Lower back pain is one of the most common physical complaints among Americans. Nearly 40 percent of adults report some form of lower back pain in the last three months, versus about 36 percent for lower limb pain, and 30 percent for upper limb pain. Back pain is one of the most common reasons people see a doctor, and is one of the most common causes of work-related disability across the globe.
Is our back extraordinarily fragile? Not really. The human spine can withstand an amazing amount of force, especially over a short period. But it is quite unique. Humans are rare in the animal world for our bipedalism – and we remain the only mammal species that consistently lives in a bipedal state, rather than utilizing all four limbs for locomotion. This places a unique stress on our spine in that our lower back deals with more weight during our day-to-day lives than our upper back, because of the way our spine is stacked.
Humans have evolved to walk on two legs, and our spines have largely adapted to this change. But, as scientists point out, there is an important distinction between survival and comfort.
Even our earliest bipedal ancestors had signs of potential back problems – and the longer you live, the more your spine goes through. The conveniences of modern living are not doing our spine any favors, either. The average human in an industrialized nation spends far too much time sitting down.
This can atrophy the muscles of the back and core, placing greater stress on our individual vertebrae, and increasing the risk of spinal problems such as degenerative disc disease and compression fractures – especially at points of curvature, where the shearing forces between individual vertebrae (spinal bones) are at their highest.
But not all lower back pain is caused by a lack of general fitness or blamed solely on age-related degeneration. There are countless different spinal conditions, nerve conditions, and musculoskeletal conditions that can cause or contribute to back pain.
What Is Causing Your Back Pain?
Back pain can be attributed to spinal health issues, neurological problems, injuries, cardiovascular health problems, even cancer – or all of the above. Identifying the cause or causes of your back pain (and any contributing conditions) is important for formulating an effective treatment plan.
Your back encompasses a collection of muscles, bones, and nerves. The spinal cord is found within the spine, which is a stacked, curving pillar of specialized bones called vertebrae. The spine is separated into the cervical spine (the neck), thoracic spine (upper back), lumbar spine (lower back), and sacrum and coccyx (hip and tailbone). Not all forms of back pain are immediately linked to the spine or its nerve roots – a lot of back pain can be linked to a bruised or strained muscle or a sprained ligament.
Some common causes of back pain include:
- Sprains. A sprained ligament. These are sharp pains that often go away on their own, with a little bit of rest, movement, and an over-the-counter painkiller.
- Strains. Strains are over-stretched or damaged muscles or tendons. A fall or lifting something too heavy can cause strain.
- Spinal conditions. Some conditions pertain specifically to the spine – such as spinal stenosis (a narrowing of the nerve tunnels between the vertebrae), spondylolisthesis (a slipped or misaligned disc), or spinal fracture.
- Nerve problems. The back is home to the spinal cord, as well as each of the body’s spinal root nerves. These branch out into the rest of your peripheral nervous system, responsible for the communication between the brain and the body. Injuries, nerve degeneration, or physical impingement (such as from a nearby growth or swelling) can cause localized, radiating, and referred pain.
- Arthritic pain. Arthritis is a medical term for joint pain, and certain causes of arthritis can affect the spine as well, such as ankylosing spondylitis, and rheumatic arthritis.
- Tumors. Both benign and cancerous growths can cause pain in the back.
- Pregnancy. A growing fetus can press on the nerves and arteries along the spine, cutting off the oxygen supply or causing pain.
- Osteoporosis. Loss of bone density can affect the structural integrity of the spine, making spinal conditions such as compression fractures and slipped discs more common.
- Fibromyalgia and other pain conditions. These account for various chronic health issues that can exacerbate or heighten pain sensitivity, cause muscle fatigue and pain, or result in sudden acute episodes of inflammation.
A thorough diagnosis is crucial. Before a doctor can refer you to a specialist, they will narrow down the list of causes for your back pain through a combination of physical tests, imaging tests, and an examination of your medical history.
Can Physical Therapy Address Back Pain?
Physical therapy utilizes an individualized exercise program to help rehabilitate an individual’s mobility after an injury, improve their quality of life, and help address certain causes of pain. A physical therapy plan can do you a lot of good – even if your pain is not strictly musculoskeletal. This is because exercise in itself can be a therapeutic tool for managing and reducing pain. But it should be treated as a tool, rather than a cure.
Physical therapy relies on consistency to achieve results. It does not replace medication, nor does it usually provide the same sort of short-term relief as direct medical intervention. However, the long-term impact of an individualized physical therapy plan can greatly affect your pain levels over a longer period, and help you become more resilient against recurring injuries or acute episodes of pain.
What Physical Therapy Can and Can Not Do for You
If your doctor recommends long-term pain management for your recurring back issues, then chances are that you will be seeing a physical therapist.
Having healthy, yet positive expectations of what physical therapy can do for you is important.
- Physical therapy can help improve your quality of life.
- Physical therapy can restore flexibility and mobility to the back.
- Physical therapy can help you perform daily tasks with little to no pain.
- Physical therapy can help you get back to work.
- Physical therapy may not address underlying neurological problems.
- Physical therapy sessions cannot compensate for a mostly sedentary lifestyle.
- Physical therapy does not always provide immediate relief.
- Physical therapy alone may not be an adequate pain management plan.
Seek a Comprehensive Approach
No matter what your treatment plan may look like, it’s important that it approaches pain treatment in a holistic fashion. Acute pain is one thing – but a person’s chronic and recurring pain problems are rarely addressed by a single drug or treatment.
In many cases, a multimodal approach is needed. This is where having an experienced and dedicated pain management team comes into play.