What are the Causes of Low Back Pain

Low back pain is one of the most common conditions treated by massage therapists. I have been asked by countless clients “what are the causes of low back pain?”, and I am afraid to say that there is no simple answer. The causes of low back pain are many, and it is important for clients to understand this, as appropriate treatment approaches differ as much as the causes themselves.

So common is low back pain that I decided to do a little research and try to get some statistics on it.

Here is what I found:

Back pain statistics from the Workers Compensation Board of British Columbia

From 2000 to 2004 WorkSafeBC (Workers’ Compensation Board) received over 107,000 claims for back strains

back strains account for just over 25% of all WorkSafeBC (Workers’ Compensation Board) claims.

Roughly 30% to 40% of all workplace absences in Canada are due to back pain

injuries may be caused by a single instance of overexertion or develop as a result of repeated motion over time.

Over two-thirds of back injuries are a result of overexertion

60% to 90% of the population will experience low back pain in their lifetime

More than 90% of low back pain cases have no specific cause (such as infection, osteoporosis, arthritis, etc.). In these cases the pain will usually subside without treatment in four to six weeks.

In the health care industry, injuries due to patient handling (lifting, transferring, or repositioning) account for about 35% of all accepted time loss claims and for about 40% of claim costs.

So, that’s all fine and well, but while “back strain” appears to be the most common cause of low back pain, and quite a generic term, there are other causes of low back pain. It is very important to identify the cause and contributing factors to low back pain for successful treatment, otherwise clients may just end up wasting time and money.

Falling into each of these 4 broad categories, which I am going to name as causes for low back pain, are several different conditions which I have seen in my practice.

Low back pain cause – Muscle fatigue or strain

Also referred to as a “pulled muscle”, this happens when muscles are overused or is weak. Muscles can also be torn from an injury, and of course, the more serious the damage, the longer it will take to heal …

This is also the primary participant in “soft tissue injuries” – the effects of which insurance companies have lead people to believe are minimal. The reality is that soft tissue injury, and the chronic inflammation which may accompany the more severe injuries, often take longer to heal than the ballpark figure in the insurance tables. However, I digress …

Pain can also be caused by an imbalance of muscle development, or a lack of “extensibility” or “stretch” of the muscles. This is very easy to see, for example, in athletes who may overuse and overdevelop one muscle group. This muscle imbalance is stressful for the body and may cause pain and spasm in the opposing muscle group as the body tries to maintain homeostasis. This lack of balance can lead to “mechanical dysfunction” of the joints of the back (see below). Muscle imbalance, can, however, be treated at home if you know what to do.

Low back pain cause – Joint and bone dysfunction

This type of back pain is often referred to as “mechanical back pain” or “mechanical joint dysfunction” when referring specifically to the joints. What this means is that a joint is not able to move as it is meant to, either from injury to the bone or joint, or hypertonicity of the surrounding muscles (hyper meaning ‘too much’, tone means the amount of tension in the muscle). Unfortunately, this can lead to several other issues and can be a self-perpetuating cycle if left untreated, often causing seemingly unrelated problems.

Of course, bones and joints can also be affected by fractures, breaks, arthritis and a multitude of other conditions which is well beyond the scope of massage therapy to diagnose and in some cases, treat. Massage therapy can, however, be used to alleviate symptoms and assist in recovery.

Low back pain cause – neurological

Low back pain from a neurological source can be a result of a variety of triggers, all of which are related to either the intervertebral disc, spinal cord, or the “nerve roots” as they exit the spinal cord. This type of pain can be excruciating and very debilitating, as anyone with a “slipped disc” will tell you. (this is a bit of a misnomer, and will be addressed in upcoming articles). This type of low back pain usually presents as symptoms in the area which the affected nerve root supplies, so the location of the symptoms is really dependent on the nerve root “level” where the injury or restriction happened. (and often the level of the injury is determined by the presentation of symptoms.) Pain which occurs in one area but originates from dysfunction in another area is called “referred” or “referral” pain.

Low Back Pain – Neurological from Bulging, or Herniated, Disc

Low back pain cause – visceral referral

In some cases pain can be a result of a dysfunction or infection of an internal organ. This happens because the “nociceptors” (pain receptors) of an organ are irritated and the pain is either felt in the skin or tissue which is superficial to (or just above) the organ, or in a classic “referral pattern”. Pain caused by visceral dysfunction can be quite severe.  A classic example is low back pain in the lumbar area which may wrap around a persons front, or extend down the sides of the thighs and into the groin.  This is a referral pattern of the kidneys, and should never be ignored.

Remember, most low back pain is a result of muscle weakness or imbalance. However, if you are not aware of any activity or cause of the pain, the pain is severe, or if the pain has been present for any length of time, I would urge you to see a physician immediately to rule out anything more serious than a muscular cause for the pain. You may also want to check out more information I have found on WebMD.

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