Lower back pain is a very common problem and affects up to 80% of the population at some stage of their life. Listed in this section are the two main types of lower back pain, lumbar disc prolapse and facet joint injuries.
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Lumbar Disc prolapse
Lumbar disc prolapse is a very common form of back pain that varies in severity from relatively mild to extremely severe. The intervertebral discs sit between your spinal bones (vertebrae) and act as shock absorbers to allow normal movement of your spine. The discs are shaped a bit like a hockey puck or a jelly donut with a firm cartilaginous exterior (annulus fibrosus) and a softer more jelly like interior (nucleus pulposus). As we age, the nucleus pulposus naturally dries out a little and the disc shows signs of wear. In a disc prolapse or herniation, the outer layer cracks causing some of the inner material to leak out of the disc. There is a wide spectrum of severity with disc prolapse, ranging from minor to severe. Mild disc problems can cause mild to moderate low back pain with no referral of pain to other areas, whereas a very severe disc herniation can cause pressure on the nerves or even the spinal cord and consequently severe leg pain, numbness and weakness. The vast majority of disc injuries do not need surgery or injection therapy, and physiotherapy can be a very effective way to help settle your symptoms. Your treatment will depend on many factors including severity and area of symptoms, whether or not you have leg pain or neurological symptoms, your prior level of fitness and function, your age, and your job/hobbies. Generally your physio will try to settle your symptoms down using gentle manual therapy techniques, showing you exercises to help relieve your pain, and advising you on posture. Acupuncture can also be helpful, and anti-inflammatories may help reduce your pain in the early stages. As you improve it is important to start strengthening the muscles around your stomach and back so that you can continue to improve and avoid further relapses. Pilates can be a very effective way of strengthening these muscles, and often works well in conjunction with your physiotherapy treatments.
Facet joint injuries
This is also a common form of lower back pain and is due to pain in the joints that connect each vertebra to the one above and below it. There are two of these joints at each spinal level, one on either side. Their function is to facilitate movement between each spinal level and therefore movement of the spine. Commonly these joints can become inflamed and painful at one or more levels. This can be due to injury, poor posture, excessive loading, or arthritis (or a combination of these). Treatment will depend on many factors but will often involve manual therapy to improve movement in the affected joints, soft tissue massage of the surrounding muscles, stretching to offload the joints, and addressing the underlying factors that may have contributed to the problem. This often includes postural and workstation advice, strengthening and stretching programmes, and training advice. Acupuncture can be useful for pain relief and to help release tight muscles.