What Causes Low Back Pain and How To Fix It
"Oh my achin’ back!”
Since about 80% of adults experience low back pain, this phrase is uttered constantly.
Low back pain is everywhere and is one of the top reasons that people miss days from work.
The back is made up of the spine which consists of different segments and structures.
It’s divided up into 4 sections, each consisting of their own individual vertebrae and discs between those vertebrae.
Cervical Spine - Top section closest to the head
Thoracic Spine - The upper back below the cervical spine
Lumbar Spine - The lower back
Sacral Spine - Bottom of low back and sacrum (triangular bone connected to the pelvis)
It’s possible to experience pain originating from any of the 4 segments but today we’re honing in on the low back or the “Lumbar Spine”.
The lumbar spine is made up of 5 vertebrae named L1-L5.
Each bony vertebrae has a gel filled disc between them.
The discs act as a cushion, impact absorber, pressure distributor and separators between the vertebrae.
Ligaments hold the discs and vertebrae together.
Tendons in the back connect muscles to the bones.
All of the tendons and ligaments of the back help stabilize the spine against excessive and/or dangerous movement.
At the rear of each vertebrae are protruding bones known as Facet Joints that link the vertebrae together. They help give the spine it’s flexible abilities.
The low back normally has a slight “curve” to it that keeps it in a naturally extended position. Since the spine can articulate to some extent it allows us to bend forward, backward and side to side.
The spinal cord runs down the center of the spinal canal in the center of the spine. The spinal cord runs from the brain to the top of the lumbar spine where it branches out to the rest of the lower body. The spinal cord and those nerves are part of the central nervous system which provides the signals to your muscles as well as provides feedback and feeling from the different parts of the body.
All of these different parts of the low back can make it difficult to identify the exact cause and source of pain, but let’s look at some of the more common issues.
Everyone is Different
Since we are all individuals, no two spines are exactly the same. If you remember from our discussion on the SHOULDER, it’s possible for people to present with abnormalities on MRI despite not having symptoms of low back pain.
A 1994 study done at Hoag Memorial Hospital in CA performed MRI’s on 98 people with NO low back pain symptoms. The researchers also included 27 MRI’s from people WITH low back pain to keep the radiologists that interpreted the MRI’s honest.
36% of the “no low back pain” group’s MRI’s presented as “normal”.
About half of the MRI’s looked at in the study showed at least some abnormalities of one more more intervertebral discs including bulges and herniations of the disc. Remember, none of these people actually had back pain.
Why do we bring this up?
Sometimes it’s tempting when you DO have pain to want to take steps like getting MRI’s done because as humans we usually feel the NEED to know what is wrong with us.
The problem is that what you see on the MRI might not actually be the source of your pain and it might send you down the path of worry that can actually make existing pain worse. Yes, there is a large psychological component of pain that we will get into in a future article.
Common Issues
Now that we’ve addressed that, let’s talk about some of the more common “issues” that people experience when it comes to their low backs.
There are varying degrees of injury that the low back can sustain.
Tweaks
On one end of the spectrum are the less serious incidents that we sometime categorize as “tweaks”.
The cause is often unexplainable and they usually resolve on their own without medical intervention.
Most of us have experienced these feelings where a certain movement cause a strange feeling or we have unexplained tightness in our back when waking up.
Sprains & Strains
Some of these tweaks are actually slight sprains or strains. These are either over stretching or tears in the muscle or ligaments and tendons that tie the parts of the back together. Maybe you picked up something too heavy or reached back into the depths of the back seat of the car and felt a pull? These can range in severity, but most of these clear up on their own within a week or two as long as the injury isn’t being constantly re-aggravated.
Degeneration
Moving down the list of potential back problems, we come to normal degeneration of the intervertebral discs. The discs between the vertebrae are actually fluid filled pads with a thick outer layer. They provide a cushion between the bones and allow for some degree of motion. Just like every part of our bodies, they are subject to aging. As we age, these discs degenerate. Their cushioning ability is reduced as they lose size and hydration. HOWEVER, don’t be alarmed if you get an MRI and have degeneration of your discs. It’s a normal part of aging that does not necessarily cause back pain. If you’re under 40, you MAY show signs of disc degeneration. If you’re over 40 you can darn well assume that you will have some degree of degeneration. I had a low back MRI in my late 30’s and had signs of degeneration. Since degeneration of the disc is part of normal aging, the best “prevention” is to stay active, train with weights and maintain healthy levels of body fat/weight.
Disk Bulging & Herniation
We mentioned “bulging” and “herniated” discs earlier in this post. The intervertebral discs are really tough. The outer layer is made up of several hard layers of cartilage that encapsulate fluid inside the disc. The outer layer is called the annulus fibrosis and the inner layer is the nucleus pulposus. Over time, or in an acute injury, the disc can protrude outward as the outer layer of the disc stretches. Imagine a water balloon that you squeeze one end of, causing the other end to get bigger. If the disc stays in tact as it protrudes it’s called a “bulged disc”. This can happen in different degrees, and the disc can bulge in different directions with bulges to the rear being the most common. Depending on the severity and location of the bulge you may have NO symptoms or you have localized pain in the back and possibly other pain “downstream” of the injury.
When the outer layer of the disc (annulus fibrosis) is stressed to the point of tearing open its said that the disc has herniated. Just like bulged discs this can happen to different degrees. The most serious part of disc herniations is that as the outer layer is torn, the fluid contained inside the disc can escape and put pressure on or cut off the nerves of the spine. This typically manifests as acute pain at the point of injury and referred pain in the buttocks and legs. In the most severe cases of disc herniations, the fluid in the disc can impinge (cut off) nerves causing weakness, numbness and complete loss of muscular control in the affected area. These are considered *Red Flag* symptoms and you should see a doctor immediately if you’re having them.
The most commonplace in the low back to have problems like bulges and herniations is at the 2 lowest discs. These are known as “L4-L5 and L5-S1”. Those stand for Lumbar 4 and 5 and Sacral 1.
The Good News
The good news about both disc bulges and non red-flag herniations is that there is a high probability of healing without surgery. The nucleus pulposus tends to reabsorb over time, and bulged discs tend to slowly reshape back to their original form, taking pressure off the nerves of the back. Surgical intervention is also possible to relieve nerve pressure by cutting away the portions of the disc and removing fluid that is causing nerve impingement.
Sciatica
Let’s talk about one more common low back problem we see, especially in the 40+ community. Sciatica. The cause of sciatica is typically an impingement of the sciatic nerve in the low back. That impingement is usually a bulged or herniated disc. Sciatica can also cause symptoms due to the narrowing of the spinal canal (spinal stenosis) that the nerves pass through. This is unfortunately a normal part of aging.
Typically sciatica presents as sharp burning pain in the buttock that continues down the back of the leg through your hamstring and calf. It can feel like a lightning bolt. Some people report increased pain after periods of sitting, or during jolting events like sneezing.
Most cases of sciatica resolve on their own over time by losing weight, being active and increasing strength. However, if you have any of the “Red Flag” symptoms we discussed earlier you should see a doctor immediately.
Muscular Pains
The last low back “injury” that I want to mention isn’t really an injury, but more a symptom of its own. These are those muscular pains we feel both during and after an incident. I hesitate to call them “spasms” as that isn’t really what they are. You probably know the feeling though when all of a sudden a muscle tightens and remains active causing discomfort even hours or days later. Research is unclear as to what exactly causes these muscular incidents. In our experience, continuing to stay active can help them dissipate more quickly.
A Word of Caution
A huge word of caution that we want to highlight is in regards to one specific way that people tend to incur a low back injury. The spine does NOT LIKE TO TWIST. This is especially true when the back is under a load like holding a weight or a heavy box. DO NOT EVER pick up something heavy and then twist your torso with it. Instead, hold the load close to your body and then move your feet in the direction that you need to go. A perfect example of this is picking up something awkward like a lawnmower and then twisting to put it into the bed of a truck. This twisting under load puts the discs in a vulnerable position for herniation as they are not designed to rotate. I hope that is clear.
If you’re still reading this you deserve to get to some practical helpful information about how you can prevent yourself from getting a low back injury and what you can do if you already have one. So here we go.
Get Stronger
You need to get stronger. Think about it for a minute. The spine is a series of bones and connective tissue. On its own it contains very little support. Even though the spine does have a fair amount of range of motion and articulation, we have to rely on the musculature surrounding the spine to provide both support and protection for it.
At the base of our back we have 2 large muscles on either side of the spine called the erector spinae or spinal erectors. These serve to help our low back maintain a normal extended position while lifting things and while standing.
Along the sides of our trunk we have the obliques that help stabilize our side to side motion as well as facilitating controlled rotation of the upper body.
In the front we have our anterior abdominals. These act as the muscles that allow us to flex forward as well as providing protection against extreme extension (leaning back)
So we said you need to get stronger. That includes all of these muscles. You can bet that weakness in these muscle groups is a leading indicator of low back pain. The back doesn’t like to operate in extreme ranges and having strong musculature surrounding the spine gives it the stability that it likes.
How to Get Stronger
So how do you get strong? We’ve written about it BEFORE, but here are some things that we recommend for building a strong injury resistant back.
How to get strong
Strong people are harder to kill, and more useful in general. - Mark Rippetoe
We’ve talked in the past about the inverse relationship between lean body mass and all cause mortality as we age. What that means is that the more lean body mass we can maintain as we get older, the less likely we are to die of ANY CAUSE. That’s an important statistic don’t you think?
Strengthen the muscles of your back with deadlifts.
You read that right.
We want you to pick up heavy things to get a healthy back.
5 Step Deadlift Set Up
Perform the deadlift with this technique and make strength gains for years with very little risk of injury.
This article teaches how we teach the deadlift.
The way that you’re going to do this is by making sure that your technique is good (you can send us a form check video by email).
Then you are going to slowly increase the weight on the bar each workout or each week of training.
It’s called progressive overload and we wrote about it HERE.
Basically you need to induce a little bit of stress on the back muscles so that they know they need to adapt and become stronger.
The amount of weight you’re lifting isn’t important, it’s just important that you increase that amount over time.
Build Your Core Strength Avoiding Excessive Sit-ups
We also want to build strength in the obliques and abdominals through isometric holds that challenge the musculature.
Why not sit-ups? I mean that’s what Jane Fonda recommended right?
Remember how we said that the spine prefers to stay mostly in it’s normal anatomically extended position? That’s pretty much the opposite of setups which require a bunch of repetitive flexing of the spine.
It’s ok to do sit-ups occasionally, but we don’t recommend them as a primary way of strengthening the core muscles.
Here’s what we do recommend for the obliques and abs:
Suitcase Holds - Stand straight with a weight at your side. Don’t allow the weight to make you lean over. Your obliques should do the work.
Side Planks - Lay on your side and prop yourself up on your elbow and foot staying in contact with the ground. Keep your body straight.
Front Planks - Do either on your hands or elbows. Don’t let your body sag.
Hollow Holds - Picture your body as a bow and rock back in forth while maintaining that position.
Bird-dog Holds - Get on all 4’s. Maintain a neutral back while reaching out with the opposite hand and foot. Hold the position.
You can use all of these exercises a few times per week.
Where you start isn’t all that important, but add difficulty over time by increasing the weight or the amount of time spent holding.
We recommend 2-3 sets of each per workout a few times per week.
Stay Active
So you’re getting strong, now you need to make sure that you’re staying active. It’s been said that “motion is lotion” and that when become idle problems seem to arise and compile. This is really true when it comes to the low back. Nothing will aggravate a grumpy low back more than sitting for long periods of time.
Sitting is essentially putting your low back into a flexed position at the hip and keeping it there the entire time that you’re sitting. If you work at a desk all day, look at getting a standing desk or something like THIS that gives you both sitting and standing options. Your back will thank you.
Go for walks in addition to your strength training. Even conservative walking stimulates the stabilizing muscles around the spine. Not to mention it’s a great mental break during a busy day. Try to go on 1 or 2 ten minute walks each day.
If You Are Already in Pain
All of this preventative maintenance is great, but what if your back already hurts?
Earlier this year I tweaked my back and was in a decent amount of pain the next day. HERE is what I did to get out of pain. My case won’t be exactly like yours, but here are the steps that you need to take.
Don’t freak out - You’re not broken and you’re really not even that fragile. Your mindset will largely affect your ability to come back from an injury.
Do things that build confidence but don’t cause your pain to get worse. Can you walk without pain? Do that. Can you squat without weight? Do that. Can you do good mornings without pain? Do that. Doing nothing is almost NEVER the answer.
Get back to the things that you were doing before. Slowly add exercises and activities that safely challenge you and build back both strength and confidence.
Continue adding load, range of motion and variety while avoiding pain. Remember, you adapt as you do more so try not to get stuck doing the exact same exercises with the exact same weights month after month.
If you’re intimated by this process that’s understandable. There are many resources available that can guide you safely through this process including therapists and coaches like us.
Quick Recap
Let’s recap what we’ve learned.
The spine is made up of 4 segments with the lumbar spine being the section just above the pelvis.
The vertebrae of the low back are separated by fluid filled discs that provide mobility and act as shock absorbers.
The bones, discs and muscles are linked with tendons and ligaments.
Even people without low back pain can have abnormalities on MRI imaging.
We can injure the tendons, ligaments and muscles by overloading them or by over stretching them.
Everyone’s discs degenerate over time to some degree. Activity and proper nutrition can help slow this.
Discs can bulge or herniate causing impingement of the sciatic nerve as well as other peripheral nerves.
Symptoms can be minor or can be severe (red flag) that require immediate attention.
Many disc injuries heal themselves over time.
Prevent injury by strengthening back muscles as well as oblique and abdominal muscles.
Don’t pick up heavy items and rotate with them.
Rehab back injuries by conservatively adding exercises and load using pain as a guide.
Hire Digital Barbell if you need help 🙂
Thank you for reading! Now go build a healthy strong back!