Lower Back Pain Physiotherapy

Various conditions can lead to lower back pain, the most common being pain arising from the lumbar spine discs, facet joints and sacroiliac joint (SIJ)

Lumbar discogenic pain is pain that occurs as a result of injury/ strain to the disc (the cushion between your lower back vertebrae). When this disc is injured, it causes fluid from within the disc to push out and irritate the nerves around the disc. This may occur as part of the aging process (we call this a degenerative disc), it can happen acutely when picking up something heavy or lifting something from an awkward angle.

Symptoms of discogenic pain include:

Constant, dull, broad band of pain in the lower back
Pain on bending forward or twisting
Pain on coughing/ sneezing and even laughing
Sharp pain when getting out of the car or out of the bed
Possibly referral of pain down the back of the leg if the nerves which sit close to the disc get irritated or compressed. We call this sciatic pain

Facet joint pain is pain arising from within the joints of the lower back, where the vertebra above meets the vertebra below. There is a facet joints on the left and the right. There are 5 lumbar vertebrae (L1-L5) and facet joints occur at each level where two vertebrae meet.

The facet joints slide on each other and both sliding surfaces are normally coated by a very low friction, moist cartilage. A small sack or capsule surrounds each facet joint and provides a sticky lubricant for the joint. Each sack has a rich supply of tiny nerve fibers that provide a warning when irritated.

Pain in this area can occur due to degeneration/ wear and tear of the cartilage which can lead to pain and stiffness in the area.

In acute conditions, the facet joints may become irritated and compressed with excessive extension of the back (for example prolonged periods of leaning back and painting). Certain sports that involve extension and twisting of the back (like fast bowling in cricket or incorrect weight-lifting technique) can also lead to facet joint pain.

Symptoms of lumbar facet joint pain include:

Typically only pain on one side of the back, usually quite a small/localised area
Pain is usually made worse extending the back (leaning backwards) or side-bending towards the painful side
Due to their likely being inflammation in the area, people will usually have stiffness in the back when they wake up in the morning
Pain could be made worse walking down stairs

Sacroiliac joint (SIJ) pain is pain which is felt right at the bottom of the lower back between the sacrum and the pelvic bones, and is often caused by sacroiliac joint dysfunction. This could be due to either too much movement in this area (hyper-mobility) or not enough movement in this area (hypo-mobility).

The SIJ is formed by the connection of the sacrum and the right and left iliac bones. The sacrum is the triangular-shaped bone in the lower part of the spine, below the lumbar spine. While the vertebrae in the lumbar spine are all mobile, the sacrum is made up of five vertebrae that are fused together and do not move. The iliac bones are the two large bones that make up the pelvis. The SIJ therefore connect the spine to the pelvis. The sacrum and the iliac bones are held together by strong ligaments.

Injuries to the SIJ can either be traumatic or biomechanical. Traumatic injuries occur when there is a sudden jolt or impact to the area (for example landing heavily on your buttocks) or unexpected load through the area (coming down heavy one leg, for example missing a step and stepping onto a surface lower than what you expected).

Pain due to biomechanical injuries occur over a period of time doing a particular job/sport and are usually due to muscles imbalances around the pelvis, knee, ankle and can even be affected by foot position.

Symptoms of SIJ pain include:

Pain usually on one side where the lower back meets the pelvis
Pain can be dull but can become sharp, restricting movement
Radiation of pain into the buttock and even into the groin
Pain is usually made worse on stair climbing or turning in bed, or putting on socks

Physiotherapy treatment is aimed at finding and diagnosing the source of your lower back pain and treating accordingly. Common treatment modalities will include: lumbar spine/pelvic mobilisations, soft tissue release, dry needling, strapping, core stability exercises, stretches and strengthening exercises to correct muscles imbalance.

If you have any queries, please don’t hesitate to call 011 064 5670 or enquire online.