Support Low back pain

This is a generalised name for some discomfort in the lower back of the body, technically the lumbar region. It is a condition that affects many people worldwide at some point in their lives and be seriously detrimental for some, including affecting livelihood. A widespread condition with our modern lifestyles it can be helpful to know how to prevent or manage it.

Low back pain can be the sign of something more serious if old or a child, or accompanied with significant sudden weight loss, a fever or numbness in the groin or legs or difficulty urinating or incontinence.  In these events, seek medical advice sooner than the 4 weeks usually suggested.


What can cause low back pain?

(A) Disc Issues

Skeletal issues can arise from either the five lumbar spinal vertebrae or radiating pain up from the sacrum, and sacroiliac joints. Disc issues can be quite broad ranging but the likely culprits are a prolapsed disc or poor posture. To confirm a disc issue will require a medical referral for an MRI or x-ray.

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  1. Degenerative disc disease usually due to ageing or poorly lubricated joints. Often worse when sitting and flare up of pain will increase over time if not cared for, especially if sedentary for too long. Usually feels stiff, tired and tight across the hips and buttocks. This may be present in other joints not just the spine. Moderate exercise eases the pain flare ups and keeps the joints lubricated.

  2. Bulging disc (prolapsed/ bulging) is where the spongy disc pushes out of the vertebrae and towards the spinal column, but has not broken the casing it is housed within. The lumbar spine is the most likely part of the spine for this to occur due to mobility of the spine, and it is very common without any pain.  Moderate exercise can help bring the disc back into alignment.

  3. Herniated disc (ruptured) in the lumbar spine is where the outer coating of the disc is torn, which allows the inner part (nucleus) to protrude and press on the spinal cord or roots of the spinal cord. This can cause radiating pain down from the disc, and is the cause of sciatica as discussed in this blog post. It can arise from high-impact sports where the disc can slip from alignment on impact, or over-bracing for prolonged periods of training, especially in heavy weights. This is similar to a bulging disc but the nucleus is no longer contained. Moderate exercise can help bring the disc back into alignment.

  4. Thinning disc (foraminal narrowing) occurs when there is pressure on the spine over time that causes the spongy disc to narrow. This causes instability in the spine, but pain only arises if the disc moves out of alignment towards the nerves. The goal here is to stabilise the spine with exercise.

  5. Facet joint problems where the stabilising joints in the vertebral column are not sufficiently lubricated and wear with time. This can lead to bone spurs, inflammation and osteophyte formation, potentially to osteoarthritis. Key to this issue is the unpredictable nature of the facet joints seizing up and mobilising the joints in a stable manner with exercise.

  6. Sacroiliac joints around the sacrum in the pelvis can become unstable, for example too much crossing the legs. If the joints become inflamed then the pain may radiate upwards into the low back, although the issue originates in the buttocks. Strength, stretch and stabilising exercises will ease this pain.

  7. Scoliosis is a curvature of the spine either from birth or through poor posture. This can be very painful depending on where in the spine and the degree of the curvature, which can impact organ function. This may be apparent to the trained eye e.g. an osteopath or trained Pilates instructor.

  8. Osteoporosis is the decrease in disc density that results in small disc fractures of the spine in the spongy bones that have become porous. Usually it is the fractures of bone that cause the ‘band-like’ pain. The pre-condition is osteopenia and there is specific guidance for nutrition and movement depending on where in the body the bone density has been affected as it is not a global body condition. Ensure you work with a qualified professional to ensure no further damage to fragile bones.


(B) Muscular Issues

There are many muscles in this region that can be the tension gripping of low back pain. An imbalance in the abdominals, low back or hips can lead to poor posture and result in strain, sprain or spasm of compensating muscles.

Strain, Sprain or Spasm?

In a lot of ways with the back it doesn’t matter what the type of muscle issue is, as all result in a similar ‘seizing’ of the back. The approach for treatment is the same regardless. Causes are often:

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1.     Lifting loads can place stress on the erector spinae muscles (long muscles along the spinal column) that compresses the intervertebral discs which then may prolapse.  If the breath or transverse abdominus (corset muscle) is not working correctly, then the spinal muscles will take too much load and compress intervertebral discs.

2.     Poor posture can place excess pressure on specific muscles and create compressed areas of vertebral discs. Healthy posture for the low back must be dynamic and responsive to upper body movements and lower body movements, so it is not about the spine being held in only one position.

3.     Use of breath is important to stabilise the low back but not bracing (100% tightening contraction of abdomen) it as this can lead to herniated discs. 

It is helpful to know that muscles that often show imbalances are:

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Quadratus Lumborum (“QL”) that help with stabilising the low back when rotating and moving the upper limbs and trunk around, so it needs to be healthy to prevent excess tearing of the lumbar discs.

Erector spinae that attach to the spines of the vertebrae and pull it backwards (extension).  

Latissimus dorsi is a large muscle ‘V’ shape muscle down the back that originates across all lumbar vertebra, the thoracolumbar fascia and the top of the sacrum and insert into the top of the arm bone. This is how arm movements affect the low back.

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The transverse abdominis connects like a corset around the entire abdominal region from the thoracolumbar fascia and into the linea alba. This muscle does not move the trunk but changes the pressure within the abdomen and is vital in breath, including relief of the low back when lifting. This is why breath is so vital in weight lifting.  

Internal and external obliques help balance the lower thoracic spine and position of the pelvis which will ensure that there is not excessive strain on the lumbar spine in either direction (short or long).

Glutes and hip muscles to stabilise the pelvis and power up from the lower body in movements. They support weight bearing movements


(C) Fascia Issues

Fascia enjoys regular movement to keep hydrated so it maintains its elastic and recoil dynamics. When the body stays in one position for more than 15 minutes the fascia becomes tense and is more prone to ‘snagging’*. Such a fascial ‘snag’ is like a ladder in stockings and it will run up the length of the fascia line, so low back pain may not be where the fascia damage occurred.

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The Superficial Back Line (SBL) of the fascia runs all the way down the back body. A likely culprit for if those who sit for extended periods which stretches the fascia in this line, as this line prefers to act as the recoil to an overarm throw or football kick.

Try rolling a tennis ball for 60 seconds under the foot, sacrum and suboccipital regions to release the SBL.

 

The Back Functional Line connects arm movements to the knee through the latissimus dorsi, lumbodorsal fascia, sacral fascia, sacrum and down through the gluteus maximus into the thigh and low knee. Think of it as the control when doing a throwing action to prevent all the strain going on the shoulder girdle alone. Effectively the Back Functional Line is a break for forward motion of throwing. It also works in stabilising the under arm motion for rowing to keep the pelvis still.

Triangle or Trikonasana in yoga stretches the BFL.

 Spiral Line crosses the linea alba and iliotibial tract at the front and sacrum in the back body, it is important in stabilising the core for the low back in twisting movements.

Twisting is one of the most frequent triggers for a low back pain episode. Any twisting movement will work BFL but go very gentle and exhale into the movement to ensure abdominal support.

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(D) Abdominal Causes

Pain from the abdomen can radiate into the low back. These causes could be:

  • Over-bracing the abdomen in training.

  • Over training or unaccustomed exercise.

  • Irritable bowel syndrome can become a low back pain issue.

  • Psoas tightness or pain (often a sign of emotional issues) can radiate back into the low back as it attaches into the low thoracic spine.

  • Pregnancy adds weight to the lumbar spine and pulls it into extension.

  • Being overweight.

  • Stress results in excess held tension, often in the back.

  • Cancer may have tumours pressing onto the low back.

  • Kidney and urinary tract infections feels like low back pain.  


(E) Emotional Energy Blocks

Back issues generally arise from the solar plexus, sacral or root chakras. To identify the cause is often an energetic and emotional complex.  

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Root chakra

These are about a lack of foundation. Emotionally this expresses itself in a lack of security, questioning your values and perhaps low moods or depression.

Physically issues with anything below the sit bones, legs down into the feet signs of root chakra energy work to support changing the energy and emotional state.

Sacral chakra

Emotions in this area are around creativity, sexuality and relationships with the external world. 

Physically it manifests around the sacrum, sacroiliac issues, hip joint and possible arthritis in the hip. Potential low abdomen pains and womb problems for women.

Solar plexus chakra

Energetically this is an imbalance in the use of the fire element - either externalised or internalised. This connects to feeling control in life and may be a sign of poor self-esteem or lacking self-confidence.

Rib placement pulls the low back out of it’s neutral position and can track up or down the spine.


Your steps to help yourself

Prevention is better than cure, but these tips will help for both in pain and prevention:

  1. Be mindful when lifting heavy items or doing lots of work bending over. Use a full and gentle exhale to engage abdominal support without bracing to support the low back.

  2. Get active and do a full range of movements for your spine.

  3. Maintain a healthy weight with diet and regular exercise.

  4. Wear supportive footwear or go barefoot for ultimate spinal health, and enjoy gentle walks.

  5. Low back sequence of Pilates (click on link for full online class).

  6. Yoga back stretches for happy low backs. Try our Back Relief video below.

  7. Self-massage technique for your feet with fascia rolling (see above fascia section).

  8. Stress reduction – perhaps try some meditation or a calming breath exercise in the Seated Breathing practice below.

Workplace wellbeing

Our team includes such specialists who deliver our workplace wellbeing workshops on ‘Sit to be Fit’ and ‘Perfect Posture’. Studies have shown that humans should not sit for longer than 15 minute periods and that we need to be dynamic for healthy posture. Our workshops share more facts and simple moves you can make in the office without feeling embarrassed.

Privates and At Home

Our teachers have worked alongside physiotherapists and osteopaths for years as part of the post-rehabilitation phase and in prevention for less acute issues. We provide functional and simple exercises for you to practice that also slim and tone the torso for a bonus of fitter feel and looks.

Nid is trained to teach Pilates for those with osteoporosis, back care, pregnancy, post-natal and scoliosis. Molly’s yoga therapy has provided her with training for spinal care.

Get in touch with us if you want more specific support for your low back health.

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* Dr. Shalini Bhat speaking on ‘The Broken Brain’ podcast episode E25 “Fascia: The Connective Tissue That Keeps You Healthy