Lower back pain, is one of the most common injuries in both the sporting and office work population. In fact, at least 85% of the population will suffer from a severe episode of LBP in their life!! Physiotherapists here at our Adelaide based CBD clinic see a lot of this injury!  For the purposes of this blog, lets focus on the main cause of LBP – the involvement of the ‘disc‘ (otherwise you’ll be here all night…)

So what is the role of our discs and how can they be injured?

To understand this, let’s brush up on our anatomy. The spine is separated into 5 distinct regions, together making up a whopping 33 vertebrae! The lower back, or ‘lumbar spine‘, consists of 5 vertebra each separated by an intervertebral disc. These discs are strong shock-absorbing cushions with a gelatinous-like substance in the middle and a tough, fibrous outer layer. Strong supportive ligaments and nerves lie alongside the discs.

When discs are subject to extreme or prolonged forces such as..

• Bending and picking up a heavy object more than you may be used to (e.g. when at the gym)
• Participating in a long period of vacuuming or gardening where the back is bent
• Repeated heavy lifting (e.g. when doing a big clean-out of the house)

This could result in a disc herniation where the gelatinous substance protrudes through the outer layer and can irritate neighbouring nerves.

So who gets disc related LBP?

Here’s a fact: Often people will have a disc herniation, without knowing, or experiencing any sort of pain!! In fact, more than 50% of people above the age of ~40years will have a disc herniation if scans were to be taken – BUT only very few will experience symptoms. Long story short – scan results do not always predict someones pain levels.

However, let’s look at who is most likely to experience a painful episode of disk herniation

• Smoking/history of smoking – possibly due to the toxins released through smoking leading to slower healing times and reduced disk nutrition
• Diabetes –  increased susceptibility to prolapse and following a prolapse, healing times may be slower
• Additional potential risk factors included age, gender and occupation

What do individuals usually report with disc-related LBP?

• Onset of pain may be gradual/spontaneous or part of a significant event
• Pain at the region of the spine where there may be disc damage or radiating across the back
• Nerve related symptoms in the buttocks region or running down the leg (e.g. tingling, numbness)
• In more severe cases, there may be more pronounced muscle weakness or sensation loss that lasts for a period of time

So what could make it worse?

• Pain may be provoked by bending and twisting movement (i.e. turning in bed, putting on shoes)
• Symptoms may worsen with prolonged activity or sitting
• Symptoms can often worsen at night or first thing in the morning
• Straightening the leg on the affected side (if there is nerve irritation)

How can this injury be diagnosed?

Generally a diagnosis can be made in an initial session following the subjective history and some physical testing. Scans can be performed if the pain doesn’t relieve in the expected timeframe or if the symptoms are very severe. An MRI or ultrasound scan may be used.

Common physiotherapy treatments

Education: Including expected recovery period, activity/work station modifications, avoiding prolonged postures >30mins, heat pack for early/middle rehab stages 

Manual therapy: Mobilisation and manipulation movements can be used to aid in pain relief and range of motion in the short term

Acupuncture: Increase activity and improve blood flow to the local area, promoting lower back healing.

Strapping, taping and bracing: External support can be used to protect the area in the acute stages of an injury and aid in movement along with acting as a sensory reminder of the injured structure whilst the area recovers.

Advice on supplements for injury recovery: Advice may be provided on nutrient intake, such as the increased demand for protein, up to 2.2g/kg (that’s a lot!) when injured.

Equip you with specialist equipment, such as foam rollers, bands, etc: In addition to educating and prescribing a treatment approach, a Physio is able to equip the individual with all the necessary equipment for their rehab journey. This may include resistance equipment, braces, mats or mobility aids.

Exercise Prescription: Both mat and equipment based exercise can provide therapeutic benefits for pain and function. Examples of exercises for in the acute stage are below..

What exercises can you do in the first 0-2 weeks?

1) Back Extensions – extensions aim to reduce pain and increase function. With your forearms on a wall, gently let your hips sink towards the wall until you feel very gentle pressure in the back, hold for 20sec.

2) Pelvic Rocking – Lying on your back, gently arch and flatten your lower back on the bed.

3) Lying knee drops – Lying on your back with knees bent up, slowly drop both of your knees to one side and repeat on the other side.

DISCLAIMER: please consult with a qualified health professional if you are having any significant pain doing these exercises, or alternatively to progress your exercises as your back strengthens! We would love to chat over the phone if you have any concerns/questions!

Key messages

1) The cause of LBP is multifactorial, there is no ‘one size fits all’ approach to management

2) Pain/symptoms are generally experienced in the lower back, buttocks and occasionally down the leg

3) The spine, discs and the surrounding structures are extremely strong in nature and with the correct management/advice, can be managed conservatively

4) Physiotherapy treatment including mobilisation, acupuncture, bracing and exercise prescription are all effective in the management of LBP

5) Strength and Flexibility exercise, whether it be at home or in Pilates, are proven to be effective in long term management of LBP

Disclaimer

None of the information in this article is a replacement for proper medical advice. Always see a medical professional for advice on your injury.

To know more about LAS and to get an assessment, book to see one of our physios through the link below:

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