by Andrew Hume, Kinesiologist

This is an extensive topic.  My intention here is just to provide a brief, non-exhaustive overview of low back pain (LBP), some of it’s suspected causes and general categorization, as well as some common treatment options – which will hopefully help improve people’s basic understanding of this complicated condition.

What is Low Back Pain?

LBP is essentially discomfort felt anywhere in the lumbar region of the back (i.e. the space between the bottom of the ribs and the top of the gluteals) typically characterized as a dull ache or a sharp pain that is more immobilizing.  LBP is one of the most significant sources of disability in modern society.  It affects both men and women of various ages, and can certainly diminish one’s quality of life.
LBP can be characterised according to the duration of the pain as either acute (few days to weeks), subacute (few weeks to months), or chronic (typically longer than 3 months).  However, most current evidence points to LBP as being a recurrent scenario for many people, and thus it is often thought of clinically as something that typically ebbs and flows for the patient.  As therapists, we always want to be positive – but the reality is that most people who experience significant LBP often end up having additional episodes at different points in their life.  This is particularly true if no effective intervention is attempted.
The following is a list of some of the most common low back conditions:
   -Herniated Discs
   -Stress fracture-related disorders
   -Spinal Stenosis
   -Spinal Nerve Root Injury
   -Disc Degeneration
   -Ligament Sprain or Muscle Strains
From a clinical perspective, LBP is one of the most challenging conditions to effectively treat, in part because there are so many factors involved.

Factors that Influence the Onset and Persistence of LBP

Age: Although LBP affects people across the lifespan, it is actually most common in people between 30-60, after which it gradually declines in prevalence.  This is true despite the fact that older adults almost always have more degenerative changes in the lumbar spine.
Smoking: This unhealthy habit is associated with increased LBP (particularly chronic) – thought to be connected to fact that smoking decreases blood flow to the discs of the spine, leading to a lack of proper nutrients and oxygen.
Occupation:  Jobs that require heavy lifting, pushing, pulling, prolonged standing or sitting/driving, and exposure to awkward positions (e.g. bending and twisting) all can predispose people to LBP.
Overweight/Obesity: Associations between being overweight and experiencing LBP are currently unclear; however, obesity (in particular abdominal obesity) does appear to increase the risk of LBP.
Skeletal and/or Muscle Irregularities: Some people develop spinal curvatures (lordosis, kyphosis, scoliosis) with accompanying muscle imbalances around the lumbar region.  These musculoskeletal irregularities contribute significantly to postural strain and impaired movement that can contribute to LBP.

Psychological Factors: Depression, anxiety, and insomnia are strongly correlated with LBP.  They can be both predisposing and resulting factors of existing LBP.  

Pregnancy: Pelvic positional changes from increased pregnancy weight gain can lead to LBP that may linger after childbirth.

Treatment Options

Because LBP is so variable, treatment goals really depend on the specifics of the condition and the individual.  Most people with acute LBP are able to return to work/life activities within a few days to weeks.  But, as was discussed above, these episodes are often recurring and can even become chronic.  Thus, treatment options for such a complex and diverse condition need to encompass a variety of approaches for effective management.

Pharmacological treatment:. Pain medications such Tylenol and Advil are helpful for short-term relief.  Muscle relaxers, a variety of over-the-counter topical creams such as Voltaren, and sometimes Narcotics are also often used.  In some cases, individuals benefit from spinal injections (typically local anesthetics or corticosteroids) which are used to relieve pain and reduce inflammation – and can be effective at allowing a patient to avoid surgery.

Surgical treatment:. The several types of surgical interventions for LBP are beyond the scope of this article.  However, what is important to know is that when  you look at all people with LBP rarely is spinal surgery considered.  If conservative treatments have failed to provide any relief, and the individual has developed substantial neurologic symptoms then the conversation is often had with the surgeon at that point.

Non-pharmacological treatment: Modalities such as transcutaneous electrical nerve stimulation (TENS) and ultrasound, although sometimes helpful for acute LBP, do not typically offer much benefit for more persistent LBP and are not recommended as a primary treatment approach.  For persistent/recurring LBP, therapies such as massage, fascial release, acupuncture, and spinal mobilization have certainly shown to be helpful for reducing and managing LBP; however, my experience as a kinesiologist for the past 20 years has taught me that such interventions are rarely enough to effectively manage LBP without also employing exercise/activity based treatment.  And indeed this is what the research supports most – active recovery.  

As a clinician, if the patient has been cleared for anything medically complicated then it is important to communicate that their condition isn’t ‘serious’, and encourage them to remain active within the limits of their pain.  Although many types of activity have been shown to help manage LBP (yoga, Pilates, walking, swimming, sensible resistance training, etc.) I would stress that it is also of the utmost importance to guide and educate the patient on proper movement and posture mechanics – so when they participate in their chosen activity it is done safely and most effectively.

I have personally been managing my own LBP for the past 15 years, and I can fully attest that what has helped me more than anything else has been losing weight, improving my nutrition, enhancing my physical capacity, and just paying closer attention to, and learning from, my body in general.  If you want to live with LBP that is managed well, for most folks it absolutely requires living differently.

To book an appointment with Andrew or inquire about his Kinesiotherapy wellness classes at our Stratford location:
Book online here or call us at (902) 370-2327.