Lower Back Pain

Injury Description

Low back pain is exceedingly common in both athletes and non-athletes alike.  Symptoms can vary from a nagging, nuisance type of ache to severe, incapacitating pain.  The causes of lower back pain can be complex and varied, but for our purposes we will discuss the 4 main causes of lower back pain.

Mechanical Low Back Pain

This is the most common cause of low back pain in athletes.  Mechanical lower back pain accounts for 70-75% of all back problems.   It is caused by strains or microscopic tears of the muscles and ligaments in the back, and is usually the easiest to treat.

Facet Joint Syndrome

The vertebrae in your back are connected by small joints (facet joints).  These joints are about the size of the joints in your finger.  They can become strained and/or inflamed when undergoing extreme forces, such as excessive twisting or arching of the back.  Since you cannot splint these joints, the pain may persist for a long time as they are constantly irritated.  This accounts for 10-15% of back problems in the active person.

Herniated Disc

This is usually the most severe of low back disorders.  Traditionally referred to as a “slipped disc”, it occurs commonly in younger patients (under 50), but can also bother older patients as well.  The disc is a soft substance that acts as a shock absorber between the vertebrae.  The inner center of the disc is similar to the liquid center of a golf ball, which can push out at a point of weakness or injury.  This deformity can then press on the nerves, causing pain from the back down to the foot.  This condition accounts for 5-10% of back problems.

Degenerated Discs

If the discs in your back lose moisture, they may occasionally shrink.  This causes the facet joints to settle closer together, thus irritating the adjacent nerves.  Disc degeneration commonly occurs in people over 40, even without acute injury.

The four conditions discussed above encompass the major causes of low back pain in the active person, but there are many other possibilities.   The treatment of each individual back problem varies, but the principles are the same.

If your symptoms change, notify your doctor immediately for re-assessment.

Treatment

Rest

In the most severe cases, total bed rest is mandatory.  You must be on a hard surface (firm mattress, floor).  The two ideal rest positions are:

• Lie on your back with pillows placed under your knees

• Lie on your side with your knees pulled up to your chest.  Place pillows between the knees.

Ice, Heat, & Massage

If your muscles are spasming, ice and/or massage can help relieve the spasms and associated pain.  To reduce stiffness, heat can be applied in the form of heating pad, bath, whirlpool, etc.

Medication

Your physician may prescribe medication depending on the nature of your low back pain.  The pills will help relieve muscle spasms, decrease inflammation in the joints or ligaments, and help reduce pain.

Physiotherapy

Physiotherapy may be needed to reduce the muscle spasms and inflammation in your back.  A rehabilitation program to prevent further episodes of back pain should be developed, based primarily on increasing the flexibility and strength of your back.

Brace

Our team may prescribe a brace to help support your back.  If sitting for long periods of time seems to aggravate your back, then special back supports may be helpful to relieve the pain.

Lifestyle

Small adjustments in the way you sit, stand, lean, and sleep can make a remarkable difference to your back.  Your doctor or physiotherapist will discuss these adjustments with you.

Weight Reduction

This is most important.  Often, losing 10 pounds can alter your posture enough to relieve the pressure on your lower back.

Sports

When lower back pain is severe, all athletic activity is out of the question.  When you do return to sporting activity, the best sports are those that keep the back straight and do not involve jarring or twisting movements which can aggravate the condition.  Try to maintain your pelvic tilt (see exercises) during the activity.

Good Sports

These sports will be easiest on your back:

• Swimming (especially backstrokes)

• Cycling (stationary)

• Walking

• Skating

Questionable Sports

These may be alright for some, but bad for others:

• Jogging

• Skiing (downhill and cross-country)

• Baseball

• Hockey

Bad Sports

These sports are particularly hard on your back

• Diving (avoid at all times)

• Racquet sports

• Football

• Volleyball

• Basketball

• Running fast or downhill

Exercises

The conditioning of stomach muscles is key to improving your lower back pain.  The basic low back exercise is the pelvic tilt.   It is important that you learn this exercise first, as it will help teach you the best position for your back to maintain during activity.  Initially, the pelvic tilt may feel awkward, but it quickly becomes second nature with practice.

The Pelvic Tilt

Lie flat on your back, knees bent, feet flat on the floor, and body relaxed.  Tighten your abdominal muscles and press the small of your back into the floor while tightening your buttocks muscles and tilting your pelvis up.  Hold 10 seconds and relax.  Repeat 10 times.

A progression of the basic pelvic tilt is the knee raise.  Tilt the pelvis as described above and raise the right knee up over your chest without using your hands.  Then, raise your left knee to join the right.  Hold this position for 5 seconds before returning feet flat to the floor.  Repeat 10 times.

Hamstring Stretch

Sit on the floor with your leg straight, knee locked, and other leg bent in.  With your back straight, bend from the hips and reach down over your leg until you feel the muscles stretch.  Hold for 10 seconds and then relax.  Repeat 3 times with each leg.  If this exercise causes pain, discontinue.

Sit-ups

Full bent-knee sit-ups can be added as pain subsides.  Maintain pelvic tilt.  Sit-ups should be done slowly, with a smooth, non-jerky motion (both up and down).  Start with only a few, and increase the number of reps as your strength improves.

Questions and Answers

Why do I have back pain?
There are many structures in the spine which may become strained, injured, worn, or diseased.  The spinal column is made up of 33 vertebrae, which work together to provide flexibility in motion, protection for the spinal cord, support for the upper body, and force redistribution.  The vertebrae are separated from each other by soft-centered discs.  If these vertebrae become inflamed, move out of line, or press too hard on the discs, you may suffer back pain.

The spine is supported by muscles and ligaments, which also may become strained or weakened.  This can lead to muscle spasms and resulting back pain.  Most back pain is caused by sprains, muscle weakness, tension, or arthritic conditions.

How does a muscle strain happen?
Muscle strains (stretching beyond normal limits) may result in inflammation of the muscle fibers and spasming.  Chronic muscle strain may be a result of poor posture or overuse of muscles.  Lifting and turning at the same time, lifting too much weight, or twisting into an awkward position may strain the involved muscle group.  Strains can occur in any area of the body – back, neck, leg, shoulder, etc.
Muscle strains can also be caused by lack of an adequate warm-up, certain traumatic conditions, or being overweight.

Why is bed rest recommended?
Bed rest is often recommended in order to allow the injured area to heal without further stress.  The amount of bed rest prescribed by your doctor will vary according to your condition.  Your physician may also recommend dry or wet heat.  Occasionally, cold, such as an ice massage, may be effective in the temporary relief of acute muscle spasms.

What role does exercise play?
Supervised exercise is the most common treatment for muscle strains.   Strong muscles help support your back, and proper tone can improve posture and reduce the chance of future muscle strains.

An exercise program should begin once the acute injury has subsided.   CONSULT YOUR DOCTOR BEFORE ATTEMPTING ANY EXERCISES.  If your doctor recommends an exercise program for you, start slowly and do not overdo it.  Follow your doctor’s instructions carefully, and consult your doctor if pain occurs.

Posture and Lifting Techniques to Minimize Back Strain

The way you stand, sit, and lift objects can be critical to your health, especially if you have back problems.  Take a look at the “right” and “wrong” way to do things, shown below.  Make a habit of being “right”, and take it easy on your back

Lifting

Riding

Basic Low Back Syndrome Conditioning Exercises

These exercises are designed to help strengthen the lower back.   CONSULT YOUR DOCTOR BEFORE ATTEMPTING THESE EXERCISES.  If your doctor recommends any of these exercises for you, start them slowly.  Follow your doctor’s instructions carefully and do not overdo it.  Consult your doctor if pain occurs.

Starting position for all exercises: lie on the floor, knees and hips bent with back flat and neck comfortably supported. Your arms should be at your sides, and feet flat on the floor.

Bring one knee to the chest. Straighten the knee, extending the leg as far as possible. Bend the knee to return to the original position.   Relax.  Repeat 5 times, alternating with each leg.  This exercise is NOT recommended for patients with sciatic pain.

Exercises for Better Back Care

General Instructions

Your best back support is derived from your own back muscles!  Faithful performance of back exercises often avoids the necessity of an external brace or corset.  Back muscles can give you all the support you need if strengthened by routine performance of prescribed exercise.

Exercises

Follow the exercise routine prescribed by your doctor.  Gradually increase the frequency of your exercises as your condition improves, but stop when fatigued.  If your muscles are tight, take a warm shower or bath before performing your back exercises.  Do not be alarmed if you have mild aching after performing exercises.  This should diminish as your muscles become stronger.

Exercise on a rug or mat.  Put a small pillow under your neck.  Wear loose clothing; no shoes.  Stop doing any exercise that causes pain until you have checked with your doctor.

Helpful Hints for a Healthy Back

Standing and Walking

Toes should be straight ahead when walking. Put most of your weight on your heels. Hold your chest forward and elevate the front of the pelvis as if walking up an incline.  Avoid wearing high heels.  Stand as if you are trying to touch the ceiling with the top of your head, eyes straight ahead.  All of the elements of good posture will flow from these simple maneuvers.

Sitting

Sit in a hard back chair with your spine pushed back. Eliminate any hollow space near the lower back.  If possible, elevate the knees higher than hips while sitting in an automobile.  Secretaries should adjust posture chairs accordingly.  Sit all the way back in the chair, with your back erect.

Lifting

Bend your knees, squat, and lift with your thigh muscles, not your back.  NEVER bend your back with your knees straight and attempt to lift with the upper torso.  Move slowly and avoid sudden movements.  Try to avoid lifting loads above the waist line.  Avoid bending over to lift heavy objects from car trunks, as this places strain on low back muscles.

Sleeping

Sleep on a firm mattress. A 3/4 inch plywood bed board is helpful, and should be used with all but very firm orthopedic mattresses.   With acute back pain, sleep with a pillow or blanket rolled under the knees and a pillow under the head.  Keep your back under your knees and head.  Keep your knees and hips bent when sleeping on your side.

Driving

Use a firm seat with a padded plywood or special seat support.  Sit close to the wheel with knees bent.  On long trips, stop every one to two hours and walk to relieve tension and relax muscles.

Working

Try to avoid fatigue caused by work requiring periods of long standing.  Flex hips and knees by occasionally placing a foot on a stool or bench.  Take exercise breaks from desk work by getting up, moving around, and performing a few back exercises in standing positions.