- Today, I'm talking about lower back pain and the most common causes that I see in clinical practice every day. So if you have lower back pain and you want to know what's causing yours then stay tuned because I'm
talking about that right now. There are so many different
causes of lower back pain. I cannot go through them all today, but what I will say is that
there are common causes of lower back pain. There are causes that
we need to be aware of that are possible and then there are the
rarer causes of lower back pain that I'm not
going to touch on today. The most common things
that I see in clinical practice are muscles, tendons,
ligaments, nerves, discs and the bony structures of the vertebrae such as the joints themselves. Most of the time, this is what
someone would present with, one of these possibilities but we also need to be
aware of other things that can happen that
affects certain age groups. For example, if you're in
your twenties and thirties, there's a high possibility
that lower back pain could be coming from a disc. As you get older, discs
tend to become thinner and more dehydrated. So unless you've had history
of a disc problem in the past, as you get into forties, fifties and older, it's less likely
to be a disc related. If you're in your
forties, fifties, sixties there's a possibility as a male
that we could have some kind of prostate issue going on. As a female of any age
you could be thinking about gynecological issues. Then as you get into your elderly years, seventies, eighties,
there's an increased chance of abdominal aortic aneurysms. And that could potentially cause a very serious medical problem. And then of course there
are the rarer problems with your lower back, which
I'm not going to touch on now. But what I will say is that if you do have lower
back pain and you haven't had it diagnosed, then
go and see a doctor just to make sure there's
nothing untoward going on. So what I'm gonna do right now is break down lower back pain in terms of what you can see with the anatomy. So this is a fairly
complete skeleton here. These are the ribs. You're looking at the
backside of someone here. These are the bumpy bits in
the spine that you can feel if you run your fingers down your spine. And then you've got the two pelvic bones on the outside here. Now, quite often, when someone comes in with acute lower back pain they will have very nonspecific pain. As in, they won't be
able to tell you exactly where that pain is. So generally speaking that pain will go all the
way across on both sides. So all in the lower back, coming up to around the region
of the 12th rib here. They won't be able to tell you
where that pain is exactly, but as that pain starts to wear off and the pain becomes
less acute and more into the chronic pain, they
will generally feel pain becoming more isolated
into one particular area. There's quite a lot going on structurally in the lower back with the
spine, the discs, nerves, so I'm just gonna show you on a spine what that might look like. Okay, so here is a model of a spine. Again, this is looking
at it from the back. On this model, though, you
can see much more easily. All of the different segments
of the vertebra to all of these white bits are the
bony segments of the spine. These are the bumpy bits that you can feel as you run your fingers down your spine. These are called spinus processes. The yellow things coming
up here are the nerves. If you look closely
where the bones overlap these are joints. And quite often these
can become compressed. And if they become compressed,
they can become irritated. These are called facet joints. And as you can see, they're
quite close to the nerves. So any inflammation or compression in these small joints
can cause inflammation that would irritate the nerves and all of the muscles that these nerves are supplying will likely become spasms. If I flip it around, you can
see this red bulgy bit here. This is loosely representing a disc bulge or a disc prolapse. So these lines that you can see here these are the intervertebral discs. So these discs allow compression and allow movement between
each vertebral segment. If one of these disks becomes
prolapsed or bulges out as you can see that is also
very close to the nerves. So when a disc bulges out,
there's usually a release of chemicals, which cause inflammation and that will sensitize the nerves again causing muscle spasm. Connecting all of the vertebra
together are ligaments. These are what hold the bones to bones. These are less likely to become damaged in normal day-to-day activities. But if you have something
like a road traffic accident where someone hits you
from behind in your car, these ligaments can quite
easily become overstretched and become sprained and
they can also cause pain. Now, if we move more superficially I will show you what it looks like the muscles attached to the lower back. So now I've got a model of the lower back. So this is purely the lower back. So the five segments of your lumbar spine this is the same view I just
showed you from the back, but this time we've added
on a load of muscles. So these muscles on this
side are the deeper muscles. As you can see, there's quite a lot of muscles that connect all
of the vertebra together. And then on this side you've got the more superficial muscles. So in relation to a back these muscles that you can see here are the kind of more superficial ones that would
generally run down the spine, either side of the spinous processes. Now, most of the time when people come in with lower back pain,
these muscles are in spasm and this is what causes
people to have that inability to move, that stiffness, and that pain when they start to move. So, as I said earlier, the
nerves can become affected which then affects the
muscles surrounding them. So these nerves branch off and they innovate the
muscles that are around. So into the lower back,
the hips, down the legs. So any of these nerves that become affected
will likely cause spasm within the muscles. So any structure that is irritated or affected in the lower back,
such as ligaments, tendons, discs will usually cause
some degree of inflammation. And it's that inflammation
that causes the local spasm because the nerves are what get affected. So when someone comes
in with lower back pain the first thing we need to try and do is to get that inflammation down and then decrease some of this spasm. Because without decreasing
that spasm people aren't gonna be able to move. And every time they do move they're gonna find it difficult and they're gonna find it painful. Now, when it comes down to it, one of the most common reasons for people to develop any of this pain whether it's a ligament,
a tendon, muscle, disc, most of the time that has arrived from people being too weak. Now, maybe this is relevant to you as well where you may have been sitting
in a chair for too long. So for example, you
might be an office worker or you might be due to the lockdown. You might be sitting on
your sofas for too long, so these muscles have become weaker. When these muscles become weaker, any activities that you do will either make you feel like you've got pain because the muscles are now unable to cope with the physical demands
or the lack of strength in these muscles has led
to a lack of stability within the spine. And that is what then has
put pressure on the discs because the muscles aren't able
to hold your spine in place. So the discs have taken
more strain through them and those discs have become weaker or the same with the
ligaments around the spine. So generally speaking most people have become
weak in their lower back. Now, not only that, but that
lack of movement has also led to an increase in
tightness in these muscles. Now, one of the common
places that people get pain is around where the pelvic
bone meets the sacrum. So where are these erector
spinae muscles come down and attach. This is one of the most common
places that people get paid. And this is because these muscles have either had too much
repetition through them. So for example, you've moved
house, you've done gardening and the muscles are just
not strong enough to cope with that new increase in demand. And then the muscles have got irritated that irritation has caused spasm. And then that spasm spreads
all across the lower back. So just to summarize the
most likely explanation for someone having acute
or chronic lower back pain, is that the muscles in the
lower back are far too weak. If it's acute and the weakness in the lower back is
what's predisposed someone to develop it from a repetitive movement or lifting something that's too heavy. Or if it's chronic lower back pain then these muscles have remained
weak because you feel pain. You haven't been
strengthening your lower back and that's put you in this constant cycle of pain and weakness, pain and weakness. So you're constantly getting weaker. But to break that cycle you need to start
strengthening those muscles in your lower back. Now when it comes to how
lower back pain presents, there's either acute lower back pain or chronic lower back pain. Acute is when someone has done something and the pain is very
intense and very recent. So it could be something that
you've done today, yesterday or within the last week
or week and a half. Generally speaking, you
will be in a lot of pain. There'll be a lot of stiffness and there'll be a lot of
pain on all movements. So generally sitting still
will be relatively painless. You might feel some sense of
spasm or tightness or aching but it's when you start
to move, that's when the pain will kick in and
it will usually stop you from easily moving from
one position to another such as standing up from a chair. Usually you might get about
halfway and then get stuck and then you need some kind of assistance to get all the way up. Or it could be something
like turning over in bed. Acute pain will usually last for about a week to week and a half. After that, it starts to become
a little bit more subacute and move towards chronic pain. Now chronic pain is
when you've had the pain for many weeks, months, or even years. Generally speaking, the
pain will be less intense. Whereas acute, you might be
looking at seven, eight, nine, out of 10. Chronic pain tends to be around
three, four, five out of 10. and you won't be able to
pinpoint where the pain is. But with chronic pain, that
pain becomes more focused and you can pinpoint exactly
where you feel the pain. So in order to improve
your lower back pain you need to distinguish
what phase you are in. Are you acute? So is your pain a six, seven,
eight or nine out of 10? Are you having problems moving? Are you having problems standing up? If that's the case you're in phase one. Now, if you've seen any
of my previous videos you probably would've heard me talk about different phases of recovery. This is something that I have
developed over the years. Phase one is about
getting you out of pain. Phase two is about
reestablish your movement, your flexibility and mobility. Then phase three is about
strengthening that region that's been injured. So if you are in acute
pain, then you are probably in phase one, you need
to get that pain down. Phase one is all about gentle movements, trying to get the muscles working, trying to get the inflammation down. Things like gentle massage,
ice packs can really be beneficial here. Phase two is once the pain has come down from a seven or more and it's now into like a
five, four, or even a three. So that's the point when
you start to stretch. So this phase is all
about just stretching. Obviously you're gonna keep moving as well but stretching is the main focus. Once you feel that your
flexibility is now getting back to normal or even better than normal then we go into phase three and phase three is all about
re strengthening the muscles. This phase is all about using body weight, using resistance work to
try and work those muscles to make them stronger. So now that you understand all
about your lower back pain, I want you to leave me a comment. Let me know how this video
has helped you understand about your lower back pain. Once you've done that,
what I want you to do is go and watch one of these,
these two videos right here that will help you to either
improve your flexibility around your lower back and your hips or help you strengthen your lower back so you can prevent lower
back pain coming back.
