What is Low Back Pain?
Low back pain is the most common musculoskeletal problem that requires medical attention, and is the fifth most common reason for a physician visit. The “lumbar” spine, which is the Latin and medical term for low back, is made of five lumbar vertebra (L1-L5). The low back bones (vertebrae) hold the intervertebral discs. The lumbar vertebrae connect to soft tissue (muscles, ligaments, and tendons), and allow five lumbar spinal nerves to exit. The spinal cord runs through the middle of the vertebrae in the spinal canal, but the spinal cord typically ends in the high lumbar area (L1-L2) in most adults.
There are two initial categories of low back pain: acute low back pain and chronic low back pain. Acute low back pain has a sudden onset and generally does not last longer than three to four weeks. Chronic low back pain is when the pain persists longer than four weeks after an acute injury, or pain lasts greater than three months with no history of an acute injury. Low back pain can be further divided into the source or pain.
Causes Of Low Back Pain
Causes of low back pain include:
- Muscle strain or tear
- Ligament strain or tear
- Myofascial syndrome, which is pain and inflammation from muscles and their connections and is often associated with trigger points
- Spondylosis or wear and tear from arthritis
- Disc related pain, such as:
- Discogenic pain, including disc tears, bulging discs, herniated discs, disc protrusion, disc extrusion, and degenerative disc disease
- Radiculitis (irritation of a lumbar nerve root)
- Radiculopathy (an abnormality of a lumbar nerve root)
- Facet joint arthritis or facet syndrome
- Central spinal stenosis or narrowing of the spinal canal
- Neuroforaminal stenosis or narrowing of the nerve-exiting canal
- Diffuse Idiopathic Skeletal Hyperostosis (DISH Syndrome), which is a syndrome with calcifications in the ligaments and tendons along the lumbar spine
- Vertebral body fracture
Treatment For Low Back Pain
Low back pain is diagnosed by a history of pain from a patient and a physical exam by a physician. Conservative measures are often taken first if pain is the primary complaint and the patient is lacking from new neurological abnormalities such as: weakness, loss of balance, and/or bladder dysfunction. Conservative measures such as rest, heat packs, and anti-inflammatory medications are often attempted first. Should these prove ineffective, diagnostic measures such as x-rays, CT scans, and MRIs are used for a diagnostic source of pain. Additional pain medications and more directed pain treatments such as physical therapy and/or chiropractic care are then initiated. If pain still persists, advanced pain practitioners (pain doctors, surgeons, and other specialists) are typically utilized.
Initially for acute low back pain, conservative treatment will be suggested. Conservative treatment consists of rest, physical therapy, and non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen. Strict bed rest can actually worsen the pain and prolong the healing process, so bed rest should be limited to no more than 2-4 days. Continuation of normal activities is advised as long as the patient remains within the limits permitted by their pain. Physical therapy will help improve range of motion and safely increase the strength of the back muscles.
There are many potential causes for low back pain and it is important to seek medical advice and treatment from a pain specialist. If you have pain in your lower back, contact your doctor immediately to learn about the best possible course of action for your specific symptoms and lifestyle.