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Lower Back Pain: Causes and Remedies

Injury prevention & Rehab
Lower Back Pain (LBP) is one of the most common reasons why an individual visits the physiotherapist or orthopaedic surgeon. Almost every individual will face lower back pain at some point in their life.

Causes of LBP: There can be several causes of LBP but they are broadly classified into two categories viz. Specific and Non-Specific LBP. Specific causes are fracture, cancer, infection and ankylosing spondylitis etc. In addition, radiculopathy and cauda equina syndrome are some of the rare causes of lower back pain in the Specific LBP category. When serious and specific causes of LBP are ruled out, the LBP is said to be a non-specific LBP. This category accounts for the majority of present-day primary care patients. It is also called as Mechanical LBP and is not caused by any anatomical disorder. Let’s talk about Mechanical LBP today. Mechanical back pain is a malady that troubles the millennial generation. Hunched on their chairs with their fingers typing furiously on their keyboards and leading a sedentary lifestyle, each and every one of us has suffered from it at some stage or another. What causes mechanical back pain? Common causes include: Muscle imbalance Acute trauma Lumbar strain or sprain Poor ergonomics Poor posture Classification Depending upon the duration of the pain, Mechanical LBP can be classified as Acute, Sub-acute and Chronic. The diagnosis is made after the specific causes of low back pain are ruled out. The radiological findings of Mechanical LBP will be absolutely normal and that’s how one can distinguish between Mechanical and Specific Lower Back Pain. But, let’s not rue the fact that it affects all individuals at some stage of their life. The good news is that only 5% of the mechanical LBP is intractable and requires treatment. Rest 95% can breathe at ease. It is self-limiting and can be prevented if one takes care of certain things. Prevention Is Better Than Cure Mechanical LBP can be prevented through corrective exercises. In order to prevent Mechanical LBP, certain precautionary measures can be taken. The commonest preventive measure is to make sure you limit the period for which you remain seated in one place i.e. walk after every 20-30 mins. around your workspace In addition, some simple ergonomic changes can also be helpful. These include: Sitting reclined at approximately 120 degrees reduces the pressure over your discs. Proper lumbar support lowers the intra disc pressures compared to chairs without lumbar support. Wider chairs with armrest help in keeping your knees wide apart and avoid a slumped posture which can occur when the knees are close to each other. A 90-degree angle should be formed at your elbow in relation to your desk where you rest your forearm, this aids in relieving overactivity of trapezius and other neck and upper back muscles. A footrest is a must to keep your blood circulation intact and relax the leg musculature. Strengthen Your Core Mechanical LBP can also be prevented by strengthening the core and glutes which are usually weak in people who suffer from lower back pain. To do this, the following exercises can be beneficial: Glute Bridges Planks Cat/Camel Pose Back Extension/ Bhujangasan Hamstring 90-90 stretch Child Pose We have already seen these exercises in detail in the September issue of FITMAG. These simple preventive measures will definitely help relieve your Mechanical LBP but what do you do when the pain has already set in? Most of us will term it ‘muscle spasm’ or ‘catch’. That, my friends, in medical parlance, is an Acute Mechanical Lower Back Pain. Acute Mechanical LBP Lifting or pushing some absurdly heavy object or weight is, very often, the cause for muscle spasm. Muscle spasm or catch is a result of sudden involuntary muscle contraction leading to tightness, overuse, weakness and pain. If the back muscles are under spasm, the first line of action should be to avoid postures and activities that produce pain. It can be managed conservatively by providing enough rest, icing or hot water fomentation. Once the pain subsides, one can start working on strengthening and stretching the weak and tight muscle’s respectively, in order to avoid recurrence of the episode. Massage is also one of the adjuncts to the basic stretches and strengthening protocol. It helps reduce pain and spasm by increasing the blood flow and removing the accumulated metabolites. However, one word of caution here. One should not get a back massage, when in severe pain, as it can worsen the condition. How Low Back Pain Can Become Chronic Chronic back pain is caused by multiple acute spinal micro traumas that accumulate throughout the day due to bad posture, incorrect rotational movements of the spine and unduly heavy load lifting. This causes the sensitisation of the damaged tissues and the same small movements now cause intense and long-lasting pain. As adequate time is not given to heal the micro-traumas, the pain ends up worsening. Everyday movements, postures and loads matter! By learning the proper lumbar spine mechanics from a trained physiotherapist and applying the movements and posture principles daily, the lower back pain can be slowly but surely resolved. DISCLAIMER: In case of persistent pain, contact a physiotherapist and don’t try different unknown therapies and remedies on your own. LBP is the leading cause of work-related disability in today’s world. The fact is that it can be easily prevented by taking simple precautions, practising ergonomics, understanding the lumbar spine mechanics and learning and applying the principles of correct posture and movements. AUTHOR CREDITS: Ismat Khoja
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