Most people suffer from back pain at some time in their life. Lower back pain in particular is a very common medical problem which affects 80-90% of all people at some stage in life.  It is usually caused by an acute or sudden injury to the muscles, tendons or ligaments of the back. However, it can also be caused by wear and tear to these tissues over time, leading to arthritis and degeneration of the tissues of the back. 

Back pain is usually due to injury but can also be cause by a number of other conditions such as arthritis. Back pain caused by injury is usually due to lifting heavy objects or a sudden awkward movement of the spine. It can also be caused by overuse of the muscles of the back, sitting for long periods of time or poor posture. This can impact the body in a variety of ways:

Muscle strain
Muscles are made up of a large amount of fibers which attach to our bones. These fibers contract to allow our bodies to move. When injured they can be torn or overstretched, often called a “pulled muscle”. This is a common cause of lower back pain when then muscles in the back are overstretched. 

Ligament sprain and tendon strain
Damage to the connective tissues of the body such as ligament sprain or tendon strain is a leading cause of back pain. Ligaments are the connective tissue which join bones to each other. When these ligaments are overstretched or damaged it is referred to as a ligament sprain. Tendons are the collagen fibers which connect muscles to the bones and enable us to move. These fibers can be torn or overstretched as the result of injury, called a tendon strain.

Slipped disc
A slipped disc is medically called a lumbar disc herniation or prolapse. Discs are the jelly-like substance which sit in between each vertebrae or bone in your spine. They keep the spine flexible and at the same time help to cushion it. A slipped disc happens when the outer casing of the disc breaks and the disc bulges out. This puts pressure on the nerves around the vertebrae leading to severe pain and or weakness and numbness in the lower back muscles. If there is a disc prolapse around the lumbar 4 or 5 vertebrae it can lead to pain, numbness and tingling down the leg. This is a separate condition called sciatica. (sciatica.net.nz)

 Above: A diagram of a slipped disc bulging onto a spinal nerve leading to back pain.

Other causes of lower back pain
Back pain including lower back pain can also be due to wear and tear over a long period of time. Medically this is called degeneration. Degenerative conditions which cause back pain include arthritis (both osteoarthritis and rheumatoid arthritis and genetic conditions of the back such as Scheuermann’s disease). There are a number of other serious but rare causes of back pain including: infection or cancer of the spine and cauda equina syndrome. If you are worried about your back pain please consult with your medical doctor or GP.

There are a number of medications which can provide symptomatic relief from lower back pain. Mild medications are available over-the-counter whereas stronger medications may require a prescription from your GP. These medications can provide relief in the short term however long term use can lead to side effects and safety issues. Please consult with your medical provider or GP when using over-the-counter products frequently or for the safe use of prescription products.

Over-the-counter pain medication
Paracetamol
Aspirin
Ibuprofen
Codeine (in Panadeine or Neurofen Plus )

Prescription pain medication
Analgesics including tramadol and codeine
Non steroidal anti-inflammatories (NSAIDs) such as Voltarin
Steroidal medications such as prednisone

ACC currently endorses the following treatment modalities or types in the treatment of lower back pain:

Acupuncture
Acupuncture is an excellent treatment for lower back pain whether it is due to an injury or the result of a degenerative or genetic problem. New studies have demonstrated how acupuncture treats pain. These studies help to provide evidence for acupuncture being an effective natural pain relief without side effects for sufferers of back pain.   However, acupuncture does not only provide symptomatic relief from pain. It has a natural anti-inflammatory effect and can also address the cause of the pain by improving the body’s immune response to repair damaged tissues. Furthermore acupuncture helps to release the muscles of the lower back so that the bones they are attached to can go back into alignment if they are out of place. A recent review of acupuncture in the medical journal Spine involving more than 6,000 patients concluded there is strong evidence acupuncture effectively treats lower back pain and stated that it is an important treatment alongside conventional treatment. Book an acupuncture consultation and treatment here.  
-The main association for acupuncture is the New Zealand Register of Acupuncturists (NZRA)

Physiotherapy
The focus of physiotherapy (called physical therapy in some countries) is to rehabilitate people suffering from injuries as well as increase functional ability in people suffering from disabilities. Physiotherapists treat a wide range of musculoskeletal conditions from back pain to limbs/extremities as well as the postural and lifestyle aspects of the problems being treated. For lower back pain physiotherapists use a variety of techniques including: massage, joint manipulation, and tailored exercises which help to rehabilitate back pain. 
-The main association for physiotherapy is Physiotherpy New Zealand

Chiropractic 
Chiropractors specialise in mobilising the spinal vertebrae or the bones in the back. In medicine this is called spinal manipulation and chiropractors specifically refer to this as an adjustment. In lower back pain the lumbar or lower back vertebrae can be out of alignment. A chiropractor is able to adjust the position of the vertebrae so that they go back into alignment. Some chiropractors also use soft tissue massage and exercises to assist with their adjustments. These treatment methods frees the muscles, nerves, blood vessels to alleviate lower back pain and rehabilitate the tissues of the lower back. 
-The main association for chiropractors is the New Zealand Chiropractors Association

Osteopathy
For lower back pain osteopaths also mobilize the joints and tissues of the lower back. There are a number of different techniques an osteopath may use including spinal manipulation as well as other manual therapies such as soft tissue massage, myofascial release, and the release of muscles while they are under strain to name a few. These techniques help to release the muscles of the lower back as well as re-orientate the vertebrae back into the correct position, to rehabilitate the lower back.
-The main association for osteopaths is the Osteopathic Society of New Zealand

Rest or movement?
With lower back pain it is important to rest the back to encourage healing of the injury. However make sure that you don’t rest to much. It is also important to stretch out the muscles (e.g gentle bending and rotating back side to side) as well as move around in order to mobilise the lower back muscles to help with recovery.

Compressions
Hot and cold compression can help to decrease swelling and reduce pain. Within 24 hours of injury use cold compression (e.g ice) to reduce swelling and stop any bleeding around the site of the injury. After 24 hours apply a hot wheat pack or hot water bottle to reduce pain and aide with the repair of damaged tissues. Hot compression is also helpful for chronic lower back injuries.

Creams and ointments
There are a number of creams and balms which can help soothe your back pain. Visit your local health store or pharmacy for more information. 

Here are some basic exercises for lower back pain courtesy of ACC. Ask your healthcare professional is these exercises are right for you.