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Lower back pain is a common cause for visits to the doctor. According to the National Institute of Neurological Disorders and Stroke (NINDS), low back pain is the most common cause of job-related disability. At least 80 percent of Americans will experience low back pain in their lifetime. Most low back pain is the result of an injury, such as muscle sprains or strains due to sudden movements or poor body mechanics while lifting heavy objects. Low back pain can also be the result of certain diseases, such as: 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, there’s a reduction in the fluid content between the vertebrae in the spine. 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 causes of low back pain? 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 remedies for these symptoms. The discs in the back are prone to injury. This risk increases with age. The outside of the disc can tear or herniate. A herniated disc, which is 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 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 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: You might feel these symptoms anywhere in the body. Many people with spinal stenosis notice their symptoms worsen when standing or walking. Scoliosis, kyphosis, and lordosis are all conditions that cause abnormal curvatures in the spine. These are congenital conditions that are usually first diagnosed during childhood or adolescence. The abnormal curvature causes pain and poor posture because it places pressure on: There are a number of other conditions that cause lower back pain. These conditions include: Arthritis is an inflammation of the joints. Fibromyalgia is long-term pain and tenderness in the joints, muscles, and tendons. Spondylitis is inflammation of the joints between the spinal bones. Spondylosis is a degenerative disorder that may cause loss of normal spinal structure and function. Although aging is the primary cause of the condition, the location and rate of degeneration is specific to the individual. Additional health conditions that can cause lower back pain include:
Your doctor will likely begin by requesting a complete medical history and conducting a thorough physical examination to determine where you’re feeling the pain. A physical exam can also determine if pain is affecting your range of motion. Your doctor may also check your reflexes and your responses to certain sensations. This determines if your low back pain is affecting your nerves. Unless you have concerning or debilitating symptoms or neurologic loss, 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. Likewise, if your low back pain continues after home treatment, your doctor may want to order additional tests. Seek medical attention immediately if you experience any of these symptoms in addition to low back pain. Imaging tests such as X-rays, CT scans, ultrasounds, and MRIs may be necessary so your doctor can check for: problems with the ligaments and tendons in your back If your doctor suspects a problem with the strength of the bones in your back, they may order a bone scan or bone density test. Electromyography (EMG) or nerve conduction tests can help identify any problems with your nerves.
What are the treatment options for low back pain? 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. Stop your normal physical activities for a couple of days and apply ice to your lower 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. 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. A warm bath or a massage can often relax stiff and knotted muscles in the back. Low back pain can occur with a number of different conditions, including: There are a number of possible medical treatments including: Your doctor will determine the appropriate dosage and application of drugs and medications based on your symptoms. Some medications your doctor may prescribe include: narcotic drugs such as codeine for pain relief Your doctor may also prescribe physical therapy, including: For severe cases, surgery may be necessary. Surgery is usually only an option when all other treatments fail. However, if there’s loss of bowel or bladder control, or a progressive neurological loss, surgery becomes an emergency option. 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 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.