It is no secret that lower back pain is a common problem, however just how prevalent is surprising. A staggering 83 percent of Canadians have reported an incidence of lower back pain at some point in their lifetime. Old treatments previously primarily consisted of resting, maybe taking a muscle relaxer, and getting over it with time. Thankfully, medical providers have a much greater understanding of back pain, its cause, and the best treatment plans to tackle the lower back pain epidemic.
The spine has several important functions. The vertebrae form a column that protects the spinal cord from injury. The spinal cord has nerve roots that emerge through the foramina of the vertebrae. These nerve roots contribute to several functions and sensations in the body. Damage to these nerves can cause serious injury. In addition, a flexible spine allows us to move as we need to to carry out our day to day activities.
In between each vertebrae in the lumbar spine are our natural shock absorbers, the intervertebral discs. These discs help absorb the impact of our day to day walking, running, jumping, and movements. Without these discs in place, our spine would be forced to take the brunt of our day to day movements leading to more rapid deterioration than what already naturally occurs.
Individual discs are composed of two parts: an outer annulus fibrosus and the inner, more watery nucleus pulposus. The analogy commonly given is that of a jelly donut where the annulus fibrosus is the outer coating, and the inner jelly is the nucleus pulposus. The nucleus pulposus is has a gel-like consistency which helps to resist compression, keeping a nice cushion between each of the vertebrae.
Unfortunately, back injuries are very common. The most simple of injuries is an acute muscle strain of the lower back. Bending or twisting the wrong way, lifting heavy weight with improper posture or even sleeping in a bad position can lead to a pulled lower back muscle. Treatment is relatively simple and a patient with an acute lower back muscle strain can expect full recovery fairly quickly.
A herniated disc, however, can be a more complicated condition. Interchangeable with ruptured or slipped disc, disc herniation occurs when the inner nucleus pulposus protrudes through the outer annulus fibrosus. Often when this occurs, back pain will be reduced, but leg pain will begin or increase as there is now pressure being placed upon nerve roots that control sensation in the leg. Signs and symptoms that indicate that there is a disc herniation include:
- leg pain (sometimes radiating all the way to the foot)
- tingling or numbness in the leg or foot
- weakness in the muscles of the leg or foot
There are a four different types of disc disease which can contribute to various symptoms.
This is when a disc will bulge into the epidural space without any disruption. The nucleus pulposus does not rupture. A disc bulge is very common and likely will not cause leg pain.
The nucleus remains contained within the annulus by only the outermost fibers.
In disc extrusion the nucleus ruptures and escapes the containment of the the annulus fibrosus. It invades the epidural space while remaining connected to the disc. This can cause nerve root irritation and leg pain. When a patient is told they have an “annular tear” that refers to disruption of the annular ligament due to the nucleus.
In a sequestered disc, pieces of not only the nucleus but the annulus as well have invaded spaces outside of the disc. Nerve root irritation is very common which results in leg and foot pain, weakness, and/or numbness.
Severe Lower Spine Conditions
The most severe results of a sequestered disc can cause Cauda Equina Syndrome, which is when the nerves of the the end of the spinal cord become irritated. Cauda Equine Syndrome is a medical emergency. Contact a physician immediately should you think you have cauda equina syndrome. Symptoms include, leg pain or weakness that continues to get worse, loss of bowel or bladder control and “saddle parathesia” which refers to numbness in the areas that would make contact when riding in a saddle.
Degenerative Disc Disease
Degenerative disc disease refers to the changes in the spine, loss of disc space, and arthritic changes that occur as a person ages. A 2009 research study revealed that 40% of individuals in the study between 18-30 had evidence of lumbar degenerative disc disease on an MRI and the number jumping to over 90% of 50-55 year olds regardless of whether the individual had back pain or not. Too often, patients will have back pain, a diagnosis of degenerative disc disease by diagnostic imaging, and will conclude that they will have back problems for the rest of their lives. This is simply not the case. There are many treatment options to relieve pain of degenerating discs and lead a healthy, active lifestyle.
As previously mentioned, the cause of lower back pain can be from aging as the discs begin to lose some of their gel-like cushion and arthritic changes occur to the spine. Other times, disc herniation can be caused from heavy or repetitive lifting, twisting or bending. There are things can predispose you to disc herniation and back pain. Some of those include: being overweight, sedentary lifestyle, smoking, and men between the ages of 30 and 50. While you cannot control age or gender, you can work towards being more active, smoking cessation, and losing weight in order to decrease your risk of disc related back pain.
The advances in medicine and technology have improved treatments options for lower back pain. For acute muscular strains, a physical therapist will almost always be able to treat the condition quickly using manual techniques such as manipulations, mobilizations, and trigger point dry needling in combination with stretches the patient can perform at home.
The old school of thought used to be that a disc herniation or disc bulge would almost always be treated with surgery. However, research shows that most cases can be conservatively managed. Combinations of physical therapy, anti-inflammatory medication, and epidural injections can successfully manage lower back pain.
What Happens if I Do Not Treat My Lower Back Pain?
The biggest problem with lower back pain is that your spine is the center from which the rest of your body operates. Untreated back pain can turn into sciatica—nerve irritation that can cause pain, numbness, and tingling in the legs and feet. Untreated lower back pain can result in hip, knee, and ankle pain as the body compensates for the pain using poor body mechanics.
What Can Physical Therapy Do for My Lower Back Pain?
Physical therapists are highly skilled in treating lower back pain—it is very common, so physical therapists frequently treat it. Back pain can be often attributed to muscle imbalances throughout the trunk and lower extremity. Your physical therapist will likely stretch hip muscles such as the piriformis, the hamstrings and the hip flexors. If the hips are inflexible, the body relies on the spine for movements that should be performed at the hips.
Additionally, a physical therapist will work with you on core stability exercises. Even people with defined abdominal muscles can have poor control over them when it comes to engaging them for lifting and strenuous activity. Your physical therapist will work with you to improve your core stability which will in turn take the pressure off of the muscles of the lower back.
Now that you are well versed on the ins and outs of lower back pain, do not hesitate to contact Bourassa and Associates to schedule your appointment today. Most lower back pain can be resolved with the help of physical therapy. We offer same day appointments and our university trained therapists are eager to explain your condition to you and help you overcome your lower back pain. Find a clinic near you to get started today.