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
most common cause of job-related disability. At least 80 percent of Americans
will experience low back pain in their lifetimes.
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. Low back pain can also be the result of certain diseases, such
as cancer of the spinal cord, a 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.
Low 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
reduces. This means discs in the spine experience irritation more easily. You
also lose some muscle tone, which makes the back more prone to injury. This is
why strengthening your back muscles and using good body mechanics are helpful
in preventing low back pain.
Are the Causes of Low Back Pain?
The muscles and ligaments in the back can stretch or tear due to excess
activity. Symptoms include pain and stiffness in the lower back, as well as
muscle spasms. Rest and physical therapy are remedies for these symptoms.
The discs in the back are prone to injury, and this risk
increases with age. The outside of the disc can tear or herniate. A herniated
disc (also known as a slipped or ruptured disc) occurs when the cartilage
surrounding the disc pushes against the spinal cord or nerve roots. The cushion
that sits between the spinal vertebrae extends 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 usually feels
like burning or pins and needles.
Spinal stenosis is when the spinal column narrows, putting
pressure on the spinal cord and spinal nerves. Spinal stenosis is most commonly
due to 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. Pressure on the spinal nerves causes symptoms such as numbness,
cramping, and weakness. You might feel these symptoms anywhere in the body.
Many people with spinal stenosis notice their symptoms worsen when standing or
Abnormal Spine Curvatures
Scoliosis, kyphosis, and lordosis are all conditions that cause
abnormal curvatures in the spine. These are congenital conditions and are
usually first diagnosed when patients are children and teenagers. The abnormal
curvature places pressure on the muscles, tendons, ligaments, and vertebrae,
causing pain and poor posture.
There are a number of other conditions that cause lower back
pain. These conditions include arthritis, fibromyalgia (long-term pain and
tenderness in the joints, muscles, and tendons), spondylitis (inflammation of
the joints between the spinal bones), and spondylosis (a degenerative disorder
that may cause loss of normal spinal structure and function). Although aging is
the primary cause of spondylosis, the location and rate of degeneration is
Kidney and bladder problems, pregnancy, endometriosis, ovarian
cysts, uterine fibroids, and cancer can also cause low back pain.
Is Low Back Pain Diagnosed?
Most doctors begin by conducting a physical examination to
determine where you’re feeling the pain. A physical exam can also determine if
pain is affecting your range of motion. Your doctor may also check your
reflexes and your response to certain sensations. This determines if your low
back pain is affecting your nerves. 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 low back pain resolves
using simple self-care treatments.
Certain symptoms like lack of bowel control, weakness, fever, and
weight loss might require more testing. Likewise, if your low back pain continues
after home treatment, your doctor may wish to send you for tests. Seek medical
attention immediately if you experience any of these symptoms in addition to
low back pain.
Imaging tests such as X-rays, CT scans, ultrasound, and MRI may
be necessary 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 help identify a problem with your nerves.
Are the Treatment Options for Low Back Pain?
Self-care methods are helpful for the first 72 hours after the
pain begins. If the pain doesn’t improve after 72 hours of home treatment, you
should call your doctor.
Stop your normal physical activities for a couple days and apply
ice to your low back. Doctors generally recommend using ice for the first 48 to
72 hours, then switching to heat. Alternate ice and heat to relax muscles. The RICE
protocol (rest, ice, compression, and elevation) is recommended within the
first 48 hours.
Take over-the-counter pain medication, such as ibuprofen (Advil,
Motrin IB) or acetaminophen (Tylenol), to relieve pain.
Sometimes lying on your back causes more discomfort. If so, try
lying on your side with your knees bent and a pillow between your legs. If you can
lie comfortably on your back, place a pillow or rolled-up towel beneath your thighs
to reduce the pressure on the lower back.
A warm bath or a massage can often relax stiff and knotted
muscles in the back.
Low back pain can occur with a number of different conditions,
including muscle strain and weakness, pinched nerves, and spinal cord
misalignment. There are a number of possible medical treatments including
medications, medical appliances, and physical therapy. Your doctor will
determine the appropriate dosage and application of drugs and medications based
on your symptoms.
Some medications your doctor may prescribe include muscle
relaxants, nonsteroidal anti-inflammatory drugs (NSAIDs), narcotic drugs such
as codeine for pain relief, steroids to reduce inflammation, and corticosteroid
Your doctor may also prescribe physical therapy, including
massage, stretching, strengthening exercises, and back and spinal manipulation.
For severe cases, surgery may be necessary. Surgery is usually
only an option when all other treatments fail unless there is loss of bowel or
bladder control or a progressive neurological loss when it becomes an
A discectomy relieves pressure from a nerve root 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.
A foraminotomy is 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. This makes
the disc wall thicker and cuts down on the inner disc’s bulging and irritation
of the nerve.
A nucleoplasty uses a wand-like device inserted through a needle
into the disc. It can then remove inner disc material. The device then uses
radio waves to heat and shrink the tissue.
Radiofrequency lesioning or ablation is a way to use radio waves
to interrupt the way the nerves communicate with each other. A surgeon inserts
a special needle into the nerves and heats it, which destroys the nerves.
Spinal fusion makes the spine stronger and cuts down on painful
motion. The procedure removes discs between two or more of the vertebrae. The
surgeon then fuses the vertebrae next to each other with bone grafts or special
A spinal laminectomy, also known as spinal decompression, removes
the lamina to make the size of the spinal canal bigger. This relieves pressure
on the spinal cord and nerves.
Can I Prevent Low Back Pain?
There are many ways to prevent low back pain. Practicing
prevention techniques may also help lessen the severity of your symptoms if you
have a lower back injury. Prevention involves exercising the muscles in your
abdomen and back, losing weight if you are overweight, lifting items properly (bending
at the knees and lifting with the legs), and maintaining proper posture.
Sleep on a firm surface and sit on supportive chairs that are at
the correct height. Avoid high-heeled shoes. If you smoke, you should quit – nicotine
causes degeneration of spinal discs and also reduces blood flow.