What is LBP ?

According to the European Guidelines for prevention of low back pain, low back pain is defined
as “pain and discomfort, localized below the costal margin and above the inferior gluteal folds,
with or without leg pain"

Another definition, according to S.Kinkade, which resembles the European guidelines is that low
back pain is “pain that occurs posteriorly in the region between the lower rib margin and the
proximal thighs”.

Ref:Kinkade, S., 2007. Evaluation and treatment of acute low back pain. American family
physician, 75(8), pp.1181-1188.

Causes of LBP:
Back pain often develops without a cause that your doctor can identify with a test or an imaging
study. Conditions commonly linked to back pain include:

 Muscle or ligament strain. Repeated heavy lifting or a sudden awkward movement

can strain back muscles and spinal ligaments. If you're in poor physical condition,
constant strain on your back can cause painful muscle spasms.
 Bulging or ruptured disks. Disks act as cushions between the bones (vertebrae) in
your spine. The soft material inside a disk can bulge or rupture and press on a nerve.
However, you can have a bulging or ruptured disk without back pain. Disk disease is
often found incidentally when you have spine X-rays for some other reason.
 Arthritis. Osteoarthritis can affect the lower back. In some cases, arthritis in the
spine can lead to a narrowing of the space around the spinal cord, a condition called
spinal stenosis.
 Osteoporosis. Your spine's vertebrae can develop painful fractures if your bones
become porous and brittle.
 Spine arthritis. Due to aging, genetics and wear over time, the joints of the spine
may develop arthritis and cause pain and stiffness.
 Bulging disc. The soft material inside a disc can lose cells or become inflamed,
causing low back pain. Disc bulge or rupture may press on a nerve, causing leg pain.
 Sacroiliac joint pain. Located where your lower spine and pelvis connect,
inflammation or wear over time can cause pain in the buttocks or back of the thigh.
 Skeletal irregularity.Abnormal curves, defects or abnormal bone sizes in the spine
can result in back pain.
 Infection and tumor. Certain infections and tumors that affect the vertebra or spinal
canal can cause back pain.
 Symptoms of LBP:
Low back pain can incorporate a wide variety of symptoms. It can be mild and merely annoying
or it can be severe and debilitating. Low back pain may start suddenly, or it could start slowly—
possibly coming and going—and gradually get worse over time.

Depending on the underlying cause of the pain, symptoms can be experienced in a variety of
ways. For example:

 Pain that is dull or achy, contained to the low back

 Stinging, burning pain that moves from the low back to the backs of the thighs,
sometimes into the lower legs or feet; can include numbness or tingling (sciatica)
 Muscle spasms and tightness in the low back, pelvis, and hips
 Pain that worsens after prolonged sitting or standing
 Difficulty standing up straight, walking, or going from standing to sitting
In addition, symptoms of lower back pain are usually described by type of onset and duration:

 Acute pain. This type of pain typically comes on suddenly and lasts for a few days or
weeks, and is considered a normal response of the body to injury or tissue damage.
The pain gradually subsides as the body heals.
 Subacute low back pain. Lasting between 6 weeks and 3 months, this type of pain is
usually mechanical in nature (such as a muscle strain or joint pain) but is prolonged.
At this point, a medical workup may be considered, and is advisable if the pain is
severe and limits one’s ability to participate in activities of daily living, sleeping, and
working.
Chronic back pain. Usually defined as lower back pain that lasts over 3 months, this type of

Source: https://www.spine-health.com/conditions/lower-back-pain/lower-back-pain-symptoms-
diagnosis-and-treatment

People are more likely to suffer from LBP:

Patients with one or more of the following factors may be at risk for back pain:
  Aging. Over time, wear and tear on the spine that may result in conditions (e.g., disc
degeneration, spinal stenosis) that produce neck and back pain. This means that
people over age 30 or 40 are more at risk for back pain than younger individuals.
People age 30 to 60 are more likely to have disc-related disorders, while people over
age 60 are more likely to have pain related to osteoarthritis.
 Genetics. There is some evidence that certain types of spinal disorders have a genetic
component. For example, degenerative disc disease seems to have an inherited
component.
 Occupational hazards. Any job that requires repetitive bending and lifting has a
high incidence of back injury (e.g., construction worker, nurse). Jobs that require long
hours of standing without a break (e.g., barber) or sitting in a chair (e.g., software
developer) that does not support the back well also puts the person at greater risk.
 Sedentary lifestyle. Lack of regular exercise increases risks for occurrence of lower
back pain, and increases the likely severity of the pain.
Excess weight. Being overweight increases stress on the lower back, as well as other joints (e.g.
knees) and is a risk factor for certain types of back pain symptoms.

Causes Occupation related of LBP:

One of the most commonly cited risk factors of occupational related LBP is sitting. Other
risk factors may include heavy physical work, heavy or frequent lifting, combined postures
with rotation and flexion, pushing and pulling, and exposure to whole body vibration
(WBV) such as motor vehicle driving.
According to Shaw et al., back disability is highly associated with seven variables:

1. Work that involves heavy physical demand

 Bending, lifting, pushing, or pulling heavy objects for a long period of time at
work
2. Inability to modify work
3. Stressful work demands
 Time pressure, productivity demand, and inability to control the speed of
work
4. Lack of workplace social support+
 Isolated work environment, unusual working hours, new place of
employment, recent departmental transfer, past conflicts with
coworkers/supervisors, or difficulty developing social ties in the workplace
5. Job dissatisfaction+
  Unrewarding few prospects for transfer or advancement
 Overall discontent for the job
6. Poor expectation of recovery and return to work
7. The fear of re-injury
+ These have also been confirmed by Waddell et al. as psychosocial aspects that contribute to
increased time off work.

Source:https://www.physio-
pedia.com/Prevention_and_Management_of_Occupational_Related_LBP#cite_note-Shaw-9

Prevenotin of LBP:
You might avoid back pain or prevent its recurrence by improving your physical condition
and learning and practicing proper body mechanics.

To keep your back healthy and strong:

 Exercise. Regular low-impact aerobic activities — those that don't strain or jolt
your back — can increase strength and endurance in your back and allow your
muscles to function better. Walking and swimming are good choices. Talk with
your doctor about which activities you might try.
 Build muscle strength and flexibility. Abdominal and back muscle exercises,
which strengthen your core, help condition these muscles so that they work
together like a natural corset for your back.
 Maintain a healthy weight. Being overweight strains back muscles. If you're
overweight, trimming down can prevent back pain.
 Quit smoking. Smoking increases your risk of low back pain. The risk increases
with the number of cigarettes smoked per day, so quitting should help reduce this
risk.

Avoid movements that twist or strain your back. Use your body properly:

 Stand smart. Don't slouch. Maintain a neutral pelvic position. If you must stand
for long periods, place one foot on a low footstool to take some of the load off
your lower back. Alternate feet. Good posture can reduce the stress on back
muscles.
 Sit smart. Choose a seat with good lower back support, armrests and a swivel
base. Placing a pillow or rolled towel in the small of your back can maintain its
 normal curve. Keep your knees and hips level. Change your position frequently,
at least every half-hour.
 Lift smart. Avoid heavy lifting, if possible, but if you must lift something heavy,
let your legs do the work. Keep your back straight — no twisting — and bend
only at the knees. Hold the load close to your body. Find a lifting partner if the
object is heavy or awkward.