Low Back Pain

Background

The human lower back is an intricate frame of interconnected and overlapping structures, including muscles, tendons, soft tissues, highly sensitive nerves, nerve roots (from which nerves travel from the lower back down to the legs and feet), small and complex joints, spinal discs and their gelatinous inner cores. A problem with any of these structures can result in low back pain (also called lumbago), which can be mild or severe depending on the cause. Clinicians have stated that a simple lower back muscle strain might in fact be excruciating enough necessitating an emergency room visit, while a degenerating vertebra disc might cause only mild, occasional discomfort. According to George Ehrlich (in the Bulletin of the World Health Organization), low back pain is actually neither a disease nor a diagnosis of any sort, it is a pain of variable duration in the lower back region, so often that it is has become a paradigm of responses to external and internal stimuli. Experts have reported that the incidence (or prevalence) of low back pain is relatively high (about 80% of adults) and roughly the same across world regions. It occurs in similar proportions in all cultures, races and population groups- causing disability, interfering with quality of life, limiting work performance, and usually among the top reasons for medical consultations. Symptoms of low back pain are basically described as acute (pain is short term, usually lasting from a few days to 4 weeks), sub-acute (pain lasting between 4 and 12 weeks) or chronic (pain that persists for more than 3 months). Accurate identification of symptoms and proper diagnosis remain vital in the successful management of low back pain.

 

Causes of low back pain

It is imperative to discuss causes of low back pain with reference to age, as some specific causes of lower back pain have a tendency to occur more at a certain stage of life.
Younger Adults (Usually between 25 to 55 years): Two common causes here are back muscle strain and herniated disc.

Back muscle strain: Affected people present with severe or aching pain in the lower back after activity, sudden movement or lifting heavy objects. Pain may be associated with severe muscle spasms that can prevent walking or standing.

Lumbar herniated disc: Patients present with low back pain that travels (or radiates) to the buttocks, legs and feet. Many refer to this as sciatica, which is a term that describes the symptoms experienced when a nerve root in the lower spine is compressed, causing pain and numbness to travel along the large sciatic nerve that serves the buttocks, legs and feet. Sciatica may be associated with pain that is worse in the leg and foot than in the lower back, or may be felt on one side of the buttock or leg only. The pain is usually worse after long periods of standing still or sitting and relieved relatively when walking. It may also be accompanied by weakness and difficulty moving the leg or foot.

Older adults (usually over 60 years): They are more likely to suffer from pain related to joint degeneration (e.g. osteoarthritis or spinal stenosis) or from a compression fracture.

Osteoarthritis of the spine: Also referred to as facet joint osteoarthritis. This is a degenerative condition of the spine that develops over time, with pain caused by the breakdown of the cartilage between the facets joint in the spine. It is characterized by stiffness in the back with patient unable to bend easily at the waist. There may be redness and soreness around the area of the spine affected when the back is observed and pressed, respectively. Pain may interrupt sleep, and is usually most pronounced first thing in the morning and towards the end of the day. Osteoarthritis of the spine may eventually result in sciatica as it worsens.

Lumbar spinal stenosis: This condition can place pressure on the nerves at the point where they exit the spine, such that when affected people stand upright or walk, it increases pressure on the nerve and results in leg pain. Patients may be unable to walk far due to the severity of the leg pain. Pain is usually relieved after sitting down. Sciatica may also develop as the condition worsens.

Compression fracture: This usually results from osteoporosis (porous bones). It is characterized by sudden onset of back pain, limited flexibility of the back and possible height loss. Standing or walking also makes this pain worse. Pain may be relieved when patients lie on the back. Experts have stated that as a general rule, a compression fracture may be a possibility after any sudden onset of back pain in adults over age 50, especially in post-menopausal women (with osteoporosis) or anyone who has been on long-term corticosteroid use.

Risk factors for developing low back pain

  • Advancing age: Low back pain is typically first experienced in people aged between 30 and 50 years, and becomes more common with advancing age. As people grow older, loss of bone strength results, muscle elasticity and tone decrease, and intervertebral discs lose fluid and flexibility. All these are intrinsic causes of low back pain noted above.
  • Physical inactivity: Back pain is more common among people who are inactive and physically unfit. Research findings have shown that minimal exercise is beneficial for maintaining the integrity of intervertebral discs.
  • Overweight or obesity: Significant weight gain can result from unhealthy diets as well as physical inactivity. This can put stress on the back, and consequently affect the back muscles and the spine.
  • Occupational factors: Jobs that require heavy lifting, pushing, or pulling may lead to back injury and pain. In addition, a desk job may also contribute to back pain, especially if you don’t maintain appropriate sitting posture, or you sit all day in a chair without adequate back rest.
  • Pregnancy: This is commonly associated with low back pain due to pelvic changes and weight gain. This will however almost always resolve after delivery.
  • Genetics: Genetic have been indicated in some causes of back pain, such as ankylosing spondylitis, which is a form of arthritis that involves fusion of the spinal joints leading to some immobility of the spine.
  • Children’s backpack overload: As noted above, children rarely have low back pain. However, overloading their school backpacks with books may strain their back and cause muscle fatigue, which may potentially result in low back pain during later life. According to the American Academy of Orthopedic Surgeons, a child’s backpack should weigh no more than 15 to 20 percent of the child’s body weight.

 

Staying healthy

It is important to take note of these risk factors to stay healthy. Most low back pain cases get better within 6 weeks with simple medical intervention. If you are having low back pain, it is still important you consult your family physician for proper medical advice and treatment. However, the home remedies below may be useful.

  • Rest: It is important to rest for few days to allow injured tissue and nerve roots to heal. It is however not advisable to take more than a few days of rest, as this can lead to weakening of the muscles. Patients need to gradually commence minimal exercise to aid quick recovery. Your family physician may direct you to a physiotherapist or orthopedic surgeon if need be.
  • Heat and Ice Packs: These help relieve most types of low back pain by reducing inflammation around the area affected. Applying ice packs has been reported to be useful in the first three days of injury, while dry heat may be applied thereafter.
  • Avoid bending down and sleeping on soft mattresses: It is important we avoid bending down to prevent further damage to the back, especially for cases of herniated disc. If we must bend down, it is better we knee down straight and stand up straight. Sleeping on hard (or orthopedic) beds is also advised, as these will also help keep the spine intact.

 

As noted above, most cases of low back pain may not require urgent care, but patients should report immediately to the hospital (or call for assistance) if they experience low back pain as a result of severe trauma, or if low back pain is accompanied by fever, unexplained recent weight loss, significant leg weakness, severe continuous abdominal pain (may be associated with abdominal aortic aneurysm), and sudden bowel and/or bladder incontinence, i.e. difficulty passing urine or having a bowel movement, or loss of control of urination or bowel movement (which may be associated with a condition known as cauda equina syndrome).

 

Conclusion

This is yet another brief look at an important medical condition. I implore us to read more on low back pain. Above all, let us take good care of ourselves. Eat and rest well, take plenty fluids and fruits, be physically active and very observant.

Dr. Davies Adeloye is a medical doctor and epidemiologist. He currently lectures at Covenant University, Ota, Nigeria

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