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Lower Back Pain: Causes and Management Strategies (A Definitive Guide 2022)

Ben Dillon
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Lower back pain is one of the main injuries that I see in the clinic on a day to day basis. The nature of our daily activities can have such a profound effect on not only the occurrence of the lower back but how to heal it.

Lower back pain is characterized by shooting, aching, and sharp pain through the lumbar spine. Pain largely occurs when muscle, nerve, or disc have been damaged or undergone trauma, this may be due to repetitive strain, sudden incidents of trauma (accidents), or general wear and tear.

Having work for over a decade in clinical and studio-based settings I have formed treatment plans and strategies that have assisted hundreds of my clients

So in this article, I am going to give you the rundown on the lower back, tips to treat it and how to move forward.

Let’s jump in.

5 Most Common Injuries - Low back painWhat’s Inside:

  1. What is Lower Back Pain
  2. 5 Components of Lower Back (Anatomy)
  3. What is the Reason for Lower Back Pain (Causes, Symptoms, Treatment)
  4. How do you know if Lower Back Pain is Serious?
  5. How do you know if Lower Back Pain is Muscle or Disc?
  6. What is the Best Treatment for Lower Back Pain (Invasive vs Non-invasive Treatment)
  7. How to Relieve Lower Back Pain (7 Best Non-Invasive Treatment Methods)
  8. 5 Lower Back Exercises and Stretches

What is Lower Back Pain?

Lower back pain is something many of us have or will experience in our lifetime, whether this is due to our daily activities or just general wear and tear, and while not all cases may not be serious or overly painful,  having to deal with it can be not only painful but inconvenient.

So, what is the lower back?

This is such a broad topic, so let’s start with basics (If you’re looking for more practical advice, check out other headings through the post regarding treatment).

Characterized by achy, sharp or shooting pain, lower back pain can happen for a number such as muscular tears, ligament sprains, disc and joint-related issues.

Now, for the sake of this article, I’m going to categorize the lumbar (lower back) and the pelvis into the term ‘lower back’, as their partnership creates the largest junction of joints, muscles, and ligaments in the body, of which is capable of bearing considerable weight, producing large amounts of power and providing the body with a near-endless range of control.

And you know what, we often don’t use it the way we are meant to.

That’s why we have lower back pain!

5 Components of the Lower Back (Anatomy)

Now, let’s talk about the five main elements that make up our lower backs.

The lower back (lumbar and pelvis) work as a team to create a range of functional movements for our bodies, due to the dense layering of ligaments, and muscles.

1. Ligaments: are strong connective tissue style attachments that provide support and stability to our joints. They are less stretchy than muscles and can often take longer to heal, as they have less blood supply than muscles.

2. Muscles: are elastic and have an excellent supply of blood. Muscles require oxygen-rich blood for muscular contractions. These muscles throughout the lower back can cross multiple joints, with many of them even attaching to the upper leg.

Hip Anatomy Canva CT Hip Anatomy Canva Muscles

(Images provided by Essential Anatomy 5)

3. Bones/vertebra: more specifically in this case are what give our spine its shape, and are the sites for muscular and ligamentous attachments, as well as housing hundreds of nerves, blood vessels.

4. Discs: Made up of a strong, dense outer layer of fibrocartilage and a jelly-like inside, a disc can provide stability, protection and shock absorption for the spine.

Vertebrae Disc Lumbar Nerves Front

5. Nerves/Spinal cord: Passing through the vertebrae is the spinal cord, which at every vertebral level is a nerve outlet that is responsible for supplying muscles and organs with the ability to function.

The combination of these elements makes for an incredibly durable, adaptable and robust structure.

So, why do we get lower back pain?

What is the Reason for Lower Back Pain? (Causes, symptoms, treatment)

Even though there is a long list of durable tissue lining and controlling our lower backs, we are still susceptible to damage and trauma to these structures whether they are through a direct means, like an accident or indirectly through wear and tear.

So let’s break these down into some categories, muscles strains/spasms, ligament sprains, disc damage, and nerve impingement.

Check out the table below.

Lower Back Pain (Causes, Symptoms, Recovery Time, Conditions, Recommended Exercises)

ConditionSymptomsCausesEst. Recovery TimeTreatmentRec. Exercises
Ligament Sprain/Tear
Pain, Swelling, bruising, reduced movement of joint,
Direct/indirect trauma3-8 Weeks
Physical/Manual Therapy, Exercise
Muscle Tear/Strain
Pain, Bruising, difficulty moving/contracting muscle, Muscle spasms and weakness
Over stretch or overloading tissue, sudden jerk or pull 3-6 Weeks
Physical/Manual Therapy, Exercise
Disc Damage (Protrusion, bulge, herniation)
Reduced movement, Weakness, Pain, Nerve Pain (Shooting, numbness, Tingling, Burning),
Repetitive poor lifting, sudden jerk or pull4-6 Weeks
Physical Therapy, Exercise
Nerve impingementReduced movement, Weakness, Pain, Nerve Pain (Shooting, numbness, Tingling, Burning), Muscular Weakness
Repetitive poor lifting, sudden jerk or pull, muscular spasm/strain1-2 Weeks
Physical Therapy, Exercise
This table contains data about causes, symptoms, recovery time, conditions, recommended exercises.
Disclaimer: Recovery and treatment methods may vary on a case by case basis. Please seek professional advice prior to undertaking rehabilitation exercises.

Now, these are not mutually exclusive, as disc damage can lead to nerve impingement, and ligament sprains can be accompanied by muscular spasms.

So let’s break down these conditions in more detail.

1. Ligament Sprain: A sprain is a tear to a ligament and connective tissue. As ligaments have far less blood flow they take longer to heal and if trauma is significant may need surgery.

  • Symptoms: Pain, swelling, bruising, reduced movement.
  • Recovery Time: 3-8 weeks
  • Treatment: Physical/manual therapy, exercise, reduced workload, heat, ice
  • NOTE: Ligament sprains to the spine and pelvis can often be accompanied by muscular spasm as the body attempt to stabilise the damaged area. The spasming and tightening may lead to further restriction in movement and even nerve-related pain as nerves and their pathways may be compromised by disc or muscular spasms. Recovery times may vary depending on the severity of the injury.

2. Muscle Tears (Strains): A muscle strain or tear is when the fibres of skeletal muscle are damaged and torn. This can happen as a result of excessive force, overuse, or direct/indirect trauma. Muscles tears typically heal well due to the tissue having access to an oxygen-rich blood supply.

  • Symptoms: Pain, swelling, bruising, reduced movement, spasms
  • Recovery Time: 1-4 weeks
  • Treatment: Physical/manual therapy, exercise, reduced workload, heat, ice
  • NOTE: Tears/strains to skeletal muscle surrounding the lower back and hips have the potential to restrict spinal movement, while the muscular spasms may compress nerve pathways, resulting in numbness, tingling, and shooting pain.

3. Disc Damage: A damaged disc is when the disc itself becomes compromised. Bulges, protrusions and herniations are all types of disc pathologies that have many symptoms ranging from nerve compression, pain, weakness. Healing times may vary depending on the severity of the injury.

  • Symptoms: Pain (sharp, shooting, tingling, numbness), reduced movement, spasms, muscular weakness, impaired organ function, muscular spasms, pain while coughing/sneezing, bearing down
  • Recovery Time: 4-12 weeks
  • Treatment: Physical/manual therapy, exercise, reduced workload, heat, ice
  • NOTE: Disc related issues and their healing times can have a range of effects that can vary depending on the severity of the bulge, protrusion, herniation. The spine and spinal cord are sensitive areas and seeking the advice of a professional are required.

4. Nerve Impingement: Nerve impingement is when structures surrounding or encapsulating a nerve compresses or compromise the nerves pathway. When the nerve is compromised sensations of numbness, shooting or tingling may be present and can vary in severity depending on the degree of compression or encroachment. Muscles spasms around a nerve or a disc bulge that applies pressure to a nerve are just some examples that can lead to nerve impingement.

  • Symptoms: Pain (sharp, shooting, tingling, numbness), reduced movement, spasms, muscular weakness, impaired organ function, muscular spasms, pain while coughing/sneezing, bearing down
  • Recovery Time: 4-12 weeks
  • Treatment: Physical/manual therapy, exercise, reduced workload
  • NOTE: Similar in nature and at times as a result of disc-related injuries, nerve impingement can give off symptoms such as numbness, tingling and shooting or radiating pains. The spine and spinal cord are sensitive areas and seeking the advice of a professional are required.

How do you know if your Lower Back Pain is serious?

Serious lower back pain presents with severe pain, inability to move and neurological symptoms. Nerve pain characterised by sharp, shooting pain down the legs or through the abdomen can be a sign of significant nerve impingement which should be taken very seriously. The presence of numbness, tingling accompanied by impaired bowel function is also a symptom of a seriously compromised lower back.

Often suffers from serious lower back injury will experience muscular restriction or spasming and in extreme cases neurological symptoms such as shooting down both legs. If this is the case please seek medical assistance immediately.

How do you know if Lower Back Pain is muscle or disc?

Disc related lower back pain is often more severe in nature. Disc-related conditions can often present with difficulty coughing sneezing, and passing gas. Conditions such as bulges, protrusions or herniation can compress the spinal cord and nerve root outlets which can be extremely painful. Muscular tightness may also accompany disc-related lower back pain, however muscular related lower back pain does not always result in nerve-related pain or symptoms.

A simple way to determine whether your lower back pain is disc or muscle-related is to bear down as if you’re attempting to go the bathroom.

Go on, give it a shot.

Bearing down creates a considerable amount of pressure within your abdomen and core. By doing this you will also increase the intrathecal pressure, which is the pressure with the spinal column.

Discomfort or pain when doing so suggests that there is some nerve compression by the disc.

When disc bulges, protrusions and herniation are present they push back into the spinal cord, creating an obstruction, this will further increase pressure and can create discomfort and even severe pain.

Muscular tears or strains while not always have a tendency to be more localised. This can be determined by a professional based on the incident in which it occurred and the location of the pain or trauma. Muscular tears can be accompanied by spasms, discomfort or pain when moving, and in some instances nerve-related pain.

A good example of this was many years ago when I was at university I was at the gym going through my regular gym routine. I begin my session as always starting with a set of barbell squats. Upon lowering myself into the first set of the exercise I felt what can be described as someone flicking a rubber band on my lower back.

From here, I winced, returned the bar to the rack position and gingerly walked out of the gym.

As I was leaving the gym I found it difficult to stand completely upright and could feel a significant degree of nerve-related pain down both of my legs.

Fortunately for me that weeks earlier I had learned some of these methods for diagnosis and started to test the boundaries, so I started with bearing down to see if it was disc related…

To my relief, there were no nerve-related symptoms (shooting, numbness or tingling).

From here I began the process of gently getting moving again and with some discomfort was up and moving within a couple of hours, and better yet I was fully moving the next day will some discomfort but no nerve pain.

So, in this instance, I have sustained a minor strain/tear close to my spine. Given the location of the tear, the muscle spasmed and created a level of compression to the nerve resulting in nerve-related pain.

This is an example of lower back pain that could be either disc or muscular, however, given the swift recovery time and rapid decrease in neural (nerve) symptoms this would suggest it was strictly muscular.

What is the Best Treatment for Lower Back Pain? (Invasive vs Non-Invasive Treatment)

Treating lower back pain requires a routine consisting of physical therapy and exercise. Conditions such as disc bulges, protrusions, muscular strains and ligament sprains should be treated with a non-invasive approach of manual and physical therapy. An exercise and strengthening routine, as well as pain relief, where needed prior to looking into more invasive strategies such as surgery.

Seeking the advice of a professional such as a Physical Therapist, Exercises Physiologist, Myotherapist, and General Practitioner is highly recommended as they will be able to assist with diagnosis to determine the correct course of action.

By engaging in a non-invasive approach the body will have the ability to become stronger, decreasing the occurrence of recurring injury in the future, providing the rehabilitation program is followed.

While surgery and pain relief can be effective, they will not build up the muscles and surrounding structures. Pain relief should be used to manage the pain while an exercise rehabilitation program is followed, as taking pain relief without a strengthening routine will just mask the condition leading to the issue later in life.

Surgery while highly effective, will require both prehab and rehab strengthening routines to build up bones density and soft tissue to support the newly repaired joints or tissue.  Without the strengthening and biomechanical correction, the chance of recurring injury in the future is increased.

How to Relieve Lower Back Pain: 7 Best Non-Invasive Treatment Methods

Given the nature of this blog and this website, I’m going to go into the different types of treatment non-invasive methods such as exercise, physical therapy and manual therapies that I recommend.

It’s not that I do not believe that surgery or medicine doesn’t work rather that I would like to speak from experience.

So, let me start this section with, you need to put in the work.

This is something no one wants to hear. Believe me, even seasoned athletes or gym goers grimace when I recommend the most basic of routines and programs to reduce their back pain.

The way we need to think about our pain is that it is ‘our pain’ and that we must address it accordingly. We are responsible for our results when it comes to undergoing a rehab process.

Now, this is not to say that if you get a poorly prescribed program or an awful diagnosis that you should just get over it. But when we are given management protocols and a rehabilitation program we must adhere to them.

Simply put, you get out what you put in.

I’m like many others, have had some pretty awful stretches of lower back pain which would see me barely being able to get out of bed for months until I just get on with it and be consistent with my rehab routine.

7 Best Methods to Relieve Lower Back Pain

1. Self Care: Self-care for lower back pain refers to the caring and management of your pain and condition. Pain management protocols require both reduction in workload as well as, adherence to rehabilitation programming and exercise prescription to reduce pain and the further occurrence of pain.

Too often patients of mine will return to the clinic in worse pain not because they haven’t done their programs, or workouts but because they’ve taken on too much, and pushed themselves through the pain or returned to work too early.

I want to tell you something now. If you are in pain, do not push through (unless it’s through a controlled exercises routine).

Recovering from lower back pain is long game stuff. Daily management and building up is how you ensure success in the future.

2. Exercise: Exercise is the key factor when treating lower back pain. Exercise and rehabilitation are critical parts of the recovery process as they encourage the reactivation of damaged and traumatized tissue. The use of prescription exercise and rehab programs in controlled environments (gyms, rehab centres, pools) can allow the body to regain control of lost function. From this foundation of reactivation, the body can then be incrementally challenged, becoming stronger over time, reducing the occurrence of reinjury in the future.

What is muscle activation

Exercise for many years was considered lesser of the recovery and management protocol behind medication and surgery. As years have passed non-invasive treatment methods such as exercise and rehabilitation have been preferred as they are the foundation of human movement and function.

Surgery while effective is often viewed by many as a last resort, as removing or altering damaged tissue may not always be successful.

Bed rest was also prescribed as a recovery protocol in years past, however with back pain like many other injuries getting moving and keeping the muscles engaged is a key part of not only restoring and maintaining the correct function but reducing pain.

For example, if you’re experiencing lower back pain in the morning try a warm-up and activation routine. By engaging and activating our bodies while in pain, we are not only reducing the bodies pain, body showing our bodies what muscles need to be used through the day.

Swimming for lower back pain is also excellent in reducing pain and reactivating our entire bodies. It allows the body to begin moving again gently under reduced load and level of impact.

3. Massage: Massage for lower back pain releases muscular tension and calms the nervous system. Returning the body to a parasympathetic state can greatly increase the bodies ability to heal, this can be through a remedial or relaxing massage. The use of trigger point therapy and deep tissue can also be used to release muscular tension and trigger point pain that may occur as a result of a muscular or nervous system based trauma to the body. The use of massage to increase muscle and joint mobility is highly beneficial when it comes to relieving pain and getting moving again.

13Massage is highly recommended when it comes to reducing pain and releasing muscular tensions. Often when you are suffering from high levels of pain it is hard to relax and rest, which makes it difficult for your body to heal.

What is the best massage for lower back pain? This is highly subjective but if you are in a considerable amount of pain or new to massage I suggest starting with a gentle treatment from a Swedish massage therapist. In heightened levels of pain and stress going too hard may exacerbate your pain. Something gentle should be your aim.

If you’re looking for someone to get into those trigger points and tight muscles I suggest a remedial massage therapist, Myotherapist or Osteopath. These practitioners are not only great with their hands but excellent with muscular anatomy and biomechanical function. In short, they know where the pain is and why it’s manifesting there.

While seeing a practitioner is recommended, attacking lower back pain trigger points with tools such as massage guns and massage balls as a part of self care is are great alternatives between appointments.

4. Dry Needling: Dry needling is the practice of inserting small gauge sterilised needles into muscular tissue to release muscular tension. Not to be confused with acupuncture, dry needlings basis is soft tissue focused. Commonly used by those in manual therapy practices such as Osteopathy, Myotherapist and Remedial massage therapists, Acupuncture style dry needles are applied to tight and restricted muscles to release tension. By applying a foreign object such as a dry needle into the restricted tissue, the body will create inflammation (good healing response), stimulate the nervous system, increase blood flow, which will cause the muscle to relax.

12The use of dry needles has been around for thousands of years in the practice of acupuncture. However as previously mentioned, they are not to be confused with one another as acupuncture practice is based on the treatment of bodies meridians and qi flows to treat a range of systemic and physical conditions.

Dry needling on the other hand is a relatively new practice in which strictly treats the muscular and nervous systems.

Dry needling for lower back pain has been highly effective in reducing muscular trigger points, improving mobility and reducing pain. As there are dozens of lower back and hip trigger points, the application of dry needles directly into restricted tissue can yield rapid results.

5. Kinesiology tape: KT Tape is the use of stretchy fabric-based tape to assist in muscular stimulation, and recovery. Not to be confused with rigid tape, kinesiology tape is much more flexible and gentle, rather than firm and restrictive. Kinesiology tape is applied in various patterns in a bid to assist the bodies movement, rather than restrict it. KT is also used in the healing of acute tissue damage such as sprains or strain, where the tape can be cut and applied in a cross-hatching pattern to improve lymphatic flow and assist in the recovery process.

11In recent years the use of KT has been on the rise especially within elite sporting circles. Sports such as basketball, football, CrossFit and even water-based sports have taken to using KT tape on their athletes as it provides a more free-flowing and movement supporting option, that allows and even encourages movement rather than restricting it.

By applying KT for lower back pain with a degree of stretch along with muscles in the direction of the muscle fibres, the subtle pull of the tape can help to prompt our skeletal muscle and nervous system.

KT tapes elasticity is also great for reducing bruising. When applied with the cross-hatching or decompression method, KT tape draws the upper levels of skin and fascia outwards, allowing for improved lymphatic flow, which is responsible for removing damaged tissue waste from the body.

7. Ice or heat: Cooling and warming of tissue can greatly assist and improve the bodies healing process. While wildly debated over many years ice or heat have both been highly effective in the treatment and recovery of injuries. The use of ice for recovery was seen to help decrease swelling and bruising, and levels of pain, while heat warms sore and restricted tissue up and improves lymphatic flow.

10Ice or heat for lower back pain and the treatment of muscles has been disputed over the past decade. Ice was predominately used for all injury cases in the acute phase (beginning) of an injury, however, in recent years it has been indicated that ice slows down lymphatic flow which is responsible for removing debris and waste from damaged tissue.

Heat on the other hand has been shown to increase lymphatic flow and warm-up muscles and joints, while increasing much needed oxygen-rich blood flow to the damaged area.

While the debate seems to be moving in favour of heat, I believe that ice can still play a vital role in the recovery process. Ice itself is a great way to dull the pain, which in turn will allow for gentle movement which is also highly beneficial to the recovery process.

5 Lower Back Exercises and Stretches

Recovery from lower back pain is a day to day process. What you do throughout the day can have a huge impact when it comes to effectively recovering from your injury and reactivating damaged muscle tissue.

So, here are 5 lower back exercises you can do anywhere:

1. BACK EXTENSION

Back extension is a great way to gently reintroduce activation and function to the hips (glutes) and entire back.

Back extensionPerformed on the floor in the lying face down position, it is a safe option.

HOW TO DO:

Step 1: Lying face down on the floor with hands placed flat next to shoulders

Step 2: Clench/squeeze glute muscles

Step 3: With the assistant of your hand, gently lift your chest off the floor (pause for 1 second)

Step 4: Lower yourself back to the beginning position – unclench glutes

Step 5: Repeat 5-10 times – Stop if the pain is above a 3-4/10

A simple exercise that allows you to activate your hips and back from a safe position.

2. HIP FLEXOR ROCKING

Hip flexor rocking is used to open up and stretch the front of the hip joint. Due to our sedentary lifestyle, our glutes become weak and our hip flexors can become shortened and restricted, making it difficult for us to stand in the upright position.

Hip flexor rockingHOW TO DO

Step 1: Grab a mat and find some space on the floor.

Step 2: Kneeling on one leg, with one leg up, have both knees bent at 90 degrees

Step 3: Squeeze glutes and gently push hips forward, focusing on the hip with the knee on the floor

Step 4: Gently rock back and forth working towards a gentle desired stretch

Step 5: Perform for 2 sets of 5-10 rocks on each side

3. HIP RAISES

Hip raises are a great exercise to activate the glutes from a safe position. An effectively functioning hip joint with strong glutes can greatly improve function and reduce lower back pain.

REhab Sofa Website image 3Step 1: Find some space in your house, lying face up on the ground

Step 2: Feet shoulder-width apart, with knees bent up between 90 degrees and heels resting on the floor

Step 3: Raise hips upwards, focus on lifting with both legs equally (you should feel this in the back of your thighs), raise hips as high as possible

Step 4: Gently lower yourself down. – Repeat 10 repetitions for 2 sets

Note: A safe exercise, that can be performed anywhere. If there is pain or cramping take a break and gradually build up, you set and repetitions.

 

4. BIRD DOG

A large reason why people have lower back pain is that our bodies don’t perform as one. The muscles of our bodies cross many joints and rely on their counterparts to work effectively to form a strong chain.

A good example of this is the core or abdomen. Our entire body, that is our shoulders, hips, and back all require an active core to maintain overall strength and function.

REhab Sofa Website image 1So, here is an exercise that will incorporate abdominal control, hip, shoulders and back to get your body functioning as one.

HOW TO DO

Step 1: Grab a mat and find some space on the floor.

Step 2: Begin in the quadruped position (On all fours)

Step 3: Take a deep breath and control your breathing

Step 4: Exhale and lift on arm or leg at a time with minimal shifting of the body

Step 5: Lift one limb at a time for 2 rounds each

Step 6: Try lifting the opposite leg and arm (gently reaching arm and leg back, rather than kicking upwards)

Step 7: Perform for 2 sets of 10 repetitions (1 lift is one rep)

5. CHAIR SQUAT

Now that our lower REhab Sofa Website image 4back and glutes are activated let’s make this life applicable. A chair squat is exactly that, a squat is done up and down off a chair.

This is a great exercise as it can be done at all times of the day whenever you get in and out of a chair. The chair squat is a full-body exercise that uses the hips and glutes to lift the body, which is the key to relieving your lower back pain long term.

HOW TO DO

 Step 1: Grab a chair from around the house preferably not too low

Step 2: Sit on the chair, feet shoulder-width apart

Step 3: Lean forward at the hips, slowly stand up without using hands, clench glutes (bum), thrust hips forward so you are in an upright position

Step 4: Unclench glutes, push hips back, lower self, down to seated position without using hands

A simple and life-applicable exercise that gets you to focus on your hips to do the lifting rather than your lower back.

By incorporating this into your daily life, you will see your hips and glutes take on their role much faster, and more readily.

Summary

Lower back pain can have a considerable impact on our daily function, whether it be at work, performing daily tasks or even general pain or discomfort.

A treatment plan comprising of self-care, exercise and manual therapy is your best bet to relieving your back pain and regaining control of your body.

So, are you going or have to try any of these exercises or treatment methods, if so which ones? Let me know in the comments below. I’d love to hear from you!

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