to the doctor and that’s usually because you are experiencing additional symptoms.
Here might be some reasons why you should go to the doctor because of your low back pain*:
- pain that lasts longer than 6 weeks
- pain that has no positional relief (ie. doesn’t lessen when lying down, resting, or with any other position you have tried: sitting, standing, walking.)
- recent rapid weight loss of more than 5kg for no apparent reason
- pain that is progressively getting worse over time
- any problems with bladder or bowel movements
- sensation changes/decreases especially in the pelvic region
- weakness in the leg or foot that is progressing
*this list is not exhaustive
Just because you may be experiencing some of the symptoms above doesn't automatically mean that there is something bad going on. It just means maybe there is something more to the story than just a common episode of low back pain. If you are unsure, get it checked out.
Should I worry about my low back pain?
With google it can be hard not to worry. If you google low back pain, literally the very first sentence that you read is “low back pain is the result of an injury...”
When I googled “low back pain” on may 26 2020 there were a whopping 1.460.000.000 results. That’s quite a bit. It’s no wonder it’s so overwhelming and confusing when trying to deal with it. There is just so much information, it can leave you feeling powerless and lost.
But, should you worry? ... Most of the time no! Low back pain is extremely common and most of the time it goes away on it’s own. It is actually the official recommendation that if you are experiencing acute low back pain (especially for the first time), that you seek no treatment as they can have negative outcomes (9). The term "no treatment" does not mean bed rest by the way. It means going about your life as normal as possible. It’s not usual to be slow downed by an acute episode of low back pain and indeed you might need a but of rest in the beginning, but prolonged bed rest as opposed to staying active can have a negative outcome on your recovery.
When I googled “low back pain” on may 26 2020 there were a whopping 1.460.000.000 results. That’s quite a bit. It’s no wonder it’s so overwhelming and confusing when trying to deal with it.
Unfortunately our healthcare system doesn’t help either. With medicalization as the norm, chances are that when you go to the doctor, you’re walking away with something that could be unhelpful, either scans, medication, or even more fear about what could be going on. This over-medicalization of pain can actually contribute to the persistence of pain due to anxiety and negative illness beliefs.
When should I go to the physio?
When you decide you want to go to the physio is up to you. If it’s your first time having back pain and you are not experiencing any other symptoms, you will likely not need any physiotherapy treatment in order to recover. However, seeing a physio who helps you make sense of what is going on and can show you some ways to help manage the pain for the meantime can certainly be helpful. Having the reassurance that it is not serious and that you don’t have to worry can make the all difference between recovery with confidence or suffering from stress and psychological factors of not knowing what is going on. Sometimes it is more beneficial just to get it checked out.
If you are feeling unsure or are experiencing symptoms that you can’t seem to make sense of, then book an appointment. Having another pair of eyes on the course of your condition and on your recovery can be very helpful in uncertain times. Your physio can help you make a plan to manage your condition and to work towards your goals.
How can physiotherapy help with back pain?
Physiotherapy can help in many ways. As mentioned above, peace of mind can sometimes be the most valuable thing. Knowing that someone else has eyes on your pain and in their professional opinion that it’s not serious can go a long way in terms of recovery.
A physio can help you make a plan and put it in motion.
If you do have a back condition that fall under that 10%, or have back pain that is persisting than the physio is the right person to help you manage. A physiotherapist will help you stay a fit and healthy as possible and help you work towards your goals.
Physiotherapists have many tools in their toolbox, but most importantly they have knowledge about how tissue’s heal, why pain might be persisting and the general course of recovery for the most common conditions and surgeries. Understanding your condition is the first step in learning how to move forward. This can help you set up realistic goals and expectations and help you to avoid being discouraged if you feel things are not going as quickly as you would have liked. Our communication skills are there to help you put it all together and relate of this scientific information in a way that is easy to understand.
Physiotherapists have a wealth of knowledge and we have a large repertoire of exercises for all areas of the body. We have a general (if not very in-depth) understanding of training, load management and graded-activity. We can offer lots of advice about self-management and what you can do in your own time to help you recover with confidence.
A physio can help you make a plan and put it in motion.
A physio is also coach that can keep you accountable to your goals!
Can online physio help with back pain?
Yes! Online physiotherapy is a really effective way to be seen by a healthcare professional. There have been many studies to show that online physio (tele-health) is just as effective as in-person physiotherapy. Read more about that here: What is online physiotherapy
Online physios are really no different than in-person physiotherapists! Online or not, it is always the physios job to make sure that there is not something more serious going on with your back. We perform what is called a screening where we ask a series of questions to learn more about your pain and to identify any “red flags”, or symptoms that don’t fit into a normal pattern of common low back pain! These “red flags” will help us know when we need to refer you to another healthcare practitioner or if you are ready to go with physiotherapy.
Online physios are really no different than in-person physiotherapists!
Although it can seems strange not to see a physio in person or that you don’t put their hands on your body, most conditions are actually diagnosed in the questioning part of the assessment. The movement part of the session is just to confirm our hypothesis and it makes no difference if I move you or you move yourself. Video calling is an effective and easy way to get the root of you problem.
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References:
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