Introduction

Lower back pain is a universal condition that affects millions of people worldwide every year. It's also known as lumbar pain, a type of pain that affects the region of the back located below the ribcage. With varying causes, including poor posture, injury, or chronic conditions, lower back pain often affects the quality of life and daily activities of the impacted population.

Physical therapy, also called physiotherapy, is a non-destructive, drug-free practice to manage and possibly resolve lower back issues. Its main emphasis is on exercises which stretch, strengthen, and improve flexibility.

In this article, we will feature the main causes and symptoms associated with lower back pain and the benefits of physical therapy in the management of lumbar pain.

Understanding Lower Back Pain

Common causes of lower back pain 

Muscle or ligament strain¹

This is the most frequent cause of lumbar pain. Muscle strain is when there is overstretching of muscle fibres of the back, and ligament strain occurs when there is overstretching of ligaments that connect the bones of the back. It can occur with sudden movements or twists, lifting incorrectly heavy objects, or injury during sports, falls or accidents. 

Herniated discs²

Disc herniation is also a common cause of lumbar pain. It occurs when the soft inner material of the spinal disc pouch out through the tough outer material. It can occur anywhere along the spinal cord, but it is more common in the lower back region. 

It often occurs as a natural process called disc degeneration, but can also occur from an instantaneous strain of muscles or ligaments of the back or in traumatic injuries. 

Arthritis³

Spinal arthritis is also a frequent cause of low back pain. It is triggered by inflammation of the joints of the lower back bones, which leads to swelling, pain and stiffness. 

There are numerous variations of arthritis of the spine; the most common is osteoarthritis, affecting the articular surfaces of the bones. It is more prevalent in older ages, overweight people and individuals with prior injuries to the back. 

Skeletal irregularities

Spinal irregularities or malformations are indeed a significant cause of lower back pain. 

Here are the commonest spinal irregularities causing lower back pain:

• Scoliosis: This is an anomalous curvature of the spine laterally
• Lordosis: This is an extreme curvature of the spine inward
• Kyphosis: This is an excessive curvature of the spine outward
• Spondylolisthesis: This is a forward slippage of one vertebra over another one
• Spina bifida: This is a deficient closure of the spinal canal

All these spinal irregularities have potential limitations in mobility and activities of the affected subject and may lead to psychological effects due to body image issues. 

Symptoms associated with lower back pain⁴

Localised pain 

Localised back pain can be categorised into sharp acute, dull chronic, intermittent or pain that exacerbates with movement or certain positions. 

Dull chronic pain is often reported as constant, low-intensity discomfort that can vary throughout the day, also commonly associated with muscle strain or chronic conditions like arthritis. 

Acute sharp pain is described as stabbing, intense, localised pain, often with a sudden onset and can be triggered by specific movements. It can also be linked with some conditions, like sciatica or a herniated disc. 

Radiating pain 

Lower back pain can be associated with pain that spreads out to other regions of the lower body, including the buttocks, hips, legs, or even extending to the feet and toes. 

Sciatica is a common condition in which pain radiates to the buttocks, hips and down to the legs. It goes along the pathway of the sciatic nerve, which is a major nerve of the lower limbs. 

Sciatica is often caused by nerve irritation or compression as when there is disc herniation. 

Stiffness and limited mobility

Stiffness in the lower back is the feeling of reduced flexibility and tightness in the muscles of the lower back. It is often felt after periods of prolonged inactivity or upon waking. 

Muscle spasms are characterised by involuntary, sudden contraction of the muscles of the lower back. This condition can cause limited mobility and pronounced pain.  

Benefits of Physical Therapy

The main benefits of physical therapy in lower back pain include the management and relief of pain, mobility improvement, prevention of injuries in the future and individual education on body mechanics and postures.

Pain relief and management 

This comprises targeted exercises that aim to alleviate pain, both acute and chronic.

It involves techniques to alleviate joint stress and reduce muscle tension. Other modalities like ice and electrical stimulation are also used in physical therapy to reduce pain.

Improved mobility and function 

Mobility and function are improved mainly through stretching exercises. This ranges from stretching exercises to other techniques used to improve spinal and pelvic stability.

Prevention of future injuries 

Through progressive strength training, physical therapy aims at strengthening weak muscles, training for correct posture during daily activities to prevent the risk of injury and also aims at the integration of a daily routine of physical exercise for long-term injury prevention.  

Education on body mechanics and posture

Individualised education on proper posture for various activities, aiming at improving postural awareness and control. It also involves techniques to approach muscle imbalances that contribute to poor posture. 

Recommended Physical Therapy Exercises

Physical therapy exercises are of utmost importance in the relief of lower back pain, and they constitute an important step in relieving not only physical but also mental stress. However, it is also worth noting that any therapy needs a therapist and a professional who should tailor the type and intensity of exercise according to the individual’s needs to avoid further injury and pain.

Here are some of the most recommended physical exercises for lower back pain:

Stretching Exercises 

They are an important component of physical therapy for helping reduce lower back pain. 

They help by reducing muscle tension, improving flexibility and increasing range of motion. 

Here are some examples of stretching exercises: Hamstring stretches, Cat-Cow stretch, Child’s pose. 

Core stabilisation and Strengthening Exercises 

Strengthening exercises are very effective for managing lower back pain as they not only decrease the pain but by strengthen the lower back, abdominal and pelvic muscles they also preventing future episodes of lower back pain. Here are some recommended strengthening exercises that help reduce lower back pain: Bridges; Bird-Dog exercise; Plank variations and Dead bugs.

Aerobic Conditioning⁵

Aerobic exercises are those types of exercises that increase heart rate and breathing which leads to an increase in the oxygen level in the blood. Aerobics increases blood flow to the lower back, helps management of weight and thus reduces stress on the lower back. 

Aerobic exercises are very popular and easy to adopt; the most common are walking, swimming and cycling. 

Safety Precautions

Safety is of greatest importance when exercising physically, especially when doing physical exercise for lower back pain. Each individual is unique, and the cause that led to the lower back pain should be kept in mind when planning for therapy. 

A professional should first be consulted for determining the possible cause of the lumbalgia, it can be a physical therapist or a medical professional. 

A physical therapist will guide you and elaborate on new plans and recommendations for your journey.

Physical therapy is a gradual process, and results are aimed for a long term. It is advised to start slowly and progress gradually. Patience and perseverance are required.

Summary

In summary, physical therapy exercises play a vital role in the management and prevention of lower back pain. Lower pain is increasing globally in incidence among different age groups with various causes.

The goal of physical therapy is to improve lower back pain and prevent its recurrence through different exercises and approaches. As individuals are different in their age, needs and medical conditions, physical therapy exercises should be personalised to achieve satisfactory results. 

Individuals, on the other hand, are required to commit to gradual regular exercises and call for help when needed. They should be educated about the benefits and risks of each exercise, when to start, when to stop and when to rest.