There are two ways to answer the question, what causes my low back pain?
We can either discuss it as if we were reading an MRI, looking at the discs and joints and seeing what is happening inside our bodies or we can ask the question what things have contributed to my low back pain.
Backs are tricky problems, mainly I think, because the back tends to complain because of the positions we spend a lot of time in (such as sitting or standing all day) and therefore once it’s become painful we keep it aggravated because these are the positions we work or exercise in.
The other reason is that we often leave it too late before doing something about it. Often when I ask patients if they have suffered with their backs before, they will say no not really…. Just the usual ache in the back.
It is not usual to have an ache in the back; the ache could be a signal that the back is having to put up with a bit more than it likes. Gradually, if not tended to that ache could then become a pain….
Finally, backs are tricky because they are so painful that people experiencing back pain do ANYTHING to avoid that pain again. This can lead to stopping activities in case they aggravate your symptoms and gradually this will limit you in your life.
I imagine the spine as a set of dominoes, and as one moves they all follow gracefully. All joints in the body have a normal range of movement and at the end of this range we find we reach a stretched position. Now stretching for short periods is healthy but if we keep our joints at the end stretched position for too long they will start complaining.
The spine is the same, we have 5 vertebrae in our lower back and we have 4 main movements at these joints. Forwards or bending, backwards or arching and side bending and twisting.
Each of us have different amounts we can move, some of us can easily touch our toes while others struggle to get beyond their knees. Our range is our own and we need to be aware of how much we can move.
We can discuss your back as medical folk and look at what structures maybe causing the pain. This is useful to some degree (mainly to exclude other causes to your pain). What is more useful than understanding what is wrong with my back is understanding what can I do to help my back?
What can go wrong with your back?
If we were to MRI most backs after the age of 35 you would see some changes with the structures. Discs become flatter and less spongy, joints can get stiffer and these changes can also lead to a change in how we move. So, unless we actively keep our backs moving they may naturally get stiffer with time.
From MRI’s we can see that the discs get injured, they can have a bulge or a tear and if it becomes more injured some of the donut jam can seep out. This is called an extrusion.
Any of these can cause some changes to the nerve which sits very close to the disc. If the nerve is irritated this can give you pain down the leg (sciatica) but if the nerve gets compressed by the disc it can give you numbness and pins and needles.
Things become more serious if you are getting weakness in the foot. On very rare occasions the middle part of the spinal cord can be compressed by the disc. This is called Cauda Equina syndrome and is a medical emergency. The main symptoms for these are severe pain down both legs, changes in bladder or bowel function and numbness around your perineal area.
Muscles can also play a part in giving you pain, for example if you do a lot of walking your gluteal muscles may become tight and stiff and this in turn can make your back stiff.
You may also have stiffness or pain due to stiff joints in your back known as facet joints.
What are the ways you can hurt your back?
- A sudden change of activity involving high load
Things like lifting that heavy suitcase into the car or spending the day in the garden at the start of the good weather. Both these situations put excessive load on the back and may cause an injury especially if you’ve had problems before.
- Repetitive or passive strain involving low load
This is when people say that they just bent over to tie their shoe lace and their back ‘went’. In this scenario your back is put under repetitive low load and then it suddenly can’t cope any more. Backs generally don’t like repeated movements or passive positions. Repetitive bending could be spending the day clearing weeds from the garden or if you have a manual job. Some backs don’t like standing or walking. Passive positions are positions that don’t require any active movement such as sitting especially if you sit slumped in your chair or do lots of driving.
What is important for you to know when managing your back?
Being happy with your diagnosis
You need to be happy with what the diagnosis is for two reasons. Firstly, it helps you understand your back better and secondly there is nothing worse than thinking you have a deadly illness (because your neighbour’s uncle got diagnosed with bone cancer last week) and your physiotherapist is telling you it’s back pain. If you are not convinced by the diagnosis you won’t be convinced by your treatment so it will be a road to nowhere. Always discuss your concerns with the physiotherapist and if you need, ask for an X-ray or blood tests to clear your mind.
Generally, as an experienced physiotherapist we can conduct a thorough examination that will rule out any nasty diseases.
Understanding your back pain
This is probably more important than knowing what structures are injured. Knowing the things that maybe contributing to your pain will really help you on the right path. Often when we have had problems for a long time we have almost tried to forget this and just get on ignoring our backs. What can help is writing a diary for a week to identify what activities have a negative effect on your back but also what activities have no effect and those that have a positive effect. Getting the balance of maintaining activities that feel ok and reducing activities that aggravate things is the key, but this is often hard to do on your own.
EXAMPLES OF TRIGGERS
After sitting for 20minutes or sitting on the train to work. After a run or pottering around the shops for 2 hours.
3 hours of gardening. Now looking closer at these activities, you may find that simple strategies such as having a lunch time walk or try 1 hour of gardening and then potting the plants rather than digging.
So, mixing up your activities and working out how much you can cope with will help. Often, we expect our backs to cope with ALL that we want to do because we are thinking about the activities rather than the back.
Tips to help you manage your back pain
- Backs like to move so keep them moving- 30minutes max at your desk
- Backs don’t like too much sitting or driving, spend a week limiting these and see if it helps
- Watch how much of your day you spend bending
- See what activities don’t help your back
- Work out what activities don’t aggravate your back and stick with those
- Use treatments such as physiotherapy, massage or manipulation to help reduce the pain to get you moving better.
I see so many people who have spent years gradually becoming deconditioned because they do not know what to do with their backs and are always worried that they may injure them again. As a result, they become deconditioned and demoralised.
The first stage is the hardest, but this will give you the confidence to know how to manage your back. It’s hard to do it alone so if you need help get in touch!