Affecting a third of people during their lifetime, low back pain is the fifth most common reason for Doctor’s visits. In general terms, low back pain that has been present for longer than three months is considered to be chronic.
The low back is made up of five lumbar vertebrae, named L1 to L5. The first lumbar vertebrae is below the 12th thoracic vertebrae and the last lumbar vertebrae is connected to the top of the sacrum. There is a slight curve in the lower back known as the lumbar lordosis. Facet joints are small joints on either side of the vertebral bodies, connecting the vertebrae above to the vertebrae below. The two lowest segments of the lumbar vertebrae are most prone to injury due to the fact that they carry the most weight and offer the most movement. Vertebral discs are located between two vertebrae, offering support to the spine. These discs in the lumbar area are most likely to herniate or degenerate which could lead to pain in the lower back or pain radiating into one or both lower limbs. Large muscles are found on either side of the vertebral column, offering stability as well as being responsible for movement of the trunk. Muscle strains and spasms of these muscles can also result in low back pain.
Chronic low back pain often leads to impairment in mobility. Pain can be centralised to the lower back or pain can be felt in one or both lower limbs. Patients with chronic low back pain may also experience movement and coordination problems.
Simple daily tasks such as driving and partaking in sports or hobbies may become problematic. Many people may even find sitting, standing or walking for extended periods painful. Carrying heavy objects and bending may provoke pain and associated symptoms. If symptoms persist for long periods, disruptions in the patient’s social circles, occupation and financial means and family relationships can be disrupted.
Magnetic Resonance Imaging (MRI) or CT (Computed Tomography) may be required to establish an exact diagnosis such as spinal stenosis or spondylosis.
Identifying risk factors plays a key role in developing strategies to manage and treat patients with low back pain. Some risk factors may not be able to be changed but perhaps modified. Risk factors may include socio-demographical, clinical, psychological or biological factors. For example, depression is often associated with low back pain.
Graded activity and behavioural education are promising treatment approaches in the prevention of low back pain. Explaining the physiology of pain to a patient has also shown to have preventative measures.
This approach includes treating the physical, psychological, emotional and social aspects of the disorder. This has shown to improve outcome measures in long term pain management and reduced disability compared to conventional approaches.
Physiotherapy treatment should consist of manual techniques as well as exercise therapy. Specific exercises prescribed may include general exercise prescription, specifically trained exercise therapy such as the Mckenzie method and motor control exercises. Pilates and yoga can be included in exercise therapy which has proven to be beneficial in patients that have interest in this. Biopsychosocial rehabilitation is indicated in patients with chronic low back pain. This will include education on the condition as well as graded exercises. The most important aspect in treating patients with low back pain is to choose a protocol that is best suited to each individual patient.