Lower back pain is the most common compliant among people, and defiantly the highest incidence of injuries seen by a physiotherapist. Often people associate their lower back with getting old or it’s just part of the job. Subsequently the pain is ignored and progressively worsens. However your chances of healing and being pain free are much better and will happen much faster with the correct advice and treatment.
Lumbar disc injuries have a higher prevalence among lower back injuries. The other injury associated with lower back pain is a facet joint dysfunction. These two injuries have differing presentations and rehabilitation though can often occur together. Commonly seen is the misdiagnosis of a muscle tear in the lower back. The likelihood of tearing a muscle in the lower back is extremely difficult. When a disc or facet injury occurs the muscles surrounding the area go into spasm which is a protective mechanism. This is often interrupted as muscle tears.
The intervertebral disc is a fluid filled cushion that is sandwiched between two vertebra. Functionally they act like a shock absorber to make back movements smoother and reduce any degenerative changes to the bones and joints. These discs are designed to be resilient and withstand large forces, however certain positions or movements can cause them to be more susceptible to injury. Often an acute disc injury will happen when you are least expecting it, like bending over to pick a sock up off the floor. While one movement causes the sudden onset of pain and restriction, the accumulation of repetitive poor movements and sustained positions are the contributing factor.
Another misconception is the term slipped disc. It’s the thought that when a disc injury occurs that the disc has moved out of it’s position which then affects the nerves and muscles. The actual truth is the disc does not move from their position between the vertebra. A disc injury occurs when the inside nucleus disrupts the outside disc layers.
While a lower back injury can be restrictive and painful by itself, it’s not uncommon to have associated symptoms. This includes referred symptoms in one or both of your legs can occur that can vary from pins and needles, numbness, pain and weakness. This occurs from the irritation of the nerves associated with the level of the spine that is injured. Other areas commonly affected are the sacroiliac joint (SIJ), the hip joint, the legs and also the shoulders/neck.
Over time, even in a healthy person, our disc will go through a process of degeneration. While the process of degeneration cannot be reversed, measures can be implemented to help slow the process. This includes an assessment with a physiotherapist to ascertain the source of the lower back pain, strengthening specific muscles including the deep abdominal muscle while providing education.
Treatment for disc injuries can be challenging but if done effectively can improve the functionality of your lower back well into the future. One key component to the rehabilitation is improving the activation of the deep abdominal muscle, the transverse abdominus (TrA). A function of this muscle is to intrinsically provide stability to your lower back without you knowing. Once a lower back injury occurs, the TrA muscle becomes significantly ineffective in its support of your lower back. This is why TrA exercises are prescribe from the first session.
The second important aspect of lower back rehabilitation is providing education and advice on how to avoid aggravating the injury. These include
- Avoid excessive lifting and modify how you lift or bending forward.
- Avoid prolonged positions that aggravate your pain, which is typically seating.
- Been diligent with the home exercise program
- Using pain medication for a consistent period
- If able, implement a daily walk to maintain leg strength
- Keep active and modify all pain provocaticative activities
Lower back pain associated with the disc is often perceived to be debilitating among people, though the opposite is often the case. With the correct assessment the underlying cause of your lower back pain can be identified and the most the effective rehabilitation program implemented. Most commonly this includes establishing good lumbar stability with improved TrA activation, activity modification, flexibility exercises and finally progression into functional specific exercises that allow a return normality.
This information is provided to counteract the wealth of misleading information available and to empower you to take hold of your back problem and live with it actively. The physio team at Coastal Physiotherapy and Sports Injury Clinic can assess you and put into place a proactice program to get you back on track.
To book your appointment to get on top of your back injuries or for more information, talk to your friendly Gold Coast Physio today on (07) 5574 4303.