Back pain is the second highest cause of GP visits, only after colds and flu. Maybe you’ve just bent wrong, or maybe you have a degenerative disorder that affects your back. It doesn’t matter. Lower back pain can be debilitating, and for many it interferes with their normal life.
It can be hard to diagnose, hard to treat, and many people feel like their lower back pain is untreatable. After all, nothing has worked yet.
Treating lower back pain can be an exercise in trial and error, but no matter the cause, there is often a way to help lessen your pain and stop your lower back pain from ruling your life.
The Structure of the Spine
The spine extends from the base of the skull to the pelvis. It is made up of five sections; the cervical, thoracic, lumbar, sacral and coccygeal spine, and when viewed from the side it has a natural S-shaped curve.
The cervical spine has seven vertebrae, and the first two, C1 and C2 are specialised to support the skull.
The thoracic spine has twelve vertebrae within the chest region, and are attached to the ribs.
The lumbar spine usually has five vertebrae (although some people have six). The lumbar spine bears the bulk of the body’s weight.
The sacrum is a region of the spine, which at birth is made of five vertebrae, but by the time you reach adulthood, have fused together.
The coccyx (also called the tailbone) is made of three to five bones, and in later life may fuse with the sacrum, although this is more common in women than men.
Between the vertebrae are the intervertebral discs, which are flat, round cushioning pads, made of a strong outer tissue and a soft, inner gel. These intervertebral discs act as shock absorbers during motion of the spine.
The spinal nerves originate from the spinal cord, which is encased by the vertebrae for it’s protection. These nerves and the spinal cord itself are all supplied with blood from nearby blood vessels.
Tendons attach to the bone and muscles, and assist with the contraction of muscles. Ligaments attach bone to bone, and provide strength to the joints. The muscles provide stability to the spine, and allow movement in different directions.
Causes of Lower Back Pain
Acute lower back pain refers to pain in the low back that lasts from a few days to a few weeks. While there are many causes for acute lower back pain, the most common include:
Injury caused by activities ranging from car accidents to sports injury can injure the soft tissue that support the body’s weight, which can result in low back pain.
Trauma can also cause the spinal column to become overly compressed, which can cause the intervertebral discs to herniate, which can put pressure on the nerves of the spinal column, causing significant pain.
Muscle Strain and Ligament Sprain
Strains and sprains are the most common cause of acute back pain.
A strain is when a muscle or tendon is overstretched or torn, whereas a sprain is the overstretching or tearing of a ligament. Both can cause similar types of pain, and can also be caused by similar activities.
Strains and sprains in the low back frequently occur when lifting something heavy, or too quickly, or from twisting in certain directions. Strains can also occur during exercise if the muscles are not warmed up properly.
Compression fractures to the spine can occur for a number of reasons, but the most common is osteoporosis.
Other causes can include trauma, and tumours that can either originate in the spine, or originate elsewhere and migrate to the vertebra.
Treatment involves pain management and resting the affected area. Back braces and surgery may also be recommended depending on the severity of the fractures. Assuming surgery is not required, it usually takes between 8 to 10 weeks for the injury to heal.
Piriformis syndrome occurs when the piriformis muscle becomes inflamed, which can cause the muscle to swell. This can pinch the nerve within the muscle causing significant low back pain, which can radiate down into the buttocks and leg muscle.
The pain caused by piriformis syndrome can be increased with prolonged sitting or walking, and may be alleviated by periods of lying down.
Piriformis syndrome is diagnosed by physical examination, which rules out other conditions that may be causing the individual pain.
Chronic back pain is back pain that occurs for 12 weeks or longer, even if the initial injury has been treated.
Degenerative disc disease
Degenerative disc disease is when the intervertebral discs begin to break down, which leads to pain. It is an age related condition, and occurs because the rubbery discs between the vertebrae become worn down with time and movement, and so do not offer as much protection when older.
The most common symptom for degenerative disc disease is pain, which can range from mild to debilitating, but tends to get worse over time. This pain originates in the spine, but if the damage is in the lower spine, can also radiate down the buttocks and legs.
Certain movements, including sitting, lifting and bending can make the pain worse, whereas walking and lying down can alleviate some discomfort. Exercise to improve core strength can help stabilise the spine, and help prevent flare ups.
One of the most common causes of chronic back pain is poor posture. Modern working life has reduced movement, and led to people hunching over computers for hours at a time without a proper break.
Low back pain caused by poor posture can be worse at certain times of day, can get worse over time, and stop when you change position.
Maintaining good posture can help prevent unnecessary pain, and is easy to work into your day to day life.
The intervertebral discs are made up of two layers: And tough outside called the annulus fibrosus, and a jelly like centre call the nucleus pulposus. A herniated (slipped) disc is when this soft centre pushes against the outer shell, and can erupt from it, putting pressure on the spinal nerves.
Herniated discs can occur anywhere within the spine, but are most common within the lower (lumbar) spine. It is most commonly related to aging and wear and tear, but can also be caused by trauma, e.g. a fall.
The most common treatment for a herniated disc is rest and pain relief, while incorporating gentle exercise to maintain your strength.
The spine is designed to support and distribute the weight of the body, with most of the load being borne by the lumbar spine. When a person is overweight, this means more weight has to supported by the same portion of spine, which means that more pressure is applied.
This can cause low back pain when standing and walking, and also increases the risk of conditions such as a herniated disc or degenerative disc disease. In addition, if you have an excess of fat in your abdomen, it can cause changes to your posture, which can also lead to pain.
Pain in other organs can also be felt in the lower back, as a result of signals radiating along nerves.
Kidney problems, such as infection or kidney stones can cause pain to be felt in the low back. This is usually accompanied by other symptoms such as fever.
Problems with the ovaries, such as cysts and endometriosis can also cause low back pain, and is diagnosed by gynaecological examination and tests.
Another condition that can present with sudden low back pain is abdominal aortic aneurysm. This is when the walls of the abdominal aorta weaken, and can balloon into the side of the blood vessel. This is a life threatening emergency, which requires treatment immediately.
Facet joint dysfunction
A facet joint is a small joint between the vertebrae, which stabilises the spine and allow you to bend and twist. The facet joints are almost always in motion, and therefore are subject to a lot of wear and tear.
Facet joint dysfunction is one of the most common causes of disabling low back pain, as people with facet joint dysfunction can prevent you from bending or twisting, and causes long term pain.
Treatment options can include maintenance of good posture, and gentle exercise to improve core strength. For more severe pain, surgery can be considered. Pain relief options are usually used to help maintain quality of life.
Sacroiliac joint dysfunction
The sacroiliac joint is where the iliac crest (hip bones) connect to the sacrum. Sacroiliac joint dysfunction occurs when this joint moves too little or too much. This can result in inflammation in the joint and pain, which can spread to the buttocks.
The most common cause of sacroiliac joint dysfunction is due to the cartilage between the bones being worn away, and the bones rubbing against each other. Other causes can include conditions that place uneven pressure on the pelvis, such as scoliosis or difference in leg length, and excess pressure on the joint due to obesity.
Treatment for sacroiliac joint dysfunction usually focuses on pain relief and maintaining normal joint motion. If non surgical treatments are ineffective, sacroiliac joint fusion surgery may be recommended.
Spinal stenosis is a narrowing of the spaces within the spine, which can put pressure on the spinal nerves, which causes pain. The most common type of spinal stenosis is lumbar spinal stenosis, which causes pain in the lower back.
While some people with spinal stenosis may not experience any symptoms, others may experience pain, numbness and muscle weakness, which usually gets worse over time.
Spinal stenosis usually occurs as a result of wear and tear. This regular damage can stimulate the cells in the spine to produce more bone, causing the spinal openings to narrow.
While there is no cure for spinal stenosis, treatment usually focuses on reducing pain, increasing flexibility and improving quality of life. Maintaining gentle exercise can help improve strength and flexibility, and therefore reduce pain.
Spondylolisthesis is where one of the vertebra in the spine slips out of position, and onto the bone below it. It is most common in the lumbar region of the spine, and so low back pain is the most common symptom.
Spondylolisthesis is the most common cause of back pain in teens, and particularly in young athletes.
People diagnosed with spondylolisthesis should take a break from sports and other high intensity activities, and pain relief is given as appropriate. Exercises to strengthen the abdominal and back muscles are advised to strengthen the core and stabilise the spine. If the vertebra continues to shift, or conservative treatment is not effective, surgery may be recommended.
Osteoarthritis is a condition where the protective layers of cartilage that protect the tops of bones is worn down or begins to degenerate. This causes pain and inflammation, as well as stiffness of the joints. In the spine, this is known as spinal osteoarthritis, and is where the cartilage of the discs and joints breaks down.
In general osteoarthritis is more common in older people, but it can also affect younger people, particularly if you have damage to a joint or a congenital defect of the cartilage.
In general, treatment is aimed at relieving pain and maintain a healthy lifestyle and a good quality of life.
A spinal deformity is where there is abnormal shape, formation or curvature to the spine. This can cause the spine to be out of normal alignment.
An abnormal curvature to the spine can appear in the side-to-side curvature (e.g. scoliosis), front-to-back (e.g. kyphosis). Other deformities can occur as a result of trauma, or genetic defect.
The most common symptom with spinal deformity is pain, but treatment varies depending on the cause of the deformity.
Associated To Pregnancy
Back pain associated with pregnancy is common, but there are several causes and treatments for it.
Lower Back Pain During Pregnancy
During pregnancy your centre of gravity changes as the baby grows, changing your posture. In addition, a pregnant woman’s spine has to support the weight of the growing baby as her own.
This can put pressure on the lower back and the surrounding nerves, causing significant back pain.
Gentle exercise, and exercises to strengthen the abdominal muscles. Also, keeping your back straight and bending at your knees can help prevent pain in your back.
Lower Back Pain After Pregnancy
During pregnancy, a hormone called relaxin is released into the body to prepare the body for the delivery of the baby. It acts by loosening and relaxing the ligaments in your pelvis, but can also affect your spine.
It’s also common for the two muscles that run down the middle of your stomach to separate during pregnancy. It occurs because as the uterus grows, it pushes the muscles apart.
Postpartum back pain can disappear with time, and easing back into an exercise routine can help. Also, maintaining good posture while feeding your baby can help prevent some discomfort, and warm baths can help to relax your muscles and ease discomfort.
How To Relieve Lower Back Pain at Home
How To Relieve Lower Back Pain Fast
While warmth may feel good, within the first 24-48 hours you want to turn to an ice pack instead. By applying an ice pack, you can reduce the inflammation and swelling,and therefore reduce the healing time.
Apply a cold compress to your injury, and leave it for a maximum of 20 minutes.
After 48 hours, warmth can relax the muscles in your back and reduce the pain you’re in. Use a heat pack or a hot water bottle to ease your discomfort. Like the ice pack, only apply for 20 minutes at a time.
Over the counter painkillers
Over the counter medicines can be incredibly effective in reducing back pain. Paracetamol is a common painkiller which can reduce your pain quickly.
Anti inflammatory drugs such as ibuprofen or aspirin can be used to reduce both pain and inflammation, and can be taken alongside paracetamol.
Just be sure to check with your doctor or pharmacist about any interactions with drugs you’re taking, or whether you should avoid any drugs due to certain medical conditions. For instance, people with asthma should avoid taking aspirin, as it can induce an asthma attack.
Transcutaneous Electrical Nerve Stimulation (TENS) can help to alleviate pain by using electrical current to stimulate the affected area. This can help reduce the pain signals going to the brain, and also can induce the production of endorphins, which act as natural pain killers.
For most people, TENS machines are a safe treatment for pain with no side effects, however you shouldn’t use it without medical advice if you:
- Have a pacemaker, or another type of electrical or metal implant in your body.
- Are pregnant, or may be pregnant
- Have a heart condition
- Have epilepsy
Exercise for Lower Back Pain
While it can be tempting to stop all activity when your back hurts, it’s usually best to keep yourself moving.
Obviously, if you’re in too much pain and can’t move, don’t try and push it. You’ll make it worse.
But if you’re able, keep doing your normal activities. Go for a walk, do the shopping, go to work. If you’re able to move, try to keep moving.
Swimming is an excellent form of low-impact aerobic exercise, as the water supports the weight of the body and reduces the stress and impact of the joints and spine, which can allow for a greater range of motion.
However, like many forms of exercise, you need to be careful when trying it as there are some things about swimming that can make your back pain worse. Ensure you use the proper strokes, and try and use backstroke if you can to try and prevent any further injury.
Endorphins are often described a ‘feel-good chemicals’ but they can actually be as effective as medication for pain relief.
Endorphins are naturally produced chemicals are released during exercise, and can also help reduce stress, anxiety and depression.
Aerobic exercise, meditation and yoga are all good ways to release endorphins, or receiving a massage has also shown to raise endorphin levels, and relax the muscles as well.
Pain can severely affect sleep, either finding a comfortable position, getting to sleep or staying asleep, and this can affect your entire life. Being tired all the time will affect how much you enjoy what you’re doing, or how well you do it.
Approximately two-thirds of people with chronic back pain also have difficulty sleeping, and if that wasn’t enough, difficulty sleeping can actually make your back pain worse. It’s a vicious cycle.
If you have back pain and difficulty sleeping, it isn’t enough to simply treat your pain, you need to treat your sleeping problems too.
If your lower back pain is caused by muscular problems, massage can be an effective tool for pain relief.
Massage can help reduce the tension in the muscles, and increase the flexibility and relaxation in the muscles. This can help reduce the pain and insomnia caused by tight muscles.
Massage also increases blood flow to the damaged muscles, allowing nutrients to reach the affected tissues more easily, which can aid in healing. Finally massage induces the release of endorphins, and so can help relieve pain, and improve mood.
Acupuncture was developed in China over 2500 years ago. In involves inserting needles into the body at certain points of the body called meridians.
It’s not completely understood how acupuncture works, but research suggests that the insertion of the needles at pressure points stimulates the nervous system into releasing neurotransmitters and opioid-like substances. These have natural pain relieving and anti-inflammatory properties, which can help reduce pain, swelling and muscle stiffness.
When performed by a licensed acupuncturist, acupuncture is generally a safe procedure, with serious side effects being rare, and with fewer side effects than conventional treatments for back pain. In addition, when used as an adjunctive therapy, acupuncture can reduce the need for medication.
Emotional Freedom Technique (EFT) is a psychological acupressure technique that is often overlooked. It is based upon using the same meridians as acupuncture, while speaking a positive affirmation to relieve both physical and psychological pain.
Research suggests that EFT works by tackling the emotional components associated with pain (i.e. frustration, anger etc.) while also have a chemical effect on the body. Studies have shown that treatment with EFT reduces cortisol levels, whilst stimulating endorphin release, resulting in pain and stress reduction.
Eye Movement Desensitization and Reprocessing (EMDR) began as a treatment for post-traumatic stress disorder, however more recently it has been shown to help with chronic non-specific back pain
As with EFT, EMDR focuses on also treating the psychological trauma associated with physical pain, as often the causes of injury have some psychological impact that often goes untreated.
EMDR uses eye movements to decrease emotional stress and create new associations when recalling the time of injury, and helps to reduce the awareness of back pain. This allows sufferers to become more able to relax and enjoy their lives.
How to Prevent Future Back Pain
Improve Core Strength
Once the pain in your back has receded, improving the strength in the abdominal and back muscles can help prevent the pain from returning. When the core muscles are strong, it reduces the stress applied to the spine, and so reduces the risk of back pain or injury.
By strengthening the core muscles, you can more easily maintain your posture and the proper alignment of your spine. Strengthening your hip and pelvic muscles can also give you more effective support for your back, but avoid abdominal crunches. They can actually increase the strain on your back, and undo all this good work you’re doing.
A lack of flexibility in the hamstrings, hips and glutes can contribute to low back pain, so by increasing your flexibility, you can reduce the risk of lower back pain in the future.
Gentle stretching can help relax the muscles and stabilize the spine. Hamstring stretches can help release tension in the lower back, and reduce stress on the sacroiliac joint, and studies have shown that keeping a regular yoga routine can help relieve lower back pain, and prevent pain in the future.
If you are overweight, weight loss can significantly help reduce back pain. When you are carrying around extra weight, it can add strain to muscles and ligaments in your back, as well as contributing to the degeneration of the intervertebral discs.
As the spine compensates for the extra weight, it may lose its proper alignment, making your pain worse.
Losing weight can reduce the pressure and stress placed on the vertebrae and intervertebral discs, as well as allowing the muscles and ligaments to maintain the spines correct alignment.
Eating a poor diet doesn’t only affect your waistline, it affects your whole body. When you eat a nutritionally rich diet, those nutrients can keep your bones strong and your muscles healthy. To help keep your back pain free, these nutrients are essential:
- Calcium – Low levels of calcium can cause osteoporosis, particularly in women. Eating foods high in calcium, such as kale, broccoli, milk and cheese can help keep your bones strong.
- Vitamin D – Vitamin D3 is needed to absorb calcium from your food. Without enough vitamin D, the calcium rich foods you eat will be wasted. Oily fish and eggs are great sources of vitamin D, and are a recommended part of a balanced diet.
- Vitamin K – Like vitamin D, vitamin K is needed for the body to absorb calcium properly. Vitamin K is found in leafy salads, vegetables such as brussel sprouts and cauliflower, and in meat and eggs.
Improve Posture (work space as well)
Slumping your shoulders and slouching in your chair can make it difficult for your back to support your weight correctly, and place excess strain on your spine.Maintaining correct posture can provide your with relief from back pain, as well as help prevent it from returning.
Walk tall with your shoulders back, and avoid leaning too far back or forward as you move. Keeping your eyes up, and not looking at the floor will also help you keep your spine in the correct alignment.
You can also think about reworking your office environment for the best benefits. If you’re sitting at a desk all day, you may want to invest in an ergonomic chair which is kept at the correct height, i.e. with your feet resting flat against the floor.
If you have to reach frequently for objects at your desk, you want to keep them within arms reach at all times, so you don’t have to stretch for them. Also, your computer screen should , have the top section of the screen just below your eye level, and be about an arms length away from you.
Lose the heels
No one can deny how sexy and confident your four inch heels make you feel, but no one can deny that they can also hurt like hell. And it isn’t just your feet that ache. High heels change your entire posture. They push the hips and pelvis backwards, and the chest forward, altering the entire alignment of the spine.
Swap your high heels for flats for everyday wear, and you’ll likely find that your back protests less.
This is solid advice for everyone, but if you have back problems you should definitely think about ditching this habit.
Smoking increases your risk of osteoporosis, and therefore can lead to compression fractures in the spine. Smoking also reduces your oxygen absorption, meaning the muscles supporting your spine have to work harder with less oxygen to keep you upright.
Keep Yourself Distracted
Although it’s frustrating, severe back pain can interfere with your life. With this, it can affect your productivity, your mood, and your relationships. Keeping yourself busy with things you enjoy can definitely help with your outlook, and can help to keep your mind off your pain.
Maintaining a hobby, especially one that has you spending time with your friends, can make the difference in your life while you’re recovering.
When You Should Seek Medical Attention
Most back pain can successfully be treated at home, but there are times when medical intervention is necessary.
Contact your doctor if:
- Your pain is severe, and doesn’t go away on it’s own after a few days
- It hurts to even lie down
- You have trouble standing, or there is any numbness or weakness in your legs
- You are unable to control your bladder or bowels
These can be signs that you have an underlying condition that needs to be treated by a medical professional.
Lower back pain can be a debilitating condition, which can begin to control your life, but by identifying the cause of your pain, and finding treatment that works for you, you can relieve your pain, and hopefully prevent it from coming back. With these small actions you can take back control, and begin to live your life again.