Back Pain: Causes, Diagnosis, Treatment
- Low back or lumbar area provides structural support to the body and also helps in the movement and protection of specific body tissues.
- Lumbar pain can be a result of conditions that affect the bony lumbar spine, discs between the vertebrae (intervertebral discs), ligaments around the discs and spine, nerves and spinal cord, internal organs of the pelvis and abdomen, muscle of the low back, and the skin covering the lumbar area.
- Low back pain treatment is optimally directed towards a diagnosed or suspected specific cause. A home remedy can be initially beneficial for acute back pain from the lumbar strain.
Functions of Low Back
The lumbar area or low back serves several essential purposes for a human body. These include structural support, protection of body tissues, and movement.
When we stand, the lower back functions to support the weight of our upper body. When we extend, bend, or rotate at the waist, our lower back gets involved in the movement. As a result, injury to any weight-bearing structures such as muscle tendons, bony spine, and ligaments can be detected when our body is standing erect or is in various movements.
Protecting the soft nervous system and spinal cord tissues is a critical function of the low back and lumbar spine muscles.
7 Common Causes of Low Back Pain
The frequent causes of low back pain can be categorized broadly into the following groups:
- Lumbar strain
- Nerve irritation
- Lumbar radiculopathy
- Bony encroachment
- Conditions of the joints and bones
The most common causes of lumbar strain fall into these categories. 7 frequent lower back pain causes include:
- Lumbar strain
An acute or chronic lumbar strain is a stretch injury that occurs to the ligaments, muscles, and/or tendons of the low back. The stretching results in microscopic tearing of different degrees in the tissues. As stated, a lumbar strain is one of the most common causes of low back pain.
Lumbar strain seldom occurs in people above 40 years, but it can occur at any age. The condition causes localized discomfort in the low back area after a lumbar tissue gets mechanically stressed. The severity of an injury can be mild to severe, based upon the degree of strain and resulting low back muscle spasm.
- Nerve Irritation
The mechanical pressure or impingement by bone, tissues, or other diseases can irritate the lumbar spine’s nerves. These conditions include radiculopathy or lumbar disc disease, bony encroachment, and nerve inflammation caused by a viral infection (shingles).
- Lumbar Radiculopathy
Lumbar radiculopathy is a condition of nerve irritation caused by damage to the discs between the vertebrae. These disc damages occur because of degeneration of the outer ring of the disc, traumatic injury, or sometimes both. This type of back pain usually increases with waist movements and can also grow with sneezing and coughing.
Lumbar radiculopathy treatment ranges from medical management to surgery. Medical management incorporates patient education, medications to reduce muscle spasm and relieve pain, physical therapy (exercises, ultrasound, massage by a therapist, heat, electrical stimulation), cortisone injection around the spinal cord called epidural injection, and rest.
- Bony Encroachment
The condition that results in growth or movement of the vertebrae of the lumbar spine can limit encroachment (space) for the adjacent nerves and spinal cord. Bony encroachment of spinal nerves can happen due to foraminal narrowing, spinal stenosis, and spondylolisthesis. Spinal-nerve compression in any of these conditions can cause sciatica pain radiating down the lower extremities.
Bony encroachment pain treatment varies, based upon its severity, and ranges from exercises and rest to epidural cortisone injections and surgical decompression to remove the bone that compresses the nervous tissues.
- Congenital Bone Conditions
Scoliosis and spina bifida is the congenital causes of the lower back pain or the causes that exist from birth. Scoliosis is a lateral (sideways) curvature of the spine caused when one of the lower extremities is shorter than the other or due to structural scoliosis (an abnormal architecture of the spine).
Spina bifida is a minor bony abnormality without any significant symptoms. However, it can accompany severe nervous abnormalities of lower extremities. It is a congenital disability in a bony vertebral arch over the spinal canal, generally with the spinous process’s absence. Spina bifida commonly affects the lowest lumbar vertebrae and also the top of the sacrum.
- Degenerative Joints and Bones
The protein and water content of our body’s cartilage changes as we age. The change results in thinner, weaker, and more fragile cartilage. Since the joints and discs that stack the facet joints or vertebrae are partly made up of cartilage, these areas subject to wear and tear over time (called the degenerative changes). Disc degeneration is called spondylosis.
These degenerative causes of the low back pain are usually treated with rest, intermittent heat, rehabilitative exercises, pain relive medications, and medicines to reduce inflammation and muscle spasm.
- Other Causes
Other commonly reported causes of lower back pain include injuries to bones and joints, arthritis, tumors, kidney problems, ovary problems, and pregnancy.
Older adults with osteoporosis get mostly affected by fractures of the lumbar spine and sacrum bone. For these people, even minimal stresses on the spine can cause bone fracture. These fractures cause immediate severe localized pain radiating around the waist in a band-like fashion.
The inflammatory type of arthritis called spondyloarthropathies can affect the sacroiliac joint and lower back. It leads to stiffness and low back pain that typically worsen in the morning time.
Kidney stones, infections, and traumatic bleeding are the frequent causes of lower back pain. It can be diagnosed through urine analysis, ultrasound, or other imaging studies of the abdomen.
Pregnancy often leads to low back pain through the mechanical stressing of the lumbar spine and the baby’s position inside the abdomen. Besides, estrogen (the female hormone) and relaxin (the ligament-loosening hormone) may contribute to the loosening of structures and ligaments of the back. Natural labor can also cause severe back pain.
Uterine fibroids, ovarian cysts, and endometriosis are the ovary problems that may cause low back pain. Precise diagnosis of these conditions requires gynecologic testing and examinations.
Tumors, either benign or malignant, may cause low back pain, originating in the spine bone or pelvis and spinal cord. These are primary tumors. The metastatic tumors are those that arise from elsewhere and gradually spread to these areas.
There are several risk factors for lumbar pain. They include:
- Heavy weight lifting
- Athletic activity
- Traumatic injury
- Moving luggage
- Kidney infection
Signs and Symptoms
Low back pain can cause numerous signs and symptoms depending on the back pain’s cause, as reviewed before.
Symptoms associated with low back pain include:
- Tingling and/or numbness of lower extremities
- Inability to walk without worsening pain
- Incontinence of stool or urine
- A decrease in the size of the lower extremity muscle (atrophy)
- Abdominal pain
- Weight loss
- Joint pain
- Burning on urination
Low back pain diagnosis involves a review of medical history and underlying medical conditions and a physical examination.
A doctor needs to review a complete history of back pain, including a history of any injuries, to alleviate or aggravating conditions, associated symptoms of pain (like tingling, numbness, fever, incontinence, etc.), as well as the progression and duration of the symptoms.
Apart from routine extremity and abdomen evaluations, you may require pelvic and rectal examinations as well.
Other tests for low back pain diagnosis include plain film x-ray tests, blood and urine tests, MRI scanning, CAT scanning, bone scanning, and nerve tests such as nerve conduction velocities (NCV) and electromyograms (EMG).
Treatment of the low back or lumbar pain depends upon its precise cause. Additionally, a doctor must evaluate and manage each patient individually in order to know the underlying health status and activity level.
Research presented at a national conference of the American College of Rheumatology highlighted a crucial aspect of personalized evaluation in the patient’s perception and understanding of their situation.
There are several prescriptions as well as over the counter medications that help in the management of low back pain. Pain-relieving medicines and medicines that reduce inflammation and muscle spasm are generally prescribed for lumbar pain.
Over-the-counter (OTC) pain killers, non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, narcotics, topical pain relievers, antidepressants, and injections are useful in low back pain treatment.
Home remedies or self-care remedies for low back pain include heat packs and cold applications, avoiding re-injury, topical analgesic balms, and eliminating weight lifting.
There are many ways to relieve lumbar pain or back pain naturally. Some of the most common and effective ones include:
- Fall asleep faster and sleep longer
- Enjoy an anti-inflammatory drink every day
- Try mindful meditation
- Avoid prolonged static posture
- Support your body in a warm pool
- Gently stretch your joints and tissues through exercises or yoga
- Keep a self-activating heat patch handy
The best way of preventing lumbar pain is to avoid injury to the low back. Moreover, there are several conditioning exercise programs designed to strengthen your lumbar area and adjacent tissues. They can help to minimize the risk of a low back injury.
Physical therapists can design individual programs to relieve and prevent back pain with the help of exercises and therapies.