The lower back is made up of several vertebrae that connect your pelvis to your upper back. It takes a lot of pressure from everyday activities, like twisting and bending. You have tiny muscles that help support your back while you walk, sit, reach up, or lift things.
If these tiny muscles are not working properly, they can become irritated and cause pain. In turn, this can irritate the nerves and other structures in the lower back which can make the pain worse.
Bulging discs are most common in people between the ages of 20 to 50 years. If you have a bulging disc, you'll get sudden pain while performing an activity like lifting something heavy. After the initial onset, you'll notice that your pain gets worse with bending over.
Muscle strains happen when a muscle is being over-worked or worked repeatedly in the same way for an extended period of time. The muscle itself will be inflamed and cause a burning pain sensation. You might notice that the pain gets worse with any movement, but lying down feels better.
The sciatic nerve is one of the largest nerves in the body. It travels from the lower back down the side of the hip, to the back of the knee and down to the foot. It can become irritated by anything in its path. If the spine is irritated or not moving well, the sciatic nerve will become irritated at the root.
If a muscle is irritated, it can compress the nerve in that area. The pain you'll feel is a sharp, shooting pain. You might feel it start in your back and travel down the outside of the leg.
Arthritis and stenosis are often found on X-Rays or MRIs of the spine. This can be normal as we grow older. Arthritis and stenosis become a problem if the vertebrae are not moving well in relation to each other.
People at risk of arthritis are those that have very physical and active lifestyles, like lifting heavy items or performing a high impact sport.
Pain in the lower back
Pain on the outside of the hip or buttock
Pain shooting down the leg
Tingling or numbness shooting down your leg
Weakness in your leg
Imaging is one way to see what is happening to your back. Although sometimes it can be helpful, what we see on an X-Ray or MRI is not always the cause of your pain. Having a photo of your spine can help rule out more serious things like a spinal fracture or cord compression.
Physiotherapists are regulated health professionals who are specifically trained to test and diagnose all sorts of injuries using special tests and techniques.
A physiotherapist has the ability to place stress on every structure in the lower back, including the discs, vertebrae and nerves. They can use their hands to see how each vertebrae is moving and if any of them are causing pain (this is a good way to test if the arthritis or stenosis are the cause).
The muscle test can indicate any weakness in your core stabilizers, as well as in your legs. A sensation test can be done to see how your sensitive nerves are working.
Most physiotherapists communicate with your family physician to keep them up-to-date on the findings. This gives your physician more information on how to proceed and better help you reduce your pain.
Depending on the cause of the pain, treatment will vary. In most cases, applying ice to the painful area will help temporarily relieve the pain.
Manual therapy is usually beneficial to increase blood flow and encourage the vertebrae to move the way that they are supposed to. Your therapist might perform some massage techniques to reduce muscle tension in the area.
Traction is another popular technique that physiotherapists use to create space between the vertebrae, which provides relief for most people.
As your back and sciatica pain resolves, you will begin core strengthening exercises to stabilize your back. Your physiotherapist will also make some recommendations about your posture and look at your daily functional activities to identify any triggers.
The goal is to learn how to move correctly, to prevent your back pain and sciatica from coming back!