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Low Back Pain

Anatomy Of Spine

Anatomy Of Spine -

Each area of the spine is shown in fig
Cervical spine Curved as cervical lardosis
Thoracic spine Curved as thoracic kyphosis
Low back
Lumbar spine Curved as lumbar lardosis

Function Of Vertibral Column

  • To allow movement
  • To provide support and stability
  • To transfer weight and to provide a link between different sections of the spine
  • To protect the vital organs, e.g. heart, lungs, and spinal cord.
  • To provide a surface for attachment of ligaments, tendons, muscles etc.
Function Of Vertibral Column

Movements -

Following movements of the spine are made from the following areas
  • Flexion - bending forwards
  • Extension - bending backwards
  • Side Flexion - sideways movements
  • Rotation - twisting


Common Knowledge


Static Posture - When the spine maintained in one position, pain occurs because of maintained stress
Dynamic Posture - while walking and running care has to be taken to maintain proper balance and avoid injury

Sitting -

A proper sitting posture constitutes head and body in upright position, Lumbar curve maintain and supported, and feet, knees and hips at 90 degrees. Frequent changing of position by standing up avoids stress.

Sleeping -

The bed and mattress should be reasonably firm but allow enough give to accommodate hips
and shoulders.

Work -

During work the workstation should be organised to cause minimum stress by proper sitting position, proper height of table and workplace, and proper standing or work posture.

Sports And Leasure -

Appropriate type of activity should be chosen. Contact sports like Football & Rugby and active sports like squash should be avoided. Proper clothing and footwear should be worn. 5-10 minutes of warm up be stretching and mobilisation should be done before any sporting activity. Avoid over-exertion and fatigue.

Sex -

Use comfortable supporting bed and mattress. Use a pillow to support the small of the back. Select comfortable posture/position.

Types Of Low Back Pain

Facet Joint Problems -

They open on bending forwards and close on bending back. The pain is increase on prolonged standing, extensive running (Marathon), sudden unguarded twisting, and general wear and tear that is seen after mid 40's. The pain decreases by bending forwards, sitting slumped for short periods and lying curled up like a ball (Facet joints open)
Treatment - Period of rest followed by graduated extension exercises in order to increase range of movement.

Crush Fractures

Cause - Compression force from above (Rugby tackle) or below (Fall) because the vertebra is weakest at the front. The pain is increased by sudden unguarded movements, running or extension of the spine and is reduced on rest.
Treatment - Strengthening exercises to support the injured level.

Disc Problems - A disc cannot ‘slip'

Cause - Compressive forces on the disc. Sitting, slumping, driving for long periods, and standing bent over, or long bouts of heavy lifting, increases the pain. Lying down on a flat surface reduces the pain.
Treatment - Reduce the pain and restore the movements.

Nerve Root Irritation - (Sciatica)

Cause - Disc bulge, Facet joint damage leading to nerve compression. The pain is increase by activities the lead the irritation and compression of the nerve.
Treatment - Bed rest, drugs, physiotherapy, and exercise. Epidural treatment or Surgery is done if nerve
is entrapment.

Spondylolisthesis - Slipping of one vertebra on the other

Cause - Fractures and degenerations of the vertebra. The pain is increases by bending back, standing or sitting for long periods or sudden unguarded movements
Treatment - Strengthening exercises to support the area. Surgery is done to stabilise the level.

Osteoarthritis (OA)

Cause - Age related wear and tear.
Treatment - It depends on the structure that gives rise to the pain.

Post-surgical Pain -

A large amount of scar tissue is laid down following surgery to the low back.
Treatment - Early rehabilitation and muscle strengthening exercises should be performed.


Relaxation -

Relaxation is not the same as sleeping or doing nothing. The benefits of relaxation are reduction in pain and tension, less dependency on medication, good sleep, better general health and general well being. Relaxation is done by Progressive muscular techniques, Biofeedback using monitoring device, Breathing deeply but not forcefully in a synchronised manner and Autogenics based on imagery and suggestion. Other methods of relaxation are Yoga, Ta Chi, and AlexanderTechnique.

Back Mantenance -

Different ways of self-management of back condition are advised. They are used to increase Mobility and Flexibility. Many exercises like Quadriceps Stretch and Hamstring Stretch advised.

Medical Management

Rest -

Minimum period of rest to manage the acute condition is advised. Prolonged rest may result in worsening the condition and patient going into Back-Pain Syndrome.

Physiotherapy And Exercise -

This is must to rehabilitate the back. Lumbo-Sacral Traction to controlled exercises is used depending upon the condition.

Medication -

Muscle relaxants, Analgesics and Supplements are used when indicated.

Procedures -

Many procedures are used under medical advice and care. Starting from Epidural injections to Surgeries like Laminaectomy is done depending upon the condition.