Simple low back pain is a common condition affecting individuals of all ages. Unlike other types of back pain, its exact cause remains elusive, often attributed to musculoskeletal strains. It's also known as Nonspecific low back pain (NSLBP), Mechanical Low Back Pain, or Functional Low Back Pain, each term shedding light on different facets of this condition. The terms reflect the pain's response to mechanical forces and the functional aspects of the musculoskeletal system, respectively.
The economic burden of simple low back pain is substantial, with direct annual costs in the US around $40 billion. While the prognosis is generally favourable, with most finding relief within six weeks, a small subset with persistent pain faces a less encouraging outlook. Without timely intervention, the chance of re-engaging in gainful employment diminishes, emphasizing the need for proactive management and treatment strategies.
Article Index:
Introduction
Examination & Diagnosis
Treatment
Exercises
Conclusion & References
Signs and Symptoms
Simple low back pain can manifest in various clinical presentations, which may differ among individuals. Identifying these signs and symptoms is crucial for determining the appropriate diagnostic and therapeutic interventions and seeking timely medical consultation. Common signs and symptoms associated with NSLBP include:
Pain: The primary manifestation of SLBP is discomfort in the lumbosacral region. This pain can range from a dull, persistent ache to an acute, lancinating sensation. The intensity and quality of the pain may be influenced by factors such as posture, movement, or activities performed.
Rigidity: Individuals with SLBP often exhibit stiffness in the lower back, particularly after prolonged inactivity or sustained sitting. This rigidity can impede mobility and hinder the performance of daily activities.
Muscle spasms: Involuntary muscle contractions, or spasms, can occur in the lumbar region due to SLBP. These spasms can be intensely painful and often result from muscle strain, overuse, or neurogenic irritation of the innervating nerves.
Decreased range of motion: SLBP can lead to a restricted range of motion in the lumbar spine, hindering flexion, extension, or rotation. This limitation may affect functional activities such as stooping to retrieve objects or donning footwear.
Referred pain: In some instances, SLBP may result in pain that radiates to other areas of the body, such as the hips, buttocks, or legs. This referred pain is often experienced as a deep, aching sensation and can vary in intensity.
Weakness or paresthesia: SLBP may induce sensations of weakness or numbness in the lower back or the affected leg(s). These sensations can arise due to nerve compression or irritation, which disrupts the normal sensory or motor function in the involved area.
Altered posture and antalgic positions: Individuals with SLBP may unconsciously adopt altered postures or antalgic positions to alleviate pain and discomfort. These compensatory mechanisms can result in muscle imbalances and exacerbate the underlying condition.
It is essential to recognize that the severity and duration of these symptoms can vary significantly among individuals. While some may experience mild, transient discomfort, others may suffer from debilitating pain that persists for weeks or even months.
Anatomy and Biomechanics
Understanding the anatomy and biomechanics involved in NSLBP can be a significant advantage for practitioners dealing with this condition. The lumbar spine consists of several complex structures that work together to provide support and mobility. In cases of simple low back pain (SLBP), pinpointing the exact source of pain can be challenging. Essential structures that may contribute to low back pain include:
Intervertebral discs: These cushion-like structures provide shock absorption and flexibility between the vertebrae. In SLBP, discs can undergo degeneration or sustain damage, leading to pain and discomfort. For instance, a bulging disc may exert pressure on nearby nerves, causing low back pain.
Facet joints: Located between each vertebra, these joints facilitate movement and stability in the spine. Inflammation or dysfunction in these joints can cause localized pain and restricted movement in the lumbar region, contributing to NSLBP.
Muscles: The lumbar spine is supported by various muscles, such as the erector spinae, multifidus, and transversospinales. Muscle strain, overuse, or imbalances can lead to pain and discomfort in the lower back. For example, weak core muscles may compel the back muscles to compensate, resulting in strain and pain.
Ligaments: These fibrous bands of tissue connect bones and provide stability to the spine. Injuries, like sprains or overstretching, can cause pain and inflammation in the affected ligaments, contributing to SLBP.
Nerves: The lumbar and sacral plexuses supply motor and sensory functions to the lower back and limbs. Irritation or compression of these nerves due to various factors, like disc herniation or inflammation, can lead to low back pain and other neurological symptoms.
Comprehending the interaction between these structures can assist in pinpointing and addressing potential sources of SLBP, leading to more effective treatment approaches.
Examination and Diagnosis
A comprehensive clinical examination is essential for diagnosing and managing SLBP. It involves several assessments that aim to identify the source of pain and rule out more severe underlying conditions. These assessments include:
Orthopedic assessment: This evaluation includes range-of-motion tests, joint mobility, and palpation to identify specific structures causing pain or discomfort.
Neurological assessment: This examination focuses on nerve function, reflexes, and muscle strength, helping to identify any nerve involvement in the pain.
Vascular assessment: This evaluation checks for adequate blood flow to and from the lower extremities, as some circulatory issues can manifest as low back pain.
Examination Demonstrations
Below are demonstration videos on orthopedic, neurological and vascular tests we often use with SI joint dysfunction.
Low Back Examination - Effective Orthopaedic Testing
This educational YouTube video is an excellent resource for healthcare practitioners, students, and anyone seeking to deepen their understanding of the common causes of low back pain and how to diagnose them using orthopaedic examination procedures.
Lower Limb Neuro Examination
The lower limb neurological examination is part of the overall neurological examination process and is used to assess the motor and sensory neurons which supply the lower limbs. This assessment helps to detect any impairment of the nervous system. It is used both as a screening and an investigative tool.
Peripheral Vascular Examination - Key Points
A peripheral vascular examination is valuable for ruling out signs of vascular-related pathology. The detection and subsequent treatment of PVD can potentially mitigate cardiovascular and cerebrovascular complications. In this video, we review some common procedures we perform in daily clinical practice.
Differential Diagnosis
A thorough examination, patient history evaluation, and appropriate diagnostic tests are necessary to rule out potential causes of low back pain and enable targeted management. Some common conditions that can mimic SLBP include:
Lumbar disc herniation occurs when an intervertebral disc's inner core protrudes through the outer layer, potentially compressing nearby nerves. A herniated disc may present similar symptoms to SLBP, such as localized pain, muscle spasms, and radicular pain in the lower extremities.
Lumbar spinal stenosis: This condition involves narrowing the spinal canal, which can compress the spinal cord or nerve roots. Symptoms may include low back pain, leg pain, and neurogenic claudication (pain, numbness, or weakness in the legs that worsens with walking and improves with rest).
Spondylolisthesis: This involves the slippage of one vertebra forward over the one beneath it, which can cause low back pain, muscle tightness, and nerve compression symptoms, similar to SLBP.
Sacroiliac joint dysfunction: Inflammation or dysfunction of the sacroiliac joint can mimic SLBP by causing low back pain, buttock pain, and possible referred pain in the thigh or groin.
Hip issues: Conditions like hip osteoarthritis, labral tears, or hip bursitis can present with low back pain and may be misinterpreted as SLBP. Pain may be localized to the hip or radiate to the lower back, groin, or thigh.
Systemic diseases: Inflammatory or systemic conditions such as ankylosing spondylitis, rheumatoid arthritis, or malignancy can cause low back pain that resembles SLBP. In these cases, other systemic symptoms, such as fever, fatigue, or unexplained weight loss, may be present.
A proper differential diagnosis is crucial to identifying the underlying cause of low back pain and ensuring that appropriate treatment measures are taken.
Manual Therapy
Manual therapy can be an effective component of SLBP treatment, offering pain relief and improved mobility. The inclusion of manual therapy in a comprehensive treatment plan can enhance outcomes for patients. Specific manual therapy techniques and their relation to back pain include:
Spinal manipulation: This high-velocity, low-amplitude (HVLA) thrust technique aims to restore joint mobility and alleviate pain by addressing joint restrictions and improving nervous system function. In the context of SLBP, spinal manipulation can help relieve pain caused by restricted spinal joints or muscle tension.
Spinal mobilization: This low-velocity, high-amplitude (LVHA) technique gently moves the spinal joints within their normal range of motion. Spinal mobilization can be beneficial for patients with SLBP by reducing joint stiffness, increasing joint mobility, and promoting overall spinal health.
Soft tissue manipulation: Manual manipulation of muscles, ligaments, and fascia can help alleviate pain and discomfort in SLBP patients. Techniques like deep tissue massage, trigger point therapy, and myofascial release can target specific soft tissue restrictions contributing to low back pain.
Motion Specific Release (MSR): MSR is a treatment system that integrates multiple techniques to meet the specific needs of the individual (both soft tissue and osseous procedures). This approach allows for a more personalized treatment plan, addressing the various factors contributing to SLBP. By incorporating different techniques, MSR can effectively target joint restrictions, muscle imbalances, and other issues affecting the lumbar spine.
Below are examples of treatments that could be used for SLBP. Which procedures we would use would depend on the specific case of SLBP. These are just a few of the possible procedures.
Chiropractic Adjustments
Decreased Pain, Better Posture, Improved Function - Spinal manipulation is an essential aspect of musculoskeletal therapy, with a notable impact on force distribution and shock absorption.
SI Joint Pain - Unravelling the Mystery
The sacroiliac (SI) joint, a pivotal anatomical juncture that unites the spine and pelvis, is indispensable in load distribution and spinal stability.
Treatment Frequency
Each phase has distinct goals and challenges, which the frequency of manual therapy sessions aims to address. The exact frequency should be personalized based on the individual's pain levels, functional abilities, and response to treatment. It's essential that the treatment plan also evolves to incorporate self-management strategies, exercises, and possibly other multidisciplinary approaches to empower the individual in managing their LBP and improving their quality of life. The ultimate aim is to minimize dependency on manual therapy and equip individuals with the tools and knowledge to manage their back health independently.
Acute LBP (lasting less than 4 weeks):
Frequent treatments (e.g., 2-3 times per week) may be beneficial initially to alleviate symptoms, reduce inflammation, and promote mobility.
The goal is to manage pain and prevent the condition from worsening or transitioning into a chronic state.
Sub-Acute LBP (lasting between 4 and 12 weeks):
Treatment frequency may be reduced (e.g., once a week to once every two weeks) as the acute symptoms subside.
This phase aims at promoting healing, restoring function, and preventing chronicity.
Chronic LBP (lasting 12 weeks or longer):
Chronic cases may require a more spaced-out treatment plan, such as once every 2 to 4 weeks or as needed based on symptom flares.
The focus here shifts to maintenance, managing chronic symptoms, and promoting self-management strategies.
Exercise
Exercise is essential for managing SLBP, as it improves function, reduces pain, and prevents future episodes. A comprehensive exercise program should address mobility and flexibility, strengthening, balance and proprioception. Exercise programs should be tailored to the patient's needs, considering factors like pain severity, functional limitations, and other health conditions. Specific exercises and their relation to back pain include:
Mobility and flexibility: Improving spinal mobility and flexibility can help alleviate pain and stiffness in SLBP. Examples of mobility exercises include cat-cow stretches, lumbar rotation stretches, and hamstring stretches. These exercises can help to enhance the range of motion in the lumbar spine and surrounding muscles.
Strengthening: Strengthening exercises target the core, back, and hip muscles, which can provide better support for the spine and decrease the likelihood of recurrent pain. Examples include pelvic tilts, bridges, and bird-dog exercises. By strengthening these muscle groups, patients can improve spinal stability and reduce the strain on the lumbar spine.
Balance and proprioception: Enhancing balance and proprioception can improve overall spinal function and help prevent falls or injuries that may contribute to SLBP. Exercises such as single-leg stands, tandem walking, and side planks can help patients develop better body awareness and control, reducing the risk of injury and low back pain.
Functional exercises: Functional exercises are designed to mimic daily activities or movements and help patients return to their regular activities without pain. Examples include squatting, lifting, and bending exercises. These exercises can help patients develop proper movement patterns and reduce the risk of pain and injury during everyday tasks.
When developing an exercise program for SLBP, it is crucial to consider the patient's individual needs and limitations, ensuring the program is both safe and effective. Regularly monitoring and adjusting the program as needed can help patients progress and achieve optimal results.
Below are examples of exercise routines that could be prescribed to our patients. What is important to note is that the exact prescription will vary from patient to patient, depending on their specific needs. These are just a few examples.
Stop Back Pain Fast
This routine is designed to get you out of pain ASAP. This instructional video features Miki Burton, a registered massage therapist, demonstrating an acute low back pain routine. Acute lower back pain is a debilitating condition that significantly impacts individuals' quality of life.
5 Minute Low Back Pain Relief
If you're experiencing discomfort in your lower back after prolonged sitting in front of your computer, it's essential to address it promptly. Prolonged sitting puts excessive strain on the lumbar spine and can result in lower back pain.
The 6-Minute Plank Routine
Intermediate Level" is a great way to move on from the beginner-level plank routine. We would recommend practicing the routine for several weeks before attempting the advanced plank routine.
Improve Your Balance - Advanced Exercises
Balance exercises can be of great benefit to people of any age. Balance exercises improve your ability to control and stabilize your body's position. Balance exercises are great at reducing injury risk, rehabilitating current injuries, or increasing your sports performance. You should be comfortable with the beginner exercises before attempting this series of exercises.
Simple Low Back Pain Conclusion
Simple low back pain (SLBP) is a prevalent and often debilitating issue affecting a large population segment. The complexities surrounding SLBP make it an issue that is not only medical but also social and economic in scope. While the condition is generally transient in nature, untreated or poorly managed cases can evolve into chronic pain situations, creating a ripple effect that extends beyond the individual to affect work productivity and healthcare resources.
A multi-faceted approach is strongly advised for effective diagnosis and treatment of SLBP. This should encompass a thorough clinical examination, including orthopedic tests and a nuanced understanding of spinal anatomy and biomechanics. In terms of therapeutic intervention, manual therapy techniques such as Motion Specific Release (MSR) can offer promising results. These targeted approaches aim not only at symptomatic relief but also to achieve long-term spinal health. Adopting this holistic and evidence-based methodology is essential to mitigate the widespread impact of SLBP on both individuals and society.
DR. BRIAN ABELSON DC. - The Author
Dr. Abelson's approach in musculoskeletal health care reflects a deep commitment to evidence-based practices and continuous learning. In his work at Kinetic Health in Calgary, Alberta, he focuses on integrating the latest research with a compassionate understanding of each patient's unique needs. As the developer of the Motion Specific Release (MSR) Treatment Systems, he views his role as both a practitioner and an educator, dedicated to sharing knowledge and techniques that can benefit the wider healthcare community. His ongoing efforts in teaching and practice aim to contribute positively to the field of musculoskeletal health, with a constant emphasis on patient-centered care and the collective advancement of treatment methods.
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References
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