What is lower back pain?
Low back pain is pain over the lower back that arises from injuries or diseases. It is commonly due to a strain and sprain of the muscles and tendons of the back.
Low back pain can be mild or severe. In extreme cases, you can be unable to sleep, work, walk or do anything you love.
Low back pain usually gets better with rest, simple pain medications, and appropriate exercise and therapy. Injections and other minimally invasive therapies can help you recover faster and break you out of the vicious cycle of pain. Neverthless, there will be some conditions for which surgery is required.
Who is prone to get low back pain?
80 percent of people have low back pain at some time in their lives. People with the following risk factors are more likely to develop low back pain:
- Age over 30. Individuals over the age of 30 tend to get back pain. The discs which are soft rubbery tissues that help cushion impact get worsen away, and the small joints and muscles of the back bear the brunt of day to day burdens This results in pain, spasm and stiffness.
- Being overweight: PBeing overweight and obese means more pressure on the joints and discs and muscles. The increasing numbers of people who are over their ideal weight has resulted in an epidemic of low back pain.
- Low fitness: Being unfit and having a sedentary lifestyle means lax abdominal and back muscles which cannot do their job of supporting the spine. This makes it easy to have back strain and sprains from simply missing a step or having a trivial fall.
- Work and play: People whose work involves a lot of bending and carrying heavy loads have a higher risk of low back pain. So do people who carry heavy weights in the gym, or who start Muay-Thai or other extreme sports as part of their mid life crisis.
- Back problems: People who have kyphosis or scoliosis or other rheumatological conditions can have an imbalance of forces on their spine, or have increased rate of wear and tear of the small joints.
- Genes: People Unfortunately, having parents or relatives with osteoarthritis, certain autoimmune conditions, or predisposition to obesity means that you are more likely to develop low back pain.
- Mental illness: Having depression and anxiety does not give you low back problems, but they can turn pain from being a small annoyance to something a lot more disabling.
What are the symptoms?
- Shooting pain down the buttock or the back of your legs
- ‘Pop’ sensation during the initial injury of bending or lifting
- Sneezing, coughing or straining makes it worse
- Stiffness on getting up after sitting or lying down for a while
- Walking crooked with the body weight more on one side in order take the pressure off one of the nerves
- Muscle spasms can occur as the body reacts to the damaged disc or pinched nerve. The spasm can be extremely intense, making it hard for you get to out of bed or move around.
What causes lower back pain?
- Muscle strains and sprains: This is likely to be the most common cause of low back pain. You can sprain your muscles by lifting something too heavy or lifting it wrongly. In those who are very unfit, you can sprain your back simply by sneezing or coughing too hard!
- Disc bulge and herniations: Discs are like car tires, which cushion the spine from the impact of walking running, falling. When we age, the discs become ‘flatter’ and do not offer the same level of protection as before. The discs can bulge and compress a nerve. The covering of the disc can tear and the jelly like substance within can herniate out and press on the spinal canal. In severe cases, the pressure from the ‘slipped disc’ can be so great that you are unable to control your bladder or bowel. This is a medical emergency.
- Fractures: Accidents like a vehicle collision or sports injury can lead to bones breaking. In patients with osteoporosis, even a trivial thing like sitting down hard on a chair, or carrying heavy groceries to hoard for the next pandemic can lead to fractures.
- Arthritis: Osteoarthritis is extremely common, and just as it affects the big joints like the knee, it can also affect the small joints of the back. Other types of arthritis from autoimmune conditions can cause arthritis of the small joints and lead to pain and stiffness.
- Rare diseases: Cancer, and some infections like tuberculosis can cause low back pain. Kidney stones, aortic aneurysms, constipation can also mimic low back pain.
How will the doctor investigate your low back pain?
The specialist will speak to you about your symptoms and do a physical examination. He or she will then order an imaging study if appropriate in order to confirm the diagnosis, as well as exclude some rare causes.
Investigations that may be ordered include:
- X-rays of the spine, which looks at bones and alignments that may be the cause of pain in conditions like scoliosis radiation to produce images of bones.
- MRI which uses magnetic waves and is better at looking at discs, nerves and soft tissue.
- CT scan which uses X-rays and can create 3D renderings. This is suitable for issues with the bones like fractures, and is the modality of choice in someone who has had a spine surgery and metallic implants.
- Nerve conduction studies and Electromyography test the nerves and muscles and help to differentiate between the various causes of nerve damage
- Blood tests may be ordered to check for autoimmune conditions or different causes of arthritis. Urine tests with a dipstick may help to diagnose kidney stones as the cause of your back pain, especially over the flanks.
How do you treat low back pain?
The first thing you should do is to rest. Using ice can help especially if it is due to a muscle spasm. Try simple pain medications and plasters or topical creams. After a while, it is good to try to get back to your normal routine so that the muscles do not become too lazy.
Other treatments for low back pain include:
- Pain medications: The doctor may prescribe paracetamol, non-steroidal anti-inflammatories, and Cox-II inhibitors like etoricoxib or celecoxib. He may also try you on medications to reduce nerve pain like pregabalin or gabapentin.
- Physiotherapy: The therapist will work together with you to help strengthen your core and back muscles so that they can support and protect your spine. Activating and stretching the muscles can also improve range of motion and reduce low back pain.
- Injections and pain procedures: Your pain specialist may use needles to place medication around an irritated nerve in what is known as an epidural steroid injection. He or she may target the disc or the facets with other special needles to reduce the pain that arises from them with procedures such as nucleoplasty, or facet joint medial branch radiofrequency.
- Surgery: When the above methods has been tried or if the condition is more serious, you may need to have surgery.