Lower Back Pain (Lombalgia)

Synonyms for lower back pain

• Mechanical lower back pain
• Acute lower back pain, Chronic lower back pain
• Non-specific lower back pain
• DIM or minor intervertebral dysfunction

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What is lower back pain?

Lower back pain is a general term to describe pain in the lumbar region (lower back) that does not have a specific cause, such as an accident, a sudden movement, or an identifiable pathology with imaging tests (a tumor, a herniated disc, a fracture, etc.). 

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Lower back pain is therefore synonymous with "I have lower back pain and nothing in particular happened." 

It can be frustrating to have a diagnosis of non-specific lower back pain, but on the contrary, it is a good sign because there is nothing serious related to the pain.

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What are the symptoms of lower back pain?

The general symptoms are:

• Isolated pain in the lower back that appears gradually
• Stiffness or increased pain in trunk movements (bending forward, twisting, bending backward)

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In general, there are two types of lower back pain:

• Lower back pain with symptoms in lumbar flexion (rounded back)
• Lower back pain with symptoms in lumbar extension (hollow or arched back)

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Here are the positions or movements that increase pain depending on the type of lower back pain:

• For lower back pain with symptoms when bending forward at the lower back(rounded back), the pain is increased by one or more of the following:
  
  • Sitting for long periods
  • Driving for a long time
  • Bending over
  • Putting on socks, pants, underwear, shoes
  • Sneezing

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• For lower back pain with symptoms when extending the lower back (arched back), the pain is increased by one or more of the following:
  
  • Walking for a long time (worse if walking slowly, better if walking faster)
  • Standing for a long time (grocery shopping, cooking, waiting in line, or watching a show while standing still)
  • Lying on your stomach or on your back with your legs extended

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It is possible to have both types of lower back pain at the same time and therefore have symptoms that fall into both categories. However, one category is often worse than the other.

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What are the serious symptoms of lower back pain to watch out for?

The presence of certain signs and symptoms should prompt you to seek immediate medical attention at the emergency room or from a doctor. These include:

• Severe weakness or paralysis of one or both legs
• Significant or even complete loss of sensation in one or both legs
• Recent loss of balance when walking
• Significant and new incoordination
• New difficulties with bladder or bowel control
• Loss of sensation in the genital area or when wiping after a bowel movement

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Serious symptoms are only present in less than 1% of lower back pain cases. Most of the time, although the pain can be very unpleasant, the condition improves.

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What are the causes of lower back pain?

Lower back pain does not have a specific cause and can be different for everyone. Here are some examples of possible causes:

• Overloading the back compared to what you are used to. For example:
  
  • Doing spring or fall cleaning, gardening with your back bent over for a whole weekend, driving for 10 hours in one day
  • Decreased level of physical activity (if you have become less active than before, you may develop lower back pain)
  • New job, new sport, or new activity that works your back in a new way

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How is lower back pain diagnosed?

Diagnosis is made based on the history of symptoms and a clinical examination. It is important to know that medical imaging (X-rays, magnetic resonance imaging, etc.) is not relevant in 99% of lower back pain cases.

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When to consult a physiotherapist for lower back pain?

You should consult a physiotherapist if you have symptoms as described above or if your doctor has already ruled out any other cause that may be responsible for your pain.

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You do not need to see a doctor before consulting a physiotherapist. If your condition requires you to see a doctor, your physiotherapist will be able to tell you.

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What are the physiotherapy treatments for lower back pain?

Your physiotherapist will perform an evaluation to determine the cause of your lower back pain by assessing the following elements:

• The mobility of your spine
• The gliding of your nerves
• Your postural habits
• The quality of your movements
• Your strength and stability

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Based on the assessment results, your physiotherapist will:

• Will mobilize the joints in your back and your nerves to reduce pain and improve movement.
• Provide you with specific exercises to do at home to address the cause of the problem
• Teach you how to properly manage your daily activities and hobbies to optimize healing
• Give you advice for your postural habits and movements

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What to do at home for lower back pain?

Temporarily stop doing the movements that cause too much pain, and then gradually start doing them again. Don't remain completely still for long periods, as you will become stiffer and experience more pain afterward.

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Here are some tips that may help depending on the type of lower back pain:

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For lower back pain with symptoms when bending forward at the lower back (rounded back):

• Limit the time spent sitting (get up every 20 minutes to walk around a bit)
• When you are sitting, straighten your lower back a little by sticking your buttocks out. Place a rolled-up towel in your lower back to remind you to sit up straighter.
• Go for frequent walks for a duration that is comfortable. Running might even be good for you (it depends on the person).
• In the car, sit well back in the seat and tilt the backrest slightly backward. Move the seat slightly closer to the steering wheel.
• Stick your buttocks out slightly to lean forward.
• When the pain is present, spend a few minutes on your stomach or on your back with your legs extended. This should relieve you.

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For lower back pain with symptoms when extending the lower back (arched back):

• Limit the time spent standing (sit down every 20 minutes while the pain decreases)
• If you are standing still, place one foot in front of the other and make small weight transfers forward and backward.
• When cooking, place one foot inside the cabinet in front of you.
• When the pain is present, spend a few minutes lying on your side with a pillow between your knees. This should relieve you.

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If you do not see any improvement after 10 days, you should consult a physiotherapist.

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If you're a runner, check out our blog post on running (link coming soon) for practical tips.

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Did you know?

• 90% of lower back pain episodes heal in 6 to 12 weeks
• 50% of lower back pain episodes heal in 1-2 weeks

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To learn more...

You can listen to the podcast "Parle-moi de santé" produced by one of our physiotherapists, Alexis Gougeon. Episode #7 discusses the topic of lower back pain.

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Episode #7 lower back pain

Find the episode on YouTube :

Click below to listen to episodes on podcast platforms:

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Sources

• Alexander CE, Varacallo M. Lumbosacral Radiculopathy. InStatPearls [Internet] 2019 Mar 23. StatPearls Publishing.

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