In the lower back, diagnoses are made more based on the behavior of the symptoms than on the area of the symptoms.

• Pain with sitting, and bending
• Pain with standing
• Pain early in the morning
• Pain at the end of the day
• Pain at night
• Pain which radiates down the leg, either one or both
• Pins and needles and or numbness in any part of the leg

Pain with sitting, and bending: A dull ache that comes on after sitting for a period of time is likely to have its origin in the disc of a particular level, or in more than one disc. Discs are bags of jelly that lie between the vertebrae, and have the function of acting as shock absorbers, enabling the spine to be maximally stable, whilst still providing flexibility. These bags of jelly are under load with sitting and bending and are therefore probably responsible for pain that is felt in these positions. The "bag" can ooze much the same as the air in a balloon that can bulge out if the one side of the balloon is put under pressure.

If you are experiencing such pain avoid sitting at best and if this is impossible; sit well supported and upright, ensuring you maintain your low back hollow. Avoid bending, and definitely do not lift anything. Spend time on your stomach if this is possible for you, and if not lie on your back as much as you can with your knees in a slightly bent position. Anti-inflammatories, and heat will assist the pain, but you would be wise to see us, or another physio who specializes in back problems, in order to facilitate the healing of the disc, as well as to teach you how to protect yourself from further injury. Remember, disc injuries are degenerative (get worse, with time), and so need careful management if this degeneration is to be slowed down.

Pain with standing: This is probably coming from one of the structures of the facet joints (side joints, each vertebra joins in three places with the vertebrae below itself) of your spine. These joints are under load in the standing position, especially if you stand badly. It could therefore be a ligament, the capsule, the cartilage of the joint, or any other structure of the joint causing the pain.

If you are experiencing such pain, avoid standing, reaching up above your head, ambling, or lying on your stomach. You may find that lying on your back with your knees up eases your pain, or crouching down over your knees, may also alleviate the symptoms, and if it does it is a good thing to do. A good self treatment is to lie on your back and twist your legs to the side, and let them just lie in this position of stretch for a few minutes before returning to neutral. If you have pain on only one side, only twist away from the pain. Even though sitting is not sore, be sure to sit with good posture (see ergonomics for details).

If you have sprained a ligament by a sudden jerk, with lifting and twisting, or lifting something heavy, or with a fall, or jump, the pain may be sharp and very intense. However, if you have overloaded and strained a structure then the pain may be of a dull and long-standing nature.

Physiotherapy is a good idea, as you will need to ensure that the range of movement is restored, even if your body does heal the original injury. In the case of an acute injury, the sooner you consult a physio, the faster you will heal. Also, the pain associated with such an injury, leads to inhibition and weakening of muscles, which needs to be addressed by special exercises, and training, if it is to be eliminated and the back to return to its pre- injury state.

Pain early in the morning: This is often arthritis (wear and tear), especially if it is associated with morning stiffness. No one can cure arthritis, but we can alleviate the symptoms and teach you to do the same for yourself. With special movements, joint fluid production is also stimulated, which feeds the cartilage and is excellent for arthritic joints. This early morning pain may be due to a disc injury, because the disc is most full of water in the morning and is therefore under pressure at this time. It may also be due to an inflamed facet joint structure (see earlier) which does not like being still for extended periods.

Treatment may involve careful positioning; you can help by finding and using the most comfortable position, (e.g. lying on your side with a pillow under your hip). Resting for short periods, where possible, and physiotherapy with much mobilization, and possibly traction will be of benefit. Anti-inflammatories may help.

Pain at the end of the day: This is a structure that swells when it is overused and the swelling eases with rest at night, but with activity during the day it becomes increasingly inflamed and therefore sore. It is a soft tissue structure, which has been strained or sprained.

To self treat, find and do what is comfortable and feels good and then try to avoid what you know will hurt. When your body is damaged it tells you what it needs or does not want. Rest in a good position is helpful (e.g. with your legs bent up on a low table with your body on the floor). Heat in the form of a hot pack placed on the painful area of your back or a hot shower, are also helpful. Physio and strengthening of the muscles, which protect the spine, will always be the best answer, and will provide a lasting cure.

Pain at night: This type of pain is divided into two types, that which wakes you as you turn, and that which wakes you because you need to turn. Any night pain (especially pain without movement) is a sign of serious pathology and must be investigated, by ourselves or some other back specialist. If it is pain with turning over, it is probably not too serious, it may be a swollen soft tissue structure, which pinches with movement. Pain without movement could however be bad inflammation, or something more serious like a fracture, a tumor, TB, or something equally sinister. So if you are experiencing pain that wakes you, do not panic, but get it checked out.

Pain which radiates down the leg, either one or both: This type of pain comes from something, which is either irritating the nerve, or squashing it. It is serious and should be investigated immediately to avoid it worsening, or resulting in permanent damage to the nerve. Something, which is seen early, will usually respond to physiotherapy, but something, which has been around for some time, will often not respond and may require surgery to heal. It may be a disc, or a swollen facet joint structure that causes this irritation to the nerve. The pain is measured by the distance it travels down the leg; something that causes buttock pain is less severe than something that results in foot or entire leg pain. Remember, you may have pain in your leg that you may not be aware is related to your back, only an expert could assess that for you. Remember that treatment directed at the knee, or hip, will have no effect, if the pain is actually coming from the back.

To treat this type of pain yourself is usually not possible, however any position that relieves the pain, or brings it back up the leg, is a good position. Rest always helps, as do anti-inflammatories, and heat. They will usually not cure, only relieve the symptoms, so do not waste time, trying to heal yourself. Avoid anything that causes the pain to move down the leg, or worsen. Rest in comfortable positions e.g. on you back with your knees on some pillows or in the fetal position, but not too bent up.

Pins and needles and or numbness in any part of the leg: This results from pressure on the sensory part of the nerve. It is a serious sign if it is causing these referred symptoms, as this means there is intense pressure on the nerve. The area of the symptom, determines which nerve is being squashed. To treat this symptom, consult us or some other back expert, immediately. Anti-inflammatories will also help, as will rest, but self-treatment is not an option. Weakness in any part of the leg: This results from pressure on the motor component of the nerve (the part of the nerve, which supplies the muscles). It is a serious sign and may require surgery to free the nerve. It is essential that it not be ignored, as damage may quickly become permanent. Weakness that is not severe may also result from inhibition of muscles due to pain, or when the brain wants to avoid creating pain. To treat the sign of weakness, consult us immediately.