Low Back Pain

What is Low Back Pain?

Low back pain might be one of the scariest things an individual is submitted to. Across the entire world, low back pain is the leading cause of disability among all individuals. It is estimated that across all individuals at least 80% of us will have some form of back pain at some point in life. Low back pain comes in all colors, flavors, and disguises. Our current evidence in low back pain has helped us to understand that low back pain is one of, if not the most individualized feelings one can experience. When understanding what low back pain is, and how it manifests, an individual should be taken as that, an individual. A multitude of factors including exercise, nutrition, weight, current stress levels, understanding of your pain, anxiety and fear, and beliefs about your pain, play into what you are feeling. All of these factors play into your understanding of pain, which directly influences recovery and levels of disability. In short, low back pain is a very complex process that takes a multitude of factors into account, which affects your back by increasing how sensitive it is to certain movements, positions, and activities. 

What parts of the body are involved with Low Back Pain?

When it comes to low back pain, our whole body are involved! Often you hear scary words such as herniated or bulging disc, degenerative disc disease, sciatica, or stenosis. An important note in low back pain is that while we do not want to belittle these terms, they often do much more harm than good in an individual. The bulk of current research shows that many of these findings such as bulging discs, stenosis, and degenerative disc disease are highly prevalent in a NON-PAINFUL population. What does this mean? If you take 10 people who are not having any low back pain and perform an MRI of them, it is likely they have either a herniated disc, degenerative disc disease, or some other abnormality an MD would label as problematic. This can best be described as age related changes. If you think about pain like wrinkles on our skin this is an easy concept to understand. As we get older, our skin begins to wrinkle, however, that does not mean wrinkles are causing pain. It simply shows age related change of the skin. Abnormalities or “Problems” on an x-ray or MRI in the back are very similar. When it comes to low back pain, we cannot put all of our stock into an image. It’s important to note that pain is a sensation we feel, it is not something you can see on an image such as an x-ray or MRI. So, what is causing the pain? Well, 90% or more of low back pain is considered “Non-specific.” This means that more often than not there was an increase in loading (you vacuumed, mopped, and cleaned the baseboards all day; you just started exercising again after a prolonged period of time; you are an expecting or new mother carrying an extra 10 pounds around all the time). This abnormal increase in loading put simply causes a mild “Strain” on your back. Often, we then take a trip to the MD, which leaves you with more questions than answers. This can lead to an increase in stress or anxiety, which often times compounds the effects of pain. About 10% of individuals with low back pain present with neurological symptoms. This includes diagnoses such as radiculopathy (Also known as sciatica), or stenosis. Lastly 1-2% of individuals with low back pain could have serious pathology which would include diagnoses such as infection, malignancy (cancer), or a fracture. 

How is Low Back Pain Diagnosed?

Subjective signs (Information you might notice about your injury)

The individual will report varying amounts of pain from the lumbar spine which could or could not include neurological symptoms (Like sensations going down the leg)

The individual could report pain in varying positions (sitting, standing, walking)

The individual could report pain being worse at certain points in the day (Morning versus night)

The individual could report varying levels of stress in their life currently 

Objective signs (Information your therapist finds in an examination)

The individual will show decreased motion at the lumbar spine

The individual could show a favoring of certain motions versus others (such as they spend much more time bending backwards versus forwards)

The individual could demonstrate poor activity tolerance

The individual could demonstrate increased pain with differing upper or lower extremity movements

How can a Therapist Help with Low Back Pain?

There is a connotation that when our back is hurt, we should lay in our bed until the pain is gone, which could not be further from the truth. We know that when someone experiences low back pain, they will often develop fear avoidance beliefs (This would be like injuring your back bent over cleaning the house, so you begin to avoid all activities and behaviors involving bending forward). We know that our bodies love and crave movement (Motion is lotion), so overtime if we are avoiding certain activities or movements, our body will tend to get a little angry with us and pain might continue to persist, or new pain could develop. 

A physical therapist can assist those undergoing back pain by first triaging (Making sure signs aren’t present) red flags to ensure there is not a serious pathology occurring such as cancer, infection, or a fracture.

A physical therapist can assist individuals undergoing low back pain by beginning with an examination and patient education— this will allow the therapist to understand the current factors involved in your pain and provide you with helpful information and insight to understand what and why you are feeling. As we talked about above, when it comes to low back pain, your therapy program should be tailored to you as an individual. Low back pain is as far from “Cookie cutter” programs such as increasing your abdominal or hip strength, although these can be factors. A physical therapist can help by then providing strategies to slowly improve motion, decrease signs and symptoms, improve self-confidence, decrease fear avoidance behaviors, and help you return to a pain free lifestyle.