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Understanding Lower Back Pain: Symptoms, Causes and Management.

Updated: May 25

Author: Kaveh Daei Hagh DPT, M. Clin Ex Phys, B. Ex Sp Sci. Owner and Director of Stand Sure Physiotherapy.


Introduction:

Lower back pain is a prevalent condition that affects millions of people worldwide, impacting daily activities and overall quality of life. In this comprehensive guide, I’ll explore the most common causes of lower back pain, their symptomatic presentations, and effective management strategies for acute, subacute, and chronic stages of back pain. The goal of this blog post is to provide some information that may assist the viewer learning a bit more about what they are feeling and having some clarity on appropriate course of action.

Older male having lower back assessment.

Triaging Lower Back Pain:

When evaluating lower back pain, healthcare professionals often triage patients into three main categories based on the underlying pathology and symptomatic presentation:


Serious Pathology:

This category includes conditions such as spinal fractures, infections, tumours, and cauda equina syndrome. These conditions are far less commonly the cause of lower back pain, however any thorough assessment should endeavour to rule them out as early as possible.


Symptoms may include severe, unrelenting pain, progressive neurological deficits (such as weakness, numbness, or loss of bowel/bladder control), and signs of systemic illness (such as fever or unintentional weight loss).


Should you be experiencing such symptoms - prompt medical evaluation and diagnostic imaging (such as X-rays, MRI, or CT scans) are essential to rule out serious pathology and initiate appropriate treatment.


Radiculopathy:

Radiculopathy refers to compression or irritation of spinal nerve roots, often resulting in radiating pain, numbness, tingling, or weakness along the path of the affected nerve.

Common causes of radiculopathy include herniated discs, spinal stenosis, and foraminal narrowing.


Diagnosis may involve clinical examination, neurological assessment, and imaging studies to identify the specific nerve root involved. This will guide targeted treatment approaches - of which conservative, exercises based treatment is included.


Non-specific Lower Back Pain:

Non-specific lower back pain refers to pain and discomfort in the lower back without identifiable structural or neurological pathology.


This category encompasses the majority of lower back pain cases and may result from muscle strain, ligament sprain, degenerative changes, or psychosocial factors. Management typically focuses on conservative measures such as pain relief, activity modification, physical therapy, and addressing contributing factors such as poor posture, stress or poor exercise habits etc.


Another reason it is known as non specific lower back pain is because of how difficult it is to diagnose these structures with certainty in clinic and even sometimes with imaging. Below I will try to give you an idea of some common causes of lower back pain and their respective presentations.

Health professional reviewing imaging results.

Common Causes and Symptomatic Presentations of Lower Back Pain:

Lower back pain can stem from various causes, each presenting with its own set of symptoms and complexities. Understanding these causes and their symptomatic presentations is useful when attempting to accurately diagnose and effectively manage lower back pain. Let’s explore the common causes and how they manifest symptomatically:


Muscle Strain and Sprain:

Often resulting from sudden movements or lifting heavy objects incorrectly, muscle strains and sprains cause localised pain and stiffness in the lower back. This discomfort may vary depending on the affected muscles, which include large superficial muscles and small intervertebral muscles.




Symptomatic Presentation: Localised pain, stiffness, and tenderness exacerbated by movement or activity. Pain should be somewhat consistent, worsening with increased stress on the affected muscle.


Herniated Disc:

When the soft inner core of an intervertebral disc protrudes through its tough outer shell, it can result from sudden movements or improper lifting techniques.



Symptomatic Presentation: Sharp, shooting pain that can radiate down the leg (sciatica - herniated disc protrudes on close by neural structures), sometimes causing numbness, tingling, or muscle weakness. Severe cases may irritate nearby nerves, causing additional symptoms.


Degenerative Disc Disease:

As spinal discs age and lose their cushioning properties, they may degenerate, contributing to lower back pain, stiffness, and reduced flexibility.



Symptomatic Presentation: Chronic, dull pain exacerbated by prolonged sitting or standing, and relieved by lying down.


Facet Joint Arthropathy/Degeneration:

The facet joints, located in pairs on the back of the spine, can become inflamed or degenerated, leading to pain and discomfort.



Symptomatic Presentation: Gradual onset of localised pain in the lower back, often exacerbated by extension and/or rotation, accompanied by stiffness, limited range of motion, and muscle spasms. Symptoms may be relieved with rest.


Spinal Stenosis:

Narrowing of the spinal canal or nerve root canals can compress the spinal cord or nerves, resulting in pain, weakness, and numbness in the lower back, buttocks, and legs.



Symptomatic Presentation: Pain, cramping, and weakness in the lower back and legs worsened by walking or standing, and relieved by sitting or bending forward.


Sciatica:

Compression or irritation of the sciatic nerve can cause radiating pain, numbness, and tingling sensations along the pathway of the nerve, often accompanied by muscle weakness and difficulty walking.



Symptomatic Presentation: Radiating pain, numbness, and tingling sensations along the sciatic nerve pathway, making walking and other activities challenging.


Each case may present with unique nuances, highlighting the importance of a comprehensive assessment and tailored treatment approach for optimal patient outcomes. Moreover, it’s important to recognise that there is often overlap between different causes/ symptoms of lower back pain, and individuals may struggle to accurately interpret or understand their own symptoms. In such instances, the expertise of a healthcare professional becomes useful in deciphering the complexity of symptoms and providing appropriate guidance and treatment.


Management Strategies:

During the early stages of rehabilitation, especially when dealing with lower back pain, there can be a natural inclination to avoid movement in fear of exacerbating the discomfort. While this instinct to protect the injured area is understandable, it’s essential to recognise the importance of movement and exercise in the recovery process.


Overdoing it with exercise can indeed worsen the pain and delay healing. However, the opposite extreme, underactivity, can be equally detrimental to recovery. When we avoid movement altogether, our muscles weaken, flexibility diminishes, and overall physical condition declines. This can perpetuate pain and prolong the rehabilitation process.

Senior citizen doing therapeutic exercise.

Engaging in appropriate movement and exercise early on can help to:

Promote Healing: Gentle movement and targeted exercises can facilitate blood flow to the injured area, delivering essential nutrients and oxygen to aid in the healing process.

Restore Functionality: Controlled movements can help maintain or improve range of motion, flexibility, and strength, allowing for a smoother transition back to normal activities.

Prevent Further Complications: Maintaining physical activity can prevent secondary issues such as muscle atrophy, stiffness, and reduced mobility, which can arise from prolonged inactivity.

Boost Mood and Well-being: Physical activity releases endorphins, which are natural mood enhancers, helping to alleviate stress, anxiety, and depression commonly associated with injury and pain.


When embarking on an exercise program during rehabilitation, it’s crucial to start gradually and choose activities that are appropriate for your level of fitness and the stage of recovery. Consulting with a healthcare professional can provide personalised guidance and ensure that you engage in exercises that promote healing and minimise the risk of further injury.


Acute Stage: 0-3 days

Pain Relief: Make sure to consult your doctor regarding pain medication if symptoms are severe enough. Especially if pain is impacting your sleep or appetite.

Gentle movement: within limits of pain, do whatever you can - however little! Walk a lap around the living room, a few pelvic tilts every hour, break up periods of prolonged sitting etc.

Ice/Heat Therapy: Applying ice packs or heat pads to the affected area can provide temporary relief from muscle spasms and discomfort.

Rest: Limiting activities that aggravate symptoms and allowing the back to rest and recover is necessary during the acute stage of back pain - but not for much longer!


Subacute Stage: 3 days - 16 weeks

Activity Modification: You will need to adjust your activity levels so as to avoid unnecessary exacerbations and facilitate recovery. Reintroduce physical activity gradually. Do not expect yourself to exercise at pre injury intensity.

Physical Therapy: Gentle stretching exercises, core strengthening, and manual therapy techniques can help regain range of motion, strengthen supporting muscles, and promote healing. Below are two exercises from Phase 1, of my 3 Phase Lower back rehabilitation program that you can try.


Pain Management Interventions: Epidural steroid injections or nerve blocks may be recommended for more severe or persistent pain that does not respond to conservative treatments. This decision is obviously made with input from your medical team.


Chronic Stage: 16 weeks +

Multidisciplinary Approach: Collaborating with a team of healthcare professionals, including doctors, physiotherapists, pain specialists, and psychologists, can provide comprehensive care and support for managing chronic back pain.

Cognitive-Behavioural Therapy (CBT): Addressing psychological factors such as stress, anxiety, and depression through CBT techniques can help individuals develop coping strategies and improve their overall well-being.

Lifestyle Modifications: Adopting healthy lifestyle habits such as maintaining a healthy weight, practicing good posture, and engaging in regular exercise can promote long-term spine health and reduce the risk of recurrent back pain episodes.


I earn a commission for products purchased through some of the links in this article, at no extra cost to you.

Useful Equipment for Lower Back Rehab:

Back Support Belts: These belts provide support to the lower back and abdominal muscles, helping to stabilise the spine and alleviate strain during activities that may exacerbate pain, such as lifting heavy objects or prolonged standing.

mediBrace: Back support brace

Lower back brace with amazon link below.

Mueller 255 Lumbar support

Lower back brace with amazon link below.

Lumbar Support Cushions: These cushions are designed to provide additional support to the lower back while sitting, helping to maintain proper posture and reduce pressure on the lumbar spine.

FORTEM lumbar support cushion

Lower back cushion with amazon link below.

Travel Ease Ergonomic Lumbar Support

Lower back cushion with amazon link below.

TENS Units: Transcutaneous electrical nerve stimulation (TENS) units deliver low-voltage electrical impulses to the skin over the painful area, which can help block pain signals from reaching the brain and provide relief from lower back pain.

Caremax 2.0 Classic TENS Machine

TENS machine with amazon link below.

Beurer EM49 TENS Machine


TENS machine with amazon link below.

Conclusion:

The first step is to triage lower back pain. By categorising lower back pain into serious pathology, radiculopathy, and non-specific lower back pain, we can ensure prompt and appropriate management. This blog post has attempted to shed light on some of the symptomatic presentations of common conditions of the lower back. To help you as the reader to better understand your symptoms.


Early intervention through activity modification, physical therapy, and pain management is essential for promoting healing, restoring functionality, and preventing further complications. Moreover, a multidisciplinary approach, including cognitive-behavioral therapy and lifestyle modifications, can provide comprehensive support for individuals dealing with chronic lower back pain.


Ultimately, with the right management strategies, individuals can alleviate pain, enhance their quality of life, and reduce the likelihood of recurrent episodes.


Frequently Asked Questions (FAQ)

What are the most common causes of lower back pain?

Lower back pain can arise as a result of damage to a range of structures, including muscle strains, herniated discs, degenerative disc disease, facet joint arthropathy, spinal stenosis, and sciatica.


What are the typical symptoms of lower back pain?

Symptoms of lower back pain may include localised pain, stiffness, tenderness, radiating pain, numbness, tingling sensations, muscle weakness, and difficulty with certain movements or activities.


When should I seek medical attention for lower back pain?

If you have severe and ongoing lower back pain that doesn’t change with movement and is accompanied by leg pain, numbness, weakness, or difficulty controlling your bladder or bowels, seek medical help immediately. Also, if you experience unexpected weight loss, night-time pain, I or signs of systemic illness or infection, don’t delay in consulting a healthcare provider or visiting the emergency room.


How is lower back pain diagnosed?

Diagnosis of lower back pain typically involves a thorough medical history, physical examination, and possibly imaging studies such as X-rays, MRI, or CT scans to identify the underlying cause of the pain.


What are the treatment options for lower back pain?

Treatment for lower back pain depends on the underlying cause and may include activity modification, graded rehab exercise program, massage/ manual therapy, heat pack, over-the-counter or prescription pain medications, injections, and in some cases, surgery.


Are there lifestyle changes or preventive measures I can take to reduce the risk of lower back pain?

Yes, maintaining a healthy weight, exercising regularly to strengthen the core and back muscles, practicing good posture, using proper lifting techniques, avoiding prolonged sitting or standing, and using supportive ergonomic furniture and equipment can help prevent lower back pain.


How to reach me?

If you are interested in booking a Telehealth or in clinic consultation with me - you can book online below, reach me via text or WhatsApp on +61 426 921 045 or email standsurephysiotherapy@gmail.com and we can make it happen!


I am also the co founder of On Track Online Training with my good friend and colleague Tonu Liiband, an elite strength and conditioning coach. We have teamed up to bring to you what we believe to be a very high quality online health, wellbeing and exercise service and community. Watch this space for more information very soon.


If you would like to learn a bit more about me I have written a blog post explaining exactly that here: https://www.standsurephysio.com/post/getting-to-know-kaveh-hagh-your-local-physiotherapist-and-exercise-physiologist


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