Lower Back Pain
It is estimated that as much as 80% of the population will experience low back pain at some time in their lives. Low back pain is the 2nd most common cause of disability in US adults and a common reason for lost work days. It is the 2nd or 3rd most common reason people go to visit their doctor.
Muscles and joints of the lower back can be common sources of pain (see Muscle & Joint Pain page). In addition to those, here are some lumbar spine conditions that physical therapy can help you with:
Disc Bulge or Herniation –The intervertebral discs of the spine provide shock absorption and stability throughout the neck, upper back, and lower back. The disc has two basic components; the nucleus pulposus which is a gel-like substance and the annulus fibrosus which is a rubber-like substance. Acute or repetitive trauma of the back can cause the rubber-like part of the disc to crack like a used tire which results in the gel-like nucleus of the disc to “bulge” or herniate through the annulus. There are 4 types of disc herniations which can result in varying levels of pain or dysfunction. Lumbar Disc herniations are most common at levels L4-5 and L5-S1 (near the bottom of the spine).
Degenerative Disc Disease – This is an age-related condition where the discs of the spine break down and deteriorate. It has been reported that the disc is comprised of as much as 88% water. As we age, we lose some of this water content which contributes to the break down of the disc and a loss of disc height. This process is, in part, the reason people get shorter as they age. One main difference between DDD and disc herniations as described above, is that DDD typically causes local back pain only, whereas disc herniations typically cause back pain and radiating pain into the buttock and leg.
Pinched Nerve –A pinched nerve in the lower back results in pain in the back, buttocks, hip, leg, and/or foot. Sometimes the pain is accompanied by numbness, tingling, or weakness. This condition is specifically referred to as radiculopathy. Pinched nerves in the back are usually caused by a disc herniation as described above or by degenerative joint disease leading to stenosis (narrowing) of the spinal canals. Disc herniation is more likely in 30-50 year olds whereas stenosis from DJD is more common in adults over 50.
Spinal stenosis – This is the narrowing of the canals or spaces in the spine. Narrowing can occur in the central canal where the spinal cord sits or it can occur in the foramen, the holes on the sides of the spine where nerves run. Stenosis can be caused by a disc herniation but the condition typically refers to narrowing caused by degenerative joint disease or osteoarthritis.
Sciatica – This is a term used to describe pain with or without numbness that radiates along the path of the sciatic nerve. This is a “catch all” term for pain in the buttock and down the back of the leg. It is important to be aware that there are many other problems that can cause a similar type of pain so it is important to be evaluated by a healthcare professional to determine the source.