Low Back Pain

Definition

Low back pain is an ache or discomfort in the lower part of the spine. This area has many small bones and muscles that surround and protect the spinal cord and nerves.

Bones of the Lower Back.

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Causes

Many things can cause low back pain. Some causes are:

• Muscle strains or ligament sprains
• Degenerative disc disease—wear and tear on discs in the spine
• Structural problems in the spine
• Injury
• Other health problems, such as osteoporosis

Health problems that can also cause back pain include:

• Herniated disc —the cushions between the bones of the spine develop a bulge
• Degenerative diseases, such as arthritis
• Fractures due to trauma and osteoporosis
• Spinal stenosis—narrowing of the spinal canal
• Spondylolisthesis—slippage of a bone in the lower back
• Ankylosing spondylitis—an autoimmune disease involving the spine
• Cauda equina syndrome—compression of nerve roots at the base of the spinal cord
• Tumors
• Infections

Risk Factors

This problem is more common in older adults but can happen at any age. Things that may increase the risk of injury are:

• Certain activities, such as lifting, bending, or twisting
• Lack of activity
• Obesity
• Pregnancy
• Smoking
• Prior back injury
• Prior back surgery
• Anxiety and depression
• Stress

Job-related strain, such as:

• Bending, twisting, or reaching
• Vibrations
• Heavy manual labor
• Repetitive tasks

Symptoms

The back pain may be constant or come and go. It may be worse with motion, sitting, standing, bending, and twisting. If a nerve is irritated, the pain may spread into the buttock or leg on one side. Muscle weakness or numbness may also occur.

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done. The exam will focus on the back, hips, and legs.

Imaging tests are rarely needed. They may be done for pain that is severe or does not get better with treatment.

Treatment

Back pain often improves with home care and time. If the pain is new, steps that may help to ease pain include:

• Staying away from movement that makes pain worse—absolute rest is rarely helpful.
• Cold or hot compresses over the area
• Medicines, such as:
  • Over the counter and prescription pain relievers
  • Topical pain relievers that are applied to the skin
  • Muscle relaxants to ease spasms
• Avoid intense stretching or exercise
• Physical therapy to improve strength, flexibility, and range of motion
• Cognitive behavioral therapy to learn how to manage pain

Back pain can linger for longer periods of time. Steps that may help chronic back pain include:

• Regular exercise program—avoid activities that make back worse
• Stretching program, like yoga
• Physical therapy—to improve strength and balance, find cause of problem
• Heat when back is stiff

Other treatments that may be helpful include:

• Acupuncture
• Spinal manipulation—specialist move spinal bones with controlled thrusts

Surgery may be needed for pain that is making day to day life difficult. Other treatments will be tried first before surgery. The type of surgery will depend on what is causing pain. Choices include:

• Discectomy—remove damaged tissue between spinal bones, can relieve pressure on nerves.
• Laminectomy—part if spinal bone is removed to ease pressure on nerves.
• Spinal fusion—2 or more spinal bones are fused.

Prevention

Not all back pain can be prevented. Some things that may help are:

• Regular exercise
• Practicing good posture
• Not sitting or standing in one position for too long
• Proper techniques when playing sports, exercising, or lifting heavy objects