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Low Back Pain


80% of us will have low back pain in our lifetimes. It is the most common musculoskeletal pain that patients will talk to their family doctor about.  Most of us will recover within a few days but if this isn't happening, having a physiotherapy assessment will help identify the source of your pain and start moving you in the right direction to getting rid of your pain.

One of the most common reasons clients present to a physiotherapist with low back pain is because they have overstretched or torn a portion of one of their intervertebral discs.  Anytime we sit, bend forward or lift something we slightly stretch the back part of the disc.  If this is done repeatedly (gardening, shovelling snow) or for long periods of time (sitting in the car on a long drive, computer work) the stretch may result in tearing or disruption of some of the fibres of the disc (these fibres are known as the annular fibres).  As the tear progresses, some of the material in the centre of the disc (called the nucleus pulposis) can be forced toward the back corners of the disc and exert pressure on the nerve root.  Depending on the extent of this pressure, the pain may remain in the low back or it may start to radiate or spread toward one side, into the buttock or groin area, or even down the leg.  When this occurs it is important to have a physiotherapist assess your pain and possible movement loss to identify what directions or positions you need to move into to help take the pressure off and let the disc heal.

The McKenzie method of looking at spinal mobility was developed in 1981 by Robin McKenzie and has been wonderfully successful in reducing pain and teaching clients how to manage their pain while they are healing.

Altered and potentially harmful movement patterns will be identified and once the acute pain has begun settling your physiotherapist will look at your muscle function.  This will include looking at the health of your "core" muscles.  These are the muscles that are located closest to the spine and have been identified by scientists studying low back pain as muscles that tend to weaken after only one episode of back pain.  These muscles are also thought to be key in stabilizing the back and helping prevent other injuries.  The muscles of the core are the transversus abdominus (the deepest of the four layers of abdominal muscles), the lumbar multifidus, the diaphragm and the muscles of the pelvic floor.  Your physiotherapist will assess your ability to contract these muscles individually and then look at how you are using them during functional activities such as:

  • getting in and our of a chair
  • lifting
  • squatting
  • addressing the ball in golf
  • while running

Whatever you need to be able to do in your everyday life!

Other sources of low back pain include nerve root irritation, facet joint sprain/ dysfunction and the sacroiliac joint (SIJ) to name a few.  Nerve root irritation can occur after being in a prolonged, possibly awkward posture or if a small spur or scar tissue has developed in you spine.  The facet joints are found on either side of the spine at each level.  The can be "sprained" just like any other joint in your body by moving them too fast, too far or too many times.  They can also undergoing a degenerative process like osteoarthritis (OA) and become stiff and painful.  When low back pain occurs, from any source, it makes many of the activities we do everyday difficult.  Your physiotherapist can guide you toward activities and positions that are less likely to aggravate your pain while your body gets busy healing.

Low back pain can also occur if you injure your sacroiliac joint (SIJ).  This joint is found on either side, between the outflare of the pelvis and the sacrum (the large flat bone at the bottom of the spine at the back).  This joint can become painful during pregnancy or after delivery, with sports that involve impact through the legs like soccer, running, jumping or after a fall onto the buttocks.  Depending on the mechanism of injury your physiotherapist will assess many things such as the ability of the SIJ to bear weight (as in standing on one leg), the interaction between your lumbar spine/ SIJ and hips and how your muscles work.  Your therapist will then work with you to improve the mobility in this region and help you re-train any muscle patterns necessary.