What causes low back pain?

When pain is chronic, tests usually do not identify the cause.

There are many potential causes, but usually a specific disease or abnormality in the spine causing the pain is not found with testing, and the back pain is a medically unexplained symptom.

Chronic low back pain syndrome can be one of many interrelated functional symptom syndromes composed of medically unexplained symptoms, which are “caused” by dysfunction involving the mind/brain—body connection.

To explain the unexplainable and cause, look at the terms used here and then “see the big picture.”

LOOK AT TERMS

• Functional refers to how the body works.

• Symptom Syndromes are collections of medically unexplained symptoms. They are also known as functional somatic syndromes and chronic multisymptom illnesses. Nearly every specialty defines at least one syndrome. Examples include RHEUMATOLOGY (fibromyalgia) and GASTROENTEROLOGY (irritable bowel syndrome).

• Medically Unexplained Symptoms (MUS) cannot be explained by medical tests, because they are caused by dysfunction.

• Dysfunction is disturbance or “malfunction” of how the body works.

• Mind/Brain-Body Connection refers to how the mind/brain and body communicate and talk with one another.

SEE THE BIG PICTURE
MUS and symptom syndromes frequently overlap with one another and are commonly associated with and often attributed to stress, depression, anxiety, and/or panic. Medical and scientific research is showing how the mind/brain and body communicate and both how and why symptoms are generated. One of the most important discoveries is that the "central" mind/brain can become "sensitized" to "peripheral" body feelings, such as pain originating in the low back. So these symptom syndromes are now being called, central sensitivity syndromes. 

This author and Thomas L Hudson, MDiv JD (StillHurtingFINDHEALTH.com), propose a new unifying and holistic medical model of medically unexplained symptoms and their related symptom syndromes as chronic disease, explain both how and why they occur, and show what people can do to help themselves and work effectively with their caregivers.

DISEASE IS DYSFUNCTION, AND SYMPTOMS ARE THE EXPRESSION. The cause of medically unexplained symptoms and pain can be understood as disease/dysfunction, regardless of whether the symptoms are widespread (e.g., the fatigue of chronic fatigue or the pain and fatigue of fibromyalgia) or localized to a specific area of the body (e.g., the pain of chronic low back pain syndrome).

Back pain is very common and often goes away within days to a week. Back pain which lingers can have  deeper causes such as dried out bulging or painful discs. These same discs when bulging can irritate nerve roots leading to inflammation of the nerve root which can give aching pain down an arm or a leg. Arthritis of the small joints of the spine and of the sacroiliac joint itself can cause back pain. Cancer or fractures of the spine are less common causes.

Obesity and generally being out of shape can allow for more stress on the spine and this is leading to a higher frequency of back pain complaints in  this country.

It is the job of an interventional pain physician based on history and physical to uncover these likely sources of pain and then intervene.

Sometimes it can be from muscle imbalances, commonly seen in the following muscles.

Short/Tight Muscles

• Rectus femoris
• Psoas Major
• Adductor complex ( brevis ,  longus ,  magnus )
• Bicep Femoris   
• Piriformis
• Tensor fascia latae  (TFL)
• Quadratus lumborum
• Erector spinae muscles
• Latissimus dorsi
• Soleus

Long/Weak Muscles

• Gluteus maximus
• Gluteus medius
• Inner unit musculature*
• Posterior tibialis

Here are steps to improve your low back pain.

1. Have an assessment done by a Fitness Professional
2. Integrated Warm-up:

• Self-myofascial release (SMR)
• Static stretching
• Neuromuscular stretching
• Active isolated stretching
• Dynamic stretching
• Treadmill warm-up
• Elliptical warm-up
• Cycling warm-up
• Versa climber warm-up

3. Improve Core Control

4. Train to Improve Balance

5. Train to Enhance Muscle Reaction Times

6. Improve Integrated Strength

7. Remember to do cool down exercises at the end of your workout

•  Static stretching
• Neuromuscular stretching

Answering as a personal trainer, the back pain I hear about from clients comes from a variety of circumstances:

• Muscle imbalances (too much tightness or lack of activity)
• Poor posture
• Prior injury
• Repetitive overload (Doing some type of action poorly and often)
• Poor exercise technique

Many patients assume their low back pain is from a structural problem in their spine such as a herniated disc, degeneration, or stenosis. Although these diagnoses can be the cause, you should also consider other sources.

Poor muscle stability of the smaller muscles of your trunk, such as the transversus abdominis, can lead to excessive forces on your spine. Post-partum women and chronic back pain patients usually have problems controlling these muscles. Trigger points in muscles such as the multifidus and quadratus lumborum commonly refer pain to the back. Sciatic nerve irritation is frequently associated with back pain as the nerve originates from the lower back and can also cause symptoms in the legs. If everything else has been ruled out, consider referred pain from your internal organs. For example, kidney dysfunction can present itself as back pain. There may also be an association of food allergies and vitamin deficiencies causing back pain. Lastly, serious medical pathologies as spinal based cancers should be considered.

Back Pain is incredibly common and more often than not, not a medical urgency/emergency. Anatomically, there are many structures that can contribute to low back pain.

Most commonly, the pain may be secondary to acute spasm or spasticity of the muscles of the back. If this is the case, the pain tends to come on suddenly, and there may be an inciting incident (i.e. sports injury, slept funny, etc.).

Degeneration of both the intervertebral discs and/or the joints in the back and/or the vertebral bodies themselves may also contribute to pain. This can result in both a sharp and a dull aching consistently present pain.

If the above-mentioned degeneration is affecting the nearby nerve roots, then the nerves themselves can become part of the problem. Nerve pain tends to be more sharp and electrical in nature. In this case, this may or may not involve the lower extremities as well.

Of course a combination of the discussed elements can also manifest. If back pain does not self-resolve in 2-3 weeks, it may be a good idea to consider visiting with a healthcare professional.

Low back pain is one of the most common reasons why people seek medical care. It is estimated that 80% of the population will experience low back pain at some point in their life. Fortunately, most cases will resolve with conservative treatment within 6-8 weeks.

The cause of low back pain is multi-factorial. Many conditions can cause low back pain. One of the most common reasons is muscle strain which is treated with NSAIDs, muscle relaxants, and physical therapy. Other causes, to name a few, include osteoarthritis, rheumatoid arthritis, degenerative disc disease, fractures, and spinal stenosis. An often overlooked cause of low back pain is Sacro-Iliac Joint dysfunction and inflammation. Low back pain can also be caused by tight hamstrings. More alarming causes include tumor, metastasis, bleeding and infection.

If the low back pain persists for more than 4 weeks, it is important to see your doctor who can perform a physical exam and order necessary tests which may include blood work, an x-ray, CT scan, or MRI. "Red Flags" or alarming symptoms that accompany low back pain include night sweats, weight loss, fever/chills, loss of bowel or bladder control, weakness, foot drop, and pain that awakens you. If these symptoms accompany the low back pain, seek medical attention immediately. 

The treatment is based upon the cause. When considering treatment, more conservative measures are tried first such as medication and physical therapy. Many patients find alternative treatments helpful such as acupuncture, spinal manipulation, and massage therapy. If that fails, then injections can be tried. As a rule of thumb, surgery is a last resort. In the more difficult cases, consultation with a pain management physician can help diagnose and properly manage the pain. 

Yes, barre3 exercises can be performed by both men and women. Most exercises can be modified to help accommodate flexibility concerns that men may have.

Low back pain is generally blamed on poor back-muscle tone, muscle tension or spasms, back sprains, tears in ligaments or muscles and joint problems. Sometimes nerves, as they leave the spinal cord, can be irritated by slipped disks. Such irritation can cause pain in the buttocks or legs and numbness, tingling or weakness in the legs.

The causes of low back pain are not clear, but recent research has provided some valuable insights. Autopsy studies have shown that people who had back pain also had characteristic soft tissue injuries. In particular, small tears of the connective tissue membranes that link the outer shell of the disk to the vertebrae appeared to be responsible for the pain experienced. When these membranes tear, bleeding, inflammation and swelling occur. The chemical by-products of this tissue damage make the normally alkaline disk acidic. The acidity then irritates neighboring nerves and causes the pain.

Because the disks do not have a blood supply of their own, enhanced fluid exchange is the only mechanism for improving cell nutrition and for removing offending chemical agents and excess acidity. Fluid exchange can be accomplished by physically moving extracellular fluid into and out of the disks by moving the spine. If time passes without adequate mobilization, the biochemical and mechanical changes caused by the soft tissue injury become less reversible, and the chances increase that the back pain will become chronic.

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