Low Back Pain

Low back pain is the most common cause of job-related disability and a leading contributor to missed work. Fortunately, most occurrences of low back pain go away within a few days. Others take much longer to resolve or lead to more serious conditions.

Acute low back pain generally lasts from a few days to a few weeks. Most acute back pain is mechanical in nature, the result of trauma to the lower back or a disorder such as arthritis. Pain from trauma may be caused by a sports injury, work around the house or in the garden, or a sudden jolt such as a car accident or other stress on spinal bones and tissues. Symptoms may range from muscle ache to shooting or stabbing pain, limited flexibility and/or range of motion, or an inability to stand straight.

Chronic low back pain is pain that persists for more than 3 months. It is often progressive and the cause can be difficult to determine.

Men and women are equally affected. It occurs most often between ages 30 and 50, due in part to the aging process but also as a result of sedentary lifestyles. The risk of experiencing low back pain from disc disease or spinal degeneration increases with age.

Low back pain may reflect nerve or muscle irritation or bone lesions. Most low back pain follows injury or trauma to the back causing sprain, strain or spasm in one or more muscles or ligaments of the back. But pain may also be caused by degenerative conditions such as arthritis or disc disease, osteoporosis or other bone diseases, viral infections, irritation to joints and discs, or congenital abnormalities in the spine. Obesity, smoking, weight gain during pregnancy, stress, poor physical condition, posture inappropriate for the activity being performed, and poor sleeping position also may contribute to low back pain. Additionally, scar tissue created when the injured back heals itself does not have the strength or flexibility of normal tissue and can eventually weaken the back and can lead to more serious injury.

Occasionally, low back pain may indicate a more serious medical problem. Pain accompanied by fever or loss of bowel or bladder control, pain when coughing, and progressive weakness in the legs may indicate a pinched nerve or other serious condition. People with these symptoms should contact a doctor immediately to help prevent permanent damage.

Causes

Conditions that may cause low back pain and require treatment by a physician or other health specialist include:

Bulging disc (also called protruding, herniated, or ruptured disc) – As discs degenerate and weaken, cartilage can bulge or be pushed into the space containing the spinal cord or a nerve root, causing pain. Studies have shown that most herniated discs occur in the lower, lumbar portion of the spinal column.

Sciatica – is a condition in which a herniated or ruptured disc presses on the sciatic nerve. This compression causes shock-like or burning low back pain combined with pain through the buttocks and down one leg to below the knee, occasionally reaching the foot. In the most extreme cases, when the nerve is pinched between the disc and an adjacent bone, the symptoms involve not pain but numbness and some loss of motor control over the leg due to interruption of nerve signaling.

Spinal degeneration – from disc wear and tear can lead to a narrowing of the spinal canal. A person with spinal degeneration may experience stiffness in the back upon awakening or may feel pain after walking or standing for a long time.

Spinal stenosis – related to congenital narrowing of the bony canal predisposes some people to pain related to disc disease.

Osteoporosis– is a metabolic bone disease marked by progressive decrease in bone density and strength. Fracture of brittle, porous bones in the spine and hips results when the body fails to produce new bone and/or absorbs too much existing bone.

Skeletal irregularities – produce strain on the vertebrae and supporting muscles, tendons, ligaments, and tissues supported by spinal column. These irregularities include scoliosis, a curving of the spine to the side; kyphosis, in which the normal curve of the upper back is severely rounded; lordosis, an abnormally accentuated arch in the lower back; back extension, a bending backward of the spine; and back flexion, in which the spine bends forward.

Spondylitis refers to chronic back pain and stiffness caused by a severe infection to or inflammation of the spinal joints. Other painful inflammations in the lower back include osteomyelitis (infection in the bones of the spine) and sacroiliitis (inflammation in the sacroiliac joints).

Diagnosis

A thorough medical history and physical exam can usually identify any dangerous conditions or family history that may be associated with the pain. The patient describes the onset, site, and severity of the pain; duration of symptoms and any limitations in movement; and history of previous episodes or any health conditions that might be related to the pain. The physician will examine the back and conduct neurologic tests to determine the cause of pain and appropriate treatment. Blood tests may also be ordered. Imaging tests may be necessary to diagnose tumors or other possible sources of the pain.

A variety of diagnostic methods are performed to confirm the cause of low back pain including X-ray, CT-scan or MRI. Electrodiagnostic procedures include electromyography (EMG), nerve conduction studies, and evoked potential (EP) studies. EMG assesses the electrical activity in a nerve and can detect if muscle weakness results from injury or a problem with the nerves that control the muscles. Bone scans are used to diagnose and monitor infection, fracture, or disorders in the bone.

Treatment

Most low back pain can be treated without surgery. Treatment involves using analgesics, reducing inflammation, restoring proper function and strength to the back, and preventing recurrence of the injury. Most patients with back pain recover without residual functional loss.

  • Ice and heat – Compresses may help reduce pain and inflammation and allow greater mobility for some individuals.
  • Bed rest for 1-2 days at most. Patients should resume activities as soon as possible. At night or during rest, patients should lie on one side, with a pillow between the knees.
  • Exercise may be the most effective way to speed recovery from low back pain and help strengthen back and abdominal muscles. Maintaining and building muscle strength is particularly important for persons with skeletal irregularities. Doctors and physical therapists can provide a list of gentle exercises that help keep muscles moving and speed the recovery process. A routine of back-healthy activities may include stretching exercises, swimming, walking, and movement therapy to improve coordination and develop proper posture and muscle balance.
  • Medications are often used to treat acute and chronic low back pain. Effective pain relief may involve a combination of prescription drugs and over-the-counter remedies. Patients should always check with a doctor before taking drugs for pain relief.

When back pain does not respond to more conventional approaches, patients may consider the following options: acupuncture, spinal manipulation, biofeedback, transcutaneous electrical nerve stimulation (TENS) and ultrasound therapy.

Occasionally, Interventional therapy can ease chronic pain by blocking nerve conduction between specific areas of the body and the brain. Approaches range from injections of local anesthetics, steroids, or narcotics into affected soft tissues, joints, or nerve roots to more complex nerve blocks and spinal cord stimulation.

In the most serious cases, when the condition does not respond to other therapies, surgery may relieve pain caused by back problems or serious musculoskeletal injuries.

Prevention

Recurring back pain resulting from improper body mechanics or other non-traumatic causes is often preventable. A combination of exercises that don’t jolt or strain the back, maintaining correct posture, and lifting objects properly can help prevent injuries.