LOWER BACK PAIN

Back pain is on of the most common reasons people go to the doctor or miss work and a leading cause of disability worldwide. Most people suffer a back pain at least once.

Most occurrences of lower back pain go away withing a few days. Others take much longer to resolve or lead to more serious conditions.

Function of the lower back

The low back, or lumbar area, serves a number of important functions for the human body. These functions include structural support, movement, and protection of certain body tissues.

When we stand, the lower back is functioning to support the weight of the upper body. When we bend, extend, or rotate at the waist, the lower back is involved in the movement.

Therefore, injury to the structures important for weight bearing, such as the bony spine, muscles, tendons, and ligaments, often can be detected when the body is standing erect or used in various movements.

Protecting the soft tissues of the nervous system and spinal cord as well as nearby organs of the pelvis and abdomen is a critical function the lumbar spine and adjacent muscles of the low back.

 

Low back pain facts

Pain in the low back can be a result of conditions affecting the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.

Lower back pain can vary from dull pain that develops gradually to sudden, sharp or persistent pain felt below the waist.

Lower back pain usually improves over a few weeks. It is normal for low back pain to come and go.

 

Common causes of low back pain

The causes of low back pain can vary according to the part of the spine affected. Since back pain is a symptom, it is necessary to identify the cause before treatment can be initiated.

The most common causes of low back pain are:

.injury or overuse- this can include sprains or strains of soft tissues such as ligaments and muscles.this is the commonest cause of low back pain and is due to injury of the muscles and tendons. It can be resolved within days. Fractures or compression fractures of bones, or injuries to the small joints between the bones of the spine.

.pressure on nerve roots form conditions such as herniated disc or spinal stenosis. This can result in back pain shooting down the leg, commonly referred to as sciatica.

.spinal stenosis- this a narrowing of the spinal canal, the channel through which run the spinal nerves. This causes the nerves to be compressed, producing back and often left pain affecting both legs.

.facet arthritis- this is usually due to aging or arthritis of the joints in the spine also producing back pain by making the joints themselves stiff and sore and also by creating pressure on the nerve roots.

Less common spinal conditions that can cause low back pain include:

.autoimmune disease- such as ankylosing spondylitis, which is a form of arthritis that most often affects the spine. Rheumatoid arthritis, lupus, crohn’s disease, fibromyalgia, and others.

.tumors-most tumors start in another part of the body and metastasize to the spine. these are growths on the bones and ligaments of the spine, on the spinal cord, or on nerve roots. They are not a common cause of low back pain often awakening you at night.

.infection- also called osteomyelitis is a rare, but can be a serious cause of severe pain affecting the bone, spinal discs, or spinal cord. It can be life threatening if untreated. Patients with a compromised immune system are more susceptible to developing an infection in the spine.  

 

Common symptoms of low back pain.

Low back pain affects nearly everyone at one time or another. It can often start without warning and for no apparent reasons. The pain typically can last from a few days to many weeks, and it can limit your ability to perform such simple tasks like sitting, rising from a chair, bending, or walking upright.

The lower back,or lumbar spine, is composed of 5 bones that are stacked one upon another. Between the bones is a soft spongy disc. There are many nerves that originate in the low back. Some of these nerves stay in the low back, while others travel to other parts of the body, such as the buttock or legs.therefore, symptoms of low back problems can be felt in many places in the body.

The most common symptoms of conditions coming from the low back include:

1.central low back pain- usually caused by small disk bulges or muscular strain in the low back.

2.Central low back pain with pain down both legs-it is very typical of spinal stenosis. It is a combination of low back and leg pain with walking short distances that is instantly relieved with sitting or bending forward at the waist.

3.Low back pain to one side or another, but confined to areas above the thigh-is usually due to muscular strain. A small bulging disc may also cause this type of back pain.

4.Low back pain to one side that travels down the front or back of the thigh but does not cross the knee- usually, pain that travels down the thigh is due to a pinched nerve. Pay may or may not be accompanied by numbness or tingling in the thigh, and muscle weakness may also be present.

5.Low back pain to one side that travels down the leg and into the calf, ankle, or foot- pain that travels from the low back to the lower leg is usually sciatica. This is considered by many to be the most severe presentation of low back pain. This is usually caused by a pinched nerve from a lumbar disc, an arthritis joint, or a bone spur. If pain is associated with a sudden loss of muscular strength or loss of bowel or bladder control, an immediate visit to a physician is necessary.

 

Most low back pain episodes do not last long and are likely to go away without treatment. However, one you have low back pain, chances are you will have more episodes, and occasionally these worsen with time.

 

Treatment

The goal of medical treatments is to reduce pain, but these treatments do not change the underlying source of pain. A doctor will typically prescribe medical treatments alongside a physical therapy program or other regimen.

 

Non-surgical treatment

 

. Muscle relaxants. These medications increase mobility of tense muscles by relieving pain from muscle tightness or spasms. Muscles relaxants have no role in chronic pain management.

. Painkillers medications. They are mostly used in treating intense, short-term pain, such as acute pain after an operation. They are rarely used to treat long-term pain, as they have many side effects and are easily addictive.

. Back braces. Back brace can be used to provide comfort and possibly reduce pain. The use of back brace,worn daily, in combination with a physical therapy program, can speed healing and reduce pain. A back brace may also be helpful after back surgery.

. Epidural steroid injections. These injections involve a steroid administered directly into the outer part of the dural sac, which surround the spinal cord. The goal of the injection is to temporarily relieve pain by reducing inflammation around a compressed nerve root.

Medical treatments are often used in combination with other methods.

 

Alternative treatments

Non-medical treatments are referred to as alternative or complementary care. The term “alternative” does not imply inferior, but instead not traditional according to western medical standards.

Common option include:

. Manual manipulation. A chiropractor or other healthcare provider makes physical adjustments to the spine with the goals of improving mobility and reducing stiffness, discomfort, or pain.

. Acupuncture. It stimulates points on the body by placing thin needles in the skin in order to decrease pain and discomfort in the body.

. Massage therapy. Applied to the low back, massage therapy can relieve the muscle spasms that usually contribute to low back pain. Massage also increases blood flow to the low back, which speeds up healing by bringing nutrients and oxygen to damaged muscles.

 

Surgical treatment

Surgery might be considered for sever lower back pain that does not get better after a 6-12 weeks course of nonsurgical treatments.

 

Decompression surgeries

A decompression surgery removes whatever is pressing on a nerve root from the spinal column, which might include a herniated portion of a disc or a bone spur. There are two primary types:

. Microdiscectomy, which is minimally invasive procedure for patients with sciatica.

. Laminectomy removes part of the layer of the bone of soft tissue that is compressing a nerve or multiple nerve roots. It is typically performed for a patient with leg pain and/or weakness from spinal stenosis.

 

Lumbar spinal fusion options

Fusion surgery basically removes the soft tissues between two or more adjacent vertebral bones and replaces them with bone or metal. This procedure enables the bones to grow together over time- typically 6-12 months- and fuse into one long bone to stabilize and eliminate motion at those spinal segments.

The most reliable indications for lumbar spinal fusion include spondylolisthesis, fracture, instability, deformity, degenerative disc disease, and stenosis. Tumors and infections are also treated with fusion surgery, but they are far less common.

 Other surgical options

.Lumbar artificial disc

.Posterior motion device

 

Preventing low back pain

Steps to lower the risk of developing back pain consist mainly of addressing some of the risk factors.

. Exercise- regular exercise helps build strength as well as keeping your body weight down. Low-impact aerobic activities are believed to be the best, activities that do not strain or jerk the back.

. Smoking- a significantly higher percentage of smokers have back pain incidences compared to non-smokers of the same age, height and weight.

. Body weight- the amount of weight people carry, as well as where they carry it, affects the risk of developing back pain.

. Posture when standing- make sure you have a neutral pelvic position. Stand upright, head facing forward, back straight, and balance your weight evenly on both feet.

. Posture when sitting- a good seat should have good back support, arm rests and swivel base( for working). when sitting try to keep your knees and hips level and keep your feet flat on the floor, if you can’t think of using a footstool.

. Lifting things- the secret for protecting your back when lifting thing is to think “legs not back”. In other words use your legs to do the lifting instead of your back.

. Do not lift and twist at the same time

. Shoes- flat shoes place less of a strain on the back.

. Driving- it is important to have support for your back. Make sure the wing mirrors are properly positioned so you do no need to twist.

. Bed- you should have a mattress that keeps your spine straight, while at the same time supporting the weight of your shoulders and buttocks. Use a pillow, but not one that force your neck into a steep angle.

 

 

The above article serves only as reference. Kindly refer to your primary care provider for complete consultation and treatment.

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