of low back pain, with more than half of that spent on surgical treatment.
The lower back is a well designed construction of bone, muscle and ligament. Your backbone (vertebral column) is actually a stack of more than 30 small bones called vertebrae. Together, they create a bony canal that surrounds and protects your spinal cord. Small nerves enter and exit the spinal canal through spaces in your vertebrae called the foramen.
These vertebrae are held together by muscles, tendons and ligaments. Between the vertebrae are discs, which act as "shock absorbers" and prevent the vertebrae from hitting one another when you walk, run or jump. They also allow your spine to twist, bend and extend. Since the lower back is the hinge between the upper and lower body and carries most of your weight, it is especially vulnerable to injury and is the site of most back pain. When low back pain strikes, we become acutely aware of just how much we rely on a flexible, strong back.
The Casues of Back Pain
The most common causes of low back pain are:
Pinched Nerves - Pressure or impingement on nerve roots in the spinal canal can be caused by:
Herniated Disc - A herniated disc, (also called bulging disc or slipped disc) is a rupture often brought on by repeated vibration or motion (as during machine use or sport activity, or when lifting improperly), or by a sudden heavy strain or increased pressure to the lower back. Back pain and leg pain can result when the herniated disc pinches one of the nerves. A herniated disc in the lumbar region can affect the nerves, which runs from your spinal cord to your leg. Compression or inflammation of this nerve causes sciatica - a sharp, shooting pain in your lower back, buttocks and leg.
Degenerative Disc Disease - As we age, the water and protein content of the body's cartilage changes. This change results in weaker, more fragile and thin cartilage. Because both the discs and the joints that stack the vertebrae (facet joints) are partly composed of cartilage, these areas are subject to wear and tear over time (degenerative changes). The gradual deterioration of the disc between the vertebrae is referred to as Degenerative Disc Disease.
Bone Spurs - also termed osteophytes (os-tee-o-fights). Osteophytes may be found in areas affected by arthritis such as the disc or joint spaces where cartilage has deteriorated. The body's production of osteophytes is a futile attempt to stop the motion of the arthritic joint and deal with the degenerative process. It never completely works. The evidence of bony deposits can be found on an x-ray or MRI. A bone spur may cause nerve impingement at the neuroforamen (nu-row for-a-men). The neuroforamen are passageways through which the nerve roots exit the spinal canal. Sensory symptoms include pain, numbness, burning and pins and needles in the extremities below the affected spinal nerve root. Motor symptoms include muscle spasm, cramping, weakness, or loss of muscular control in a part of the body.
Spinal Stenosis is the narrowing of the spinal canal by a piece of bone, ligamentus flavus thickening or disc material. This can cause weakness in your extremities and typically develops with age.
Osteoporosis, which means "porous bones," causes bones to become weak and brittle - so brittle that even mild stresses like bending over, lifting a vacuum cleaner or coughing can cause a fracture. In most cases, bones weaken when you have low levels of calcium, phosphorus and other minerals in your bones. The pain from an osteoporotic spinal fracture can last for several weeks as the bone heals, and then typically turns into more of a chronic, achy pain concentrated in the area of the back where the fracture occurred. This aching may be similar to the sensation reported by those with osteoarthritis. A bone density test, which measures bone mass, preferably taken of both a long bone and a vertebral body, is used to diagnose osteoporosis.
Osteoarthritis or Facet Disease is a degenerative joint condition that causes slow deterioration of cartilage. Osteoarthritis of the spine results in narrowed cartilage disks between the bones that make up your backbone. Without this cartilage cushioning, the joints (facets) between adjacent bones compress and become irregular, causing inflammation, pain, swelling and stiffness. Your body tries to compensate for this form of arthritis, but the repairs are often inadequate, resulting in little growths of additional bone called bone spurs.
Cervical spondylosis is a common condition that results from degeneration (osteoarthritis) of the bones of the neck (cervical vertebrae). This can lead to increasing pain in the neck and arm, weakness, and changes in sensation.
Spinal deformities such as scoliosis, which is an abnormal curvature of the spine. Most cases are mild, but severe cases may require treatment with braces or surgery.
Small injury to a muscle (strain) or a ligament (sprain) from improper lifting, excess body weight and poor posture. Strains and sprains can also develop from carrying heavy handbags or briefcases or sleeping in an awkward position.
Compression fractures, more common among postmenopausal women with osteoporosis, or after long-term corticosteroid use. In a person with osteoporosis, even a small amount of force put on the spine, as from a sneeze, may cause a compression fracture.
Fractures of the vertebrae caused by significant force (as from an auto or bicycle accident, a direct blow to the spine, or compressing the spine by falling onto the buttocks or head).
Most pain in the low back (lumbar region) is triggered by some combination of overuse, muscle strain, or injury to the muscles and ligaments that support the spine. Many experts believe that over time, chronic muscle strain can lead to an overall imbalance in the spinal structure. This leads to a constant tension on the muscles, ligaments, bones, and discs, making the back more prone to injury or re-injury.
The causes of low back pain tend to be interrelated. For example, after straining muscles, you are likely to use your back differently than usual. As other parts of your back work harder or move in unaccustomed ways to make up for the injured muscles, they also become more prone to injury.
The Symptoms of Back Pain
Back pain can be:
Acute, lasting less than 3 months. Most people gain relief after 4 to 6 weeks of home treatment.
Recurrent, a repeat episode of acute symptoms. Most people have at least one episode of recurrent low back pain.
Chronic, lasting longer than 3 months.
The term "low back pain" is used to describe a spectrum of symptoms. Depending on the cause, low back pain may be dull, burning, or sharp, covering a broad area or confined to a single point. It can come on gradually or suddenly and may or may not be accompanied by muscle spasms or stiffness.
Leg symptoms can be caused by lower spine problems that place pressure on a nerve to the leg; they can occur on their own or along with low back pain. Leg symptoms can include pain, numbness, or tingling, usually below the knee.
Weakness in both legs, along with loss of bladder and/or bowel control, are symptoms of cauda equine syndrome, which requires immediate medical attention.
Numbness and tingling are felt when nerve impulses aren't traveling properly from the skin to the brain. A patient with back problems may also experience numbness in other parts of the body, especially the legs and feet. This always indicates some kind of nerve damage in the peripheral nervous system or the central nervous system (i.e. the spine or the brain) and requires prompt and serious attention.
Common causes of numbness include the following:
Radiculopathy - A pinched nerve due to a herniated disc.
Stenosis - A narrowing of the spinal canal, which can compress sensory nerve fibers causing loss of sensation.
Multiple Sclerosis
Stroke, and
Diabetes
Treatment of Back Pain
Your health professional can assess acute low back pain by talking to you about your medical history and your work and physical activities, and doing a simple physical examination. For 95% of people with low back pain, this type of assessment is all that is necessary for a health professional to make treatment recommendations
