Lower back pain describes symptoms localized in the lumbar region and is due to many different causes. It is not our intention to bore you by listing all the potential causes and classification of back pain, rather to give you a general overview. This is a very common condition affecting around 85% of the population. Back pain is usually characterized by an aching pain slowly or suddenly riding up the spine, which may or may not spread to the buttocks and thighs, as well as limitations with movement as a result of this pain.

Acute back pain may occur after a sudden torsion or flexion-extension movement of the spine and can result in extreme sudden pain. Patients typically tell their doctors that they were trying to lift something heavy from a semi-fixed position and their back “got stuck” or that “something went”. In cases where normal activities continue to exacerbate pain, a period of rest may be need to be enforced. 

Chronic back pain is described as when symptoms persist for more than 3 months. Patients describe pain and feelings of stiffness in the morning that improve throughout the day, although they may experience difficulties maintain the same position. This kind of problem is particularly prevalent amongst those with sedentary occupations, including those which require long periods of sitting. During the clinical examination, it is important to identify the origin of back pain and whether or not there is any evidence of nerve root compression. Compressed nerve roots can cause sharp, burning pain and, depending on the site, a loss or altered sensation and weakness in the surrounding muscles. 

Sciatica refers to burning pain shooting down the posterior side of the thigh down to the foot, this is caused by compression or irritation of the sciatic nerve. 

Muscles governing movements of the spine are frequently contracted and sore in these cases (gluteus, quadrates lumborum, paraspinal etc.) which can cause nocturnal disturbances which affect the quality of sleep – an often overlooked and important factor in rehabilitation. 

Conservative (non operative) treatment is warranted in the vast majority of cases but as with cervical pain, it is of paramount importance to address contributing factors, such as poor posture. 

Therapeutic sessions are generally based on the use of manual therapies to aid in relaxing the muscular groups responsible for controlling movements of the spine and pelvis in addition to physical therapies designed to reduce pain. When possible, exercises are used to selectively improve tone in certain muscles and to correct imbalances of strength which are almost universally present in cases of persistent back pain. 

Patients must also become aware of how the ‘small factors’ mentioned earlier can affect the outcomes of therapy, and continue to pay attention to things like how they sit on the sofa, how much time they spend behind the wheel and perhaps most importantly, how much weight they have gained recently. It is important to focus on these seemingly trivial details in order to prevent the recurrence of symptoms.