06 Apr Low Back Pain and Its Effects on Daily Life
Low back pain is a common health problem and major cause of disability. Back pain is an assembly of symptoms that affects people of all ages from children to the elderly.
Low back pain (LBP) is defined as pain and discomfort, localised below the coastal margin and above the inferior gluteal fields, with or without leg pain occurring. In other words, pain that occurs behind the lower rib margin and the proximal thighs (Physiopedia, n.d). The most common form of LBP is the ‘non-specific – low back pain’ pain with unknown causes or disease (Physiopedia, n.d).
Based on the duration of the pain, LBP can be divided onto the following subtypes (Physiopedia, n.d):
- Acute: an episode of pain that lasts for less than six weeks.
- Sub-acute: when the pain last between six to twelve weeks.
- Chronic: LBP that is persistent for more than twelve weeks.
Causes:
Low back pain manifests when there is a disruption to the way the spine, muscle and intervertebral nerves fit and work together. There are many of causes of LBP, and can be classified as:
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Congenital:
Skeletal irregularities, such as scoliosis – curvature of the spine, lorelosis – an abnormal exaggerated arch on the lower spine, kyphosis – excessive outward arch of the spine, and other abnormalities of the spine (NINDS, 2020).
Spina bifida, the incomplete development of the spinal cord and its protective covering that causes malformation of the vertebrae, abnormal sensations, and paralysis (NINDS, 2020).
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Caused by Injuries/Trauma:
Sprains, strains, and spams of the back can result in LBP.
Traumatic injury, from sports accidents or even a fall can injure tendons ligaments or muscles that causes pain as well as compresses the spine causing the discs to rupture or herniate (NINDS, 2020).
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Degenerative Problems:
Intervertebral disc degeneration occurs when the rubbery discs wear down due to aging and the discs losing their cushioning ability.
Spondylosis is the general degeneration of the spine caused from wear and tear that occurs on the joints, discs, and bones of the spine as people get older.
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Nerve and spinal Problems (NINDS,2020):
Sciatica, when something presses on the nerve that travels through the buttocks and extends down the back of the leg. People that experience sciatica may feel a shock-like or burning low back pain as well as a pain going through the buttocks and down a leg
Spinal stenosis, when the spinal cord becomes narrow and puts pressure on the spinal cord and nerves.
Spondylolisthesis, when the vertebra of the lower spine slips out of place and pinches the spinal column.
Herniated or Ruptured discs, occurs when the intervertebral discs are compressed and bulges outwards.
Infections such as osteomyelitis infection to the vertebrae, Discitis – inflammation that develops between the disc causing painful pressure on the discus, and sacroiliitis inflammation on the joint that connects the lower spine to the pelvis, creating pain in the buttocks and lower back that can extend into the legs.
Cauda equina syndrome, a ruptured disc that pushes into a spinal canal and presses on the bundle of the lumbar and sacral nerve roots. Permanent neurological damage may result if left untreated.
Osteoporosis, a bone disease that decreases the bone density and strength that can cause fractures to the vertebrae.
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Non – spine Sources (NINDS,2020):
Kidney stones can cause a sharp pain on one side of the lower back
Fibromyalgia is a chronic pain syndrome of widespread pain and fatigue
Tumors can press on and even destroy the spine, spinal cord, and nerves in the back.
Pregnancy however, the pain symptoms that is related to pregnancy goes away after giving birth.
Even though almost everyone can experience back pain, the following factors increase the chance of LBP emerging (NINDS, 2020).
- Age: low back pain typically occurs between the ages of 30 – 50 years with the pain becoming more common with aging.
- Fitness level: back pain is more common amongst people that are not physically active, a weak back and abdominal muscles cannot support the spine.
- Weight gain: obesity, being overweight and gaining considerable amounts of weight will put pressure on the back, resulting in LBP.
- Occupational hazards: having a job that requires heavy lifting, pushing, or pulling or any activity that involves twisting or vibrating the spine can lead to injury and back pain. Working at a desk can also contribute to back pain due to poor posture or sitting in a chair without proper support.
- Mental health: psychological factors such as anxiety and depression can influence the likelihood of back pain occurring. Stress can also affect the body by leading to muscle tension.
- Smoking: prohibits blood flow and oxygen to the discs causing the discs to degenerate faster.
- Backpacks being overloaded, can cause strain and muscle fatigue, especially with kids as their school bags are often weighted down by heavy books.
Effects of low back pain on daily life:
Patients with chronic LBP experience a poorer quality of life compared to individuals without the pain. This poor-quality of life is often due to:
- A negative self-perception, by patients when they are participating in social engagements.
- Feeling shameful and frustrated because it is difficult to perform daily living activities.
- Patients tend to feel unsupported and misunderstood which results in a lower self-esteem.
- The patient’s sense of self-efficacy is decreased due to the loss of autonomy and the inability to continue with their normal daily lives.
Treatment:
Acute will require a period of rest, medication to relieve pain and inflammation, and heat and ice may also help ease the pain, reduce inflammation, and improve mobility. Gentle stretching can be done but only when advised by a healthcare professional.
Chronic pain is treated with a planned approach, starting with manual therapy and exercise, and then advancing to secondary care including advanced pain remedy options.
Firstly, patients should start with medication such as aspirin or ibuprofen. If this fails to reduce the pain and inflammation then prescribed medication such as, NSAIDS, opioids, and antidepressants can be prescribed and monitored by a doctor. self-management can be combined with medication such as the use of hot and cold packs. Patients can return to normal activities as soon as possible and advised to exercise to strengthen the core and abdominal muscles.
The next step after this would be to add complementary and alternative techniques including acupuncture, transcutaneous electrical nerve stimulation and physical therapy, as well as spinal manipulation and spinal mobilisation.
If the pain is still persistent, surgery may be considered to relieve the pain, it must be noted that surgery is not always successful and is an option when primary care fails.
Recurring low back pain can be prevented by:
- Maintaining correct posture.
- Lifting heavy objects properly. Lifting from the knees and pulling the stomach muscles in.
- Gently stretching muscles after prolonged sitting.
- Maintaining a healthy weight.
- Wearing comfortable low-heeled shoes
- Sleeping in a foetal position, as it will help open up the joints in the spine.
- Quit smoking because smoking reduces blood flow to the lower spine.
At OsteoVision we specialise in treating lower back pain. Book an appointment with us if you are experiencing any of these symptoms and a member of our team will assist you with a treatment plan, that is specific to your age, fitness level and diagnosis.