Mechanical Low Back Pain (mLBP) according to an article
by Mark Shepherd PT was referred to as the “common cold” of our spine. This is due to its increasing epidemic throughout various clinics in the US and across the globe. Most common sources of mLBP as of today are work-related — mostly occupations involving frequent heavy lifting and twisting of our body as well as activities involving whole body vibration according to a report
by Baillieres. As a clinician, the most common occupations who come to me complaining of back pain with or without nerve impingement are construction workers, seamen, factory workers and the least common are office workers. Yes, even office workers who sit around all day without proper exercise experience back pain in their life!
Your Lumbar Spine
The lumbar area’s main function is to support your upper body and transmit it’s weight evenly to your hip bone and lower limbs. This area consists of five vertebrae containing five pairs of facet joints– these joints are responsible for your daily movements of bending backward, forward and side-ward. In between each vertebral bone is your annulus fibrosus and nucleus pulposus collectively know as your vertebral disc. This special disc functions as a cushion in between your vertebrae to prevent bone to bone contact.
The main supporting structures of your lower back are your muscles! These structures contract to help prevent excessive motion that may damage your vertebral joints and discs. The back muscles mostly associated with back pain are your Erector Spinae muscle whose function is to extend your spine or bending backward with some rotatory function and your Quadratus Lumborum whose purpose is to laterally flex(side bending) your spine. Affectations of the QL is the most common source of back pain. This hardworking muscle comes in pairs connecting the spine to the pelvis and when contracting all together produces an extension motion of your lower back. The two QL activate more when the erector spinae of your lower back is weak or relaxed especially on prolonged sitting and computer use.
In between your vertebral bones and disc arises your spinal nerves. These delicate structures’ purpose is to transmit movement signals from your CNS to your lower limbs as well as transmit sensation from specific parts of your limbs back to your CNS. When ANY structure in your spine impinges on these nerves they create a unique type of discomfort involving symptoms such as Electric like pain, muscle weakness and altered sensation down to your lower legs. This symptom is called Peripheralization and can be caused by impingement, inflammation or trauma.
Different types of low back pain
Ischemia is defined as a loss of blood supply to any part of the body. The Erector Spinae and Quadratus lumborum are the most common muscles that may undergo ischemia. How does this happen? First is due to faulty posture– slouch sitting all day without regular breaks can lead to some compression to the blood vessels of your lower back. Second is due to recent trauma. Injuries to your low back muscles may alter the normal blood flow to your muscles Both of these causes can lead to discomfort and weakness of your low back muscles
When we say mechanical the first thing that comes to mind is movement– anything that involves impaired movement or position of your low back structures fall under the mechanical category– which the most common cause of low back pain in PT clinics. Cases such as lumbar strain, facet joint impingement, sacroiliac dysfunction and muscle tightness all examples of this type. Visit a PT to determine whether your pain is Ischemic or mechanical of origin
Your vertebral discs fall into a different category due to the different classifications of damage to your disks. Syndromes such as disc bulge and slipped disc fall under this category and may produce peripheralization if a nerve root impinges. The culprits of these are also impaired posture and recent trauma. Disc injuries are more likely to occur when the supporting muscles of your low back are weak and posture is already impaired
Swelling can occur on your vertebral joints, disc or muscles. When this inflammation grows and impinges your spinal nerves, peripheralization may occur. It is important to consult your physician for anti-inflammatory medications coupled together with Physical therapy.
Systemic in origin is one of the red flags of Physical therapy and further evaluation from your physician is needed. This type is caused by other problems outside your lumbar muscles and bones. The pain you feel on your low back is termed referred pain meaning pain coming from different origins in your body that is felt in a specific region on your body. Most common sources of referred pain to your low back are your kidneys, digestive tract and pelvic organs. Referral to a physician is a must!
Effective Treatments as of Today
1. Regular Exercise
This remains the number one treatment and prevention of back pain. If you are experiencing early or chronic back pain while reading this, I advise you to remain an active lifestyle despite the pain– if you’re sedentary, then this might be your calling to start stepping up your game. Whether you are into cardio or resistance training– don’t let the discomfort ruin your lifestyle and fitness goals! It is also important to know the do’s and don’ts when exercising as well as observing proper form when performing your routine.
When in doubt always ask a professional! Your go-to guy when it comes to body pain, posture, neurological involvement, and therapeutic exercise is your Physical therapist. PT is an alternative form of medicine that deals with most if not all musculoskeletal, neurological and cardiovascular problems. PT can save you from the jaw-dropping costs of medical procedures and prescriptions; some effective treatments a PT can do for your pain are prescriptive exercise, pain modalities, manual therapy, spine mobilization, and acupuncture.
A pilot study done by Brewer W. showcased the effect of a single PT session to patients with back pain stating “A comprehensive physical therapy program results in a small effect to increase the level of physical activity in individuals with Chronic Low Back Pain as soon as the first treatment session.”, so you are guaranteed improvements on your first visit. Contact your nearest Physical therapist for professional advise!
3. Massage Therapy
Your monthly or weekly spa visits may also help relieve your discomfort. Occasional visits to your pamper haven will help your body recover especially from heavy physical work. A problem with Spa visits is their procedural way of doing a massage– they mostly focus on whole body treatment without giving special attention to your lower back. This can be remedied by explaining your problem to your therapist prior to treatment so special attention may be given.
On a PT’s perspective, this will be your last resort if faced with excruciating pain. If even the slightest twitch causes you to stay in bed the whole day then I advise you to visit your physician for further evaluation and pain medication. Physical therapists still believe in the useful effects of medications and how
can they assist in the rehabilitation of our patients
I hope this information helps you achieve your pain-free and active lifestyles.
Thank you for your time and support!