What is non-specific lower back pain?
Lower back pain is a common problem experienced by many people. In fact, it is estimated that up to 80% of people will experience lower back pain at some point in their lives (Maher, Underwood & Buchbinder, 2017). Non-specific lower back pain refers to pain in the lower back that is not caused by a specific underlying medical condition. It is a general term used to describe a range of symptoms and discomfort in the lower back that is not attributable to a specific cause.
The lower back
The lower back is a complex area of the body that contains many different structures, each with its own unique purpose. Some find the idea of suffering from lower back pain very scary, and much of this comes from not understanding the makeup of this area of the body.
Some of the key structures in the lower back include:
- Vertebrae: The lower back is made up of five small, cylindrical bones called vertebrae, which stack on top of each other to form the spinal column. The vertebrae are separated by small, cushion-like discs that help absorb shock and maintain flexibility.
- Spinal Cord and Nerves: The spinal cord runs through the centre of the vertebrae and is responsible for transmitting messages between the brain and the rest of the body. Nerves branch off from the spinal cord and travel throughout the body, allowing for movement and sensation. These branches are the referral pain that can be felt through the legs when suffering from non-specific lower back pain.
- Muscles and Ligaments: The lower back contains many different muscles and ligaments that help support the spine and allow for movement. The muscles in the lower back include the erector spinae, multifidus, quadratus lumborum, and gluteus muscles. The ligaments in the lower back include the anterior longitudinal ligament, posterior longitudinal ligament, and the ligamentum flavum.
Overall, the structures in the lower back work together to support the spine, allow for movement, and transmit messages between the brain and the rest of the body.
Causes of lower back pain
The term non-specific lower back pain commonly refers to pain that is not easily identifiable (Maher, Underwood & Buchbinder, 2017). However, there are some common causes that sometimes we can attribute to.
- Prolonged positions: this term would be what many recognise as poor posture, however, nowadays we view this as prolonged positions, such as many hours of being seated or standing, being the cause of that dull achy back pain some might suffer with.
- Muscle strain or joint sprain: This is a common cause of lower back pain, often caused by lifting heavy objects, sudden movements, or overuse. This causes a pain response to be released in order to reduce the range of movement and is the body’s way of protecting from further damage.
- Herniated or bulging discs: The discs between the vertebrae in the spine can bulge or herniate, putting pressure on the nerves and causing pain.
The above are the most common issues found when lower back pain is more specific. Below are some less common, but just as important, causes of lower back pain.
- Spinal stenosis: This is a narrowing of the spinal canal that can cause pressure on the nerves, leading to pain.
- Osteoarthritis: This is a degenerative joint disease that can affect the lower back, causing pain and stiffness.
- Spondylolisthesis: Spondylolisthesis is a condition characterised by the forward displacement of one vertebral body over the one below it. This can result from a defect in the pars interarticularis, a small piece of bone that connects the facet joints of the vertebrae, or from degenerative changes in the spine.
- Lack of exercise: A sedentary lifestyle can weaken the lower back muscles and make them more prone to injury and pain.
- Psychological factors: Stress, anxiety, depression (Bener, et al., 2013), and poor sleep quality can all contribute to non-specific lower back pain. Finan (2013) understands this to be due to pain perception and sensitivity, and reduced tolerance.
It’s important to remember that some cases are easily matched up with the above causes, meaning non-specific lower back pain is the resulting diagnosis. Although it may feel unnerving to not know the direct cause of your pain, you should take reassurance in the fact that there is no serious undying disease causing the pain.
Symptoms of non-specific lower back pain
Many bouts of lower back pain come on very suddenly, also known as an acute onset. Symptoms of non-specific lower back pain can vary from person to person but typically include a dull ache or sharp pain in the lower back that may be felt in the lower back itself or can refer to other areas such as the legs, most commonly through the hamstrings that are located in the posterior thigh. Other symptoms may include stiffness or limited range of motion in the lower back, and difficulty standing or sitting for long periods of time.
Most cases of non-specific lower back pain will resolve within a week or two through its own natural history. Although the easing or complete eradication of pain is a big sigh of relief, it is common for recurrences to happen, and this is where the recognisable term ‘chronic lower back pain’ comes from. This is where engaging in sports therapy/physiotherapy can help strengthen the area and reduce the risk of this recurrence.
As previously mentioned, most lower back pain cases are non-specific and not classed as having a serious underlying cause. Some symptoms to be aware of that may indicate otherwise are:
- Gradually worsening pain over multiple days/weeks
- Weakness in legs/feet
- Persistent pain that isn’t reduced by resting or lying down.
- Numbness in the saddle area (inner thighs)
- Loss of bladder or bowel control
- Back pain after significant trauma such as a car accident
- Unexplained weight loss
Although these all sound scary and daunting, please note that these are rare, and most individuals will not experience symptoms of this nature.
Attending a physiotherapy/sports therapy clinic can be very helpful for gaining a better understanding of the cause and resolution of your lower back pain.
During an initial session, your therapist will discuss with you, in as much detail as possible, how your symptoms came about, what you were doing when you began to feel your pain, and the nature of your symptoms. The answers to these questions help us identify if there are more specific structures involved, or whether it falls into the category of ‘non-specific’.
Following this, a full physical examination will be done where we look more objectively at movements that provoke symptoms and potentially look more functional than usual as this helps us identify what needs to be worked on to improve pain and get you moving better in the future.
Treatment of lower back pain includes a combination of many different modalities, some of which include lifestyle changes that can be hugely beneficial to the health of the lower back.
When in the acute stages, attending physiotherapy/sports therapy is important to reduce symptoms more quickly, and begin the process of strengthening the lower back. A study in 2018 promotes the use of manual therapy treatments such as massage, dry needling, and mobilisations as they have shown to be very helpful in reducing symptoms and making the strengthening element of therapy much easier to carry out (Foster et al., 2018).
Pilates can be a fantastic way of aiding the prevention of lower back pain through the use of core stabilisation and strengthening work. Additionally, general strength training that includes specific back-focused, and core-focused exercises to build a strong and stable midline will contribute significantly (You, Kim, Oh & Chon, 2014). If lifting already, ensuring good technique when loading through the posterior chain (back, hamstrings and glutes) is important as this can be a common cause of sudden bouts of acute lower back pain.
Treatments you can put into action yourself are
- Keeping active. This goes for both during and after suffering from lower back pain. Keeping moving, as much as pain allows, when in the acute phase is vital as this reduces stiffness and improves mobility which can, in turn, reduce long-term pain. Current evidence encourages movement over rest and suggests that this will speed up your recovery.
- Sleep. Ensure you are getting a sufficient amount of sleep to aid the recovery process. Trying to find a comfortable position can sometimes be difficult, but usually putting a pillow between the knees when side lying can help alleviate pain.
- Heat. Using a hot compress, such as a hot water bottle, over the lower back can help reduce a lot of the symptoms felt throughout the day. Although this won’t fix the cause of the pain, it will more than likely reduce symptoms to help you get about your day-to-day activities much more easily.
Reducing the likelihood of recurrence
Although it can’t be completely avoided, there are things you can do to help reduce the risk of further bouts of lower back pain. These come in the form of simple lifestyle changes such as maintaining a healthy active lifestyle full of exercise, a good recovery and sleep schedule, and being back-aware when it comes to moving around through daily activities. Additionally, taking regular breaks when sitting or standing for long periods of time can also be helpful to avoid those prolonged positions that can bring on lower back pain.
If you’re struggling with some non-specific back pain, why not try to perform our back mobility routine?
Maher, C., Underwood, M. and Buchbinder, R. (2017). Non-specific low back pain. The Lancet, 389(10070), 736-747.
Finan, P.H., et al. (2013). The association of sleep disturbances with non-specific low back pain. Pain Medicine, 14(10), 1638-1645.
Bener, A., et al. (2013). Association between psychological factors and chronic low back pain in the United Arab Emirates. Spine, 38(3), 218-225.
Foster, N.E., et al. (2018). Prevention and treatment of low back pain: Evidence, challenges, and promising directions. Lancet, 391(10137), 2368-2383.
You, J. H., Kim, S. Y., Oh, D. W., & Chon, S. C. (2014). The effect of a novel core stabilization technique on managing patients with chronic low back pain: A randomized, controlled, experimenter-blinded study. Clinical rehabilitation, 28(5), 460-469.