Low back pain

Low back pain – Definition

Low back pain is an ache or discomfort in the area of the lower part of the back and spinal column. The lower spinal column consists of many small bones that surround and protect the spinal cord and nerves. Low back pain is very common, affecting most adults at some point in their lives.

Low back pain – Causes

There are many possible causes for low back pain, including:

• Sprain or strain of muscles or ligaments in the area (most common cause of back pain), such as from:
  • Heavy lifting
  • Lifting incorrectly
  • Sudden awkward movement
• Herniated (ruptured) disc —the cushions between the bones of the spine bulge out of place
• Disc degeneration, caused by aging or arthritis
• Spinal stenosis — narrowing of the spinal canal
• Spondylolisthesis — slippage of a bone in the lower back
• Fractures due to trauma and/or osteoporosis
• Fibromyalgia — a condition that causes muscle aches and fatigue
• Ankylosing spondylitis — a hereditary disorder involving the spine
• In rare cases:
  • Benign or malignant tumors
  • Infections
  • Arterial problems such as an aortic aneurysm
  • Cauda equina syndrome — nerve roots at the base of the spinal cord are compressed

Low back pain – Risk Factors

These factors increase your chance of developing low back pain:

• Older age
• Certain activities (such as lifting)
• Sedentary lifestyle
• Pregnancy
• Obesity
• Smoking
• Prior back injury
• Prior back surgery
• Other factors which may negatively influence back pain include:
  • Psychological factors, such as low job satisfaction
  • Fatigue or sleep deficit
  • Drug or alcohol abuse
  • Stress

Low back pain – Symptoms

Pain is usually localized in the low back. It can get worse with back motion, sitting, standing, bending, and twisting. If a nerve is irritated, the pain may extend into the buttock or leg on the affected side, and muscle weakness or numbness may be present. It usually gets better with rest, and there is good bowel and bladder control.

When Should I Call My Doctor?

Often, back pain improves with self-treatment. However, some serious symptoms may occur which may require more immediate medical attention. Call your doctor if back pain:

• Is severe or gets significantly worse
• Has not started to improve within about a week
• Causes difficulty walking, standing, or moving
• Is worse at night, or worse when you lie down
• Spreads down your legs
• Comes with pain or throbbing in your abdomen
• Is new and you are over age 50
• Is associated with:
  • Numbness, weakness, or tingling in your buttocks, genitals, or legs
  • Loss of bowel or bladder control
  • Difficulty with urination
  • Fever, unexplained weight loss, or other signs of illness

You should also call your doctor if you have back pain and a history of cancer or osteoporosis or you have a history of steroid use or IV drug use.

Low back pain – Diagnosis

The doctor will ask about your symptoms and medical history, and perform a physical exam. In particular, the doctor will examine your back, hips, and legs and usually will test for strength, flexibility, sensation, and reflexes.

Other tests your doctor may order in certain situations include:

• X-rays — a test that uses radiation to take a picture of structures inside the body, especially bones.
• Computed tomography (CT) scan — a type of x-ray that uses a computer to make pictures of structures inside the body. This test provides a good picture of the vertebrae and the spinal canal.
• Magnetic resonance imaging (MRI) scan — a test that uses magnetic waves to make pictures of structures inside the body and shows the intervertebral discs and any abnormality of the discs.
• Bone scan — a test to determine mineralization of the bones
• Blood tests — such as complete blood count (CBC) or sedimentation rate
• Urine test — to check for urinary infection or blood in the urine

It is important to keep in mind that imaging tests, like CT or MRI scan, may not be helpful immediately after a back injury.

Low back pain – Treatment

Treatment options include:

Stay Active

Bed rest is not generally recommended in normal individuals. It may only be suggested in those with severe debilitating back pain, and for not more that 1-2 days. Your doctor may recommend that you restrict activities for a period, and then resume activities as soon as possible. By staying active and exercising, you may be able to shorten your recovery time.

Medication

Medicines that your doctor may suggest include:

• Over-the-counter pain relievers, such as acetaminophen (Tylenol), aspirin (Bayer), or ibuprofen (Motrin, Advil)
• Muscle relaxants for muscle spasm — These medicines are not used in cases where you need to be alert, such as driving or operating machinery.
• Cortisone injections
• Antidepressants — These may also be prescribed for chronic low back pain.

Physical Therapy

A physical therapy program may include:

• Applying hot or cold packs
• Doing stretching, strengthening, and balance exercises for back and stomach muscles
• Participating in an aerobic exercise program (eg, walking, swimming)
• Learning about how to deal with back problems
• Getting massage therapy
• Undergoing ultrasound treatments or electrical stimulation

Alternative Medicine

• Relaxation training
• Biofeedback
• Acupuncture
• Chiropractic or osteopathic manipulation

Surgery

Only a small number of patients need surgery. It may be needed if nerve problems develop or other treatments fail to provide relief. Common procedures are diskectomy, laminectomy, and spinal fusion.

If you have low back pain, follow your doctor’s instructions.

Low back pain – Prevention

The following steps may help you avoid low back pain:

• Begin a safe exercise program with the advice of your doctor.
• Maintain a healthy weight.
• If you smoke, quit.
• Practice good posture to reduce pressure on your spine.
• Avoid sitting or standing in one position for prolonged periods.
• If you must remain standing for long periods, rest one foot at a time on a small stool to relieve pressure on your low back.
• When lifting, hold the object close to your chest, maintain a straight back, and use your leg muscles to rise slowly.
• Avoid aggravating activities, for example bending, twisting, and sudden movements.
• Consider job retraining if your work requires a lot of heavy lifting or sitting.
• If you have back pain during pregnancy, try wearing a BellyBra. This is a special bra to support your back and abdomen.

While some people think that using shoe inserts will prevent back pain, so far there is not a lot of evidence to support this.