Low back pain affects at least 1 in 3 people at some point in their life, it’s one of the most common complaints seen in General Practice, and is a leading cause for taking medical leave from work.
The severity of symptoms can vary a lot from person to person. Diagnosing the source of pain can occasionally be difficult, leaving some doctors shrugging their shoulders. The pain might not just be located in the lower back – it can literally be a pain in the butt! In fact some people may not have much low back pain, but they have a low back disorder that’s causing pain to be referred or travelling to other areas.
The good news – most of the time it’s not serious. A lot of the time it can just go away on its own after a few days to several weeks, or depending on the cause, with a little exercise and some help from a professional manual therapist.
The intensity of the pain doesn’t tell you how serious it is either. You may struggle to get out of bed and even feel the need to take a trip to the emergency room because of the excruciating pain, but it may be a relatively simple cause and treated conservatively. On the other hand, I sometimes see people with low level pain that seem to be functioning day to day pretty well and yet they have severe degeneration to the intervertebral discs in the spine (these are like tough jelly shock absorbers in between the bones in your spine). Pain, or at least the intensity of the pain, shouldn’t be the only consideration to diagnose your problem.
Once you have had one low back pain episode, you are more likely to have it again at some point in your life. We all know eating sugary food can lead to cavities in our teeth, so we (should) limit this, brush our teeth and visit the dentist on a regular basis for checkups. However; we don’t seem to give our spines the same love and care that they deserve, especially when you consider how common low back pain is. Knowing a few things about low back pain, lifestyle factors that can affect it, preventative measures you can take, and who to see if/when it does affect you can go a long way to reduce its impact on your life.
- Strain of the lower back muscles.
- Irritation of the joints (lumbar facet and sacroiliac joints).
- Mechanical – restrictions, lack of general mobility and misuse or underuse.
- Intervertebral disc strain, herniation, or prolapse. ‘Slipped disc’.
- Large or small nerve irritation and/or compression.
- Degeneration of the disc or bones.
- Spinal anomalies or deformities (such as spondylolisthesis)
Less common but still have to be aware of:
- AAA – abdominal aortic aneurism.
- Cauda equina.
- Kidney stones.
- Endometriosis and other female reproductive organ related conditions such as ovarian cysts and uterine fibroids..
- Systemic conditions involving inflammation such as rheumatoid arthritis, psoriatic arthritis, or ankylosing spondylitis.
With the more serious causes, these are more likely if you’ve had some kind of trauma (fall off a horse for example), family history (certain cancers or inflammatory conditions) or a direct history of a related condition (such as ovarian cysts, but previously didn’t cause symptoms). If in doubt, see a professional with medical knowledge and training.
It’s also worth noting how complex pain is. In some cases, even though you can remove the mechanical cause of it, the pain may still remain. This can be due to a number of things including chronic pain changes in the nervous system, fear avoidance, and even stress and depression. This is why it’s important to have a holistic approach to caring for your back.
Most of the time low back pain is not related to a serious condition and may go away on its own, with some general exercise, or manual therapy. Pain or anti-inflammatory medications may ease the symptoms but you shouldn’t depend on these, especially long term.
Osteopaths, physiotherapists and chiropractors are trained to assess your biomechanics as well as screen for possible non-mechanical underlying causes. Therapists may have different approaches, even within the same profession, but generally they will use varying combinations of muscle release and massage techniques, mobilizations or manipulations of the joints, exercises specific to your condition and often provide general ergonomic or lifestyle recommendations.
Lower back pain, while usually not serious, may need follow up investigations if you experience any of the symptoms below:
- Numbness in the ‘saddle’ area or genital region.
- Bladder dysfunction – either loss of control or inability to fully empty.
- Bowel dysfunction.
- Pain on bowel/bladder motions.
- If you’ve previously had cancer.
- Constant back pain that doesn’t change with any movement or laying down.
- Unexplained weight loss.
- Sudden weakness or shooting pain into the legs.
Unless you have any of the severe symptoms above, conservative treatment should be the first action. The treatment and advice depends on the cause, but your osteopath or primary care practitioner may recommend exercises, ergonomic advice, acute self care (such as using ice therapy or prescribing pain relieving postures) in addition to providing hands on manual therapy.
The hands on therapy will be guided by the biomechanical assessment and may include massage or specific stretching techniques for the muscles, trigger point therapy, mobilization or manipulation of the joints or soft tissue structures, and techniques to help the fluid drainage.
If this is unsuccessful or symptoms worsen then it may warrant further investigation. You may need to be referred for X-ray, MRI, or other tests such as blood tests. Once the diagnosis is clear then treatment can be prescribed accordingly which may include cortisone injections, prescribed pain and anti-inflammatory medication or in some cases surgery may be necessary.
There are various surgical options available with different success and recovery rates. This article won’t go into further depth about these as they would need to be discussed with your doctor and surgeon. There are plenty of resources on the internet telling you about different types of surgery, but the vast majority of low back pain cases do not require this.
Even if you have been diagnosed with a ‘slipped’/herniated intervertebral disc it doesn’t mean you’re destined for surgery. Studies vary but generally 20-50% of people with no low back pain or symptoms related to low back pain actually have a disc bulge or herniated disc. I’ll write that another way so it’s perfectly clear: up to 50% of people have ‘slipped’ discs but they don’t have any symptoms! Imaging (X-ray. MRI etc) can sometimes be useful for the osteopath, physiotherapist or doctor, but for the patient it can be detrimental; they may see the disc prolapse and think they have to get it removed in order to get better. The majority of people suffering from back pain, this isn’t the case. A combination of manual therapy, exercises and sometimes pain killers or anti-inflammatories along with ergonomic and lifestyle advice can improve your function, strength and reduce inflammation which causes the pain.