Illustration of the vertebrae, connective soft tissue (ligaments and intervertebral disc) and nerve roots of the lumbar spine (lower back)
Intervertebral disc injuries
Intervertebral discs sit between and attach to adjacent vertebral bodies in the lumbar spine. They are the same shape as the vertebral bodies, which in the lumbar spine is an oval/kidney shape. They are made up of a mixture of a gel-like substance (nucleus pulposus) and tough ligament-like material (annulus fibrosus). The nucleus pulposus is meant to be contained in the centre to rear half of the disc. A disc may become painful because of either a tear in the outer layers of the annulus fibrosus, a bulge in the outer annular wall of the disc (usually rearwards) or, less commonly, a herniation of the gel material through the annular wall (usually rearwards).
An injury to an intervertebral disc in the lumbar spine can cause pain in the lower back, buttock or thigh. This pain can begin suddenly, or develop gradually over a longer period of time. Most disc injuries are treated quite effectively with physiotherapy. Only a small number of people with disc injuries require surgical intervention.
Not all disc injuries can be treated the same, dynamic MRI studies show that exercises that may help one type of disc injury may not help another. Our physiotherapist will determine through a clinical examination which treatment options are appropriate for your particular injury.
Physiotherapy treatment for disc injuries of the lumbar nerve root includes mobilisation of the lumbar spine, traction (longitudinal stretching of the spine) and home exercises. At times we may also use manipulation, massage and dry needling/western acupuncture, where these techniques are appropriate and the client agrees to their use. Learning how to position your spine correctly when sitting or performing your work, sport or home duties is also a key element in accelerating your recovery.
Nerve root compression (a ‘trapped’ or ‘pinched’ nerve)
Compression of a nerve root in the lower back can result in a variety of signs and symptoms anywhere from the lower back to the foot. Pain due to a compressed lumbar nerve root will usually be experienced in a specific pattern (dermatome) in the leg, and possibly foot. Often the intensity of the leg pain will be more severe than the associated lower back pain. Some people with a symptomatic compressed nerve root will experience an increase in leg pain when coughing, sneezing or straining, or a feeling of coldness in the leg. With more significant compression of a nerve root, there is loss of light touch sensation over the same dermatome, loss of power in the muscles innervated by that nerve root, and reduction, or loss, of related tendon reflexes. Our physiotherapist will assess for each of these signs to help establish the level and severity of nerve root compression.
Some of the nerves travelling within the lumbar spine control your bladder and bowel function. If you notice the onset of some incontinence associated with lower back pain, you should see your family doctor as soon as possible.
Physiotherapy treatment for a compressed lumbar nerve root includes mobilisation of the lumbar spine, traction (longitudinal stretching of the spine) and home exercises. At times we may also use manipulation, massage and dry needling/western acupuncture, where these techniques are appropriate and the client agrees to their use.
Zygopophyseal (facet) joint pain
The zygopophyseal joints are the small cartilage-lined joints either side of the spine that (apart from the intervertebral disc) allow the spine to move. Pain arising from these joints is a common cause of back pain. The pain arising from these joints will often radiate into the buttock and/or thigh.
Physiotherapy treatment for zygopophyseal (facet) joint pain includes mobilisation or manipulation of the lumbar spine, massage and home exercises. Dry needling/western acupuncture is another option that we would offer when appropriate.
Stress injury/fracture (pars interarticularis)
This condition is more common in middle to late teenagers who are playing regular sport that involves high volumes of running and/or jumping. Common sports associated with this injury include fast bowling, soccer or other football codes. In this condition the high volumes of running and/or jumping stress a part of the lower lumbar spine beyond its ability to repair quickly enough. If the athlete continues to train and compete despite the pain, a fatigue or stress fracture may develop. Pain associated with this injury usually develops gradually and is usually brought on with the offending activity and settles with avoidance of that activity. It is important that this condition is detected early, and strict rest adhered to, as this will result in the best chance of the stress injury healing.
If our physiotherapist suspects that your back pain may be due to a stress injury, they will ask you to talk to your doctor about having a SPECT (Single Photon Emission Computer Tomography) scan. This scan is the ‘gold standard’ test to determine whether a stress injury in the lumbar spine is the cause of your lower back pain.
The extent of rest required, between 2 and 12 weeks, will depend on the results of the SPECT scan. Following the required period of rest, the athlete must complete a programme of stretching and core strengthening exercises before returning to sport to reduce the risk of a recurrence. Modification of technique (in fast bowling or sprinting for example) and better management of training and competing load are also important aspects of a successful rehabilitation programme.
Stress fracture of the pars interarticularis in the lumbar spine
Spondylolisthesis describes a vertebra having moved forward or backwards relative to the vertebra beneath it. The presence of a spondylolisthesis is determined from radiographic investigations (x-ray or CT) or MRI. This positional change can result in pain being felt in the lower back, at times radiating to the buttock or thigh. The pain may arise from irritation of a number of related structures, including spinal muscle, intervertebral disc, ligaments or the zygopophyseal joints.
Physiotherapy treatment includes various manual therapy techniques and home exercises to settle the current symptoms. These manual therapy techniques include mobilisation, light traction, massage and dry needling/western acupuncture. Once the current episode of pain has sufficiently settled, a programme of core strengthening helps to reduce the intensity and frequency of future episodes.
Spondylosis refers to degenerative changes of the spine. These are often normal age-related changes, but can also be the result of trauma or inflammatory diseases. The presence of these degenerative changes is determined from radiographic investigations (x-ray or CT) or MRI. Many people have these changes without experiencing any pain. The presence of these changes is taken into account, along with the rest of the clinical examination, when the physiotherapist is determining the cause of the back pain.
Treatment for lower back pain due to spondylosis includes mobilisation and manipulation of the lumbar spine, massage, home stretches and core strengthening exercises.
Ankylosing Spondylitis refers to an inflammatory condition that mainly affects the spine and pelvis. In some cases the hips and shoulders are also affected. The symptoms include stiffness and pain, particularly in the morning. Other body systems may also be affected, including the lungs, eyes, bowel and skin.
If our physiotherapist suspects that your back pain may be due to Ankylosing Spondylitis, you will be asked to see your family doctor for further investigations and a possible referral to a Rheumatologist.
Physiotherapy treatment for Ankylosing Spondylitis primarily consists of a stretching and programme to try and improve/maintain spinal flexibility. Hydrotherapy (exercise in warm water) may also be helpful.