In this blog, we are going to dive deep into the very interesting and complex subject of Low Back Pain (LBP). We are going to discuss what LBP is and what we need to pay attention to, we are also going to talk about prevention and treatment.

So, let’s dive…

What is Low Back Pain?

Low back pain will typically extend from the lower part of the rib cage to the buttock area, it can be one-sided or 2 sided. LBP can include symptoms in one or two legs and may have associated neurological signs to the lower limb.

Millions of people around the world suffer from low back pain. Among the leading causes of disability and missed work days, it can significantly affect a person’s quality of life.

The first thing that is important to understand regarding LBP is that it is a symptom and not a disease.

In some cases, persistent low back pain is caused by serious issues (tumors, fractures, systemic diseases), but this is a very small percentage (about 1%).  Often, persistent low back pain involves psychological, social, and biophysical factors. We can divide LBP into acute and chronic phases:

Acute LBP:

A type of pain that is felt in the lower back, typically lasting less than six weeks. It is often caused by a sudden injury, and can be accompanied by muscle spasms, stiffness, and difficulty moving. Acute low back pain can range in severity, from mild discomfort to severe pain that makes it difficult to perform daily activities.

In most cases, it can be treated with over-the-counter pain relievers, physiotherapy, rest, and gentle stretching, but in some cases, more intensive treatment may be necessary.

Chronic LBP:

A type of pain in the lower back that persists for more than three months. It can be the result of a chronic condition, such as arthritis or spinal stenosis, but can also be caused by a previous injury that has not fully healed.

Chronic back pain can be difficult to treat and can interfere with a person’s ability to perform daily activities. Symptoms may include a dull, constant ache or sharp, intermittent pain, as well as stiffness, weakness, and difficulty moving.

Treatment for chronic back pain may include pain medication, physical therapy, and lifestyle changes, such as maintaining a healthy weight and engaging in regular exercise. In relatively rare cases, surgery may be necessary.

How common is Low Back Pain:

Low back pain is the number one cause of disability globally, this extremely common symptom is affecting more than half a billion people in any given moment. LBP-related medical expenses are similar to those associated with diabetes, cancer, and heart disease, combined.

Other than the first decade of life, LBP is common in all of the age groups, 40% of people aged 9-18 experienced at least one incident of LBP.  Most adults will have LBP at some point, when it will peak in Mid-life. Back pain is more common in women.

According to the World Health Organization, 80% of people will experience low back pain at some point in their lives.  In the United States, it is the second most common reason for doctor’s visits, and it is estimated that approximately $50 billion is spent on low back pain each year.

Causes for low back pain

Low back pain can be caused by a variety of factors. Some of these possible contributors to LBP may include poor posture, prolonged sitting or standing, improper lifting techniques, and being overweight or obese. Other potential causes include spinal abnormalities, arthritis, and muscle or ligament strains.

To make things even more complicated, in a great majority of the cases a specific cause to the pain can not be identified, therefore they are classified as a non-specific low back pain (NSLBP). The role of images such as X-ray, Ct scan and even an MRI is very debatable.  Many of the things that are seen in the image of people suffering from LBP, can be found among asymptomatic people. Furthermore, it is unclear if MRI results can predict the chances of developing back pain in the future.

There are a few potential specific pathological causes of LBP that we should be aware of, Important to mention that these cases are rare, in most research less than 1% of the cases.

These specific pathological reasons include : Vertebra fracture, systemic diseases, tumors and intra-abdominal causes. In any case of trauma (significant falling/ car accident) history of cancer or metabolic disease such as osteoporosis, we should be aware of the possibility of specific pathological causes. However, in about 99% of the cases this is not the cause. We refer to this specific pathological reasons as Red Flags;

Red flags are signs or symptoms that may indicate a serious underlying condition that requires urgent medical attention. In the context of back pain, red flags may include symptoms such as a very severe pain, weakness or numbness in both legs and especially in the groin region, unexplained weight loss, fever, urinary incontinence or retention, and history of cancer. Another important sign is what is known as “droop Foot”, meaning inability to extend the foot against gravity. When the patient walks, we can hear a “clapping” noise.   These symptoms may indicate a more serious underlying condition, such as a spinal infection or a tumor, that requires immediate medical attention.

It is important to pay attention to red flags when experiencing back pain, and to discuss any concerns with your doctor or physiotherapist, in severe cases it may be needed to visit the ER. If you are experiencing any red flags, it is important to seek medical attention as soon as possible to ensure that your condition is properly diagnosed and treated.

Causes for low back pain

Psychological and social effects of back pain:

While the physiological aspects of LBP are clear and often discussed, there are also some significant psychological and social effects of back pain. Many people suffering from LBP are struggling to meet their social expectation which causes worry and fear, hopelessness, family strain as well as financial difficulties and general disappointment from the healthcare system. These factors in turn lead to more pain, as chronic LBP is strongly associated with depression and general wellbeing. In a way, this is a vicious cycle in which pain leads to depression that aggravates the pain and so on.


In many cases, low back pain can be effectively treated with a combination of medications, physical therapy, and lifestyle changes. Over-the-counter pain relievers, such as ibuprofen and acetaminophen, can help to reduce inflammation and manage pain. Physical therapy can help to strengthen the muscles in the back and improve flexibility, while making changes to one’s diet and exercise routine can help to support overall spinal health.

One of the more researched and effective methods to treat back pain is known as the “Mckenzie” method, The main idea behind the McKenzie method is that the cause of back pain is often due to mechanical dysfunction in the spine. This means that the spine is not moving or functioning properly, which can cause pain and other symptoms. The McKenzie method focuses on identifying and correcting these dysfunctions through a series of specific movements and exercises.

The McKenzie method is often used to treat conditions such as herniated discs, sciatica, and spinal stenosis. It is based on the principles of spinal diagnosis and treatment, and emphasizes the importance of proper posture and body mechanics. The McKenzie method is typically performed by a physical therapist who has been trained in this approach. The therapist will assess the patient’s back pain and other symptoms, and develop a treatment plan that is tailored to the individual’s needs. This may involve a series of exercises and movements that are designed to improve spinal function and relieve pain.

However, in some cases, low back pain can be chronic and difficult to manage. In these instances, more advanced treatments, such as injections or surgery, may be necessary. It is important for individuals experiencing chronic low back pain to work closely with their healthcare provider to develop a treatment plan that is tailored to their specific needs.

Overall, low back pain is a widespread problem that can have a significant impact on a person’s daily life. By understanding the potential causes and seeking appropriate treatment, individuals can take steps to manage their symptoms and improve their quality of life.