Not all back pain is created equal. One thing which all back pain sufferers have in common, they want relief, and they want it FAST. The first step in recovery is understanding what could be causing the pain, activities which will be beneficial, and what other lifestyle modifications can be made to help reduce back pain. Let’s cover some basic anatomy and how that anatomy can lead to pain.
There are different regions of our spine: cervical (neck), thoracic (mid-back), lumbar (low back), and sacrum (tailbone). The vertebrae are the bones that make up the spinal column, they serve to support our bodies and protect our spinal cord. The spinal cord transmits signals between your brain and the rest of your body. The vertebral disc sits between each vertebral body for shock absorption and to create space (vertebral foramen) for the nerves roots which come off the spinal cord. The spinal canal is the space surrounded by the vertebra for the spinal cord to run through.
Disc Herniation: Why Does It Hurt?
An injury to the disc is something that occurs over time. Many of us spend our days sitting and bending forward to complete our daily activities, such as shaving, brushing our teeth, and tying our shoes. The average person bends forward 4,000 to 5,000 times a day and only extends back 400-500 times a day (1). This unequal amount of motion puts increased pressure on the front our discs leading to the disc material most often pushing back towards the spinal nerves and leading to pain. The disc material may put pressure on the nerve roots at that specific spinal level. When the nerves are inflamed in the lower back, it can lead to pain and paresthesia (numbness and/ or tingling) anywhere along the nerve’s distribution: buttock, thigh, calf, and/ or foot.
Common symptoms associated with a lumbar disc injury include increased pain with bending, lifting, twisting, and sitting. The good news? Disc injuries heal very well with guided exercises and progressive activity.
Spinal Stenosis: Why Does It Hurt?
Stenosis of the spine (narrowing of the spaces where neurovascular tissue travels) is something that occurs over time. As we age, the disc that separates our vertebra decreases in height, bone can grow along the edge of the vertebral body causing spurs, and the ligaments that connect the bones of our spine begin to thicken. All of these changed structures can infringe into the space of the spinal canal or vertebral foramen. This leads to “pinching” on the nerve which leads to pain. If the nerve is pinched and inflamed, it can cause pain and/or paresthesia anywhere along the nerve distribution (similar to the disc injury).
Common signs of spinal stenosis include increased pain with walking, prolonged standing, and lifting, which is improved rapidly by sitting down and resting. Spinal stenosis is a manageable condition which responds well to progressive stretching, core strengthening exercise, and activity modification.
Lumbo-sacral Instability: Why Does It Hurt?
Your spine connects to your hips through the tailbone via a joint called the sacral iliac (SI) joint. This joint is very stable and does not like to move a lot. However, lack of support due to weakness in the gluteal and core musculature leads to excess motion at this junction. This results in increased friction and inflammation within these joints leading to potential arthritic changes and bone irritation.
The common sign of an SI joint dysfunction is pain with changing positions, which includes rolling in bed, climbing stairs, getting in or out of a chair, and getting in or out of the car. Treatment for this condition requires consistent hip and core strengthening exercises.
It is important to understand what is causing the low back pain to determine the solution. There is one thing which we know is consistent throughout all low back injuries: movement is medicine. The old theory of bed rest and medications have been proven wrong. Knowing what exercises and movements are safe is the first step in returning to pain-free activity and sustainable independence and mobility.
If you are suffering from low back pain in your daily life, click the link below to schedule your free discovery visit with a physical therapist at Buffalo Rehab Group.
1. McKenzie R. Treat Your Own Back. Raumati Beach, N.Z.: Spinal Publications New Zealand Ltd; 2011.
2. McGill S. Enhancing Low-back Health through Stabilization Exercise. ACE Certified News. 2003;February/March:3-6.
3. https://www.caseychiro.net/spinal-stenosis (Pic)
4. http://www.skatefins.com/breathtaking-medical-human-lumbar-anatomy-spine-pictures/ (Pic)