The Causes and Treatment of Low Back Pain

Dr. Jill Murphy, DPT, LAT, CSCS

Back PainIt is a well-known fact that 80% of us will face the challenge of low back pain at some point in our lifetime. While the medical community is confident in that statistic, we are sadly far from clear cut in how you might both prevent and treat low back pain. While lots of research has been reported on low back pain in the past 40 years, much of the new research actually discounts the old results. What’s the everyday person to do? Read on for the best advice of the moment here, but we concede, this all might change again in 20 years.

The possible contributors and causes of low back pain and its frequent acquaintance sciatica are many. Increased body mass, poor lifting mechanics, poor hip and abdominal strength and stability, unlucky genetic factors, sedentary lifestyle, smoking, poor seating surfaces, poor posture, trauma and motor vehicle accidents, depression, and life stressors can all increase your risk of experiencing low back pain and/or hamper your recovery from low back pain.

That’s a very long list, so what are the basic things you can do to reduce your risk of low back pain and sciatica? Work out in a healthy and balanced way, performing hip and abdominal strengthening/stabilization exercises (NOT sit-ups and crunches, keep reading for the reason why), and changing your posture throughout the day are the best ways to improve your spine’s ability to respond appropriately to the micro-traumas of everyday life, so you never reach the macro-trauma of low back pain limiting your daily activities.

What causes low back pain? Your low back is one of the first areas of your body to display the aging process. The majority of 30 year olds who obtain an MRI of the lumbar spine will find active disc degeneration to some extent, whether or not any pain in the low back is reported. Most of us begin this process sometime in our 20’s, blissfully unaware of the insult our spine is under as we chase our degrees, careers, and spouses, and eventually even the little ones that tend to come along. These changes in our discs, little tears, fissures, and loss of disc height are truly a normal part of the aging process. Most of the time, we feel no pain from these phenomena. However, these changes are easily blamed for the pain patients may feel early in life, because they are the only deficit seen on MRI that can be pointed out in imaging as the reason for your back pain. Not shown on MRI could be a variety of other reasons for your back pain, including facet joint tightness, a facet joint disc pinch (impingement), SI (sacroiliac) joint sprain or tightness, muscle strain or spasm, muscle imbalance on both sides of your trunk, and soft tissue tightness in the muscles around your spine and pelvis.

JengaWhile each of the above listed entities can be creating your pain, they all contribute to the overall problem of spinal instability. Ever play the game Jenga? You build a tall, stable tower out of many little wooden pieces, only to pull them out one by one and hope and pray the tower stays standing during your turn. This is the perfect analogy for spinal instability. Our spine feels stresses and micro-trauma from a variety of sources, and all of these insults eventually lead to our spine’s inability to be stable enough to deal with the stresses our bodies face during the daily wear and tear of life.

The symptoms of spinal instability may be quite familiar: achiness, small trauma creating a large amount of pain, needing to shift in your seat and change your posture frequently whether sitting or standing, less pain with movement like walking compared to being at rest, shifting or juddering in your spine when you bend forward or backward, and symptoms that worsen as the day progresses. If you are treated by the typical medication, X-ray, and or MRI, you will find some benefit, but probably not very much.

If we know the overall cause, a lack of stability in your tower or spine, then the treatment becomes fairly obvious- we need to re-build or fortify the tower. What you need are stabilization exercises intended to stabilize and support your spine, so you can better tolerate the everyday stresses of life. You may also benefit from some hands-on, manual therapy treatment to alleviate some of your tight joints and muscles to allow you to participate in your exercise program. You also will likely need some education in good postures for sitting, sleeping, and standing, as well as safe body mechanics for bending, squatting, lifting, and twisting. If you have pain down your leg, more commonly referred to as sciatica, you will be shown some neural mobilization or flossing exercises.  Finally, you will definitely benefit from functional activity training to teach you how to perform daily activities in a safe way for your spine, as well as someone guiding you to a safe return to, or an easy introduction to some aerobic exercise and strength training to further fortify your body to prevent re-occurrence of your back pain.

The stabilization exercise approach is not the typical sit-ups and crunches performed to strengthen the abdominals in the 1980’s. No, research has told us we need to strengthen specific muscles in the abs, not the already strong rectus abdominus, but rather transversus abdominus and the internal and external obliques that are amazingly weak in the overwhelming majority of humans. Research has also told us to address our culture’s tendencies toward impressive gluteus medius and maximus weakness, as well as the rest of the pelvic floor muscles, as we need to create a strong foundation for our towering spine to flourish.

Disc DegenerationWhat about surgery, you ask? Isn’t it a much quicker, more modern road to recovery from low back pain? Patients have found that surgery is not the option for the functional spinal instability described above. While surgery is excellent and appropriate for cases of severe disc bulges that actually impinge on the nerve root and create weakness in the legs to the extent of tripping when walking, that case is the exception to the majority of Americans facing low back pain. In fact about 98% of cases of low back pain are effectively treated with conservative, non-surgical approaches such as a spine stabilization program along with other physical therapy techniques. It is not a quick, easy surgical solution, but it is a safe, effective, and long-lasting approach to building a healthy back capable of lasting throughout a lifetime of wear and tear.

While there is not enough space here to outline all of the exercises included in a typical spine stabilization program, please visit our Patient Info page for the full series of stabilization exercises for low back pain in our Build a Better Body series.