Low back pain is an extremely common condition, and many people can’t do the activities that they enjoy in life because of their pain.
About 80% of adults experience it at some point in their lifetime, and it is believed to be the biggest factor limiting activity in young adults under the age of 45.
Among patients who seek medical care for their low back pain, up to one-third report pain of at least moderate intensity one year after an acute episode, and 20% reports substantial limitations in activity.
Not all back pain is the same
The causes of back pain are varied, in young athletes is usually due to overload of lumbar joints from repetitive jumping or bending (such as in gymnasts). Young adults often have a first episode of back pain after doing unaccustomed or heavy activities such as starting a new job that involves heavy lifting (we see many tradies with this issue). Such activity irritates their lumbar discs (cushion like structures that absorb impact between the vertebrae), they usually describe some build-up of stiffness or “niggly” back days before the onset of pain.
It is also common that individuals develop pain due to fatigue after repetitive movements that cause fatigue in already deconditioned core muscles, resulting on overload of the lumbar joints.
Low back pain can be accompanied by other symptoms like numbness, tingling and weakness in the legs due to irritation in the nerves that arise from the lumbar spine, this is commonly called sciatica.
If not well managed, back pain becomes recurrent
Repetitive stress in the spinal structures, as well as aging, have a negative impact on the amount of water present in the lumbar disc, less water means less disc height and in consequence, their ability to absorb impact during daily activities or sports is compromised. This leads to disc tears and in worse cases rupture of the disc fibres (bulging disc).
A flatter disc also causes a reduction in the space between the vertebrae, therefore, less space for the joint to move freely, which leads to low back wear and tear (osteophyte formation, facet joint arthropathy, and ultimately, spinal stenosis).
A common feature in people that suffer from recurrent back pain is weakness in the core muscles. A good analogy is thinking of the spine as a mast on a ship. The muscles that attach to the spine are the ropes that support the mast and prevent it from curving and becoming unstable. If the supporting muscles (core muscles) are weak or imbalanced, the spine experiences stress that can lead to pain, stiffness and ultimately degeneration.
Early management is key to recover from back pain and physiotherapists are the best to help with this. Getting better involves understanding your condition well, what to do and what to avoid will have a big impact in your symptoms. Hands-on physiotherapy will help loosen up stiff joints and tight muscles that may be contributing to the pain. And most importantly, a specific rehab program focused on core strength and spinal mobility will restore and improve your back.
Remember, the most effective way to relieve and prevent your back pain is to stay active!
Do I need an MRI?
The majority of back pain is not caused by a serious underlying condition, and imaging such as MRIs and X-rays are not usually necessary. However, they should be considered when patients present severe motor or sensorial deficits (i.e. progressive or severe lower limb weakness, loss of sensation or reflexes) and to rule out other conditions.
In general, most adults over 60 years old will show degenerative changes in their spine when undertaking scans, however, not all of them will experience back pain. In addition, MRI findings of wear and tear in the lumbar spine are not predictive of low back pain in the future.
Tonosu, J., Oka, H., Higashikawa, A., Okazaki, H., Tanaka, S., & Matsudaira, K. (2017). The associations between magnetic resonance imaging findings and low back pain: A 10-year longitudinal analysis. PloS one, 12(11), e0188057. doi:10.1371/journal.pone.0188057
William Rea, Sandeep Kapur, Hirachand Mutagi, Intervertebral disc as a source of pain, Continuing Education in Anaesthesia Critical Care & Pain, Volume 12, Issue 6, December 2012, Pages 279–282, https://doi.org/10.1093/bjaceaccp/mks028
Zhang, Y.-g., Guo, T.-M., Xiong, G., & Wu, S.-X. (2009). Clinical diagnosis for discogenic low back pain (Vol. 5).