The lumbar spine refers to the lower back, it starts about 5-6 inches below the shoulder blades and connects the thoracic spine to the sacral spine.
Consisting of 5 vertebrae (L1 – L5) the lumbar spine is designed for power and flexibility – lifting, twisting and bending. The lower the vertebra the more weight it must bear, therefore the two lowest spinal segments L4 – L5 bear the most weight and are most prone to degeneration and injury.
The lumbar spine meets the sacrum at the lumbosacral joint L5 – S1. This joint allows for considerable rotation so that the pelvis can swing when walking and running.
The spinal cord travels from the skull through the spinal column to where the thoracic spine meets the lumbar spine at T12 – L1. Here numerous nerve roots continue down and branch out forming the cauda equine or ”horse’s tail”. These nerves extend to the lower body (buttocks, legs, feet).
Two vertebrae, for example L4 – L5 are stacked vertically with an intervertebral disc in between, this provides shock absorption and as well as flexibility. Facet joints in the back of the spine connect the two adjacent vertebrae and allow movement such as bending and twisting. Nerves branch from the spinal column at each level of the spine; they pass through small holes (foramen) in the back of the lower spine, then connect together again to form the sciatic nerve, which travels into the legs down the back of each thigh and continues into the calves and feet.
Causes of Lower Back Pain
1. Muscle Strain or Ligament Sprain
The most common cause is a torn or pulled muscle and/or ligament. Strains occur when a muscle is stretched too far and tears, damaging the muscle itself. Sprains occur when over-stretching and tearing affects ligaments.
Common Causes of Strains & Sprains
- Lifting a heavy object
- Twisting the spine whilst lifting
- Poor posture over time
- Sports injuries, particularly those that involve twisting or impact forces
2. Degenerated Discs – as we age intervertebral discs lose hydration and wear down, which means they don’t resist forces as well. This may lead to tears in the disc wall and cause pain or weakening that leads to herniation. A disc can also collapse and contribute to stenosis.
3. Lumbar Disc Herniation – when the jelly like substance at the centre of of a lumbar disc breaks through the outer layer causing inflammation, pressure on/irritation of a nearby nerve.
4. Sacroiliac Joint Dysfunction – see Spine Blog part 2
5. Spondylolisthesis – occurs when one vertebra slips forward over the one below it. Most common in L4- L5
6. Osteoarthritis – sometimes called facet joint arthritis . Ageing and wear and tear can cause the cartilage covering the facet joints to become worn and frayed. Excess friction can produce bone spurs and swelling which in turn places pressure on the nerve causing pain and reducing range of motion.
7. Lumbar Stenosis – narrowing of the spinal canal or nerve root canals can cause squeezing of the nerves resulting in leg pain and/or tingling
8. Fractures and Trauma – resulting from osteoporosis, motor vehicle accidents or a fall.
Less Common Causes of Low Back Pain
1. Infection – also called osteomyelitis.
2. Tumor – most start in the body (breast, prostate, kidney, thyroid, lung) and metastasise to the spine
3. Autoimmune Diseases – for example rheumatoid arthritis, ankylosing spondylitis, lupus, Crohn’s disease, fibromyalgia.
Is Your Pain Chronic?
Back pain is described as chronic once it has lasted longer than 3 months. Often this is due to a disc problem, joint issue and/or an irritated nerve root.
What Can You Do?
A programme of lumbar stretching and strengthening combined with range of movement exercises has been shown to produce excellent results. However, an individual approach is required as people respond very differently depending on body type, movement patterns and habits.
Strengthening the muscles that support your spine will keep it and your upper body stable. It can also relieve back pain and prevent further injury.
Stretching the muscles that you strengthen is important for restoring range of motion and preventing injury by improving your overall flexibility.
We Target the Following Muscle Groups?
- Cervical Spine
- Latissimus Dorsi
- Back Extensors and Erector Spinae
- Quadratus Lumborum
- External and Internal Obliques
- Gluteus Maximus
- Gluteus Medius
Always work in a pain free zone; start gently, slowly increasing dynamic range and the length of time you exercise. My mantra is little and often. Integrating your learning experience into your everyday life is the easiest and most far reaching way of cementing the changes.
- Head Rolls
- Lying on a Foam Roller in Neutral Spine Position
- Child’s Pose
- Kneeling Back Extension
- Spinal Twist
- Modified Side Straddle
- Single & Double Knee to Chest
- Segmental Pelvic Rotations
- Four Point Kneeling
- Two point Kneeling
- Pelvic Tilts
- Hip Bridge
- Abdominal Bracing
- Pelvic Floor Exercises
- Alternate Arm & Leg Lifts/”Swimming”
- Chest Lifts/”Sunbather”
- Single Leg Lifts
- Double Leg Lifts
- Daily Walks