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Lower back pain



Eighty percent (80%) of people will experience lower back pain at some stage of their life. Back pain is a symptom caused by many conditions. It’s one of the most common reasons for people missing work and seeing a doctor, physiotherapist, and Pilates instructor. Fortunately, most back pain is caused by musculoskeletal conditions and can be treated with great success. Generally, lower back pain is something you can avoid with the added knowledge of some back education, back care strategies and exercise. Please seek advice specific to your low back pain.


What Can Cause Severe Low Back Pain?


Acute low back pain is most often caused by a sudden injury to the muscles and ligaments supporting the back. The pain may be caused by muscle spasms or a strain or tear in the muscles and ligaments. But occasionally, it can have a more sinister cause.


Sudden Low Back Pain Causes

  • Muscle Strain or Muscle Spasms

  • Spinal Disc Injury

  • Compression fractures eg Osteoporosis

  • Sciatica

  • Spine Cancer

  • Non-Musculoskeletal Causes of Low Back Pain

  • Despite most low back pain is musculoskeletal in origin, other health conditions can cause low back pain.

  • Abdominal aortic aneurysm

  • Infection of the spine

  • Kidney infection or kidney stones

  • Spondyloarthropathies: eg rheumatoid arthritis, psoriatic arthritis.


Female reproductive organs: eg pregnancy complications, ovarian cysts or cancer, endometriosis


Please seek the professional advice of your trusted and experienced healthcare practitioner to diagnose the cause of your lower back pain.


What Causes Lower Back Pain?


Lower Back Pain is categorized by researchers and spinal health care practitioners into the following categories:

1. Specific Spinal Pathologies (<1%)

2. Radicular Syndromes (5-10%) Radicular Pain eg Sciatica, Radiculopathy, Spinal Stenosis

3. Non-Specific Lower Back Pain (NSLBP) (Bardin et al., 2017)


Specific Spinal Pathologies


Some conditions that cause back pain do require an urgent and specific referral and treatment. These can include spinal infections, cancer/malignancy, spinal arthropathies (eg rheumatoid arthritis or ankylosing spondylitis), cauda equina syndrome or spinal fractures. These conditions do require early diagnosis and prompt referral to the appropriate medical specialist. Luckily these conditions account for less than 1% of back pain sufferers, but you don't want them missed.


Radicular Syndromes


Lower back pain can result from structural damage that can irritate or pinch a nerve.

Researchers believe that radicular syndrome causes 5-10% of the presentations of back pain to general practitioners. The most common nerve that can be pinched in the lower back is your sciatic nerve. You may be diagnosed with sciatica if you are suffering radicular pain down your leg due to a back injury. While the sciatic nerve is the most common nerve that can be affected by a spinal injury any nerve can be affected, eg femoral nerve. Sciatica is also commonly confused with pyriformis syndrome, which is caused by the pyriformis muscle being tight and restricting the sciatic nerve as it runs through the hip.


Back injuries such as a herniated disc (slipped disc), facet joint sprain, spondylolisthesis, spondylolysis, degenerative disc disease, spondylosis, and back ligament sprain can all contribute to, or cause, radicular pain syndrome due to swelling or space-occupying material adjacent to the spinal nerve. The nerve is either irritated (radicular pain) or pinched/compressed (radiculopathy).


Lumbar radiculopathy can result in functionally disabling conditions such as foot drop, foot slap or evertor muscle weakness that can affect your ability to walk. Spinal stenosis is a slightly different condition and relates to compression of the spinal canal. Spinal stenosis is usually more prevalent as you age.

Did you know that Pilates is one of the most spinal decompressing forms of exercise?!


Non-Specific Lower Back Pain (NSLPB)


Non-Specific Lower Back Pain (NSLBP) is the diagnostic term used to classify sufferers of lower back pain where no specific structure has been injured. It is really a diagnosis of exclusion. In other words, your spinal health care practitioner has excluded specific spinal pathologies and any syndromes mentioned above as the cause of your back pain or symptoms.


Fortunately, these conditions account for approximately 90-95% of the lower back pain causes and they can nearly always be successfully managed conservatively and without the need for surgery. Most improve within two to six weeks. They can be fast-tracked with pain relief physiotherapy techniques such as manual therapy, and Pilates for decompressing core and back exercises.

NSLPB Causes


Most lower back pain causes are musculoskeletal in origin and known as non-specific low back pain (NSLPB). The causes of lower back pain are numerous but roughly fall into either a sudden (traumatic) or sustained overstress injuries.


Most people can relate to traumatic injury such as bending awkwardly to lift a heavy load that tears or damages structures. However, sustained overstress injuries (eg poor posture) are probably more common but also easier to prevent. In these cases, normally positional stress or postural fatigue creates an accumulated microtrauma that overloads your lower back structures over an extended period of time to cause injury and back pain. During your initial visit to your local Pilates studio, your instructor should assess, correct, and document your movement patterns. They should also give you homework exercises and tools so that you can continue to move correctly.


Most commonly, NSLBP is caused by back muscle strain, back ligament sprain. Other chronic back conditions such as degenerative disc disease may underly the acute conditions and predispose you to acute pain. This strain in the back can also be caused due to a lack of support from surrounding muscles. The core being weak means that you have little spinal decompression, and if the glutes are weak, then you will use your back to lift.

The good news is that you can take measures to prevent or lessen most back pain episodes. Early diagnosis and specific individualized treatment is the easiest way to recover quickly from lower back pain and to prevent a recurrence.


Suffering Back Pain. What Should You Do?


As you can see while lower back pain is common, the diagnosis of the cause of your back pain is specific to you and therefore the treatment you use also needs to be specific to you!

A spinal health care professional can assist you with a prompt diagnosis, early referral, acute and chronic back pain relief, plus long-term self-management or back pain prevention strategies specific to your back pain. You should feel confident that your practitioner has screened you for specific pathologies that require urgent medical attention. Plus, they should also assess you for any neurological deficits such as loss of bowel or bladder function, leg muscle weakness, loss of sensation, diminished reflexes and day-to-day function to determine whether you have radiculopathy or stenosis, which may require different treatment options to NSLBP or radicular pain.


Pilates has always been the highest referral of exercise for low back pain. It’s a supportive way to decompress your spine, strengthen your abdominals, glutes, and back (aka your core muscles), and correct your posture and movement patterns.


Remember, Pilates is for ANYBODY and ANYBODY can do Pilates.

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