Low back pain

Every week I am posting about  everything you need to know about hormones. This weeks topic is about low back pain

Did you know..

  • Is a significant global public health concern.
  • It is estimated that up to 84 % of adults have low back pain at some time in their lives.
  • The prevalence of low back pain in 2017 was estimated to be about 7.5% of the global population, or around 577 million people.
  • Low back pain has been the leading cause of years lived with disability since 1990.
  • Is the most common cause of job-related disability.
  • The 2010 Global Burden of Disease Study estimated that low back pain is among the top 10 diseases and injuries that account for the highest number of DALYs, which is Disability-Adjusted Life Year that measures the of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death.
  • In short low back pain is one of the most common reasons people go to the doctor and or miss work, and it is a leading cause of disability worldwide.
  • Most low back pain is the result of an injury, such as muscle sprains or strains due to sudden movements, poor body mechanics, poor muscle strength and flexibility while lifting heavy objects.
  • But low back pain can also be the result of certain diseases, such as:

– a ruptured or herniated disc

– sciatica

– arthritis

– kidney infections

– infections of the spine

– cancer

  • For many individuals, episodes of back pain are self-limited, ie. they resolve naturally.
  • For others medical intervention and treatments may be necessary.
  • Low back pain is categorized.
  • Acute – lasting up to 4 weeks.
  • Subacute – lasting between 4 and 12 weeks.
  • Chronic back pain – persists for more than12 weeks.

Meet Sally and get to know all about Low back pain


Preventing Low Back Pain

Low Back Pain & the Gut Microbiome

Causes of Low Back Pain

  • Back pain is one of the most common reasons people go to the doctor or miss work, and it is a leading cause of disability worldwide.
  • Back pain often develops without a cause or that can be identified with a test or an imaging study.

Common Causes

Muscle or Ligament Strains

  • Repeated heavy lifting
  • A sudden awkward movement
  • Poor physical condition

Bulging or Ruptured Disks

  • Disks act as cushions between the bones (vertebrae) in your spine.
  • The soft material inside a disk can bulge or rupture and press on a nerve.
  • However, you can have a bulging or ruptured disk without back pain.
  • Disk disease is often found incidentally when you have spine X-rays for some other reason.


  • Osteoarthritis can affect the lower back.
  • Can lead to a narrowing of the space around the spinal nerves, a condition called spinal stenosis.


  • Porous, brittle bone ie. low bone density
  • Can cause spinal fractures

Less Common Causes

  • Kidneys stones or infection
  • Endometriosis – endometrial cells, grow outside the uterus
  • Uterine fibroids
  • Pancreatitis
  • Ulcerative colitis

Overlooked Causes

  • Long term stress
  • Diet
  • Allergies
  • Changes to the central nervous system that make the body become more sensitive to pain

Diagnosing Low Back Pain

Physical Exam

  • your ability to sit, stand, walk and lift your legs, twist, bend, extend your torso, etc.
  • rate pain on a scale of 0 to 10..
  • how well you’re functioning with your pain

Imaging Exams

X-ray show

  • alignment of bones
  • arthritis
  • broken bones
  • do not show problems with your spinal cord, muscles, nerves or disks.

MRI or CT scans generate images

  • reveal herniated disks
  • problems with bones, muscles, tissue, tendons, nerves, ligaments and blood vessels.

Blood tests determine

  • infection or other condition that might be causing your pain.

Bone scan detect

  • bone tumours
  • compression fractures caused by osteoporosis.

Nerve studies Electromyography (EMG) measure

  • electrical impulses produced by the nerves and the responses of your muscles
  • can confirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinal stenosis).

Treating Low Back Pain

In general

  • For many, back pain resolves within 14 days to a month
  • For some, the pain doesn’t go away for a few months
  • For few, the pain is persistent even severe.

1st Aid Treatments

  • Over-the-counter pain relievers, such as NSAIDs Nonsteroidal anti-inflammatory drugs Ibuprofen, Advil, Naproxen, etc may help relieve back pain. NB! – Overuse of over the counter NSAIDs can cause serious side effects.
  • Heat treatment, such as warm packs, infrared light may be all you need.
  • Ice treatments, such as ice packs may help.
  • Bed rest isn’t recommended.
  • Continue your activities as much as you can tolerate.
  • Try light activity, such as walking and activities of daily living.
  • Stop any activity that increases pain.
  • Do not avoid activity out of fear of pain.
  • No matter which home treatment you try – If it helps you, if it makes you feel better, keep doing it.
  • If home treatments aren’t working after e few weeks, talk to a back specialist, such as your doctor, a physio, a chiropractor, osteopath, rehabilitation and performance consultant.

The Physical Approach

Physical therapies

  • Exercise to increase flexibility and strength
  • Exercise and awareness to improve posture
  • Education of how to modify movements during an episode of back pain
  • Manual therapies, such as chiropractic, osteopathy, massage
  • Acupuncture, especially dry needling to work with muscle trigger points.

The Medical Approach


  • Depends on the cause of / type of back pain
  • Prescription NSAIDs
  • Muscle relaxants.

NB! Muscle relaxants can make you dizzy and sleepy.

  • Topical pain relievers deliver pain relieving substances (NSAIDs) through your skin via creams, salves, ointments or patches.
  • Narcotics, such as opioids oxycodone or hydrocodone, may be used for a short time.

NB! Opioids don’t work well for chronic pain.

  • Antidepressants, such as Cymbalta and Amitriptyline have been shown to relieve chronic back pain independent of their effect on depression.

Other Medical Procedures

  • Cortisone injections – decrease inflammation around the nerve roots.

NB! pain relief usually lasts only a month or two.

  • Local anaesthesia – into the space around your spinal cord – the epidural space.
  • Radiofrequency neurotomy – insertion of a fine needle near the area causing your pain through which Radio waves are passed damaging the nearby nerves, which interferes with the delivery of pain signals to the brain.
  • Implanted nerve stimulators – implanted under the skin can deliver electrical impulses to certain nerves to block pain signals.


  • Usually reserved for pain related to structural problems, such as
  • Narrowing of the spine – spinal stenosis
  • A herniated disk – prolapsed disc.

The Holistic Approach

– Avoid excessive sitting, consider a standing desk

– Rotate activities sit for a while then stand for a while

– Make 5 squats every 30 – 60 minutes

  • Avoid proinflammatory foods, such as

– Gluten

– Raw plant foods

– Seeds, grains, nuts and legumes

– Dairy

– Eggs

  • Optimize gut health

– TRE Time Restricted Eating – 8-10 hour eating windows

– Probiotics – BUY HERE

  • De-stress

– Optimize circadian health Activity & Food 6am – 6pm : Rest & Fasting 6pm – 6am

– Mindfulness techniques.

Preventing Low Back Pain

  • Prevention is always better than cure.
  • The healthier your body is in general the less likely you are to get low back pain.
  • Improve your physical condition.
  • Learn and practice proper body mechanics.
  • Exercise – regular low-impact aerobic-activities, such as walking and swimming.
  • Build muscle strength and flexibility especially abdominal and back muscle to strengthen the core, the natural corset for your back.
  • Avoid movements that twist or strain your back.
  • Maintain a healthy weight. Being overweight strains back muscles.
  • Quit smoking as smoking impairs blood flow which increases your risk of low back pain.

Use your Body Properly

Stand smart

  • Don’t slouch
  • Maintain a neutral pelvic position
  • If you must stand for long periods, place one foot on a low footstool to take some of the load off your lower back
  • Alternate feet
  • Good posture can reduce the stress on back muscles.

Sit smart

  • Choose a seat with good lower back support, armrests and a swivel base.
  • Placing a pillow or rolled towel in the small of your back can maintain its normal curve.
  • Stools and fit-balls are also excellent choices, my preferred choice.
  • Keep your knees and hips at max 90 degrees.
  • Change your position frequently, at least every half-hour.

Lift smart

  • Avoid heavy lifting.
  • If you must lift something heavy, let your legs do the work.
  • Keep your back straight – no twisting – bend your knees not your back.
  • Hold the load close to your body.
  • Find a lifting partner if the object is heavy or awkward.

Be aware

  • Because back pain is so common, numerous products promise prevention or relief.
  • There’s no definitive evidence that special shoes, shoe inserts, back supports, specially designed furniture or stress management programs can help.
  • Nor one type of mattress that’s best for everyone with low back pain.
  • What feels most comfortable to you is often the best for you.

Low Back Pain & the Gut Microbiome

  • Back pain is the leading cause of disability worldwide.
  • Alterations in intestinal microbiome may contribute to the emergence of back pain through metabolites affecting immune and inflammatory responses.
  • Back pain in obesity may be driven by a persistent state of chronic low-grade inflammation partially driven by dysbiosis of the gut microbiome.
  • Instability and dysbiosis of the gut microbiome can be caused by many factors.

– Infection and the use of antibiotics

– Diet

– Lack of exercise

– Poor sleep and poor circadian rhythm

– Various co-morbidities, such as obesity

  • Restoring a healthy microbiome could potentially prevent or treat back pain through reducing systemic inflammation

Diet and The Microbiome

Our foods are made up of a lot of pro-inflammatory molecules, which affect gut health negatively in many different ways, such as

  • Oxalates
  • Lectins
  • Phytates
  • Tannins
  • Gluten

Check the article The Dark Side of Plant foods here.

This article will walk you through the foods you need to avoid / reduce to restore your gut microbiome to reduce / remove your low back pain and improve you health in general.

Questions? Please don't hesitate to contact me

Sign up