Lower Back Pain

Although there are a large number of possible causes of lower back pain, a precise diagnosis is made in only a small proportion of cases.

The good news is that lower (or low) back pain frequently goes away with simple home based remedies. We discuss some of these conservative treatment options in this post. In the comparatively rare cases in which it does not respond to conservative treatments, doctors have several proven remedies for it.

What Is The Lower Back And Why Is It A Common Source Of Pain?

The lower back is the area of the back that extends downwards from just below the ribcage to the buttock creases. This region is also called the lumbar region. Pain in this area is commonly described as lower back pain to distinguish it from upper back pain. People with lower back pain sometimes have pain in the upper legs as well.

The lower back contains a complex network of bones, nerves and soft tissues.  They combine to form a strong and flexible structure that supports the head and upper body. The structure also plays a key role in everyday activities such as bending, twisting and heavy lifting. It even plays a pivotal role in the act of walking. It supports the spinal column and also flexes and rotates the hips during walking or running.

The lower back also contains a network of nerves that control the muscles in the lower body. It also carries sensations and pain from the lower body to the brain via the spinal column.

However, this very complexity renders the area susceptible to injury and, in many cases, pain. Injuries to any of these nerves, muscles or bones can cause lower back pain and inflammation.

When pain occurs, the complexity of the structures in the lower back can often make it difficult to understand its precise source. Sometimes, two very different types of injuries can initially feel very similar. In general, injuries to soft tissues such as muscles or ligaments tend to heal more rapidly than damage to other tissues such as spinal discs.

Symptoms Of Lower Back Pain

Low back pain can take on several different forms depending on its underlying cause:

• It can range from a mild or dull ache to a sharp or stinging pain. For some causes, the patient can even experience a numbing or tingling sensation in the lower back or elsewhere;
• It may be contained to the lower back or it may move from that area to one or both buttocks or thighs. In some cases, the pain can move even further into the lower legs or feet;
• Lower back pain may be accompanied by muscle spasms and/or a tight feeling in the lumbar region or in the hips or pelvis;
• In some cases, lower back pain can get worse after prolonged sitting or standing;
• People with lower back pain may experience difficulty standing straight or walking. They may also find it difficult to go from a standing to a sitting position.

Types Of Lower Back Pain

Lower back pain can be categorized among three different types:

Acute Low Back Pain

This type of pain usually appears without warning. It is usually short term in nature and may last for just a few days or weeks. It is normally a response to a soft tissue injury in the lower back and usually subsides as that injury heals.

Subacute Low Back Pain

This type of low back pain is also caused by a soft tissue injury such as a muscle strain. However, it usually lasts longer than acute pain (possibly between 6 weeks and 3 months). Patients with this type of pain should consult with their healthcare advisors for medical advice & a diagnosis.

Chronic Low Back Pain

This type of lower back pain is more long term in nature and generally lasts for 3 months or longer.

Once it is clear that this pain is not responding to initial home based treatments, affected individuals should seek medical advice, diagnosis & treatment for the problem..

Causes Of Low Back Pain

The most common specific cause of acute or subacute types of back pain is a sprain or sprain of back soft tissues. This is usually the result of  a pulled muscle or ligament.

The most common causes of chronic low back pain tend to be:

• Herniated Discs;
• Degenerative Disc Disease;
• Sacroiliac joint dysfunction. This is associated with inflammation or other damage to the joint connecting the bottom of the spine to each side of the pelvis;
• Spinal stenosis, in which the spinal canal narrows and starts to compress the nerves traveling through it;;
• Osteoarthritis, in which the cartilage covering adjacent bones wears away and the bone ends start to come into direct contact with each other;
• Spinal curvature such as may result from scoliosis;
• Spinal fractures or dislocations such as may occur in a fall or motor vehicle accident;
• Osteoporosis that eventually causes a compression fracture in which the spinal vertebrum caves in on itself.

Doctors also sometimes categorize lower back pain according to its underlying cause rather than whether it is acute or chronic. With this type of categorization, the two main categories are mechanical or radicular causes.

Mechanical Low Back Pain

This type of lower back pain comes from the muscles, ligaments, joints or bones in or adjacent to the spine. Mechanical pain tends to remain in a narrow area comprising the lower back, buttocks and the top of the legs.

In addition to its localized nature, mechanical low back pain tends to be affected by loading or unloading the spine. (It may also become more or less severe as a result of movements like twisting, standing or sitting.) The pain is usually eased by lying down flat and made worse if the patient moves the back, coughs or sneezes. It  typically varies in severity with posture or activity.

In most cases, mechanical pain tends to be acute or subacute in terms of its  duration. It is usually the result of a back sprain or strain.

Radicular Low Back Pain

This type of low back pain is usually associated with damage leading to spinal nerve impingement.  Typically, this can occur as a result of a herniated disc.

In contrast to the localized nature of mechanical pain, radicular pain can radiate into the buttock area or down one leg.

It also tends to be sharp or burning in nature. It can sometimes be accompanied by numbness or weakness in the lower back or surrounding areas.

Another characteristic of radicular pain is its tendency to occur on one side of the body only.

Other Types Of Low Back Pain

In addition to mechanical and radicular causes, low back pain can also be a result of the following back problems:

• Inflammatory problems such as rheumatoid arthritis or ankylosing spondylitis (a rare type of arthritis that affects the spine, but the commonest inflammatory cause),
• Pain caused by a disorder elsewhere in the body that eventually migrates to the back (ie kidney stones, biliary colic or cholecystitis); this is called referred pain.
• Neuropathic pain, which could be caused by spinal stenosis or lumbar disc prolapse. This is a chronic but sharp pain that is usually associated with damage to the nerves or malfunctioning of the nervous system. Other neurological signs and symptoms like reduced muscle power and weak reflexes can also be present.
• Tumors in the lower back area (primary tumour or secondary deposits); symptoms suggestive of this include weight loss, lethargy and isolated areas of tenderness
• Infections in the lower back; examples for this include osteomyelitis, tuberculosis of the spine and discitis
• Pain can also appear with no specific cause. In this case, doctors are forced to treat the patient by offering pain relief instead of dealing with the fundamental causes.
• A discussion of back pain would be incomplete without mentioning cauda equina syndrome. This results from compression of the cauda equina (a group of nerve roots at the lower end of the spinal cord) below the level of L2. Features of this syndrome include urinary and faecal incontinence, sensory numbness of the buttocks and back of the thighs (so-called saddle anaesthesiae, ie  the areas in contact with a bicycle saddle while riding) and leg weakness associated with inability to dorsiflex and plantarflex the foot and toes. Cauda equina syndrome is an emergency that needs to be referred urgently to orthopaedics/neurosurgery for nerve root decompression. A common cause is disc prolapse at L4/5 level.

Treatment Of Lower Back Pain

Treatment options for lower back pain include home based remedies, non traditional treatments and surgery.

Home Based Treatments

Home based treatment can be a viable remedy for lower back pain due to a muscle strain or sprain. It can also be effective in reducing the symptoms of severe and chronic pain, although it does not address the fundamental cause.

Home based self care may include some or all of the following:

• A short period of rest (i.e. refraining from strenuous activity) can often be sufficient to allow a mild back sprain or strain to heal. However, the patient should be careful not to let this rest period continue for too long. Bed rest should not be considered as a treatment. It may cause the back muscles to atrophy and make healing more difficult in the long term. A gradual return to normal activities should be encouraged as soon as possible;
• A back belt can be useful in taking the strain of everyday activities off the lower back and allowing damaged soft tissues to heal;
• Alternatively, patients attempting home based treatment can try to adopt activities that allow them to stay active while avoiding positions that may aggravate their pain. For example, patients can try to avoid standing for too long if that tends to aggravate the pain;
• Applying a cold compress to the lower back can be helpful in easing pain due to inflammation (e.g. arthritis). Do this for 20-30 minutes at a time and at intervals of 2-3 hours. Avoid allowing the compress (into) to have direct contact with the bare skin, as this could cause skin damage.
• On the other hand a heat compress can be useful in alleviating a stiff or sore back. It improves blood circulation that supplies damaged muscles and ligaments with oxygen and fresh nutrients;
• Over the counter pain relief medications such as Advil or aspirin can also be helpful. To counter inflammation, patients can try Non Steroidal Anti Inflammatory Drugs (NSAIDs) such as Ibuprofen and this can be combined with paracetamol. Other options for NSAIDS include diclofenac and naproxen. If the pain is not adequately controlled with paracetamol and NSAIDS, the paracetamol can be replaced by co-codamol (a preparation containing paracetamol and codeine phosphate). If tension in the musculature of the lower back is a problem, then the short-term use of a muscle relaxant like diazepam or baclofen can be considered. A tricyclic antidepressant like amitriptyline can also be used, particularly if the back pain is associated with sciatica caused by irritation or compression of the sciatic nerve root. Of all these medications, only paracetamol, ibuprofen and low-strength co-codamol can be purchased over the counter. The others can only be obtained on prescription.
• Topical pain relievers,such as a topical NSAID like ibuprofen, can be helpful in relieving pain without the risks of side effects, addictions or other complications;
• A physical therapy program consisting of stretching and/or strengthening lower back exercises can be helpful once the pain is less severe. They will prepare the patient for a return to normal activity with stronger back muscles that are less likely to suffer injury;

Non Traditional Treatments

Some individuals have reported success in easing low back pain by following these non-traditional remedies:

• Spinal manipulation by a chiropractor;
• Acupuncture;
• Massage therapy;
• Meditation or cognitive behavioural therapy (CBT).

These treatments tend to be used if the home-based ones do not alleviate symptoms and/or if the pain persists for too long (ie becomes subacute or chronic).

Surgery

The surgical options available for the treatment of low back pain include:

• Decompression surgery to relieve pressure on a nerve root that is being compressed within the spinal column;
• Lumbar fusion, in which the surgeon removes the soft tissues between adjacent vertebra and replaces them with bone or metal. This is an option for treatment of many causes of chronic back pain, including spondylolisthesis, degenerative disc disease and spinal stenosis;
• Replacement of spinal discs with artificial substitutes (as a treatment for degenerative disc disease);

As with home based treatments, a program of physical therapy exercises is an essential component of rehabilitating the patient as (s)he returns to regular activity.