Lower Back Pain Causes And Treatment
It is now widely recognized that lower back pain problems are due to abuses of the body found in modern life such as; lack of exercise, poor posture, stress, and being in unusual positions for long periods of time, like bending forward while working or on a computer.
Realizing that most low back problems result from our modern, sedentary style of living is good news – it means you can prevent most back problems by learning new habits and taking some reasonable actions to help your back stay healthy.
More than half of those who have back pain once will experience ongoing or chronic back problems. Many find their low back pain is getting worse, more frequent or disabling than previous episodes. Some have a chronic lower back problem that has not responded to traditional therapy, Chiropractic or prescribed medications. By taking responsibility for your own care through self management techniques, many find there is hope for a more lasting and consistent relief.
What is a back pain flare up?
- A 2019 study in the Journal of Pain came to a consensus based on both professional and consumer understanding. “A flare-up is a worsening of your condition that lasts from hours to weeks that is difficult to tolerate and generally impacts your usual activities and/or emotions”. This helps distinguish it from other lower back pain symptom variations as in self reported flares.
- A 2021 study in the Clinical Journal of Pain found the low back patients with self reported flares do not always indicate an increase in greater than average pain, but may relate to worse psychosocial features. This emphasizes that a self reported flare has broader dimensions than pain alone, thus necessitating greater objective verification.
In most people, back pain often starts without warning and for no obvious reason. It interferes with daily activities and prevents a good night’s sleep, eventually, it subsides. After recovering from an episode, most forget their lower back problems. However, when recurring back problems have developed, we repeatedly seek assistance to relieve the pain. There is a general lack of understanding about how to deal with back problems and how to prevent them in the future.
Despite the varied therapies to treat lower back pain (massage, manipulation, heat, ultrasound, acupuncture and medications), self management is widely accepted and can be more effective for long term management of your low back problems.
Most back pain is mechanical in nature, caused by problems with the moving parts and certain movements or positions can lead to pain or make it worse. Typically, the pain is worse when bending forward for extended periods and when sitting for prolonged periods at a desk or in a car. It can be difficult to rise from a bent forward position or to get up from sitting. Usually, the pain eases when walking or changing positions frequently and stiffness is experienced when getting out of bed in the morning.
A herniated disc in the back may be an incidental finding on an MRI, or can be a disabling condition. You should seek professional advice; if you experience low back pain for the first time, if you have constant pain into the leg and to the foot, if you have numbness or weak muscles, bladder control problems, and if along with your pain you feel generally unwell.
The lower back consists of five spinal bones (vertebrae) called the lumbar spine which sits on the sacrum, a triangular shaped bone that extends to the tailbone (coccyx).
Special cartilage called a disc separates the bones and provides cushions for the bones. The most frequent location for disc problems in the lower back is the disc between the last lumbar vertebra and the sacrum, called the lumbo-sacral joint. This is also the location of the center of gravity in the human body.
Between the joints are openings for the spinal nerves and running up through the vertebrae is the spinal cord.
Similar in function to ropes supporting a tent and its poles, each joint is held together by ligaments. Just as a tent will not be stable if the ropes are damaged, the spine becomes unstable when ligaments are damaged by overstretching. When the ligaments are functioning properly, the lower back is held in a forward curve providing strength and flexibility.
Treatment depends on the cause. Causes range from a strain or torn muscle, to more complicated sprains involving ligaments, disc injuries, complications involving arthritic disease, postural strain and ergonomics, and related problems which can be overlooked like facet syndrome, sacroiliac joint problems, and low virulent spinal infection.
- A 2022 study in Gait & Posture indicated symptomatic disc degeneration show different movement strategies, disability levels, anxiety, depression and quality of life. The authors recommend effective care may benefit from evaluating and targeting these differences.
Treatment must also focus on related areas other than the primary location in the lumbar spine. For example, it has been shown that lower back pain sufferers have leg weakness and this can affect balance, especially in the elderly. This can have repercussions involving falls leading to injuries.
- A 2021 study in the European Review of Aging and Physical Activity showed that balance performance was impaired in elderly people with low back pain. The study showed an increase in the area and velocity of movement of the center of pressure, slower walking and rising from sit to stand.
- A 2019 systemic review in the Journal of Musculoskeletal and Neuronal Interactions found that patients with low back pain had lower and often significantly lower muscle strength of hip abductor/extensors and knee extensors compared to health controls.
What Causes Back Pain Flare-ups?
- A 2019 survey study in the journal Pain Medicine asked what causes a low back pain flare up? The authors noted a trend against recent pain theories which focus on psychological factors, whereas participants, almost 85%, identified mainly biological/physical causes of flare-ups instead of non-biomedical (15%).
- Active movements (35%)
- Static postures (28.1%)
- Overdoing a task (5.3%)
- Biomechanical dysfunction (4.4%)
- Comorbidities (4%)
- Lack of exercise (3.3%)
- Work (1.8%)
- Medications (1.5%)
- Psychological state (6%)
- Weather (5%)
- Sleep (2%)
- Diet (1.2%)
- Fatigue (1%)
The authors indicated, “Recognition of patients’ views on causes of LBP [low back pain] flares is crucial to better guide clinical practice and inform further research.”
- Another 2019 survey in the journal Spine of almost 18,000 individuals found the two highest factors for an occurrence of new lower back pain were working in poor postures and occupational lifting.
Of all factors studied: weight/height, smoking, physical activity, depressive symptoms, occupational lifting, working in twisted positions, and sleep problems, only smoking and physical activity were not associated with risk of experiencing low back pain.
Did you Know?
- A 2020 systematic review in Neurouroly & Urodynamics found a significant link between low back pain and urinary symptoms. In in large epidemiological studies, lower back pain and urinary incontinence are associated. The authors indicate that although the relationship is unclear, one condition seems to predispose the development of the other.
- A 2020 BMC Musculoskeletal Disorders study found that Isotretinoin, used to treat acne and sold under the brand name Accutane among others (Absorica, Zenatane, Myorisan, Claravis, and Amnesteem) has low back pain as a very common complication. The authors found it can be mechanical or even inflammatory pain and is dose related. It can also mimic inflammation of the sacroiliac joint.
- A 2021 Review in the journal Semergen B vitamin complex combination of Thiamine, Pyridoxine and Cyanocobalamin (TPC) found it has an analgesic effect in mixed pain, specifically in low back pain and other musculoskeletal disorders with pain and nerve components. This is a combination of B1, B6, and B12 and I like Dr. Mercola’s formula the best.
- A 2020 analysis in the journal Pain Medicine found an analgesic effect of thiamine, pyridoxine, and cyanocobalamin (TPC) in alone, and also when combined with nonsteroidal anti-inflammatory drugs (NSAIDs), in a synergistic manner in acute LBP.
- A 2021 study in BMC Musculoskeletal Disorders found that both stabilization and strengthening exercises reduce pain, however, stabilization exercise is superior to strengthening exercise in improving proprioception, balance, percentage change of muscle thickness, and reducing functional disability and fear of movement in patients with subacute non-specific low back pain.