Why does my back hurt?
Low back pain (LBP) is the most common musculoskeletal condition and will effect more than 80% of people at some point in their lives. It can be caused by a variety of different sources including but not limited to inactivity, excessive and improper lifting of objects, physical trauma to the area, arthritis and others. Anyone is susceptible to back pain; from office workers to construction workers and everyone in between.
Back pain can present itself in many ways. Some experience sharp pain of a specific region of the back, with aching pain radiating down one leg, while others report a dull aching in the back which worsens throughout the day but does not affect the legs. Regardless of how your back pain presents, it is important to know the importance of seeking attention of a physical therapist as soon as possible. Many scientific studies have shown the benefit of physical therapy treatment for lower back pain. Science also shows that the earlier than someone is seen following the onset of LBP, the better they typically respond to conservative treatment and the quicker they experience relief.
Why is LBP so common? One interesting theory involves the evolution of our species from one which used all 4 limbs to move around, to one which stands upright and uses mainly the legs for mobility. Lets look at other animals who walk on all fours for insight. Take a dog for example. Their spine runs horizontally with the ground during normal daily activities. This means that there is far less pressure being placed along intervertebral discs, or the discs between each of the bones of the spine. There is also far less work required of the muscles of the lower back to keep them upright. In a bipedal animal, gravity places much larger forces on the muscles of the lower back, especially when bending forward or carrying a load, increasing the risk for damage to the discs, arthritis of the bones and strain of the lower back muscles. As humans evolved from quadripedal to bipedal, more and more force was being placed on the lower lumbar verebrae and discs. Our spines were not designs for walking upright and therefore are not optimal for bipedal ambulation.
What can you do to avoid LBP? By increasing the strength and maintaining proper mobility of the lumbar and thoracic spine, you can oftentimes reduce the force being required of the intervertebral discs. The muscles which run along the spine act as “shock absorbers.” With proper strength in these muscles, the discs are not required to sustain as much force, reducing their chance of damage. In terms of maintaining mobility, stretching of the hip and trunk musculature improve the ability of the back muscles to maintain the appropriate range of motion. This is a highly simplified explanation of the mechanisms behind LBP, however by improving and maintaining hip and trunk (core) strength and flexibility, the chances of getting LBP are greatly reduced.
What does physical therapy treatment of LBP involve? This really depends on each persons individual cause for the LBP. If the cause of pain is due to one single event, the treatment will likely involve reducing the inflammation or “acute pain response” of the body. This oftentimes will reduce the intensity of pain. Treatment of acute LBP may involve modalities such as electrical stimulation, manual therapy to relax musculature or reduce the sensitivity of the nerves in the area, and/or whats called isometric strength training. Other treatment methods are available, but these are simply some of the more common treatments provided. It is then important to ensure that the body is trained to reduce the risk of this injury happening again. This typically involves strength training and stretches to areas which are less flexible or are found to be weaker than required for daily activities. More gradual onset of LBP sometimes may require more time for relief to be experienced, but as with everything, every injury is different and every person is different. Something important to keep in mind with chronic LBP is this: if the injury is a result of 30 years of insult to the area, it may not simply resolve in 2 or 3 sessions. There is no magic treatment for these types of injuries. Not even surgery.
Following the instruction of your physical therapist both in the clinic and at home will be instrumental to your recovery. You will likely be provided with a home exercise program or HEP. Be consistent with it. The more consistent you are with your HEP, the more likely your pain is to improve. Remember, the goal of your PT is to help you meet your goals and get back to pain-free living!
I have low back pain. What should I do? See a physical therapist! As previously discussed, the sooner than you seek treatment, typically the better your chances of a quick reduction in pain. In many states, you can get in to see a PT without a physician referral, so call the clinic in which you wish to be treated and they will be able to assist you with getting the process started!
Please let me know if you have any questions!
Dr. Cameron Dennis, PT, DPT