The lower back is critical to our function as a human being. It provides structural support as well as enabling movement in all directions. The lower back is primarily responsible for forward and backward movements and also allows sideways bending and rotation. Another critical function of the lower back is to protect the tissues of the nervous system, spinal column as well as the organs of the pelvis and stomach. As such an essential aspect of our lives it is also susceptible to a number of injuries that cause us pain. The top 8 most common causes are outlined below.
8. Bone Injuries
Fractures of the lumbar spine usually occur after a traumatic event such as a fall or motor vehicle accident. If the fracture is unstable, risk of damage to the spinal cord and permanent paralysis is extremely high. Patients are stabilised and immobilised for long periods. If the fracture is stable patients are treated with rest and pain relief. In some cases people with osteoporosis, or those taking medication such as cortisone long term, can be susceptible to fractures even with minimal stress on the spine. This may cause a crush fracture where the vertebrae loses some of its height. Pain can be severe and is often aggravated by movement.
7. Congenital Inherited Conditions
Some of the common inherited conditions that cause lower back pain include scoliosis which is a sideways curve of the spine, sometimes caused when one leg is shorter than the other (functional scoliosis). You can also get structural scoliosis which is a fixed sideways curve often due to unknown factors, more common in women. Another common congenital cause of lower back pain is a forward slip of the lower lumbar vertebrae on top of the sacrum. This is referred to as spondylolisthesis, which in some cases can be associated with fractures of the joining bones in the vertebrae and is known as a pars defect.
6. Bone Encroachment
Sometimes when the bony canal of the spinal cord and the spaces that the nerves exit can be narrowed by bone spurs or other soft tissues. This can cause sciatic pain which radiates down the leg. Often pain from narrowing of the spinal canal gets worse with walking and improves with rest.
Arthritic changes and inflammation can affect the lumbar vertebrae as well as sciatic joints and can commonly cause lower back pain and stiffness, which is often worse in the morning. Degeneration can also affect the disc and is known as sponydolosis. This shows up on x-rays as narrowing of the lumbar disc joint space.
4. Lumbar Radiculopathy – Damage to a Disc
When the disc is injured or weakens over time the outer rim can bulge or rupture (herniate), putting pressure on the spinal cord and/or the nerves exiting the bones. This can produce both local low back pain as well as sciatica characterised by pain down the leg. It can also be associated with pins and needles, numbness and weakness. In more serious cases, patients may experience problems with bladder and bowel function. They should seek medical attention immediately.
3. Nerve Irritation
The nerves exiting the bones of the lower back can be irritated by pressure from bone, soft tissue, as well as inflammation. Pain can be both local, as well as radiating down the leg.
2. Tendon and Ligament Strains
The soft tissues supporting and connecting the bones of the lower back can be stretched or injured in a number of ways. Commonly there is some sort of microscopic tear of varying degree which is often caused by an acute injury or overuse.
1. Muscle Strain
The most common form of lower back pain is of muscular origin. Muscle pain can be brought on by poor posture, overuse, improper use, sustained positions and even trauma. It is so common because not only is it the primary cause of most lower back pain, it is a significant component of all the other causes of lower back pain. This is because with arthritic changes, structural changes, such as curvature of the lower back, disc disease or even ruptures will all sensitise the muscles. This is why it is essential to understand muscle pain specifically, to learn strategies for prevention as well as self-management long term.
If you, your friend or family member suffer from back pain please do not hesitate to contact one of our friendly Camp Hill physiotherapists on 07 3847 8040. Our Camp Hill physios can also provide treatment from our Camp Hill Physiotherapy practice in Brisbane.