Lower Back Pain

Musculoskeletal low back pain may arise from any of the structures in the lumbar and sacral region. The typical sources of spine pain is muscle strain and tension, joints (facet and sacroiliac joints), slipped disc with pinched nerves. These symptoms may be associated with buttock pain and radiation and referral into the lower limbs.

The commonest pain generator and source of lower back pain:

Facet joint pain
Facet joint pain can have a number of causes, including pressure overload of the joints, injury or wear and tear(aging). The joint could become strained an activity which an individual undertakes regularly, such as forms of physical exercise or manual work. Disc degeneration can be a typical precursor to the pressure overload on the facet joints, as it causes the narrowing of the space between each vertebra, which in turn leads to a build-up of pressure on the articular cartilage surface. Facet joint arthritis has the ability to destroy the cartilage and fluid which is used for lubrication of the joints, causing pain.

Sacro-iliac joint
There are several causes of sacroiliac joint pain. The joint could become strained or inflamed through injury, wear and tear(aging), or through a problem developed through an activity which an individual undertakes regularly, such as forms of physical exercise or manual work. Damage to the ligaments of the sacroiliac joint is another possible reason for the joint dysfunction, while a type of arthritis known as ankylosing spondylitis can damage the sacroiliac joint. Pregnant women can suffer from sacroiliac joint pain due to the release of hormones which have the ability to alter joint movement and cause pain. It has also been found that an uneven leg length can disrupt the rhythm of strides while walking and lead to sacroiliac joint pain.

Myofascial pain – eg Pirirfomis, Quodratus lumborum
The most frequent cause of myofascial pain is overuse or following a specific trauma of a particular muscle or group of muscles. Areas of muscle which are stressed or strained, can become irritated and sensitive to pressure. Repetitive motions can increase the strain on particular muscles or joints and so put individuals at higher risk of developing myofascial pain. Medical specialists also believe that having a poor posture and stress may be a factor.

Management of Lower Back Pain

Our individualised holistic approach:
Full history and assessment
Education about lower back pain so you can take steps to manage the condition
Occupational and lifestyle advice
Medication review and optimisation
Physiotherapy and exercises enabled by the window of pain relief from medications and interventions
Psychology based treatments

If you have any of the following Red flags symptoms, it may signify a serious back problem and require urgent medical attention.

Sciatica in both legs
Numbness between thighs and genital region (saddle anaesthesia)
Sudden weakness in the legs
Lose the ability to control your bladder or bowels
History of cancer
New onset pain at the age <16 or >50
Generally feeling unwell with weight loss, fevers, night sweats
Night time pain
Thoracic pain
Reduced level of immunity

Call 999 or go to your nearest A&E department if you are experiencing numbness or a pins and needles sensation between your thighs and genital region, sudden weakness in the legs, or lose the ability to control your bladder or bowels, as this could be a sign of a more serious back problem.