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Chronic Low Back Pain

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Chronic Low Back Pain

If you have low back pain, you are not alone—most people in their lifetime experience one or more episodes of this pain. In most cases, the pain goes away within days to weeks; however, it can last for three months or more. These extended episodes are defined as chronic low back pain.
The standard treatment approaches for low back pain include exercises, relaxation techniques and medications.

Chronic Low Back Pain

Low Back Pain Structures and Treatment Approaches

To understand how these treatments work, let’s first look at the structure of your lower back. The spinal column is made up of twenty-four vertebrae. Back problems and back pain commonly occur in the lumbar region. Each vertebra has an opening that forms the spinal canal and protects the spinal nerves. Facet joints and intervertebral discs connect the vertebrae above and below. These structures are held together by groups of ligaments and muscles. Muscles attached to the spinal column allow us to move, and they also support the spine bearing the body’s weight. (What is Spinal Decompression?)
If some of these muscles are tight, weak or imbalanced, pressure can result in excessive wear and tear of other structures.

learn all about pain management techniques and treatments.

Disc Herniation

For example, a common problem in the lower back is disc herniation.

In this case, pressure on an intervertebral disc has caused its centre, the nucleus pulposus, to protrude backwards and push against the spinal nerves, resulting in that.

For some patients, this pain can also be felt in nearby areas where the spinal nerves from the lower back also extend, such as the leg and foot on the affected side. Exercise can relax muscles and reduce pressure in the lower back structures (See Also Our Exercise Therapy Service page).

It is essential to consult your health team to determine which exercises are best for your condition.

Consider one standard low back pain exercise program called the McKenzie Method.

For patients with posterior disc herniation, lying in a prone position reduces the pressure on the disc.

If the pain condition allows, extension movements can gently stretch and relax tight muscles.

Your lower spine also becomes more arched with time, bringing the disc centre forward into the correct position and reducing the irritation on your nerves, therefore decreasing the pain in your lower back and legs.

Exercise and Back Pain

For some patients, relaxation techniques such as meditating in a relaxed position, as well as cognitive behavioural therapy, can ease that.

This is because our brain not only perceives the pain but also regulates pain signals.

When back structures are damaged, pain signals ascend from the lower back through the spinal cord arrive in the brain region that perceives pain, the sensory cortex. However, this is not a direct route; at least two connections must be made. It’s at these relay stations, which include the spinal cord and the thalamus, that pain signals can be regulated by the brain.

Let’s take a closer look at the first relay station located in the dorsal horn of the lumbar spinal cord. The incoming pain signals are passed from a sensory neuron in the lower back to a relay neuron in the spinal cord. The pain signals then ascend to the brain. This pain impulse can be reduced by a specific neuron carrying Signals back from the brain. As a result, fewer pain signals are sent to the brain, so we feel less pain.

However, if, for instance, you are stressed, these brain signals can increase the pain signals. Therefore, studies show that patients with depression or anxiety experience more pain, while patients who have positive attitudes and are engaged in their treatments feel less pain.

Back Pain Medications

Your health professional may also suggest that you take pain-relieving medications that fit your existing medication regimen. The effects vary greatly depending on what type of medication is prescribed.

Some medications help relax muscles, and some act on neurons in the relay stations to reduce the pain signals. It is important to follow the advice of your health team and do exercises, learn relaxation techniques and perhaps take medications.

The benefits might not be felt right away; it takes time and your active participation. By taking an active and informed role in your health, you are guaranteed to control your pain better and lead a healthier life!

Lumbar Disc Injuries and Treatment

Your spine is composed of individual bones called vertebrae. Your vertebrae form a protective tunnel called the spinal canal, which surrounds the spinal cord as it travels down the length of your spine.
On each side of the spinal cord, spinal nerves exit the spinal canal through small, bony channels called neural foramina. Your lumbar spine is the lower third of your spinal column. Between each vertebra, a flexible pad called an intervertebral disc acts as a shock absorber for your spine.
Lumbar disc pressure can increase by more than 50% when you change from a standing position to bending over or by more than 80% between an upright position and sitting with no back support.
The intervertebral discs’ rigid outer ring is known as the annulus fibrosus.
The soft, gel-like center is called the nucleus pulposus. During a traumatic injury, your spine may lurch forward forcefully, causing your vertebrae to compress the front of one or more of your lumbar disks beyond normal limits.
As a result, the back of your disc protrudes backward, causing small tears and thinning of your annulus fibrosis.
Over time, your damaged annulus fibrosis may weaken and change shape. And your nucleus pulposus may dry out and lose flexibility.
As your intervertebral disk deteriorates, your nucleus pulposus may push your annulus outward, resulting in a disc bulge.
Depending on its location, the bulge may push on or influence, one of your spinal nerves, your spinal cord, or your cauda equina, which is a collection of spinal nerve roots at the end of your spinal cord. Central disc bulges protrude backward into your spinal canal. Lateral disc bulges extend into your neural foramen. Severe lumbar disc injuries can tear your annulus fibrosis. Pressure from your vertebrae may push your nucleus pulposus out of your torn annulus, causing a disc herniation. A herniated lumbar disc can impinge upon your cauda equina or spinal nerves and cause symptoms such as pain, numbness or weakness in one or both of your legs.
Treatments for lumbar disc injuries may include rest, anti-inflammatory medication, muscle relaxants, ice or heat applied to the injured area, physical therapy, an epidural steroid injection, given directly into the area of nerve irritation, and more severe cases, surgery.

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