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Low Back Pain

Low back pain is one of the most common musculoskeletal problems seen by physicians and physical therapists. It is said that we don't "use" the back, we "abuse" it. Whether we are sitting at a desk, bending over to pick up and object or reaching above our heads, the back is constantly being used and over time becomes irritated or injured. There are many things that can cause pain at the back so understanding its structure and what needs to be done to keep your back healthy is important for much of the pain that we experience can be avoided or corrected by keeping the body's back structure strong and flexible.

General Anatomy

Bones
Provides structural support for the body and serves as an anchor points for ligaments and tendons.

Ligaments
Ligaments are non-elastic tissues which connect one bone to another bone giving our body structure its stability. When frequently or severely injured, ligaments become "stretched out" causing the joint to become loose or more unstable. Ligaments have a poor blood supply so have a tendency to heal more slowly than other tissues. Injuries to ligaments are called "sprains".

Tendons
Tendons are elastic tissues that connect a muscle to a bone.

Muscles
Muscles are elastic tissues. Muscles and tendons work together to create the body's motion. Injuries to muscles and tendons are called "strains".

Cartilage
Cartilage is the spongy material that lines the ends of the bones. It works as the body's "shock absorber", helping to cushion the impact placed upon the bones during activity as well as directly protecting the ends of the bones. This is called articular cartilage.

Bursa
Bursa are fluid filled sacs that lie between tissues or tissues and bones preventing friction.

Bones

The low back is made of up 5 lumbar vertebrae, you sacrum which then connects to your right and left him, so there are a lot of moving joints and structure involved that can be involved with pain. As we move, each joint with either flex, extend or rotate to create motion. Throughout these motions, disks can become pinched, muscles strained, ligaments sprained, etc.

Diagram of Lower Back - Vertebra, Disk, Nerve Diagram of the Sacroiliac Joints, Sacrum, and Ilium

Ligaments

Again, ligaments hold our bones together, so extreme bending, twisting, etc can stretch (sprain) them resulting in back pain and instability. The use of proper body mechanics and ergonomics can help prevent this.

Back Ligaments Ligaments of the Vertebra

Muscles

When it comes to the back, we often overlook the importance that muscles play. We consider the disks, the nerves and the bony alignment but can quickly forget that all of those structures are held together and are animated by the network of muscles. If our muscles are weak and/or tight it leads to increased pressure on disks, poor alignment of the vertebrae, increased stress on joints, increased strain when lifting/bending, etc. The better our muscles are, the better our backs become.

When our backs hurt, we become very focused on "the back"; however, the back is greatly supported by the abdominal and hip muscles as well as the hamstrings. As seen in the picture below, there are hip muscles that actually attach to all the low back vertebrae but they attach on the front side. So the weaker the hip and abdominal muscles, the more pain we have in the back. Consider the scenarios of pregnancy and "beer guts". Both types of individuals commonly complain of back pain, but when we assess their mechanics and body set up, the back pain is resulting from stretched out, weak abdominal muscles which in turn place stress at the back.

The Hamstrings also play a very key role in the health of your back. The hamstrings attach to the bottom of your pelvis and if they are tight directly increase the amount of tension at your low back. This tension magnifies as you twist and bend over which can lead to sprains, strains, disk buldges, herniations, etc.

Back Muscles Diagram of the Lower Back with Muscular Skeleton Connection Support Muscles of the Lumbar Spine Stomach and Back Muscle Diagram Side View of Lower Back Muscles

Nerves

There are numerous nerves that exit the low back. Nerves emit and pain signal when they are irritated. This can come from increased pressure from muscle tightness, secondary inflammation, a bulging disk, herniated disk, etc. Ultimately the nerve pain is not the problem (however due to the pain it is very problematic!), but is merely the result of something else. An existing body imbalance, etc, led to this condition.

Sciatic Nerve
The Sciatic Nerve can be common to back, buttock and back of the leg pain. This is due to where it is located and it's pathway down the leg to the foot. The sciatic nerve is a large nerve the exists the back, runs down the buttock and back of the leg, then branches into two separate nerves that lead to the foot. Because of its location and pathway it is commonly involved.

Diagram of the Nerves in the Lower Back Skeletal View of Lower Back Nerves Sciatic Nerve Diagram Sciatic Nerve