The Ultimate Guide to your Lower Back Pain
Everything you need to know about a painful lower back.
If you're reading this article, you're probably dealing with a type of lower back pain, and you're not alone. According to the Australian Bureau of Statistics (ABS), four in six Australian adults need treatment for lower back pain at some stage in their life.
Fortunately, what's causing pain in your lower back isn't always a serious issue, and it can, in most cases, be treated successfully.
This article was written, reviewed and contributed to by some of Australia's leading experts in the field of pain and lower back pain. We aim to empower you to better understand what's causing your pain and alleviate any concerns or anxiety you may have. Or perhaps enlighten you with some new information if lower back pain is something you've been dealing with over a long period.
Included is a practical and actionable plan, backed by the latest medical research to treat your lower back pain (including things you can do from home) and help you get back feeling your best.
Read on as we guide you to understand the different types of lower back pain and discover what type you may have.
What is Low Back Pain?
According to the World Health Organisation (WHO), lower back pain is defined as "pain and discomfort below the costal margin and above the inferior gluteal folds, with or without referred leg pain."
Lower back pain can result from a problem in one or several parts of the lower back, including:
Bone injuries - in the lower back, the bones are referred to as vertebrae
Discs - the shock absorbers between each vertebra
Back pain is usually categorised as either acute, subacute or chronic back pain.
Acute pain: (0 days - 6 weeks)
Acute low back pain is a type of pain that comes on quickly, usually due to an injury or fall. The pain is a normal response to the injury and usually subsides once it has calmed down. This can be in a matter of days, or sometimes several weeks, depending on the type of injury.
Subacute low back pain: (6 weeks - 3 months)
Sub-acute low back injuries are usually when slightly more tissue damage is involved, like a muscle strain. People tend to move from acute to subacute pain if their injury doesn't heal quickly, and they continue to aggravate it with too much exercise or painful movements.
Chronic back pain: (3 months +)
Chronic lower back pain is any pain that lasts over three months. Chronic pain is tricky, as it is usually pain that hasn't responded to initial treatments successfully. This can sometimes be the result of severe injury, but in other cases can be a sign of some other underlying issues that are causing the pain to be prolonged. Those issues may be stress, anxiety or poor recovery.
What are the symptoms of lower back pain?
There are some telltale symptoms of low back pain to look out for, giving you an understanding of whether or not you have low back pain that a physiotherapist can help you with.
Lower back stiffness
Sudden or sharp low back pain
Weakness in the leg or foot
Pins and needles down the leg
Hip aches or pains
Low back muscle spasms
Numbness in the leg or a tingling sensation
Problems with walking
Inability to stand upright
What causes low back pain?
Lower back pain, otherwise known as lumbar spine pain can occur for a variety of reasons.
Some of the most common reasons for low back pain include disc injuries, facet joint problems, muscle issues or inflammation.
Low back pain can be a real nuisance, stopping you from doing the things you want and need to do.
Some of the more common causes of low back pain are:
Prolonged computer work
Sitting for long periods
Arthritic or inflammatory issues
This list is only really a tiny fraction of the things that can cause low back pain. Usually, there are several causes all happening at once, to create a situation in which pain increases.
The causes of low back pain are usually quite helpful in then working out what injury we might be dealing with.
The most common injuries that cause low back pain:
Bulging disc: A condition which refers to a problem where the disc between the spinal bones is protruding and causing pain. Patients find any bending type movement painful.
Herniated Disc: This is more severe than a bulging disc, where the disc has actually broken and fluid from within the disc has leaked out. This will make bending movements even more painful than a bulging disc.
Sciatica: A common pain that starts in the lower back, with pain radiating down the “sciatic” nerve. Prolonged sitting particularly causes pain for patients with sciatica.
Degenerative Disc Disease: A long-term problem occurring mainly in older age, where the discs of the spine are more brittle and are worn out.
Spinal Compression Fractures: This can happen more in cases of impact, like car accidents or falls and is more likely in women and people over 50.
Spinal Stenosis: A narrowing of the spinal canal, which can lead to nerve-related pain. Patients find extension movements uncomfortable.
Spondylolysis: Spondylolysis is a small crack or stress fracture in one of the vertebrae (usually in the lower back). This is quite common in teenagers and adolescents participating in high-level sport, like gymnastics.
Spondylolisthesis: Spondylolisthesis occurs when one of your vertebrae slips out of place onto the vertebra below it causing severe low back pain.
Conditions that cause lower back pain
There are also a number of conditions that may present with low back pain. If you have any of these conditions, low back pain could be one of the symptoms:
Sports which increase the risk of low back pain Is it your favourite activity that is causing your pain?
Previously, we listed some of the more common causes of low back pain like heavy lifting, or prolonged computer work. However, low back pain may also occur when playing sports. Here is a list of the most common sports that result in low back pain:
Other risk factors include:
Lower back pain can happen to anyone, even young people. However, these risk factors might increase your likelihood of getting low back pain:
Age: The chances of low back pain increase as you age, with anyone 30+ much more likely.
Lack of exercise: Motion is lotion; not using your back muscles can lead to weakness and, in turn, increased chances of pain
Poor lifting techniques: Putting extra stress on your back instead of using your legs to lift can lead to back pain.
Obesity / overweight: Extra body weight increases both the mechanical load on the back and increases chronic inflammation.
Diseases: Rarer conditions like arthritis and even cancer can contribute to the chances of getting back pain
Psychological conditions: Even though it may not seem like a direct link, people prone to depression or anxiety appear to have an increased risk of low back pain.
Smoking: At this point, the evidence clearly shows smoking is not great for anything, but it can increase back pain too. The cause may be increased coughing and pressure on the back and the toxic inflammation caused by the cigarettes.
How is lower back pain diagnosed?
There are several options available to you when it comes to diagnosing low back pain. One of the most common, and one that is most recommended by Australian GP’s, is an assessment from a physiotherapist.
Low back pain is extremely common and something that physiotherapists see on a regular basis, and the process of diagnosing is straightforward.
Like any other pain or injury, a physiotherapist will start with a detailed history of your activities and previous injuries - this is an interview-like process that is usually referred to as a consultation. A typical session with a physio will last between 30-60 minutes, and in this time you will discuss the specific issues you are having related to your low back pain.
After establishing the history of your low back pain, the physio will carry out a hands-on assessment, performing a series of physical tests to determine the cause of your problem and rule out other conditions.
Following your initial assessment, a treatment plan will be created that is tailored to you, according to the severity of your injury. After this, your physiotherapist will establish how many sessions are required, what home exercises you need to do, and provide you with a timeline for how long a full recovery should take.
How is lower back pain treated?
(How can physiotherapy help low back pain?)
Did you injure your lower back in the last 24hrs?
Here are the top 5 things you can do with acute low back pain
*If you at all are concerned about a serious low back injury, consult your physio or GP immediately.
As a physiotherapist; a question I get a lot is “should I use heat or cold?”
You need to ask yourself the following: Is your lower back red? Hot to touch, or even swollen?
These are all signs of inflammation - which is really common in the first few hours after a low back injury.
If this is the case, then you must ice the affected area - ice can be effective as a pain reliever, taking the edge off any sharp pain you may be experiencing. Heat will only increase blood flow to the area, potentially making the inflammation worse!
Top 5 things to do:
1. As well as using ice, you should also:
2. Make sure you keep moving - within your pain limits of course, but don’t allow your muscles to stiffen up any more than they already have.
3. Do some gentle stretching - similar to keeping moving, the idea is to keep motion in your lower back.
4. Avoid aggravating activities - might seem like an obvious one, but now is not the time to rearrange the garage, or tackle the home painting job. Listen to your body and avoid things that will flare up your pain.
5. Get a good night's sleep - recovery is key! Make sure you get to bed early!
Having low back pain can be irritating and limit your function, and can even worsen if left untreated. Therefore, it is essential to have your condition assessed by highly qualified experts such as physiotherapists to provide you with the appropriate treatment solutions.
There are several options when it comes to treating low back pain. One of the more common, and the treatment option that is referred by Australian GP’s the most, is physiotherapy.
Low back pain is an injury that physios come across all the time, and the process of treating it is straightforward. Following an initial consultation, the physiotherapist will be in the best position to determine your treatment plan.
Depending on the severity of your low back pain, a physio may provide you with a combination of the following types of treatments:
Education and professional advice: Speaking to a physiotherapist is vital in gaining the correct information regarding low back pain
Manual therapy: Hand-on physiotherapy, used to help reduce pain and increase range of motion
Therapeutic massage: Another hands-on-technique, primarily used to reduce muscle tension
Soft tissue and joint mobilisation: Specific joint mobilisations are used to reduce stiffness in particular areas
Therapeutic exercises: Specific exercises tailored to improve your low back pain
Core stabilisation exercises: Exercises targeted to improve your core strength
Stretching: Stretching will help lengthen muscles and increase range of motion
Dry needling: A technique used to help alleviate pain and reduce muscle tension
Heat and electrotherapy: Used to reduce tension and pain in acute situations
A typical physiotherapy session with your local physio will last anywhere between 30-60 minutes, and it is not uncommon for your low back pain to improve in just one session.
Next step: Creating a treatment plan made for you.
Following your initial appointment, a tailored treatment plan will be crafted by the physiotherapist that will highlight what course of action is required, including what exercises you need to do at home and provide you with a timeline for how long it should take for a full recovery.
Self Care for lower back pain
Whilst a physiotherapist is the obvious choice for professional help when it comes to low back pain, that doesn’t mean there aren’t things you can do also, to help your recovery.
If you think you have low back pain, here are the best things you can do.
Here are the do’s and don'ts when you think you’ve got low back pain.
Things you should do:
Take a break. Listen to your body and have a rest.
Drink plenty of water, hydration is always good for recovery.
Use hot packs for pain relief - they can be extremely useful
Things you should avoid:
- If you’re experiencing pain while at work, playing sports, or even cleaning the house, don’t push through, there’s no benefit! This will only increase your pain and prolong your recovery.
Do I need a specialist or even surgery?
In rare cases, physiotherapy and other conservative management doesn’t always fix the problem.
The best suggestion is to speak with your physiotherapist if treatment isn’t getting adequate results, and discuss the need for further assessment.
In most cases, starting with an MRI and/or X-ray will be the most sensible suggestion, that way, the surgeon can have a clearer understanding of what they are dealing with.
Good surgeons will always consult with your physiotherapist to come up with the best solution for you.
What is the recovery time / prognosis for low back pain?
Low back pain recovery is an extremely individual thing and is hard to measure exactly.
There are a number of factors however, that will either increase or decrease the likelihood of a quick recovery time.
Severity of injury - probably the most obvious factor. Minor muscle issues can come and go in a number of days, but if you’ve really hurt yourself don’t be too alarmed if it takes a number of weeks to settle down.
Age - unfortunately, the reality is that we do just “bounce back” quicker when we are younger.
General health - if your body is in good shape otherwise, then you’ve got the best chance of a quick recovery. A healthy body is a quick-to-heal body.
Delaying treatment - the quicker you get help the better!
How can back pain be prevented?
These tips can double as things to prevent low back pain from occurring as well as helping reduce symptoms if you already have back pain.
Exercise - maintaining good flexibility and strength is absolutely essential in minimising the risk of low back pain!
Look after yourself - at the risk of repeating myself, overall health and wellbeing cannot be understated as a preventative strategy. Less weight, stronger muscles!
Avoid obvious things that do hurt your back - this one is a bit more individualised. If bending over a low bench for hours really hurts you, then you should probably stop doing it.
If back pain occurs with tasks you can’t avoid like computer work, then try and build in strategies to reduce that, like regular breaks, or a sit to stand desk.
- Be resilient - whilst avoiding obvious things that flare up your back is a sensible thing, it is healthy to participate in activities that you enjoy.
Don’t sideline yourself in fear of back pain. At the end of the day, you are robust, strong and can withstand plenty!
The outlook and the main takeaways
If there is one main takeaway from this article, it's that there are many types, causes and severities of lower back pain, and the most important thing you can do is act on these pain signals (you're getting them for a reason). Book a time, and have your lower back pain diagnosed by a physiotherapist today.
Experts answering your questions about lower back pain.
Q. Can Covid-19 cause lower back pain?
At the time of writing, there have been no studies that have found an association between Covid-19 and low back pain.
A. Scott Gentle - Physiotherapist
During this pandemic caused by Covid-19 - there has been a swift movement to working from home, this has caught a lot of people off guard with poor home office setups, usually sharing the dining room table with their kids doing homework. So while back pain and Covid-19 may not have a clear link, it is, however, indirectly associated given the increase in working from home (WFH) and poor ergonomics.
Here are my Top 3 recommendations for anyone who is working from home:
1. Build in a commute: take a 15-minute walk before and after work
2. Improve your setup: whilst it may come at a cost initially, a good chair and desk will save you plenty of aches and pains in the long run
3. Take regular breaks: not only will it help relieve back pain, but it is proven to increase your productivity (your boss will have no reason to complain)
Q. Is lower back pain dangerous?
A. Scott Gentle - Physiotherapist
Whilst low back pain can feel quite uncomfortable, in fact sometimes very painful, it is extremely rare for lower back pain to be considered dangerous. Your doctor and physiotherapist are highly qualified to spot any red flags associated with severe low back pain.
Q. Do I need a referral from my doctor to see a physiotherapist?
A. Scott Gentle - Physiotherapist
For you to access physiotherapy for low back pain, you do not need to have a referral from your GP. Physios are known as primary health care practitioners, meaning you can simply book with any physiotherapist directly, without the need for a referral.
Q. What is the cost of back pain physio in Australia?
A. Scott Gentle - Physiotherapist
Physiotherapy in Australia is largely delivered by private organisations, with most clinics charging between $85-$110 per session, with these sessions typically lasting between 30-45 minutes.
If you have private health insurance in Australia, you should expect a rebate for physiotherapy, ranging from $25-$95 per session, depending on your cover.
Check with your current provider to see what your rebate will be.
In Australia, a Medicare rebate is available for patients with chronic health conditions as diagnosed by a GP.
If you are eligible, there is a rebate of $54.95 available per session, leaving a gap payment of anywhere between approximately $30 and $55.
Anatomy of the lower back
The lower back generally comprises 3 main components. Firstly, there are 5 vertebral bodies, L1-L5.
Secondly, between each vertebrae, there are intervertebral discs, and finally, there are spinal nerves exiting the lumbar spine at each level.
The vertebral bodies of the lower back are larger than any other of the spine, as their main function is dealing with force and load on the body. The discs are also subsequently larger, to allow for as much shock absorption as possible. The nerves that exit the lumbar spine all innervate the muscles and tissues of the pelvis and lower limbs.
The last vertebrae of the lower back is L5, and it sits upon the sacrum - which is connected to the tailbone. In some cases, the L5 and the top of the sacrum are fused together, whilst in most cases, they are separated by a disc.