Radicular pain. This type of pain can occur if a spinal nerve root becomes impinged or inflamed. Radicular pain may follow a nerve root pattern or dermatome down into the buttock and/or leg. Its specific sensation is sharp, electric, burning-type pain and can be associated with numbness or weakness (sciatica). It is typically felt on only one side of the body.
Most Australian adults will experience low back pain at some time in their lives. Most low back pain gets better without the need to see a doctor, and gentle activity, not bed rest, seems usually to be the best treatment. Low back pain (lumbar pain) can be caused by a problem in the muscles, ligaments, discs, joints or nerves of the spine.Some back pain is due to serious problems, but most back problems are ‘mechanical’ in nature and can be prevented by looking after your back and keeping it in good shape.SymptomsThe symptoms of low back pain may include:Dull ache in the lower back;Stiffness of the lower back;Tingling or numbness of the leg(s);Tingling or pain in a buttock;Pain in the hip;Muscle spasms or seizing up of the back muscles;Sharp pain;Difficulty walking or standing up straight;Weakness of the leg or foot.Sometimes back pain is more on one side of the spine than the other.When to seek immediate medical help for back painRarely, back pain may be a sign of something serious. There are some signs and symptoms that may accompany the back pain or features of the pain that mean you should seek medical help immediately. These include:New bowel or bladder problems, such as not being able to urinate or incontinence.Numbness over the buttocks, especially in a pattern like a saddle.Fever or chills.A recent fall or injury to the back.Back pain that is worse when you are resting, lying down or in bed at night.Throbbing in the abdomen.Weakness in a leg, which might show itself as dragging a foot or one leg.Unexplained weight loss.Also, if you are over 50 or under 16 and have back pain you should see your doctor. Similarly, if you have ever had cancer or suffer from osteoporosis, or the back pain is accompanied by unexplained weight loss, you should seek medical advice.Diagnosis and tests for low back painTo help diagnose the cause of your back pain or rule out any serious problems, your doctor  may ask questions about the pain, such as:Did the back pain come on suddenly, does it come and go, or has it gradually worsened over time?Is your back sore to the touch?Is your back pain affected by your position, e.g. is it worse or better when you stand or sit, or bend over or lie down?Was it brought on by exercise or activity that you are unaccustomed to?Do you have any pain in your feet or legs?Is there any tingling in your legs or feet?Is the back pain accompanied by any swelling?Is the pain worse during the night?Are you having any problems going to the toilet?Your doctor will examine your back and may wish to feel and locate any areas of sensitivity and pain. They may ask you to perform movements so they can see your range of motion. They may also test the nerves.These examinations will not usually reveal the exact cause of the back pain, but they help your doctor to rule out any serious problems or problems needing immediate attention. In many cases, knowing the exact cause of the pain does not change the recommendations for treatment. Most non-specific back pain or uncomplicated back pain does not need a precise diagnosis of the anatomical problems that are causing it before treatment is started.X-rays or other radiological imaging tests are not usually recommended initially for low back pain as the findings do not necessarily correspond with the severity of symptoms. For example, many adults have signs of damage (such as to discs or facet joints) on X-ray,  but have no symptoms of back pain. And conversely, many people with low back pain will have no obvious signs of damage on X-rays.If the back pain has been ongoing, or your doctor suspects a fracture or specific cause, they may suggest you have some imaging tests. Sometimes, your doctor may wish to order blood tests to rule out or confirm causes such as infection, inflammation or cancer.Imaging tests used in low back painIf your doctor suspects a specific cause of the back pain then they may refer you for imaging tests such as X-ray of the lumbar spine (although plain X-rays are rarely useful), or an MRI scan. MRI scans can show the spinal discs and the nerve roots and the soft tissues. MRIs are probably the most useful imaging technique for low back pain as they can show problems with the discs and whether anything is pressing on the nerves of the spinal cord. Sometimes a CT scan will be suggested, if an MRI is not available.Ultrasound may be used if kidney stones are suspected as the cause of the pain.Nerve conduction studies called electromyography may be suggested, however the results often don’t reflect the symptoms, so this test may not give any useful information.Should I see a specialist for low back pain?Depending on the results of tests, your doctor may refer you to a specialist, however, 99 per cent of low back pain that GPs see is not serious. Specialists that treat low back pain include pain specialists, neurosurgeons, rheumatologists and orthopaedic surgeons.In addition to doctors, many people find consulting with a physiotherapist or osteopath may help. Osteopaths and physiotherapists may help with diagnosis of some back problems, mobility, exercises, stretching and advice.Osteopaths and physiotherapists don’t require you to have a referral from your GP. Their services are only rebated on Medicare as part of a specific chronic disease plan, but may be covered by private health insurance extras cover.Causes of low back painMost backaches are due to problems with the muscles, ligaments and joints. More serious problems occur when the nerves or spinal cord are injured, usually by local pressure.Back muscle strainsLow back pain can be due to a pulled or torn muscle in the lumbar region. There are many muscles involved in the lower back, which help support the spine and the upper body. These include extensor muscles (such as the erector spinae), the oblique muscles and the flexors (such as the psoas).When any of these muscles are stretched or torn (strained), there are micro-tears in the muscle fibres and these tears give rise to inflammation and pain. Myofascial pain like this from the muscles around the spine usually resolves after a short period of active recovery. But, it can also be present alongside other causes of back pain.Lumbar sprainA lumbar sprain happens when the ligaments of the lower back are stretched or torn. Ligaments are the tough connective tissue that joins bones, joints and cartilage together and keeps them stable. If the ligaments are stretched too far they can tear.The symptoms and treatment of a lumbar sprain are the same as for lumbar strain - which affects the muscles, rather than the ligaments.Muscle spasmsYou won’t usually know whether your low back pain is a result of a muscle problem or a ligament problem. Both can cause quite severe pain and cause inflammation in the surrounding area and sometimes spasm of the surrounding muscles. A back spasm is felt as a cramping or tightening of the muscles. Spasms are involuntary contractions of the muscle - that means you have no control over them.Muscle spasms are usually caused by the back trying to protect itself from damage to the muscles themselves or may indicate that there is an underlying injury to the spine itself.Degenerative disc diseaseDegenerative disc disease refers to normal changes to the spinal discs caused by ageing. The intervertebral discs are cushion-like structures between the vertebrae - the bony joints of the spine. The discs have a tough outside casing and are filled with a gel-like centre. They act like shock absorbers.As we age the discs become stiffer, drier and thinner. This makes them less flexible and supple and they may restrict movement and cause pain. Degenerative changes are more frequent in the lumbar (lower) spine and the cervical (neck) region of the spine.Degenerative disc disease of the spine may cause chronic (ongoing) low back pain, interspersed with more painful flare-ups from time to time. The pain is often worse when sitting, as the back is carrying more load in that position, and the pain may be relieved by standing up, changing positions or lying down.With ageing, bone spurs - tiny growths on the edges of the bones of the spine - may also occur. These bone spurs (osteophytes) are usually smooth and may not cause any pain.Ruptured, prolapsed or herniated discSometimes called a ‘slipped disc’, a herniated disc happens when the soft jelly-like centre of a spinal disc bulges out of a tear in the outer casing of the disc. The disc itself doesn’t move, but a split in its casing allows the soft middle (nucleus pulposus) to bulge out (herniate).Herniated discs don’t always cause problems -  up to a third of people who don’t have back pain are shown to have herniated discs on imaging.  However, sometimes the bulging part can press on a nerve and cause pain, tingling and other problems, such as weakness. Inflammation from the site may also contribute to symptoms. Prolapsed discs like this can be the cause of sciatica. The discs in the lumbar spine are most likely to herniate - these are the discs between the 5 lumbar vertebrae - L1 to L5.Over time, the herniated portion of the disc  (that’s the part that’s bulging out) usually gets smaller (regresses) and the symptoms ease and may go away. Most people with symptoms will improve in 2 weeks.Facet joint problemsFacet joint problems are common causes of back pain and the resulting condition is commonly referred to as facet joint pain or facet joint syndrome.The facet joints are small stabilising joints between and behind the vertebrae of the spine. There are 2 facet joints between each 2 vertebrae at every level of the spine (except the very top vertebrae in the neck). They allow some flexibility so that you can slightly twist and turn around, but they give you stability so that there isn’t excessive movement in your spine. The facet joints in the lumbar region allow only flexion and extension, so no twisting. Facet joints are synovial joints, so the joint surfaces have cartilage to allow them to glide smoothly together and they are enclosed  in a lubricant-filled capsule.Over time, facet joints can wear out, and with wear and tear the cartilage can become thin, leading to the bones rubbing on each other. This osteoarthritis leads to inflammation and pain, and bone spurs can form on the surface of the bone. As the intervertebral discs become thinner with age, more pressure still is put on the facet joints.Facet joints can also slip (dislocate) and become locked in position. Locked facet joints happen suddenly, for example when a person bends down to tie a shoelace and then experiences that their back seizes up. Problems with facet joints can be unpredictable.Symptoms of facet joint problems include tenderness over the affected facet joint, decreased movement and stiffness, pain when bending backwards and pain in the buttock or radiating down thigh (but not beyond knee).Spinal stenosisSpinal stenosis means narrowing of the spaces in the spine, either:narrowing of the spinal canal (the hollow ‘tube’ that holds the spinal cord);narrowing of the spaces where the nerve roots exit the side of each vertebrae; orNarrowing and impingement of the nerve root after it has exited the vertebrae.Spinal stenosis can be caused by degeneration of other structures in the back, such as the facet joints or discs, for example by bone spurs or herniated discs. Some people inherit a small spinal canal in the first place.Symptoms of spinal stenosis often start slowly and worsen over time. They may include tingling,  numbness or weakness in the feet or legs. If you have symptoms like these, you must visit a doctor.Ankylosing spondylitisAnkylosing spondylitis is a type of arthritis affecting the spine. The cause is not known, but there is a strong inherited component to the disease.The symptoms of ankylosing spondylitis are lower back pain and stiffness (especially first thing in the morning), tiredness and pain over the buttocks and down the thigh. The pain tends to ease as the day goes on. Rest does not help back pain from ankylosing spondylitis.Ankylosing spondylitis also causes pain and arthritis in other joints of the body, other than the spine.SpondylolisthesisSpondylolisthesis is when one of your vertebrae slips forwards or backwards out of its normal alignment, causing a step in the building blocks of the spine. It most commonly affects one of the lumbar vertebrae in the lower back.It doesn’t always cause pain, but when it does the pain is usually worse during activity and relieved by lying down. If the slipped vertebra presses on a nerve, then you may have symptoms of sciatica - tingling down your leg and over your buttock. People with spondylolisthesis often have tight hamstrings.Spondylolisthesis may be due to a fracture or a defect that is inherited. It may be caused by a traumatic injury, such as from high-impact sports (e.g. gymnastics)  or a motor vehicle accident. If the spine has become worn and arthritic, then spondylolisthesis is more likely.Sacro-iliac joint problemsProblems with the sacro-iliac joints - the 2 joints that join your sacrum (tailbone) to your pelvis - can give rise to low back pain. You have a sacroiliac joint on the left and one on the right of your sacrum (the triangular shaped bone at the base of your spine).The sacro-iliac joints are designed to be fairly stiff, and don’t normally allow more than a few degrees of movement. They function as shock absorbers. If the joints are abnormally mobile (too much movement) or restricted in movement they can give rise to low back pain. The SI joints may also become inflamed (called sacroiliitis).Symptoms of sacro-iliac joint pain include low back pain, leg pain (but rarely below the knee), pain in the sacro-iliac region itself or in the buttocks. There may be muscle spasms of surrounding muscles as they try to protect themselves or respond to underlying damage.Cauda equina syndrome (CES)Cauda equina syndrome is a medical emergency caused by compression of the spinal nerve roots. Below the waist near where the lumbar spine starts, your spinal cord separates into a bundle of nerves and nerve roots that resemble a horse’s tail; this is the cauda equina. These nerve roots supply messages to your legs, feet and pelvic organs. Anything that compromises the nerves can affect the function of your bladder, bowel, legs and feet and could result in paralysis or loss of continence.Symptoms of cauda equina syndrome may come and go, developing slowly over time, or come on suddenly and include:numbness of the buttocks in the pattern of where you would sit on a saddle;severe low back pain;tingling, weakness or pain in one or both legs;changes to bowel or bladder function;abnormal sensations in the bladder or rectum;sudden loss of sexual function;loss of some reflexes.If you develop any of these symptoms, you should visit a doctor or the emergency department straightaway.CES can be caused by a severe rupture of a lumbar disc, spinal stenosis, spine injury, inflammation or a birth defect.Spinal fractureOsteoporosis - a condition causing spongy bones - can cause sudden compression fractures (cracks) of the vertebrae. These osteoporotic compression fractures usually affect the vertebrae of the thoracic (upper) spine, but may also affect the lumbar (lower) vertebrae. They cause sudden back pain when they happen and can lead to ongoing pain, pain that is worse when standing or walking, and loss of height. Vertebral fractures such as this are common in postmenopausal women and older men.Spinal fractures may also be due to trauma, falls, sports injuries, or motor vehicle accidents.SpondylolysisSpondylolysis is a type of fracture or stress fracture in the vertebrae. It often affects young athletes who do sports such as gymnastics or football. Whilst the fractures sometimes spontaneously heal, they may not heal correctly and can cause ongoing back pain.Mostly there are no symptoms in young people with spondylolysis, but symptoms can include lower back pain which may extend into the buttocks or legs.Spondylolysis is a common cause of spondylolisthesis (mentioned earlier) where one vertebra slips out of position over another. Conversely, in older people with spondylolisthesis, this can lead to uneven loading of the facet joint, causing a compression fracture.CancerCancer is a rare cause of back pain. Tumours affecting the spine are usually secondary cancers that have spread from the primary tumour somewhere else in the body. Symptoms of spinal tumours include back pain, unexplained weight loss, weakness or numbness in arms or legs, and pain that is worse at night and which doesn’t go away with rest.Risk factorsRisk factors for low back pain include:Being overweight or obese - which puts more strain on the back.Being middle aged or older - back pain is more common the older you get.Lack of exercise - which can lead to weak back muscles that don’t support the spine.Poor posture - this can lead to muscle imbalances.Heavy physical work and lifting weights that are too heavy.Incorrect lifting technique, e.g. using your back instead of your legs.Overdoing it or doing unaccustomed exercise.Being pregnant.Stress - this can lead you to unconsciously tighten your back muscles.Sitting for long periods of time.Scoliosis - an abnormal curving of the spine sideways.Treatment and self-help for low back painMost uncomplicated back pain resolves after a period of active recovery and people are generally back to normal within 4 weeks.See your doctor if you are at all concerned about your back pain, and especially if any of the following occur:Your back pain has not improved after a couple of weeks;The pain is getting worse as time goes on.
Active recovery includes trying to do normal activities as much as possible and keeping active. Gentle walking, which improves blood flow and speeds up healing, can help. Doctors now know that inactivity and rest will lead to stiffness and more pain and is more likely to lead to ongoing back problems.Careful stretching may help relax muscles, especially if you have muscle spasms.You may find that sleeping with a pillow between your legs can make night-times more comfortable.Over-the-counter painkillers such as paracetamol or anti-inflammatories, e.g. ibuprofen (Nurofen), may help ease pain and reduce inflammation. If they are suitable for you, anti-inflammatories may be more effective than paracetamol. The pain probably won’t be completely eliminated, but this should enable you to resume gentle activity. Make sure you take the recommended dose. These medicines are not suitable for everyone, so always check with your doctor or pharmacist.Topical pain relievers are applied to the skin at the site of the pain. They are creams or ointments, usually. Some use the same ingredients that are in the tablet forms of over the counter pain relievers, such as ibuprofen or aspirin. Others have ingredients such as capsaicin, a compound from chilli peppers, or menthol.Stronger painkillers. Depending on the circumstances of your back pain, your doctor may prescribe other painkillers, antidepressants or other medicines.There is no evidence to support using muscle relaxants to treat low back pain. Oxycodone (prescribed as Endone or Oxycontin) is a strong painkiller belonging to the opioid group of medicines and is sometimes prescribed for back pain. Oxycodone can lead to addiction if used for long periods and also carries the risk of overdose. Whilst it may be effective in the short term for sudden onset of back pain, oxycodone is not recommended long term and there is no evidence for it being effective in the long term. Codeine is another strong painkiller, sometimes used in the short term for back pain. Codeine is another opioid and can also lead to addiction.Hot or cold packs may help with the pain as may sitting in a warm bath. Heat loosens tight muscles and increases blood flow, bringing more oxygen and nutrients to the area. Cold can help reduce pain and swelling. Cold is usually used in the beginning stages of an injury.Exercise programs - A physiotherapist or osteopath should be able to help you with an exercise programme to improve mobility, reduce pain, prevent further injury and help with recovery from back pain.Don’t worry too much or allow negative thoughts to run amok - the relationship between our thoughts and pain is complex. Worry and anxiety about back pain can make the pain worse.Acupuncture - there is no evidence to show that acupuncture has any effect in improving low back pain, however, it is unlikely to be harmful.TENS (transcutaneous electrical nerve stimulation) - this technique uses low voltage electrical current and is said to block pain signals. At the moment, there is no evidence to show TENS has any effect in helping low back pain.Therapeutic massage - The evidence to support the effectiveness of massage to help lower back pain is not very strong, but some people have found it offers relief. Spinal manipulation is definitely not recommended, though, as it may not be safe in some situations.Pilates - Studio training with experienced instructors can help with core stability and posture, and improve the health of your spine and muscle strength. Pilates training works on the deep support muscles of the spine and should help protect you from future episodes of back pain.Yoga -  Yoga can help with flexibility and posture, and along with the breathing and meditation aspects yoga may help to relieve lower back pain and improve function of the spine. Some yoga positions are not safe for people with certain back conditions, so you should always let a yoga instructor know if you have back problems.Alexander technique - The Alexander technique helps you to recognise and correct poor postural habits which lead to tension and pain in the body. Teachers in the Alexander technique observe the way you move and then with gentle guidance help you to learn safer and more relaxed ways of moving your body. One-to-one lessons in the Alexander technique have been shown to have a beneficial effect on back pain and functioning in people with ongoing or recurrent low back pain, even 12 months after the lessons have finished.Anti-inflammatory diet - Some foods have been shown to contribute to inflammation in the body, which in turn might aggravate back pain. Processed foods are generally acknowledged to be pro-inflammatory (causing inflammation). On the other hand, some foods are known to have an anti-inflammatory effect or can help with pain relief. Some foods known to reduce inflammation are omega-3 fatty acids (found in fish),  and antioxidants from colourful fruit and vegetables.Facet joint injections - Facet joint injections are corticosteroid injections. Australian guidelines now recommend that in most cases, facet joint injections are not helpful. They were done when a facet joint was suspected of causing the back pain. If the pain went away then this confirmed the diagnosis of facet joint disease or facet joint syndrome.Back surgery - In ongoing, non-specific back pain, there is no evidence that surgery helps. Surgery is usually only relevant for a minority of people with back pain, who have specific anatomical causes of their back pain, such as problems that cause pinching of a nerve. Techniques for back surgery are becoming less and less invasive, many being carried out using keyhole surgery.Types of spinal surgery include:  spinal fusion, which permanently connects 2 vertebrae together using a bone graft;lumbar decompression, which removes structures that are pressing on a nerve root, by either microdiscectomy, where the protruding pieces of a herniated disc are removed under microscopic view; or laminectomy, a more open type of surgery, where the facet joints may be trimmed,  as well as problems with discs resolved.Kyphoplasty - insertion of a balloon to expand a compressed vertebra, followed by injection of bone cement into the vertebra. These compression fractures  are usually from osteoporosis.Vertebroplasty - injection of bone cement into a compressed vertebra.OutlookMost people who have an episode of non-specific low back pain improve quickly, and usually recover within 4 weeks. A positive outlook can help you recover more quickly. However, a minority of people will have ongoing problems - the risk of this happening increases with age. Older people are particularly at risk of having recurrent episodes of back pain.PreventionIf you’ve hurt your back already, then prevention is probably the last thing on your mind. However, some people have further episodes of back pain after the initial episode has resolved, so it’s worth finding out what you can do to protect your back from further attacks of back pain.The back is at least risk of injury when it is in its neutral position. Anything that forces it to tilt can cause strains to the ligaments, and pain can result. Twisting when lifting is one common cause of low back pain.The way we lift, sit at our desks, operate machinery and do hundreds of minor tasks can all affect our backs. Trying to keep the back in a neutral position at all times will reduce the risk of backache. This is particularly important with tasks such as gardening and housework, which involve a lot of bending. Whenever possible, bend the knees and keep the back straight when doing things at ground level.Here are some things you can do to try to avoid back pain.Maintain good posture. Try to sit and stand with a ‘neutral spine’ (a physiotherapist or pilates instructor will be able to show you this). Use your legs to walk up hills (not your back) by staying upright and not bending forwards. Slow down if you have to, to maintain good posture. Sit with your knees slightly higher than your hips.Stay active. Low impact exercise, such as walking or swimming can strengthen the back muscles and the muscles of the core, which allows them to support the spine correctly. Regular exercise can help with strength and flexibility, ease pain and stiffness and protect bones.Back strengthening exercises. Try to do these every week at least a couple of times. A physiotherapist or pilates instructor will be able to help you with the best exercises for your back.Avoid heavy lifting. Avoid lifting weights that are too heavy for you. Learn correct lifting techniques - bend from the knees and use your legs to push up, and contract your abdominal muscles before you lift. Don’t twist when you lift, and don’t bend from the waist. Push, rather than pull, heavy objects.Pay attention to your carrying technique. Try not to load down one side of your body with heavy bags or handbags - distribute the load as evenly as possible and keep your shoulders square. Swap sides often when carrying heavy bags.Avoid stress. Being stressed or anxious leads to muscle tension by causing blood vessels to narrow, reducing blood flow and oxygen to the body’s tissues. This leads to  a build-up of waste products, which cause the muscles to spasm or contract. Being under constant stress causes the muscles to tighten and shorten, causing pain - often in the neck and back.Stretching. Stretching can help to reduce muscle tension. Tight hamstrings - the muscles down the back of your thigh - can be a cause of low back pain, so make sure your hamstrings are stretched out and not too tight.Not smoking. Smoking is linked to the development of low back pain. Doctors think this is due to reduced blood flow (which reduces the nutrients reaching the back), jarring from coughing and the fact that the bones of smokers have a lower mineral content.Eat a healthy diet. Some foods have been shown to have anti-inflammatory or pain-reducing properties. An anti-inflammatory diet, such as the Mediterranean diet, may help keep inflammation at bay and so lessen your chance of back pain.Stay hydrated. As we age, the soft gel-like centre of our intervertebral discs dries out and the discs become less effective as shock absorbers. Staying hydrated may go some way to help keep the discs plumped up and slow down this process.Maintain a healthy weight. Being overweight can make it harder to move about and puts more strain on your body. Being overweight also creates inflammation in the body.Avoid high heels. High heels alter your body’s alignment and put a strain on your back. Unsupportive footwear, such as thongs or flipflops, do not support the arches of the feet and so can lead to poor posture and back pain. Last Reviewed: 2 October 2017

Two types of strength-training moves that may benefit the lower back are flexion and extension exercises. In flexion exercises, you bend forward to stretch the muscles of the back and hips. In extension exercises, you bend backward to develop the muscles that support the spine. One example is doing leg lifts while lying on your stomach. Depending on the cause of your back pain, there are some exercises you should not do. If you have back pain, make sure to talk to your doctor about what exercises are safe for you.
Pregnancy commonly leads to low back pain by mechanically stressing the lumbar spine (changing the normal lumbar curvature) and by the positioning of the baby inside of the abdomen. Additionally, the effects of the female hormone estrogen and the ligament-loosening hormone relaxin may contribute to loosening of the ligaments and structures of the back. Pelvic-tilt exercises and stretches are often recommended for relieving this pain. Women are also recommended to maintain physical conditioning during pregnancy according to their doctors' advice. Natural labor can also cause low back pain.
How to do it: Stand with your feet together, holding dumbbells by your sides. Take a wide step out to your right and lower into a side lunge, reaching dumbbells on either side of right leg [as shown]. Bend your left knee and shift your weight into both legs, into a wide squat position, reaching the dumbbells to floor in front of you, then extend your right leg and shift your weight to the left, moving into a side lunge with your left leg.
In terms of diagnosing hip pain, typically a patient will expect when they come in to be asked about their symptoms, and it’s very important to find out when did these symptoms start, how long they have been going on, how frequent they are, if they come on in the morning or the evening, do they come on with any certain activity, and if there is something that makes it better or worse. The intensity of the pain is also important. Does it have any associated radiating symptoms? Is it localized in one spot or does it move? After getting a history and finding out what type of pain the patient is having, which also includes whether the pain is dull, aching, sharp, or intense, then it’s important to do a good physical exam. The physical examination involves testing the muscle strength, testing for sensation, doing provocative maneuvers which might help us rule out one type of injury from another.
In this study, one patient with sciatica was sent for ten MRIs, which produced 49 distinct “findings,” 16 of them unique, none of which occurred in all ten reports. On average, each radiologist made about a dozen errors, seeing one or two things that weren’t there and missing about ten things that were. Yikes. Read a more detailed and informal description of this study.

Approximately 9–12% of people (632 million) have LBP at any given point in time, and nearly 25% report having it at some point over any one-month period.[7][8] About 40% of people have LBP at some point in their lives,[7] with estimates as high as 80% among people in the developed world.[22] Difficulty most often begins between 20 and 40 years of age.[1] Men and women are equally affected.[4] Low back pain is more common among people aged between 40 and 80 years, with the overall number of individuals affected expected to increase as the population ages.[7]
Epidural injections of steroid drugs are frequently used to treat sciatica, despite limited evidence for their effectiveness. Moreover, these treatments are based on the assumption that reducing local inflammation in the vertebral column will relieve pain, but an association between structural abnormalities, inflammation, and sciatica symptoms has not been clearly demonstrated. NINDS-funded researchers are using a new imaging technique that can detect inflammation to better understand what causes chronic sciatica pain and to provide evidence to inform treatment selection.
If the pain is still not managed adequately, short term use of opioids such as morphine may be useful.[73][13] These medications carry a risk of addiction, may have negative interactions with other drugs, and have a greater risk of side effects, including dizziness, nausea, and constipation.[13] The effect of long term use of opioids for lower back pain is unknown.[74] Opioid treatment for chronic low back pain increases the risk for lifetime illicit drug use.[75] Specialist groups advise against general long-term use of opioids for chronic low back pain.[13][76] As of 2016, the CDC has released a guideline for prescribed opioid use in the management of chronic pain.[77] It states that opioid use is not the preferred treatment when managing chronic pain due to the excessive risks involved. If prescribed, a person and their clinician should have a realistic plan to discontinue its use in the event that the risks outweigh the benefit.[77]

Im a skateboarder and a couple weeks ago i skated alot every day and my lefy hip was starting to get sore. But of course i couldnt resist skating so i kept skating and it got worse and worse to the point i couldnt really skate at all without my hip hurting but of course i would still mess around on the board doing tiny tricks but a couple days ago i was just skating around not really doing tricks and i slipped and kicked my leg out and REALLY hurt my hip and thought i tore a tendon or something and couldnt walk for two days, but its gotten alot better and i can walk fairly normal and i ice it everyday but whenever i stretch it its just a really sharp pain it doesnt feel like im stretching it. What do i do when all the stretch does is make a sharp pain? How do i strengthen my hip? And how long would it take to strengthen my hip to full strength again? Because i cant stand not being able to skate. Please reply so i can skate as soon as possible thank you


In diagnosing the causes of hip pain, it’s important to understand hip anatomy. The hip is basically a ball-and-socket joint similar to the shoulder joint and the arms. The hip joint is impressive in that it serves two factors, it is a support structure and also very flexible. Because it is a strong support structure, it tends to get injured. Because it’s very flexible, it similarly can be susceptible to injuries.
Treatment options include physical therapy, back exercises, weight reduction, steroid injections (epidural steroids), nonsteroidal anti-inflammatory medications, rehabilitation and limited activity. All of these treatment options are aimed at relieving the inflammation in the back and irritation of nerve roots. Physicians usually recommend four to six weeks of conservative therapy before considering surgery.
Start in a runner’s lunge, right leg forward with knee over ankle and left knee on ground with top of your foot flat on the mat. Slowly lift torso and rest hands lightly on right thigh. Lean hips forward slightly, keeping right knee behind toes, and feel the stretch in the left hip flexor. Hold here, or for a deeper stretch, raise arms overhead, biceps by ears. Hold for at least 30 seconds, then repeat on opposite side.
How to: Get into a high plank position on the floor, hands planted under your shoulders, butt down (a). Engage your abs by pulling your belly button in towards your spine (b). Squeeze your left glute to lift your left leg two inches off the ground, keeping your leg straight (c). Tap your left leg out to the side, then back to starting position. Repeat, then switch legs (d).

How to: Lie on your back with your right knee bent and foot flat on the floor (a). With your left leg fully extended, press into your right foot to shift onto your left hip. This is your starting position (b). Then, squeeze your right glutes to press your left hip open until you feel a stretch, pause, then return to start. That’s one rep (c). Perform six to eight reps, then repeat on the opposite side.
If you have a stiff, tight or painful hip then www.HipFlexors.info will unlock your hip flexors and restore movement the way it should be. Unlocking your hip flexors instantly breathes new life, energy, and strength into your body! I experienced immediate results. I've been able to loosen up my hips, decrease back tightness, and even workout harder. With so many people suffering with hip pain out there, this program is a great tool for anybody that wants to reduce pain while improving strength, performance, and overall health. Hip flexibility, mobility and strength is one of the most important things you can do to keep your overall body healthy. The video presentation and visuals in the exercise program give me confidence that I am doing the exercises correctly which for me is key with no personal trainer. The website is very complete in listing the possible causes of tight hip flexors and other factors that can lead to the issue. It has detailed, descriptive information regarding the anatomy of the hip, causes of such injuries, and a very progressive and well explained exercise and stretching schedule that will assist to re-balance the hip and pelvic region, safely stretch and strengthen the muscle group. Best of luck to you! :) Report

Exercise therapy is effective in decreasing pain and improving function for those with chronic low back pain.[50] It also appears to reduce recurrence rates for as long as six months after the completion of program[61] and improves long-term function.[57] There is no evidence that one particular type of exercise therapy is more effective than another.[62] The Alexander technique appears useful for chronic back pain,[63] and there is tentative evidence to support the use of yoga.[64] Transcutaneous electrical nerve stimulation (TENS) has not been found to be effective in chronic low back pain.[65] Evidence for the use of shoe insoles as a treatment is inconclusive.[51] Peripheral nerve stimulation, a minimally-invasive procedure, may be useful in cases of chronic low back pain that do not respond to other measures, although the evidence supporting it is not conclusive, and it is not effective for pain that radiates into the leg.[66]


Radiculopathy is a condition caused by compression, inflammation and/or injury to a spinal nerve root. Pressure on the nerve root results in pain, numbness, or a tingling sensation that travels or radiates to other areas of the body that are served by that nerve. Radiculopathy may occur when spinal stenosis or a herniated or ruptured disc compresses the nerve root.
3. Tendinitis and bursitis Many tendons around the hip connect the muscles to the joint. These tendons can easily become inflamed if you overuse them or participate in strenuous activities. One of the most common causes of tendinitis at the hip joint, especially in runners, is iliotibial band syndrome — the iliotibial band is the thick span of tissue that runs from the outer rim of your pelvis to the outside of your knee.
Discectomy or microdiscectomy may be recommended to remove a disc, in cases where it has herniated and presses on a nerve root or the spinal cord, which may cause intense and enduring pain. Microdiscectomy is similar to a conventional discectomy; however, this procedure involves removing the herniated disc through a much smaller incision in the back and a more rapid recovery. Laminectomy and discectomy are frequently performed together and the combination is one of the more common ways to remove pressure on a nerve root from a herniated disc or bone spur.
Pregnancy commonly leads to low back pain by mechanically stressing the lumbar spine (changing the normal lumbar curvature) and by the positioning of the baby inside of the abdomen. Additionally, the effects of the female hormone estrogen and the ligament-loosening hormone relaxin may contribute to loosening of the ligaments and structures of the back. Pelvic-tilt exercises and stretches are often recommended for relieving this pain. Women are also recommended to maintain physical conditioning during pregnancy according to their doctors' advice. Natural labor can also cause low back pain.
3. Hug it out. Start the supine hip flexor stretch the same as the glute bridge, but keep the right leg relaxed on the floor. Pull shoulder blades down and back to lift hips. Grab the back thigh of the left leg and pull the knee toward the chest. Keep the right leg straight and push its heel into the floor (to feel it in the butt). Hold for 30-45 seconds and switch legs.
Endometriosis implants are most commonly found on the ovaries, the Fallopian tubes, outer surfaces of the uterus or intestines, and on the surface lining of the pelvic cavity. They also can be found in the vagina, cervix, and bladder. Endometriosis may not produce any symptoms, but when it does the most common symptom is pelvic pain that worsens just prior to menstruation and improves at the end of the menstrual period. Other symptoms of endometriosis include pain during sex, pain with pelvic examinations, cramping or pain during bowel movements or urination, and infertility.

This game-changing mat is what every yogi wishes they could practice in. Its smooth top layer provides better grip for tricky poses and sweaty hot yoga sessions. The thick fabric supports knees and elbows when you're in plank and pigeon. But what sets this yoga mat apart is its ability to roll up on its own and snap in place. This self-rolling mat also pairs with the Women's Health Amazon Alexa app, which walks you through the flow of the day.
Exercise therapy is effective in decreasing pain and improving function for those with chronic low back pain.[50] It also appears to reduce recurrence rates for as long as six months after the completion of program[61] and improves long-term function.[57] There is no evidence that one particular type of exercise therapy is more effective than another.[62] The Alexander technique appears useful for chronic back pain,[63] and there is tentative evidence to support the use of yoga.[64] Transcutaneous electrical nerve stimulation (TENS) has not been found to be effective in chronic low back pain.[65] Evidence for the use of shoe insoles as a treatment is inconclusive.[51] Peripheral nerve stimulation, a minimally-invasive procedure, may be useful in cases of chronic low back pain that do not respond to other measures, although the evidence supporting it is not conclusive, and it is not effective for pain that radiates into the leg.[66]

A complete medical history and physical exam can usually identify any serious conditions that may be causing the pain. During the exam, a health care provider will ask about the onset, site, and severity of the pain; duration of symptoms and any limitations in movement; and history of previous episodes or any health conditions that might be related to the pain. Along with a thorough back examination, neurologic tests are conducted to determine the cause of pain and appropriate treatment. The cause of chronic lower back pain is often difficult to determine even after a thorough examination.


3. Tendinitis and bursitis Many tendons around the hip connect the muscles to the joint. These tendons can easily become inflamed if you overuse them or participate in strenuous activities. One of the most common causes of tendinitis at the hip joint, especially in runners, is iliotibial band syndrome — the iliotibial band is the thick span of tissue that runs from the outer rim of your pelvis to the outside of your knee.
Arthritis: The spondyloarthropathies are inflammatory types of arthritis that can affect the lower back and sacroiliac joints. Examples of spondyloarthropathies include reactive arthritis (Reiter's disease), ankylosing spondylitis, psoriatic arthritis, and the arthritis of inflammatory bowel disease. Each of these diseases can lead to low back pain and stiffness, which is typically worse in the morning. These conditions usually begin in the second and third decades of life. They are treated with medications directed toward decreasing the inflammation. Newer biologic medications have been greatly successful in both quieting the disease and stopping its progression.
Exercise therapy is effective in decreasing pain and improving function for those with chronic low back pain.[50] It also appears to reduce recurrence rates for as long as six months after the completion of program[61] and improves long-term function.[57] There is no evidence that one particular type of exercise therapy is more effective than another.[62] The Alexander technique appears useful for chronic back pain,[63] and there is tentative evidence to support the use of yoga.[64] Transcutaneous electrical nerve stimulation (TENS) has not been found to be effective in chronic low back pain.[65] Evidence for the use of shoe insoles as a treatment is inconclusive.[51] Peripheral nerve stimulation, a minimally-invasive procedure, may be useful in cases of chronic low back pain that do not respond to other measures, although the evidence supporting it is not conclusive, and it is not effective for pain that radiates into the leg.[66]
From a physical therapist’s perspective, these are excellent exercises for lower back pain (LBP) resulting from muscular tightness or stiff joints. However, LBP can also be caused by bulging (or “herniated”) discs, pinched nerves, and the like. If your LBP worsens (or radiates into your leg) upon attempting these or any other low back exercises, you should seek medical attention. Physical therapists are musculoskeletal experts that are able to properly evaluate and treat your back pain symptoms. And, according to a recently passed law in the state of Michigan, a physician referral is no longer necessary to seek treatment from a physical therapist. So, if you are experiencing LBP that is not improving…#getPT!
You'll need a resistance band for this one. With this exercise you're focusing on four movements—flexion, extension, abduction and adduction. Try and stand up straight while doing the exercise. If you have to lean excessively, step closer to the anchor point of your band to decrease resistance. You'll find that not only are you working the muscles of the leg that's moving, the muscles of your stance leg will work quite hard stabilizing and balancing.
For example, one workout you may want to do lateral lunges with mini-band ankle walks. Another workout you may choose rotational step-ups with the 4-way cable hip exercise. The activation, mobility, and flexibility exercises can be done more frequently and not necessarily as part of a stand-alone workout. There's no one-right way to incorporate these exercises, so don't be afraid to experiment.
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Tight hip flexors can result in lower back pain, hip pain and injury.  A lot of strain is put on those muscles during activities that involve sprinting and kicking.  For example, runners are more prone to hip flexor injuries because of the small, repetitive movement during running.   But even if you’re not an athlete, hip flexor injuries can occur during everyday activities (for instance, slipping and falling or running to catch a bus).  When those tight muscles are suddenly stretched beyond what they are accustomed to, you might also experience pain in the upper groin region, typically where the hip meets the pelvis.   
Mechanical pain is often called back strain because it is linked with the movement, or "the mechanics" of the spine. This type of pain occurs when injury to the spine's discs, facet joints, ligaments, or muscles results in inflammation. It is called mechanical pain because it relates to the mechanics of your spine. The more you use your back, the more it hurts.
How to: Lie on your back with your right knee bent and foot flat on the floor (a). With your left leg fully extended, press into your right foot to shift onto your left hip. This is your starting position (b). Then, squeeze your right glutes to press your left hip open until you feel a stretch, pause, then return to start. That’s one rep (c). Perform six to eight reps, then repeat on the opposite side.

In addition to strengthening the core muscles, it's also important to address any mobility problems, says Jacque Crockford, M.S., C.S.C.S., exercise physiology content manager at American Council on Exercise, which can sometimes be what's causing pain. If specific movements like twisting or bending or extending your spine feel uncomfortable, there may be mobility (flexibility) issues at play. Doing some gentle stretching (like these yoga poses) might help. (If it gets worse with those stretches, stop and see a doctor.)

In addition to strengthening the core muscles, it's also important to address any mobility problems, says Jacque Crockford, M.S., C.S.C.S., exercise physiology content manager at American Council on Exercise, which can sometimes be what's causing pain. If specific movements like twisting or bending or extending your spine feel uncomfortable, there may be mobility (flexibility) issues at play. Doing some gentle stretching (like these yoga poses) might help. (If it gets worse with those stretches, stop and see a doctor.)
While leg lifts, certain ab exercises, and even hula hooping can all help work the hips, the hip flexors can still be a tricky part of the body to stretch Kinetics of hula hooping: An inverse dynamics analysis. Cluff, T., Robertson, D.G., and Balasubramaniam, R. School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada. Human Movement Science, 2008 Aug; 27 (4): 622-35.. To get them even stronger and more flexible, try these five simple hip flexor stretches:
If the pain is still not managed adequately, short term use of opioids such as morphine may be useful.[73][13] These medications carry a risk of addiction, may have negative interactions with other drugs, and have a greater risk of side effects, including dizziness, nausea, and constipation.[13] The effect of long term use of opioids for lower back pain is unknown.[74] Opioid treatment for chronic low back pain increases the risk for lifetime illicit drug use.[75] Specialist groups advise against general long-term use of opioids for chronic low back pain.[13][76] As of 2016, the CDC has released a guideline for prescribed opioid use in the management of chronic pain.[77] It states that opioid use is not the preferred treatment when managing chronic pain due to the excessive risks involved. If prescribed, a person and their clinician should have a realistic plan to discontinue its use in the event that the risks outweigh the benefit.[77]
Treatment for greater trochanteric bursitis includes stretching and strengthening your IT band, hip abductors, and gluteal muscles, all while avoiding running on banked surfaces. Applying ice to the painful area for 15 minutes, three to four times per day can help, too. A cortisone injection may be beneficial if your injury is severe. Worsening pain should raise suspicion for a stress fracture, in which case you should see your doctor right away.
Pregnancy commonly leads to low back pain by mechanically stressing the lumbar spine (changing the normal lumbar curvature) and by the positioning of the baby inside of the abdomen. Additionally, the effects of the female hormone estrogen and the ligament-loosening hormone relaxin may contribute to loosening of the ligaments and structures of the back. Pelvic-tilt exercises and stretches are often recommended for relieving this pain. Women are also recommended to maintain physical conditioning during pregnancy according to their doctors' advice. Natural labor can also cause low back pain.
Stand tall with your hips square and bend your right knee, bringing your foot towards your bum. Grab the right foot with your right hand and actively pull the foot closer to your glutes. As you do this, send the right knee down towards the ground and keep both knees together. squeeze your butt to promote a posterior pelvic tilt and hold — then switch sides.
Pregnancy symptoms can vary from woman to woman, and not all women experience the same symptoms. When women do experience pregnancy symptoms they may include symptoms include missed menstrual period, mood changes, headaches, lower back pain, fatigue, nausea, breast tenderness, and heartburn. Signs and symptoms in late pregnancy include leg swelling and shortness of breath. Options for relief of pregnancy symptoms include exercise, diet, and other lifestyle changes.
MRI and x-ray for low back pain are surprisingly unreliable,1 because things like bulging discs usually aren’t a deal,2 most back pain goes away on its own,3 and trigger points (“muscle knots”) are common and can be alarmingly intense but aren’t dangerous.4 Most patients are much better off when they feel confident about these things. The power of justified, rational confidence is a huge factor in back pain.5 Sadly, many healthcare professionals continue to perpetuate the idea of fragile backs,6 which undermines that valuable confidence.
Most Australian adults will experience low back pain at some time in their lives. Most low back pain gets better without the need to see a doctor, and gentle activity, not bed rest, seems usually to be the best treatment. Low back pain (lumbar pain) can be caused by a problem in the muscles, ligaments, discs, joints or nerves of the spine.Some back pain is due to serious problems, but most back problems are ‘mechanical’ in nature and can be prevented by looking after your back and keeping it in good shape.SymptomsThe symptoms of low back pain may include:Dull ache in the lower back;Stiffness of the lower back;Tingling or numbness of the leg(s);Tingling or pain in a buttock;Pain in the hip;Muscle spasms or seizing up of the back muscles;Sharp pain;Difficulty walking or standing up straight;Weakness of the leg or foot.Sometimes back pain is more on one side of the spine than the other.When to seek immediate medical help for back painRarely, back pain may be a sign of something serious. There are some signs and symptoms that may accompany the back pain or features of the pain that mean you should seek medical help immediately. These include:New bowel or bladder problems, such as not being able to urinate or incontinence.Numbness over the buttocks, especially in a pattern like a saddle.Fever or chills.A recent fall or injury to the back.Back pain that is worse when you are resting, lying down or in bed at night.Throbbing in the abdomen.Weakness in a leg, which might show itself as dragging a foot or one leg.Unexplained weight loss.Also, if you are over 50 or under 16 and have back pain you should see your doctor. Similarly, if you have ever had cancer or suffer from osteoporosis, or the back pain is accompanied by unexplained weight loss, you should seek medical advice.Diagnosis and tests for low back painTo help diagnose the cause of your back pain or rule out any serious problems, your doctor  may ask questions about the pain, such as:Did the back pain come on suddenly, does it come and go, or has it gradually worsened over time?Is your back sore to the touch?Is your back pain affected by your position, e.g. is it worse or better when you stand or sit, or bend over or lie down?Was it brought on by exercise or activity that you are unaccustomed to?Do you have any pain in your feet or legs?Is there any tingling in your legs or feet?Is the back pain accompanied by any swelling?Is the pain worse during the night?Are you having any problems going to the toilet?Your doctor will examine your back and may wish to feel and locate any areas of sensitivity and pain. They may ask you to perform movements so they can see your range of motion. They may also test the nerves.These examinations will not usually reveal the exact cause of the back pain, but they help your doctor to rule out any serious problems or problems needing immediate attention. In many cases, knowing the exact cause of the pain does not change the recommendations for treatment. Most non-specific back pain or uncomplicated back pain does not need a precise diagnosis of the anatomical problems that are causing it before treatment is started.X-rays or other radiological imaging tests are not usually recommended initially for low back pain as the findings do not necessarily correspond with the severity of symptoms. For example, many adults have signs of damage (such as to discs or facet joints) on X-ray,  but have no symptoms of back pain. And conversely, many people with low back pain will have no obvious signs of damage on X-rays.If the back pain has been ongoing, or your doctor suspects a fracture or specific cause, they may suggest you have some imaging tests. Sometimes, your doctor may wish to order blood tests to rule out or confirm causes such as infection, inflammation or cancer.Imaging tests used in low back painIf your doctor suspects a specific cause of the back pain then they may refer you for imaging tests such as X-ray of the lumbar spine (although plain X-rays are rarely useful), or an MRI scan. MRI scans can show the spinal discs and the nerve roots and the soft tissues. MRIs are probably the most useful imaging technique for low back pain as they can show problems with the discs and whether anything is pressing on the nerves of the spinal cord. Sometimes a CT scan will be suggested, if an MRI is not available.Ultrasound may be used if kidney stones are suspected as the cause of the pain.Nerve conduction studies called electromyography may be suggested, however the results often don’t reflect the symptoms, so this test may not give any useful information.Should I see a specialist for low back pain?Depending on the results of tests, your doctor may refer you to a specialist, however, 99 per cent of low back pain that GPs see is not serious. Specialists that treat low back pain include pain specialists, neurosurgeons, rheumatologists and orthopaedic surgeons.In addition to doctors, many people find consulting with a physiotherapist or osteopath may help. Osteopaths and physiotherapists may help with diagnosis of some back problems, mobility, exercises, stretching and advice.Osteopaths and physiotherapists don’t require you to have a referral from your GP. Their services are only rebated on Medicare as part of a specific chronic disease plan, but may be covered by private health insurance extras cover.Causes of low back painMost backaches are due to problems with the muscles, ligaments and joints. More serious problems occur when the nerves or spinal cord are injured, usually by local pressure.Back muscle strainsLow back pain can be due to a pulled or torn muscle in the lumbar region. There are many muscles involved in the lower back, which help support the spine and the upper body. These include extensor muscles (such as the erector spinae), the oblique muscles and the flexors (such as the psoas).When any of these muscles are stretched or torn (strained), there are micro-tears in the muscle fibres and these tears give rise to inflammation and pain. Myofascial pain like this from the muscles around the spine usually resolves after a short period of active recovery. But, it can also be present alongside other causes of back pain.Lumbar sprainA lumbar sprain happens when the ligaments of the lower back are stretched or torn. Ligaments are the tough connective tissue that joins bones, joints and cartilage together and keeps them stable. If the ligaments are stretched too far they can tear.The symptoms and treatment of a lumbar sprain are the same as for lumbar strain - which affects the muscles, rather than the ligaments.Muscle spasmsYou won’t usually know whether your low back pain is a result of a muscle problem or a ligament problem. Both can cause quite severe pain and cause inflammation in the surrounding area and sometimes spasm of the surrounding muscles. A back spasm is felt as a cramping or tightening of the muscles. Spasms are involuntary contractions of the muscle - that means you have no control over them.Muscle spasms are usually caused by the back trying to protect itself from damage to the muscles themselves or may indicate that there is an underlying injury to the spine itself.Degenerative disc diseaseDegenerative disc disease refers to normal changes to the spinal discs caused by ageing. The intervertebral discs are cushion-like structures between the vertebrae - the bony joints of the spine. The discs have a tough outside casing and are filled with a gel-like centre. They act like shock absorbers.As we age the discs become stiffer, drier and thinner. This makes them less flexible and supple and they may restrict movement and cause pain. Degenerative changes are more frequent in the lumbar (lower) spine and the cervical (neck) region of the spine.Degenerative disc disease of the spine may cause chronic (ongoing) low back pain, interspersed with more painful flare-ups from time to time. The pain is often worse when sitting, as the back is carrying more load in that position, and the pain may be relieved by standing up, changing positions or lying down.With ageing, bone spurs - tiny growths on the edges of the bones of the spine - may also occur. These bone spurs (osteophytes) are usually smooth and may not cause any pain.Ruptured, prolapsed or herniated discSometimes called a ‘slipped disc’, a herniated disc happens when the soft jelly-like centre of a spinal disc bulges out of a tear in the outer casing of the disc. The disc itself doesn’t move, but a split in its casing allows the soft middle (nucleus pulposus) to bulge out (herniate).Herniated discs don’t always cause problems -  up to a third of people who don’t have back pain are shown to have herniated discs on imaging.  However, sometimes the bulging part can press on a nerve and cause pain, tingling and other problems, such as weakness. Inflammation from the site may also contribute to symptoms. Prolapsed discs like this can be the cause of sciatica. The discs in the lumbar spine are most likely to herniate - these are the discs between the 5 lumbar vertebrae - L1 to L5.Over time, the herniated portion of the disc  (that’s the part that’s bulging out) usually gets smaller (regresses) and the symptoms ease and may go away. Most people with symptoms will improve in 2 weeks.Facet joint problemsFacet joint problems are common causes of back pain and the resulting condition is commonly referred to as facet joint pain or facet joint syndrome.The facet joints are small stabilising joints between and behind the vertebrae of the spine. There are 2 facet joints between each 2 vertebrae at every level of the spine (except the very top vertebrae in the neck). They allow some flexibility so that you can slightly twist and turn around, but they give you stability so that there isn’t excessive movement in your spine. The facet joints in the lumbar region allow only flexion and extension, so no twisting. Facet joints are synovial joints, so the joint surfaces have cartilage to allow them to glide smoothly together and they are enclosed  in a lubricant-filled capsule.Over time, facet joints can wear out, and with wear and tear the cartilage can become thin, leading to the bones rubbing on each other. This osteoarthritis leads to inflammation and pain, and bone spurs can form on the surface of the bone. As the intervertebral discs become thinner with age, more pressure still is put on the facet joints.Facet joints can also slip (dislocate) and become locked in position. Locked facet joints happen suddenly, for example when a person bends down to tie a shoelace and then experiences that their back seizes up. Problems with facet joints can be unpredictable.Symptoms of facet joint problems include tenderness over the affected facet joint, decreased movement and stiffness, pain when bending backwards and pain in the buttock or radiating down thigh (but not beyond knee).Spinal stenosisSpinal stenosis means narrowing of the spaces in the spine, either:narrowing of the spinal canal (the hollow ‘tube’ that holds the spinal cord);narrowing of the spaces where the nerve roots exit the side of each vertebrae; orNarrowing and impingement of the nerve root after it has exited the vertebrae.Spinal stenosis can be caused by degeneration of other structures in the back, such as the facet joints or discs, for example by bone spurs or herniated discs. Some people inherit a small spinal canal in the first place.Symptoms of spinal stenosis often start slowly and worsen over time. They may include tingling,  numbness or weakness in the feet or legs. If you have symptoms like these, you must visit a doctor.Ankylosing spondylitisAnkylosing spondylitis is a type of arthritis affecting the spine. The cause is not known, but there is a strong inherited component to the disease.The symptoms of ankylosing spondylitis are lower back pain and stiffness (especially first thing in the morning), tiredness and pain over the buttocks and down the thigh. The pain tends to ease as the day goes on. Rest does not help back pain from ankylosing spondylitis.Ankylosing spondylitis also causes pain and arthritis in other joints of the body, other than the spine.SpondylolisthesisSpondylolisthesis is when one of your vertebrae slips forwards or backwards out of its normal alignment, causing a step in the building blocks of the spine. It most commonly affects one of the lumbar vertebrae in the lower back.It doesn’t always cause pain, but when it does the pain is usually worse during activity and relieved by lying down. If the slipped vertebra presses on a nerve, then you may have symptoms of sciatica - tingling down your leg and over your buttock. People with spondylolisthesis often have tight hamstrings.Spondylolisthesis may be due to a fracture or a defect that is inherited. It may be caused by a traumatic injury, such as from high-impact sports (e.g. gymnastics)  or a motor vehicle accident. If the spine has become worn and arthritic, then spondylolisthesis is more likely.Sacro-iliac joint problemsProblems with the sacro-iliac joints - the 2 joints that join your sacrum (tailbone) to your pelvis - can give rise to low back pain. You have a sacroiliac joint on the left and one on the right of your sacrum (the triangular shaped bone at the base of your spine).The sacro-iliac joints are designed to be fairly stiff, and don’t normally allow more than a few degrees of movement. They function as shock absorbers. If the joints are abnormally mobile (too much movement) or restricted in movement they can give rise to low back pain. The SI joints may also become inflamed (called sacroiliitis).Symptoms of sacro-iliac joint pain include low back pain, leg pain (but rarely below the knee), pain in the sacro-iliac region itself or in the buttocks. There may be muscle spasms of surrounding muscles as they try to protect themselves or respond to underlying damage.Cauda equina syndrome (CES)Cauda equina syndrome is a medical emergency caused by compression of the spinal nerve roots. Below the waist near where the lumbar spine starts, your spinal cord separates into a bundle of nerves and nerve roots that resemble a horse’s tail; this is the cauda equina. These nerve roots supply messages to your legs, feet and pelvic organs. Anything that compromises the nerves can affect the function of your bladder, bowel, legs and feet and could result in paralysis or loss of continence.Symptoms of cauda equina syndrome may come and go, developing slowly over time, or come on suddenly and include:numbness of the buttocks in the pattern of where you would sit on a saddle;severe low back pain;tingling, weakness or pain in one or both legs;changes to bowel or bladder function;abnormal sensations in the bladder or rectum;sudden loss of sexual function;loss of some reflexes.If you develop any of these symptoms, you should visit a doctor or the emergency department straightaway.CES can be caused by a severe rupture of a lumbar disc, spinal stenosis, spine injury, inflammation or a birth defect.Spinal fractureOsteoporosis - a condition causing spongy bones - can cause sudden compression fractures (cracks) of the vertebrae. These osteoporotic compression fractures usually affect the vertebrae of the thoracic (upper) spine, but may also affect the lumbar (lower) vertebrae. They cause sudden back pain when they happen and can lead to ongoing pain, pain that is worse when standing or walking, and loss of height. Vertebral fractures such as this are common in postmenopausal women and older men.Spinal fractures may also be due to trauma, falls, sports injuries, or motor vehicle accidents.SpondylolysisSpondylolysis is a type of fracture or stress fracture in the vertebrae. It often affects young athletes who do sports such as gymnastics or football. Whilst the fractures sometimes spontaneously heal, they may not heal correctly and can cause ongoing back pain.Mostly there are no symptoms in young people with spondylolysis, but symptoms can include lower back pain which may extend into the buttocks or legs.Spondylolysis is a common cause of spondylolisthesis (mentioned earlier) where one vertebra slips out of position over another. Conversely, in older people with spondylolisthesis, this can lead to uneven loading of the facet joint, causing a compression fracture.CancerCancer is a rare cause of back pain. Tumours affecting the spine are usually secondary cancers that have spread from the primary tumour somewhere else in the body. Symptoms of spinal tumours include back pain, unexplained weight loss, weakness or numbness in arms or legs, and pain that is worse at night and which doesn’t go away with rest.Risk factorsRisk factors for low back pain include:Being overweight or obese - which puts more strain on the back.Being middle aged or older - back pain is more common the older you get.Lack of exercise - which can lead to weak back muscles that don’t support the spine.Poor posture - this can lead to muscle imbalances.Heavy physical work and lifting weights that are too heavy.Incorrect lifting technique, e.g. using your back instead of your legs.Overdoing it or doing unaccustomed exercise.Being pregnant.Stress - this can lead you to unconsciously tighten your back muscles.Sitting for long periods of time.Scoliosis - an abnormal curving of the spine sideways.Treatment and self-help for low back painMost uncomplicated back pain resolves after a period of active recovery and people are generally back to normal within 4 weeks.See your doctor if you are at all concerned about your back pain, and especially if any of the following occur:Your back pain has not improved after a couple of weeks;The pain is getting worse as time goes on.
Active recovery includes trying to do normal activities as much as possible and keeping active. Gentle walking, which improves blood flow and speeds up healing, can help. Doctors now know that inactivity and rest will lead to stiffness and more pain and is more likely to lead to ongoing back problems.Careful stretching may help relax muscles, especially if you have muscle spasms.You may find that sleeping with a pillow between your legs can make night-times more comfortable.Over-the-counter painkillers such as paracetamol or anti-inflammatories, e.g. ibuprofen (Nurofen), may help ease pain and reduce inflammation. If they are suitable for you, anti-inflammatories may be more effective than paracetamol. The pain probably won’t be completely eliminated, but this should enable you to resume gentle activity. Make sure you take the recommended dose. These medicines are not suitable for everyone, so always check with your doctor or pharmacist.Topical pain relievers are applied to the skin at the site of the pain. They are creams or ointments, usually. Some use the same ingredients that are in the tablet forms of over the counter pain relievers, such as ibuprofen or aspirin. Others have ingredients such as capsaicin, a compound from chilli peppers, or menthol.Stronger painkillers. Depending on the circumstances of your back pain, your doctor may prescribe other painkillers, antidepressants or other medicines.There is no evidence to support using muscle relaxants to treat low back pain. Oxycodone (prescribed as Endone or Oxycontin) is a strong painkiller belonging to the opioid group of medicines and is sometimes prescribed for back pain. Oxycodone can lead to addiction if used for long periods and also carries the risk of overdose. Whilst it may be effective in the short term for sudden onset of back pain, oxycodone is not recommended long term and there is no evidence for it being effective in the long term. Codeine is another strong painkiller, sometimes used in the short term for back pain. Codeine is another opioid and can also lead to addiction.Hot or cold packs may help with the pain as may sitting in a warm bath. Heat loosens tight muscles and increases blood flow, bringing more oxygen and nutrients to the area. Cold can help reduce pain and swelling. Cold is usually used in the beginning stages of an injury.Exercise programs - A physiotherapist or osteopath should be able to help you with an exercise programme to improve mobility, reduce pain, prevent further injury and help with recovery from back pain.Don’t worry too much or allow negative thoughts to run amok - the relationship between our thoughts and pain is complex. Worry and anxiety about back pain can make the pain worse.Acupuncture - there is no evidence to show that acupuncture has any effect in improving low back pain, however, it is unlikely to be harmful.TENS (transcutaneous electrical nerve stimulation) - this technique uses low voltage electrical current and is said to block pain signals. At the moment, there is no evidence to show TENS has any effect in helping low back pain.Therapeutic massage - The evidence to support the effectiveness of massage to help lower back pain is not very strong, but some people have found it offers relief. Spinal manipulation is definitely not recommended, though, as it may not be safe in some situations.Pilates - Studio training with experienced instructors can help with core stability and posture, and improve the health of your spine and muscle strength. Pilates training works on the deep support muscles of the spine and should help protect you from future episodes of back pain.Yoga -  Yoga can help with flexibility and posture, and along with the breathing and meditation aspects yoga may help to relieve lower back pain and improve function of the spine. Some yoga positions are not safe for people with certain back conditions, so you should always let a yoga instructor know if you have back problems.Alexander technique - The Alexander technique helps you to recognise and correct poor postural habits which lead to tension and pain in the body. Teachers in the Alexander technique observe the way you move and then with gentle guidance help you to learn safer and more relaxed ways of moving your body. One-to-one lessons in the Alexander technique have been shown to have a beneficial effect on back pain and functioning in people with ongoing or recurrent low back pain, even 12 months after the lessons have finished.Anti-inflammatory diet - Some foods have been shown to contribute to inflammation in the body, which in turn might aggravate back pain. Processed foods are generally acknowledged to be pro-inflammatory (causing inflammation). On the other hand, some foods are known to have an anti-inflammatory effect or can help with pain relief. Some foods known to reduce inflammation are omega-3 fatty acids (found in fish),  and antioxidants from colourful fruit and vegetables.Facet joint injections - Facet joint injections are corticosteroid injections. Australian guidelines now recommend that in most cases, facet joint injections are not helpful. They were done when a facet joint was suspected of causing the back pain. If the pain went away then this confirmed the diagnosis of facet joint disease or facet joint syndrome.Back surgery - In ongoing, non-specific back pain, there is no evidence that surgery helps. Surgery is usually only relevant for a minority of people with back pain, who have specific anatomical causes of their back pain, such as problems that cause pinching of a nerve. Techniques for back surgery are becoming less and less invasive, many being carried out using keyhole surgery.Types of spinal surgery include:  spinal fusion, which permanently connects 2 vertebrae together using a bone graft;lumbar decompression, which removes structures that are pressing on a nerve root, by either microdiscectomy, where the protruding pieces of a herniated disc are removed under microscopic view; or laminectomy, a more open type of surgery, where the facet joints may be trimmed,  as well as problems with discs resolved.Kyphoplasty - insertion of a balloon to expand a compressed vertebra, followed by injection of bone cement into the vertebra. These compression fractures  are usually from osteoporosis.Vertebroplasty - injection of bone cement into a compressed vertebra.OutlookMost people who have an episode of non-specific low back pain improve quickly, and usually recover within 4 weeks. A positive outlook can help you recover more quickly. However, a minority of people will have ongoing problems - the risk of this happening increases with age. Older people are particularly at risk of having recurrent episodes of back pain.PreventionIf you’ve hurt your back already, then prevention is probably the last thing on your mind. However, some people have further episodes of back pain after the initial episode has resolved, so it’s worth finding out what you can do to protect your back from further attacks of back pain.The back is at least risk of injury when it is in its neutral position. Anything that forces it to tilt can cause strains to the ligaments, and pain can result. Twisting when lifting is one common cause of low back pain.The way we lift, sit at our desks, operate machinery and do hundreds of minor tasks can all affect our backs. Trying to keep the back in a neutral position at all times will reduce the risk of backache. This is particularly important with tasks such as gardening and housework, which involve a lot of bending. Whenever possible, bend the knees and keep the back straight when doing things at ground level.Here are some things you can do to try to avoid back pain.Maintain good posture. Try to sit and stand with a ‘neutral spine’ (a physiotherapist or pilates instructor will be able to show you this). Use your legs to walk up hills (not your back) by staying upright and not bending forwards. Slow down if you have to, to maintain good posture. Sit with your knees slightly higher than your hips.Stay active. Low impact exercise, such as walking or swimming can strengthen the back muscles and the muscles of the core, which allows them to support the spine correctly. Regular exercise can help with strength and flexibility, ease pain and stiffness and protect bones.Back strengthening exercises. Try to do these every week at least a couple of times. A physiotherapist or pilates instructor will be able to help you with the best exercises for your back.Avoid heavy lifting. Avoid lifting weights that are too heavy for you. Learn correct lifting techniques - bend from the knees and use your legs to push up, and contract your abdominal muscles before you lift. Don’t twist when you lift, and don’t bend from the waist. Push, rather than pull, heavy objects.Pay attention to your carrying technique. Try not to load down one side of your body with heavy bags or handbags - distribute the load as evenly as possible and keep your shoulders square. Swap sides often when carrying heavy bags.Avoid stress. Being stressed or anxious leads to muscle tension by causing blood vessels to narrow, reducing blood flow and oxygen to the body’s tissues. This leads to  a build-up of waste products, which cause the muscles to spasm or contract. Being under constant stress causes the muscles to tighten and shorten, causing pain - often in the neck and back.Stretching. Stretching can help to reduce muscle tension. Tight hamstrings - the muscles down the back of your thigh - can be a cause of low back pain, so make sure your hamstrings are stretched out and not too tight.Not smoking. Smoking is linked to the development of low back pain. Doctors think this is due to reduced blood flow (which reduces the nutrients reaching the back), jarring from coughing and the fact that the bones of smokers have a lower mineral content.Eat a healthy diet. Some foods have been shown to have anti-inflammatory or pain-reducing properties. An anti-inflammatory diet, such as the Mediterranean diet, may help keep inflammation at bay and so lessen your chance of back pain.Stay hydrated. As we age, the soft gel-like centre of our intervertebral discs dries out and the discs become less effective as shock absorbers. Staying hydrated may go some way to help keep the discs plumped up and slow down this process.Maintain a healthy weight. Being overweight can make it harder to move about and puts more strain on your body. Being overweight also creates inflammation in the body.Avoid high heels. High heels alter your body’s alignment and put a strain on your back. Unsupportive footwear, such as thongs or flipflops, do not support the arches of the feet and so can lead to poor posture and back pain. Last Reviewed: 2 October 2017
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Approximately 9–12% of people (632 million) have LBP at any given point in time, and nearly 25% report having it at some point over any one-month period.[7][8] About 40% of people have LBP at some point in their lives,[7] with estimates as high as 80% among people in the developed world.[22] Difficulty most often begins between 20 and 40 years of age.[1] Men and women are equally affected.[4] Low back pain is more common among people aged between 40 and 80 years, with the overall number of individuals affected expected to increase as the population ages.[7]
Imagine not being able to climb stairs, bend over, or even walk Changes in hip joint muscle-tendon lengths with mode of locomotion. Riley, P.O., Franz, J., Dicharry, J., et al. Center for Applied Biomechanics, University of Virginia, Charlottesville, VA. Gait & Posture, 2010 Feb; 31 (2): 279-83.. All pretty essential if you ask us! But that’s what our bodies would be like without our hip flexor muscles. Never heard of ‘em? It’s about time we share why they’re so important, how your desk job might be making them weaker (ah!), and the best ways to stretch them out.
Massage therapy does not appear to provide much benefit for acute low back pain.[1] A 2015 Cochrane review found that for acute low back pain massage therapy was better than no treatment for pain only in the short-term.[89] There was no effect for improving function.[89] For chronic low back pain massage therapy was no better than no treatment for both pain and function, though only in the short-term.[89] The overall quality of the evidence was low and the authors conclude that massage therapy is generally not an effective treatment for low back pain.[89]
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