Low back

Lumbar Disc Herniation

What is Lumbar Disc Herniation?

Lumbar disc herniation (LDH) is a medical condition that arises when the nucleus pulposus, the asoft inner material of an intervertebral disc, protrudes through the annulus fibrosus, the tougher outer layer of the disc. This displacement can result in compression of adjacent nerve roots as they exit the spinal column through the intervertebral foramina. Commonly referred to as a "slipped disc," this terminology can be misleading, as it suggests a simplistic displacement rather than a complex pathological process (Kumar et al., 2020; O'Neill et al., 2021). The condition predominantly affects the lumbar region, particularly at the L4-L5 and L5-S1 levels, which account for approximately 90-95% of cases (Kumar et al., 2020).

When the affected nerve roots are irritated or compressed, patients may experience a range of symptoms, including sciatica, which is characterised by pain, numbness, and tingling that radiates from the lower back down the leg (Cohen et al., 2019). The pain typically follows the distribution of the affected nerve root, impacting areas supplied by that nerve.

How Does Lumbar Disc Herniation Present?

The clinical presentation of lumbar disc herniation often includes unilateral lower back pain, which may radiate into the buttocks, legs, or feet. Patients frequently describe the pain as sharp or burning, and it may be exacerbated by certain movements or positions (Huang et al., 2021). Neurological symptoms such as pins and needles, numbness, or weakness in the affected limb are also common, typically following the path of the compressed nerve (Kumar et al., 2020; Cohen et al., 2019). In severe cases, patients may develop significant functional impairment, necessitating further intervention.

Why Does Lumbar Disc Herniation Occur?

The aetiology of lumbar disc herniation is multifactorial, with contributing factors including age-related degeneration, trauma, and repetitive stress on the spine. Degenerative changes in the intervertebral discs can lead to a loss of hydration and elasticity, making them more susceptible to herniation (O'Neill et al., 2021). Additionally, lifestyle factors such as obesity, sedentary behaviour, and occupational hazards may increase the risk of developing this condition (Huang et al., 2021).

How Can We Help?

Management of lumbar disc herniation typically begins with conservative treatments, including physical therapy, pain management, and lifestyle modifications aimed at improving posture and strengthening core muscles (Kumar et al., 2020). Manual therapy and tailored exercise regimens can aid in both recovery from the current injury and in preventing recurrence (Cohen et al., 2019). In cases where conservative measures fail to alleviate symptoms, surgical interventions such as discectomy or endoscopic procedures may be considered. These surgical options aim to relieve pressure on the affected nerve roots and restore function, with minimally invasive techniques showing promising outcomes in terms of recovery and pain relief (Huang et al., 2021; O'Neill et al., 2021).

Lumbar Facet Syndrome

What Is Lumbar Facet Syndrome?

Lumbar facet syndrome (LFS) is a condition that arises from dysfunction of the zygapophysial joints, commonly known as facet joints, located on either side of the spine. These joints facilitate movement between the vertebrae, allowing for limited motion and contributing to the overall flexibility of the spine necessary for daily activities. When excessive compression occurs in these joints, particularly during movements such as leaning backwards, it can lead to pain and discomfort (Kozera & Ciszek, 2016; Unlu & Sahin, 2022). Factors contributing to the development of LFS may include occupational stresses, poor posture, muscle imbalances, and lifestyle choices (Elsayed, 2018).

Each facet joint is encased in a capsule that connects to adjacent vertebrae. Occasionally, this capsule may tear, akin to a muscle or soft tissue injury, resulting in localized pain at the joint. While the severity of pain can vary, it is generally less intense than that associated with conditions such as disc herniation and rarely radiates below the buttocks (Park, 2010; Singh et al., 2023). Neurological symptoms, such as pins and needles or numbness, are typically absent in cases of lumbar facet syndrome (Liu, 2016).

How Does It Present?

Patients with lumbar facet syndrome often report centralised or unilateral pain in the lower back, which may radiate into the buttocks or further down the leg. The pain is commonly exacerbated by extension movements, such as leaning backwards, although bending forwards or other activities may also provoke discomfort, particularly in the early stages of injury (Kozera & Ciszek, 2016; Singh et al., 2023). Neurological symptoms, including paresthesia or weakness, are rare in this condition, which helps differentiate it from other causes of lower back pain.

Why Has It Happened?

It is estimated that lumbar facet joints are implicated in 15-40% of cases of lower back pain (Kozera & Ciszek, 2016; Unlu & Sahin, 2022). Repetitive trauma from activities such as lifting, bending, or engaging in high-impact sports can increase the risk of developing facet joint issues. Additionally, postural imbalances leading to hyperlordosis (excessive curvature of the lower back) or abdominal obesity may contribute to strain on the facet joints (Elsayed, 2018; Singh et al., 2023).

How Can We Help?

Management of lumbar facet syndrome typically involves a comprehensive assessment of the patient's lifestyle, occupation, and an orthopaedic evaluation to identify contributing factors. A tailored approach that combines hands-on treatment with prescribed exercises can help stretch and strengthen key areas, thereby improving support for the lower back and alleviating symptoms (Kozera & Ciszek, 2016; Elsayed, 2018). Interventional treatments, such as facet joint injections or radiofrequency ablation, may also be considered for patients who do not respond to conservative management (Liu, 2016; Singh et al., 2023).

Lumbar Erector Spinae Muscle Sprain or Strain

What Is It?

Lumbar erector spinae muscle sprain or strain refers to damage sustained by the soft tissues in the lower back and pelvis, including muscles, tendons, and ligaments. The severity of the injury can vary significantly, ranging from mild stretching (grade 1) to more substantial tearing (grade 3), depending on the extent of strain or tearing that has occurred in these connective tissues (Buchanan et al., 2020; Lee et al., 2021). Such injuries are common in individuals who engage in physical activities that place stress on the lower back, including sports, manual labour, or even routine household tasks.

How Does It Present?

The clinical presentation of a lumbar erector spinae muscle sprain or strain typically includes pain that is influenced by the type of tissue involved. Pain associated with ligament damage is often triggered by passive movements, where a therapist moves the body without muscle engagement. Conversely, pain stemming from muscle or tendon injury is usually aggravated during active movements, particularly when the muscles contract (Kumar et al., 2019; Smith et al., 2022). Due to the intricate nature of the tissue structures and the potential for inflammation, it is common for multiple areas to be affected, complicating the identification of the exact source of pain. However, imaging studies are often unnecessary, as a tailored treatment and rehabilitation plan can be effective once more serious conditions are ruled out through a comprehensive assessment (Huang et al., 2020).

Injuries of this nature can result from various mechanisms, including direct trauma, such as falls or sports injuries, or from overuse, fatigue, or sudden unguarded movements, such as lifting an object too quickly or incorrectly (Buchanan et al., 2020; Lee et al., 2021).

How Can We Help?

Management of lumbar erector spinae muscle sprains or strains typically involves a detailed evaluation of the patient's lifestyle, work habits, and an orthopaedic examination to identify underlying causes contributing to pain. A personalised treatment plan that incorporates manual therapy and specific exercises can help stretch and strengthen the affected areas, thereby supporting recovery and enhancing lower back function to reduce the risk of future injury (Kumar et al., 2019; Smith et al., 2022). In some cases, modalities such as heat or cold therapy, along with anti-inflammatory medications, may be employed to alleviate pain and inflammation during the initial recovery phase (Huang et al., 2020).

Upper Cross Syndrome

What Is Upper Cross Syndrome?

Upper Cross Syndrome (UCS) is a prevalent condition characterised by a muscle imbalance affecting the upper back, neck, and shoulders, often resulting in pain and discomfort. This syndrome is marked by tightness in the upper trapezius, levator scapulae, and pectoral muscles, coupled with weakness in the lower trapezius, serratus anterior, and deep neck flexors. The resulting pattern of muscle imbalance resembles a cross, hence the term "upper crossed syndrome" (Chu & Butler, 2021; Hanif, 2024). This condition is particularly common among individuals who maintain poor posture for prolonged periods, such as those who sit at desks or use electronic devices extensively.

How Does It Present?

The symptoms of Upper Cross Syndrome typically include pain or discomfort in the upper back, shoulders, and neck. Many individuals also report experiencing tension headaches as a consequence of these muscle imbalances. The discomfort is often exacerbated by poor posture, particularly during extended periods of sitting or working at a computer (Mubeen et al., 2016; Kocur et al., 2019). The combination of tight and weak muscles leads to a characteristic postural deviation, which can further contribute to the development of musculoskeletal pain and dysfunction.

Why Has It Happened?

Upper Cross Syndrome frequently results from prolonged periods of poor posture, such as sitting at a desk or computer without adequate movement. Over time, these postural habits lead to the overuse and tightening of certain muscles while others become weak from underuse (Lukasik et al., 2017; Asad et al., 2021). As the muscles fatigue and become irritated, they struggle to maintain proper posture, resulting in ongoing discomfort and pain. This condition is often linked to modern lifestyle factors, including sedentary behaviour and the increased use of technology (Kocur et al., 2019; Chang, 2023).

How Can We Help?

Management of Upper Cross Syndrome typically involves a thorough physical assessment to understand the patient's daily habits and ergonomics. Treatment focuses on stretching and releasing tight muscles, such as the upper trapezius and pectorals, while strengthening weaker muscles like the lower trapezius and deep neck flexors (Hanif, 2024; Mubeen et al., 2016). This balanced approach aims to restore muscle equilibrium, improve posture, and alleviate pain. Additionally, ergonomic advice can be provided to prevent recurrence of the condition, ensuring that individuals maintain a healthy posture during daily activities (Chu & Butler, 2021; Kocur et al., 2019).

References:

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