Lumbago (Back Pain)

Almost all of us have had lower back pain. If you haven’t, you’re either quite young or really lucky! Lower back pain can present itself for many reasons, it can vary in severity and duration, and it can be specific or general.

The dull, generalized pain can often be frustrating. We don’t always know what is causing the  back pain. The term for a generalized, lower back pain, without medical cause is referred to as “lumbago”. It’s a fun word, but not fun to deal with. It isn’t crippling, but it’s there nonetheless, being its nagging old self. Many seek out a Physiotherapist or Registered Massage Therapist to help with this lumbago, and many may not be able to give an answer as to why it may be happening, simply stating “it’s just been there since I can remember”.

Now, let’s take the focus away from the lower back for a moment, bring it down to the lower extremity. If you can recall any injury to one of the lower limbs that caused you to develop a limp, it may be the underlying reason as to why that nagging lumbago just won’t go away.

The human body is designed and built to function in a certain way, and is (usually) evenly balanced and stacked. In a vague description, we stand evenly on 2 legs, with a pelvic bowl sitting nicely between the hips, and a Jenga-like tower of vertebrae stacked upwards from the back center of – the pelvis. When an injury occurs to one of the lower limbs, our weight is shifted off of that limb for a period of time to ease pain and allow healing without stress. What was once a job for 2 legs has now become a job for one leg, and a compensation pattern develops through the musculature of the unaffected leg, hip, and, yes, the lower back. To paint the best picture, here are a couple case scenarios:

A woman partially tore a ligament in her right knee 3 years ago. When standing and walking on it, her knee felt very unstable. To compensate for this, her body shifted more of the weight distribution over to the left hip and leg so as not to overwork the compromised tissue and to ease the pain. The damaged ligament of her right knee eventually heals, but the neural pattern developed of overusing her left lower limb has not been corrected. Over time, her right hip and leg muscles remained weaker from underuse and didn’t learn to properly support again. This causes a subtle tilt of the pelvic bowl, and thus a lean in the Jenga tower. For 3 years, the muscles in the left side of her back, hip, and leg have taken on an increased weight load trying to keep that Jenga tower straight. Overused muscles tend to result in pain and tightness.

Next, we have a young man who tears his left Achilles tendon playing basketball. He gets it surgically repaired and starts the rehabilitation process. It’s been one year, and although his Achilles has healed well, the left side of his lower back aches chronically. When we walk, the calf muscles (continuous with the Achilles tendon) play a very important role in pushing off

when walking. After a trauma like a severe tear, the calf muscles aren’t quite as strong as they used to be and may have difficulty giving a full push off. To compensate, the same side lower back muscles can activate to excessively lift up the hip and get that leg through the full swing of your gait cycle. Again, the muscles are overused and display pain.

There are endless case scenarios that could be used as examples, but hopefully you can see how your back pain could be caused by something other than an injury to your back.

Through a proper assessment process, your RMT can help to correct the cause of the improper alignment, and release the muscles that have been holding on too long. The cause can be something as simple as flat arches, or as severe as a previously fractured femur. In either case, a domino effect occurs up to everything that is stacked above it. The importance of the assessment process and proper rehabilitation can make the world of difference when it comes to relieving your lumbago.

The Latest on Lower Back Pain

The Latest on Lower Back Pain

Physiotherapy » Category: "Back"

The Latest on Lower Back Pain

With all of this mild weather we have been experiencing in the Okanagan it really does feel like spring is just around the corner. I’m sure many of you have started to do some work in your yards in preparation for the gardening season. Each year during the start of spring there is something that comes along with the longer days and warmer temperatures: lower back injuries.

So what can we do to avoid hurting our backs?

A recent study published in the Journal of Arthritis Care and Research looked at just shy of a thousand patients over the age of 18. They found 8 different risk factors for lower back pain. In order of highest to lowest risk the 8 factors were: distraction during a task, manual tasks involving awkward postures, manual tasks involving objects not close to the body, manual tasks involving people or animals, manual tasks involving unstable or unbalanced objects, manual tasks involving heavy loads, moderate or vigorous physical activity, fatigue/tiredness. Being fatigued tripled the odds of suffering a lower back injury, while distraction increased the risk by 25 times! So based on this recent information when you are getting outside to do your yard work or gardening this spring make sure to remember this list and try to avoid these risk factors. Take frequent breaks during your day to avoid fatigue. When lifting, bring objects close to your body and focus on what you are doing to avoid distraction. When lifting, bend at your hips and knees (sticking the butt out) while keeping a straight spine to minimize dangerous pressure on the spinal discs and joints. As well, a recent study done at the University of Sydney in Australia found that almost half of the lower back injuries they looked at occurred in the morning between 8 and 11 am. The cause is yet unknown but it is thought that it may be due to the fact that your spinal discs fill with fluid overnight, making them more susceptible to pressure in the first few hours of your day. It makes sense then to take your time in the morning when possible and make sure your muscles and joints are warmed up before jumping right into your ‘spring cleaning’. Of course we don’t live in a perfect world where we can always completely avoid risk of injury. But keeping some of these latest study results in mind I hope that you can stay healthy during this upcoming spring season.

Don’t take a holiday from good low back posture.

Don’t take a holiday from good low back posture.

Don’t take a holiday from good low back posture.

Physiotherapy » Category: "Back"
Trains, planes and car rides to visit friends and family; sitting down for a big turkey meal; sledding or hitting up the ski hill on snowy days; lounging around on Christmas morning admiring the tree and wrapped presents – this all sounds like a perfect holiday. While it is a wonderful combination for good times and many smiles, it unfortunately for some can also be a perfect recipe for a sore back. Something that all of those activities listed above have in common is a forward bent – or ‘flexed’ – position of the low back.

With normal standing posture, the low back has a slight curve, which is known as ‘lordosis’. When we bend forward or sit, we lose the lordosis and our lumbar spine – the low back – goes into flexion.  Spending too much time flexed, or performing heavy tasks in this position, can put a strain onto the lumbar discs. The ‘intervertebral disc’ is a structure that sits between adjacent vertebrae in the spine. It is composed of a tough, fibrous periphery with a gel-like nucleus in the centre. Repetitive or sustained flexion, as well as heavy lifts or bends, can injure the disc by causing tears in the fibrous rings. When this occurs, the gelatinous nucleus can bulge into the tear. In more severe cases, the gel can even push outside of the disc. It is most common for injury to occur in the back of the disc rather than the front.

To visualize what happens, imagine a jelly donut, where the dough is the fibrous outside of the disc, and the filling is the nucleus. Line up the hole that was used to fill the donut as being at the back/side of the imaginary spine. If you push on the front of the donut, the jelly will squeeze out toward the back, and can even push out of the donut (which would be the case in severe injury, or ‘prolapse’).  Forward bending is similar to this – there is an increased pressure on the front, and a suction force at the back, causing the gelatinous nucleus to move posteriorly if the fibrous rings are not holding it in place. Even with just an outward bulging of the disc (so, the jelly in the donut has moved but hasn’t escaped through the hole) can cause inflammation, and irritation of surrounding tissues, including nerves.

There are several strategies that can be used to help in the prevention of lumbar disc injuries. A few are:

  • Use a firmly rolled towel, or a ‘lumbar roll’, in the curve of your low back if sitting. It is helpful to keep one in your vehicle
  • Avoid the slumped position when sitting. A lumbar roll helps with this, as does your leg posture. Having your hips and knees in a deep bend, such as in a low chair, increases the forward bend in your back
  • Take standing and walking breaks when traveling, or during long meals
  • Stay flexible – tight hamstrings (backs of the thighs) in particular can have an effect on low back posture
  • Keep a strong core to help support your back during activities. This doesn’t necessarily mean doing crunches or sit-ups, but exercises that target the deep core muscles
  • During the post-holiday clean-up, avoid stooping to bend down to pick things up. Instead, bend your knees and hips to get into a good squat position. It’s a good way to exercise your legs, too!

Even with taking precautions, injuries can occur either with a single incident or over time. When this is the case and you notice you are having back pain, it is important to seek care from a health provider. Lumbar disc injuries, along with other causes of low back pain, can often be treated conservatively (meaning, non-operatively).  It is important to note that not all back pain is due to disc injury. A physiotherapist can help to determine what structure may be causing your pain, and give you appropriate exercises, stretches, hands-on treatment, and strategies for management, specific to your injury.