Low Back Pain

1 Low Back Pain Summary

You may easily recall the last time you have had low back pain. Low back pain is a very common cause of disability among adults. Low back pain (medically known as lumbago) is any pain or discomfort in the lower back.

Low back pain can be a dull ache or sudden sharp pain, and it is often incapacitating. Low back pain is a symptom, and it is not a disease or a diagnosed medical condition. Low back pain usually has a specific cause.

Many people with low back pain also experience other symptoms such as weakness or numbness, or pain in the foot or a leg, or back stiffness, swelling, or sensation of a knot or tight spots. Some experience a momentary loss of control of bowel or bladder along with back pain.

Low back pain is so prevalent that almost all adults experience it at some point in their lives. It often occurs without warning, and sometimes, the discomfort lasts for some time. Most experience resolution without any treatment.

To understand low back pain, keep in mind that your spine is a complex of bones, muscles, connective tissues, nerves and blood vessels. Nearby organs in the lower back area include the spinal cord, the kidneys, pancreas, spleen, liver, some portions of the intestines, and stomach. Any problem in these areas can cause symptoms including low back pain. Unfortunately, in most patients the exact cause is unknown.

Low back pain often requires a thorough examination, as no single diagnostic test can determine the cause. Doctors have to choose from a multitude of tests to diagnose the cause of recurrent or severe low back pain.

You have to give a detailed medical history and undergo several physical examinations as well. However, most patients with low back pain do not receive enough medical care to assess and treat the cause of low back pain. Many just resort to painkillers regardless of whether the cause is known or not.

Treating low back pain depends on the cause. A multitude of treatments can be done, ranging from physical therapy routines to invasive surgery. Many advanced treatments for low back pain are somewhat sophisticated and are reserved for severe cases and for cases with loss of body function.

Also, lifestyle change is very important for treatment of low back pain. The doctor usually prescribes set activities to do daily to patients with low back pain, since its cause is usually associated with your current lifestyle. Still, no treatment is 100% effective for low back pain. If treatment fails, the doctor simply considers other treatments.

The good news is that most cases of low back pain are highly manageable. Low back pain may recur or worsen even with treatment, but their severity and extent of disability can be reduced. With therapy or treatment, anyone suffering from recurrent low back pain is capable of handling a job or performing daily activities.

2 Causes

Low back pain is a symptom, so usually, it has a specific cause.

Poor posture

In most people, the most common causes of low back pain are poor body mechanics or posture. Most people first experience low back pain at work, which can be related to poor body mechanics (like improper sitting or lifting posture) and overwork, which can put a significant amount of strain on the back. Improper posture when sitting or lifting can result in problems such as back pain. Poor seats, slouching, sleeping on air beds, not wearing proper work equipment (like specified harnesses or belts) can also result to back pain. Many cases of low back pain are associated with long working hours, heavy lifting, too much bending, squatting, or frequent twisting of the trunk.

Stress

Feelings of stress can also cause low back pain. Sometimes, being tired or fatigue can bring symptoms of low back pain. Sometimes, lack of enough sleep can also cause low back pain.

Medical conditions

Some cases of low back pain are caused purely by problems in the musculoskeletal system. The bones of the spine (called vertebra), spinal cord and nerves, connective tissue and the muscles attached to the spine are confined in a very small space. Therefore, any problem or inflammation in these areas can result to low back pain.

Some of these conditions include:

  • Ankylosing spondylitis – a condition that happens when some of the bones of the vertebra fuses together, making the spine less flexible. The cause is usually inflammation.
  • Herniated or ruptured disk – this occurs when the connective tissue between the vertebra, called spinal disk, is torn or ruptured that allows bones to irritate spinal nerves, causing low back pain. This condition is also known as ‘slipped disk.' This is usually caused by aging-related wear-and-tear.
  • Intervertebral disc degeneration – is a condition where the spinal disk degenerates and loses integrity. This is usually caused by aging.
  • Osteoarthritis of the spine – osteoarthritis can also affect the spine and cause low back pain. In osteoarthritis, the cartilage that lines the bones wear out, causing bones to rub against each other.
  • Osteomyelitis – is the infection of the bone, and it can happen in the spine and cause low back pain as a symptom. Infections in the body can sometimes cause osteomyelitis.
  • Osteoporosis – is the brittleness of the bones, and sometimes it can affect the spine as well.
  • Paget’s disease of the bone – is a condition caused by the excessive and disorganized growth of the bone. Paget’s disease of the bone tends to affect older men.
  • Sacroilitis – a condition caused by inflammation of the joints connecting the pelvis to the spine. This can be caused by heavy loads (like pregnancy), infection, trauma or arthritis.
  • Scoliosis – a mainly inherited condition that causes abnormal curvature of the spine, which may cause low back pain.
  • Fractures in the spine – which can be caused by lifting heavy loads, trauma or accidents.
  • Spinal stenosis – is a condition caused by narrowing of the opening in the spine where spinal cord runs through, which puts pressure on the spinal cord. This results to low back pain and loss of functions below the affected area of the spinal cord, such as control of bowel and bladder. Conditions like tumors, osteoarthritis, herniated disk and back injuries can cause spinal stenosis.
  • Radiculopathy – is a condition caused by compression of the root of nerves exiting the spine. Many problems in the spine can cause radiculopathy.
  • Spondylolisthesis – this condition happens when any bone in the spine slips ‘out of place’, causing pressure to the spinal cord and nerves resulting in symptoms such as low back pain.

Other medical conditions

Low back pain can be a feature of certain conditions such as pregnancy, kidney infection or kidney stones, obesity or sciatica (compression of the spinal nerves in the lower back), fibromyalgia, and endometriosis (presence of uterine tissue outside the uterus). Very rarely, low back pain is a telltale symptom of a largely asymptomatic aortic aneurysm, which is the dangerous swelling of the aorta that can burst and cause massive internal bleeding.

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3 Diagnosis & Treatment

Determining the cause is very important for proper diagnosis and treatment of low back pain.

Diagnosis

Doctors usually start by examining medical history and performing physical examinations. Your doctor may perform several physical tests to check for mobility, loss of function or sensation anywhere in the body, or do tests to check your nerves. Depending on the results and presence of other symptoms, doctors may order blood tests and imaging tests such as bone scans, bone density tests, CT scans, myelograms or magnetic resonance imaging (MRI). Sometimes, pelvic examinations are done to determine problems in the reproductive system that can cause low back pain.

Treatment

Treatment for low back pain largely depends on the cause. If underlying medical problems are present, they are addressed first. If the cause is obesity, osteoporosis, inflammation or problems in the nerves or pelvic organs, those problems are addressed.

There are lots of medicines that can be used for low back pain. However, the problem is that drugs (especially painkillers) are easily misused, and it usually does not resolve the ultimate cause of low back pain. Many drugs for back pain such as muscle relaxants, opioid painkillers, antidepressants, and steroid drugs, must be used only under close doctor’s supervision to reduce the risk of potential addiction and avoid serious side effects.

Many cases of low back pain are related to overwork and poor body mechanics. If this is the case, doctors prescribe exercises and physical therapy and teach you how to lift loads, stand or sit properly. Physical therapy is needed if you experience reduced or loss of function along with low back pain. Good body mechanics while sitting, lifting or standing to reduce strain or weight on prone areas such as the lower back and neck, and places it on resilient muscles of the legs, knees, and shoulders.

Contrary to popular belief, rest is not a remedy for low back pain, and it may actually worsen it in some cases. Light physical activities work the best for low back pain, and it works even for longstanding cases whose cause is not known.

Exercise helps relieve low back pain, reduces disability, and promotes recovery. Research has shown that exercises like aerobics, Pilates, yoga, exercises for improving core strength and stability work well for low back pain.

Surgery is sometimes considered if there are clear problems in the musculoskeletal system causing back pain. Surgical procedures in the spine are complicated, and still not a guarantee of cure to low back pain. Even if you have surgery, you still need to stick to proper diet and exercise requirements, as well as attend physical therapy sessions, for proper recovery and good results.

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