Welcome to Orleans Physiotherapy'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
how these parts work
Hear from some of our patients who we treated for Back Pain
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I just happened to stumble upon this clinic when searching for an emergency appointment for a herniated disc. Jagrutiben Asudani had an opening within 48hrs, and I'm so grateful for it. She is... ”
“ I just happened to stumble upon this clinic when searching for an emergency appointment for a herniated disc. Jagrutiben Asudani had an opening within 48hrs, and I'm so grateful for it. She is knowledgeable, thorough and very professional. She uses a variety of techniques and sends clear instructions for completing exercises at home. I highly recommend Jag. ”
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I have a fantastic experience working with this medical facility. Jag is a knowledgeable and skilled physiotherapist who is an expert in the human body. She utilized a variety techniques, including... ”
“ I have a fantastic experience working with this medical facility. Jag is a knowledgeable and skilled physiotherapist who is an expert in the human body. She utilized a variety techniques, including manual therapy, acupuncture, and personalized exercises, to help me find relief from my lower back pain. I highly recommend Jag to anyone seeing expert physiotherapy treatment delivered with skill and passion. ”
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Having injured my back two weeks ago, I was looking for a clinic that could see me right away as things were progressively getting worse. I've then had the pleasure of finding this place and meeting... ”
“ Having injured my back two weeks ago, I was looking for a clinic that could see me right away as things were progressively getting worse. I've then had the pleasure of finding this place and meeting Jagrutiben. Her gentle approach made me feel that I was in good hands. She is very knowledgeable and friendly. She does not rush you, she takes time to explain you and inform you about what can be done to relieve your pain. The treatments received from her including the acupuncture, massage, the circulation promoter device used to stimulate the muscles and nerves, the streching,... helped to improve my condition and I am getting better everyday. A big thanks to Jagrutiben for just being one of the best Physiotherapist out there❣️ ”
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Clint was quick to diagnose and explain the problem with my back. His prognosis was accurate, and now I'm in recovery. The exercise program he provided was very applicable. Thanks for your help.... ”
“ Clint was quick to diagnose and explain the problem with my back. His prognosis was accurate, and now I'm in recovery. The exercise program he provided was very applicable. Thanks for your help. Clinic staff was very helpful and efficient - thanks to you too. ”
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There are many physiotherapists close home; however, I choose to drive the 40km round trip, twice a week to receive the top notch care I get at Orleans Physiotherapy. Natasha Green treated me at... ”
“ There are many physiotherapists close home; however, I choose to drive the 40km round trip, twice a week to receive the top notch care I get at Orleans Physiotherapy. Natasha Green treated me at another clinic a few years ago following a car accident. I was delighted to be able to find her again when my back and legs were giving me so much trouble. Natasha is very knowledgeable, professional and friendly. After years of suffering from chronic pain, with her treatments and exercise plans, I have had so much more mobility, better sleeps and overall improved quality of life. The clinic itself is very clean, bright and welcoming. The office staff are all wonderful. Very polite, friendly and excellent with communications. I highly recommend Natasha and Orleans Physiotherapy and am grateful for their services. ”
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I am thrilled to say how pleased I am with the amazing, professional, knowledgeable and always up-to-date staff at Orleans Physiotherapy from the front desk staff to the health care professionals. I... ”
“ I am thrilled to say how pleased I am with the amazing, professional, knowledgeable and always up-to-date staff at Orleans Physiotherapy from the front desk staff to the health care professionals. I had gone to see them 15 years ago for a back issue and later a knee issue. I am now there for neck, shoulder, arm pain. Natasha Green is one of the newer members on the team and I cannot say enough about her expertise, compassion and knowledge. She uses techniques that work magic on my pain - dry needling, manual therapy (where she pinpoints precisely the area of need), laser etc. And of course, Orleans Physiotherapy follows all Covid protocols to ensure everyone is safe. I highly recommend Orleans Physiotherapy! ”
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I have been seeing Clint at Orleans Physiotherapy on and off for several years for different problems either for shoulder issues. back issues or knee issues and I had always received excellent care.... ”
“ I have been seeing Clint at Orleans Physiotherapy on and off for several years for different problems either for shoulder issues. back issues or knee issues and I had always received excellent care. Most important. I have always recover with the help of the treatments and the exercises.I am now seeing Clint for knee issues and in spite of the pandemic I feel safe as the staff take all the safety measures necessary to protect their clients. The receptionists are polite, knowledgeable and will do their best to accommodate my schedule. ”
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I have been a client of Clint’s for several years. Without a doubt one of the best decisions I have ever made. Recently have been suffering with extreme sciatica. Clint has made it possible to keep... ”
“ I have been a client of Clint’s for several years. Without a doubt one of the best decisions I have ever made. Recently have been suffering with extreme sciatica. Clint has made it possible to keep my daily activities possible. I highly recommend The Orleans Physio family they really know what you need to recover and keep living a full life and truly care about each of their patients. ”
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I highly recommend Orleans Physio. Very knowledgeable and friendly staff. Have been with them for a few years now for various issues. Hurt my lower back last week and they took me right away...went... ”
“ I highly recommend Orleans Physio. Very knowledgeable and friendly staff. Have been with them for a few years now for various issues. Hurt my lower back last week and they took me right away...went for my follow-up today and am almost 100%. They are truly the best...thanks to Clint, Natasha and Clifford. ”
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I was treated mostly by Clint for lower back pain issues. I herniated 2 discs about 40 years ago and have been living with various degrees of pain during that time. I consulted with Orleans... ”
“ I was treated mostly by Clint for lower back pain issues. I herniated 2 discs about 40 years ago and have been living with various degrees of pain during that time. I consulted with Orleans Physiotherapy after a move since I felt that the pain I was experiencing was much more than I normally experience. After just a couple of sessions, I noticed a huge improvement. I continued with the treatments and prescribed exercises for about 4 months. The pain is not fully gone but much more tolerable. I would imagine that at age 62, part of the reason for the pain is due to a certain amount of arthritis and that I must continue to stay active and exercise regularly. This is the best physiotherapy clinic I’ve been to and can highly recommend their services. The staff is always happy to see you and they have a great sense of humour as well. Keep up the great work and thanks for everything guys! ”
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I am a first time client at Orleans Physio. I was referred by my family doctor for lower back pain. Natasha was my assigned physio. I could not have been happier with my experience. I left my first... ”
“ I am a first time client at Orleans Physio. I was referred by my family doctor for lower back pain. Natasha was my assigned physio. I could not have been happier with my experience. I left my first appointment with an exercise plan, and tips to facilitate comfortable sitting and standing. I came in the clinic feeling one way and left feeling more comfortable and encouraged. Natasha is professional, competent and caring. I am delighted I was referred to this clinic and delighted to have Natasha as my physio. Thank-you, Orléans Physio. ”
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**I’m back for more and happy to see my wonderful friends here at Orleans Physiotherapy ** Me and my family and friends have been going to Orleans Physiotherapy for years. They are the nicest... ”
“ **I’m back for more and happy to see my wonderful friends here at Orleans Physiotherapy ** Me and my family and friends have been going to Orleans Physiotherapy for years. They are the nicest people that you would ever meet. Not only do they meet every challenge with up-to-date knowledge and equipment but they do it with a smile and a wonderful atmosphere. It really is a family. My recent injury to my side (originating from my back as it turns out) was debilitating. I can now take a full breath AND roll over in bed without crying. I am soooo grateful. They really are the best! ”
“
I had heard about Orleans Physiotherapy Clinic for years and have now started seeing Clint for my back issues. He is attentive, friendly and takes his time to explain what he is doing, why and how it... ”
“ I had heard about Orleans Physiotherapy Clinic for years and have now started seeing Clint for my back issues. He is attentive, friendly and takes his time to explain what he is doing, why and how it will help. The overall service at the clinic is excellent and I would highly recommend Orleans Physiotherapy. ”
“
Have been coming to Orleans Physio for my back and they have done wonders for my recovery! Great service and knowledgeable staff!! Would definitely recommend to friends and family! ”
“ Have been coming to Orleans Physio for my back and they have done wonders for my recovery! Great service and knowledgeable staff!! Would definitely recommend to friends and family! ”
“
Unfortunately, I had to visit the Physiotherapist for the first time this week... after calling a few places telling me they were unable to fit me in last minute until the next couple of days, I ended... ”
“ Unfortunately, I had to visit the Physiotherapist for the first time this week... after calling a few places telling me they were unable to fit me in last minute until the next couple of days, I ended up calling Orleans Physio and 4 hours later I was sitting in with Celine. I could barely walk or breathe due to massive back pain. I have a high pain tolerance and this pain was unbearable. Within 48 hours of my visit, I was back to doing my everyday activities with minor back pain. The staff was phenomenal and you can tell they care for your well being. Celine went over and beyond to adequately suit my needs and answer all of my questions. I highly recommend this clinic! Thank you Orleans Physio! ”
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.
Lower Vertebrae
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.
Bony Ring
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.
Facet Joints
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.
Articular Cartilage
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.
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
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.
Ligaments
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 spinae, 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.
Summary
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.
The important parts of the lumbar spine include:
