Lower back pain is a common cause for visits to the doctor. According to the National Institute of Neurological Disorders and Stroke (NINDS), low back pain is the second most common neurological problem in the U.S., and Americans spend an average of $50 billion per year treating low back pain. (NINDS, 2012)
Most low back pain is the result of an injury, such as muscle sprains or strains due to sudden movements or poor body mechanics while lifting heavy objects. But low back pain can also be caused by certain diseases, such as cancer of the spinal cord, ruptured or herniated disc, sciatica, arthritis, kidney infections, or infections of the spine. Acute back pain can last anywhere from a few days to a few weeks, while chronic back pain is pain that lasts longer than three months.
Lower back pain is more likely to occur in individuals between the ages of 30 and 50. This is partly due to the changes that occur in the body with aging. As you grow older, the fluid content between the vertebrae in the spine becomes reduced, which means discs in the spine are more easily irritated. Some muscle tone is also lost, which makes the back more prone to injury. This is why strengthening your back muscles and using good body mechanics are helpful in preventing lower back pain.
The muscles and ligaments in the back can be stretched or torn due to over-activity. Symptoms include pain and stiffness in the lower back, as well as muscle spasms. These symptoms tend to be relieved with rest and physical therapy.
The discs in the back are prone to injury, and this risk increases with age. The outside of the disc can be torn or may be herniated. A herniated disc (also called a slipped or ruptured disc) and occurs when the cartilage surrounding the disc pushes against the spinal cord or nerve roots. The cushion that sits between the spinal vertebrae is pushed outside its normal position. This can result in compression of the nerve root as it exits from the spinal cord and through the vertebral bones. Disc injury usually occurs suddenly after lifting something or twisting the back. Unlike a back strain, pain from a disc injury usually lasts for more than 72 hours.
Sciatica can occur with a herniated disc if the disc presses on the sciatic nerve. The sciatic nerve connects the spine to the legs. As a result, sciatica can cause pain in the legs and feet. This pain is usually felt as a burning or pins-and-needles sensation.
Spinal stenosis is when the spinal column narrows, putting pressure on the spinal cord and spinal nerves. Spinal stenosis is most commonly caused by degeneration of the discs between the vertebrae. The result is compression of the nerve roots or spinal cord by bony spurs or soft tissues, such as discs. Symptoms are usually caused by the pressure on the spinal nerves and may include numbness, cramping, and weakness. These symptoms may be felt anywhere in the body. Many people with spinal stenosis notice their symptoms worsen when standing or walking.
Abnormal Spine Curvatures
Scoliosis, kyphosis, and lordosis are all conditions that cause abnormal curvatures in the spine. These are congenital conditions and are usually diagnosed in children and teenagers. The abnormal curvature places pressure on the muscles, tendons, ligaments, and vertebrae, causing pain and poor posture.
Along with the above conditions, there are a number of other conditions that cause lower back pain. These conditions include:
- arthritis (Lumbar osteoarthritis is a very painful condition which affects the lower back)
- fibromyalgia - long-term pain and tenderness in the joints, muscles, and tendons
- spondylitis - inflammation of the joints between the spinal bones
- spondylosis (spinal osteoarthritis) is a degenerative disorder that may cause loss of normal spinal structure and function. Although aging is the primary cause, the location and rate of degeneration is individual.
- kidney and bladder problems (severe infections of the bladder can cause low back pain)
- pregnancy (due to the increased strain on the lower back and the change in body posture)
- endometriosis - a painful condition where cells from the uterus grow in other parts of the body
- ovarian cysts - a fluid-filled growth on the inside or outside of an ovary
- uterine fibroids - non-cancerous tumors in the uterus
Most doctors begin by conducting a physical examination to determine where you are feeling the pain, as well as if your range of motion has been affected. Your doctor may also check your reflexes and your response to certain sensations. This is done to determine if your nerves are affected by your lower back problem. Unless you have concerning or debilitating symptoms, your doctor will probably monitor your condition for a few weeks before sending you for testing. This is because most lower back pain resolves using simple self-care treatments.
If you are experiencing certain symptoms like lack of bowel control, weakness, fever, or weight loss, or your low back pain remains after several weeks of home treatment, your doctor may wish to send you for tests. Seek medical attention immediately if you are experiencing any of these symptoms in addition to lower back pain.
Imaging tests include X-rays, computerized tomography (CT) scans, ultrasound, and magnetic resonance imaging (MRI), may be ordered so your doctor can check for bone problems, disc problems, or problems with the ligaments and tendons in your back.
If your doctor suspects a problem with the bones in your back, they may send you for a bone scan or bone density test. Electromyography (EMG) or nerve conduction tests can be ordered if a problem with your nerves is suspected.
Self-care methods are suggested for the first 72 hours after the pain began. If the pain is not getting better after 72 hours of home treatment, you should call your doctor. Self-care includes:
- rest - stop your normal physical activities for a couple days
- applying ice - generally doctors recommend using ice for the first 48 to 72 hours then switching to heat
- RICE protocol (rest, ice, compression and elevation) is recommended within the first 48 hours
- alternating ice packs with a heating pad to relax muscles
- taking over-the-counter pain medication like ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol) can relieve pain and inflammation
- sometimes lying on your back causes more discomfort; if so, trying lying on your side with your knees bent and a pillow between your legs; if you are lying on your back reasonably comfortably, it is helpful to place a pillow or rolled-up towel beneath your legs to elevate your feet to reduce the pressure on the lower back
- a warm bath can often relax stiff and knotted muscles in the back
Because the cause of typical lower back pain is related to a number of different things, including muscle strain and weakness, pinched nerves, and spinal cord misalignment, there is a wide variety of medical treatments such as medications, medical appliances, and physical therapy. Your doctor will determine the appropriate dosage and application of drugs and medications based on your symptoms. Medical treatment for low back pain may include:
- muscle relaxants
- non-steroidal anti-inflammatory drugs (NSAIDs)
- narcotic drugs (such as codeine) for pain relief
- steroids (to reduce inflammation)
- corticosteroid injections
- physical therapy, including massage, stretching, strengthening exercises, and back and spinal manipulation
For severe cases, surgery may be required. As back surgery can be invasive, surgery is usually only considered when all other options have been exhausted and your doctor knows the cause of your lower back pain. Different potential surgical procedures include:
- discectomy - to take pressure off a nerve root being pressed on by a bulging disc or bone spur, the surgeon will remove a small piece of the lamina, a bony part of the spinal canal
- foraminotomy - a surgical procedure that opens up the foramen, the bony hole in the spinal canal where the nerve root exits
- IntraDiscal Electrothermal Therapy (IDET) - involves inserting a needle through a catheter into the disc and heating it up for 20 minutes, which makes the disc wall thicker and cuts down on the inner disc’s bulging and irritation of the nerve
- nucleoplasty - a wand-like device is inserted through a needle into the disc so inner disc material can be removed; the device then uses radio waves to heat the tissue and shrink it
- radiofrequency lesioning - a way to use radio waves to interrupt the way the nerves communicate with each other; a special needle is inserted into the nerves and is heated, which destroys the nerves
- spinal fusion - in order to make the spine stronger and cut down on painful motion, the discs between two or more of the vertebrae are removed and the vertebrae next to each other are fused with bone grafts and/or special metal screws
- spinal laminectomy - also called spinal decompression, this surgical technique removes the lamina to make the size of the spinal canal bigger, which relieves pressure on the spinal cord and nerves.
There are many ways in which low back pain can be prevented. Practicing prevention techniques may also help to lessen the severity of your symptoms should you experience a lower back injury. Prevention involves:
- exercising the muscles in your abdomen and back
- losing weight if you are overweight
- lifting items properly by bending at the knees and lifting with the legs
- maintaining proper posture
- sleeping on a firm surface
- sitting on supportive chairs that are at the correct height
- avoiding high-heeled shoes
- quitting smoking – nicotine degenerates spinal discs and also reduces blood flow