Why Do I Have Lower Back Pain?

Lower Back Pain is Multi-Factorial and Can Be Affected By More Than Just Physical Issues

Lower back pain sucks. You’re not alone, though- 80-90% of Americans will experience acute low back pain at some point in their lives. So, why do you have lower back pain? Our focus as physical therapists is to educate you that low back pain is multifactorial.. Spinal mobility and strength may be a contributing factor. Hip strength and mobility may be a factor. But… have you ever wondered what the research suggests are the most relevant risk factors for low back pain? How about the prognostic factors that would indicate you are more likely to develop recurrent or chronic low back pain? We believe knowledge is power. And through education and movement medicine, we want to change the course of your life.

*The following is according to 2012 Low Back Pain Clinical Practice Guidelines*

Risk Factors for the Development of Low Back Pain 

1. Operating heavy equipment

2. Cardiovascular risk factors are associated with sciatica

3. “Degenerative changes” are not strongly related to low back pain symptoms 

4. Inconclusive evidence for trunk muscle strength or mobility of the lumbar spine, and the risk of low back pain 

What it means for you: 

Operating heavy equipment is not always a modifiable risk factor. Your job is your job. We want you to focus on what is in your control. These risk factors suggest that we should maintain good cardiovascular health, build a strong, robust spine, and incorporate mobility into our routine.

Psychosocial factors (larger prognostic role than physical factors): 

1. Fear plays a role, distress/depression plays a role early on.

2. Expectations of recovery is a predictor of return to work. 

3. Active coping style is associated with a better outcome. 

4. Higher pain intensity is associated with worse outcomes.

What it means for you: 

Your thoughts are very powerful! If you believe you can or if you believe you can’t, you’re probably right! We suggest you focus on positive self-efficacy- focusing on what is in your control (this is also called internal locus of control). We often discuss these topics with patients experiencing acute low back pain to ensure it doesn’t persist and progress to chronic low back pain. Your thoughts and beliefs about your pain have the ability to help you modulate your pain experience. Stay positive! Utilize active coping strategies, like going for a walk, meditating, positive affirmations, leaning on your support system, etc.

Prognostic factors for development of recurrent pain: 

1. History of previous episodes

2. Excessive spine mobility 

3. Excessive mobility in other joints

What it means for you:

You can’t control that you’ve had previous episodes of low back pain. We know that previous injury is likely going to result in future episodes of pain. Expecting that flare ups and exacerbations are likely is important because you won’t overreact or excessively stress when you do in fact have a flare up. Focus on what you know helps when you have a flare up of your low back pain. Almost always, something is going to help: ice, heat, walking, specific core exercises, specific stretches, positive self-talk, breathing exercises, etc. With respect to excessive mobility, this may suggest that more robust spine and hip musculature can be helpful in preventing future episodes of low back pain. There is conflicting evidence here, with some evidence suggesting no correlation between “core strength” and prevalence of low back pain. With that said, exercise is almost always a great option. There is very limited downside to exercising, it’s low risk, and yields high returns on overall physical fitness and mental health. Can’t go wrong getting strong!

Prognostic Factors for development of chronic pain: 

1. Presence of radiating symptoms below the knee 

2. Psychological distress or depression 

3. Fear of pain, movement, or reinjury

4. Low expectations of recovery, pain of high intensity

5. Passive coping style

What it means for you:

We want to try to centralize your symptoms as quickly as possible. That means getting symptoms to stop traveling down your leg and bringing it back up towards the spine itself (which is the origin of the pain). We do that in our practice through a series of techniques based on directional preference and neurodynamics (feel free to consult us, if interested in learning more about that). As stated above, we want to avoid fear avoidance, facilitate active rest and recovery as you heal, and calm your anxieties about re-injury. This ensures the best possible long term result. We want to facilitate active coping, as discussed above, while you heal. We want to help you understand that healing will occur over time, and your patience is key in allowing you to self-modulate your pain. 

We hope you found this article on lower back pain helpful. If you are experiencing lower back pain and would like to consult us, please feel free to reach out below.

Disclaimer: This is not intended to be formal medical advice. Your individual needs should be met by the appropriate health care practitioners. Please consult with a trusted provider.

Dr. Paul Nasri, PT, DPT, OCS, COMT

Doctor of Physical Therapy

The Game Plan Physical Therapy