What is Mechanical Low Back Pain?
Mechanical low back pain refers to pain that arises intrinsically from the spine, intervertebral discs, or surrounding soft tissues. It is a broad term that encompasses various causes of low back pain, including muscle strain, disc herniation, spondylosis, spondylolisthesis, vertebral compression fractures, and acute or chronic traumatic injury.
What Causes Mechanical Low Back Pain?
The fundamental causes of Mechanical Low Back Pain include:
Lumbosacral muscle strains/sprains
- Often following isolated traumatic incidents or repetitive overuse
- Pain is worse with movement and relieved by rest
Intervertebral disc herniation
- Most often involves the L4-L5 or L5-S1 disc levels
- It can cause pain, paresthesia, sensory changes, and motor weakness depending on the affected nerve root
Lumbar spondylosis (degenerative disc and facet joint disease)
- It is more common in people over 40 years old
- Pain may radiate from the back to the hips and is often worse with activity
Vertebral compression fractures
- It can occur slowly over time or acutely with mild trauma, especially in those with osteoporosis
- Causes sudden and severe back pain
Lumbar spinal stenosis
- Narrowing of the spinal canal or nerve root passages, often due to degenerative changes
- Can cause radiating leg pain (sciatica)
Spondylolisthesis
- Forward slippage of one vertebra over the one below
- It can occur in the lumbar spine and cause back pain
Mechanical low back pain has a wide range of potential causes, including both acute traumatic events and chronic degenerative conditions affecting the spine and surrounding structures. Identifying the specific underlying cause is essential for guiding appropriate treatment.
How is Mechanical Low Back Pain Treated?
The critical treatments for Mechanical Low Back Pain include:
Conservative Treatments
- Physical therapy, including exercises, stretching, and the McKenzie method
- Over-the-counter medications like NSAIDs (e.g. ibuprofen) for short-term pain relief
- Topical treatments like heat/ice packs, TENS units, and massage
Medications
- Prescription NSAIDs or opioids for more severe pain
- Muscle relaxants and some anticonvulsants (e.g. topiramate) may also be used
Injections
- Epidural steroid injections for radicular pain or severe cases
Surgery
- Open discectomy or microdiscectomy for herniated discs
- Decompressive laminectomy for spinal stenosis
- Considered for severe, persistent, or progressive cases that do not respond to conservative treatment
Patient Education and Self-Management
- Advice to stay active, avoid aggravating movements, and return to regular activity
- Addressing psychosocial factors like fear avoidance and low self-efficacy
A stepwise, multimodal approach is generally recommended, starting with conservative treatments and progressing to more invasive options if needed. Identifying and addressing the underlying cause is also essential for guiding appropriate treatment.
Dr Clem Bonney – Mechanical Low Back Pain
Mechanical Low Back Pain is a common condition seen very frequently by Dr Clem Bonney. Unlike his GP counterparts, who may see MLBP acutely once or twice a week, Dr Bonney has presentations multiple times daily. Treating those with MLBP involves explanations and education, early allied health intervention, and, ideally, remaining at work on a suitable duties program. Dr Clem Bonney, as an Occupational Physician, is ideally placed to assist workers and employers in a speedy recovery and remain engaged with the workplace