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Physical Therapy for Lower Back Pain, Part 1

Lower back pain is the most common complaint seen in many physical therapy clinics, affecting 85-90% of Americans at some point in their lives. It is the second leading cause of visits to a doctor, after the common cold. Lower back pain is also the leading cause of lost time at work, and billions of dollars are spent each year diagnosing and treating lower back pain.

 

In this series, we will examine the very common, but very painful condition of lower back pain. Fortunately, there are excellent prevention and treatment options for the sufferer.

 

The Lumbar Spine

The lower back, or lumbar spine, consists of five vertebrae (bones), stacked upon one another. Between the bones are soft, spongy shock absorbers called intervertebral discs. The spinal cord and nerves are protected by these vertebrae. Multiple ligaments and muscular attachments provide stability and mobility to the lumbar spine.

What to do When Lower Back Pain Occurs

Stay Calm. When an acute episode of lower back pain strikes, don't panic. Most studies indicate that acute lower back pain is short lived and most symptoms resolve spontaneously in a few short weeks. With that in mind, lower back pain, although short lived, tends to be episodic in nature. Many times, people have multiple episodes of lower back pain during their lifetimes. Recurrent episodes tend to get progressively worse with the passage of time. Therefore, it is important to not only treat the symptoms of lower back pain, but also to have a strategy to prevent future lower back problems.

One of the most important times to care for your lower back is when you have no symptoms. By maintaining proper posture and appropriate strength and mobility in the spine, episodes of lower back pain may be avoided completely.

If you are currently experiencing lower back pain, one or two days of rest is indicated. After this short time period, gentle self-care exercises should be started to restore mobility and decrease pain. Since poor posture is a major cause of lower back pain, maintaining proper posture is important. Use a small pillow or towel roll to support the spine while sitting. Remember, if pain prevents you from exercising or if pain persists for more than 2-3 weeks, a visit to a physician, physical therapist, or other health care provider is necessary.

 

Lower Back Pain Symptoms

Symptom location may also be helpful to identify the cause of the problem and to start self-management of lower back pain. The most common symptoms coming from the lumbar spine include:

  1. Central low back pain. Central low back pain is usually caused by bulged discs or muscular strain in the lower back. This type of lower back pain usually responds to gentle stretches and corrected posture.

  2. Central low back pain with pain down both legs. This situation is very typical of a condition called spinal stenosis. Spinal stenosis occurs when the spinal canal is too narrow and the nerves that travel down the legs are compressed. The common presentation of stenosis is low back and leg pain with walking short distances that is instantly relieved with sitting or bending forward at the waist. Research shows that physical therapy can be an effective treatment for this condition.

  3. Lower back pain to one side or another, but confined to areas above the thigh. This type of pain is usually due to muscular strain and should readily respond to postural correction and gentle stretching. A small bulging disc may also cause this type of back pain.

  4. Lower back pain to one side that travels down the front of or back of the thigh but does not cross the knee. Usually, pain that travels down the thigh is due to a pinched nerve. Nerves can be pinched by either a bulging or herniated disc, an arthritic facet joint, or an overgrowth of bony material, such as a bone spur. Pain may or may not be accompanied by numbness or tingling in the thigh, and muscle weakness may also be present.

  5. Lower back pain to one side that travels down the leg and into the calf, ankle, or foot. Pain that travels from the low back to the lower leg is called sciatica. This is considered by many to be the most severe presentation of lower back pain. The pain may or may not be accompanied by numbness or tingling. This is usually caused by a pinched nerve from a lumbar disc, an arthritic joint, or a bone spur. Remember, if pain is accompanied by sudden loss of muscular strength or loss of bowel or bladder control, an immediate visit to a physician is necessary.

 

Most Common Causes of Lower Back Pain

  • Heavy Lifting:  Jobs that require heavy lifting can place incredible stress on the spine. This stress can lead to muscle strains, and it can also increase pressure in the intervertebral discs. The pressure can cause lower back pain or sciatica. Proper lift technique is essential to controlling or preventing pain. This means lifting with the legs; not the back.
  • Poor Sitting Posture:  The correct position of the lower back should have a slight forward curve called the lordosis. When a person slouches in his seat, the lordosis straightens out - or worse - reverses itself.  This loss of the forward curve of the spine can cause increased pressure on the intervertebral discs of the back. The increased pressure can displace the discs leading to lower back pain. A physical therapist can teach patients the proper way to sit in order to decrease, eliminate, or prevent back pain.
  • Repetitive Forward Bending:  A lot of time spent performing repetitive tasks that require forward bending may place increased pressure on the spine, which can cause pain. Bending properly at the knees to help keep pressure off of the spine can help decrease back pain.
  • Trauma:  Sometimes trauma may cause lower back pain. Lower back muscle strains can be caused by a fall, a car accident, or athletic trauma while performing sports. While physical therapy can help back pain after trauma, it is always a good idea to check with a doctor after a traumatic event to ensure that no major damage is causing the pain.
  • Degenerative Conditions:  Sometimes, degenerative conditions that are the normal result of aging may cause lower back pain. These conditions include:
    • spinal stenosis,
    • arthritis, or
    • degenerative disc disease

Congenital conditions, like scoliosis or spondylolisthesis can also cause back pain. Most degenerative back problems can be improved with movement and exercise. A physical therapist can help determine the correct exercises for each individual patient.

  • Non-mechanical Disease Processes:  Non-mechanical disease processes like tumors, kidney infection or stones, or even cancerous growth may cause lower back pain. These symptoms are often accompanied by other symptoms such as unexpected weight loss, fever, or malaise that indicate a non-mechanical cause of your pain. These diseases are rare, but if the back pain continues for more than a few weeks after physical therapy treatment begins, a doctor should be consulted in order to rule out a more serious condition.

Although trauma may be a cause of lower back pain, most often there is no apparent reason for the onset of symptoms. Thus, it is thought that repetitive strain on the structures around the lumbar spine is the main cause of lower back pain.

If you are experiencing back pain, don’t wait for your family physician; visit Excel Rehabilitation Services on Burnside Ave. in Gonzales, Louisiana. You will receive one-on-one care from an experienced physical therapist!

 

Online Sources:

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https://www.spine-health.com/treatment/physical-therapy/physical-therapy-benefits-back-pain

https://www.verywell.com/common-causes-of-low-back-pain-2696188

Nancy Honey/The Image Bank/Getty Images

https://www.spine-health.com/blog/7-tips-protect-your-lowerer-back

http://flexpt-2734.kxcdn.com/wp-content/uploads/2016/10/back-pain-1.jpg

https://www.verywell.com/degenerative-disc-disease-fast-facts-2552312

 

 

 

 

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