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Lower Back Pain. Causes and Treatments


Lower back pain is a very important and major player in public health, which can highly affect productivity, work ability and even life. To handle lower back pain, it is important not to stay in bed, but try to be active and do mindful exercises.

Prevalence of lower back pain

About 60 to 80% of people experience lower back pain in their lifetime. An important fact is that lower back pain (LBP) in childhood predicts LBP in adult life.

A study combining 28 countries analyzed lower back pain prevalence in adolescence. The study noted that many adolescents have lower back pain monthly or more frequently and that this prevalence increases with age. 26.4% of adults from the United States report that they felt back pain at least a day in the past three months. This type of pain is the most common in the U.S.

What is lower back pain?

To understand lower back pain, it is important to have basic knowledge about the spine. Let’s take a look at the anatomy of the spine.

The vertebral column consists of:

  • Cervical part with seven vertebrae (lordotic curve).
  • Thoracic part consists of 12 vertebrae (kyphotic curve).
  • Lumbar part consists of five vertebrae (lordotic curve).
  • Coccygeal region has three to five fused vertebrae (kyphotic curve).

The lumbar spine vertebrae are the biggest, as well as the lumbar spine discs, because they need to absorb loads from the chest and cervical spine and transfer it to the pelvis and lower limb.

The five segments of the lumbar spine together provide the flexion from standing more than 50° (± 28.0°) and rotation about 7 to 7.5°. So the load acts on the lumbar spine in flexion and rotation, especially when we lift heavy things. The method of ergonomic weight lifting can help to avoid LBP or not provoke or repeat it.

The sacrum is lower than the lumbar spine. It connects with the pelvis at the sacro-iliac joint. Why is this joint so important? It transfers the load between the lumbar spine and your extremities. In some cases, the sacro-iliac joint can be the source of lower back pain, because of damage to your ligaments, shear forces, inflammation and soft tissue injuries.

Your coccyx attaches to muscles to create the pelvic floor. Ligaments and pelvic tendons also attach to the coccyx and support and stabilize your body in a sitting position.

The lower back is defined as extending from your twelfth rib to the iliac crest and the pain here is divided into non-specific and specific LBP.

Non-specific lower back pain is pain without a known cause and represents about 90 to 95%, while the remaining 5 to 10% represents specific lower back pain.

Specific lower back pain is defined when one of these conditions appear: cancer, tumor, disc herniation, vertebral fracture etc., while non-specific lower back pain does not show visible changes in imaging tests and no specific cause can be identified.

Lower back pain is divided in three phases of symptoms duration:

  • Acute LBP, which lasts up to 4 weeks.
  • Subacute pain, which lasts from 4 to 12 weeks.
  • Chronic LBP, which lasts more than 12 weeks.

Also, it is important to know about the presence or absence of radicular symptoms – such as lower extremity pain, weakness or paresthesia – which are the result of nerve root impingement.

It’s essential to act during an acute lower back pain episode. People who seek medical care during the acute back pain phase manage their pain in the first month, compared with those who do not seek medical care.

Factors that can cause lower back pain

Specific lower back pain has radiological proof of cause of spine pain. It can be caused by:

  1. Lumbar herniated disc.
  2. Degenerative disc disease.
  3. Facet joint dysfunction.
  4. Sacroiliac joint dysfunction.
  5. Spinal stenosis.
  6. Spondylolisthesis.
  7. Osteoarthritis.
  8. Deformity.
  9. Trauma.
  10. Compression fracture.
  11. Infection.
  12. Tumor
  13. Autoimmune disease.

Factors that can lead to non-specific lower back pain include:

  • Lifestyle (prolonged seated position; low physical activity etc.).
  • Obesity.
  • Physiological factors.
  • Emotional and psychological factors.

According to literature, individuals who suffer from lower back pain have additional pain in other body areas and also have mental health problems when compared with people who do not have lower back pain.

Emotional and psychological factors – anxiety, depression, pain-related fear behaviors – lead to poor prognosis of non-specific lower back pain. So it is very important to review the biopsychosocial factors which see illness as the interaction of cellular, tissue, cognitive and interpersonal factors.

Guidelines to reduce lower back pain

Non-specific lower back pain does not have any pathological cause, so there is no specific treatment for this condition.

Most non-specific lower back pain is related to physical and physiological factors, lifestyle, obesity, and depression. However, the management of the pain can include education, non-pharmacological therapies and analgesic medicines.

Non-pharmacologic therapies may include:

  • Exercise.
  • Manual therapy.
  • Massage.
  • Acupuncture.
  • Superficial heat.
  • Low-level laser therapy.
  • Lumbar supports.
  • Pilates.
  • Yoga.
  • Tai Chi.
  • Motor control exercises.
  • Psychological therapies.

It is important to mention that bed rest should be avoided in most cases. Instead, a little movement or going to work is necessary to treat lower back pain conditions. During chronic lower back pain it is important to practice mindful exercises, such as Yoga, Tai Chi and Qigong. According to this study, Tai Chi has a superior effect compared with conventional exercises or core training in reducing pain.

There are interventions to prevent lower back pain, by limiting exposure to risk factors: use of lifting devices in workplaces, braces to support the spine, short and active breaks during working hours, especially in a prolonged sitting position and use of ergonomic furniture.

Conclusion

About 60 to 80% of people experience lower back pain in their lifetime. To handle lower back pain, it is important not to stay in bed, but to be active and do mindful exercises.

Key take away

  • Lower back pain increases over time.
  • Act during an acute lower back pain episode, to manage pain quicker.
  • It is strongly recommended to have non-pharmacologic treatment for patients with chronic lower back pain. Instead, use rehabilitation, exercises, acupuncture, mindfulness- based stress reduction and mindful exercises such as Tai Chi and Yoga, and progressive relaxation.
  • The bed rest during LBP should be avoided in most cases and a little movement or going to work is necessary to increase the healing process.

Resources

National Library of Medicine. Perceived body discomfort and trunk muscle activity in three prolonged sitting postures.

National Library of Medicine. An international survey of pain in adolescents.

American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians.

Science Direct. Anatomy of the vertebral column.

National Library of Medicine. Functional anatomy of the spine.

National Library of Medicine. Materials for the Spine: Anatomy, Problems, and Solutions.

National Library of Medicine. Sacroiliac joint fusion for low back pain: a systematic review and meta-analysis.

National Library of Medicine. Biomechanics of the sacroiliac joint: Anatomy, function, biomechanics, sexual dimorphism, and causes of pain.

National Library of Medicine. Low back pain.

Lancet. What low back pain is and why we need to pay attention.

National Library of Medicine. "Selling" chronic pain: physiotherapists' lived experiences of communicating the diagnosis of chronic nonspecific lower back pain to their patients.

National Library of Medicine. A Comprehensive Review of Over the Counter Treatment for Chronic Low Back Pain.

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