Low back Pain

An Overview

Low-back pain is a very common problem in the United States and around the world. About 80 percent of adults have low-back pain at some point in their lives. It’s the most common cause of job-related disability and a leading contributor to missed work days and visits to physicians. Most episodes of low-back pain last only a short period of time. Health professionals call this acute low-back pain. Acute low-back pain is often defined as pain that lasts for up to 4 weeks. In most cases, acute low-back pain goes away without causing any lasting problems.

Types of Low back pain

  • Mechanical pain. By far the most common cause of lower back pain, mechanical pain is pain primarily from the muscles, ligaments, joints (facet joints, sacroiliac joints), or bones in and around the spine. This type of pain tends to be localized to the lower back, buttocks, and sometimes the top of the legs. It is usually influenced by loading the spine and may feel different based on motion (forward/backward/twisting), activity, standing, sitting, or resting.
  • Radicular pain. This type of pain can occur if a spinal nerve root becomes impinged or inflamed. Radicular pain may follow a nerve root pattern or dermatome down into the buttock and/or leg. Its specific sensation is sharp, electric, burning-type pain and can be associated with numbness or weakness. It is typically felt on only one side of the body.

Symptoms for Low back pain

Back pain can range from a muscle aching to a shooting, burning or stabbing sensation. In addition, the pain may radiate down your leg or worsen with bending, twisting, lifting, standing or walking. Other warning signs include a loss of bowel or bladder control, numbness in the groin area, leg weakness, fever and pain when coughing or urinating. Low back pain can incorporate a wide variety of symptoms. It can be mild and merely annoying or it can be severe and debilitating. Low back pain may start suddenly, or it could start slowly possibly coming and going  and gradually get worse over time.

Depending on the underlying cause of the pain, symptoms can be experienced in a variety of ways. For example:

  • Back sprain or strain. Back pain typically begins on the day after heavy exertion or an activity that requires twisting. Muscles in the back, buttocks and thighs are often sore and stiff. The back may have areas that are sore when touched or pressed.
  • Fibromyalgia. In addition to back pain, there are usually other areas of pain and stiffness in the trunk, neck, shoulders, knees and elbows. Pain may be either a general soreness or a gnawing ache, and stiffness is often worst in the morning. People usually complain of feeling abnormally tired, especially of waking up tired, and they have specific areas that are painful to touch, called tender points.
  • Degenerative arthritis of the spine. Together with back pain, there is stiffness and trouble bending over, which usually develops over many years.
  • Cancer in the spinal bones or nearby structures. Back pain is consistent and may become worse when you are lying down. Numbness, weakness or tingling of the legs that continues to get worse. If cancer spreads to spinal nerves that control the bladder and bowel, there may be bowel or bladder incontinence (loss of control).
  • Pain that is dull or achy, contained to the low back.
  • Stinging, burning pain that moves from the low back to the backs of the thighs, sometimes into the lower legs or feet, can include numbness or tingling (sciatica).
  • Muscle spasms and tightness in the low back, pelvis and hips.
  • Pain that worsens after prolonged sitting or standing.
  • Difficulty standing up straight, walking or going from standing to sitting.

Causes of Low back pain

Back pain often develops without a cause that your doctor can identify with a test or an imaging study. Conditions commonly linked to back pain include:

  1. Muscle or ligament strain.Repeated heavy lifting or a sudden awkward movement can strain back muscles and spinal ligaments. If you’re in poor physical condition, constant strain on your back can cause painful muscle spasms.
  2. Spinal steno sis. 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.
  3. Bulging or ruptured disks. Disks act as cushions between the bones (vertebrae) in your spine. The soft material inside a disk can bulge or rupture and press on a nerve. However, you can have a bulging or ruptured disk without back pain. Disk disease is often found incidentally when you have spine X-rays for some other reason.
  4. Arthritis. Osteoarthritis can affect the lower back. In some cases, arthritis in the spine can lead to a narrowing of the space around the spinal cord, a condition called spinal stenosis.
  5. Osteoporosis. Your spine’s vertebrae can develop painful fractures if your bones become porous and brittle.
  6. Strains. 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.

Diagnosis

Your doctor will likely begin by requesting a complete medical history and conducting a thorough 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 responses to certain sensations. This determines if your low back pain is affecting your nerves.

Treatment

Epidural Steroid Injection. Epidural steroid injections are most commonly used in situations of radicular pain, which is a radiating pain that is transmitted away from the spine by an irritated spinal nerve.

Alternative medicine. Alternative medicine for lower back pain includes the use of chiropractic care and acupuncture. Chiropractic is the practice of manually realigning the spine and other weak or injured areas of the musculoskeletal system.

Surgery. Relatively few people require surgery for chronic, severe back pain. However, it remains an option if other treatments don’t provide relief. Small disc fragments that have broken off or disintegrated can be surgically removed to take pressure off nerve paths. Injured or abnormal vertebrae that cause lower back pain may be fused together to straighten your back and help you regain mobility.

Prevention

You can help prevent some forms of back pain by strengthening your back with exercises and by avoiding activities that lead to back injury. Measures that may help prevent back pain include:

  • Maintaining good posture.
  • Sleeping on your side or on your back with a pillow under your knees if you can.
  • Exercising regularly, but stretch before and after.
  • Practicing abdominal crunches to strengthen abdominal muscles, which support your lower back. Also, walk or swim regularly to strengthen your lower back.

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