Top 3 causes of lower back pain
Pain which presents in the lower back is thought to be one of the “bread and butter” concepts of an Osteopath. Osteopaths are trained to assess, diagnose, treat & manage lower back pain of all sorts ranging from acute episodes to severely chronic cases. Lower back pain is a condition that affects millions of people daily with many of these people not understanding how much help they could potentially be getting from a manual therapy approach, such as Osteopathy (we promise we’re not being biased!).
With chronic cases in particular, long term medications are used that all come with their potential side effects. Many of these side effects can often be worse than the lower back pain itself. One of the goals as an Osteopath is to assist people, suffering from lower back pain, to wean themselves off their medications (in conjunction with the compliance and supervision of their General Practitioner).
A successful outcome of an Osteopathic consult is to constantly review the patient’s management strategies when it comes to their lower back pain. Management strategies that have no reliance on medications and are committed to manual interventions including muscle release techniques, gentle mobility and strength exercises (where indicated) is often preferred.
There are many potential sources of lower back pain which can make a diagnosis very difficult to make. Often the pain is not necessarily coming from one particular source, but multiple sources — let’s not get into the chronic pain discussion today, but we will have to do so in the near future. In saying that, a thorough physical assessment will always be required, and from this it is possible to deduce what is potentially the main culprit in creating the primary site of pain.
Below are the most common lower back pain presentations, along with their characteristics. As already stated, usually there is an overlap in the presentations and it is not one singular source that is creating the pain.
FACET JOINT IRRITATION
Onset:
Usually appears suddenly: Generally with twisting movements or repeated spinal movements (eg with moving house, gardening etc)
Can also present chronically in very stubborn cases
Quality of pain:
Sharp pain
Usually described as “pinchy”or “pinched nerve”
Aggravating factors:
Spinal rotation
Sit-to-stand
Coughing or sneezing (can cause ‘catching’ through the irritated area)
Relieving factors:
Manual therapy
Gentle range of movement & muscle release techniques (think stretching, foam rolling etc)
Spinal flexion (bending forward)
Management:
Gentle range of movement through the area (eg. pelvic tilts & standing side-to-side movements) - be sure to stick to one plane of motion
Muscle trigger point release through the glutes, hips & lower back
Stretching through the glutes, hip flexors & hamstrings
Short-term use of anti-inflammatories can also be very effective
Prognosis:
With manual therapy & adequate management: 10-14 days
Without manual therapy & poor management: 21-30 days
DISC BULGE / DISC IRRITATION
Onset:
Is usually a condition which builds up over time with an incident or event that acts as ‘the straw that broke the camel’s back’
Tends to coincide with high periods of stress
Quality of pain:
Sharp with certain movement, otherwise constant aching and nagging pain
This pain can come with and/or without pain that radiates down certain pathways in the leg “sciatic-type pain”
Along with pain down the leg, the person may experience numbness & tingling and/or weakness in the lower extremity
Aggravating factors:
Sitting (or standing) for prolonged periods
Coughing, sneezing and/or bearing down (putting pressure on the irritated disc)
Bending forward (although usually the person will hold themselves in a position where they lean forward and veer off to one side)
Relieving factors:
Manual therapy
Regular, gentle movement
Rest
Certain taping techniques / braces which can help to offload the irritated disc
Management:
As per relieving factors
Anti-inflammatories and analgesics may be required (pending opinion from a General Practitioner)
In severe cases, surgical intervention may be indicated - this could include a discectomy (removal of the disc) or spinal fusion (where segments of the spine are fused together to improve stability
Prognosis:
Usually disc presentations appear in “flares ups”
With adequate management and care, an irritated disc / flare up can last anywhere from 6-12 weeks or even longer if aggravating factors are not avoided
As this is a presentation that tends to occur in flare ups, people become good at recognising signs and symptoms pre-flare up thereby allowing for earlier intervention
SACRO-ILIAC JOINT IRRITATION
Onset:
Usually a gradual onset over time: think repetitive movements which involve spinal rotation, bending over and single leg movements
Onset also relates to altered biomechanics from the lower limb - eg previous history of foot / ankle injury resulting in altered gait with walking and/or running
Very common in pregnancy
Quality of pain:
Can be quite acute with certain movements
Generally presents as an annoying, nagging ache which radiates across the lower back - pain can swap from left-to-right
Aggravating factors:
Getting in and out of the car
Rolling over in bed
Single leg movements (eg. step ups, lunges, running)
Pregnancy
Relieving factors:
Manual therapy
Muscle release techniques through the glutes, groin, hamstrings & lower back
Certain bracing techniques (to assist in providing external pelvic stability - this mimics the action of the glutes)
Management:
Gentle mobility and muscle release techniques in the acute phase
Once pain has settled, glute activation & strength exercises are brilliant to assist in providing stability through the pelvis
Prognosis:
Can certainly become an ongoing issue if the underlying cause of pelvic instability isn’t addressed
Flare ups may last 4-6 weeks which can occur based on movement and activities
If any of these resonate with you or you are unsure about what to do from here, get into contact with us! We’d be more than happy to have an obligation-free chat. Alternatively you can book an Osteopathy appointment online by clicking BOOK NOW.
