Low back pain is extremely common with 80 to 90% of people eventually developing low back pain at some point in their lifetime.
Common causes include degenerative arthritis, degenerative disc disease, excessive and prolonged poor posture and mechanics, and inadequate conditioning. This can lead to strain of the muscles/tendons, ligament sprains, herniated discs, and “pinched” nerves.
Advanced degenerative changes in the spine can lead to spinal stenosis. Serious falls and accidents can cause significant pain and disability due to fractures and injury to the spinal cord. Not uncommonly, some individuals will experience low back pain that does not come from the spine.
Causes include problems in the hip joint, kidney stones, infection, stomach ulcers, abdominal aortic aneurysms, and cancer.
Back Pain Anatomy
The human spinal column consists of 33 vertebrae interconnected by intervertebral discs, facet capsules, and ligaments that house our spinal cord and its nerve roots The low back, also known as the lumbar spine, is composed of the lowest 5 vertebra that sit above the sacrum. The sacrum itself is a triangular complex of bone, composed of 5 fused vertebra, that supports the spine and forms the posterior part of the pelvis. Its connection to the pelvis forms the sacroiliac joint on the left and the right. Further below the sacrum is the coccyx, frequently described as the tailbone, which consists of 4 small coccygeal vertebrae that make up the final segment of the spine.
Each vertebra can be divided into a front portion, known as the vertebral body, and the back portion called the vertebral arch. Vertebral bodies are connected together by our intervertebral discs, which are the main shock absorbers when it comes to supporting our bodies in the upright position. They have an inner jelly-like material known as the nucleus pulposus and are surrounded by an outer fibrous ring known as the annulus fibrosis. The posterior portion of our vertebra houses our spinal cord, which is then covered by the vertebral arch. Along the left and right sides of the vertebral arch we have facet joints, also called the zygapophyseal joints, which provide another connection between vertebra. They help limit motion of the spine and are also loading-bearing structures like the vertebral bodies.
Other structures important to the low back include an extensive network of ligaments and muscles. They play essential roles in providing flexibility and constraint and allowing humans to be bipedal creatures.
Back Pain Symptoms
There are many possible causes of low back pain, and so symptoms can be diverse and overlapping depending on the underlying pathology. In addition, it is possible to have low back pain with relatively normal imaging results, and no or minimal pain with significant abnormalities. Low back pain is often categorized as acute (lasting less than 6 weeks), subacute (lasting 6-12 weeks), and chronic (lasting more than 12 weeks).
Symptoms of lumbar strain or sprain may include back stiffness, muscle tenderness and spasms, and pain with flexion and stooping. Degenerative conditions and arthritis in the low back are frequently achy in nature, worse with inactivity and sitting/standing too long. Bone spurs, narrowed discs, and/or herniated discs can sometimes cause irritation to nerve roots, which can produce abnormal sensations such as burning, shooting pain, or prickling (paresthesias) in the legs. When irritation or compression of nerve roots causes damage or disturbance to nerve function, it is termed lumbar radiculopathy. When the spinal canal becomes narrowed by these changes and compresses the spinal cord, it causes a condition called spinal stenosis. Spinal stenosis can lead to back and/or leg pain with standing/walking too long, and quickly gets relieved with sitting down.
Circumstances when you should seek immediate medical attention for low back pain include: Significant preceding trauma or low back surgery; new onset leg weakness or sensory loss; sudden unexplained weight loss, night sweats, or fever; loss of bowel or bladder function; color changes in the legs or feet.
Back Pain Diagnosis
A detailed history and physical examination is the first step in the evaluation and management of low back pain. Imaging studies may be appropriate depending on your age, symptoms, medical history, and physical examination. If further diagnostic information is needed, X-rays are usually the first study performed to rule out any structural abnormalities. More advanced imaging studies include magnetic resonance imaging (MRI) and computed tomography (CT) scan, which can provide greater detail into the structures of the spine. Other diagnostic tests include electrodiagnostic studies to test and check muscles and nerves.
Back Pain Treatment
Despite being a leading cause of disability, the natural history of low back pain is very favorable, with 95% of people getting better in 6 to 12 weeks. Most patients can usually be treated conservatively with prevention, brief rest, ice/heat, pain relievers, muscle relaxants, and physical therapy.
Acetaminophen and nonsteroidal antiinflammatory medications (NSAIDs) are often used to help relieve mild to moderate back pain. If pain persists then prescription pain medications, muscle relaxants, and antidepressants may be used.
Exercise and Physical therapy
For individuals with persistent back pain, exercise and physical therapy is the cornerstone of treatment. Stretching, strengthening, and stabilizing exercises assist with decreasing pain, restoring function, and preserving range of motion. Therapists will sometimes use instruments and other modalities to help treat soft tissue injuries. In conjunction with exercise, spinal manipulation and other manual therapies may also be useful in relieving low back pain, and improve joint and soft tissue movement. Manual therapy is performed by chiropractors, physical therapists, and physicians.
Injections for the treatment of low back pain allow for targeted treatment to sources of pain including trigger points, arthritis, herniated discs, and pinched nerves. Injections are usually recommended only after conservative treatments such as medications and physical therapy have not brought relief.
Back surgery in Kansas City should be reserved for patients who have failed conservative care and have signs and symptoms associated with a mechanical disorder that can be corrected by surgical intervention. Whether or not surgery is appropriate will depend on an individual’s specific signs and symptoms, medical history, and diagnostic studies.
When low back pain has been present long enough to become chronic, oftentimes it requires a multidisciplinary approach that addresses the physical, psychological and psychosocial aspects of the condition.
Other Back Pain Treatments:
- General health measures: smoking cessation, aerobic exercise, weight management.
- Correct posture: use positions and perform activities with an emphasis on a neutral lumbar spine position.
- Stress reduction: stress may interfere or delay the recovery process. Activities that may help reduce stress include meditation, cognitive behavioral therapy, support groups.
- Psychological and mind-body therapies: examples include yoga, Tai-chi, pilates, cognitive behavioral therapy, etc.
- Massage, acupuncture