Lower Back Pain

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 three main causes of lower back pain: lumbar disc prolapse, facet joint injuries and sacroiliac joint injuries.

If you have any further questions or would like to book an appointment, please get in touch.

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.

Sacroiliac joint injuries

The sacroilliac joint, or SIJ, is the joint at the base of your spine that connects your tailbone to your pelvis. Injury can be caused by a sudden impact such as directly landing on your side or bottom during a fall, a motor vehicle incident, or during a pivoting movement. Injuries to this joint can range from mild to complex and cause pain in your lower back and buttocks. Your physio will do a few tests in the physical examination, and have a feel around your pelvis and lower back to diagnose this problem. They may also send you for an Xray to confirm the diagnosis. All but the most severe SIJ injuries are treated conservatively with rest, physiotherapy and pain relief. Sometimes you may wear a SIJ belt for a short period to help with your pain. Physiotherapy will initially aim to improve your range of movement and decrease your pain. Once you can move your lower back freely you will need to do some strengthening exercises before you return to sport and lifting. Recovery can take anywhere from 3-12 weeks depending on the severity of your injury.

The SIJ can also be affected by arthritis. This is called Ankylosing Spondylitis or AS and is a form of arthritis that mainly affects the spine, although other joints can become involved. It causes inflammation of the spinal joints that can lead to severe, chronic pain and discomfort. In the most advanced cases (but not in all cases), this inflammation can lead to new bone growth on the spine, causing the spine to fuse in a fixed, immobile position. Almost all cases of AS are characterized by acute, painful episodes followed by temporary periods of remission where symptoms subside. An Xray will help with the diagnosis of this problem. Along with medication, physiotherapy can help to decrease your pain, increase your strength and mobility and manage the condition.

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 three main causes of lower back pain: lumbar disc prolapse, facet joint injuries and sacroiliac joint injuries.

If you have any further questions or would like to book an appointment, please get in touch.

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.

Sacroiliac joint injuries

The sacroilliac joint, or SIJ, is the joint at the base of your spine that connects your tailbone to your pelvis. Injury can be caused by a sudden impact such as directly landing on your side or bottom during a fall, a motor vehicle incident, or during a pivoting movement. Injuries to this joint can range from mild to complex and cause pain in your lower back and buttocks. Your physio will do a few tests in the physical examination, and have a feel around your pelvis and lower back to diagnose this problem. They may also send you for an Xray to confirm the diagnosis. All but the most severe SIJ injuries are treated conservatively with rest, physiotherapy and pain relief. Sometimes you may wear a SIJ belt for a short period to help with your pain. Physiotherapy will initially aim to improve your range of movement and decrease your pain. Once you can move your lower back freely you will need to do some strengthening exercises before you return to sport and lifting. Recovery can take anywhere from 3-12 weeks depending on the severity of your injury.

The SIJ can also be affected by arthritis. This is called Ankylosing Spondylitis or AS and is a form of arthritis that mainly affects the spine, although other joints can become involved. It causes inflammation of the spinal joints that can lead to severe, chronic pain and discomfort. In the most advanced cases (but not in all cases), this inflammation can lead to new bone growth on the spine, causing the spine to fuse in a fixed, immobile position. Almost all cases of AS are characterized by acute, painful episodes followed by temporary periods of remission where symptoms subside. An Xray will help with the diagnosis of this problem. Along with medication, physiotherapy can help to decrease your pain, increase your strength and mobility and manage the condition.