Lower Back Pain is a very common complaint. Most people in India ignore Lower back pain till it is acute and seek medical help only when it is accompanied by some form of chronic pain, says a study. Popping a pain killer to cope with back pain may not be the best answer. Back pain affects other parts of your body and becomes more and more severe with time.
Researchers found that 56% patients had waited for ~1-2 months before taking action about their back pain. The findings showed , worldwide trend is that 20% of back pain patients become chronic, but in India, 56% patients are chronic even before they seek medical help.
Back pain is a common reason for absence from work and doctor visits. Although back pain at times painful and uncomfortable, it is not usually serious. Back pain can affect people of any age but it is more common among age group 35 and 55 years. Experts say that any kind of pain is associated with the way our bones, muscles and ligaments in our body work together.
Pain in the lower back may be linked to the discs between the vertebrae, bony lumbar spine, spinal cord and nerves, ligaments around the spine and discs, lower back muscles, abdomen and pelvic internal organs and also the skin around the lumbar area. Pain in the upper back may be due to disorders of the aorta, tumors in the chest, and spine inflammation.
Lower back pain can be caused by many different reasons, including problem in any parts of the complex, interconnected network of spinal muscles, bones, nerves, discs or tendons in the lumbar spine. Common sources of lower back pain include:
- The smaller nerves that supply the low back may be irritated
- The nerve in the low back that go to the legs may be irritated
- An intervertebral disc may be degenerating
- The bones, ligaments or joints may be damaged
- The large paired lower back muscles (erector spinae) may be strained
Problem with any of these above mentioned structures may cause lower back pain, pain that radiates from other parts of the body. Many lower back problems also cause back muscle spasms, which don’t sound like much but can cause severe pain and disability.
While lower back pain is quite common, the symptoms and severity of lower back pain varies for individuals. A simple lower back muscle strain might be pain full enough for an emergency doctor visit, while a degenerating disc might cause only mild, intermittent discomfort.
Risk factors: Reasons for Lower back pain
Risk Factor is something which increases the probability of developing a disease. The following factors are linked to increase the risk of developing lower back pain:
- A mentally stressful job
- Strenuous physical work
- Pregnancy – pregnant women are more likely to get Lower back pain
- A sedentary lifestyle increases the risk of developing Lower Back Pain
- Strenuous physical exercise (if not done properly)
- Age – older adults are more susceptible to lower back pain
- Gender – back pain is more common among females than males
- Anxiety, Depression
Lower Back Pain Symptoms & Signs
Most people experience lower back pain sometime in their lives. The causes of lower back pain could be numerous; some are self-inflicted due to lifestyle and others could be due to trauma, muscle strains, and sports injuries. Although the causes are different but often they have same symptoms.
If you feel any of the following signs or symptoms accompanies a lower back pain you should see your doctor:
- Persistent aching or stiffness anywhere along the spine, from the base of the neck to the tail bone
- Sharp, localized pain in the neck, upper or lower back — especially after lifting heavy objects or doing other strenuous activity
- Chronic pain in the middle or lower back, especially after sitting or standing for long duration
- Lower Back pain that radiates from the low back to the buttock, down the back of the thigh, and into the calf and toes
- Inability to stand straight without having pain or muscle spasms in the lower back
- Weight loss or fever
- Urinary incontinence or Difficulty urinating
- Fecal incontinence – losing bowel control
- Inflammation (swelling) on the back
- Numbness around the genitals, anus, buttocks.
- A recent injury, blow or trauma to back
Causes of Lower back pain
The human back is composed of a complex structure of muscles, ligaments, tendons, disks and bones – the segments of our spine are cushioned with cartilage-like pads. Problems with any of these components can lead to lower back pain. In some cases of lower back pain, its cause is never found.
Certain causes of lower back pain have a tendency to occur more often in younger individuals versus older adults:
- People between 30-60 yrs age group are more likely to experience back pain from lumbar disc herniation or degenerative disc disease or from a back muscle strain or other soft tissue strain.
- People >60yrs of age are more likely to suffer from pain related to joint degeneration i.e. osteoarthritis or spinal stenosis or from a compression fracture.
Strain is one of the most common causes of Lower back pain. Lifting something in an improper manner is a could cause of lower back pain.
Structural– the following structural problems may also result in Lower back pain:
- Ruptured disks– each vertebra in our spine is cushioned by disks. If the disk ruptures there will be more pressure on a nerve, resulting in Lower back pain.
- Bulging disks– same way as ruptured disks, a bulging disk can result in more pressure on a nerve.
- Sciatica– a sharp and shooting pain that travels through the buttock and down the back of the leg, caused by a bulging or herniated pressing on a nerve.
- Arthritis– patients with osteoarthritis commonly experience problems with the joints in the hips, lower back, knees and hands. In some cases spinal stenosis can develop – the space around the spinal cord narrows.
- Abnormal curvature of the spine– if the spine curves in an unusual way the patient is more likely to experience a lower back pain. An example is scoliosis, when the spine curves to the side.
- Osteoporosis– bones, including the vertebrae of the spine, become brittle and porous, making compression fractures more likely.
Everyday activities or poor posture. Lower Back pain can also be the result of some everyday activity or poor posture. We live in a world of computers. Adopting a very hunched sitting position when using computers can result in increased back and shoulder problems over time.
- Bending awkwardly or Bending down for long periods
- Pushing, pulling, Lifting, Carrying something heavy
- Standing for long periods
- Over-stretching, Twisting
- Coughing or Sneezing
- Sitting in a hunched position for long periods
- Long driving
Internal Problems– the following internal problems may also result in Lower back pain:
Below are some other causes of Lower back pain:
- Sleep disorders– individuals with sleep disorders are more likely to experience a lower back pain, compared to others.
- Bad mattress– if a mattress does not support specific parts of the body and keep the spine straight, there is a greater risk of developing lower back pain.
Diagnosing Lower back pain
Most Doctors will be able to diagnose Lower back pain by doing a physical examination but in some cases imaging scans may be required. Also, if the doctor suspects the back pain might be due to an underlying cause, or if the pain persists for too long, further tests may be recommended.
Suspected disc, nerve, tendon, and other problems – X-rays or some other imaging scan, such as a CT or MRI scan may be used to get a better view of the state of the soft tissues in the patient’s back.
- X-rays can show the alignment of the bones and whether the patient has arthritis or broken bones. They are not ideal for detecting problems with muscles, the spinal cord, nerves or disks.
- MRI or CT scans– these are good for revealing herniated disks or problems with tissue, tendons, nerves, ligaments, blood vessels, muscles and bones.
- Bone scan– a bone scan may be used for detecting bone tumors or compression fractures caused by osteoporosis.
- Electromyography or EMG– the electrical impulses produced by nerves in response to muscles is measured. This study can confirm nerve compression which may occur with a herniated disk or spinal stenosis.
- The doctor may also order a blood test if infection is suspected.
Lower back pain Treatment
In the vast majority of cases back pain resolves itself without medical help – just with careful attention and home treatment. Pain can usually be addressed with OTC (over-the-counter, no prescription required) painkillers. Resting is helpful, but should not usually last more than a couple of days – too much rest may actually be counterproductive.
Types of Lower Back Pain:
Usually lower back pain is categorized into two types:
- Acute Lower Back Pain– back pain comes on suddenly and persists for a maximum of three months.
- Chronic Lower Back Pain – the pain gradually develops over a longer period, lasts for over three months, and causes long-term problems.
A considerable percentage of patients with back pain experience both occasional bouts of more intense pain as well as more-or-less continuous mild back pain, making it harder for the doctor to determine whether they have acute or chronic back pain.
Physical Therapy – the application of heat, ice, ultrasound and electrical stimulation, as well as some muscle-release techniques to the back muscles and soft tissues may help alleviate pain. As the pain subsides the physical therapist may introduce some flexibility and strength exercises for the back and abdominal muscles. Techniques on improving posture may also help. The patient will be encouraged to practice the techniques regularly, even after the pain has gone, to prevent back pain recurrence.
Surgery – surgery for back pain is very rare. If a patient has a herniated disk surgery may be an option, especially if there is persistent pain and nerve compression which can lead to muscle weakness. Examples of surgical procedures include:
- Fusion– two vertebrae are joined together, with a gone graft inserted between them. The vertebrae are splinted together with metal plates, screws or cages. There is a significantly greater risk for arthritis to subsequently develop in the adjoining vertebrae.
- Artificial disk– an artificial disk is inserted; it replaces the cushion between two vertebrae.
- Discectomy (partially removing a disk)– a portion of a disk may be removed if it is irritating or pressing against a nerve.
- Partially removing a vertebra– a small section of a vertebra may be removed if it is pinching the spinal cord or nerves.
Lower Back Pain Remedy
Aside from being conscious of how you sleep and where you sleep, there are a few daytime habits that can help reduce lower back pain as well. Much of the recommended habits for prevention go hand-in-hand with leading a generally healthy lifestyle.
Steps to lower the risk of developing lower back pain consist mainly of addressing some of the risk factors.
- Smoking– a significantly higher percentage of smokers have lower back pain incidences compared to non-smokers of the same age, height and weight.
- Posture when sitting– a good seat should have good back support, arm. When sitting try to keep your knees and hips level and keep your feet flat on the floor or use a footstool. If you are using a keyboard, make sure your elbows are at right-angles and that your forearms are horizontal.
- Do not lift and twist at the same time. If something is heavy keep looking straight ahead, not up nor down, so that the back of your neck is like a continuous straight line from your spine.
- Moving things– it is better for your back to push things across the floor, rather than pulling them.
- Shoes– flat shoes place less of a strain on the back.
- Driving– it is important to have proper support for your back. Make sure the wing mirrors are properly positioned so you do not need to twist. If you are on a long journey, have plenty of breaks – get out of the car and walk around.
- Your bed– you should have a mattress that keeps you spine straight, at the same time supporting the weight of your shoulders and buttocks. Use a pillow, but not one that forces your neck into a steep angle.
Lower back pain is not a small or insignificant problem, but for many people the side effects and severity can be minimized with fairly simple changes to habits. Awareness of ideal sleep positions and the relationship between mattresses and backs are essential for keeping pain at bay during the night, and paying attention to posture and movements improves comfort throughout the day.
When to Seek Immediate Treatment for Lower Back Pain
Most cases of low back pain do not require urgent care, but anyone should see a doctor immediately if low back pain is a result of trauma, or if pain is accompanied by any of the following symptoms:
- Fever and chills
- Unexplained recent weight loss
- Significant leg weakness
- Sudden bowel and/or bladder incontinence—either difficulty passing urine or having a bowel movement, or loss of control of urination or bowel movement (cauda equina syndrome)
- Severe, continuous abdominal pain (abdominal aortic aneurysm)
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