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Low Back Pain
Definition:
Most people will experience some sort of back pain during their life, usually in the lower back (lumbar spine), as this area of the spine bears most of the weight.
The spine has 33 bones, each separated by an intervertebral disc. Attached to the spine are muscles, ligaments, tendons and blood vessels, and running through the tunnel formed by the spine are nerves and the spinal cord. Bearing in mind how much lifting, straining, twisting and other movements we perform throughout the day, it is hardly surprising that occasionally some part of the lower back will be injured.
Low Back Pain Causes:
The aging body is responsible for many instances of low back pain. The intervertebral discs begin to deteriorate and lose the ability to adequately cushion the vertebral bones. They can become herniated or ruptured. Ligaments attaching bone to bone thicken and lose elasticity, increasing the risk of strain or sprain.
Daily life contains many possibilities for injury to the lower back. One of the most common is failing to maintain correct posture when lifting heavy objects. Standing incorrectly, or sitting in a poor position for a long time, or even sleeping in a bad position will increase strain on the back. Normal activities such as gardening or playing golf, especially after a long period of inactivity, place a huge strain on weakened muscles. A person's job may also be a factor. Driving a jackhammer or heavy industrial machinery which cause a lot of vibration will again put the lower back at risk of strains or tears to the muscles and ligaments.
Fractures, either through accident or a condition such as osteoporosis, are likely to cause low back pain. Pregnancy, with the associated increase in weight and strain on the body, can be a cause, as can various female reproductive disorders. Many diseases or conditions, especially arthritic conditions, can trigger low back pain, as can some skeletal abnormalities such as scoliosis or kyphosis.
Being middle-aged or older, smoking, being overweight, and performing heavy work or exercise after extended inactivity all increase the risk of developing low back pain.
Low Back Pain Symptoms:
Low back pain is what it says it is: pain in the lower back. The ways the pain is experienced are many and varied. It might feel dull or be sharp and 'shooting'. It could be constant, or come and go. It might feel like burning or pins-and-needles. It could range from mild to severe and the severity could change. You might experience muscle spasms, cramping or stiffness, or possibly weakness or numbness.
When low back pain is the result of a nerve being pinched, as happens when you have suffered a herniated disc, the pain will radiate down one leg, anywhere from the buttock to the foot. It will feel worse when sneezing, coughing or straining to pass a stool.
Pain resulting from an arthritic condition will most likely feel worse in the back and hip. It probably starts gradually, becomes increasingly painful and generally lasts a few months. It will feel worse after rest and first thing in the morning, and better after moving around.
Diseases of the spine cause low back pain that tends to be worse in the affected area. The pain might be accompanied by fever and sensitivity of the spine to touch.
Low Back Pain Diagnosis:
It is necessary to determine the particular cause of the low back pain in order to decide upon the correct course of treatment.
Your doctor will ask for your medical history, including any previous back problems. You will be asked about your current symptoms; what makes the pain better or worse; the type of pain you are experiencing, and the site of the pain and whether it radiates to any other part of the body. You will probably be asked about any remedies that you have already tried.
You will have a physical assessment, including your posture, spinal alignment, reflexes, muscle strength and range of motion. You may be asked to sit or lie down and raise one straight leg into the air, to see if you might have a herniated disc.
Other diagnostic tests, depending on what the doctor thinks might be the problem, might include X-ray, CT (computed tomography) or MRI (magnetic resonance imaging) scans. Occasionally a bone scan might be ordered, as might a discogram or myelogram.
Low Back Pain Treatment:
Time usually solves most low back pain.
Self-help options:
Avoid overexerting yourself for a few days. Rest your back, but do not spend too long in bed as this has been shown to make matters worse. Unless the pain is so severe that you really can't get up, try to stay reasonably active.
Apply ice to the area for 20 minutes at a time, several times a day. After any muscle spasms have eased, apply gentle heat in the same manner.
Over the counter pain medication such as acetaminophen (Tylenol) could be tried, as well as NSAIDs such as ibuprofen (Advil), aspirin or Aleve if there is also inflammation.
When sleeping, put a small pillow between your knees if you lie on your side, or under your knees if you are a back sleeper.
Gradually return to your normal routine and activities, avoiding any heavy lifting or anything else that might aggravate your back.
Walk, ride a stationary bike, or swim.
Gentle exercises such as those listed below will improve muscle strength and flexibility.
Alternative medicine:
Chiropractic medicine may be useful if your range of motion is limited.
Massage provides relief from tension in the muscles, and is very popular.
Be sure to check with your doctor first, but capsaicin cream, devil's claw or white willow bark may help.
Your doctor might prescribe stronger pain medication such as morphine or codeine, if needed, or perhaps a muscle relaxant. Sometimes an anti-depressant can work as they block messages to the brain and can increase mood-improving endorphins. You may also be given an epidural steroid, a nerve blocker or a facet joint injection.
Physiotherapy might include:
Massage
Heat and cold treatment
TENS, to reduce muscle spasms
Ultrasound, to increase the blood supply to the area
Exercises for strength, posture and flexibility
Using a brace to restrict motion and improve posture while the injured or weak part of your back recovers.
What to look for in a brace to help with low back pain:
The exact brace you might find helpful will vary according to your particular needs, but you should look for good support for the lumbar region. Compression of the abdomen will lessen the pressure on your spine and provide relief, allowing healing to take place.
Low Back Pain Rehabilitation Exercises:
Avoid toe touches, sit ups and leg lifts, all of which will put strain on your back.
Pelvic tilt:
Lie on your back with feet flat on the floor and knees bent.
Breathe out, tighten abdominal muscles and 'pull' your belly button towards your spine to flatten the lower back. Hold 5 seconds. Repeat 10 times.
Knee to chest:
This will help if your pain is better when sitting.
Lie on your back and gently pull one knee towards your chest, using your hands to hold the stretch. Hold 10 seconds. Switch legs and repeat. Do 3-5 for each leg.
Repeat exercise but this time pulling both knees together to your chest. Hold for 10 seconds. Repeat 3-5 times.
Bridge:
This will help if your pain is better when standing or lying down.
Lie on your back with arms by your sides, feet flat on the floor and knees bent. Slowly raise your hips off the floor. Tighten your buttock muscles (gluteus maximus). Hold for 3-5 seconds. Release. Repeat 10 times.
Prevention:
Avoid activities or positions that have caused lower back pain before, but if you must perform them, take extra care, warm up first and keep the sessions brief.
Maintain good posture at all times, but especially when lifting.
Exercise to promote strong muscles and flexibility.
If you smoke, stop.
Maintain a healthy weight.
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