Lower Back Pain

Lower back pain is very common and can generally be classified into acute lower back pain and mild to moderate lower back pain. It is not always possible to make a precise diagnosis of a specific back injury or condition which might be causing lower back pain. However, this should not prevent the back pain from being managed or treated.

Acute Lower Back Pain

Severe low back pain usually comes on suddenly and caused by a minor movement such as bending over. The pain may increase over a couple of hours as inflammation develops. The pain is usually in the lumbar area of the spine but can radiate into the buttocks.

What can be done for acute or severe or acute lower back pain?

• Get into a position of least pain. Suitable positions may be lying on the back (supine), on the front (prone) or on the side. Whatever the most comfortable position for the patient is best.
• If it hurts dont do it. Avoid movements or positions that make the pain worse.
• Bed rest may help but not for more than two days as resting for too long can make back injuries worse. Often movement is needed after the initial pain and inflammation has gone.
• Taping the lower back can relieve pain and give support, as can use of a specialist back support belt or back brace.
• The doctor may prescribe NSAID's (non steroidal anti inflammatory drugs) to relieve pain and muscle spasm.
• Electrotherapy can be used to relieve pain. For example TENS (electrical stimulation) or magnetic field therapy or ultrasound therapy may be helpful.
• Avoid sitting in the same position for long periods of time.
• Very light massage techniques may help reduce pain.
• Use of an inversion table to apply gentle traction may also help relieve symptoms.

Once the severe back pain symptoms have gone then the patient is usually treated as if having mild to moderate back pain and more intensive treatments can be started.

Mild or Moderate Low Back Pain

Mild or moderate lower back pain is the type of pain that would be associated with chronic or long term back problems. Longer term back pain is usually caused initially by an injury, usually to the joints in the back but over time other structures in particular soft tissue such as muscles contribute to the pain.

Muscles will tighten up in response to a back injury and if left they can tighten, weaken or adaptively shorten causing changes in posture or movement which then also make the condition worse.

Symptoms of moderate low back pain

• An aching pain that may be constant or come and go.
• Pain may be on either side, both sides or in the middle. A common complaint is that the pain is in a band all the way across the lower back.
• There may be pain in the buttocks or hamstrings as well.
• A reduced range of motion.
• The 'slump test' may increase pain or show restricted movement.
• Tenderness over the spinus processes.
• Hypomobility (lower than normal mobility) in one or more of the intervertibral segments.
• Muscle spasms in the lower back and buttocks.

Treatment of mild to moderate low back pain

• Identify possible causes including:
  • Hyperlordosis (increased curve in the lower back)
  • Scoliosis (an S shaped spine)
  • Poor posture while sitting.
  • Poor posture while standing.
  • Pelvic instability.
  • Bad lifting techniques.
  • Sleeping in a bed that offers poor support.
• Reduce pain and inflammation through ice, NSAID's, electrotherapy and rest.
• Restore full range of movement.
• Increase flexibility and strength.
• Return to full sports specific fitness.

Because there are so many causes of back pain and so many back pain conditions and injuries no single treatment programme is going to work for everyone. Some methods may work best for some people, most would benefit from a combination of treatment methods and approaches.

It is often possible to make a diagnosis for patients with the following conditions:

• Fractures through direct trauma. There is often soft tissue injury associated with this kind of injury also.
• Nerve route compression with pain radiating down a specific part of the leg.
• Spondylolysthesis or stress fracture of the pars interarticularis.
• Spinal canal stenosis (more usually seen in older athletes).

The above conditions are thought to account for less than 10% of lower back pain. Back pain can be categorised into severe or acute low back pain and mild to moderate low back pain. Most people have mild or moderate low back pain.