Lower back pain

Lower Back Pain, what is it?

Lower back pain can impact all aspects of life. Back pain is very common, and it is important to know that lower back pain, while it can be debilitating at times, rarely is caused by a serious illness.

Almost all people – nearly 80% – will experience low back pain at some point.  Regardless of the cause of lower back pain, most cases will, on average, resolve within six weeks of onset of symptoms. Many cases respond even more rapidly.

Not only is back pain common, but it also has a significant price tag attached to it. Billions of dollars are spent on direct and indirect costs.  Direct costs are for treatment, imaging, and interventions.  Indirect costs include, but are not limited to, lost work time and wages and legal and insurance costs, among other associated expenses.  Managing back pain quickly and conservatively is important to controlling rising health care costs.

The lower back is considered the area below the rib cage, but above the legs. Pain in this region is typically categorized into three different types – acute, recurrent, and chronic.

Acute low back pain lasts three months or less.   Recurrent low back pain is considered cyclical, meaning that symptoms may periodically come and go within the first 3 to 6 months of onset.  Chronic low back pain is present consistently for more than three months.

Lower Back Pain

What causes Lower Back Pain?

There are various reasons and causes for low back pain. Among the most common causes are related to muscles, tendons, and ligaments. A muscle contracts, relaxes, and stretches to enable movement of the joints, which is the name for where two or more bones meet.   At the ends of the muscle are structures called tendons, which is where the muscle narrows down, changes, and then attaches to the bones. Ligaments, which do not stretch much, help hold one bone to another, with their role described as providing stability to the joint. Ligaments prevent unwanted or extra movements of the joint.

Injuries to muscles, tendons, and ligaments are described as strains or sprains. A strain is over-stretching or tearing of the fibrous tissue within the muscle and tendon. A sprain is stretching or tearing of the fibrous tissue within the ligament.

Both strains and sprains can be painful and will take some time to heal. Either can occur from poor body mechanics with lifting objects, twisting motions, or a sudden and unexpected movement.

With a strain or sprain, muscle spasms or tightness may occur. This may happen directly within the injured tissue or indirectly around the surrounding tissue. Muscle spasms and tightness can be uncomfortable and may impact daily activities.

The cause of low back is not always related to muscles, tendons, or ligaments. Sometimes it is the cushion between the bones of the spine, also known as the disc, or the nerves nearby, that may be responsible for back pain.

33 bones, called vertebrae, make up the spine. Four distinct components of the spine exist: the cervical (the neck), the thoracic (middle), lumbar, and sacral. The lumbar spine is below the rib cage and above the pelvis, and the sacral spine resides within the pelvis area.

The lumbar spine includes five bones (L1, L2, L3, L4, and L5). This area of the spine bears a lot of weight and has the capability for multi-directional movement including forward bending, twisting, side bending, and backward bending.

The sacral (sacrum) spine also is categorized by five bones (S1, S2, S3, S4, and S5).  These joints are fused and do not move on one another, unlike the lumbar spine.  Together, they form a triangular shape, and the back wall of the pelvis. The sacrum also connects with the bones of the pelvis, forming joints that have a small amount of movement, called the sacroiliac joints. Injury to this area is likely to be caused by trauma, most likely due to a fall or landing on directly on the buttocks.  Instability in this area also can occur as ligaments become lax during pregnancy.

The 33 vertebrae of the spine stack upon one another.  When viewed from the side, the spine lines up in the shape of an “S.”  These curves are balanced properly for stability, mobility, and optimal function.  Between every vertebra is a cushion called a disc.  This disc, which is made up of a gelatinous center and a firmer outer rim of fibrocartilage, acts as a spacer and a shock absorber, and helps to allow movement.

Over time, the discs may change, just as any structure in the human body does.  Phrases like bulging, herniation, and degeneration may sound frightening and serious.  However, they are quite common.  It is anticipated that 50% of adults have at least one bulging disc, and often are not aware of it, since they are not feeling any pain symptoms.  But for others, pain can occur, especially when a nearby nerve is involved.  Bulging discs and herniated discs are different things, and along with disc degeneration, can be contributory to back pain and other symptoms, including numbness, tingling, and sometimes weakness in the legs if nerves are compressed.

The following are some other, less common causes of low back pain; listed alphabetically, and some are much more serious than others:

  • Abdominal aneurysm-ballooning of the large artery next to the spine
  • Osteoporosis-vertebrae bones become brittle
  • Osteoarthritis- wear and tear of the joints where the bones connect
  • Scoliosis-abnormal curvature of the spine
  • Spinal Stenosis-narrowing of the bony spaces within the spine
  • Spondylolisthesis-when vertebrae slide forward on one another
  • Tumor of the spine

Symptoms of Lower Back Pain

Nonspecific low back pain symptoms can vary from mild to very severe.

  • Tenderness to touch
  • Stiffness
  • Dull ache during or after activity
  • Muscle spasms
  • Sharp pain in a very specific location
  • Radiating pain that moves into one or both legs
  • Weakness, tingling, or numbness in one or both legs

While extremely rare, the following requires immediate medical attention:

  • Change in bowel or bladder function or loss of sensation in this area

How is Lower Back Pain diagnosed?

Medical providers and/or physical therapists (PT) are a great place to start.   Early intervention and treatment can reduce symptoms and help restore function quickly.

PT’s are the experts in the musculoskeletal system and are skilled in evaluation and treatment of conditions related to muscles, tendons, ligaments, bones, and nerves.

A visit with a medical provider or PT will include a complete physical exam, medical history review, questions about specific symptoms, and clinical tests.  This will often properly pinpoint the issue. Recent research has shown with nonspecific low back pain imaging is not needed, except in very specific circumstances. If the PT feels the patient’s condition requires additional testing or an assessment by a medical provider, the PT will be in communication with the patient’s medical provider immediately.

Research has also proven those experiencing low back pain who seek PT treatment first recover more quickly, as early activity is a good predictor of improvement.  After the evaluation, the PT will immediately begin creating a treatment plan exclusive to the individual patient’s needs.

Treatment of Lower Back Pain

A PT takes a conservative approach to care, which is individualized to each patient and based on the findings of on the evaluation. PT has been researched and studied to be effective for treating back pain and help patients resume their activities.  The physical therapist bases their treatment plan and interventions based on their assessment and clinical findings.

All states allow access to a physical therapist without referral from a medical provider, but there are variations in the rules for each state.  Some insurance carriers do require a medical provider referral to be eligible for coverage.  The American Physical Therapy Association’s website Physical Therapy Direct Access By State provides information, as do all insurance carriers about benefits and coverage.

Next Steps

Early intervention and treatment of back pain is key to conservative care in restoring activity and function.

As a consumer of health care, an individual has a choice in finding the right provider.

Find A Clinic. will help identify a PT with good outcomes in treating back pain by geographical region.


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