Vertebrogenic Low Back Pain: The Role of Physiotherapy

Vertebrogenic low back pain refers to pain that originates in the vertebral structures in the lumbar region. This is a type of lower back pain that originates from problems inside the spine, including the vertebrae, discs, facet joints, ligaments, and other related structures. This type of pain is often different from other causes of low back pain, such as muscle or soft tissue pain.

Causes of Vertebrogenic Low Back Pain

Common causes of vertebrogenic low back pain include:

Degenerative disc
Facet joint dysfunction
Spinal stenosis
Herniated Disc
Spondylolisthesis
Spinal Misalignment

Symptoms of Vertebrogenic Low Back Pain

Symptoms of vertebrogenic back pain vary depending on the underlying cause and individual factors. However, common symptoms associated with spinal back pain include:

Localized Pain - usually centered in the lower back area and described as dull, aching, or sharp.
Stiffness - experience stiffness especially in the morning or after periods of inactivity.
Limited Range of Motion
Pain Radiation
Numbness and Tingling - irritation or compression of nerves can lead to sensations of numbness
Pain Aggravation - movements, such as bending, lifting, or twisting, might exacerbate the pain
Relief with Rest
Nighttime Discomfort

Risk Factors

Several risk factors can contribute to the development of vertebrogenic low back pain. These factors can increase the chances of experiencing issues related to the vertebral structures in the lower back. Some common risk factors include:

Age - risk of vertebrogenic low back pain tends to increase with age.
Occupational Factors - involve heavy lifting, repetitive bending and twisting, prolonged sitting or standing, and exposure to vibrations (such as truck drivers or machine operators etc.
Sedentary Lifestyle - lead to weakened muscles and decreased flexibility, making the spine more susceptible to injury.
Obesity- Excess body weight puts additional strain on the spine and its supporting structures
Poor Posture - can place abnormal stress on the spine
Spinal Abnormalities - Conditions like scoliosis (abnormal curvature of the spine) or spondylolisthesis (vertebral slippage) can increase the risk of experiencing vertebrogenic low back pain.
Trauma - lead to structural changes that make the spine more vulnerable to pain.
Weak Core Muscles – Spine is more susceptible to injuries and pain.
Psychosocial Factors - Stress, anxiety, depression, and other psychosocial factors tells how individuals cope with and manage their pain.
Certain Medical Conditions - Conditions such as osteoporosis, ankylosing spondylitis, and rheumatoid arthritis increase the risk.

What Conditions mimic Vertebrogenic Low Back Pain?

When evaluating a patient with symptoms of vertebrogenic low back pain, physiotherapist consider a range of potential diagnoses to ensure an accurate and comprehensive understanding of the underlying condition. The following is a list of differential diagnoses that could be considered when assessing vertebrogenic low back pain:

Muscle Strain or Sprain: Muscular injuries or overuse can lead to localized pain in the lower back. These injuries often result from sudden movements, lifting heavy objects, or improper lifting techniques.
Referred Pain: Pain originating from other areas of the body, such as the hips, pelvis, or internal organs, can be perceived as low back pain. Conditions like kidney stones, urinary tract infections, or pelvic inflammatory disease can cause referred pain to the lower back.
Spinal Stenosis: This condition involves the narrowing of the spinal canal, which can lead to nerve compression and result in pain, numbness, and weakness. Spinal stenosis is more common in older adults.
Spondylolisthesis: Spondylolisthesis occurs when one vertebra slips forward or backward relative to an adjacent vertebra. It can cause lower back pain and nerve compression if severe.
Herniated Disc: A herniated or ruptured disc occurs when the gel-like inner core of a spinal disc pushes through its outer layer. This can lead to nerve compression and pain that might radiate down the leg (sciatica).
Facet Joint Arthritis: Arthritis in the facet joints, the small joints connecting adjacent vertebrae, can cause pain and stiffness in the lower back.
Ankylosing Spondylitis: This inflammatory condition primarily affects the spine and sacroiliac joints, leading to stiffness and pain, often worse in the morning or after periods of inactivity.
Osteoporotic Compression Fracture: In individuals with osteoporosis, weakened bones can lead to fractures, resulting in sudden and severe back pain.
Infection: Infections of the spine, such as vertebral osteomyelitis, can cause localized pain and discomfort.
Tumor: Rarely, tumors originating in the spine or spreading to the spine can cause persistent back pain. Tumors might also lead to unintentional weight loss and neurological symptoms.
Visceral Conditions: Conditions affecting the internal organs, such as gastrointestinal issues (e.g., pancreatitis, peptic ulcers), can cause referred pain to the lower back.

Psychosocial Factors: Emotional stress, anxiety, and depression can influence the perception of pain and contribute to chronic pain syndromes.
Fibromyalgia: A condition characterized by widespread pain and tender in muscles, ligaments, and tendons.

Physiotherapy Management of Vertebrogenic Low Back Pain

Physical therapy is a common and effective treatment for treating vertebral low back pain. An experienced physical therapist creates a customized treatment plan based on your specific condition, symptoms and needs. Physical therapy goals for spinal low back pain typically include pain relief, improved range of motion, and increased strength and flexibility. Here are some of the components of a physical therapy treatment plan:

Pain Management:

Electrotherapy modalities are used to alleviate pain, including heat or cold therapy, therapeutic ultrasound and transcutaneous electrical nerve stimulation.

Exercises

Core strengthening exercises: Focus on strengthening the muscles of the abdomen, lower back, and pelvis to provide better support to the spine.

Flexibility exercises: Stretching exercises for the hamstrings, hip flexors, and lower back can help improve flexibility and reduce muscle tension.

Aerobic exercises: Low-impact activities like walking, swimming, or stationary cycling can help improve cardiovascular fitness without placing excessive strain on the spine.

Manual Therapy:

Skilled physical therapists may use hands-on techniques to mobilize stiff joints, release muscle tension, and improve joint mobility. Techniques might include joint mobilization, soft tissue manipulation, and myofascial release.

Some further points can be taken into consideration when treating vertebrogenic low back pain:

Postural Training:

Correcting poor posture and teaching proper body mechanics is crucial to prevent further strain on the spine. Your therapist will guide you on how to maintain good posture during daily activities.

Stabilization and Functional Training:

As your pain improves, physical therapists will focus on exercises that challenge your core stability and functional strength. This helps prepare you for real-life activities while minimizing the risk of re-injury.

Home Exercise Program:

To achieve long-term benefits, your physical therapist will likely provide you with a home exercise program. Consistently performing the prescribed exercises can help maintain the progress achieved during your therapy sessions.

Gradual Return to Activity:

If your back pain was triggered by a specific activity or sport, your physical therapist will guide you in gradually returning to these activities while ensuring proper form and minimizing the risk of recurrence.

Clinical Scenario Illustrating Vertebrogenic Low Back Pain:

Patient Presentation:

John, a 45-year-old office worker, comes to the physiotherapist complaining of persistent lower back pain that has been bothering him for the past few months. He reports that the pain initially started as a dull ache in his lower back, but it has gradually become more pronounced. John mentions that he has a history of occasional back pain due to long hours of sitting at his desk and occasional heavy lifting at home.

Description of Pain:

John describes the pain as a constant, deep ache centered in his lower back, just above his hips. He states that the pain is worse after sitting for prolonged periods at work and after lifting heavy grocery bags or bending down to pick up objects.

Aggravating and Relieving Factors:

He notes that the pain gets worse when he bends forward to tie his shoes or when he tries to lift heavy objects. The pain also seems to be more intense in the morning when he wakes up and eases up a bit after he moves around and stretches.

Radiation of Pain:

John mentions that at times, he feels a shooting pain that travels from his lower back down the back of his right thigh. He also experiences occasional tingling and numbness in the same area.

Impact on Daily Life:

The pain has started affecting John's daily life. He struggles with sitting through work meetings and has even been avoiding social activities that involve extended periods of sitting. Additionally, he's unable to participate in his regular jogging routine due to the discomfort.

Physical Examination:

During the physical examination, the physiotherapist observes that John tends to hold his lower back slightly arched and stiff. Palpation of the lower back reveals some tenderness over the lumbar vertebrae. The therapist also performs a few neurological tests to check for any signs of nerve irritation and assesses John's range of motion, which appears limited due to pain.

Initial Diagnosis:

Based on the clinical presentation and physical examination, the physiotherapist suspects that John is experiencing vertebrogenic low back pain. The shooting pain and tingling down the back of his right thigh suggest the possibility of nerve involvement, possibly due to a compressed lumbar nerve root.

Next Steps:

The physiotherapist discusses the potential causes of John's pain, which might include issues like lumbar disc degeneration or herniation, and recommends further diagnostic tests such as an MRI to assess the condition of his intervertebral discs and nerves. In the meantime, the physiotherapist advises John to practice good posture, avoid activities that worsen the pain, and provides him with some gentle stretching exercises to help alleviate discomfort.