The spine has 3 main functions:
- It connects the pelvis to the trunk and head.
- It protects and houses the spinal cord.
- The spine provides stability, balance, flexibility, and mobility in order for us to perform our daily activities.
Clinically, low back pain is described two ways: acute or chronic. Acute low back pain is defined as lower back of less than 3 months duration. Chronic low back pain is defined as pain/problems lasting greater than 3 months. Regardless of the cause or duration of your low back pain, physical therapy treatment can improve your symptoms, strengthen your back, and help return your to your daily activities.
Treatment of the low back will be based on your primary problem and will include:
- A pain relief program and patient education on the back (including its anatomy, risk factors for pain, and ways to manage pain in the short term at home)
- Assessment of other joints/driving factors
- Postural assessment and education to prevent undo stress on the back
- Development of a home treatment program to speed recovery
- Manual therapy (massage and hands-on stretching) to normalize range of motion and muscle tone
- Exercise to improve movement and strength
Some common conditions of the low back:
Muscle spasms: are involuntary contractions of a muscle that can decrease flexibility of that muscle and often cause pain. These occur in the paraspinal muscles and deep rotator muscles of low back as a means of “protection” and usually indicate that something is out of alignment (the vertebrae/pelvis), strained (one of the lumbar extensor muscles for example), or traumatized after a sudden injury (with bruising/trauma). On occasion, the muscle spasms can last for days or even weeks. In these cases, often stretching and rest alone is not enough to alleviate them. Physical therapy will involve addressing the underlying cause of the spasm, performing soft tissue massage to help lengthen and relax the muscle, and strengthening/re-educating the muscle so it does not reoccur.
Symptoms of a muscle spasm in the back may include:
- Pain/tenderness along one side of the back
- Loss of motion
- Sensation of “pulling/twitching” in the affected motion
- Fear of movement: if you move suddenly of too far, the spasm increases and the pain gets worse
Stenosis: is the narrowing of the spinal canal. This can occur around the spinal cord, or around the nerve roots as they exit the intervertebral foramen. Typically this condition occurs with aging and is similar to arthritis. Because of mechanical compression and blood flow congestion; spinal stenosis can result in severe pain. With lumbar or low back spinal stenosis, symptoms often include low back pain and a diffuse radiation of pain into the buttocks and thighs.
Other symptoms include:
- pain with walking, extending (arching the back), or prolonged standing
- tingling/numbness along with radiating pain down the legs
- symptoms often improve with sitting, flexing (rounding the back), or laying on the back with the legs bent to take the weight off the back
- a common complaint with spinal stenosis is decreased walking tolerance
- Disk involvement: (includes herniation, rupture, and degenerative disc disease)
The disc can be damaged by force (a fall, a motor vehicle accident), poor posture, obesity, and degeneration (arthritis, stenosis). Often when the disc is damaged, pressure is placed on the nerve roots and radiating symptoms (pain in areas other than the back) may be present.
Other symptoms may include:
- pain/stiffness in the back that is worst in the morning and at night
- a burning pain/tingling that radiating into the buttocks and/or thighs
- limited motion and an overall loss of flexibility
- in severe cases, atrophy of the muscles along the path of the compressed nerves (weakness/decreased muscle size)
Sciatica is a symptom, not a disorder. The radiating pain of sciatica signals another problem involving the nerve, such as a herniated disk, misalignment of the pelvis, or muscle spasm/tightness that compresses the nerve in the buttock. Symptoms may include:
- pain in the lower back that radiates to the buttock/leg
- hip/groin pain
- loss of strength/flexibility (more prominent on one side than the other)
- difficulty sleeping, walking, and sitting for prolonged periods