Rough Draft of Research Article: Low Back Pain

This is a copy of my very rough draft of my research article. An updated and more complete article will be uploaded shortly.

Retrieved from here

Low back pain (LBP) is among the leading causes of disability worldwide (Hartvigsen et al., 2018). The greatest increases in disability from LBP have come from low- and middle-income countries which emphasizes the importance of preventing LBP and educating safe at-home therapies (Hartvigsen et al., 2018). It’s been noted that up to 80% of Americans will experience back pain at least once in their life (Marras, 2008). It can be painful, debilitating, and severely limit a person ability to carry out daily tasks. Pain can stem from a variety of reasons. Some cases of LBP can be relieved with the correct treatment or even prevented with preventative exercises. Unfortunately, many people either don’t have access to the proper treatment, can’t afford it, don’t have the time, or are unaware of safe preventative and rehabilitative exercises.  

There are different ideas as to how to go about treating LBP and the best plan of action for Physicians and therapists (Hasenbring, Rusu, & Turk, 2012). Near 85% of patients with LBP are not able to be given a specific diagnosis (Deyo & Weinstein, 2011). Deyo and Weinstein (2011) note that when seen within three days of the arrival of LBP up to 90% of patients can feel relief within two weeks based off a study conducted. However, they also report that about 40% of patients have the pain come back again. A problem that can turn an acute episode of back pain into a chronic one. Pain that stems from a traumatic injury likely requires far different treatments then pain coming from a postural flaw that increases in severity over time. Some sources of LBP can be only be relieved through surgery while other sources can be relieved through manual therapy or corrective exercise. Discrepancies in treatment plans make LBP difficult to fix and therefore resolving it becomes an issue of time and money for the patient.   

There’s a variety of exercises that can be beneficial to preventing low back pain in the first place. These are called preventative exercises and usually carry the common goal of strengthening the core or stretching tight muscles that can facilitate bad posture. Muscles surrounding the spine need adequate strength in order to help stabilize the low back during daily tasks. Increasing the ability of our muscles to support and stabilize the spine helps in the event that we slip, fall, or get hit. The exercises should also help reduce the strain placed on our spine by improving our posture. Increasing the stability of the spine should therefore help reduce the risk of injury from many sources. Swezey and Calin (2006), propose a 5-Minute back saver program in the book Low Back Pain, that aims to help people prevent the onset of LBP. It’s also recommended that people participate in regular exercise like strength training to help prevent LBP (Deyo & Weinstein, 2001).  

When talking about LBP, it’s important to realize why the low back is so susceptible to injury. Risk factors play a large role in the number of LBP cases. For people between 35-55 years old, their age is considered a risk factor as this range tends to present with the highest amount of cases (Marras, 2008). While males and females both present with many cases of LBP, it has been documented that females report more cases when occupation is not reflected in the statistics (Marras, 2008). Males and females taller than 180cm and 170cm respectively have been noted with increased risk of LBP (Marras, 2008). Other notable risks factors include people who are not physically strong, are obese, consume alcohol, or smoke cigarettes (Marras, 2008).

It’s difficult to talk about the treatment and prevention of LBP without having at least a basic understanding of anatomy of the back and structures that contribute to stabilizing the back. The back is composed of vertebrae that are essentially stacked and continue from our pelvis to the base of our skull (Marras, 2008). They help form cervical, thoracic, lumbar, sacral and coccygeal regions of our spine. Conditions relating the lumbar spine and the lower part of the thoracic spine are what commonly constitutes as LBP. Between each vertebra are what’s called intervertebral disks and they can be seen in Figure 1. These disks function in three main ways. They help absorb shock in the spine, they help distribute weight throughout he spine, and the allow some movement between the vertebrae (Marras, 2008).

Figure 1. Lateral view of lumbar spine. Retrieved from here

The spinal cord follows a canal that is located between the vertebral body and spinous processes (Marras, 2008). As you can see in Figure 1, nerve roots branch out from each section of vertebrae and their purpose is to send and receive signals form the brain to carry out bodily functions (Marras, 2008). These nerves are sensitive are can often be a source of pain when compressed.

Many muscles surround the spine but only a few are thought to have a large enough impact to contribute to supporting the spine in a way that could affect LBP (Marras, 2008). Some of the most notable muscles are the erector spinae, multifidus, internal and external obliques, rectus abdominus and quadratus lumborum which can be seen in Figure 2 (Marras, 2008; Swezey & Calin, 2006). While these muscles directly impact the spine, many other muscles like the glutes, hamstrings, hip flexors, and more can affect the spine indirectly. These muscles can contribute to placing unwanted tension on them or create imbalances that affect the spine or muscles stabilizing the spine.

Figure 2. Anatomy of the back. Retrieved from here

There are numerous causes of LBP. Traumatic injuries like falling on the back can cause damage in the form of a fractured vertebrae, in which case has a much different plan of treatment than a musculoskeletal caused injury. This type of injury is also not necessarily preventable with preventative exercises. However, many causes of LBP are either preventable or the damage to structures could be lessened with prior exercise.

Disc herniations or a “slipped disk” are common sources of back pain. In this case, the vertebrae slip, and the intervertebral disk can be protruding from the spine and place pressure on the nerves causing pain as seen in Figure 3.

Figure 3. Normal disk vs. herniated disk. Retrieved from here

References

Deyo, R.A., & Weinstein, J.N. (2001). Low back pain. The New England Journal of Medicine, 344(5), 363-70.

Hartvigsen, J., Hancock M.J., Kongsted, A., Louw, Q., Ferreira M.L., Genevay, S., … Underwood, M. (2018) What low back pain is and why we need to pay attention. The Lancet, 391, 2356-2367. http://dx.doi.org/10.1016/S0140-6736(18)30480-X

Hasenbring, M., Rusu, A., & Turk, D. (2012). From acute to chronic back pain : Risk factors, mechanisms, and clinical implications. Oxford, UK: Oxford University Press.

Marras, W. (2008). The working back : A systems view. Hoboken, NJ: Wiley-Interscience.

Swezey, R., & Calin, A. (2006). Low back pain. Oxford, UK: Health Press Limited.