Almost everyone will experience low back pain at some point in their lives. This pain can vary from mild to severe. It can be short-lived or long-lasting. However it happens, low back pain can make many everyday activities difficult to do.
There are many causes of low back pain. It sometimes occurs after a specific movement such as lifting or bending. Age also plays a role in many back conditions. As we age, our spines age with us. Aging causes degenerative changes in the spine. These changes can start in our 30s — or even younger — and can make us prone to back pain, especially if we overdo our activities.
One of the more common causes of low back pain is muscle soreness from over-activity. Muscles and ligament fibers can be overstretched or injured. This is often brought about by that first softball or golf game of the season, or too much yard work or snow shoveling in one day. This pain can come on suddenly or slowly progress with overuse.
Some people develop low back pain that does not go away within days. This may mean there is an injury to a disk.
- Disc Tear: Small tears to the outer part of the disc (annulus) sometimes occur with aging. Some people with disk tears have no pain at all. Others can have pain that lasts for weeks, months, or even longer. A small number of people may develop constant pain that lasts for years and is quite disabling. Why some people have pain and others do not is not well understood.
- Disk herniation: Another common type of disc injury is a “slipped” or herniated disc. A disc herniates when its jelly-like center (nucleus) pushes against its outer ring (annulus). If the disc is very worn or injured, the nucleus may squeeze all the way through. When the herniated disc bulges out toward the spinal canal, it puts pressure on the sensitive spinal nerves, causing pain. Because a herniated disc in the low back often puts pressure on the nerve root leading to the leg and foot, pain often occurs in the buttock and down the leg. This is often described as sciatica. A herniated disc often occurs with lifting, pulling, bending, or twisting movements.
- Disc Degeneration: With age, intervertebral discs begin to wear away and shrink. In some cases, they may collapse completely and cause the facet joints in the vertebrae to rub against one another. Pain and stiffness result. This “wear and tear” on the facet joints is referred to as osteoarthritis. It can lead to further back problems, including spinal stenosis.
Degenerative Spondylolisthesis: (Spon-dee-low-lis-THEE-sis): Changes from aging and general wear and tear make it hard for your joints and ligaments to keep your spine in the proper position. The vertebrae move more than they should, and one vertebra can slide forward on top of another. If too much slippage occurs, the bones may begin to press on the spinal nerves.
Spinal Stenosis: Spinal stenosis occurs when the space around the spinal cord narrows and puts pressure on the cord and spinal nerves. When intervertebral disks collapse and osteoarthritis develops, your body may respond by growing new bone in your facet joints to help support the vertebrae. Over time, this bone overgrowth (called spurs) can lead to a narrowing of the spinal canal. Osteoarthritis can also cause the ligaments that connect vertebrae to thicken, which can narrow the spinal canal. Some patients may develop symptoms of nerve compression while other will not.
Scoliosis: This is an abnormal curve of the spine that may develop in children, most often during their teenage years. It also may develop in older patients who have arthritis. This spinal deformity may cause back pain and possibly leg symptoms, if pressure on the nerves is involved.
Additional Causes: There are other causes of back pain, some of which can be serious. If you have vascular or arterial disease, a history of cancer, or pain that is always there despite your activity level or position, you should consult your primary care doctor.
Back pain varies. It may be sharp or stabbing. It can be dull, achy, or feel like a “charley horse” type cramp. The type of pain you have will depend on the underlying cause of your back pain.
Most people find that reclining or lying down will improve low back pain, no matter the underlying cause.
People with low back pain may experience some of the following:
- Back pain may be worse with bending and lifting.
- Sitting may worsen pain.
- Standing and walking may worsen pain
- Back pain comes and goes, and often follows an up and down course with good days and bad days.
- Pain may be relieved by bending forward (felxion)
- Pain may extend from the back into the buttock or outer hip area, but not down the leg.
- Sciatica is common with a herniated disk. This includes buttock and leg pain, and even numbness, tingling or weakness that goes down to the foot. It is possible to have sciatica without back pain.
Regardless of your age or symptoms, if your back pain does not get better within a few weeks, or is associated with fever, chills, or unexpected weight loss, you should call your primary care doctor.
In general, treatment for low back pain falls into one of three categories: medications, physical medicine, and surgery.
Medications: Several medications may be used to help relieve your pain.
Physiotherapy can include passive modalities such as heat, ice, massage, ultrasound, and electrical stimulation. Active therapy consists of stretching, weight lifting, and cardiovascular exercises. Exercising to restore motion and strength to your lower back can be very helpful in relieving pain.
Braces are often used. The most common brace is a corset-type that can be wrapped around the back and stomach. Braces are not always helpful, but some people report feeling more comfortable and stable while wearing them.
Chiropractic or manipulation therapy is provided in many different forms. Some patients have relief from low back pain with these treatments.
Traction is often used, but without scientific evidence for effectiveness.
Other exercise-based programs, such as swimming, Pilates or yoga are helpful for some patients.
Injections can be very helpful for this condition and they may include:
- Cortisone (Corticosteroid)
- Platelet Rich Plasma (PRP)
- Trigger Point Injections
Surgery for low back pain should only be considered when nonsurgical treatment options have been tried and have failed. It is best to try nonsurgical options for 6 months to a year before considering surgery.
In addition, surgery should only be considered if you doctor can pinpoint the source of your pain.
Surgery is not a last resort treatment option “when all else fails.” Some patients are not candidates for surgery, even though they have significant pain and other treatments have not worked. Some types of chronic low back pain simply cannot be treated with surgery.
Spinal Fusion: Spinal fusion is essentially a “welding” process. The basic idea is to fuse together the painful vertebrae so that they heal into a single, solid bone. Spinal fusion eliminates motion between vertebral segments. It is an option when motion is the source of pain. For example, your doctor may recommend spinal fusion if you have spinal instability, a curvature (scoliosis), or severe degeneration of one or more of your discs. The theory is that if the painful spine segments do not move, they should not hurt. Fusion of the vertebrae in the lower back has been performed for decades. A variety of surgical techniques have evolved. In most cases, a bone graft is used to fuse the vertebrae. Screws, rods, or a “cage” are used to keep your spine stable while the bone graft heals. The surgery can be done through your abdomen, your side, your back, or a combination of these. There is even a procedure that is done through a small opening next to your tailbone. No one procedure has been proven better than another.
The results of spinal fusion for low back pain vary. It can be very effective at eliminating pain, not work at all, and everything in between. Full recovery can take more than a year and includes physiotherapy throughout this recovery time.
Microdiscectomy and canal enlargement: The most common procedure used to treat a single herniated disc is microdiscectomy and/or patients with central canal stenosis with a canal enlargement procedure. The procedure is done through a small incision at the level of the disc herniation and often involves the use of a microscope. The herniated part of the disc is removed along with any additional fragments that are putting pressure on the spinal nerve. Excess amount of arthritis and ligament thickening that are putting pressure on a spinal nerve can also be removed. Removing the pressure involves opening up the spinal canal. This procedure is called a laminectomy.
It may not be possible to prevent low back pain. We cannot avoid the normal wear and tear on our spines that goes along with aging. But there are things we can do to lessen the impact of low back problems. Having a healthy lifestyle is a good start.
- Exercise: Combined aerobic exercise, like walking or swimming, with specific exercises to keep the muscles in your back and abdomen strong and flexible.
- Proper Lifting: Be sure to lift heavy items with your legs, not your back. Do not bend over to pick something up. Keep your back straight and bend at your knees.
- Weight: Maintain a healthy weight. Being overweight puts added stress on your lower back.
- Avoid Smoking: Both the smoke and the nicotine cause your spine to age faster than normal.
- Proper Posture: Good posture is important for avoiding future problems. A therapist can teach you how to safely stand, sit, and lift. Ergonomic assessment for work and home can aid in maintaining proper posture.