Back pain is a symptom. Common causes of back pain involve disease or injury to the muscles, bones, and/or nerves of the spine. Pain arising from abnormalities of organs within the abdomen, pelvis, or chest may also be felt in the back. This is called referred pain. Many disorders within the abdomen, such as appendicitis,aneurysms, kidney diseases, kidney infection, bladder infections, pelvic infections, and ovarian disorders, among others, can cause pain referred to the back. Normalpregnancy can cause back pain in many ways, including stretching ligaments within the pelvis, irritating nerves, and straining the low back. Your doctor will have this in mind when evaluating your pain.
- Nerve root syndromes are those that produce symptoms of nerve impingement (a nerve is directly irritated), often due to a herniation (or bulging) of the discbetween the lower back bones. Sciatica is an example of nerve root impingement. Impingement pain tends to be sharp, affecting a specific area, and associated with numbness in the area of the leg that the affected nerve supplies.
- Herniated discs develop as the spinal discs degenerate or grow thinner. The jellylike central portion of the disc bulges out of the central cavity and pushes against a nerve root. Intervertebral discs begin to degenerate by the third decade of life. Herniated discs are found in one-third of adults older than 20 years of age. Only 3% of these, however, produce symptoms of nerve impingement.
- Spondylosis occurs as intervertebral discs lose moisture and volume with age, which decreases the disc height. Even minor trauma under these circumstances can cause inflammation and nerve root impingement, which can produce classic sciatica without disc rupture.
- Spinal disc degeneration coupled with disease in joints of the low back can lead to spinal-canal narrowing (spinal stenosis). These changes in the disc and the joints produce symptoms and can be seen on an X-ray. A person with spinal stenosis may have pain radiating down both lower extremities while standing for a long time or walking even short distances.
- Musculoskeletal pain syndromes that produce low back pain include myofascial pain syndromes and fibromyalgia.
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.
- Rest. Ceasing activity for a few days allows injured tissue and even nerve roots to begin to heal, which in turn will help relieve lower back pain. However, more than a few days of rest can lead to a weakening of the muscles, and weak muscles have to struggle to adequately support the spine. Patients who do not regularly exercise to build strength and flexibility are more likely to experience recurrent or prolonged lower back pain.
- Heat and Ice Packs help relieve most types of low back pain by reducing inflammation. Often patients use ice, but some prefer heat. Both may be used alternately.
- Medications. A wide variety of over-the-counter and prescription medications is available to help reduce symptoms of lower back pain. Many medications reduce inflammation, which is often a cause of pain, while others work to inhibit the transmission of pain signals from reaching the brain. Each medication has multiple unique risks, possible side effects and drug (or food or supplement) interactions, which need to be evaluated by a physician.
- Exercise for Lower Back Pain. Exercise is a key element of almost any lower back pain treatment plan. Whether completed at home, or with a spine health professional, such as a physical therapist, chiropractor, or physiatrist, a plan will typically include three components: aerobic conditioning, stretching, and strengthening. The exercises are best done through a controlled, progressive program, with the goal of building toward a stronger, more flexible spine.
- Low Impact Aerobic Exercise. In addition to exercises specific to the lower back, any low impact aerobic exercise, such as walking, is often an ideal exercise for the lower back because it helps bring oxygen to the soft tissues in the back to promote healing. Swimming or water exercise has the same effect and is an excellent option if walking is too painful.
- Chiropractic Adjustment (also called Chiropractic Manipulation)can help improve spinal function by decreasing pain and inflammation to increase range of motion and physical function.
- Epidural Steroid Injections deliver steroids directly into the painful area of the lower back to reduce inflammation. The steroids do not heal the components of the back, but often provide enough pain relief to allow patients to move, exercise and heal.
- Surgery for Lower Back Pain is usually considered after pain has not been relieved with nonsurgical methods. Still, surgery is always the patient’s decision, and a qualified spine surgeon will be able to explain the pros and cons of each procedure. For sciatica, laminectomy andmicrodiscectomy have been shown to significantly reduce pain symptoms by relieving the pressure on compressed nerve roots.Fusion surgery, which is used to stop the motion at a motion segment, is a bigger surgery but can be effective at relieving pain due to a painful motion segment.