What Causes Lower Back Pain?

Introduction

In the UK today, more than 2.5 million people suffer from back pain on a regular basis. It is estimated that back pain costs the UK some £6 billion a year with 180 million working days lost.

So what can cause Back Pain?

De Rosa and Porterfield state, “… at present, identifying with any certainty the exact tissues involved in most low back pain is virtually impossible” ( quoted from 1) .

Bogduk states, “Virtually every structure in the lumbar spine has at one time or another been implicated as a possible source of low back pain. As a result, controversy outweighs conviction in the field of low back pain. There is however, an increasing amount of information that sheds light on this field” (2) .

There are very frequent references in literature however, for the need for postural correction as part of the treatment.

Below, is a list of possible primary and secondary causes of lower back pain:

• poor posture
• faulty ergonomics
• muscle imbalance
• faulty lifting techniques
• poor abdominal wall function
• Visceral-Somato Reflex
• Spinal fractures
• Spinal tumours
• Spinal infections
• Degenerative disease

By no means is this list exhaustive.

Poor Posture

“Posture is usually defined as the relative arrangement of parts of the body. Good posture is that state of muscular and skeletal balance which protects the supporting structures of the body against injury or progressive deformity irrespective of the attitude (erect, lying, squatting, stooping) in which these structures are working or resting. Under such conditions the muscles will function most efficiently and the optimum positions are afforded for the thoracic and abdominal organs. Poor posture is a faulty relationship of the various parts of the body which produces increased strain on the supporting structures and in which there is less efficient balance of the body over its base of support.” (1)

In today’s society, good posture has almost become extinct. With a general lack of activity and an increase in sedentary jobs, poor posture has become the norm.

“Bad posture is a bad habit and unfortunately, is of rather high incidence. Postural faults that persist can give rise to discomfort, pain or disability. The range of effect from discomfort to incapacitating disability is related to the severity and persistence of the faults. ” (1)

Faulty Ergonomics

One of the biggest causes of poor posture today is sitting at desks and use of computers and telephones. Many workers today sit slumped for eight hours a day, looking down at their computer, whilst hunching their shoulders to use their keyboard. Those who spend many hours driving a vehicle are also very prone to poor posture.

“The incidence of postural faults in adults is related to this tendency towards a highly specialized or repetitive pattern of activity.” (1)

Being seated for eight hours a day using a computer can be described as ‘repetitive’.

Sitting with poor posture for long periods of time can cause muscles that are in a shortened position to stay shortened. Also, muscles that are in a lengthened position for long periods tend to stay lengthened and normally become weak.

Muscle Imbalance

When opposing muscles crossing joints are not at their normal lengths it is known as a muscle imbalance. Muscle imbalances cause joints to sit in an unnatural position. In other words, they lose their optimal axis of rotation.

Muscles that stabilize joints, also known as Tonic muscles, have a tendency to shorten under faulty loading. Muscles that move joints, also known as Phasic muscles, have a tendency to become long and weak under faulty loading. Often a joint will have phasic muscles on one side of a joint and tonic muscles on the other. The tonic muscle if held in a shortened position for long enough will develop a greater resting tone in the muscle than the opposing phasic muscle. This will pull the joint towards the tonic muscle and into an unnatural position.

Muscle imbalance results in undue stress and strain on bones, joints ligaments and muscles. The greater a persons muscle imbalance, the more wear and tear their joints and connective tissues are likely to have over time.

Muscle imbalances in the body can cause the following in the lower back:

• excess pressure or compression on the discs
• shear and torsion on the vertebrae and vertebral discs.
• disc degeneration
• spinal instability
• entrapment of spinal nerve roots
• fracture of pars articularis
• Sacro-Iliac Joint dysfunction
• Scoliosis (unnatural lateral curvature of the spine)
• abdominal wall dysfunction

Any of the above outcomes of muscle imbalance can potentially cause pain or injury.

Pain in the lower back can also radiate down one or both legs. Pain radiating down one or both legs may indicate that a dorsal root ganglia is compressed. This is known as Radicular Pain. The dorsal root ganglia in basic terms, is one of two strands of nerves originating from the spinal cord and passing through the gap (or foramina) between vertebrae.

In addition to poor sitting and ergonomics, there are other possible causes of poor posture and muscle imbalance.

They include:

• lack of physical activity and exercise leading to muscle weakness
• poor breathing pattern
• faulty jaw mechanics
• faulty vision
• Atlas subluxation (rotated first cervical vertebra)
• Visceral (organ) stress
• Emotional blockages.

As mentioned earlier, many therapists and exercise professionals are not trained to identify the aetiology of back pain. This can only be accurately found after a detailed assessment.

Unfortunately, many therapists are guessing. This is why many people do not overcome their back pain and have to keep going back for regular treatments. This is not to suggest therapists aren’t good at what they do. In fact, I refer many of my clients to therapists.

The human body is the most complex system we are aware of. It is unlikely you will ever find one person who will be able to do everything required to get you functioning optimally and pain free.

Faulty Lifting Technique

It has also been shown that many injuries occur due to faulty lifting technique. Injury occurrence has been shown to be high when an object is lifted far from the body, with straight knees or with the body in a twisted position.

When lifting objects, especially heavy objects, you should always ensure the object is close to your base of support. This is normally just in front of your feet. You should also ensure you bend your knees, do not twist your torso and keep your lower back from flattening (or rounding) as much as possible.

Quite often an injury caused by lifting can merely be ‘the straw that breaks the camel’s back’. In other words, the spine and surrounding tissues may have been progressively degenerating for some time without pain. A pain free back does not necessarily mean a healthy back.

Having a strong body with good muscle balance will reduce the likelihood of hurting your back whilst lifting objects.

Mothers with small children have to be particularly careful when picking up their children. Pregnancy and labour weakens the musculature that supports the lower back and can take up to two years to fully recover. It is possible for the musculature to never get back to pre-pregnancy levels, especially if the woman leads a sedentary lifestyle.

It is highly recommended that post-natal women seek the guidance of a C.H.E.K Practitioner to re-condition the abdominal wall musculature after pregnancy.

Poor Abdominal Wall Function

The abdominal musculature helps to support the lower back. Muscles such as the Transverse Abdominus, Multifidus, Diaphragm, Pelvic Floor and Internal Obliques (3,4,5) along with the connective tissue called Thoraco-Lumbar Fascia (3) help to keep the lower back stable and strong.

This is believed to be partly achieved through three identified mechanisms, Intra-abdominal Pressure, Thoraco-lumbar Fascia Gain (3,4,5) and the Hydraulic Amplifier Mechanism (3) . It is believed there are other mechanisms that play a role that we are not aware of yet .

If these abdominal muscles do not have adequate strength and endurance they leave the spine exposed’ and more susceptible to injury.

The abdominal wall musculature can also be inhibited by gut inflammation which can be caused by Food Intolerance, Fungal Infection and Dysbiosis (more bad bacteria than good in the gut). This will also leave the spine exposed.

So it could also be the foods you eat that are causing your back pain. A C.H.E.K Holistic Lifestyle Coach or Healthexcel Metabolic Typing Intermediate Level Advisor can help you identify if your foods are causing your back pain.

Visceral-Somato Reflex

Back pain can also be caused by the visceral-somato reflex. This is where an internal organ is dysfunctional and because it is linked neurologically to a muscle or group of muscles, the pain is felt in the muscle and not the internal organ. Viscero-somato Reflex can cause spasm or inhibition (relaxation) of muscles.

Dysfunction to the bladder, kidney, spleen or large intestine is known to sometimes cause lower back pain (6) .

Spinal Fractures, Tumours, and Infections

Spinal fractures, tumours and infections are uncommon, even in older people.

I have seen a number cricketers and dancers with a fracture of the spine, known as Spondylolisis. Careful assessment and a precise corrective exercise programme helped them become pain free and in some instances get them back performing.

If you require any further information on obtaining a healthy, pain free spine, please contact me.

In health and happiness,

Leigh Brandon

(T) 0870 486 2470

(E) info@bodychek.co.uk

(W) www.bodychek.co.uk

Disclaimer
No person should rely on the contents of this article. We expressly disclaim all and any liability and responsibility to any person in respect of anything contained in this article. It is advised that you always follow the advice of your Doctor.

To find out how we can help you further, call us on 0870 486 2470 or email us at info@bodychek.co.uk.

References:

1. Kendall F et al, “ Muscles, Testing & Function”, Williams & Wilkins, 1993.
2. Bogduk N, “ Clinical Anatomy of the Lumbar Spine”, Churchill Livingstone, 1997.
3. Chek P, “ Scientific Core Conditioning”, Correspondence Course, CHEK Institute, 1998
4. Richardson C, et al, “ Therapeutic Exercise for Spinal Segmental Stabilization in Low Back Pain”, Churchill Livingstone, 1999
5. Lee D, “The Pelvic Girdle”, Churchill Livingstone, 1999.
6. Chek P, “ CHEK Certification Program Level 1”, Course Manual, CHEK Institute, 2001
7. Chek P, “ Scientific Back Training”, Correspondence Course, CHEK Institute, 1998

Disclaimer
No person should rely on the contents of this article. We expressly disclaim all and any liability and responsibility to any person in respect of anything contained in this article. It is advised that you always follow the advice of your Doctor.

To find out how we can help you with your back pain, call us on 0870 486 2470 or email us at info@bodychek.co.uk.