The causes and symptoms of chronic lower back pain

Lower back pain is characterized by a feeling of pain around the lumbar region (curve of the back connecting the upper back and glutes- muscles in the buttock that are responsible for thigh movement) caused by muscle or ligament injury. The spinal area is most likely to be affected by lower pain as it may impair routine activities like walking and standing. Any lower back pain that lasts for more than ninety days can be considered as chronic.

Causes of lower back pain

There are plenty of causes for lower back pain. Anything that exposes the lumbar area of the spine to a level of stress beyond its capacity can cause lower back pain. These causes are-

1. Disorders of the discs

The spinal area in the lower back comprises of small bones called the vertebra, which are connected to each other by pieces of cartilage known as discs. These discs act as shock absorbers, and when exposed to excessive shock can cause the disc to bulge, resulting in herniated discs. Wear and tear of the discs can also occur.

2. Spinal stenosis

Spinal stenosis occurs when the area around the spine becomes narrow. It may affect the nerves surrounding the lower back, resulting in pain.

3. Wear and tear of the joints and ligaments

Normal wear and tear of the joints and ligaments cause difficulties in holding the spine in its proper position and this progresses with age. This may cause a vertebra to slide over another and affect the nerve endings, giving rise to pain.

Symptoms of lower back pain

The symptoms of lower back pain are usually a dull or excruciating pain in the lower back. It can also affect other parts of the body such as the hips and the legs. In case of severe pain, simple activities like walking, bending and sitting will be impaired.



The Causes and Symptoms of Chronic Lower Back Pain

About 80 percent of people all across the globe experience lower back pain at some stage in their lives. It is one of the most common reasons why people miss their work and appoint a physiotherapist. But lower back pain is an ailment that can be avoided with proper knowledge and some back exercises. In case your lower back pain is not under control and you have been neglecting it, you are susceptible to acute pain, sciatica, nerve pain and pain in other regions caused from a pinched nerve. Long-term pain in the back portion can lead to permanent ailments like degenerative disc disease or spinal stenosis.

Probable causes of lower back pain
Severe pain in the lower back region can be caused due to a herniated disc, back muscle pain, ligament strain or any other non-specific pain. An individual may also suffer from lower back pain due to systemic conditions like rheumatoid arthritis, fibromyalgia or ankylosing spondylitis. Though these causes are very common in most people suffering from lower-back pain, the diagnosis varies from person to person and to ensure the best care to alleviate the pain, you must consult a responsive musculoskeletal physiotherapist.

Stages for assessing and treating lower back pain
Managing the back pain is the primary objective of physiotherapy. In reality, back pain is the final symptom that is developed and the first thing that must be addressed.

Stage I
Back pain relief: The physiotherapist is going to use different types of tools and items to help the pain subside along with the inflammation. These include electrotherapy, acupuncture, ice application, soft-tissue massage and deloading taping techniques. Sometimes the physiotherapist may also recommend an anti-inflammatory drug if the pain is intolerable.

Stage II
Restoring normal strength: With the settling of pain and inflammation, you are more susceptible to injury because though your pain has subsided, your ligaments and muscles are weak. Your doctor will aim at restoring normal motion of lumbar spine, muscle endurance and strength, proprioception, balance and walking abilities.

Stage III
Restoring full body function: Depending on your daily chores and activity, your physiotherapist will aim at restoring the function of your back portion to keep you safe while performing the chosen activities. For some, it may be taking a slow walk around the park while for others it may mean taking part in some sports activity.

Stage IV
Preventing recurrence: Your physiotherapist will rehabilitate you to prevent further occurrence of this excruciating pain by suggesting proper postures, exercise and core muscle workout.

Each of these stages are important to help you get rid of severe back pain and with daily exercise, you can regulate your body and spare yourself from recurrence of this lower back pain.

Treating Chronic Lower Back Pain

Pain is unpleasant suffering caused by injury or illness. Back pain may be sudden/constant, dull, severe or not responding to short rest and medication. Constant pain in back in any region of spine for more than few days to weeks needs intervention.

Pain which is intense especially at night requires urgent visit to a specialist.

Sudden onset of pain in back with or without injury needs urgent attention.

Back pain with difficulty in walking, pain while getting up from position of comfort, pain during change of posture or pain after prolonged sitting (for work) can lead to serious permanent damage, if left untreated.

Pain which travels to one or both legs may be due to pressure on the nerve/s and if left untreated for long can lead to permanent weakness or damage.

Pain associated with numbness, tingling or weakness in legs, especially below the knees, commonly called Sciatica, needs to be investigated. Various spinal ailments can lead to weakness in one or two limbs or all four limbs. There may be associated or isolated numbness (loss of sensation to touch, pain or temperature) without back pain.

Numbness, tingling or weakness may be the only symptoms without any complaint or without history of back pain.

Problems related to bladder control which may be difficulty to control, hesitancy in passing or dribbling of urine. There may be associated constipation. Loss of bowel/bladder control is caused by pressure on spinal cord &/or nerves which may be due to injury, infection, disc prolapse or tumor.

Sudden swelling and redness in back usually happens after an injury or accident but sometimes are signs of underlying severe illness.

Loss of normal shape/curvatures of spine can present with or without pain. It can lead to forward, sideways or rarely backward bending.

Unintentional weight loss, loss of appetite, evening rise of fever or disturbed sleep with associated back pain/weakness/numbness needs visit to a specialist.

When Should You See Your Doctor in Back Pain?

Lower back pain can be one of the most physically debilitating things that can affect you and limit your mobility. Even if the pain isn t that acute, it could still signal something deteriorating in your lower back. While oral medications, topical creams or sprays can help in reducing pain, there are other effective remedies you can try on your own. These will be handy when you have no medications at hand. One of these is the hot and cold therapy.

Heat therapy for lower back pain

Heat works well with lower back pain as it can dilate blood vessels and improve circulation within the tissue. This will help in circulation and also result in lowering the pain. Heat therapy will also loosen up other muscles in the area and help soothe sore areas which have been taking the burden along with the lower back muscles. Some of the techniques that can be applied are:

1. All day heat wraps: These are specially manufactured belts or wraps which wrap around your abdomen and keep tightness and pressure on your lower back as well as supplying heat.

2. Electric heating pads: These are mechanized heating pads which generate heat with electricity. You can place them under you back and then either sit or sleep with it positioned behind you. However, ensure that you don t keep these for too long as they could burn your skin.

3. Hot Compress with towels or hot water bags: Use a clean towel and heat it over a conductive surface and apply it on your lower back. You can also use hot water bags for the same purpose.

Cold therapy for lower back pain

Cold therapy uses the principle of constriction of blood vessels as well as slowing circulation. This will help numb the area and thus help relieve the pain. Some of the ways these can be administered are mentioned below.

1. Ice towel: In this method, soak a towel in ice cold water, wring it to dry it and then apply on your lower back. This will numb the pain without transferring the sting of the cold or damaging your skin.

2. Ice packs: Put about half a kg of ice in a plastic Ziploc bag and pour water over the ice to just about cover it. Push out the air out of the bag and then lock it. Use this ice pack with a towel to ensure that you back doesn't get wet.

3. Ice gel packs: These are ready made packs, which can be bought from medical stores and kept frozen to be used whenever you need it in order to relieve lower back pain.

Treating Lower Back Pain Using Hot and Cold Therapy

Back pain is something that affects many people all over the world. Persistent and chronic pain seems to be one of the most common complaints. Middle back pain is back pain that is felt in the thoracic vertebrae region, which is located between the base of the neck and top of the lumbar spine. The ribs attach to a long, flat bone in the middle of the chest called the sternum and wrap around the back. In case, there is a nerve around there is squeezed, disturbed, or injured, you are likely to feel pain in different spots where the nerve goes through, for example, your arms, legs, chest and the stomach.

Some of the most common causes of middle back pain are as follows:

Middle back pain can happen as a consequence of injury or sudden damage or it can happen through strain or poor stance after some time.
The most widely recognized reason for middle back pain seems to begin from soft tissue problems or muscular irritation. These can emerge from poor stance, lack of strength, prolonged sitting in front of a computer, utilizing a heavy backpack, overuse injuries, (for example, repetitive movement), or injury, (like a whiplash damage brought about by an auto crash or as a consequence of a sports injuries).
The middle back is a moderately normal site for inflammatory, degenerative, metabolic, infective and neoplastic conditions.
Middle back pain and its dysfunctions are connected with various conditions, for example, essential and optional osteoporosis (particularly vertebral cracks and hyperkyphosis emerging from vertebral bone loss), ankylosing spondylitis, osteoarthritis and Scheuermann's infection.
Muscle strain, overuse or damage to the muscles, tendons, and discs that are backing your spine can also cause middle back pain.
Weight on the spinal nerves from specific issues, for example, a herniated disc.
A fracture in one of the vertebrae can also cause pain in this region.
Osteoarthritis created by the breakdown of ligament or cartilage that cushions the little joints in the spine.
Myofascial pain that influences the connective tissue of a muscle or gathering of muscles.
In uncommon cases, pain might be brought about by different issues, for example, gall bladder disease, cancer or an infection.
Getting hit hard in the back can also cause chronic pain.
Lift something too heavy may cause pain and a sudden pressure in this area.
A compression fracture of the vertebra can also bring about intense or chronic pain in the middle back. The injury may bring about a fracture, however in ladies over age 50 without critical injury or somebody known to have osteoporosis, an unconstrained vertebral fracture is possible.
Other contributing factors to injury include lack of strength which can be treated by a Pain Management Specialist using non-surgical methods.

Common Causes of Middle Back Pain

Most of us suffer from lower back pain at some point in our lives; be it from a sedentary lifestyle, spending hours at the office desk or from strenuous physical exercises. In most cases, a little bit of rest does the trick. However, if the lower back pain persists for 3-6 weeks, physiotherapy is recommended.

How does physiotherapy help?

The main purpose behind physiotherapy is reducing lower back pain and increasing muscle and bone function, so that such instances are avoided in the future. Physiotherapy is the first line of defence against lower back pain. More drastic measures such as surgery are undertaken once physiotherapy fails to do is job.

Physiotherapy is often recommended when the back pain is caused due to lifestyle factors, a minor injury like a fall or other moderate factors. For more severe back injuries, doctors recommend surgery straight away when there is no scope of performing physiotherapy.

Low-intensity back pain can be cured using a combination of heat packs, ultrasound wave therapy and Iontophoresis (using a localized current source to introduce medical ionic compounds to the body).

A physical therapy program for back pain usually has two components:

Passive physical therapy to help reduce the patient's pain to a more manageable level

Active exercises

Passive Physical Therapy - Modalities

The physical therapist may focus on decreasing pain with passive physical therapy (modalities). These therapies are considered passive because they are done to the patient. Examples include:

Heat/ice packs

TENS units

Iontophoresis

Ultrasound

Active Physical Therapy - Back Pain Exercises

In addition to passive therapies, active physical therapy (exercise) is also necessary to rehabilitate the spine. Here are some of the common exercises for back pain:

Back Stretch: Put your hands underneath your head while lying back. Bend your knees but put your feet on the ground. Roll your legs to one side and hold them there for 10 seconds. Repeat three times for each side.

Deep Lunge: For this, you need to kneel on one knee with the other foot pointed towards the front. Lift the back knee up and hold it there for five seconds and then bring it down. Repeat this exercise three times for each side.

One Leg Stand: This is the simplest of exercises. Hold on to a wall for support while standing and face towards it. Then slowly hold one leg and bend it behind you. Hold in the same position for five seconds before bringing it down. Repeat the process three times for each leg in five second gaps.

Physiotherapy for Back Pain

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