Low back pain
Low back pain will affect a high percentage of us at some point in our lives. In fact, worldwide, low back pain causes more disability than any other condition. When it’s not possible to identify a particular cause this is called ‘non-specific’ low back pain, so it can be challenging to reach a diagnosis. It will usually improve over the course of several weeks or months, but it can still be frustrating to live with and disruptive to your everyday life.
When we talk about low back pain, we are referring to our “lumbar” region which has five vertebrae. Each of these has a label from “L1” up to “L5”, the latter sitting at the bottom of your spine. In between these vertebrae are discs which are the shock absorbers to support and cushion your spine. It’s usually L4 and L5, your lowest vertebrae, which get injured as they take the most force and pressure during everyday life.
You use your back day in, day out so there is constant strain being applied in nearly everything you do. Activities like bending down, lifting objects and even just sitting down awkwardly can make it vulnerable. Quite often a common cause is wear and tear, or degenerative changes, which usually start to occur in your 30s. We will all experience these changes as we get older, but not everyone will experience symptoms. However, there are lots of other possible causes of pain, such as falling over or injuries such as a disc prolapse (also called a slipped disc).
Just like you can pull a muscle in your hamstring, you can pull a muscle in your back when you bend or stoop. Your lower back is extremely complex so injuries can occur to bones, joints, muscles, ligaments, discs or nerves.
Low back pain can be categorised by the length of time you’ve had symptoms for. Here are the three main stages:
- Acute low back pain – pain over the last couple of weeks.
- Sub-acute low back pain – have experienced pain for two to twelve weeks.
- Persistent/chronic low back pain – longer term pain lasting more than 12 weeks.
The purpose of a physiotherapy assessment is to identify the problems, symptoms and patterns of pain to suggest a treatment plan.
MRI scans can also help with a diagnosis, so your physiotherapist may recommend you seek a referral. However, a scan on its own may not tell the whole story. For instance, several studies have demonstrated that a significant number of patients without back pain have damage which has shown up in the scan, yet this was not actually causing any problems. Disc injuries and general wear and tear may be picked up, but actually aren’t relevant to that particular injury. Therefore, these scans are used alongside a full assessment to make sure they are put into context.
Our physiotherapy team also work closely with consultant spinal surgeons. You can book a consultation directly with a surgeon, or your physiotherapist may recommend you see a colleague for further assessment. Consultant surgeons can provide a wide range of further treatment options aside from physiotherapy, such as injections or surgery if appropriate.
A disc prolapse, or slipped disc, is when a disc in your back bulges or displaces to put pressure on other parts of your spine, such as surrounding nerves. Spinal discs have an inner core with a gel-like structure, and a harder outer shell. When this inner core protrudes out from the middle it can cause inflammation and irritation around the area, sometimes putting pressure on the nerve root. Your body’s response is to try to heal and repair itself. In doing so, the nerve endings can become sensitised which in turn gives you pain.
Explaining why you have low back pain will be part of your treatment, so we can help you to avoid worries about your injury.
Low back pain lasting for longer than 12 weeks is considered to be chronic or persistent pain. This can have a big impact on your mood and general mental wellbeing. There are actually links between persistent low back pain and anxiety and depression.
Patients who lead an active lifestyle and really enjoy playing sport can be really affected if they suddenly can’t play due to back pain. This can potentially lead to fear-avoidance, where they can become concerned that doing an activity will cause them pain. However, there are various techniques which can be included in a treatment plan and Circle Rehabilitation also has a Clinical Psychologist who can help if needed.
Low back pain is not always worse at night as it very much depends on the individual. You don’t move as much in your sleep, so this may be why your symptoms are worse. Many people find their back is stiff when they wake up, but gradually loosens throughout the day as they get moving. Your physiotherapist can offer advice on sleeping positions and pillows which can help.
It’s also a common misconception that you should lie down as much as possible when you have back pain. When you lie down you don’t have the compressive forces in your spine, which is why it can help in the short term. However, prolonged periods can cause other problems such as back stiffness and loss of strength so you should try to keep moving during the day as much as possible.
When you’re standing up, the compressive forces on your back are higher. When you walk or run, you have a shock/impact which travels up to the spine, increasing pressure and potentially irritating any injury you may have. While it may not be advisable to run if you have low back pain, short periods of walking or moving around is generally considered to be good for your back.
Your physiotherapy assessment will last for approximately one hour. The first 20 minutes will be a discussion around the background to your injury, with the other 40 minutes used for objective tests. The aim is for you to leave with a treatment plan to address your symptoms, with practical tips and exercises to help.
Your physiotherapist will want to get as much information as possible about the injury, including your medical history, how you hurt your back, along with your symptoms and patterns of pain. Here are some things you may be asked:
- How did your injury happen? When did you first notice the pain?
- Where is the pain? Is there anything that makes it better or worse?
- Are you having any issues sleeping? Are there times of the day where the pain is worse?
- Have you had a similar injury before?
- Do any of your family suffer from back problems?
Your physiotherapist will also make sure you aren’t experiencing any other symptoms which may indicate another more urgent cause of the pain. If you are experiencing any other unusual symptoms alongside your back pain, contact your GP or NHS 111 straight away. Further information from the NHS is here.
Here are some examples of tests your physiotherapist may do. These are simply to assess your range of movement and strength, so they can tailor your treatment plan:
- Observing your posture
- Range of movement
- Review any nerve related issues
- Press around your lower back
- Strength tests
A treatment plan details your next steps towards your recovery and the goals you would like to achieve. Your physiotherapist will tailor exercises based on the findings of the assessments, gradually increasingly the frequency and intensity of exercises as you recover over time.
Your plan will include a range of back care advice e.g. on your posture, and potentially options for manual therapy and massage. These can be effective in loosening up the spine by treating muscle spasms and joint stiffness. You’ll also get self-management techniques, such as stretches and exercises you can do at home to help.
Our team of expert physiotherapists have a wealth of experience in treating low back pain. We also have access to state-of-the-art equipment and facilities to help in your recovery, including:
- AlterG anti-gravity treadmill – this helps to shorten recovery time, improve mobility and reduce injury
- Aquatic treadmill – to relieve joint and muscle pain and increase your range of motion
- Spinal strengthening technology – to help strengthen your core muscles
- Clinical Pilates class – a variant of Pilates adapted by physiotherapists, focusing on effective ways to prevent and recover from injuries