Anatomy, Pathology and Treatment of the Lower Back

Lower Back Anatomy

The Lower Back comprises the Lumbar, Sacrum and Coccyx sections of the Spine. To look at this in clearer detail it’s best to divide these 3 sections into 2 parts, the Lumbar Spine and the Sacrum and Coccyx.

Lumbar Spine

The Lumbar Spine section of the Lower Back comprises 5 vertebrae (spinal bones). These sit one on top of each and are separated by Intervertebral Discs. These Intervertebral Discs act as the ‘shock absorbers’ of the Lower Back.

Sacrum and Coccyx

The Sacrum and Coccyx sections are unlike other bones in your spinal column. The Sacrum, is a large, flat triangular shaped bone nested between the hip bones and positioned below the 5th and last Lumbar vertebra. The Coccyx, commonly known as the ‘tailbone’, is positioned below the Sacrum. Individually, the Sacrum and Coccyx are composed of smaller bones that fuse (grow into a solid bone mass) together by age 30. The Sacrum is made up of 5 fused vertebrae (S1-S5) and 3 to 5 small bones fuse creating the Coccyx.

All 3 sections of the Lower Back, i.e. Lumbar, Sacrum and Coccyx are all supported by a magnitude of soft tissues including muscles, ligaments and fascial tissues.

The robust and strong nature of all of these structures listed above (vertebral bones, muscles, ligaments and fascial tissue) are there to protect the Spinal Cord as it sits within the Spinal Column of the Spine.

At each level of the 3 sections of the Lower Back, a branch of Nerves feed off the Spine and pass into specifics areas of the Lower Limb, acting as the ‘Power’ for all Lower Limb functioning. The Sciatic and Femoral Nerves tend to most heard off of these Nerves.

Lower Back Pathology

Pathology within the Lower Back can also be broken down into 3 sections. These are:

• Non-Specific Lower Back Pain
• Radicular Syndromes
• Specific Spinal Pathology

Non-Specific Lower Back Pain

This type of Lower Back Pathology accounts for around 90-95% of Lower Back Pain and it includes pathologies caused by:

• Issues/injury to Soft Tissues supporting the Lower Back e.g. muscle strains, ligament sprains
• Issues with Posture
• Issues with ‘Overloading’ the Spine
• Stress
• Underlying joint changes- wear and tear of the Spine

All of these Pathologies can be managed and treated with Physiotherapy and symptoms will settle with conservative treatment usually within a 6-week period.

Radicular Syndromes

This type of Lower Back Pathology accounts for around 5-10% of Lower Back Pain and it includes pathologies caused by:

• Neural irritation (radicular)
• Neural compression (radiculopathy)
• Spinal Stenosis

The majority of these Pathologies can be managed and treated with Physiotherapy and symptoms will settle with conservative treatment usually within a 12-week period.

Specific Spinal Pathology

This type of Lower Back Pathology accounts for <1% of Lower Back Pain and it includes more serious pathologies caused by more:

• Cauda Equina
• Cancers
• Infections
• Rheumatoid Arthritis
• Ankylosing Spondylitis
• Spinal Fractures

These types of Lower Back Spinal Pathology are serious and require urgent and immediate medical attention.

Lower Back Pathology Risk Factors

It is worth noting that there are several Risk Factors which leave you more at risk of developing any of the above Lower Back Pathologies. These are:

• Age- the effects of degenerate change with aging
• Fitness Level- poor fitness levels=higher risk
• Weight Gain- increased weight=increased stress on structures supporting the Lower Back
• Genetics- we are all unique but can mean some of us are more inclined to suffer with Lower Back Pathology
• Occupational Risk Factors- Sedentary job/Manual jobs will have an impact on your Lower Back in different ways
• Mental Health Factors- Anxiety and depression can have a direct impact on the Lower Back
• Pregnancy- The Lower Back is at greater risk of Pathology due to weight gain and hormonal changes with pregnancy

Lower Back Pathology Treatment

The White House Clinic is much more than just a regular physiotherapy clinic. We have the ability to facilitate any intervention that is needed to help manage and rehabilitate any type of Lower Back Pathology or issue. The information below outlines all of the services available at the clinic.

Physiotherapy Assessment and Treatment

We have a group of highly experienced physiotherapists who will be able to provide a thorough assessment and diagnosis of your Lower Back issue. Following this they will be able to provide you with the best evidence-based treatment to ensure improvement and hopefully resolution of your symptoms. Treatment for Lower Back pathology could include Manual Therapies, progressive Exercise Prescription, Shockwave Therapy or Acupuncture depending on your symptoms.

State-of-the-art gym and rehabilitation facilities

Several of our clinics are equipped with both a gym and a studio. These are filled with modern equipment enabling our physiotherapists to have the best facilities to provide your rehabilitation.

Workspace and Ergonomic Assessment

If it is determined that your working position or setup is causing or contributing to your Lower Back issue, we have physiotherapists who are highly experienced in Workspace or Ergonomic Assessments. They will be able to assess and advise on the best setup of your workspace and desk to ensure symptoms are resolved and prevent the risk of reoccurrence in the future.

Rapid access to investigative and scanning facilities and direct referral links to the top orthopaedic specialists in the area

If you require further investigation such as an x-ray or MRI scan, we have the clinical pathways to refer you quickly. We also have long-standing professional relationships with the top orthopaedic specialists in the area so in the scenario where referral to a specialist is required, we are able to refer swiftly and directly.

Pre-operative and Post-operative rehabilitation

We have a vast amount of experience in dealing with patients before and after Lower Back spinal surgery. Many of the local hospitals refer a large variety of surgical cases to us.
Prior to surgery it is best practice to maintain and optimise as much function of the Lower Back as possible. This will allow for a quicker recovery after surgery.

After surgery there is a surgical protocol that is followed and advised by the surgeon. Our physiotherapists will be able to guide you through this protocol to ensure optimal recovery is achieved.

Summary

At the White House Clinic, we are able to help you with any form of Lower Back issue at any stage of the process to recovery.
The Lower Back can be a source of pain and decreased function for many people.  There is however, almost never a situation where you should ‘just have to live with it’.
If you have any questions about your Lower Back or any of the services that we provide, then get it contact with us today and we will be happy to help.