Back in the day were you an all-star football player? Basketball? Cheerleading? Or do you just love adventure? With the years passing, are your fun times catching up with you? Most low back pain, if you didn't know, is the result of a previous injury or trauma.
Regardless of the cause, your muscle sprains or strains are due to that trauma paired with sudden movements or poor body mechanics while lifting heavy objects and BAM! — you are in chronic lower back pain.
Maybe none of the above defines you. Low back pain can also be the result of certain diseases, such as cancer of the spinal cord, a ruptured or herniated disc, sciatica, arthritis, kidney infections or infections of the spine.
Acute back pain can last anywhere from a few days to a few weeks, while chronic back pain is pain that lasts longer than three months. Low back pain is more likely to occur in individuals between the ages of 30 and 50. This is partly due to the changes that occur in the body with aging. As you grow older, the fluid content between the vertebrae in the spine reduces. This means discs in the spine experience irritation more easily. You also lose some muscle tone, which makes the back more prone to injury.
This is why strengthening your back muscles and using good body mechanics are helpful in preventing low back pain.
What are the Possible Causes of Low Back Pain?
Strains: The muscles and ligaments in the back can stretch or tear due to excess activity. Symptoms include pain and stiffness in the lower back, as well as muscle spasms. Rest and physical therapy are known remedies for these symptoms.
Disc Injury: The discs in the back are prone to injury, and this risk increases with age. The outside of the disc can tear or herniate. A herniated disc (also known as a slipped or ruptured disc) occurs when the cartilage surrounding the disc pushes against the spinal cord or nerve roots. The cushion that sits between the spinal vertebrae extends outside its normal position.
This can result in compression of the nerve root as it exits from the spinal cord and through the vertebral bones. Disc injury usually occurs suddenly after lifting something or twisting the back. Unlike a back strain, pain from a disc injury usually lasts for more than 72 hours.
Sciatica: Sciatica can occur with a herniated disc if the disc presses on the sciatic nerve. The sciatic nerve connects the spine to the legs. As a result, sciatica can cause pain in the legs and feet. This pain usually feels like burning or pins and needles.
Spinal Stenosis: Spinal stenosis is when the spinal column narrows, putting pressure on the spinal cord and spinal nerves. Spinal stenosis is most commonly due to degeneration of the discs between the vertebrae. The result is compression of the nerve roots or spinal cord by bony spurs or soft tissues, such as discs.
Pressure on the spinal nerves causes symptoms such as numbness, cramping, and weakness. You might feel these symptoms anywhere in the body. Many people with spinal stenosis notice their symptoms worsen when standing or walking.
Abnormal Spine Curvatures: Scoliosis, kyphosis, and lordosis are all conditions that cause abnormal curvatures in the spine. These are congenital conditions and are usually first diagnosed when patients are children and teenagers. The abnormal curvature places pressure on the muscles, tendons, ligaments, and vertebrae, causing pain and poor posture.
There are a number of other conditions that cause lower back pain.
These conditions include:
- Spondylitis — inflammation of the joints between the spinal bones
- Spondylosis — a degenerative disorder that may cause loss of normal spinal structure and function
- Kidney and bladder problems
- Ovarian cysts
- Uterine fibroids
How is Low Back Pain Diagnosed?
Most doctors begin by conducting a physical examination to determine where exactly you’re feeling the pain. A physical exam can also determine if your pain is affecting your range of motion.
Your doctor may also check your reflexes and your response to certain sensations. This determines if your low back pain is affecting your nerves. Unless you have concerning or debilitating symptoms, your doctor will probably monitor your condition for a few weeks before sending you for testing.
This is because most low back pain resolves using simple self-care treatments.
Imaging Tests such as X-rays, CT scans, ultrasound, and MRI may be necessary so your doctor can check for bone problems, disc problems, or problems with the ligaments and tendons in your back. If your doctor suspects a problem with the bones in your back, they may send you for a bone scan or bone density test.
Electromyography (EMG) or nerve conduction tests can help identify a problem with your nerves.
Certain symptoms like lack of bowel control, weakness, fever and weight loss might require further testing. Likewise, if your low back pain continues after home treatment, your doctor may wish to send you for tests. Seek medical attention immediately if you experience any of these symptoms in addition to low back pain.
What are the Treatment Options for Low Back Pain?
Home Care: Consider stopping your normal physical activities for a couple days and apply ice to your low back. Doctors generally recommend using ice for the first 48 to 72 hours, then switching to heat. Alternate ice and heat to relax muscles. The RICE protocol (rest, ice, compression, and elevation) is recommended within the first 48 hours.
Take Over-the-Counter Pain Medication: such as ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol), to relieve pain.
Sleeping Positions: Sometimes lying on your back causes more discomfort. If so, try lying on your side with your knees bent and a pillow between your legs. If you can lie comfortably on your back, place a pillow or rolled-up towel beneath your thighs to reduce the pressure on the lower back.
Heat Therapy: A warm bath or a massage can often relax stiff and knotted muscles in the back.
Self-care methods are helpful for the first 72 hours after the pain begins. If the pain doesn’t improve after 72 hours of home treatment, you should call your doctor.
Medical Treatment: Low back pain can occur with a number of different conditions, including muscle strain and weakness, pinched nerves and spinal cord misalignment. There are a number of possible medical treatments including medications, medical appliances, and physical therapy. Your doctor will determine the appropriate dosage and application of drugs and medications based on your symptoms.
Some medications your doctor may prescribe include:
- Muscle relaxants
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Narcotic drugs
- Codeine for pain relief
- Steroids to reduce inflammation
- Corticosteroid injections
Your doctor may also prescribe physical therapy, including:
- Strengthening exercises
- Back and spinal manipulation
For severe cases, surgery may be necessary. Surgery is usually only an option when all other treatments fail unless there is a loss of bowel or bladder control or a progressive neurological loss when it becomes an emergency.
Here are the possible surgery types:
- A Discectomy relieves pressure from a nerve root pressed on by a bulging disc or bone spur. The surgeon will remove a small piece of the lamina, a bony part of the spinal canal.
- A Foraminotomy is a surgical procedure that opens up the foramen, the bony hole in the spinal canal where the nerve root exits.
- Intradiscal Electrothermal Therapy (IDET) involves inserting a needle through a catheter into the disc and heating it up for 20 minutes. This makes the disc wall thicker and cuts down on the inner disc’s bulging and irritation of the nerve.
- A Nucleoplasty uses a wand-like device inserted through a needle into the disc. It can then remove inner disc material. The device then uses radio waves to heat and shrink the tissue.
- Radiofrequency Lesioning or Ablation is a way to use radio waves to interrupt the way the nerves communicate with each other. A surgeon inserts a special needle into the nerves and heats it, which destroys the nerves.
- Spinal Fusion makes the spine stronger and cuts down on a painful motion. The procedure removes discs between two or more of the vertebrae. The surgeon then fuses the vertebrae next to each other with bone grafts or special metal screws.
- A Spinal Laminectomy, also known as spinal decompression, removes the lamina to make the size of the spinal canal bigger. This relieves pressure on the spinal cord and nerves.
How Can I Prevent Low Back Pain?
There are many ways to prevent low back pain. Practicing prevention techniques may also help lessen the severity of your symptoms if you have a lower back injury.
Prevention involves exercising the muscles in your abdomen and back, losing weight if you are overweight, lifting items properly (bending at the knees and lifting with the legs) and maintaining proper posture.
Sleep on a firm surface or sit on supportive chairs that are at the correct height.
Avoid High-Heeled Shoes.
If You Smoke, You Should Quit. Nicotine causes degeneration of spinal discs and also reduces blood flow. Consider the nicotine patch to curb your cravings.
Are you worried that your lower back pain may progress into something more severe? It may be worth it to get checked out by a physician. Consider calling your medical team, making an appointment and find out once and for all what your symptoms are.