This is the first post in our series about low back pain, common diagnoses, and effective treatment strategies including manual therapy, exercise, and ergonomics. Continue to check back each week for new posts!
Low back pain has been termed an “epidemic” in modern society. Recent studies have found that the one year incidence rate of people experiencing their first episode of low back ranges from 6.3-15.3%, but the one year incidence rate of people experiencing any episode of low back pain may be as high as 36%.1 The numbers are even more staggering when you consider the lifetime prevalence of low back pain for adults, which can be as high as 65-80%.2 The Journal of Orthopaedic & Sports Physical Therapy has written that, “Low back pain is the leading cause of activity, limitation and work absence throughout much of the world and is associated with an enormous economic burden.”1
The back can generally be divided into five sections: the cervical spine (neck), thoracic spine (midback), lumbar spine (low back), sacral spine (tailbone), and coccyx (tailbone). The back is mainly composed of the spine, which has 33 bones called vertebrae that run from the base of the head to the tailbone. The vertebrae stack on top of each other and are separated by disks. Disks are mainly composed of collagen fibers, and they are hydrophilic in nature, which means that they attract water. Healthy disks are well hydrated and are able to distribute pressure evenly throughout their surface area.
The spinal cord, a thick bundle of nervous tissue, runs through the central part of the spine and branches off at each vertebra to form smaller nerves, which in turn form groups and run to the arms and legs, supplying sensation and muscular function to the limbs. Additionally, muscles, tendons, ligaments, and other tissues surround the spine to support it and help the body move in certain directions.
Types of Low Back Pain
There are different types and causes of low back pain, but one of the main types of low back pain is called mechanical low back pain. Mechanical low back pain is back pain that is due to issues in the spine, disks, or soft tissue (i.e. muscles, tendons, nerves, ligaments, etc.) around the spine.3 Some of the most common types of mechanical low back pain with the percentage of patients that they impact include:
- Lumbosacral muscle strains/sprains (70%): the stretching or tearing of muscle fibers or ligamentous fibers, respectively, in the low back
- Lumbar spondylosis (10%): wear and tear in the spinal disks of the low back, potentially causing bone spurs to develop
- Disk herniation (5-10%): when part of a disk between two spinal vertebrae partially moves into the spinal canal, impacting the nerve roots exiting the spinal cord
- Spondylolysis: (<5%): a defect or stress fracture in the pars interarticularis (a thin part of the vertebrae in the back of the spine)
- Vertebral compression fracture (4%): a fracture (break) in the vertebrae of the spine
- Spondylolisthesis (3-4%): when one spinal vertebra moves either forward or backward relative to the vertebra beneath it
- Spinal stenosis (3%): a narrowing of the spinal canal3
Risk Factors for Developing Low Back Pain
There are a number of risk factors for developing low back pain, but the strongest predictor is a previous episode of back pain.4 Various studies have been conducted on the risk of recurrence of low back pain, with some studies finding that up to 77.1% of patients may have more than one episode of low back pain.4 Other risk factors include stress, psychosocial factors such as depression, and occupational risks such as manual handling of objects, bending and twisting, and static work postures/sitting.
Physical Therapy and Low Back Pain
In an article published in the American Family Physician Journal, the authors stated that “Physical therapists play an integral role in the diagnosis and treatment of low back pain… Exercise therapy is as effective as other therapies for the treatment of acute low back pain, and is slightly effective at reducing pain and improving function in chronic low back pain. However, early guideline-directed physical therapy has substantial reductions in use of health care and overall costs.”3
Although the rates of low back pain are high, physical therapists can help mitigate pain and prevent future recurrences. A recent study found that in patients with acute low back pain, early physical therapy helped decrease the chances of future injections, surgery, and physician visits for the patients’ back pain.2
Physical therapy for low back pain can include manual therapy; exercises for coordination, strengthening, and endurance; exercises to have you move your back in a certain direction; exercises to mobilize your nerves; neuromuscular re-education; self care training; ergonomics; modalities such as traction; and patient education. A recent large study found that exercise was valid for helping reduce pain in patients with chronic low back pain, helping reduce days absent from work in patients with subacute low back pain, and treating patients with acute low back pain.5
While low back pain rarely becomes life-threatening, it can be very painful and can significantly interfere with our daily lives. A physical therapist can help you identify factors that might contribute to back pain and help you develop a prevention plan, or treat back pain and prevent a recurrence.
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- Delitto A, George SZ, Dillen LV, et al. Low Back Pain. Journal of Orthopaedic & Sports Physical Therapy. 2012;42(4). do:i10.2519/jospt.2012.42.4.a1.
- Gellhorn AC, Chan L, Martin B, Friedly J. Management Patterns in Acute Low Back Pain. Spine. 2012;37(9):775-782. doi:10.1097/brs.0b013e3181d79a09.
- Will JS, Bury DC, Miller JA. Mechanical Low Back Pain. American Family Physician. 2018;98(7):421-428.
- Silva TD, Mills K, Brown BT, Herbert RD, Maher CG, Hancock MJ. Risk of Recurrence of Low Back Pain: A Systematic Review. Journal of Orthopaedic & Sports Physical Therapy. 2017;47(5):305-313. doi:10.2519/jospt.2017.7415.
- Hayden J, Tulder MWV, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane Database of Systematic Reviews. 2005. doi:10.1002/14651858.cd000335.pub2.