everything you need to know about lower back pain

Everything you need to know about lower back pain

This is an information guide on lower back pain.

Learn about:

1) What is lower back pain

2) Medical history assessment

3) Physical examination

4) Treatment without surgery

Start reading.

What is lower back pain?

There are two broad categories of lower back pain:

1) Acute sprains or strains

2) Chronic lower back pain

Acute Sprains and Strains

A lower back sprain or strain can happen suddenly or it can develop slowly over time from repetitive movements.

If you have acute pain, the most common cause is a sprain or strain.

  • Ligament Sprain – A sprain occurs when ligaments ( tissue that connect bones together ) are over-stretched or torn.
  • Muscle Strain – A strain occur when muscles are over-stretched or torn, commonly called a pulled muscle

Sprains and strains are typically not long-lasting and treatment can be for a short period of time only.

Sprains and strains can be caused by:

  • Poor posture awareness over time
  • Lifting overly heavy object
  • Sports injury from forceful impact or twisting
  • Sudden movement (e.g. a fall)
  • Body changes in pregnancy

Chronic Lower Back Pain

Lower back pain is considered chronic once it lasts for a long period (e.g. 3 months or more), exceeding the body’s natural ability to heal.

There are several mainly age-related causes:

  • Facet joint dysfunction

This arthritis-like condition is caused by the natural degeneration of a facet joint in the spinal bones, allowing conjoining vertebrae to rub against each other. This can occur when cartilage in the joints wears down.

  • Sacroiliac joint dysfunction

The cartilage in the sacroiliac joint between the iliac bones and the sacrum can wear down with age, causing pain when the bones rub together. The pain can start in the lower back and buttocks and radiate outward.

  • Lumbar herniated disc

This occurs when the nucleus material of a lumbar disc is displaced through the outer ring and irritates the nearby nerve root, resulting in inflammation and pain.

  • Lumbar stenosis

When the spaces in the spine canal narrow from wear and tear, it can put pressure on the nerves in the spine, causing pain, tingling or numbness in the lower back.

  • Degenerative disc disease

Despite its name, degenerative disc disease is not a disease. It is a condition that occurs naturally with age-related wear and tear (degeneration) of the discs in the spine.

  • Spondylolisthesis

When a vertebra shifts out of place and slips over an adjacent vertebra, it will cause instability in the spine and compression of the nerves. Spondylolisthesis can occur from age and from strenuous sports.

  • Hyperlordosis

Sometimes called swayback, hyperlordosis occurs when the spine curves excessively inward at the lower back. It can occur when a vertebra slips forward or becomes fragile, leading to a breakdown of the joints and pain.

  • Compression fractures

Fractures or weaknesses in the vertebra can cause the spine to compress, leading to persistent pain. This can occur from trauma, osteoporosis or cancer.

  • Acute fractures

Acute fractures or dislocations of the spine after a trauma, such as a motor vehicle accident or a fall, can lead to changes in posture and lingering pain.


Diagnosing Lower back pain: Medical History Assessment

Before any physical examination, a physiotherapist will need a detailed description of your symptoms, your lifestyle and your medical history. This may help the physiotherapist understand the source of the pain and its cause.

Some of the issues that need to be explored include:

  • Pain symptoms

The physiotherapist may ask where the pain started and how far it has spread. It’s also critical to know the quality of the pain: is it sharp, tight, dull, achy or hot and stinging? Just as importantly, the physiotherapist will need to know about other symptoms like numbness and weakness.

  • Activities

The physiotherapist will need to know how active or sedentary your lifestyle is. How long you sit at your desk and how long you sit may indicate the source of any posture issues. What you do for exercise and how strenuous it is may indicate other causal issues of the pain.

  • Sleeping position

Whether your pain allows you to sleep on your left side, your right side or on your stomach may indicate the cause of the pain and where it resides. The physiotherapist may also ask about the type of mattress and pillow you use because the amount of support you receive affects the pressure and comfort you experience.

  • Injuries

An injury from long ago may not seem relevant to convey, but it could have resulted in an undiagnosed microfracture or other damage. Even if you did not injure your back, an injury elsewhere could have caused your body to compensate by changing your posture which led to your back pain. The best course of action is to give your physiotherapist a full history.

  • Diet

Excessive weight sugar-rich foods can place stress on joints and the spine. In addition, some foods like red meat and trans fats can contribute to joint inflammation and should be reduced.

Diagnosing Lower back pain: Physical Examination

The physical examination will further narrow down possible causes of pain. It will typically include some of the following procedures:


Postural Analysis

to understand your habitual static posture and stability preferences


Gait Analysis

to assess your dynamic posture and movement habits


Range of motion

to identify limitations and available pain free movements

Surface Palpation

to palpate for abnormalities and muscle tone 

Treating Lower back pain without surgery

Non-surgical treatments aim to provide enough pain relief to improve the quality of life during the healing process and prevent further injury or stress to the back.

These treatments generally fall under four categories:

  1. Self-care
  2. Exercise for rehabilitation
  3. Alternative medicine
  4. Medical treatments


These are basic remedies for self-treatment of acute pain from muscle strains and ligament sprains, as well as reducing the effects of chronic pain. 

Behavior Modifying

  • Short rest
  • Modify or avoid aggravating activities
  • Self-correcting your posture
  • Diet improvements that reduce weight and inflammatory foods

Non-behavior Modifying

  • Heat or ice therapy
  • Non-prescription pain medication (e.g. Ibuprofen)
  • Wearing an inelastic back brace
  • Changing mattress and pillows
  • Changing footwear (e.g. flat heels)

Exercises for Rehabilitation

In addition to self-care, physical therapy is usually recommended as part of low back pain management to rehabilitate the back and supporting muscles.

Exercises can be conducted with a physiotherapist:

  • Stretching exercise – stretching the lower back, buttocks, hips and legs
  • Strength training – strengthening abdominal, hip and gluteus muscles
  • Low-impact cardio – to increase blood flow and support healing process
  • Pilates and yoga – for overall strength and mobility

Alternative Medicine

There are a variety of popular alternative medicine techniques that are effective for pain relief.

  • Acupuncture to relieve muscle and joint pain
  • Cupping and massage therapy to increase blood flow
  • Chiropractic or osteopathic manipulation to the spine and joints
  • Mindful meditation to reduce anxiety and increase relaxation
  • Aquatic therapy for strength and endurance
  • Transcutaneous electrical nerve stimulation 

Medical Treatments

Medical treatments are usually the last resort for non-surgical treatments.

They are intended to stop or reduce chronic pain for short periods of time and are not intended as long-term solutions.

  • Prescription pain medication and muscle relaxants
  • Epidural steroid injection into the spine
  • Selective nerve root injection into the nerve
  • Facet joint injection into the facet joint
  • Sacroiliac joint injection into the sacrum
  • Radiofrequency ablation (rhizotomy)

That’s everything you need to know about lower back pain.

Covering types of lower back pain, various assessment and treatment options available.

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Get our Physiotherapy + Rehab Pilates TRIAL at RM100 (N.P RM250) inclusive of a thorough assessment and customized plan.

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Physiotherapist & Pilates Instructor

Jun Xian work with clients on pain management, regain and progress them to higher fitness level with combination of Physiotherapy and Pilates.

He love sharing his knowledge around topics of lower back pain, hip and knee problem.

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