Low back pain – Lumbar spine

Low back pain can restrict your activity and reduce your work capacity and quality of enjoyment of everyday living.

Anatomy of the Lumbar spine

The lumbar spine is commonly referred to as your low back. It consists of 5 vertebrae, the discs and nerves between them and the surrounding muscles. The lumbar spine connects your upper body to your lower body. It is an important part of your spine providing both mobility and strength. The mobility allows movements such as turning twisting and bending and the strength allows walking, standing and lifting.

Common causes of low back pain include

•    Strain/sprain
•    Ageing
•    Hyper or hypo mobility

Sprain and strain

The muscles in the low back provide the strength and power required for standing, walking and lifting. A strain of the muscle can occur when the muscle is weak or overworked. The ligaments of the low back interconnect the five vertebral bones and provide support/stability for the low back. A sprain of the low back can occur when a sudden, forceful movement injures a ligament which has become stiff or weak through poor conditioning or overuse.

Ageing

The normal effects of ageing and “wear and tear” can result in:
•    Osteoporosis or weakness of bone
•    Decreased elasticity and strength of ligaments and muscles
•    Disc degeneration – loss of shock absorbing ability of the discs
•    Arthritic changes e.g. formation of bony spurs, inflammation of joints

Although wear and tear will occur in everyone only some people will present with back pain. The ageing process does however predispose the individual to injury with minimal trauma (e.g. with osteoporosis crush fractures of the vertebrae can occur with normal daily activities). Because the ligaments and muscles are weaker and less elastic they are more easily injured (e.g. when lifting).

Hypomobility and hypermobility

In general hypomobility (stiffness) of one more intervertebral segments is often associated with low back pain. Occasionally there can be increased mobility of the lumbar spine e.g. in someone who is generally mobile in their other joints. If however only one level is hypermobile this would indicate lumbar instability.

Symptoms of Low back pain

•    Localized pain to the low back area that can be unilateral or bilateral depending on what is injured
•    Movement of the low back may be limited by pain – the direction of limitation will depend on the structures involved
•    Tenderness of the involved vertebrae
•    Muscle tightness or spasm with tenderness

Diagnosis and treatment

Your physiotherapist will be able to diagnose and treat common causes of low back pain. In most of the above cases the initial aim is to reduce pain and inflammation. This may involve a period of rest. Your physiotherapist may at this time use electrotherapeutic modalities, ice, heat, gentle soft tissue techniques and gentle exercises.

Once the initial pain has settled your physiotherapist will aim to restore full function of the low back. This may include mobilizations, more vigorous soft tissue techniques, stretches, and strengthening exercises to restore the muscle support system (corset) of the lumbar spine. Mobilizations would not however be used in the case instability, with the main treatment being the strengthening of the muscular corset. Your physiotherapist will also educate you on correct posture and preventative measures to reduce the recurrence of low back pain (e.g. correct lifting techniques, walking aids to prevent falls in the elderly).