Low Back Pain

Low back pain is extremely common. Almost every person will have at least one episode of low back pain at some time in his or her life. The pain can vary from severe and long term to mild and short lived. It will resolve within a few weeks for most people.

Anatomy Cause Symptoms Diagnosis Treatment Videos Prevention

Anatomy

There are 24 vertebrae in three upper segments of the spinal column. These three segments create three natural curves of the back: the curves of the neck area (cervical), chest area (thoracic), and lower back (lumbar). The lower segments of the spine (sacrum and coccyx) are made up of a series of vertebrae that are fused together.

The lower back is a complex area that connects the upper body (including the chest and arms) to the lower body (including the pelvis and legs). The lower back is composed of several vertebrae, disks of soft cartilage, muscles, joints, ligaments, and nerve tissue.

• Lumbar vertebrae - five cylindrical bones stacked one upon the other, connecting the upper spine to the pelvis
• Disks - act as shock absorbers between the vertebrae, and allow for spine movement
• Spinal cord and nerves - the "electrical cables," which travel through a central canal in the lumbar vertebrae, connecting the brain to the leg muscles
• Small joints- between vertebrae, they allow movement and provide stability
• Muscles and ligaments - provide strength and power, as well as support and stability

The lower back provides the body with power and mobility, allowing such movements as turning, twisting or bending, as well as the strength to stand, walk, and lift. Proper functioning of the lower back is needed for almost all activities of daily living.

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Cause

Doctors have many ideas about what causes low back pain, but no single explanation applies to everyone.

The lower back is a complex area that connects the upper body (including the chest and arms) to the lower body (including the pelvis and legs). The lower back is composed of several vertebrae, disks of soft cartilage, muscles, joints, ligaments, and nerve tissue.

Low back pain may be related to aging of the disk. As a result of wear and tear on the spine, ligaments, and disks, a disk may begin to protrude or collapse. The problem can be aggravated by associated conditions, such as narrowing (stenosis) of the canal or shifting of the vertebra (spondylolisthesis), one upon the other.

Doctors do not know why some people with acute back pain go on to suffer from long term (chronic) low back pain. They also don't know why some people go on to feel quite well between episodes of severe pain.

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Symptoms

Pain in the lumbosacral area (lower part of the back) is the primary symptom of low back pain.

• The pain may radiate down the front, side, or back of your leg, or it may be confined to the low back.
  
  
• The pain may become worse with activity.
  
  
• Occasionally, the pain may be worse at night or with prolonged sitting such as on a long car trip.
  
  
• You may have numbness or weakness in the part of the leg that receives its nerve supply from a compressed nerve.
  
  
  • An example of this would be an inability to plantar flex the foot. This means you would be unable to stand on your toes or bring your foot downward. This occurs when the first sacral nerve is compressed or injured.
    
    
  • Another example would be the inability to raise your big toe upward. This results when the fifth lumbar nerve is compromised.

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Diagnosis

A thorough medical history and physical exam can usually identify any dangerous conditions or family history that may be associated with the pain. The patient describes:

• the onset, site, and severity of the pain
• duration of symptoms and any limitations in movement
• history of previous episodes or any health conditions that might be related to the pain
• The physician will examine the back and conduct neurologic tests to determine the cause of pain and appropriate treatment.
• Blood tests may also be ordered.
• Imaging tests may be necessary to diagnose tumors or other possible sources of the pain.

Diagnostic Methods

Diagnostic methods that may be used include:
• X-rays (imaging methods that help diagnose the cause and site of back pain)
• Discography (involves the injection of a contrast dye into a spinal disc thought to be causing low back pain)
• Computerized Tomography (CT) (a quick and painless process used when disc rupture, spinal stenosis, or damage to vertebrae is suspected as a cause of low back pain)
• Magnetic Resonance Imaging (MRI) (used to evaluate the lumbar region)
• Electrodiagnostic Procedures (including electromyography (EMG), nerve conduction studies and evoked potential (EP) studies)
• Bone Scans (used to diagnose and monitor infections, fractures, or disorders in the bone)
• Thermography (uses infrared sensing devices to measure small temperature changes)
• Ultrasound Imaging (uses high-frequency sound waves to obtain images inside the body)

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Treatment

Self-help treatments

There are a number of steps you can take to help yourself.

• Stay active - It's important to return to your normal level of physical activity as soon as possible. Staying active will help your back to get better, and reduces your risk of getting simple back pain again.
• Stay positive - remember that back pain usually goes away quickly.

Medicines

Taking a painkiller that you would normally take for a headache (eg paracetamol or ibuprofen) is usually enough to relieve simple back pain and can help you keep active. It is best to get into a routine and take this at the same time every day. Always follow the instructions on the patient information leaflet that comes with the medicine and speak to your pharmacist.

Prescription-only muscle relaxants such as diazepam may help with muscle spasms. Doctors rarely prescribe these as they can be addictive. Using a hot water bottle or an ice pack on the painful area can help reduce the pain. Don't put ice directly on your skin, as this can cause an ice burn.

Epidural for back pain relief

This is an injection of a painkiller or steroid directly into the bottom of your spine to decrease the inflammation, which may be causing the pain.

Surgery

If your chronic back pain isn't helped by exercises, painkillers or other simple methods, then surgery is considered as a last resort. There are hundreds of different types of back surgery, too many to describe on this page. Your doctor will discuss the different options with you in more detail.

Some of the most common surgical procedures used are:

• Discectomy - Using a surgical microscope, a small piece of the disk that is pinching the nerve is removed to relieve the pain caused by pressure on the nerve
• Laminectomy - Very simular to Discectomy. A small piece of bone that is pinching the nerve is removed to relieve the pain caused by pressure on the nerve.
• Spinal Fusion - Two or more bony segments in the spine are Fused together to prevent them from slipping against each other.
• Disk Replacement - The worn out disk is removed and replaced by a synthetic disk.

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Prevention

Exercise
Regular exercise is important to help maintain mobility and strength. It should be done without pain and it should be done regularly. Brisk walking, swimming and cycling are all excellent exercises, but you should do what is suitable for you and what you enjoy.

Preparation
You should warm up your body before any form of physical activity, whether it is sports, gardening or DIY'ing. This prepares the body for action and helps to prevent injuries.

Cooling Down
Cooling down and stretching after exercise or physical activity is just as important as a warm up. Never "bounce" your stretches and do it gently without pain.

Lift Correctly
You don't have to lift something heavy in order to hurt your back. Picking up something light incorrectly is far more likely to hurt your back than picking up heavy objects correctly. Lifting things away from your body is also likely to cause damage. When you pick up anything, no matter how heavy, get it as close to your body as you can and keep your back as straight as you can and don't twist with it.

Keep Active
Whether you are at home, at work or in the car, prolonged sitting causes load on the discs and weakness of the muscles. Get up and move every now and then, even if it is only for a minute. The body is designed for movement not for slouching in front of the TV or driving for hours on end.

Sit Properly
So called "comfortable chairs" do not do your back any good. They are usually too low, too soft and the seat is too long with a rounded back. They force you to slouch and sit awkwardly which puts stress on your back. Choose a chair that is supportive, allows you to sit up correctly with your feet flat on the floor. The right bed is also important. Beds can be too hard. The base of the bed should be firm and the mattress should be soft enough to mould to the contours of your body but be firm enough to give you support in the right places. Futons are not good for most backs and the word "Orthopaedic" when applied to beds means absolutely nothing.

Sleep Properly
Sleep in a comfortable position. On your side in the "fetal" position is usually the least stressful on your back. Sleeping on your front puts most stress on your back and neck and can lead to trouble. Using a pillow of the right height which supports the neck is also important.

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