Lower Back Pain

Lower back pain is very common and according to the World Confederation of Physical Therapists, is the number one cause of disability across the globe. Only 1-5% of all lower back pain is attributed to serious disease or injury and it is one of the most frequent issues patients attend our clinics, seeking professional input and support.

There is a complex network of soft tissue structures in the lower back which may contribute to your symptoms including muscles, nerves, tendons, ligaments, joints, inter-vertebral discs and connective tissue. Consequently, this leads to difficulty in attributing your symptoms to a specific structure. Because of this, the most common term used is non-specific lower back pain, meaning that the pain is not due to any specific or underlying disease that can be found.

• You may experience pain immediately after lifting a heavy or unevenly weighted item, or after a sudden, atypical movement.

• Pain in the lower back may arise spontaneously without any specific cause – patients may just wake up one day with low back pain.

• Symptoms can range from very mild to severe and each case is entirely different.

• The pain is most commonly reported in one area of the lower back – either across the lower back or one-sided; it may spread into either or both buttocks or thighs also.

• Lying flat usually reduces symptoms and is commonly aggravated with movement of the area and with sudden movements like coughing, sneezing or turning over in bed.

• Symptoms of nonspecific low back pain vary significantly but tend to be posture or activity related – mechanical in nature. It may become sore or stiff when in prolonged postures such as sitting or first thing in the morning and can be relieved with gentle motion.

An over-stretch or ‘sprain’ of a ligament/muscle is thought to be likely cause in some cases. In other scenarios, symptoms may be related to an issue with a disc between spinal bones (vertebrae), referred to as an inter-vertebral disc. Symptoms may also be associated with stiffness or inflammation of the small stabilising joints called facets. As highlighted above, there are numerous structures that could be related to symptoms, proving that a certain tissue being the root cause is highly unlikely.

For some, the exact cause of the pain being undetermined could be unsettling. However, when thought of from a different perspective, you may be reassured knowing that the diagnosis is nonspecific back pain, meaning there is no serious problem or disease.

Our skilled and experienced Physiotherapists will carry out a detailed history and thorough physical examination to provide you with information on the structures that may be contributing to your symptoms. They will also produce an accurate diagnosis so that the most suitable and effective treatment can be applied immediately for optimal outcomes.

Many of our patients visit with the hope that an X-ray or MRI may help establish the cause of their symptoms. Other than in specific circumstances where imaging may be helpful to inform the medical or emergency management of your condition, they are rarely required. Research has demonstrated that very rarely do scans match up with symptoms, it doesn’t benefit treatment, results tend to be unclear or misleading, it costs the health system and may make you worse and could increase the likelihood of ineffective treatment.

There are occasions where imaging or further investigation may be appropriate. Should this occur, your Physiotherapist at Pure will give you a clear explanation of how this will help your recovery and modify your treatment direction. The video below, supplied by the Chartered Society of Physiotherapists gives a great overview of managing back pain.

Following diagnosis, your Physiotherapist will work with you to create an individualised home exercise and self-management strategy. Your Physiotherapist will equip you with the knowledge and skills to effectively manage your symptoms and support you in your recovery. By working closely with each patient, our Physiotherapists at Pure can understand what is important regarding your limitations and important activities so that the management plan is directed towards your goals. We value regular re-assessment to make certain you are making progress and to ensure you are receiving the most effective treatment.

Your Physiotherapist will create a bespoke home exercise plan that will be modified and progressed throughout your treatment. This will allow you to work towards achieving your goals. Please find the patient resources section of our website where we have created a series of dedicated exercise programmes for lower back pain. We advise consulting with your Physiotherapist prior to trying any of these exercises.

In combination with the exercises and self-management strategies, Your Physiotherapist may provide complementary hands on treatment. Our Physiotherapists will use targeted soft tissue mobilisation techniques and manual therapy to reduce the pain in the affected structures, help improve movement and promote optimal healing. A vast majority of our clinicians are also trained in acupuncture which involves the insertion of medical-grade needles into specific anatomical sites as another modality for reducing pain and optimising healing.

Together with lower back pain which can gradually worsen or come on suddenly, it is common for patients to report symptoms spreading into the buttock and leg, sometimes as far as the foot.

This condition is usually indicative of sciatica which is an umbrella term used in the medical world describing irritation of the nerves which exit through holes between each spinal bone of the lower back to supply our legs. These nerve roots are extensions of our spinal cord and form our peripheral nervous system, sending electrical impulses throughout our limbs. To reach our limbs, the nerves branch out of the spine in gaps between each vertebra called foramen. Approximately one third of the space at each foramen is taken up by the nerve root, leaving plenty of space.

Through mechanisms including inflammation, swelling, age-related changes and trauma, the pressure around where each nerve root exits from the spine can become irritated. This pressure around the sensitive nerve root may affect all the various branches it supplies, helping to explain symptoms experienced into buttock and further down the leg. For more information on Sciatica click here.

As well as pain, altered sensation in the form of pins and needles or numbness can also be a symptom of sciatica and tends to be provoked with movements/actions which put more pressure on the nerve roots. It is important to note that if you experience worsening symptoms in both legs and you are losing power and function in your legs without pain, we recommend you seek urgent medical advice and attend A&E. Also, if you are experiencing significant changes in your bladder, bowel and/or sexual function or sensation, we also recommend that you attend A&E as this relates to a rare but serious medical condition known as cauda equina syndrome which although is very rare, may become permanent if not addressed urgently. Click here for more information.

10 facts about back pain

Advice from the Chartered Society of Physiotherapists website on being active with long-term conditions

Click here to read about how Sheron managed to get active following her diagnosis of Osteoarthritis which caused sciatica

National Institute of Health and Care Excellence. (2016). Lower back pain and sciatica in over 16s: assessment and management. NICE guideline [NG59]. Retrieved from https://www.nice.org.uk/Guidance/NG59. [Accessed 8/7/2020].