I have lower back pain. How?

How have I hurt my lower back?

In part one of this series on the lower back we discussed what structures can cause your lower back pain. In this article we will discuss what can predispose you to pain.

Have you ever reached forward into a lower cupboard and felt a grab in your lower back?  Or felt a twinge when coughing or sneezing?  And then wondered how such a small activity can result in pain when the previous day you were moving 20 kilogram bags and didn't feel anything!

Why is this so?

Firstly this article is mainly focused on the most common causes of lower back pain.  I will not be discussing in detail the more serious causes of lower back pain such as cancer; fractures from falls; infections; abdominal causes such as colitis; or inflammatory arthritic disorders such as ankylosing spondylitis.  These issues require specific management targeting the cause of the pain and do not occur frequently (less than 1% of the population).

The vast majority of lower back pain does not have a serious cause, though is something that can follow a long lasting variable course.  Generally most lower back pain is significantly better after 6 weeks and by 12 months pain levels are low.

There are a number of risk factors for lower back pain.  These include the presence of other chronic conditions such as asthma, headaches, diabetes, or mental health conditions.  In addition, factors that relate to lower general health also increase the risk of low back pain such as smoking, obesity and low levels of exercise.  There is also a strong association between pregnancy and lower back pain.

It has also been found that poor levels of concentration, heavy manual tasks, poor postures and fatigue increase the risk of a new episode of lower back pain.

But why the pain?

The spine is designed to move in ways that we require it to move.  The structure of the spine allows us to bend forward, lean backwards, twist, squat etc.  Stresses and loads are placed on the lower back and generally it handles it comfortably.

Sometimes the spine doesn't handle it comfortably and a pain signal is sent to the brain and the brain responds.  The response from the brain is dependent on all the risk factors listed above.  If you have had pain in your lower back previously the brain remembers this episode and this will influence how much pain you feel.

There is evidence that a degenerating disc has a larger frequency of pain receptors.  This would suggest as we get older the risk of lower back pain will also increase.  However, lower back pain generally begins earlier in life with the highest frequency of symptoms in the 35 to 55 year old age group.

What I am trying to describe is that there is no one reason why you will have lower back pain.  There are a number of factors that contribute to lower back pain. Some of them are preventable others are non-preventable such as age.

The next article will describe how to manage an acute episode of lower back pain and following articles on how to prevent recurring back problems.