Lower Back Pain

While there are many causes of lower back pain, most cases of low back pain can typically be linked to either a general cause - such as muscle strain - or a specific and diagnosable condition, such as degenerative disc disease or a lumbar herniated disc.
In the US, lower back pain is one of the most common conditions and one of the leading causes of physician visits. In fact, at least four out of five adults will experience it at some point in their lives.
Ironically, the severity of the pain is often unrelated to the extent of physical damage. For example, lower back spasms from a simple back strain can cause excruciating lower back pain that can make it difficult to walk or even stand, whereas a large herniated disc or completely degenerated disc can actually be completely painless.

Types of Low Back Pain
Low back pain is typically classified as either acute or chronic:
  • Acute back pain is short term, generally lasting from a few days to a few weeks. Some acute pain syndromes can become more serious if left untreated.
  • Chronic back pain is generally defined as pain that persists for more than three months. The pain may be progressive, or may occasionally flare up and then return to a lower level of pain. With chronic pain, the exact cause of the pain can sometimes be difficult to determine.
Types of Lower Back Pain that Indicate a Surgical Emergency
There are a few symptoms that indicate a possible serious medical condition requiring surgery. Patients with these symptoms should seek medical attention immediately. Symptoms include:
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Sudden bowel and/or bladder dysfunction (cauda equina syndrome)
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Progressive weakness in the legs (cauda equina syndrome)
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Severe, continuous abdominal and low back pain (see abdominal aortic aneurysm)
People with fever and chills, history of cancer with recent weight loss, or who have just suffered a severe trauma should also seek immediate medical attention.
Lower Back Anatomy
The causes of low back pain can be very complex, and there are many structures in the spine that can cause pain. Any of the following parts of spinal anatomy are typical sources of low back pain:
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The large nerve roots in the low back that go to the legs and arms may be irritated
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The smaller nerves that innervate the spine in the low back may be irritated
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The large paired lower back muscles (erector spinae) may be strained
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The bones, ligaments or joints may be damaged
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The intervertebral disc may be damaged
The causes of low back pain can be very complex, and there are many structures in the spine that can cause pain. Any of the following parts of spinal anatomy are typical sources of low back pain:
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The large nerve roots in the low back that go to the legs and arms may be irritated
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The smaller nerves that innervate the spine in the low back may be irritated
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The large paired lower back muscles (erector spinae) may be strained
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The bones, ligaments or joints may be damaged
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The intervertebral disc may be damaged
It is important to note that many types of low back pain actually have no known anatomical cause; but this doesn’t mean that the pain doesn’t exist. The patient’s pain generator may not be identifiable, but this does not necessarily signify that the pain is all psychosomatic. Actually, an estimated 90% of patients with pain will not have an identifiable cause of their pain.Low Back Pain from Muscle StrainThe majority of episodes of acute lower back pain are caused by damage to the muscles and/or ligaments in the low back. Even though a muscle strain doesn’t sound like a serious injury, the low back pain can be surprisingly severe and is the cause of many emergency room visits each year.
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A muscle strain happens when the muscle is over-stretched or torn, resulting in damage to the muscle fibers (a pulled muscle).
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A lumbar sprain happens when ligaments are stretched too far or torn. Ligaments are very tough, fibrous connecting tissues that connect the muscles to the bones and joints.
For practical purposes, it doesn’t matter if a muscle strain or ligament sprain are the source of the lower back pain, since the treatment for all of them is the same.
When the muscles or ligaments in the low back are strained or torn, the area around the muscles can become inflamed. With inflammation the muscles in the back can spasm and cause both severe lower back pain and difficulty moving. Pain from muscle strains or sprains is often relieved with rest.
Lower back pain from a muscle strain occurs most frequently from lifting a heavy object, lifting while twisting, or a sudden movement or fall. The pain is usually localized (doesn’t radiate to the leg), and there may be muscle spasms or soreness upon touch. The patient usually feels better when resting.
Low Back Pain Treatment for a Strained Muscle
Fortunately, muscle strains usually heal with time (a couple of days or weeks) because muscles in the low back have a good blood supply to bring the necessary nutrients and proteins for healing to take place.If the pain is severe, the patient may be advised to rest, but for no more than one or two days. Pain medication, ice application and/or heat application may all help alleviate the pain from the strained or sprained muscle.
If an episode of low back pain lasts for more than two weeks, the muscles may start to weaken. Since using the muscles hurts, the tendency is to avoid using them. This process leads to disuse atrophy (muscle wasting), and subsequent weakening, which in turn causes more low back pain because the muscles are less able to help hold up the spine.
Back Exercises as Muscle Strain Treatments
As a general rule, people who are active and well-conditioned are much less likely to suffer from low back pain due to muscle strain, as regular exercise stretches the muscles so they are less likely to strain, tear or spasm.
There are three types of muscles that support the spine:
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Extensors (back muscles and gluteal muscles)
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Flexors (abdominal muscles and iliopsoas muscles)
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Obliques or Rotators (side muscles)
While some of these muscles are used in everyday life, most do not get adequate exercise from daily activities and tend to weaken with age unless they are specifically exercised. See Abdominal and back exercise recommendations.A complete exercise program for the low back should consist of a combination of:
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Stretching
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Strengthening
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Aerobic conditioning