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’.
If you’re currently living with Back Pain, here’s 7 more reasons Why it could be lasting longer than it should:
If any of these have happened to you, we would love to help you by inviting you to book an appointment. Scheduling an appointment with one of our physios at our Pretoria Physiotherapy practice to find out what we can do to help you. The fact that you’ve tried any or all of these things already is a GOOD THING because then you know what doesn’t work. Therefore you are closer to finding the thing that does!
Click the link below to book a call with us if you would like to get some solid advice given to you over the phone. The phone call is complimentary, and there is no obligation to book any appointments with us after the call is over. Our goal is to help you make the right decision about what to do next.
You thought it would go away on it’s own – but it didn’t
You went to the Doctor who told you to rest and take painkillers – but the pills did nothing to help your back, and as soon as they wore off the Back pain struck again
A family member, or friend, told you that everybody gets Back pain as they get older, so you just accepted it
You already tried other Healthcare Professionals, or a Physio in the past, but nothing they said or did seemed to help
YouTube exercises either didn’t do a thing, or made your Back pain ten times worse
You thought it would be a good idea to rest because your Back pain was so bad, but all that did was make it feel even more stiff and tight
Maybe you tried to get a few “massages” hoping that would fix the pain, but all they did was feel nice and relaxing, and didn’t do anything to fix it long term…
“How can choosing to see a Physiotherapist at Cilliers & Swart Physio help you get rid of your Lower back pain – in the next few days?”
Here’s just a few of the things our Physiotherapist Team can do for you:
We can quickly take away the pain and stiffness – often within a couple of sessions
We can help you find out what’s going on, and get to the root cause of your back pain once and for all.
Pain can steal your energy and limit a peaceful nights sleep – we can help you to enjoy sleeping at night and living with more energy each day
Cilliers & Swart will ensure that your problem is “managed” and “treated” properly – and we will provide you with the perfect set of exercises that will speed up your recovery
We can help you put an end to taking all of those painkillers that are no good for your health long-term
Our physiotherapists can help you avoid dangerous spinal surgery – and painful injections
We can help you keep out of the Doctor’s waiting room or from making repeat visits only to be given more pills!
Our experts can help you get back to enjoying quality time with family and friends that back pain has stolen from you
We can help you to finally get a good night’s sleep without tossing and turning trying to find that one position that feels right
We can help you to sit more comfortably and walk longer than 15 minutes without your back feeling weak and painful or like it is going to “give-way”…
Basically, we can help you get back to living life free from the curse of chronic back pain
If you want to know what it costs – and what availability we have at our physiotherapist practice in Pretoria, then please just click the button below:
“What can I do to get rid of my back pain Quickly?”…
Well, here’s 4 things you can do:
First off, you need to decide to get help.
So many people procrastinate for so long, thinking that Back pain will ‘just go away with time’. Unfortunately but then six months down the line they’re still putting up with it, and nothing’s changed… Or it gets worse
Do the RIGHT exercises.
One of the best things to help you ease your back pain is the right series of progressed exercises. The right activities will help reduce pain and allow you to move freely again. Above all, it will make sure that the problems don’t come back anytime soon. Wrong exercises will aggravate your back even more.
Avoid sitting for long periods and rest.
Ever tried to get up from the sofa after resting for a while, but you struggle because your back feels so painful and tight? That’s because one of the worst things you can is rest, and sit for long periods. Too much rest and sitting in awkward positions make your back stiff and tight. It would help if you were given specific strengthening exercises for better posture. Together with the hands-on treatment, we get you active and healthy.
Get real, “hands-on” Physio.
Physio is proven to help people with low-back pain. In fact at Cilliers & Swart Physiotherapist it’s one of the most common injuries we see. If your back pain is affecting your job and your ability to keep active. Or if it threatens your independence or gets in the way of spending quality time with family and friends. Physiotherapy can help get you back to living the life you deserve as quickly as possible.
If you would like to know how the Physiotherapy team at Cilliers & Swart Physiotherapist can help you by reducing your lower Back pain, we invite you to start with a completely free, no-obligation, risk-free “Call me back” phone call.
Note: This Free Call is something that we offer to people who are nervous or unsure. You might not know if Physiotherapy is right for you. If that sounds like you, then 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 risk on your part. Further more you have nothing to lose except your pain.