Know your Injuries – Part 8: Lower Back Injuries
Dr Meenakshi (P. T.) with a Master’s Degree in Sports Physiotherapy is Gāyo Fitness Academy’s (Hon.) Senior National Faculty and Assessor in Sports Medicine, Sports Medical Rehabilitation and Exercise Therapy. Her impressive work experience includes working her Asst. Professorship in Department of Physiotherapy, P.D.M University Bahadurgarh (Haryana) and practice as Sports Physiotherapist in Sports Authority of India National Boxing Academy, Rohtak. She has attended to India’s world-class women’s boxing teams. She is currently attached to SAI, Lucknow.
She can be contacted at email@example.com. Dr Meenakshi will write regularly on exercise and sports injuries management.
Dr Meenakshi presents the early management of Lower Back injuries in Part 8 of her Sports Injury Management Series.
It is estimated that up to 84% of adults have low back pain at some time in their lives. For most individuals, episodes of back pain are self-limited. Patients who continue to have back pain beyond the acute period (four weeks) have subacute back pain (lasting between 4 and 12 weeks) and may go on to develop chronic back pain (persists for ≥12 weeks). This pain rarely leads to serious medical conditions.
What Is Low Back Pain?
The low back, also called the lumbar region, is the area of the back that starts below the ribcage. Almost everyone has low back pain at some point in life. It is one of the top causes of missed work across the world.
Fortunately, it often gets better on its own. When it does not, your physiotherapist or doctor may be able to help with several effective treatments.
Understanding the lower back anatomy is key to appreciating the root of lower back and hip pain.
The human spine is composed of 4 sections of vertebrae –
- cervical (neck)
- thoracic (upper and middle back)
- lumbar (lower back)
- sacrum (tailbone)
The lumbar and sacrum region make up the bones of the lower back anatomy. The spinal cord is contained within the spine’s vertebrae, running through the vertebral foramen and branching out to the peripheries through the intervertebral foramen. The muscles of the low back work together with the transverse abdominal muscles to increase intra-abdominal pressure.
The four upper back muscles are –
- Latissimus dorsi,
- Rhomboid muscles,
- Levator scapulae and
These muscles work with most of the shoulder muscles to assist in shoulder movements.
The lower back muscles include –
- Erector Spinae
- Latissimus Dorsi
There are many back muscles which can cause pain. The pelvic floor muscles also help increase this pressure, which provides stability to the spine and trunk. Common hip and back pain causes include injury to muscles from overuse, disc injury/degeneration or spinal stenosis.
The Latissimus Dorsi or the Lats is the largest muscle in the back. Anatomically it is the length of the spine and is located in both the upper back and the lower back making up the largest portion of your back musculature.
Dr Meenakshi breaks down her explanation in terms of –
- first aid
- basic rehab movements
Signs that a muscle might be injured include –
- sudden onset of pain,
- limited range of motion,
- muscle spasms,
- stiffness, and
Muscle injuries of the lower back are commonly caused by an improper lift, lifting while twisting, or a sudden movement or fall, which may cause lower back pain.
Carrying a heavy bag or backpack, wearing high heeled shoes, your posture while working or sitting or standing – all these can lead to low back pain!
The multifidus muscle keeps the back straight and stable. Multifidus issues usually lead to other problems due to improper recruitment of other muscles to avoid pain.
Muscle injuries may also occur due to prolonged improper posture, such as a forward flexed posture, which stretches out the back muscles. Lower back pain from sitting is also very common. Proper lifting procedures and keeping a proper posture will reduce pressure to the hip and lower back structures and musculature. Always be aware of the positioning of your lower back anatomy.
Another common cause of lower back and hip pain is disc injury or herniation. Degenerative Disc Disease may also lead to lower back and hip pain. This is basically where the disc shrinks and decreases the space between each vertebra. This may lead to arthritis in the spine or Spondylosis. Bone spurs and nerve compression may result from degenerative changes.
Tight lower body and hip muscles can also contribute to low back pain.
Risk increases with –
- Contact sport
- Throwing sports
- Cardiovascular problem that reduces blood circulation
- Medical history of bleeding
- Poor muscle condition
- Poor nutrition
- History of previous injury
Most people experience back pain first when they’re in their 30s. The odds of additional attacks increase with age. Other reasons your low back may hurt include –
- Being overweight
- Being sedentary or hypokinetic
- Lifting heavy weights on the job or in the gym
Prevention is better than cure! The precautions to be taken are common to all sports and exercise injuries. But it is worth reminding the reader!
- It is essential to engage in a physical conditioning that involves appropriate strength and flexibility building movements prior to playing sports.
- Stretch the core muscles as also the tendons prior to physical activity.
- Improve functional movement and dynamic stability of the hip joints.
- Try to be in shape to play your sport; don’t play your sport to get in shape!
There is no definitive way to prevent back pain as you age, but there are steps you can take to lower your risk:
- Stay at a healthy weight.
- Exercise regularly.
- Lift with your legs, not your back.
- Make sure your office desk position is not contributing to your pain.
Follow the P.R.I.C.E. drill –
- Protect the injured part, not allowing any further damage.
- Rest the injured part.
- Apply ice or cold treatment for 15-20 minutes.
- Compression: use of mild to moderate pressure to the injured area with bandages / crepe bandages is advisable.
Current international standards have replaced P.R.I.C.E. with P.O.L.I.C.E.
- P – Protection of injured part
- O/L – Application of Optimal load (local injury factors) / Training load
- C.E. – as mentioned earlier (ice + compression+ elevation)
True muscle strains (pulled muscles) are rare. Most muscle pain in the lower back is due to muscle spasms from other lumbar spine injuries. Disc injuries are more likely.
If there is muscular pain use an ice pack initially. Gentle movement exercises may help, such as lying on the back, bending both knees, and gently rotating them together to each side, without pushing into pain. Start with 5 to 10 reps. Gentle yoga may be helpful once the acute symptoms improve. Modalities such as ice or heat can certainly stop the back muscles from going into a spasm.
Follow up on First Aid
Most of the time, pain in the lower back is better in standing. If your pain is less in standing position, a light walk may also be beneficial. It is best to start with a short distance and see how the pain responds. Sometimes, inflammation and pain increase several hours after an activity. So, it is best not to overdo it initially, even if there is no initial increase in pain.
Also consider starting a Pilates or Yoga program. Both will help get relief from low back pain.
If pain increases in standing, please consult your physiotherapist and / or doctor before beginning a walking or Pilates or Yoga program. In any case, ensure that you do avoid violent, jerking movements and hyper-extension of the back.
Pain that comes on suddenly is “acute.” It might happen during sports or heavy lifting. Pain that lasts more than 3 months is considered “chronic.” If your pain is not better within 72 hours, you should consult your physiotherapist or doctor.
Nutrition plays a big role in the recovery process and the injured person must consult a certified sports nutritionist.
Exercises to prevent injuries and strengthen the hamstrings
Dr Meenakshi (P. T.) recommends these rehab exercises to help recover from lower back related injuries.
Exercises for low back pain – general back pain with no specific diagnosis.
- Pelvic tilting
- Bridging, progress to single leg
- Knee hug, both knee hug
- Truck rotation
- Prayers stretch
- Cobra pose/ upward dog
- Downward dog
- Cat and cow.