How To Understand Low Back Pain

Published: 01 Apr 2016

How To Understand Low Back Pain

During my years as a physiotherapist in both Europe and Australia I have seen many clients come in with low back pain.  Sometimes this presents just as localised pain but sometimes it is in combination with radiating pain or other  symptoms like numbness, tingling/burning sensations, stiffness,  loss of coordination, weakness or a feeling of instability.  In rare cases clients have even presented with symptoms like loss of bladder and/or bowel function, complete loss of muscle activation and abnormal reflexest.

Estimates from the Australian Bureau of Statistics 2011–12 National Health Survey suggested that 3 million Australians have back problems. It is estimated that 70–90% of people will suffer from lower back pain in some form at some point in their lives.

I have come to the conclusion that while people with low back pain present in similar ways, every low back pain is unique and requires an individualised approach to management.  Just as every person is unique, so is every spine. Demands on an individual will change over time and so the way they need their body to work will also vary.  Factors like someone’s age, use of medication, smoking, drinking, overall fitness, core activation, scoliosis (twist in the spine), body weight, posture, work, pregnancy, sport, injury or accident etc. all play a role.  And these are just a few examples.

To make understanding low back pain even more confusing, there is a range of terminology that is used to describe it. You may have heard some of these terms.


This simply means low back pain and is not very specific at all.  It does not tell you what the cause is and where the symptoms are coming from.

Non-Specific Low Back Pain (NSLBP)

This tells you that the person who has looked at your back does not know exactly where the pain in your lower back is coming from.  This diagnosis does not tell you which structure could be causing the symptoms and  therefore you do not know how to manage it.


Pain in the lower back radiating into the leg.  Or even radiating pain into the leg without having lower back pain.   This sciatic pain can come with or without tingling, numbness and/or with other neurological symptoms.  So if someone tells you he or she has got sciatic pain we still do not know what could be causing it.  It could be a disc, a pinched nerve,  an inflammation or maybe even an abnormal growth.

Why So Many Vague Words?

There are so many words that label low back pain, but actually don’t not tell you anything specific and certainly provide no information about the nature of the problem, like when the symptoms will resolve, and how best to manage the problem in the mean time.  All anyone with low back pain wants is to get on with work, sport, hobbies, playing with the children or just simply sit or stand comfortably.  The spine and all the surrounding structures are very complex and in order to ascertain the exact nature of the the lower back and pelvic area in specific are very complex structures that need to be thoroughly assessed by a physiotherapist or specialist in order to be diagnosed properly.

Risk Factors For Developing Low Back Pain

So what are risk factors for developing low back pain?   This is one of the many questions physiotherapists are asked often.  Here are a few to give you an idea.  The truth is that low back pain sometimes seem to occur for no reason at all.  However most often there will be a history of:

  • Lifting, often heavy items (especially more than 20 kg)  or repetitive lifting, especially if this is in combination with twisting the spine.  This combination is very stressful on the discs and even picking up a pen from the ground could be causing low back pain.
  • Sitting or standing too long in one position.  We were not designed to be stationary!
  • Repetitive workof any nature.
  • Being exposed to vibrations.  Driving heacy vehicles, especially where the seat is not hydraulic, or sitting in a car or train.   Expect off road driving or mountain biking to be more intense on the lower back structures.
  • Being overweight,  even when just sitting or standing this puts more strain on the lower back and especially with movement.
  • Posture, such as not sitting properly or in a too deep chair or sleeping on a mattress that is to soft or to firm.

These a just a few examples.

What Structures Could Be Involved When Getting Low Back Pain?

There are many structures that could be causing low back pain, and in some instances there will be multiple structures involved.  Here are just a couple of examples of what structures and why they could be causing discomfort:

  • Muscle:  overuse or a muscle strain can give pain causing the muscle to spasm and give pain, stiffness or feeling of tightness
  • Disc:  an oval shaped structure in between the vertebral bones (you might be interested in our article, I’ve slipped my disc!!).  The disc could be bulging and pressing against a nerve. This can give localised pain or even referred sensations.

    Lumbar Spine Disc

    Lumbar Spine Disc

  • Sacroilliac joint(s) (SIJ):  the joints that make up the base of the spine.  The sacrum is the very bottom of the spine with both ilia attached to it on the sides.  Both ilia join together at the front forming the symphysis.

    Sacro Illiac Joint

    The Sacro-Illiac Joint

  • Facet joints:  the joints that are sitting at the back of the spine.  When strained or in case of an inflammation they can give a significant amount of pain localised or even with radiating pain.

    Facet Joint

    Facet Joint

  • Bone fracture:  in rare cases over use injuries may result in stress fractures in the spine, usually in athletes, especially those that are still growing, also severe trauma can cause fractures
  • Bone bruising:  due to a contusion or trauma there can be bruising within the bone causing pain.
  • Referred pain from organs:  kidney stones for example can give severe low back pain.

It’s Complicated…

So, looking at all the risk factors and all the different structures that can cause back pain it is not easy to give a straight forward answer to what can be causing your back discomfort.  However, when you are assessed by a physiotherapist, he or she will take in account all the risk factors, look at your personal situation and do a range of specific tests to accurately determine the source of your symptoms are coming from and what needs to be done next.  In some cases advice with exercises will be enough to manage the problem.  In other cases we use deep tissue massage, fascial release and manual therapy techniques.   If required we can send you for a x-ray, MRI/CT/bone scan or even refer you to a GP (general practitioner) or specialist.  In some, more complex cases a team of people will be taking care of your situation.

When you have low back pain with any of the above mentioned symptoms at The Healthy Body Company we will do our best to pinpoint what the cause of your problem is and give you a specific course of action.   I believe that every person is individual and needs personal management of their low back pain.

Michiel van Straten