- Today, I'm talking about lower back pain
and the most common causes that I see
in clinical practice every day.
So if you have lower back pain
and you want to know what's causing yours
then stay tuned because I'm talking about that right now.
There are so many different causes of lower back pain.
I cannot go through them all today,
but what I will say is that there are common causes
of lower back pain.
There are causes that we need to be aware of
that are possible
and then there are the rarer causes of lower
back pain that I'm not going to touch on today.
The most common things that I see in clinical
practice are muscles, tendons, ligaments, nerves, discs
and the bony structures of the vertebrae
such as the joints themselves.
Most of the time, this is what someone would present with,
one of these possibilities
but we also need to be aware of other things
that can happen that affects certain age groups.
For example, if you're in your twenties and thirties,
there's a high possibility that lower back pain could
be coming from a disc.
As you get older, discs tend to become thinner
and more dehydrated.
So unless you've had history of a disc problem in the past,
as you get into forties, fifties
and older, it's less likely to be a disc related.
If you're in your forties, fifties, sixties
there's a possibility as a male that we could have some kind
of prostate issue going on.
As a female of any age you could be thinking
about gynecological issues.
Then as you get into your elderly years,
seventies, eighties, there's an increased chance
of abdominal aortic aneurysms.
And that could potentially cause a very
serious medical problem.
And then of course there are the rarer problems
with your lower back, which I'm not going to touch on now.
But what I will say is that
if you do have lower back pain and you haven't
had it diagnosed, then go and see a doctor just
to make sure there's nothing untoward going on.
So what I'm gonna do right now is break
down lower back pain in terms
of what you can see with the anatomy.
So this is a fairly complete skeleton here.
These are the ribs.
You're looking at the backside of someone here.
These are the bumpy bits in the spine that you can feel
if you run your fingers down your spine.
And then you've got the two pelvic bones
on the outside here.
Now, quite often, when someone comes
in with acute lower back pain
they will have very nonspecific pain.
As in, they won't be able to tell you exactly
where that pain is.
So generally speaking
that pain will go all the way across on both sides.
So all in the lower back, coming
up to around the region of the 12th rib here.
They won't be able to tell you where that pain is exactly,
but as that pain starts to wear
off and the pain becomes less acute and more
into the chronic pain, they will generally feel pain
becoming more isolated into one particular area.
There's quite a lot going on structurally
in the lower back with the spine, the discs, nerves,
so I'm just gonna show you on a spine
what that might look like.
Okay, so here is a model of a spine.
Again, this is looking at it from the back.
On this model, though, you can see much more easily.
All of the different segments of the vertebra to all
of these white bits are the bony segments of the spine.
These are the bumpy bits that you can feel
as you run your fingers down your spine.
These are called spinus processes.
The yellow things coming up here are the nerves.
If you look closely where the bones overlap
these are joints.
And quite often these can become compressed.
And if they become compressed, they can become irritated.
These are called facet joints.
And as you can see, they're quite close to the nerves.
So any inflammation or compression
in these small joints can cause inflammation
that would irritate the nerves and all
of the muscles that these nerves
are supplying will likely become spasms.
If I flip it around, you can see this red bulgy bit here.
This is loosely representing a disc bulge
or a disc prolapse.
So these lines that you can see here
these are the intervertebral discs.
So these discs allow compression
and allow movement between each vertebral segment.
If one of these disks becomes prolapsed or bulges out
as you can see that is also very close to the nerves.
So when a disc bulges out, there's usually a release
of chemicals, which cause inflammation
and that will sensitize the nerves again
causing muscle spasm.
Connecting all of the vertebra together are ligaments.
These are what hold the bones to bones.
These are less likely to become damaged
in normal day-to-day activities.
But if you have something like a road traffic accident
where someone hits you from behind in your car,
these ligaments can quite easily become overstretched
and become sprained and they can also cause pain.
Now, if we move more superficially
I will show you what it looks like
the muscles attached to the lower back.
So now I've got a model of the lower back.
So this is purely the lower back.
So the five segments of your lumbar spine
this is the same view I just showed you from the back,
but this time we've added on a load of muscles.
So these muscles on this side are the deeper muscles.
As you can see, there's quite a lot
of muscles that connect all of the vertebra together.
And then on this side
you've got the more superficial muscles.
So in relation to a back these muscles
that you can see here are the kind of more
superficial ones that would generally run down the spine,
either side of the spinous processes.
Now, most of the time when people come
in with lower back pain, these muscles are in spasm
and this is what causes people to have that inability
to move, that stiffness, and that pain
when they start to move.
So, as I said earlier, the nerves can become affected
which then affects the muscles surrounding them.
So these nerves branch off
and they innovate the muscles that are around.
So into the lower back, the hips, down the legs.
So any of these nerves
that become affected will likely cause spasm
within the muscles.
So any structure that is irritated
or affected in the lower back, such as ligaments, tendons,
discs will usually cause some degree of inflammation.
And it's that inflammation that causes the local spasm
because the nerves are what get affected.
So when someone comes in with lower back pain
the first thing we need to try
and do is to get that inflammation down
and then decrease some of this spasm.
Because without decreasing that spasm people
aren't gonna be able to move.
And every time they do move
they're gonna find it difficult
and they're gonna find it painful.
Now, when it comes down to it,
one of the most common reasons
for people to develop any of this pain
whether it's a ligament, a tendon, muscle, disc,
most of the time that has arrived
from people being too weak.
Now, maybe this is relevant to you as well
where you may have been sitting in a chair for too long.
So for example, you might be an office worker
or you might be due to the lockdown.
You might be sitting on your sofas for too long,
so these muscles have become weaker.
When these muscles become weaker,
any activities that you do will
either make you feel like you've got pain
because the muscles are now unable to cope
with the physical demands or the lack of strength
in these muscles has led to a lack of stability
within the spine.
And that is what then has put pressure on the discs
because the muscles aren't able to hold your spine in place.
So the discs have taken more strain through them
and those discs have become weaker
or the same with the ligaments around the spine.
So generally speaking
most people have become weak in their lower back.
Now, not only that, but that lack of movement has also led
to an increase in tightness in these muscles.
Now, one of the common places that people get pain
is around where the pelvic bone meets the sacrum.
So where are these erector spinae muscles come down
and attach.
This is one of the most common places that people get paid.
And this is because these muscles have
either had too much repetition through them.
So for example, you've moved house, you've done gardening
and the muscles are just not strong enough to cope
with that new increase in demand.
And then the muscles have got irritated
that irritation has caused spasm.
And then that spasm spreads all across the lower back.
So just to summarize the most likely explanation
for someone having acute or chronic lower back pain,
is that the muscles in the lower back are far too weak.
If it's acute and the weakness
in the lower back is what's predisposed someone
to develop it from a repetitive movement
or lifting something that's too heavy.
Or if it's chronic lower back pain
then these muscles have remained weak because you feel pain.
You haven't been strengthening your lower back
and that's put you in this constant cycle
of pain and weakness, pain and weakness.
So you're constantly getting weaker.
But to break that cycle
you need to start strengthening those muscles
in your lower back.
Now when it comes to how lower back pain presents,
there's either acute lower back pain
or chronic lower back pain.
Acute is when someone has done something
and the pain is very intense and very recent.
So it could be something that you've done today, yesterday
or within the last week or week and a half.
Generally speaking, you will be in a lot of pain.
There'll be a lot of stiffness
and there'll be a lot of pain on all movements.
So generally sitting still will be relatively painless.
You might feel some sense of spasm or tightness or aching
but it's when you start to move, that's when
the pain will kick in and it will usually stop you
from easily moving from one position to another
such as standing up from a chair.
Usually you might get about halfway and then get stuck
and then you need some kind
of assistance to get all the way up.
Or it could be something like turning over in bed.
Acute pain will usually last
for about a week to week and a half.
After that, it starts to become a little bit more subacute
and move towards chronic pain.
Now chronic pain is when you've had the pain
for many weeks, months, or even years.
Generally speaking, the pain will be less intense.
Whereas acute, you might be looking at seven, eight, nine,
out of 10.
Chronic pain tends to be around three, four, five out of 10.
and you won't be able to pinpoint where the pain is.
But with chronic pain, that pain becomes more focused
and you can pinpoint exactly where you feel the pain.
So in order to improve your lower back pain
you need to distinguish what phase you are in.
Are you acute?
So is your pain a six, seven, eight or nine out of 10?
Are you having problems moving?
Are you having problems standing up?
If that's the case you're in phase one.
Now, if you've seen any of my previous videos
you probably would've heard me talk
about different phases of recovery.
This is something that I have developed over the years.
Phase one is about getting you out of pain.
Phase two is about reestablish your movement,
your flexibility and mobility.
Then phase three is about strengthening that region
that's been injured.
So if you are in acute pain, then you are probably
in phase one, you need to get that pain down.
Phase one is all about gentle movements,
trying to get the muscles working,
trying to get the inflammation down.
Things like gentle massage, ice packs can really
be beneficial here.
Phase two is once the pain has come
down from a seven or more
and it's now into like a five, four, or even a three.
So that's the point when you start to stretch.
So this phase is all about just stretching.
Obviously you're gonna keep moving as well
but stretching is the main focus.
Once you feel that your flexibility is now getting back
to normal or even better than normal
then we go into phase three
and phase three is all about re strengthening the muscles.
This phase is all about using body weight,
using resistance work to try and work those muscles
to make them stronger.
So now that you understand all about your lower back pain,
I want you to leave me a comment.
Let me know how this video has helped you understand
about your lower back pain.
Once you've done that, what I want you to do is go
and watch one of these, these two videos right here
that will help you to either improve your flexibility
around your lower back and your hips
or help you strengthen your lower back
so you can prevent lower back pain coming back.