LOWER IT DOWN...
Defined as pain below the rib cage and above the gluteal folds, Lower Back Pain (LBP) is one of the most prominent skeletomuscular pathological conditions influencing humanity. It influences about 3–4% of adults below 45 years of age that have chronic low back pain, and 5–7% of adults over 45 years of age. This amounts to 619 million people at any given time worldwide and about 26.4 – 34.3 million in the United States. Lower back pain is often associated with loss of work productivity and thus produces a huge economic burden on individuals and societies (to include countries).
With an estimated 140 million people being born per year and an estimated 67 million people dying every year, the number of humans should reach about 10 billion people by 2050 – 2055. This is about a 1.36-fold increase and with it, a substantial increase in the extent of lower back pain cases, especially those of chronic lower back pain. With an estimated 1.36 growth in cases by 2050, 849 million cases worldwide, and 35.9 – 46.65 million cases in the USA will exist.
Advertisement
Lower back pain is the single leading cause of disability worldwide and the condition for which the greatest number of people may benefit from rehabilitation. It can be experienced at any age, and most people experience lower back pain at least once in their life. Prevalence increases with age up to 80 years, while the highest number of lower back pain cases occurs at the age of 50–55 years, and greater prevalence in women overall.
We divide lower back pain into non-specific lower back pain and specific back pain. Non-specific lower back pain is the result of an unknown cause, thus, could be defined as idiopathic lower back pain. While we know the expected symptoms of non-specific lower back pain, and have guidelines for management, we do not associate it with a specific reason causing it. Specific lower back pain is the result of a known underlying medical or clinical condition, making it a secondary condition.
Non-specific lower back pain is the most common presentation of lower back pain (about 90% of cases), while specific lower back pain cases account for only 10% of all lower back pain cases. The increase in lower back pain cases spans multiple reasons that include 1) Population expansion; 2) Population aging; 3) Lack of none exercise physical activity (NEPA), exercise, and participation in sports; 4) The obesity pandemic; and 5) Breast enlargement surgery.
Lower back pain can be acute, sub-acute, or chronic. It can affect anyone, making it hard to move and can affect a person’s quality of life and mental well-being. It limits work activities and engagement with family and friends. Specific chronic lower back pain is caused by a certain disease or structural problem in the spine, or when the pain radiates from another part of the body.
In all types and at all stages of lower back pain, rehabilitation is essential to achieve 1) Reassurance - in the possibility of gaining function back; 2) Helping the person make sense of their pain – an educated client/patient is a better one; 3) Help the person return to activities they enjoy – enjoyment increases the chances of success and persistence; 4) Identify strategies to support recovery and improve function; 5) Identify specialized care pathways for specific lower back pain cases.
Lower back pain can further be divided into acute lower back pain lasting 6 weeks or less, sub-acute lower back pain lasting 6–12 weeks or chronic lower back pain lasting over 12 weeks. Symptoms of lower back pain can include a doll ache or sharp pain, electric shock feeling, radiating pain (especially the legs called Sciatica or Radicular Pain), sleep problems, low mood, distress, numbness, tingling and weakness in some skeletal muscles may be experienced with the leg pain.
In most cases of acute lower back pain, symptoms go away on their own and most people will recover well; When associated with lower back pain, radicular signs and symptoms are often due to a spinal nerve root injury. Radicular symptoms without lower back pain, occur when a nerve is compressed or injured distal to the spinal column. Risk factors for non-specific lower back pain include low physical activity levels, smoking, obesity, and high physical stress at work. Specific lower back pain can be explained by an underlying disease (e.g., cancer), tissue damage (e.g., fracture), or may be referred from other organs (e.g., from kidney or an aortic aneurysm).
Commonly involving connective tissue such as skeletal muscles, ligament, tendons, and fascia, lower back pain results from mechanical pressure on one or more nerves. Such mechanical pressure is often the result of a strained muscle, turned tendon, or overstretched ligament. Understanding lower back pain, demands knowledge and understanding of the anatomy of the spinal column, and its meanings as structure determines function.
Vertebrae are irregular shaped bones, that allow a great number of joints to be created. They are perfect as a basis for ligaments and muscle tendons to latch on to, as a stable and safe base for their function. With that said, they are also capable of moving one compared to the other, if not kept in place. Such movement would put our ability to stand erect at risk, thus the need for a great number of connective tissues. As a result, an increased potential for mechanical pressure on a nerve exists, as connective tissue is known for its ability to translocate forces from one place to another.
Severe pathological conditions causing chronic lower back pain include sway back, lumbar lordosis, thoracic kyphosis, forward head, and scoliosis. For specific lower back pain, treatments focus on treating the underlying condition causing the pain, while treatments for non-specific lower back pain include physical therapies to improve muscle strength and ability to move and resume physical activity and exercise, psychological and social support to help people manage their pain and return to doing activities they enjoy and reducing strain during physical work.
Lifestyle changes including more physical activity, a healthy diet and good sleep habits; medications can be used to reduce the symptoms of lower back pain and should ideally be combined with other treatments; painkillers should not be the first-line treatment; older people and those with other medical conditions should speak to a healthcare provider before using medications.
With the onset of any lower back pain, a comprehensive clinical assessment is essential to tailor the care needed; The longer a person experiences lower back pain, the more likely that limitations in functioning will manifest. Adopting a bio-psychosocial approach to assessment and care planning becomes increasingly important where rehabilitation includes sets of interventions that aim to achieve and maintain independence in daily living and optimal participation in meaningful activities.
Advertisement
Interventions for rehabilitation in lower back pain include non-pharmacologic and pharmacologic options, whereas non-pharmacological interventions have in most cases, a higher priority. Self-care is an important part of managing lower back pain and returning to meaningful life activities. Symptom reduction and prevention of non-specific lower back pain is achieved by NEPA, physical activity, exercise, optimizing mental well-being, maintaining a healthy body weight, not smoking, proper sleep, education, and support - develop strategies to self-manage and deal with the symptoms.
For acute to sub-acute lower back pain symptom reduction and prevention is achieved by medications, NSAIDS, muscle relaxants, and thermotherapy; Other options that may help include massages, acupuncture, spinal manipulations, and Exercise. For chronic lower back pain, it is suggested to avoid medications at first, utilize exercise, acupuncture, meditations, stress relief, Tai Chi, yoga, and spinal manipulations. If these don’t work, we incorporate NSAIDS and opioids.
Comments