Welcome to Body Balance Physical Therapy & Sports Performance's patient resource about Lumbar Spine problems.
Knowing the main parts of your low back and how these parts work is important as you learn to care for your back problem.
Two common anatomic terms are useful as they relate to the low back. The term anterior refers to the front of the spine. The term posterior refers to the back of the spine. The section of the spine that makes up the low back is called the lumbar spine. The front of the low back is therefore called the anterior lumbar area. The back of the lower spine is called the posterior lumbar area.
This article gives a general overview of the anatomy of the low back. It should help you understand: what parts make up the low back and how these parts work.
Lumbar Spine Anatomy The important parts of the lumbar spine include: bones and joints
nerves connective tissues muscles spinal segments. This section highlights important structures in each category.
Bones and Joints
The human spine is made up of 24 spinal bones, called vertebrae. Vertebrae are stacked on top of one another to form the spinal column. The spinal column is the body's main upright support. From the side, the spine forms three curves. The neck, called the cervical spine, curves slightly inward. The middle back, or thoracic spine, curves outward. The outward curve of the thoracic spine is called kyphosis. The low back, also called the lumbar spine, curves slightly inward. An inward curve of the spine is called lordosis.
Three Curves in Spine
The lumbar spine is made up of the lower five vertebrae. Doctors often refer to these vertebrae as L1 to L5. The lowest vertebra of the lumbar spine, L5, connects to the top of the sacrum, a triangular bone at the base of the spine that fits between the two pelvic bones. Some people have an extra, or sixth, lumbar vertebra. This condition doesn't usually cause any particular problems.
Each vertebra is formed by a round block of bone, called a vertebral body. The lumbar vertebral bodies are taller and bulkier compared to the rest of the spine. This is partly because the low back has to withstand pressure from body weight and from movements such as lifting, carrying, and twisting. Also, large and powerful muscles attaching on or near the lumbar spine place extra force on the lumbar vertebral bodies.
A bony ring attaches to the back of each vertebral body. This ring has two parts. Two pedicle bones connect directly to the back of the vertebral body. Two lamina bones join the pedicles to complete the ring. The lamina bones form the outer rim of the bony ring. When the vertebrae are stacked on top of each other, the bony rings form a hollow tube that surrounds the spinal cord and nerves. The laminae provide a protective roof over these nerve tissues.
A bony knob projects out at the point where the two lamina bones join together at the back of the spine. These projections, called spinous processes, can be felt as you rub your fingers up and down the back of your spine. Each vertebra also has two bony knobs that point out to the side, one on the left and one on the right. These bony projections are called transverse processes. The projections in the low back are broader than in other areas of the spine because many large back muscles attach and impart powerful forces on them.
Between the vertebrae of each spinal segment are two facet joints. The facet joints are located on the back of the spinal column. There are two facet joints between each pair of vertebrae, one on each side of the spine. A facet joint is made of small, bony knobs that line up along the back of the spine. Where these knobs meet, they form a joint that connects the two vertebrae. The alignment of the facet joints of the lumbar spine allows freedom of movement as you bend forward and back.
The surfaces of the facet joints are covered by articular cartilage. Articular cartilage is a smooth, rubbery material that covers the ends of most joints. It allows the ends of bones to move against each other smoothly, without friction.
On the left and right side of each vertebra is a small tunnel called a neural foramen. (Foramina is the plural term.) The two nerves that leave the spine at each vertebra go through the foramina, one on the left and one on the right. The intervertebral disc (described later) sits directly in front of the opening. A bulged or herniated disc can narrow the opening and put pressure on the nerve. A facet joint sits in back of the foramen. Bone spurs that form on the facet joint can project into the tunnel, narrowing the hole and pinching the nerve.
Neural Foramen Nerves
The hollow tube formed by the bony rings on the back of the spinal column surrounds the spinal cord. The spinal cord is like a long wire made up of millions of nerve fibers. Just as the skull protects the brain, the bones of the spinal column protect the spinal cord.
The spinal cord extends down to the L2 vertebra. Below this level, the spinal canal encloses a bundle of nerves that goes to the lower limbs and pelvic organs. The Latin term for this bundle of nerves is cauda equina, meaning horse's tail. Between vertebrae, two large nerves branch off the spinal cord, one on the left and one on the right. The nerves pass through the neural foramina of each vertebra. These spinal nerves group together to form the main nerves that go to the organs and limbs. The nerves of the lumbar spine (cauda equina) go to the pelvic organs and lower limbs.
Connective tissues are networks of fiber that hold the cells of the body together. Ligaments are strong connective tissues that attach bones to other bones. Several long ligaments connect on the front and back sections of the vertebrae. The anterior longitudinal ligament runs lengthwise down the front of the vertebral bodies. Two other ligaments run full-length within the spinal canal. The posterior longitudinal ligament attaches on the back of the vertebral bodies. The ligamentum flavum is a long elastic band that connects to the front surface of the lamina bones (just behind the spinal cord). Thick ligaments also connect the bones of the lumbar spine to the sacrum (the bone below L5) and pelvis.
A special type of structure in the spine called an intervertebral disc is also made of connective tissue. The fibers of the disc are formed by special cells, called collagen cells. The fibers may be lined up like strands of nylon rope or crisscrossed like a net. An intervertebral disc is made of two parts. The center, called the nucleus, is spongy. It provides most of the shock absorption in the spine. The nucleus is held in place by the annulus, a series of strong ligament rings surrounding it.
Two Parts of Intervertebral Disc Muscles
The muscles of the low back are arranged in layers. Those closest to the skin's surface, the superficial layer, are covered by a thick tissue called fascia. The middle layer, called the erector spinal, has strap-shaped muscles that run up and down over the lower ribs, chest, and low back. They join in the lumbar spine to form a thick tendon that binds the bones of the low back, pelvis, and sacrum. The deepest layer of muscles attaches along the back surface of the spine bones, connecting the low back, pelvis, and sacrum. These deepest muscles coordinate their actions with the muscles of the abdomen to help hold the spine steady during activity.
Low Back Muscles Spinal Segment
A good way to understand the anatomy of the lumbar spine is by looking at a spinal segment. Each spinal segment includes two vertebrae separated by an intervertebral disc, the nerves that leave the spinal column at each vertebra, and the small facet joints that link each level of the spinal column. The intervertebral disc separates the two vertebral bodies of the spinal segment. The disc normally works like a shock absorber. It protects the spine against the daily pull of gravity. It also protects the spine during heavy activities that put strong force on the spine, such as jumping, running, and lifting. The spinal segment is connected by two facet joints, described earlier. When the facet joints of the lumbar spine move together, they bend and turn the low back.
Many important parts make up the anatomy of the back. Understanding the regions and structures of the lumbar spine can help you be more involved in your health care and better able to care for your back problem. Portions of this document copyright MMG, LLC.
This article will help you understand:
The important structures of the shoulder can be divided into several categories.
Bones and Joints
The bones of the shoulder are the humerus (the upper arm bone), the scapula (the shoulder blade), and the clavicle (the collar bone). The roof of the shoulder is formed by a part of the scapula called the acromion.
There are actually four joints that make up the shoulder. The main shoulder joint, called the glenohumeral joint, is formed where the ball of the humerus fits into a shallow socket on the scapula. This shallow socket is called the glenoid.
The acromioclavicular (AC) joint is where the clavicle meets the acromion.
Acromioclavicular and Glenohumarel Joints
The sternoclavicular (SC) joint supports the connection of the arms and shoulders to the main skeleton on the front of the chest.
Sternoclavicular and Scapulothroacic Joints
A false joint is formed where the shoulder blade glides against the thorax (the rib cage). This joint, called the scapulothroacic joint, is important because it requires that the muscles surrounding the shoulder blade work together to keep the socket lined up during shoulder movements.
Articular cartilage is the material that covers the ends of the bones of any joint. Articular cartilage is about one-quarter of an inch thick in most large, weight-bearing joints. It is a bit thinner in joints such as the shoulder, which don't normally support weight. Articular cartilage is white and shiny and has a rubbery consistency. It is slippery, which allows the joint surfaces to slide against one another without causing any damage. The function of articular cartilage is to absorb shock and provide an extremely smooth surface to make motion easier. We have articular cartilage essentially everywhere that two bony surfaces move against one another, or articulate. In the shoulder, articular cartilage covers the end of the humerus and socket area of the glenoid on the scapula.
Ligaments and Tendons
There are several important ligaments in the shoulder. Ligaments are soft tissue structures that connect bones to bones. A joint capsule is a watertight sac that surrounds a joint. In the shoulder, the joint capsule is formed by a group of ligaments that connect the humerus to the glenoid. These ligaments are the main source of stability for the shoulder. They help hold the shoulder in place and keep it from dislocating.
Ligaments attach the clavicle to the acromion in the AC joint. Two ligaments connect the clavicle to the scapula by attaching to the coracoid process, a bony knob that sticks out of the scapula in the front of the shoulder.
A special type of ligament forms a unique structure inside the shoulder called the labrum. The labrum is attached almost completely around the edge of the glenoid. When viewed in cross section, the labrum is wedge-shaped. The shape and the way the labrum is attached create a deeper cup for the glenoid socket. This is important because the glenoid socket is so flat and shallow that the ball of the humerus does not fit tightly. The labrum creates a deeper cup for the ball of the humerus to fit into.
The labrum is also where the biceps tendon attaches to the glenoid. Tendons are much like ligaments, except that tendons attach muscles to bones. Muscles move the bones by pulling on the tendons. The biceps tendon runs from the biceps muscle, across the front of the shoulder, to the glenoid. At the very top of the glenoid, the biceps tendon attaches to the bone and actually becomes part of the labrum. This connection can be a source of problems when the biceps tendon is damaged and pulls away from its attachment to the glenoid.
Anatomy Ligaments and Tendons
The tendons of the rotator cuff are the next layer in the shoulder joint. Four rotator cuff tendons connect the deepest layer of muscles to the humerus.
Muscles the rotator cuff tendons attach to the deep rotator cuff muscles. This group of muscles lies just outside the shoulder joint. These muscles help raise the arm from the side and rotate the shoulder in the many directions. They are involved in many day-to-day activities. The rotator cuff muscles and tendons also help keep the shoulder joint stable by holding the humeral head in the glenoid socket.
Rotator Cuff Tendons
The large deltoid muscle is the outer layer of shoulder muscle. The deltoid is the largest, strongest muscle of the shoulder. The deltoid muscle takes over lifting the arm once the arm is away from the side.
Nerves all of the nerves that travel down the arm pass through the axilla (the armpit) just under the shoulder joint. Three main nerves begin together at the shoulder: the radial nerve, the ulnar nerve, and the median nerve. These nerves carry the signals from the brain to the muscles that move the arm. The nerves also carry signals back to the brain about sensations such as touch, pain, and temperature.
Nerves and Blood Vessels
Blood Vessels traveling along with the nerves are the large vessels that supply the arm with blood. The large axillary artery travels through the axilla. If you place your hand in your armpit, you may be able to feel the pulsing of this large artery. The axillary artery has many smaller branches that supply blood to different parts of the shoulder. The shoulder has a very rich blood supply.
Bursae sandwiched between the rotator cuff muscles and the outer layer of large bulky shoulder muscles are structures known as bursae. Bursae are everywhere in the body. They are found wherever two body parts move against one another and there is no joint to reduce the friction. A single bursa is simply a sac between two moving surfaces that contains a small amount of lubricating fluid.
Think of a bursa like this: If you press your hands together and slide them against one another, you produce some friction. In fact, when your hands are cold you may rub them together briskly to create heat from the friction. Now imagine that you hold in your hands a small plastic sack that contains a few drops of salad oil. This sack would let your hands glide freely against each other without a lot of friction.
Shoulder - Bursa
As you can see, the shoulder is extremely complex, with a design that provides maximum mobility and range of motion. Besides big lifting jobs, the shoulder joint is also responsible for getting the hand in the right position for any function. When you realize all the different ways and positions we use our hands every day, it is easy to understand how hard daily life can be when the shoulder isn't working well.
Portions of this document copyright MMG, LLC.
There can be a variety of root causes of sciatica, such as a herniated disc, degenerative disc disease, facet joint dysfunction, osteoarthritis and more. The center of a lumbar disc is filled with a jelly-like substance that can break through the outer layer and press on a nearby nerve root.
This nerve compression can cause nerve root pain in the back. Keep in mind that the disc walls are abundant with nerve fibers. Any tear through the wall can cause severe pain. As people age, the lumbar discs lose hydration and wear down. There is no cushion for any impact. Tears can also develop and cause pain. This condition is known as degenerative disc disease.
Facet joint dysfunction can also cause back pain and sciatica. If the cartilage of these joints is damaged or not functioning properly, the end result can be back pain or sciatica. Osteoarthritis is associated with aging. It is a condition that gradually progresses.
The discs and facet joints are worn down. It causes back pain, swelling and instability. Any trauma or compression fracture can result in sciatica, such as a car accident or a fall.
Do You Feel That Way Too?
Backpain and sciatica are often related. Sciatica causes back pain, numbness and weakness that radiates along the sciatic nerve.
The sciatic nerve is a big nerve that travels the full length of the body, following the lumbar region of the back and down the leg all the way to the feet.
Pain that radiates from your lower (lumbar) spine to your buttock and down the back of your leg is the hallmark of sciatica. You might feel the discomfort almost anywhere along the nerve pathway, but it's especially likely to follow a path from your low back to your buttock and the back of your thigh and calf. Pressure is usually put upon the lumbar nerve root. It is important to note that sciatica is a symptom of an underlying problem. It is not a diagnosis in itself. The pain can vary widely, from a mild ache to a sharp, burning sensation or excruciating pain. Sometimes it can feel like a jolt or electric shock. It can be worse when you cough or sneeze, and prolonged sitting can aggravate symptoms. Usually only one side of your body is affected. Some people also have numbness, tingling or muscle weakness in the affected leg or foot.
You might have pain in one part of your leg and numbness in another part.
Well, here's 4 things you can do:
1. First off, you need to make a decision about getting help. So many people procrastinate for so long, thinking that Sciatic pain will ‘just go away with time’, but then 6 months down the line they’re still putting up with it, and nothing’s changed… Or it gets worse
2. Next, do the RIGHT exercises - one of the best things to help you ease your Back and Sciatic pain is to do the right series of progressed exercises - the right exercises given to you by a Physical therapist will help reduce pain, and allow you to move freely again quick - and make sure that the problems don’t come back anytime soon (or aggravate your back even more like some exercises do).
3. Avoid sitting and long periods of rest - ever tried to get up from the sofa after resting for a while, but you struggle because your back feels so painful and tight? That’s because one of the worst things you can do that adds to Back pain is rest, and sit for long periods of time. Too much rest, and sitting in awkward positions makes your back stiff and tight. It would really help if you were given appropriate strengthening exercises for better posture, alongside hands-on treatment, to get you active and healthy as quickly as possible.
4. Get real, “hands-on” Physio - PT is proven to help people with low-back pain. In fact, at Body Balance Physical Therapy, it’s one of the most common injuries we see. If your back pain is affecting your job, your ability to keep active, if it threatens your independence or gets in the way of spending quality time with family and friends - Physical Therapy can help get you back to living the life you deserve as quickly as possible.
If you would like to know how the Physical Therapy team at Body Balance Physical Therapy can help you live with less Back pain - we invite you to start with a completely free, no-obligation, risk free appointment at our clinic.
Let's talk about exercise and back pain…
Last week I had a question asked by one of our patients, Mary, 58, from Lakeway… And it’s one that we get asked often at Body Balance Physical Therapy!!
“Is it ok to exercise when my back is hurting? I’ve just got into a good routine sticking to the gym and working out three times a week, and I really don’t want to stop…”
I get the frustration, and I also know that the thought of doing any movement at all when you’re going through some kind of pain might feel a little scary… You don’t want to run the risk of aggravating it any more in case it turns into something more serious.
You don’t want to go ‘too hard’ in the gym for fear you pull another muscle.
And you don’t want to wake up one day to find that you can no longer roll out of bed easily, walk down the road, or even drive because what you did, made it worse.
But don’t let that worry you too much – that’s rarely ever the case! An aching lower back doesn’t mean you’ve got to be housebound, with heat and ice packs until it magically disappears. You CAN keep moving! In fact, not moving at all can make your back pain worse! Here’s why…
If you suffer from lower back pain that comes and goes, gentle walking with exercises designed to improve lower back strength and movement added in, will make a big difference. Walking is a completely natural movement that keeps your joints mobile and muscles working – even those in your feet, lets, hips and torso – which play an important role in keeping the muscles in your back that hold you up right, strong.
Stretching combined with walking will improve your backs strength, flexibility and posture, which in turn, can help stop back pain from creeping up on you when you least expect it. What’s more, it can also reduce how painful it feels and how much it gets in the way of day to day life.
So here’s the important question to answer now that you know it 100% is ok to exercise even if you’ve got a bad back…
What exercise can you actually be doing? Because of course, too much exercise, or exercise that’s strenuous could make it worse or keep it hanging around longer.
Introducing Yoga. Even though there’s false beliefs around Yoga, like ‘you’ve got to be flexible’ etc., etc., etc… you can ditch those false beliefs behind because it’s for anyone! Let me tell you why – Yoga helps build strength.
Yoga requires you to concentrate on specific muscles in the body when holding poses – many of which improve back strength. When these muscles are stronger your back pain can be greatly reduced and is less likely to affect you as bad as it once did.
As well as strengthening, Yoga relaxes the body and reduces any tension in stress-carrying muscles (a.k.a your back!)
For people with lower back pain, stretching is important. Stretching the muscles in your legs actually help to increase range of movement in your hips, taking the stress off your lower back – which in addition increases blood flow, allowing nutrients to flow in, taking care of the muscles in your back.
It’s also one of the best forms of exercise to maintain and improve a healthy posture. Great for your back, stopping back pain in its tracks, and add to that it feels great when you can walk around confident and tall.
So there you have it, gentle walks and yoga. Both of these will help you gain back your strength in your back, so you can return to doing the exercise you love the most.
To start your physical therapy journey, go to
www.BodyBalanceLakeway.com and let us help heal you.
OK, I HAD to share this with you…
I received the most incredible email and photos this week from a patient of ours who only a year ago had been told her retirement plans, after working so hard for them, may in fact never become a reality.
How to Avoid the Trap of Back Pain Compromising Your Retirement Plans and Dreams… Retirement for many patients we see here at Body Balance means freedom to do what you want, when you want! You’ve worked so hard for it all your life and you’ve earned it!
Here’s just a few of the common retirement goals that our patients have shared with us: “When I retire I’m going to be more active, walk more, travel, spend more quality time with the family and my grandkids.”
I’m sure you’ve heard similar, and maybe you’re even planning the same for your retirement too? If so… keep reading!
There’s a common factor that we don’t take into consideration when planning our dreams than can often creep up on us – particularly in our 50s and 60’s…. And that’s the curse of back pain. So many of us have a lifestyle and jobs that involve a lot of sitting.
Whether this is on a computer, in an office or driving to and from work, its unavoidable! And our backs simply aren’t designed to take the pressure of sitting for so much of our lives. The thing is, when you’re younger you can “get away with it”. But here’s the thing, when we get older – it becomes hard to get away with this! Think of your body like a car – after so many years and miles of working hard, cars need a tuning up again to run smoothly. Well our bodies are exactly the same. So when was the last time you gave you’re body a complete check-up and tune-up? …
Ok, so back to Bridget (who has sent me her incredible photos) Bridget had a great career as a teacher – and a damn good one too, and had planned walking holidays far and wide with her husband for when they both retired.
Not long after she retired was when the most dreaded thing happened. ***BANG***. Back pain literally stopped her in her tracks.
Yes, Bridget had suffered with the odd aches and pains in her back over the years when she sat too long, but that’s quite normal right?
Those aches and pains are your bodies’ way of letting you know something’s not right and you need a "Tune-up".
After repeatedly being told by her physician “it's just ‘wear and tear’, keep taking pain killers” … Bridget came to us desperate to keep her dream of enjoying all of the walking holidays that she’s worked all her life for, alive.
Luckily Bridget (like many others suffering unnecessarily with aches and pains), just needed a few tight muscles relaxing and weak muscles strengthened. Simple!
Thank goodness Bridget didn’t listen and just "rest it", or she’d still be suffering now. Sounds scary right?
But instead she has just returned from an incredible two-week walking holiday in the Swiss Alps.
Now keeping herself strong with Pilates and her monthly “check-up” in the clinic, Bridget already has many more holidays planned for the future with her husband and family.
If you want to know more about how to make sure your future isn’t compromised by ill health just get in touch and go to www.BodyBalanceLakeway.com and claim your FREE discovery call today!