• Age - Most patients experience lower back pain as they age. Osteoporosis can develop, leading to fractures. Additionally, spinal stenosis increases with age due to lost cushioning and reduced muscle elasticity in the vertebrae
• Fitness - Out-of-shape people are more likely to develop back pain. Weak abdominal muscles create lack of support for the spine
• Pregnancy - Pelvic changes caused by increased pregnancy weight gain can cause lower back injuries. This does not always resolve after childbirth
• Obesity - Excess weight can cause back aches and pains
• Genes - Inherited conditions can cause lower back pain. Ankylosing spondylitis, a genetic form of arthritis, can cause lower back pain as spinal joints fuse together

• Job-related risks - Lifting and pushing heavy objects can cause injuries. Sedentary desk jobs can trigger back pain due to poor posture or back support
• Mental illness - Anxiety and depression can alter how a person perceives pain. Chronic pain can also lead to the development of psychological issues that affect the body in several ways
• Backpack overload - Heavy backpacks can strain younger children’s back muscles. Backpacks shouldn’t weigh more than 20 percent of the child’s body weight
• Smoking - Smokers have increased rates of back pain. This may occur because smoking prompts more coughing, which can lead to herniated disks. Smoking can also decrease blood flow to the spine and increase the risk of osteoporosis

1. Pain management

• TENS - TENS therapy has been used to relieve both chronic (long lasting) and acute (short-term) pain
• Soft tissue manipulation (STM) -
  • Promote local and systemic relaxation and invigoration
  • Improvement the vascular and lymphatic circulation
  • Regulation of the nervous system
  • Reduction of muscular tension
• Joint mobilization - A physical therapy technique designed to relieve pain and muscle spasms, release tension and improve flexibility in a joint. By increasing the client’s awareness of the correct position and movement of a joint and simulating smooth joint function, joint mobilization improves range of motion and mobility
• Mulligan techniques - Designed to reduce pain and improve the patient’s range of motion the Mulligan technique involves Natural Apophyseal Glides (NAGS), Sustained Natural Apophyseal Glides (SNAGS) and Mobilization with Movement (MWM) for the treatment of musculoskeletal injuries

2. Stretching exercises

• Used to reduce tension in muscles supporting the spine; tension in these muscles can worsen pain from any number of back pain conditions
• Improving range of motion and overall mobility
• Reducing risk of disability caused by back pain
• Examples of stretching exercise for back pain :
  • Knee to Chest Stretch - Lie on the back with the knees bent and both heels on the floor, then place both hands behind one knee and pull it toward the chest, stretching the gluteus and piriformis muscles in the buttock
  • Piriformis Muscle Stretch - Lie on the back with knees bent and both heels on the floor. Cross one leg over the other, resting the ankle on the bent knee, then gently pull the bottom knee toward the chest until a stretch is felt in the buttock. Or, lying on the floor, cross one leg over the other and pull it forward over the body at the knee, keeping the other leg flat

3. Strengthening exercises

• Strengthening the muscles that support the spine, removing pressure from the spinal discs and facet joints
• Minimizing the frequency of back or neck pain episodes, and reducing the severity of pain when it does occur
• Examples of strengthening exercise for back pain :
  • bridge -
    • Lie on the ground and bend the knees, placing the feet flat on the floor hip-width apart
    • Press the feet into the floor, keeping the arms by the sides
    • Raise the buttocks off the ground until the body forms a straight line from the shoulders to the knees
    • Squeeze the buttocks with the shoulders remaining on the floor

• • Lower the buttocks to the ground and rest for a few seconds
  • Repeat 15 times and then rest for 1 minute
  • Do 3 sets of 15 repetitions
• draw-in maneuver - works the transversus abdominis. This muscle is on the front and side of the abdomen, stabilizing the spine and lower back region
• To perform the draw-in maneuver -
  • Lie back on the floor with knees bent and feet flat, keeping the arms by the sides
  • Breathe in deeply
  • While breathing out, pull the bellybutton toward the spine, tightening the abdominal muscles and keeping the hips still
  • Hold the position for 5 seconds
  • Repeat 5 times