Low Back Pain – a Physiotherapy perspective

Low back pain is something that most adults will experience at some point in their lives. For some it may be a mild episode lasting a few days and others severe and lasting months. What is common to both is that, far more often than not, there is no obvious incident or injury that triggers it. People often say ‘I woke up with it’ or ‘it just came on’.

The exact mechanisms that cause low back pain are complex, even if the symptoms are quite mild and it varies between individuals. Pain that is felt in the low back does not mean that the low back is where the pain is coming from. Similarly, if the pain is radiating into the leg it does not mean that the leg is at fault.

Broadly speaking, the mechanisms that contribute to low back pain (and most others pains as well) can be divided into structural, biomechanical and lifestyle.

Structural mechanisms include strain and inflammation to joints muscles, discs, ligaments and other soft tissues.

 Biomechanical mechanisms refer to the way the body is ‘set up’ for normal movement. If someone has stiff joints or one group of muscles tighter than another it will alter the way the body moves which increases the ‘load’ that various structures are under which increases the risk of pain.

Lifestyle mechanisms include work, posture and hobbies. The largest group of people who suffer with low back pain are those who sit for extended periods of time during the day, for example computer work or driving.

When assessing someone with low back pain consideration has to be given to all three mechanisms for pain to be alleviated. Treating joint inflammation, for example, may not be effective if advice regarding posture and lifestyle habits are not addressed. Similarly, a restricted hip joint would need to be stretched to allow normal working of the spinal joints to help alleviate the joint pain.

Low back pain is not just about taking tablets from the doctor, although these may be necessary in the early stages of pain, but assessment of all three mechanisms is essential to maximise the chance of recovery. A physiotherapist has the expertise and time to look at all the factors contributing to low back pain.