Whether you enjoy lazing around on the sofa, digging up the garden weeds or pounding the pavements to produce that wash board chest in time for the summer holiday, you are very much at risk of experiencing lower back pain (LBP).
LBP is a huge problem all over the world affecting both men and women alike, and strikes every type of worker, from truck drivers and labourers, to executives and homemakers.
Although LBP is common, when you are the one who has it, it may seem that no-one else can truly understand your suffering. It can influence your sleeping habits, and your ability to work and function normally.
The back is composed of a complex arrangement of muscles, ligaments, bones, joints and nerves. The lower spine supports 70% of our body weight. When any one of these structures becomes worn, injured or inflammed, pain can occur. The spine is actually a stacked column of bones called ‘vertebrae’. The vertebrae are connected to each other by joints which allow the spine to bend forwards, backwards, and side to side. One of the many structures thought to be responsible for LBP is the disc structure. The disc provides a flexible space between each vertebra acting like a cushion, helping to absorb pressure and load throughout the spine. It is made up of a centre called the ‘nucleus pulposus’ and an outer region called ‘annulus fibrosis’
The nucleus and annulus are often described as two separate structures, they contain similar components but in different concentrations. The nucleus contains more water is softer than the annulus which is more fibrous, although as the disc ages the nucleus becomes less hydrated and more fibrous resulting in less distinction between the two.
As we age the disc can stretch or bulge and the annulus may tear causing pain and inflammation. This is known as ‘degenerative disc disease’ (DDD) . Unfortunately this is a result of the normal ageing process, just like grey hair and wrinkles, not really a ‘disease’. Most people once they are over the big ’30’ have some degenerative changes in their discs. Those who have played strenuous sport or engaged in strenuous work may develop DDD at an earlier age. Key conditions for a disc injury involve compression, bending twisting, quick movements, and a combination of all rather than in isolation, increases the chance of injury to the disc.
Although the disc can be a source of LBP in some cases it does not necessarily cause the symptoms of pain. In addition to bulging and stretching, discs can rupture or herniate causing material to protrude and press against a spinal nerve, nearby ligament or nerve root. The irritated nerve or structure can then cause pain and sometimes weakness in the area of the body connected to the nerve. A good example of this is pressure of the sciatic nerve root resulting in pain, weakness or numbness in the leg or foot. These symptoms are commonly called ‘sciatica’.
Joints in the back can also cause problems like any other joint in the body. Minor injuries, excessive movement and arthritis can all cause joints to become inflammed, tender and painful. Other structures such as muscles, tendons, ligaments and bone can also be sources of LBP. Faulty alignment can add stress and strain to our soft tissues, contributing to pain. Posture is how we hold and move, it is unique to each one of us and can be influenced by our mood, culture and environment. Our posture is balanced when our head, spine and pelvis are maintained in its natural alignment with optimum muscle effort. Habits, such as leg crossing and arm folding, are what come easiest and strongest to us, we may not be aware of them or realise the harm that they are doing to us, and it is difficult to break a habit. So, as you can see, LBP can be a very complicated problem caused by a variety of reasons.
If you are suffering LBP it is wise to go and visit your friendly Physiotherapist and have a full assessment to really work out where your pain is coming from. Back pain care is very simple once an assessment has been carried out.
So next time you’re in a slouched, twisted position on the sofa eating that chocolate, or watching the television, give some consideration to those ageing discs, you only get one set!