What is Non-Specific Lower Back Pain?
There are a number of different structures in your back that can cause lower back pain. These can include:
• Intervertebral disc (for true disc-related lower back pain, see our article on discogenic lower back pain)
• Zygopophyseal joint (the joints between two vertebrae)
• Vertebrae (spinal bones)
• Other spinal ligaments
• Dura mater (membrane of the central nervous system)
• Thoracolumbar fascia (connective tissue that runs over the top of the spine and spinal muscles
Lower back pain will affect up to 85% of the general population at least once in their lives, and 90% of these cases are classified as non-specific lower back pain. This means that any of the above structures can be contributing to the pain. The reason for such a general diagnosis is discussed below.
The difficult aspect with regards to lower back pain is that the relationship between the findings on images or scans, and a patient’s pain, is minimal. This often means that there is no definitive cause for a patient’s lower back pain. Research has shown that there are very high percentages (up to 91%) of abnormal findings on an MRI in patients who don’t have pain – so take the results of your scans with a grain of salt! These changes are often just related to the process of ageing – much like losing your hair or going grey, and do not necessarily correlate to lower back pain.
Symptoms of Non-Specific Lower Back Pain:
Common symptoms of non-specific lower back pain can include:
• A deep, dull ache in your lower back that is hard to locate specifically
• Decreased movement through your lower back
• Pain that may increase to a sharp pain with certain activities including:
• Twisting your back
• Bending forward
• Coughing or sneezing
• Standing up after sitting for long periods of time
• Increased tightness through your trunk muscles
Assessment of Non-Specific Lower Back Pain:
Your All Care Physiotherapist will ask you a series of questions about the symptoms, onset and behavior of your pain, your occupation and any history of lower back pain you may have. They will then complete a comprehensive assessment to determine the nature of your lower back pain. This may include assessment of your:
• Range of movement in your lower back, hips and pelvis
• Strength, sensation and reflexes in your legs
• Nerve mobility
• Individual spinal joint movement
• Core muscle strength
Treatment for Non-Specific Lower Back Pain:
The good news is that physiotherapy can help your non-specific lower back pain. It is very important that you follow your All Care Physiotherapy plan from start to finish, even once you are pain-free to prevent future episodes of lower back pain from occurring.
Treatment for non-specific lower back pain can include:
• Advice and education on what your condition is and what you can do to get better faster
• Postural correction
• Soft tissue massage
• Joint mobilisations
• Gentle exercises to increase your range of movement
• Core muscle strengthening program
• Workplace assessment
What Can You Do to Help?
1. Gentle lumbar rocks:
2. Forward bending on hands and knees:
• Get onto your hands and knees
• Gently rock backwards onto your feet so your arms are stretched out in front of you
• Hold for 5s. Repeat 5 times.
3. Transversus abdominus (deep core exercises):
• The transversus abdominis is a deep core muscle that is part of the corset-like action that works to stabilise your spine.
• When you have back pain, the transversus abdominis does not activate as often or as strongly, which can further contribute to your back pain.
• The contraction of the transversus abdominis is a very gentle contraction (about 20% effort).
How to activate your transversus abdominis:
• Lying on your back, bend your knees up so you are comfortable.
• Place your hands on the inside of your hip bones to feel the muscle contracting.
• Breathe in, breathing into your stomach.
• Gently breathe out and then pause your breathing.
• Draw in through your lower abdominals; you should feel a gentle tensioning underneath your hands. If you feel a bulge you are trying too hard! Keep your ribcage still.
• Transversus also works with the pelvic floor, so it may also help to try and activate the muscles that stop the flow of urine.
• Holding the contraction, begin breathing again into your stomach.
• Aim for 10 x 10s holds. You should be able to feel yourself begin the contraction and also feel when the contraction is relaxed. If you cannot feel the contraction relax then try for a shorter duration hold
4. Deep Breathing Exercises:
• This helps to relax your trunk muscles, and encourages return of normal movement patterns faster.
• Take a slow, gentle deep breath in, feeling your ribs and stomach expand and spread as you breathe in.
• Breathe in as deeply as you comfortably can.
• Hold 5s.
• Repeat 3-4 times hourly.
5. Gentle Walking:
• Staying active is extremely important when you have non-specific lower back pain.
• Is it recommended to try and maintain an active lifestyle, even if you have to modify this to suit your pain.
• Just because your back is sore, does not mean you are doing damage! Exercise should be completed to a level where you are not excessively increasing your pain, and you should gradually build up your tolerance.
To get on top of your lower back pain, call All Care Physiotherapy today on 1300 291 133 and get back to the activities you enjoy!
All Care Physiotherapy