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The lower back is where most of the back pain occurs. It supports much of the weight of the upper body.
Structure of the lower spine
It is made up of 5 lumbar vertebrae with these rubbery shock absorbers called intervertebral discs in between.
Bands of tissues known as ligaments hold the vertebrae in place and tendons attaches muscles to the spinal column. Multiple pairs of nerves that originate from the spinal cord and exit the spinal column in between these vertebrae.
You can imagine the lumbar vertebrae as a pole that supports whatever is on top of it and this pole itself is being reinforced and supported by the ligaments and tendons and muscles surrounding it. Any issues or problem affecting any of these structures can cause back pain of varying duration and degree.
Risk Factors of Lower Back Pain
the first attack of lower back pain typically occurs between the ages of 30 to 50.
With advancing age, we can have the loss of muscle elasticity and tone. The intervertebral discs begin to lose fluid and flexibility as well, reducing their ability to cushion the vertebrae.
Loss of bone strength from osteoporosis can lead to fractures too.
2. Poor fitness levels
Back pain is more common amongst those who are not physically active. Weak back and abdominal muscles may not properly support the spine.
“ Weekend warriors “ are more likely to suffer painful back injuries than people who make moderate physical activity a daily habit. Studies show that low-impact aerobic exercise can help maintain the integrity of intervertebral discs.
3. Weight gain
Being overweight, or quickly gaining significant amounts of weight can put stress on the back and lead to lower back pain.
4. Job related factors
Having a job that requires heavy lifting, pushing or pulling, particularly when it involves twisting or vibrating of the spine, can lead to injury and back pain.
Working at the desk all day long can contribute to pain, especially from poor posture or from sitting in a chair with poor back support and poor ergonomic design.
.There are also growing evidence that suggests high workload, monotonous work and job dissatisfaction are linked to lower back pain.
Smoking can restrict blood flow and oxygen to the discs and that can cause them to degenerate faster.
6. Mental health
Anxiety and depression and stress can influence how closely one focuses on their pain as well as their perception of its severity. Stress can affect the body in numerous ways, including causing muscle tension which can then contribute to back pain as well.
Causes to lower back pain
This refers to causes that may be inborn or from a very young age. For example, a lot of young girls may have a curved spine otherwise known as scoliosis.
Some children can also have fractures of the vertebrae joint from birth - medically known as spondylolysis. These can result in back pain from a young age.
This is the opposite of congenital. These conditions occur due to age related wear and tear and the breakdown of joints and support structures of the lower back.
Intervertebral disc degeneration occurs resulting in the rubbery discs eventually drying up reducing their shock absorption capability. Lumbar spondylosis which is basically wear and tear and degeneration of the joints and bones of the spine as people get older.
Age related loss of muscle and tendon elasticity
These age related conditions are amongst the top causes of lower back pain injuries.
Fractures of the vertebrae, Sprains, strains, tears and spasms of back muscle, tendons and ligaments due to sports, falls or accidents are also common reasons for sudden severe back pain.
Some medical causes of lower back pain may include inflammatory conditions like spondylitis, rheumatoid arthritis.
Treatments for lower back pain
like paracetamol, NSAIDS, opioids and muscle relaxants can be used from time to time to relieve intense back pain.
However caution against reaching out for pain killers the moment you feel pain as you may become dependant on them. Mainly use to reduce intense pain so that patients can be mobile enough to carry out stretching and physiotherapies.
Topical pain relief such as medicated creams and gels or patches can also be useful in reducing pain.
b) Physical therapy
This involves using extremes of temperature or muscle stimulations to modify the perception of pain.
Hot or cold packs when applied to the region of pain can reduce the intensity.
TENS or transcutaneous electrical nerve stimulation are battery powered device which places electrodes on the skin over the painful area. They send electrical impulses into the muscles causing muscle twitching, these are designed to block or modify the perception of pain.
Massages or gentle spinal manipulations can be done by experienced practitioners to provide small to moderate short term relieve of back pain ( with the approval of your doctors )
c) Avoidance of prolonged bed rest
as this can further weakness your core muscles. Resume normal activities as soon as you can.
D) Stretching and exercise
This is probably one of the top options for chronic lower back pain. A vast majority of back pain are occupational related or age related.
Exercises and stretching can help to reduce muscle spasms and knots. In addition, by strengthening the core or abdominal muscles, you are increasing the support for your vertebrae as well.
These can accelerate recovery from back pain and to reduce and prevent future occurrences.
Some stretches include (please view video for instructions) :
- Knee to chest stretch
- Seated Spinal Twist
- Lower Back Rotational Stretch
- Sphinx pose
- Cobra pose
By : Dr Chen Yiming
Family Physician, MBBS (Singapore), GDFM (NUS), GDFP Dermatology (NUS)