Why Does My Low Back Always Hurt?
Lumbar Disc Injuries
There are two types of disc injuries that we see daily in our office- disc protrusions and annular tears.
Both injuries typically start after lifting something heavy or twisting awkwardly. Pain onset may be immediate or delayed.
Annular Tears
This type of injury is far more common but less frequently talked about. This is an injury on the inside of the disc that causes inflammation between the layers of the disc. Whilst painful, it doesn’t typically present with leg pain/ numbness but can feel like a screwdriver is stuck into your back and it may be hard to stand straight for days to weeks.
Disc Protrusions
The ‘classic’ disc injury that everyone has heard about. Symptoms can include back pain, leg pain, and numbness that can last weeks to months and often requires surgery to relieve symptoms.
Why does my back always hurt?
Disc injuries can be quite slow to heal. This can result in chronic pain patterns which can lead to the feeling that your back is always weak or easily aggravated by certain movements and exercises.
What happens when the pain becomes chronic?
There is a very important deep stabilising muscle in your low back called the multifidus. When you’ve had low back pain for a while, this muscle undergoes significant changes in which it becomes infiltrated with fat (1), and up to a quarter of the muscles fibres turn into scar tissue (2). As you can imagine, this change in the muscle considerably compromises its main function, which is to stabilise your spine whilst you move. If the muscle is unable to function properly, this means that extra pressure is placed on surrounding muscles, joints, and discs. Simple tasks such as getting in and out of your car or getting dressed can cause your back to ‘go’ and end in all sorts of discomfort to the next week or two.
Why do we use shockwave therapy?
We use shockwave therapy/ radial pulse wave (RPW) as it allows us to impact the deeper tissue that we can’t quite reach with our thumbs. RPW creates a high pressure shockwave (sound wave) which can travel up to 4cm into the tissue. Healthy tissue absorbs this pressure wave without much issue. Unhealthy tissue (such as scar tissue in the multifidus) can’t absorb the pressure wave and will break down under the correct tension. We test the progress by using range of motion testing before and after treatment to measure the improvement.
How do I stop my back from hurting?
Once we have cleaned out the unhealthy tissue in the low back, there will be a reduction in pain and an improvement in your function. The final step in this process is to re-strengthen the weakened muscles to prevent recurrence. We achieve this by using a series of simple exercises aimed at gently loading the tissue as to not overdo it and cause a flareup.
Band squat level 1
Band squat level 2
Good morning with broom handle
Single leg deadlift
Hex bar squat
(1) Hodges PW, Danneels L. Changes in structure and function of the back muscles in low back pain: different time points, observations, and mechanisms. Journal of orthopaedic & sports physical therapy. 2019 Jun;49(6):464-76.
(2) Hodges PW, James G, Blomster L, Hall L, Schmid A, Shu C, Little C, Melrose J. Multifidus muscle changes after back injury are characterized by structural remodeling of muscle, adipose and connective tissue, but not muscle atrophy. Spine. 2015 Jul 15;40(14):1057-71.