Pain Column: Back Pain

Author: Vivian Chak, Registered Physiotherapist

Lower back pain is a common condition suffered by many Hong Kong people, including office workers, athletes, and housewives.This pain column from Aloha Wellness & Physiotherapy will address the causes, symptoms, daily impact of lower back pain, and precautions for those affected. Make sure to read to the end for treatment recommendations from Aloha.

Causes of Lower Back Pain:

1.       Musculoskeletal Problems

1. Spinal Ligament Strain
   Small ligaments connect each segment of the spine, maintaining its stability and balance, and allowing for movement. If the range of motion of the thoracic spine joints is restricted, the lumbar ligaments will bear increased stress. When subjected to significant impact, the lumbar ligaments are more prone to strain and inflammation, leading to acute lower back pain. If not treated properly, adhesions can form around the inflamed area, resulting in chronic lower back pain.
2. Herniated Disc
   Intervertebral discs are cartilaginous tissues between the vertebrae, filled with water and elasticity, acting as excellent shock absorbers for the spine. However, if the spine is subjected to improper stress for a long time, leading to excessive wear and tear of the bones and intervertebral soft tissues, the discs can bulge or herniate, compressing nearby nerve tissues and causing discomfort and pain from the lower back down to the legs.
3. Myofascial Trigger Point Referred Pain
   Trigger points refer to a small bundle of muscle fibers that remain contracted and tense, making the area sensitive and causing intense pain when pressure is applied. When trigger points occur in muscles near the lower back, such as the iliopsoas, gluteus medius, and rectus abdominis, they can lead to muscle dysfunction and referred pain in the lower back.

2.       Chronic Health Conditions

• Kidney inflammation
• Rheumatoid arthritis

Symptoms of Pain (Daily Impact) 

1. Musculoskeletal Problems

• Persistent dull pain even at rest, due to ligament inflammation
• Tearing and stabbing pain in the lower back when moving to a certain range of motion
• Sharp pain when external pressure is applied to the injured spinal ligaments
• An indescribable dull ache in the lower back during prolonged sitting
• Sudden sharp pain in the lower back when coughing or sneezing
• Initial dull pain can progress to numbness and tingling, with pain radiating to the buttocks or down the back of the leg
• Difficulty getting out of bed, with pain occurring even with slight bending of the waist
• Weak core muscles, leading to instability when performing exercises like the Bird Dog
• No relief from lower back discomfort despite all attempts to relax the lower back
• Prone to anterior pelvic tilt

Who is prone to knee pain:

1. Pregnant Women
   Hormonal changes during pregnancy can cause ligaments to relax, reducing spinal stability and making sprains and strains more likely.
2. Individuals with Poor Thoracic Spine Mobility
   People who frequently hunch their backs or have rounded shoulders.
3. Manual Workers
   Repeatedly bending and lifting heavy objects.
4. People who sit or stand for long hours
   Studies show that poor sitting posture can put approximately 200 kg of pressure on the lumbar spine. Prolonged sitting can cause the iliopsoas muscles to remain shortened, gradually leading to the formation of trigger points over time.

Aloha Physiotherapy Treatment Recommendations for Lower Back Pain:

• Vacuum Cupping:
  Focuses on relaxing the superficial fascia of the relevant muscles. Compared to stationary cupping, vacuum cupping is more effective in relaxing large areas of superficial fascia through a pulling force, helping to improve the overall efficacy of the treatment.
• Dry Needling Therapy:
  Involves needling the inflamed ligaments, which has a pain-relieving effect and can induce a slight inflammatory response at the affected site to accelerate recovery.
• Postural Correction:
  Designing appropriate corrective plans to address chronic incorrect postures, balancing relative muscle strength, and solving pain from its root cause.
• Anti-inflammatory and Pain Relief:
  Physiotherapists will use corresponding instruments to alleviate pain and reduce inflammation at the affected site, depending on the cause of the lower back pain. (Ultrasound therapy, interferential current therapy, shockwave therapy)

Q&A Session:

Q: I have anterior pelvic tilt and lower back pain. Can solving the anterior pelvic tilt solve the lower back pain?

A: Research shows that most people have a pelvic tilt of 6-13 degrees, which is a common phenomenon and not a pathological condition. Research also indicates no significant relationship between pelvic tilt and lower back pain. If you want to thoroughly resolve lower back pain, it is recommended to consult a doctor or physical therapist.

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