Low Back Pain, Explained!
Chances are that you have had some form of back pain at some point in your life. Whether it’s just a bit of an ache or excruciating pain.
Low back pain is the most common musculoskeletal disorder in the world, and is the most common reason an individual will seek treatment from a healthcare practitioner.
Around 65-80% of the worldwide adult population will suffer from at least 1 episode of low back pain in their lifetime.
50% of which will have their first experience of back pain by the age of 20. Research also shows that up to 50% of the population have back pain at any one time.
42-75% of those that develop low back pain, have it for 12 months or longer, or suffer from relapses of pain.
Why is back pain so common?
One of the main reasons is that the population is become more and more sedentary. Obesity is becoming increasingly common in the UK and levels of exercise or physical activity are falling. That includes children’s activity levels, which are much lower than 20-30 years ago, with games consoles, mobiles, tablets, computers,netflix etc replacing sport, leisure and recreation and this leads to an unfit, deconditioned population which is less able to cope with the daily demands placed upon the back.
Back pain is most commonly explained by the Biopsycosocial model:
Bio: Describes a physical or biomechanical problem such as a strain, sprain, fracture or bulging disc for example.
Psycho: Describes mood disturbances, stress, anxiety, depression.
Social: Work and family life.
All of the above can contribute to back pain!
Much of the population are working more hours than ever before, and simply do not have the time to exercise. This may also cause low moods, and social withdrawal which can impact recovery and physical condition.
Furthermore, there is an increasing 'claim culture' in the UK population. There has been a noticeable rise in individual's suffering with back pain following a road traffic accident. Some may even exaggerate the extent of their injuries in an attempt to get higher compensation packages, which inhibits their recovery.
To help you understand what’s going on back there, let’s go through some anatomy first.
The lumbar spine is a remarkably complex structure of interconnecting bones, ligaments, muscles, cartilage, discs and nerves.
The spine is made up of 33 bones known as vertebrae and is split into 4 distinct sections:
The Cervical Spine (Neck), 7 Vertebrae
The Thoracic Spine (Upper Back), 12 Vertebrae
The Lumbar Spine (Lower Back), 5 Vertebrae
The Sacrum, 5 Vertebrae
The Coccyx, 4 Vertebrae
Let’s break this down a little further:
At each vertebra the following structures are evident:
Spinous Process- This is the bony point at the back of each vertebra that you can often see or feel sticking out.
Annulus Fibrosus- This is the tough circular exterior of the interverterbral disc; it is a ligamentous structure that surrounds the soft inner core.
Nucleus Pulposus- This is the jelly like inner core of the interverterbral disc; it consists mainly of water. This allows the spine to withstand forces of compression and torsion.
Facet Joint- These are the joints of the spine which allow movement. They also serve to prevent excessive movement and provide the spine stability. Nerves from your spinal cord exit through these joints.
Defining Low Back Pain:
Typically, low back pain is defined by pain, stiffness or muscular tension anywhere between the bottom rib and the inferior region of the gluteal complex.
Back pain is commonly referred to by practitioners as ‘lumbago’, which simply means pain in the lower back. You should never accept this as a diagnosis from a healthcare practitioner; this is simply an umbrella term for a range of conditions that exist relating to the lower back.
Classifying Low Back Pain:
However, back pain is often non-specific, which means that there is no direct cause or specific condition that has led to your back pain. Non-specific back pain usually relates to back pain that has developed spontaneously or gradually over time with no clear explanation. This could be explained by a range of factors which include, but are not limited to lifestyle, type of occupation, stress or poor posture.
Specific back pain accounts for less than 10% of cases, which explains why many cases often go undiagnosed. Here at Peak Performance Therapy, we help you get to the root cause of your pain!
Low back pain can be acute or chronic in nature.
The initial onset of pain
Usually resolves spontaneously within 2-4 weeks for 90% of patients
Back pain that does not resolve within 3 months
Pain that partially improves but never really goes away
Occasional ‘flare ups’
Why does my back hurt?
There are many reasons why your back that might be causing your pain and there are many inter-connected and overlapping structures that are capable of producing your back pain. The back is often prone to developing pain and/or injury because it is subjected to so much demand through poor postures, lifting, sitting, running, exercising etc.
Quite often back pain seems to arise gradually and slowly worsens over time, with no apparent cause if this is the case, your back pain could be arising from a number of causes such as:
Strains- Occurs when a muscle is over stretched too far, resulting in tears of the muscle fibres.
Sprains- Occurs when the spine is forced beyond normal range of motion resulting in damage to the ligaments that connect your bones (vertebrae) together.
Poor Posture- This often causes the muscles surrounding and supporting the back to be continually overworked to counterbalance the increased pull of gravity on your joints. This can lead to increased stress on your muscles, ligaments, discs, nerves and joints.
Degenerative Disc Disease- Your interverterbral discs are the cushions between each vertebra. Over time, it is common for your discs to dehydrate and begin to wear. As this develops, your disc(s) may not be able to tolerate the stresses and forces placed upon it as sufficiently. Degeneration of the discs is extremely common, and rarely results in pain or injury; it is part of the natural aging process.
Herniated Disc- This occurs when the jelly like substance contained in your disc breaks through the walls of the disc, which often results in compression of a nerve root. The disc wall is also richly supplied by nerve fibres, and a tear of the wall can cause acute pain.
Facet Joint Dysfunction- Facet joints are where one vertebra joins another. They serve to prevent excessive motion at the spine. These may have become blocked, inflamed, irritated or subjected to degeneration.
Spinal Stenosis- Relates to a narrowing of the opening spaces of the spine which may put pressure on the spinal cord and nerves. This most commonly occurs in the lower back. Stenosis does not always produce symptoms; however it can produce pain, muscle weakness or pins and needles.
Sacroiliac Joint Dysfunction- The SIJ relates to the joint at the bottom of your lumbar spine. Where your sacrum bone connects to your pelvis. Pain in the SIJ usually arises when there is too little or too much movement.
Deformity- Such as scoliosis (sideways curvature). Kyphosis and Scheuermann’s disease (front-to-back curvature). Spondylolisthesis (a vertebra sliding forward out of position). Ankylosing spondylitis (a type of arthritis in the spine).
Spondylolysis- Refers to a stress fracture in the spine, most commonly found in the pars interarticularis (a small segment of bone that joins your facet joint).
Piriformis Syndrome- The Piriformis muscle lies underneath your glutes and crosses over the sciatic nerve. If this muscle shortens, inflames or becomes thickened, this may cause impingement of the sciatic nerve.
Osteoarthritis- Typically results in degeneration of the cartilage relating to your joints and/or discs. May result in bony spurs that can put pressure on your nerves.
Trigger Points- These may be a cause of your pain or subsequent to another issue. Trigger points are hard nodules within taut bands of tissue, that when physically compressed, cause pain.
Should I seek help?
If you are suffering from back pain that simply is not going away, or suffering from back pain that eases but returns without warning, then it is important that you get this checked out by a qualified health care professional.
Perhaps you have already sought help somewhere before, and didn’t quite get the help you needed. There’s nothing wrong with getting a second opinion.
At Peak Performance Therapy, we will help you get to the root cause of your pain and help you to develop a sustainable, long-term solution.
You should consult your GP immediately if you have any of the following symptoms:
Pain that keeps you awake at night- this could indicate a more serious problem
Saddle Anaesthesia or Paraesthesia - Numbness or Pins & Needles of the buttocks, genitals, pelvic floor region or inner thigh
Bladder or bowel dysfunction such as incontinence
Unexplained weakness of the leg(s)
How is back pain treated?
Most of the time back pain can be treated conservatively. This means that the issue can be resolved without the use of more invasive measures, such as injection therapy or surgical intervention.
Research shows that only approximately 5% of those that suffer with back pain require surgery.
Conservative treatment options may consist of:
Soft tissue therapy- to loosen tight structures such as muscles, tendons and fascia.
Spinal mobilisation or manipulation- to enhance mobility and reduce pain.
Electrotherapy- To reduce pain and enable movement.
Cryotherapy- The application of ice or cooling agents to reduce swelling and inflammation.
Thermotherapy- The application of heat to promote blood flow and muscle relaxation.
NSAIDs- Non-steroidal anti-inflammatory drugs, such as ibuprofen or naproxen.
Rehabilitation- to improve posture, strength, core stability, balance, co-ordination, flexibility, range of motion, joint stability, endurance etc.
If you are concerned about back pain or have any questions surrounding your symptoms then why not get in touch with a fully qualified specialist to discuss them.
Simply call us on 07949919142 or email
Why not check out our back care package at:
Danny Baker MSc BSc (Hons) GSR