Ask the therapist: Causes and solutions of lower back pain

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Monday, 31 October 2022

This month we start a new series of articles on our Blog: Ask the Therapist. 

On this first issue, we are going to focus on one of our most treated symptoms, lower back pain. We asked our therapists Lore, Asad, and Charlotte to explain what in their opinion could be its causes and treatment solutions.

Let’s see their answers:

Lore:

A sore lower back might be the result of muscle or ligament strain. Commonly this happens because of repeated heavy lifting or a sudden awkward movement that can strain back muscles.

Other times, this derives from a medical condition like a slipped disc or sciatica.

The trick is to understand why your lower back is painful in the first place. I believe that one factor that’s often overlooked is hip flexibility. That’s because, if your hips are tight, your lower back must compensate for their lack of movement, hence the pain and stiffness. One solution could be working on Core Strengths. Your core strength is a massive factor in eliminating your lower back pain for good! 

Pilates is a great way to work on your core strength, as well as with treatments. Massage therapy is an incredible ally: by improving blood flow and working on improving posture, with time, the strengthening comes naturally. This is the beauty of Remedial massage! The therapist can also treat trigger points, bringing health back into muscles and relieving pain. Remedial massage therapy has been shown through studies to be extremely beneficial for patients with lower back pain, especially when the treatment is combined with exercises and education. 

Another great tip would be to practice Mindfulness and Meditation: Chronic back pain can be straining both physically and emotionally. These techniques are good ways to manage frustration, irritability, depression, and other psychological aspects of dealing with chronic pain. You may also get referred to a rehabilitation psychologist. This specialist may recommend meditation, yoga, tai chi, and other cognitive and relaxation strategies to keep your mind from focusing on pain.

Asad: 

In my experience the 5 most common causes of lower back pain are:

- Accumulated stress;

- Bad Posture: commonly the sitting posture we assume after long hours at work or, even when relaxing at home. This could also derive from our position whilst sleeping, or a bad mattress.

- Poor technique for exercises (e.g. deadlift or squats done without appropriate support and supervision);

- Running with poor footwear or not stretching afterward;

- Previous injuries to the spine, or hip/leg. 

These can often be treated by making small improvements to our lifestyle, although, in more series cases, it would be wise to seek medical attention.

In combination with Rehab and Massage Therapy. there are some small things that we could do in our day-to-day life, that might have a great impact when dealing with pain:

• - Rest: It is important to get at least 8 hours of sleep at night. It would be beneficial to also take regular rest time from screens and free our minds from distractions. A body generally well-rested is the key to achieving relief from pain. 
• - Improve posture. This can be achieved by using a cushion to support the back whilst sitting, or by investing in a good quality mattress and pillow.  It’s also important to try to get in the habit to sit up and assume a straight posture when sitting for a long time, for example, whilst working at the computer. It might be helpful to ask for peers’ assistance in achieving this, for example by asking a colleague to remind us to straighten up our posture when they notice we are slouching a bit on the chair.
• - Work with a trainer or partner when exercising to make sure to perform the correct movements. You might also take a video to check on yourself, but it is important to always remember that technique comes before lifting or speed!
• - Another good tip would be to ask for a Gait analysis when purchasing a new pair of running shoes. Your running style is crucial to determine what type of shoes you need. Some shops also offer this service for free.

And then of course, as mentioned before, it is important to start treatment with Rehab or Physiotherapy.  This is where my own expertise comes into place: remedial and sports massage are great to take effective action on lower back pain. As a therapist, I would work with a mixture of trigger point therapy and stretching to promote flexibility in the muscles.

 Charlotte:

Your spine, or backbone, is made up of 33 fused and unfused bones, or vertebrae, that are separated from one another by a gel-like disc. There are 26 vertebrae in your spine and the rest in your coccyx. The vertebrae enable you to stand and bend while safeguarding your spinal cord. Numerous issues can alter the anatomy of the spine or harm the vertebrae and the soft tissue around them. They consist of:  

• Infections 
• Bone changes that occur with aging, such as spinal stenosis and herniated discs; 
• Underlining health conditions;
• Conditions including ankylosing spondylitis and scoliosis.

The pain associated with spinal disorders is frequently brought on by bone abnormalities that impose pressure on the spinal cord or nerves. hence, they can restrict movement. Depending on the condition, different treatments are available such as surgeries or back braces, rehabilitation, massage, postural correction, and pain relief.

The lumber (L1-L5) and sacral S1-S5 regions are the most reported nerve pain sites. Although the pain in these areas can be excruciating and affect one's ability to sit or walk, the sacral region is the best place to injure of the two because it significantly lowers the likelihood of needing a wheelchair and has a higher recovery rate. Although the healing from nerve impingement cannot be estimated in terms of time, most patients recover from a pinched nerve with rest and other conservative treatments within a few days, weeks, months, or years, depending on the severity. Rest, relaxation, muscle release, symmetrical stretching, and avoiding overuse are the main keys.

Flexibility, regular exercise, core strength, and postural alignment are key to enabling a stable and healthy spine, a good way to test if it is nerve related is to sit on a chair, lean forward a fraction and raise one leg then repeat on the other leg, if the movement is restricted, catches or feels over tight it normally is connected to the nerve, this test identifies the location of the impingement, although it’s important to note that if the leg rises more than 80/90 degrees there is no nerve pain and most likely, the pain is due to a weak or tight hamstring.

Other aspects that might affect the scaffolding of the spine are the sacroiliac joint which connects the hip bones (iliac crests) to the sacrum, and the triangular bone between the lumbar spine and the tailbone (coccyx) The primary function of the sacroiliac joints is to absorb shock when the upper body collides with the pelvis and legs. The sacroiliac joint doesn't move much in everyday life. Small movements at the joint help with tension absorption and forward/backward bending. The joint is reinforced by sturdy ligaments, some of which cross it at the back of the pelvis. The sacroiliac joint is thought to be the cause of 15% to 30% of cases of lower back pain nowadays.

A good way to indicate if the sacroiliac joint is stuck or not engaging is if you bend your knee up to your chest whiles standing (with one hand on the wall for support), and if one leg moves better than the other,  normally that means the lower back needs stretching and releasing. An easy stretch is to lay on your back and hug your knees and slightly wiggle your hips, or sit in a chair and lean forward and concentrate on your breathing and try to get lower to the floor and feel the stretch down the lower back, if you feel pulling down on the leg that’s fine, it means one side is tighter than the other. 

The piriformis and gluteus maximus muscles are two other muscles that support the sacroiliac joint's healthy operation. While weak, this can exhibit sciatic tendencies, be extremely tender to sit on, cause pain when standing for extended periods of time, and give the appearance that a person has no bottom. The best thing is to stretch them, the Pigeon stretch pose in yoga is a good one, or sit on a tennis ball/therapy ball and cross your leg over the other knee to increase the stretch.

I reckon the best thing to do is to book in with your therapist, so that we can identify where the issues are, offer postural correction and release the tension to finally make you pain-free!