The Why, What's and Where's of Lower Back Pain.

These questions are often asked in clinic:

WHY has this happened to me? WHAT has caused it? WHERE is it coming from? HOW can I avoid this in the future?

Well the answer to these questions is a rather large and in-depth one! However, in these times of isolation it is even more important to understand what may have happened to your back and how to avoid further injury and most importantly, pain.

Here we will briefly go through the most common types of injury I see involving the lower back, what causes them and the symptoms that are related.

Types Of Injury

Disc Injury

WHY: Often disc injury is work related. If you do a job that requires you to lift alot (Builders, labourers, nurses -still happens even with hoists!) or repetitive bending, you are vulnerable. Often it can be a gradual onset that you are aware of, however it can suddenly appear after one single episode without any prior warning.

WHAT: A disc related injury is down to repetitive stress caused by increased load/weight on this area. Bending and lifting create this. The end stage (that you usually know about!) is when part of the soft centre of a disc bulges out and presses on a nerve root behind it coming from the spine.

WHERE: Normally if the disc is one sided, symptoms can include lower back pain on that side but often pain in the buttock, back of the thigh and even down into the calf and foot (Sciatica). Often you will stand off to one side, leaning away from the pain. This creates more space and less compression on the disc. Pins and needles can often accompany the pain, although you can have the tingling without pain too. If the disc bulge is central you can feel these symptoms on both sides.

EMERGENCY: If you suffer altered sensation/tingling in the “saddle region,” (private parts area) or

bladder or bowel incontinence, you must get to hospital asap. This could be Cauda Equina, which means you have a disc pressing on your spinal cord and could cause paralysis if it isn't dealt with rapidly.

It's important to note here that you won't necessarily experience pain or discomfort with a disc bulge, it will depend on whether it is pressing on any other structure, such as the nerve root. Apparently many of us are walking around with one!

Lumbar Facet Joint Strain

WHY: Disturbance of the lumbar facet joints often comes from overloading and an inefficiency of the musculoskeletal system to support this area. Therefore lack of health and fitness is the most common reason, this means stability with mobility, not one without the other. If you are particularly mobile (hypermobile), you are more at risk. Due to the increase range of movement within these joints, more muscle strength and support is required to limit those abnormal movements that may occur. Any degenerative change in the body such as osteoarthritis will increase the risk of this as the joints are less smooth and therefore more easily annoyed!

Facet Joint dysfunction is said to be the cause of 40% of chronic lower back pain.

WHAT: Abnormal movement through the facet joint causes inflammation, this can be through compression of the joint or coincide with a ligament strain. The facet joints connect between each vertebrae either side of the spinous process (the bony bit that you can feel along your spine). These joints can often "lock" or fix itself in one position, usually on one side. Repetitive movement or loading increases your chances of an abnormal strain and stress on this joint as muscles fatigue that would normally support this area. Usually there is a build up of events (unusual stress), such as extra gardening or DIY that you can put your finger on, before if finally gives in.

WHERE: Frustratingly this type of injury can resemble other lower back pathologies. With a facet joint strain often comes nerve root irritation as the nerve root sits so close to the facet joint before it travels into the leg. Therefore you can get pain radiating into the legs, often it is in the buttock or the back or front of the thigh only. Occasionally into the shin. If both facet joints in the lower vertebrae are affected, you can often feel pain straight across the lower back.

Twinges in the lower back can present randomly and with longer strides when walking.

Sacro-illiac Joint Strain

WHY: Leaning over when gardening or sweeping are likely culprits. It can be sudden or a gradual build up. There are a few factors that increase the risk such as being overweight, this increases the stress on your back due to the increased load on the front. Pregnancy causes some instability due to the hormones creating more laxity in the ligaments supporting the pelvis, this then increases as the baby grows due to the extra weight gain.

WHAT: There are two Sacro-iliac joints. This joint sits between the sacrum and the ilium (large bony part of the pelvis). There should be some degree of movement within these joints when we go from sitting to standing or when we're walking. When this joint is strained, this movement doesn't happen and further still, it aggravates all the muscles and ligaments attaching to it! PLUS, there is extra pressure on the lower spine and hip as they all have to work together for optimal body movement. This type of injury often occurs when in a prolonged position that puts stress on this area, such as what is mentioned above.

WHERE: Pain is usually very localised on one side, it will be around the bony part of the pelvis just off the centre in the lower back. Sometimes pain can radiate into the buttock and thigh, patients often complain they feel like they have been kicked up the bum! Sometimes pain is felt around the hip and into the groin or even around the knee. You may notice one leg feels heavy or disconnected in someway.

Hip Pathology

WHY: Occasionally a twist through a weight bearing leg will aggravate the joint and can possibly cause a cartilage tear or impingement. There can be some genetic involvement which increases the extent of osteoarthritis as well as just normal wear and tear that happens to us all!

WHAT: This occurs due to the overload and torsion through the hip joint. There are many factors that increase the load on the hip, for example, being overweight. Though being underweight with little muscle strength will not help protect the joint either. Most commonly osteoarthritis is the cause of hip pathology, and this occurs due to many years of overload. However, this comes in different stages and I have seen many people where additionally factors such as muscle imbalance and weakness have created further strain on the hip joint. Correcting the muscle imbalance can allow the hip to work more efficiently by taking a lot of that load rather than the joint itself.

WHERE: Pain is often felt in the groin and can radiate down the inner thigh as well as in the lower back. The lower back is usually aggravated due to the extra movement it is having to do, particularly when walking as your hip joint can not do it! Lengthening the leg out straight on that side may feel very difficult.

This is an introduction to some of the lower back issues that can arise, little details can sometimes give you an indication of what's going on. However as you can see, there is a lot of crossover in symptoms and an expert eye, some further examination and testing will get you a definitive answer.

IN A NUTSHELL: Your less prone to injury by keeping healthy with regular body movement focusing on strength with mobility and avoiding prolonged or repetitive tasks such as bending and lifting, that put strain on to your back.

I will write more about this next time so stay tuned!

If you'd like to know more on an individual basis book online for a virtual appointment or give me a call: 07788243824.

Bye for now,

Emma

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