I still have to meet the one person who hasn’t experienced a bout of lower back pain. The lower back is made up of many different structures that can cause pain (muscles, nerves, tendons, ligaments, discs, joints, and vertebrae). Irritation, damage or injury to these structures may start with slight discomfort but may progress to cause severe pain. The pain can result in severe dysfunction and disability. In a nutshell, back pain will affect 80% of the general population.
Accurate diagnosis of the underlying cause of the pain is the first step in obtaining effective pain relief. Without an accurate diagnosis, the treatment becomes ineffective, wasting your time and money. Above all, being treated without a diagnosis is a recipe for failing therapy.
What causes lower back pain?
When the structures that should support the back and doesn’t do its job the spine is unstable. The spine struggles to keep its upright position. To understand these structures and why they are not supporting the back as they should we investigate.
Imagine your back’s like a suspension bridge which is held together by cables and pulleys (the muscles and ligaments). One of the main muscular supports is the Multifidus muscles and the Transverse Abdominis (TA) muscle. These muscles act like scaffolding or support struts to hold the lower back in place, while the other muscles move your back into different directions. Importantly, when these muscles don’t activate like they should the whole lumbar spine becomes vulnerable and moves beyond its normal limits. This excessive movement can cause increased wear and tear on the joints or discs.
Fascia is a dense connective tissue that reacts to the forces acting on it. These connective tissues are like a spiderweb that connects EVERYTHING in your body. So these fascial strands can cause restrictions due to excessive movement into a specific direction. This, in turn, restricts the normal movement of the joints in the back and that leads to other problems. In addition, the opposite direction can then also have too little tension.
Lower back Joints
Facet joints are the connections between two vertebrae and looks like people holding hands. The palms of the hand represent the two joint surfaces that can glide, slide and move on top of each other. In some cases, these joint become compacted due to stiffness in the back or more commonly from increased constant pressure. This constant pressure occurs when people sit for a long period (2-3 hours) without getting up. That is to say that sustained positions can place undue strain on the joints of the back.
You can imagine the pressure of your upper-body resting on a few small joints in your back for hours on end. Compare this to how long you are able to stand on your feet before you start getting restless. Naturally, you want to sit down in order to relieve the pressure off your feet. For example occupations like Lawyers, Auditors, Accountants, Programmers typically sit around 9 – 12 hours a day. Also in the same vein, occupations where you bend over forward causes similar issues.
Misconceptions regarding lower back pain
Back pain usually starts as stiffness before you experience pain. That feeling of something is about to go wrong. It’s inevitable that if you do not change the way you use your back and identify the problem, it will result in injury. However, there is the possibility of it relieving by itself. Also if you feel no pain, we assume it has healed, but I would like to warn you about how the body can start to compensate.
Your body has an amazing ability to repair itself and can provide temporary relief from an acute episode of back pain. Unfortunately, overcompensation offers only short term relief. Due to this compensation, 62% of those with pain will come back in the next 12 months. The problem is the back pain never goes away; you just stop doing certain activities. In short, you learn to live with it rather than work to rid it.
How can we help?
We identify these pattern during an assessment and prevent a perpetual cycle. We can stop these episodes or flare-ups from becoming longer and longer. Treatment prevents the pain from returning faster and more severe with each episode. Your body is extraordinary in its ability to heal and restore itself, up to a point. At a certain stage, adequately repair is impossible due to the amount of misuse and abuse. After a while, you start to feel the pain again. This pattern then repeats endlessly, and most people will tell me that they have had back pain for several years. After that, they give up on doing rehabilitation because it seems to be part of their lives.
Types of lower back pain
These are not concrete, but a good guideline to which structure produces what type of pain
Symptoms of lower back pain
- Dull, burning pain
- Sharp stabbing pain
- Single point or over a broad area
- Occur with muscle tightness or joint stiffness
- Start suddenly or slowly get worse
- During and after activity
- Pain and stiffness when getting out of bed
- Pain when sitting or driving
- Unable to stand upright after sitting
- Electrical pain when bending forward
- Unable to bend forward
- Numbness & tingling in legs & butt
- Sharp electrical pain when walking
- Unable to walk without pain
- Pain when lying down
- Numbness in legs
- Sharp Pain with breathing, sneezing & coughing
- Weakness of leg muscles
- Legs giving away when walking
- Dead feeling over skin
- Unable to control bladder
- Pain when sitting on the toilet and bearing down
- Fainting or dizziness
- Skin color changes on legs
If you read the previous section, you will understand my next statement. Your body is a interconnected machine that has different structures, performing various jobs thus it’s critical to identify the structure/s at fault before we start with treatment. We have heard so many stories about patients getting advice from family members, friends, or following a exercise program on the internet. These people tend to get frustrated because in most cases, they feel that “nothing seems to help“. These people tend to give up before they have even started the process. You would not take smarties and expect it to cure a cold. In the same way you cannot expect unspecific treatment to improve your condition.
Why doesn’t my medication work?
How can treatment or advice be given without knowing what the exact problem is?
This is why two people, both with back pain, can take the same medication and one can improve and the other doesn’t. The one’s problem is directly related to the structures that the medication acts upon. If the medication is designed to act on the muscles, for example a muscle relaxant then if the first person’s pain was mainly muscular then his pain would improve. However if the second person takes the same medication, but they have a joint problem, it will have no or little effect on his pain.
The above mentioned scenario explains why different movements, exercises, techniques, medication, and any form of treatment must be guided by the effect on the structure at fault, and not just a shot in the dark. Myths such as ‘it will always be weak’, ‘it’s hard to fix’, ‘it won’t get better’, ‘there is nothing that can be done’ — is not true. We specialize in difficult cases and have had great success with these “hopeless cases”.
Our experience with lowerback pain
The biggest problem we as physiotherapists face are that people wait too long! It is disheartening when we see a patient that initially had a minor issue, but only consults us months. The problems have escalated and developed into a complex series of compensations.
A good example starts with lower back muscle stiffness with no current pain. The muscular tightness results in joint compression as the muscles press the vertebrae together. Furthermore, the disc (shock absorber) gets squashed and starts to degenerate. The compression entraps the nerves that run down the legs. Now you are sitting with excruciating sharp electrical pains that shoot down your leg. The pain is so severe you barely want to move.
Instead of just treating the muscle stiffness, now we have a long process of undoing all the other problems. The issue now has a joint, nerve and disc component. Early treatment is faster and more cost-effective. Treatment started within the first three days from the onset of pain is the ideal.
Even if you suspect it’s a small problem. Please don’t ignore it. Ask a medical professional, ask the experts!
When do you need scans for lowerback treatment
We can extensively test the muscles, ligaments and joints without any scans. Physiotherapists use a variety of stress, pressure, movement, slide and glide tests. The tests can identify the specific site or tissues where the problems are. In some cases where there is direct trauma (car accident, fall) we might approach it more carefully. We will refer you directly for X-rays that we make sure there are no fractures (structural instability).
In most cases, X-rays is helpful when there is no improvement in symptoms. The identification of the problem sight may be correct, but it doesn’t react to treatment. Also, the symptoms can span over too many levels to pinpoint precisely.
It should make sense first to identify the structure at fault before we send you for expensive scans and tests. Remember that not all scans show the same structures. X-rays only show the bones, a sonar or ultrasound just shows the ligaments and muscle tissue on the surface. CT scan/ CAT scan shows more connective tissue than a sonar, but less than an MRI. MRI scans can be used to identify most structures which include nerves, arteries, and all the others.
There is no use getting an x-ray done of your back if you have a muscle or ligament problem. So we advise patients to start the process with us to identify the issues. We will investigate the relationships between the structures in your back before you go spending thousands of rands on unnecessary scans and tests.
Other causes of lowerback pain
Stenosis is the narrowing of the central spinal channel in which the spinal cord sits. The spinal cord that carries the impulses via nerves from your brain down to the level where it exits the cord to the rest of your body. The narrowing of this space can cause a specific group of symptoms.
Spondylosis involves the narrowing of the space between the vertebrae. It is when the holes where the nerves (power cables) that exit your spine and travel to the rest of your body become smaller. These holes are called the inter(between)-vertebral foremen (hole), and the narrowing of these holes could put pressure on the nerves that exit at that hole, on that level. Symptoms will relate to the level (e.g. L5/S1) where the narrowing is taking place.
Common lower back injuries
Facet joint injuries – generally but not always facet joint injuries will be worse when bending backwards and twisting. The back will feel locked so you can’t move any further into that movement. Facet joint injuries can also limit you bending backwards.
Disc injuries e.g. irritation/ inflammation or bulges – generally a little more serious and can take a fair while longer to settle depending on if the nerve has been affected or not. Disc injuries are usually worse with bending movements, but can also be very restricted going backwards into extension.
Sacro-iliac joints/ pelvic instability – these injuries are generally worse with asymmetrical activities e.g. running, steps and walking. SIJ injuries can often be relieved when sitting in a slouched position, in contrast to a disc injury which can be worse in a slouched position.
Muscular strains are the least severe pathology and usually the quickest to resolve. Depending on which muscle is injured will depend on which movement hurts the most. Most soft tissue injuries can fully resolve within six weeks.
Help to diagnose
One of the factors which can assist in diagnosis for a treating practitioner is knowing which movements or activities make your back pain worse and which movements make it better. For example bending or sitting is more likely to be associated with flexion injury whilst walking or standing is usually an extension based injury. Similarly if a disc is involved then your shock absorption will be worse so running, jumping, skipping etc will usually make your symptoms worse. It’s important to remember that you won’t always get pain at the time of exercising but it can be as late as the next morning when you wake up.
Usually during a back injury you can continue training to a degree unless you have nerve symptoms. These include:
– Pins and needles/ numbness down an arm or leg
– Pain radiating down an arm or leg
These symptoms don’t have to be going all the way down your arm or leg, they can just be referred to your buttocks or hamstrings.
After any injury ice is usually applied immediately in a wet towel to help limit any inflammation and swelling. As the joints in the back don’t tend to swell as much as other joints, heat can be used as an alternative to ice in helping to decrease muscle spasm or guarding.
Use the ice or heat for 10-15 mins as often as is required for pain relief.
Remember you don’t have to be sitting down to apply ice or heat, if you’re short on time any treatment is better than nothing.
Comfortable sleeping positions
- Sleep on your side with a pillow in between your knees to limit rotation of your back
- Sleep on your back with a pillow under your knees
One of the most important things that can contribute to low back pain is your mattress. Ensure you have a good quality mattress that supports your back so that you don’t wake up stiff or sore. When you go shopping for a new mattress it’s a good idea to go when your back is a little stiff or sore, so you can see which mattress supports you best.
Things to avoid with a back injury:
- Movements that cause an increase in pain, i.e. twisting and bending movements
- Heavy lifting
- Sitting for longer than 30 mins, especially in a slouched position or in an unsupported chair
- Picking up children, putting them in car seats etc
Preventing lower back injuries:
- It’s common to re-injure your back, and there are ways to protect your spine with exercise and correct lifting techniques.
- With lifting make sure you bend your knees, keep your back straight, and the load close to your body. This includes when lifting or carrying children.
- Avoid twisting your back with lifting and always move your feet to turn. If you have a desk job, make sure you have a chair with a supported back or lumbar roll, and every half an hour to get up from your desk and stretch your back.
Have you asked yourself these questions?
“How to put an end to Back Pain & Stiffness – without taking painkillers, without risking surgery & without having to wait to see the GP!”
If you’ve got lower back pain, stiffness or an ache, it’s very tempting to think that it’s nothing and therefore that it will go away on its own. Or, you pass it off as having just “slept awkwardly”, or that it’s just a “spasm” or a bit of stiffness that “everyone” your age suffers.
There’s no apparent reason why it happened, but it doesn’t seem to be relieving. Most importanly, if that’s happening to you, you’re not alone. aWe hear these words daily. In fact, lower back pain is THE most common problem that we see in our physio practice. And when it comes to living with back pain, everybody we see wants to know the following:
“Why is this happening to Me?” or, “Why am I still suffering from Back Pain after putting up with it for six months?”
Most people think that when they get back pain, it’s just going to go away on its own. Similarly, they’ll wake up one morning, and like magic, it is gone.
But then six months later you’re still living with back pain and in addition, an even worse pain.
Does That Sound Like You?
Another scenario we see all the time in our Physio Practice is when people go to the Doctors, and the Doctor tells them to rest and “try these painkillers” and “see how it goes”.
But this is rarely ever the best advice, and often six weeks later, they end up going back to the Doctor again because it hasn’t got any better. Worse, they’re often given yet another prescription of even stronger pills and advised MORE rest. This is madness and explains why so many people are suffering from chronic lower back pain.
Has this happened to You?
Why else does back pain last longer than it should? Well, it’s easy to get confused because you’ve been told different things, by different people. There are lots of people out there who are happy to dispense advice – but not all of it is credible. As a result, thereof it is difficult to find a workable solution.
Maybe you think your back pain was caused by doing something – like lifting or sleeping awkwardly – but it was caused by years and years of poor posture that caused the muscles in your lower back to become weak and the lifting of the awkward sleeping position was just the EFFECT of that.
If you don’t know what you’re doing – back pain can be very confusing. Many people just end up accepting it as ‘part of life’, thinking as if it’s normal and ‘just the way it is’.
Why is your back pain lasting longer than expected?
You believed the pain would go away over time (on its own) but it didn’t
You went to the Doctor who told you to rest and take painkillers. The painkillers helped to relieve the immediate pain but didn’t help your injured back. As soon as the painkillers wore off, the back pain returned
A family member (or friend) told you that “Everybody experiences back pain as they grow older,” and that you should just accepted it
In the past you went to other Healthcare Professionals (or a Physiotherapist) but nothing they said or did seemed to help
YouTube exercises and home remedies didn’t help relieve the pain, or in some cases made the back pain ten times worse
You thought it would be a good idea to rest because your back was so sore. However, afterwards your back felt even more stiff and tight than before
You went for massages, hoping they would relieve the pain. The massages felt pleasant and relaxing, but didn’t do anything to fix your back pain in the long term
Experiencing these situations or applying similar advice and not getting results is a good thing. Why? Because these experiences help you know what doesn’t work for you. It means that you are closer to finding out what does work for you!
We invite you to book an appointment with a Physiotherapist (at our Pretoria practice). During an appointment we assess your symptoms, diagnose the cause, educate you about what is happening in your body and then start treatment. See our FAQ for more in depth information about what to expect from a physiotherapy session.
Alternatively, click the link below to book a FREE phone call. The phone call is complimentary and there is no obligation to book any appointments with us after the call is over. This is an opportunity to get an expert’s advice about your situation. Our goal is to help you make an informed decision about what to do next concerning your back pain.
Choose a Cilliers & Swart Physiotherapist to aid you in getting rid of your lower back pain
What can we do for you?
We quickly put an end to pain and stiffness – often within a couple of sessions
We help you find out what is going on in your body and help you understand the root cause of your back pain
Pain can rob you of sleep or rest. We make it easier for you to return to your normal sleeping patterns and positions so that your energy and potential for recovery increases
Cilliers & Swart Physiotherapists closely manage and treat your problem. We also provide you with related exercises to speed up your recovery
Using painkillers in the long-term can be harmful to your health. We help you lower or completely stop your need for painkillers to manage pain
Our physiotherapists safeguard you against dangerous and costly spinal surgeries and painful injections
We reduce visits to specialists or doctors who only order you to take more pills
Back pain can limit the activities you enjoy with your family and friends. Our experts help you get back to spending quality time on the activities you (and your loved ones) like
We can get you to sit comfortably and walk longer than 15 minutes, in both cases without feeling that your back is weak, in pain or about to collapse
In short, we help you get back to living life free from chronic back pain. For information about costs and availability, click the button below:
4 Steps to getting rid of back pain
Decide to get help.
Many people put off going for treatment, that by the time they receive treatment the injury has worsened over time or caused other problems. Don’t think that back pain will ‘just go away with time’. It might sound brave to ‘put up with pain’ over an extended period of time, but the lack of treatment could end up costing you more in terms of time (for recovery) and resources (money) the longer you wait.
Do the RIGHT exercises.
One of the best things to help ease your back pain is the appropriate series of progressed exercises (as advised by your Physiotherapist or Health Professional). The right kind of activities can reduce your pain and increase your range of movement. Above all, exercises ensure that problems don’t come back. However, the wrong kind of exercises have the potential to increase the pain in your back even more.
Avoid sitting still for long periods.
Ever tried to get up from the sofa after resting for a while, but you struggle because your back feels painful and tight? That’s because one of the worst things you can do is to ‘rest’ in a sitting position for too long. Too much rest and sitting in awkward positions makes your back stiff and tight. As a safety measure we recommend specific strengthening exercises for better posture. We can help you get active by combining these exercises with our Physiotherapists’ hands-on treatment.
Get hands-on Physiotherapy treatment.
Physiotherapy is proven to improve the lives of people suffering from lower back pain. In fact, Cilliers & Swart Physiotherapists consider it as one of the most common injuries seen in patients who pass through the practice. Your back pain could be affecting your physical performance in a professional or private capacity. It could even threaten your independence or get in the way of spending quality time with family and friends. Physiotherapy can enable you to live the life you desire as quickly as possible.
If you would like to know how the Physiotherapy team at Cilliers & Swart can help you, we invite you to book a FREE, no-obligation, risk-free “Call me back” phone call.
Note: This free phone call is a service we offer to people who are nervous or unsure. You might not know if Physiotherapy is the right treatment for you. If you are unsure, please fill out our online form. We will contact you to find out what is wrong and how we can help. There is no financial obligation or risk on your part. You have nothing to lose except your pain.