Low Back Pain

Low back pain will affect over 80% of the U.S. population at some point in their lives. It has cost billions of dollars in medical care, has debilitated millions of people from being able to work every year and, continues to be a growing problem. As widespread as this problem is, however, there is much you can do to lessen the severity of symptoms. With early action and adopting certain consistent habits, one may prevent the occurrence altogether.

Fortunately, studies reveal that the great majority of those affected with Lower Back Pain (LBP) will recover in 1-2 months with/without medical treatment. Since the odds are in one’s favor, it is highly unlikely that drastic life changes, a lifetime of medication, or surgery will be necessary. This DOES mean that a very active role must be taken. If habits of the past have led to debilitation, the old ways must be thrown out and new lessons must be learned for a healthier lifestyle.

The lumbar spine is made up of 5 bones called vertebrae. These vertebrae are named L1-L5. The lowest vertebrae of the lumbar spine, L5, connects to the top of the sacrum, a triangular bone at the base of the spine. The lumbar vertebral bodies are taller and bulkier compared to the rest of the spine because the lower back has to withstand pressure from body weight and from movements such as lifting, carrying, and twisting. Also, large and powerful muscles attaching on and near the lumbar spine place extra force on the lumbar vertebral bodies.

Between the vertebrae of each spinal segment are two facet joints. The facet joints are located on the back of the spinal column. Where these knobs meet, they form a joint that allows movement as you bend forward, backward, and side to side. The surfaces of the facet joints are covered by articular cartilage, which is smooth, rubbery material that covers the ends of most joints allowing for smooth motion. On both sides of each vertebra is a small tunnel called a neural foramen. The two nerves that leave the spine at each vertebra go through the foramina, one on the left and one on the right. The intervertebral disc sits directly in front of the opening. The disc has outer looser and inner stiffer layers of an annulus. The outer annulus is most type I collagen with neurovascular structure, meaning sensitive nerves exist and can be irritated. There is a center of the disc referred to as the nucleus pulposus. It is made of 80%-85% water on the inside. The disc can be thought of as a shock absorber between the bones to keep the bones from hitting each other. It moves like a water balloon squeezed on one end to bulge in the other.

If this disc is kept in a bulging position through consistent slouching in the lumbar spine, month after month, then this bulged or herniated disc can narrow the opening and put pressure on the nerve.

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Bone spurs that form on the facet joint from arthritic changes can also project into the tunnel, narrowing the hole pinching the nerve. This pinched nerve becomes irritated, in turn affecting and tightening the muscles it controls leading to LBP. If allowed to worsen, this irritation continues to the end of the nerve down the entire leg leading to numbness/tingles to the toes (sciatica). A nerve that has been pinched severely can shutdown muscle control of the lower abdomen (bowel and bladder control) or leg muscles and coordination with mobility and a physician should be seen immediately.

A Physician Should be Consulted If:

There is unexplained muscle weakness such as an inability to walk on toes or heels
Inability to control bowel/bladder through excessive OR limited evacuation
Pain gets worse when lying on your back
Trauma has occurred i.e. a fall, car accident, etc.
Unexplained dizziness, coordination problems, numbness in extremities.

Low back pain can be categorized in two different categories: Flexion injuries and Extension injuries. Flexion injuries increase pain when the lumbar spine is in flexion. These injuries create pain with sitting, bending forward, and lifting; relief will come with standing up / walking and lying down. Flexion injuries tend to involve the disc. With flexion injuries, it is important to maintain the normal curve in you lower back, especially when sitting. This can be accomplished by putting a small towel roll in the small of your back when sitting. Extension injuries tend to create pain with standing and walking; relief will come with sitting and lying down. Extension injuries tend to involve the structures in the back of the spine, mainly the facet joints. With extension injuries, you need to avoid hyperextension of your back.Now is the time to help prevent these incidents from occurring. Tightness and stiffness of the back muscles are warning signs ones should pay attention to and change daily habits. To begin with, inactivity does not seem to be the answer. Studies have consistently shown patients who were in bed only 2 days during acute LBP got better more quickly than patients who were kept in bed 7 days. Studies also show that a controlled exercise program can not only restore function, reduce distress, promote quicker returns to work, but also decrease pain.

Now is the time to help prevent these incidents from occurring. Tightness and stiffness of the back muscles are warning signs ones should pay attention to and change daily habits. To begin with, inactivity does not seem to be the answer. Studies have consistently shown patients who were in bed only 2 days during acute LBP got better more quickly than patients who were kept in bed 7 days. Studies also show that a controlled exercise program can not only restore function, reduce distress, promote quicker returns to work, but also decrease pain.

One of the best things you can do to prevent back pain is to exercise regularly and keep your trunk muscles strong. Various approaches for strengthening the front, sides, and back of your abdomen and hips are vital. This increases the stability of the trunk and allows the muscles to function as “shock absorbers”, reducing impact on the components of the spine. Stretches are also important to maintain flexibility, reduce tightness, and avoid excessive stresses on the spine due to restricted motion of the pelvis or spine. Exercises that increased balance and strength can decrease your risk of falling and injuring your back or breaking bones.

Eating a healthy diet also is important. For one thing, eating to maintain a healthy weight (or to lose weight, if you are overweight) helps you avoid putting unnecessary and injury-causing stress and strain on your back. A higher power-to-weight ratio will facilitate less incidence of LBP. To keep your spine strong, as with all bones, you, need to get enough calcium and vitamin D daily. These nutrients help prevent osteoporosis, which is responsible for a lot of bone fractures that lead to back pain. Calcium is found in dairy products; green leafy vegetables; and fortified foods. Your skin makes vitamin D when you are in the sun; about 20 minutes/day is sufficient.

Correct posture is essential. Sitting is the highest disc pressure posture there is. Sitting with the ears over the shoulder and avoiding the tendency at computers to lean the head forward over the chest is important. Maintaining shoulders over hips in sitting, driving, and other prolonged activities is important to relieve pressure of the disc off the nerve roots as well. Frequent breaks from prolonged sitting at desks and car rides will also help relieve pressure on the back. Practicing good posture, supporting your back properly, and avoiding heavy lifting in poor posture, all help you prevent injury. If you do lift something heavy, keep your shoulders directly over your hips as much as possible, bending your knees and using your lower body’s strong musculature to lift. Most incidents of low back pain are preventable.

Consult one of your Physical Therapists for a complete evaluation for a specified custom program in
which you can take an active role in limiting low back pain.

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