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Anatomy of the lumbar spine
What makes up the lumbar spine?
The lumbar spine, also known as the lumbar spine, is made up of several structures that together provide support, flexibility and protection to the spinal cord and nerve roots. This section of the back is responsible for bearing a large part of the body’s weight and allows for many basic movements, making it particularly prone to injury and wear and tear.
The spine
The lumbar spine is made up of five lumbar vertebrae (L1 to L5). These vertebrae are larger and stronger than the vertebrae in other parts of the spine in order to support the weight of the upper body and allow a wide range of movements.
Vertebrae: Each lumbar vertebra consists of a vertebral body and a vertebral arch that protects the spinal cord. The vertebral body is cylindrical and acts as the main supporting structure, while the vertebral arch encloses and protects the spinal cord and nerve roots. Each vertebra also consists of various projections, including the transverse and spinous processes, which act as attachment points for muscles and ligaments, among other things.
Facet joints: Between each pair of vertebrae are two facet joints, one on each side. These joints, which are located at the back of the spine, allow movements such as bending and twisting while providing stability. The facet joints are synovial joints, which means they contain synovial fluid that reduces friction and allows smooth movements.
Intervertebral foramina: Between each pair of vertebrae are openings (foramina) through which nerve roots leave the spine and branch out into the body. These nerve roots are responsible for sending signals to and from the brain and different parts of the body.
Discs
Intervertebral discs are located between each vertebra and act as shock absorbers and allow flexibility of the spine.
Annulus fibrosus: The outer ring of the disk, made of fibrous cartilage that provides structure and protects the inner core. The annulus fibrosus is made up of concentric layers of collagen fibers that are strong and durable.
Nucleus pulposus: The inner, jelly-like core that acts as a shock absorber by absorbing pressure and strain. The nucleus pulposus is composed primarily of water and proteoglycans, making it elastic and capable of distributing pressure evenly across the disk.
Muscles and ligaments
The lumbar spine is surrounded by muscles and ligaments like in the spine that allow movement, stability and protect internal structures.
- Erector spinae: A group of muscles that run along the spine and are responsible for keeping the back upright and enabling movements such as stretching and twisting. These muscles are made up of three main parts: the iliocostalis, longissimus and spinalis.
- Quadratus lumborum: A muscle that extends from the pelvis to the twelfth rib and lumbar vertebrae. This muscle helps stabilize the lumbar spine and allows for side bends.
- Psoas major: A deep muscle that extends from the lumbar vertebrae to the femur. This muscle plays an important role in hip joint and spine flexion. It is also important for stabilizing the spine.
- Ligaments: Various ligaments help to hold the vertebrae in place and provide stability to the spine. These include:
Ligamentum flavum: An elastic ligament that connects the laminae (arches) of adjacent vertebrae and helps to keep the spine upright.
Interspinous ligaments: Ligaments that connect the spinous processes of adjacent vertebrae and limit excessive bending.
Supraspinous ligaments: ligaments that run along the spinal column and connect the spinal shoulders, contributing to the stability of the spine.
Anterior and posterior longitudinal ligaments: ligaments that run along the front and back of the vertebral bodies respectively and prevent excessive bending and stretching.
Why do you get lumbar spine problems?
Problems with the lumbar spine and low back pain can occur for several reasons, including injury, age-related changes and poor posture. Understanding the causes can help prevent and treat these problems effectively.
Injuries and overexertion
Problems in the lumbar spine are often caused by acute injury or chronic overexertion.
Muscle strains: These occur when the muscles in the lumbar spine are overstretched, usually as a result of lifting heavy objects, twisting suddenly or overexertion. Muscle strains can cause pain, stiffness and muscle spasms.
Slipped disc: A condition in which the nucleus pulposus is pushed out through a tear in the annulus fibrosus, which can cause pain and pressure on nerve roots. Herniated discs are most common in the lower lumbar vertebrae and can cause sciatica, a pain that radiates down the leg.
Fractures: Fractures of the lumbar vertebrae can occur in serious accidents or trauma, such as falls or car accidents. Osteoporosis, a disease that weakens the bones, can also increase the risk of fractures in the lower back.
Age-related changes
With age, the spine undergoes natural degenerative changes that can lead to pain and reduced function.
Disk degeneration: The disks in the spine lose their fluidity and elasticity with age, which can lead to decreased disk height and increased risk of herniated disks and other problems. Degenerative disc changes can cause chronic pain and stiffness in the lower back.
Spinal stenosis: a narrowing of the spinal canal caused by degenerative changes in the disks, ligaments flavum and facet joints, which can press on the spinal cord or nerve roots. It can lead to pain, numbness and weakness.
Osteoarthritis: Wear and tear of the facet joints can cause pain and stiffness in the lower back. Osteoarthritis of the facet joints can lead to bone deposits (osteophytes) which can further aggravate symptoms.
Posture and ergonomics
Poor posture and ergonomics can also contribute to lower back problems.
Sitting: prolonged sitting, especially with poor posture, can lead to stiffness in the lumbar muscles and increased pressure on the lumbar vertebrae, which can cause pain,
Poor lifting technique: Improper technique when lifting heavy objects can cause damage to the muscles and ligaments of the lower back. It is important to bend your knees and keep your back straight when lifting to reduce strain on the lower back.
Weak trunk muscles: A weak trunk can lead to overloading of the lumbar structures as these muscles help stabilize the spine. Strengthening the abdominal and back muscles can help reduce the risk of low back problems.
Symptoms of low back problems
Symptoms of low back problems can vary depending on the cause and extent of the problem. Common symptoms include pain, stiffness, sciatica and muscle weakness.
Pain and stiffness
Acute pain: sharp and sudden pain that often occurs with injury or overexertion. This type of pain can make it difficult to move and may require immediate treatment.
Chronic pain: persistent pain that may be due to degenerative changes or poor posture. Chronic pain can be mild to severe and may be aggravated by activity or prolonged inactivity.
Stiffness: Reduced mobility in the lumbar spine, especially in the morning or after prolonged inactivity. Stiffness can make it difficult to bend, twist or perform daily activities.
Sciatica and numbness
Sciatica: Pain radiating from the lumbar spine down the whole leg. The pain is caused by pressure on the sciatic nerve. Sciatica can cause burning, stabbing or electrical pains that radiate from the lower back to the buttock and leg.
Numbness and tingling: May occur in the lower back, buttocks, or legs and is caused by nerve compression. These symptoms may be intermittent or constant and may affect one or both sides of the body.
Weakness and muscle tension
Muscle weakness: Reduced strength in the legs or feet may be a sign of nerve damage or more serious conditions. Muscle weakness can make it difficult to walk, stand or perform other activities that require muscle strength such as going to the toilet.
Muscle tension: Involuntary muscle contractions that can cause pain and limited mobility. Muscle tension can be a reaction to pain or a consequence of overexertion and can lead to further stiffness and discomfort.
Traditional treatment for lower back problems
Diagnostics before treatment:
Diagnostic tools such as MRI, CT scan and ultrasound to identify the cause of the low back pain. A thorough medical history and physical examination are also essential to make an accurate diagnosis.
MRI (magnetic resonance imaging ): a detailed imaging technique that uses magnetic fields and radio waves to create images of the structures of the spine, including disks, vertebrae and soft tissues.
CT (Computed Tomography): an imaging technique that uses X-rays to create cross-sectional images of the spine and can provide detailed pictures of bone structures.
Ultrasound: Sometimes used to examine the soft tissues and muscles of the back and can help identify inflammation or injury.
Physiotherapy:
Physiotherapists can develop personalized exercise programs to strengthen the trunk muscles, improve mobility and reduce pain. Exercises can include strength training, stretching and balance exercises.
Strength training: Specific exercises to strengthen the muscles of the back, abdomen and legs, helping to support the spine and reduce strain on the lumbar spine.
Stretching: Stretching exercises to improve flexibility and reduce muscle tension, which can help relieve pain and stiffness.
Balance exercises: Exercises that improve balance and coordination can help prevent falls and reduce the risk of injury.
Manual therapy:
Techniques such as massage, chiropractic and naprapathy can be used to improve lumbar function, reduce muscle tension and relieve pain.
Massage: Used to relax tense muscles, improve blood circulation and reduce pain.
Chiropractic: Quick small movements help to align the facet joints, increase the mobility of the lumbar spine and improve its function.
Naprapathy: rapid, controlled movements used to realign the facet joints and restore normal movement, and soft tissue treatment in the form of massage.
Medical treatment:
Includes painkillers, anti-inflammatory drugs and, if necessary, injections of cortisone or hyaluronic acid to reduce inflammation and pain.
Painkillers: Over-the-counter medicines such as ibuprofen or paracetamol can help relieve pain and reduce inflammation.
Cortisone injections: used to reduce inflammation and relieve pain in specific areas of the lower back.
Hyaluronic acid injections: can be used to lubricate joints and reduce pain in osteoarthritis.
Ergonomic advice:
How to adapt your workplace and daily activities to improve posture and reduce lower back strain. This may include adjustments to sitting posture, lifting techniques and the use of ergonomic aids.
Seating position: Adjust the chair so that your back is adequately supported and your feet are flat on the floor.
Lifting technique: Learn to lift objects correctly by using your legs instead of your back and keeping the object close to your body.
Ergonomic aids: Use aids such as supportive cushions, height-adjustable desks and ergonomic keyboards to reduce lumbar strain.
Lifestyle advice:
Lifestyle changes, including weight loss, diet and physical activity, which can help improve your back health and reduce the risk of future problems.
Weight loss: Reducing excess weight can reduce strain on the spine.
Diet: A balanced diet rich in nutrients such as calcium and vitamin D can strengthen bones and support the spine.
Physical activity: Regular exercise can improve strength, flexibility and endurance, which can reduce the risk of back problems.
How we can help you
At the FasciaClinics, we focus on a holistic approach when it comes to treating lower back problems. The fascia is the network of connective tissue that binds and permeates everything in our body. All cells, tissues (even bone), muscles and organs contain fascia. Fascia treatment focuses on releasing tension and adhesions in the fascia and increasing its flow. This allows us to have an improved mobility of the body with less pain and improved self-healing.
During a treatment, we adjust the pelvis and straighten the body so that the load on the lumbar vertebrae is reduced. Tense muscles in the lumbar spine relax, reducing pain and increasing mobility.
