Hopefully, you’re fortunate enough to have a healthy back that rarely hurts or feels stiff. But, that’s not the case for the majority of the population. Many people suffer from lower back pain at one time or other, if only for a short period of time. In fact, 23% of the population worldwide experiences chronic lower back pain that either doesn’t go away or keeps coming back. That’s a class you don’t want to be in! Back pain can really cramp your style, especially if you work out. Yet, working out can protect against lower back pain by strengthening the muscles the support your spine.
Anatomy of Back Pain
Most lower back pain arises from the five bony vertebrae in the lumbar region. This is the portion of your back that’s most susceptible to injury. Between each vertebra in the vertebral column, including the lumbar vertebrae, lies a disc. The purpose of the disc is to cushion and absorb shock. Unlike the hard, bony vertebrae, vertebral discs are made up of a gel-like material and are around 80% water.
The discs connect to the boney vertebrae via an endplate that’s made of tough cartilage. Surrounding the vertebrae are ligaments that help support the spinal column. In fact, ligaments run the entire length of the vertebral column in the front and back. Their purpose is to prevent excessive flexions or extension of the spine.
The purpose of these structures as a whole is to protect the delicate spinal cord that houses the important nerves that run from the brain to the peripheral tissues. When all of these structures are functioning properly, you can move your spinal column without experiencing pain. Unfortunately, things can go wrong, and you can end up with a painful back. Here are some of the most common causes of pain in the back.
Lumbar Muscle Strains
Lumbar muscle strains make up around 70% of lower back pain. Lumbar muscle strains are the garden-variety type of lower back pain that comes from overuse and “pulling” a muscle, which really means overstretching it. With a lumbar strain, the discomfort typically gets worse when you move a certain way and gets better when you rest. Certain anatomical problems such as excessive curvature of the lower back, weak back or core muscles, anterior pelvic tilt, and tight hamstrings increase the risk of developing a lumbar muscle strain. The good news is strengthening the muscles that support the spine and strengthening your core helps lower the risk of this common type of back pain.
Lumbar spondylosis
Lumbar spondylosis is also fairly common. In fact, it accounts for 10% of all cases of lower back pain. This cause of back pain is more common during middle-age or later and is associated with natural wear-and-tear. What exactly is it? Spondylosis is where new, bony outgrowths form from normal bone. These outgrowths are called osteophytes and are often referred to as bone spurs. Often, these overgrowths form in areas where the bone is most stressed. But, osteophytes don’t always cause back pain. If they do, the pain is usually worse with activity, especially with rotation or extension of the back. Spondylosis is most problematic when the bone spurs, or osteophytes, encroach upon the spinal nerves. Being overweight or obese and being inactive may increase the risk of developing this back condition.
Disc Herniation
You hear a lot about herniated discs, but they’re not that common of a cause of lower back pain. A herniated disc accounts for only 7% of cases of lower back pain. Herniate means to protrude and that’s exactly what happens with a herniated disc. The outer, connective tissue layer of the disc tears and the gel-like material pokes through the hole. The symptoms of a herniated disc vary based on whether the disc material presses on nerves in the spinal cord. Depending upon the degree of herniation, it can press on or irritate a nerve that carries sensory or motor information. You can experience a wide range of symptoms with a herniated disc, including numbness, tingling, weakness, loss of reflexes, or pain.
How do you get one? A herniated disc can come on suddenly, as when lifting something heavy. More often, it’s an age-related problem. With age, the discs lose water. This loss of water makes discs throughout the spinal column more prone toward tearing, especially when you twist your body suddenly Being overweight or obese also raises the odds of developing a herniated disc.
Spondylolysis
Unlike other forms of lower back pain that become more prevalent with age, one form of spondylolysis is more common in younger people, particularly athletes. Less than 5% of lower back pain problems are due to spondylosis, but it’s one of the more frequent causes of back pain in adolescent athletes. It’s especially common in adolescents who play sports that require repeated lumbar hyperextension and rotation of the spine, like soccer. In some people, spondylosis is associated with a defect in one of the arches in the spine, usually in the lumbar region and is brought on by repeated mechanical stress. Over time, the stress and the defect can cause a stress fracture of vertebrae. Depending on how severe it is, the stress fracture can make it so that the vertebrae shifts out of place, a condition called spondylolisthesis. Spondylolysis and spondylolisthesis are more common in people who have increased lordosis of the lower back and increased kyphosis of the thoracic spine as well.
Vertebral Compression Fractures
Vertebral compression fractures are where a bone in the spinal column breaks with minimal trauma. Sometimes, this happens gradually over time rather than suddenly. Typically, people who experience a vertebral compression fracture have weakened bones due to osteoporosis or have been taking medications like prednisone for a long time. Prednisone and other steroid medications increase bone loss. Back pain due to a vertebral compression fracture is usually worse when you flex your back or bend it forward.
How to Prevent Lower Back Pain
Much lower back pain is due to mechanically stressing or overworking the muscles or is due to chronic stress on the discs or vertebrae themselves. Therefore, much lower back pain can be prevented by using good form when working with weights and when lifting heavy objects and by correcting posture problems that force your spine out of alignment.
Unfortunately, most people lift incorrectly. Instead of bending at the hips and knees, they bend over at the waist to lift a heavy object. It’s a bad practice that can lead to a serious back injury. It’s also important to hold whatever object you’re lifting close to your body.
You can also lower your risk of back pain by strengthening the muscles in your back and core. The way to do that is through strength training. A strength training workout should be balanced. If you work the core muscles in the front of your body, it’s vital that you work the muscles in the back as well.
Also, reduce the time you spend sitting in a chair. Take walking breaks, and when you do sit, support your back. Avoid spending excessive amounts of time looking down. When you look down, it places added force on your neck.
The best way to lower your risk of a vertebral compression fracture is to prevent bone loss as much as possible. Talk to your physician about when you should get your first bone density study and make sure you’re leading a lifestyle designed to preserve bone health. Strength training and high impact exercise stimulate the synthesis of new bone and help prevent bone loss.
Finally, maintain healthy body weight. Back pain is more common in people who are overweight or obese. Tummy fat is particularly detrimental as it throws your body’s alignment off. Exercise can help you stay a healthy body composition as well.
References:
American Family Physician. October 1, 2018. Volume 98, No. 7.
John Hopkins Medicine. “Muscle Strain”
Medscape.com. “Lumbar Spondylosis”
Mayo Clinic. “Herniated Disc: Symptoms and Causes”
OrthoInfo.com. “Spondylolysis and Spondylolisthesis”
North American Spine. “Spondylosis Causes”
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