1. LOWER BACK PAIN
CHRONIC AND ACUTE

2. Nature of Condition Related to Anatomy
The lumbar spine refers to the lower back, where the spine curves inward toward the abdomen. The five vertebrae of the lumbar spine (L1-L5) are the biggest unfused vertebrae in the spinal column which enables them to support the weight of the entire torso. The lowest two spinal segments bear the most weight and are therefore the most prone to damage and injury.
The spine is supported by the erector spinae group. These muscles both support the spinal column as well as the weight of the upper body. The five lumbar vertebrae are connected by tough ligaments that help to maintain the position of the spinal column.
These muscles, ligaments, and bones all work together to provide control and strength for nearly all activities. For this reason, the lumbar spine is prone to injury, and when an injury has been sustained, people have difficulty performing many activities.

3. The first image to the left shows the most superficial muscles of the lower back - you might experience general ache covering the whole region.
The middle image shows the next level of muscles which are the Erector Spinae muscles - you might experience pain a little more specific to these muscles.
The image on the right shows the Sacroiliac Joints which are a common source of pain and the Quadratus Lumborum(QL) muscles.

4. When the lumbar spine is strained or sprained, inflammation of the soft-tissues result causing pain and sometimes muscle spasm. People are often surprised at how painful a lumbar strain or sprain can be. They often cause severe symptoms for a few days and may not completely resolve for weeks or months. That said, over 90% of patients are completely recovered from an episode of lumbar muscle strain or sprain within one month.
Back pain is classified according to how long it lasts:
Acute back pain – described as pain that has lasted
less than 6 weeks in duration may resolve itself with little
or no intervention.
Sub-acute back pain – described as pain that lasts
between 6 and 12 weeks in duration.
Chronic back pain – described as pain that lasts longer
than 12 weeks in duration and is likely to require attention
and care.

5. Causes of Lower Back Pain
Pain in the lower (lumbar) back - sometimes called lumbago is the most common form of back pain. Most of the time, low back pain improves on its own within a few weeks and people can return to everyday activities. But back pain can also be very disabling, and become a chronic physical and psychological burden.
Muscle strains and lumbar sprains are the most common causes of lower back pain.
A lower back muscle strain occurs when the muscles of the back are abnormally stretched too far.
A lumbar sprain occurs when the ligaments, (the tough bands of tissue that hold bones together), are torn from their attachments.
Pain in any part of the back can be caused by problems affecting the bones, muscles or nerves of the spine.

6. A few examples include: Bad posture, poor conditioning, age, obesity, improper use, lifting technique or damage to a spinal disc can cause back pain.
Back pain is a very individual matter and can have many causes. People can have no sign of anything wrong and still be in pain – while others can show signs of wear and tear in their back on an x-ray, and have no pain whatsoever.
There are a lot of factors that tend to influence the development of lower back pain, and often these symptoms strike in unexpected situations. Most commonly, patients who develop a lumbar strain or sprain are doing an activity that places their back at risk.
This may be a sudden forceful movement, lifting a heavy
object, or twisting the back in an unusual manner.
Knowing how to properly lift can help to prevent many
back injuries.

7. Signs and Symptoms
Pain in the lower back can be anything from an occasional ache to a constant discomfort that affects a person’s work and home life.
These lower back pain symptoms include any combination of the following:
Inflammation
Local soreness upon touch
Pain that tends to be dull and achy
Pain around the low back and upper buttocks
Low back muscle spasm, which can be mild or severe
Pain associated with activities, and is generally relieved with rest
Difficulty moving that can be severe enough to prevent walking or standing
Severe or aching pain in the lower back after activity, sudden movement or lifting a heavy object.

8. Benefits of Massage
For overall relaxation and circulation, many patients find the Swedish Massage technique helpful. Shiatsu Massage is also a popular technique that utilizes some of the elements of Neuromuscular Therapy, which involves the therapist applying alternating levels of concentrated pressure (10-30 seconds) on the areas of muscle spasm. The patient will feel some pain or discomfort from the pressure, but the muscle spasm should be lessened after the massage. Any soreness from the pressure should fade in 1 to 3 days, and the muscles that were worked on should feel less tight for a week or two afterwards.
A combination of massage and exercises for lower back pain are most effective. This exercise could be moderate physical therapy, working out more often (which also helps loosens muscles), or slow and controlled movements such as those used in yoga.
The majority of healthcare practitioners recognize massage for lower back pain as beneficial and actively encourage patients with back pain to seek therapy of this kind in addition to conventional medical treatment.

9. When should you not massage someone with lower back pain?
Contraindications
When should you not massage someone with lower back pain?
If a client has Osteoporosis (especially common in elderly people or women after menopause) as the calcium in the bones reduces and the bones become soft and crumbly, there may be chronic back pain and in advanced stages the vertebrae may fracture. Massage in this circumstance should be gentle, with no stretches or joint manipulations.
If a client has Cauda Eqina Syndrome (CES), a significant narrowing of the lower part of the spinal canal in which nerves become pinched and may cause severe pain, weakness, loss of feeling in one or both legs, and bowel or bladder problems.
If a client has a herniated disc, which is compression of a nerve root when a vertebral disc ruptures and part of the contents is displaced onto the spinal cord or more often the nerve roots. In acute stages of this, refer clients to an osteopath, chiropractor or physio practitioner. In non-acute stages massage may relax associated muscle tension.

10. Conclusion
Nearly everyone will experience lower back pain at some point in their life.
While most lower back pain and injuries are caused by a muscle strain or ligament sprain, there are serious conditions that require more immediate treatment. If you are unsure of the cause of your symptoms, you should be evaluated by a physician.