Low Back Pain

Low back pain (LBP) is very common, affecting more than 3 million people in the US per year and more than 600 million people globally. It is the single leading cause of disability worldwide, one of the top causes of missed work in the US, and the condition for which the greatest number of people may benefit from physical therapy.  It can result from a strain to the muscles and tendons, from arthritis and degeneration, or from injuries to the disc.  Physical therapy can help reduce your risk of LBP by staying active, maintaining flexibility, and improving core strength.

Prevalence

Nearly every person (4 out of 6 people) will experience LBP at least once in their life.  The peak in the number of cases occurs at age 50-55 and women experience LBP more frequently than men.  The prevalence and disability impact of LBP are greatest among older people aged 80-85 years.  As one ages, recurrent LBP episodes are more common and can be classified as specific or non-specific.  Non-specific LBP is when it isn’t possible to identify a specific disease or structural reason to explain the pain.  LBP is non-specific in about 90% of cases.  Specific LBP is pain that is caused by a certain disease or structural problem in the spine.

Risk Factors

Age:  People over 30 have more back pain.  Intervertebral discs (soft, rubbery tissue that cushions between vertebrae) wear away with age.  As the disc weakens and wears down, pain and stiffness can result.

 

Weight:  People higher in obesity or who are overweight are more likely to have back pain.  Excess weight puts pressure on joints, vertebrae, and discs.

 

Occupation and Lifestyle:  Occupations and activities of daily living that require heavy lifting or repetitive bending can increase the risk of a back injury.

 

Overall Health and Mental Health:  Weakened abdominal muscles that can’t support the spine can lead to back strains and sprains.  People who smoke, drink alcohol excessively, or live a sedentary lifestyle have a higher risk of back pain.  It has also been shown that depression and anxiety can lead to LBP.

 

Structural Issues:  Severe back pain can result from structural pathology such as scoliosis, stenosis, or spondylolithesis that change spine alignment and spacing. 

 

Disease:  People who have a family history of osteoarthritis, degeneration, and disease have a higher risk of low back pain.

 

Posture:  Your back supports weight best when you don’t slouch.  This means sitting with good lumbar support, with your shoulder back, and feet resting on the ground or low stool.  When standing, keep weight evenly balanced on both feet.  

Signs & Symptoms

Low back pain can be sharp or dull, acute or chronic, and can radiate down the lower extremities.  One may experience numbness, tingling, or electrical type pain that can travel into either lower extremity.  Some people may experience these radicular symptoms without actually having low back pain.  


Other symptoms may include muscle spasms accompanied by stiffness, making walking and getting up out of a chair painful and difficult. 

 

In most cases of acute LBP, symptoms go away on their own and most people will recover well.  However, for some people the symptoms will continue and turn into chronic pain, requiring physical therapy.

Common Causes of Low Back Pain

Muscle Strain/Sprain:  The most common cause of back pain.  You can injure muscles, tendons, or ligaments by lifting something too heavy or by improper lifting technique.  Some people strain their back by sneezing, coughing, twisting, bending over, and lifting. 

Disc Issues:  Discs provide cushion and height between the vertebrae.  Discs can either bulge or tear/herniate from their position in the spine and press on a nerve, resulting in radicular symptoms such as buttock or lower extremity pain, burning, numbness, or tingling.  With age, discs degenerate and become flattened, offering less protection and resulting in degenerative disc disease (DDD) with possible nerve involvement and associated radicular symptoms.

Structural Problems

  • Spinal Stenosis: a condition when the spinal column is too narrow for the spinal cord, potentially causing severe sciatic nerve pain and lower back pain.
  • Scoliosis: a curvature of the spine that can lead to pain, stiffness, and difficulty moving
  • Spondylolithesis: a condition that causes the vertebrae in the spine to slip out of place, either anteriorly or posteriorly.  It leads to low back pain and often leg pain as well as it can place pressure on a nerve as it moves out of place. 

Fractures:  The bones in the spine can break during an accident like a car crash or a fall.  Certain conditions such as spondylolysis or osteoporosis increase the risk of fractures.  

  • Spondylolysis:  a small crack between two vertebrae.  Can also be considered as a pars fracture.  It is more common in kids and teens, especially children who play contact sports.  Most common causes are overuse, growth spurts, and genetics.  Most people do not need surgery to treat it.  Rest, medication, and physical therapy are most successful when started early. 
  • Osteoporosis:  condition that silently weakens your bones, which can make you more likely to experience a bone fracture. 

Arthritis: Osteoarthritis is the most common type of arthritis to cause lower back pain.  Ankylosing spondylitis is a type of arthritis that affects joints in the spine, causing lower back pain, inflammation, and stiffness.  It also affects the sacroiliac joint where the base of the spine meets the pelvis.

 

Sacroiliac Joint Pain: Sacroiliitis, Ankylosing spondylitis, and malalignment. 

Elite Physical Therapy & Sports Medicine Treatment for LBP

Whether acute, chronic or post-operative, we can help get you back to doing the things you want to do. 

 

Restoring or improving the lumbar spine’s mobility and flexibility is typically focused on first.  As muscle spasms and pain reduce and mobility is improved, focus shifts towards stabilizing the spine and strengthening the core all the while re-introducing activities you desire to return to.  

 

Manual therapy, Dry Needling, Kinesio Taping, and applied functional science are just some of the techniques that can be helpful in getting you back to what you want to do.