What is the lower back?

The lower back, often referred to as the lumbosacral region is a complex structure of interrelated and overlapping parts, which is located between the bottom of the ribs and the top of the legs. The parts within the lower back include tendons and muscles that attach to and surround the spine, as well as other soft tissue parts. There are also extremely sensitive nerves located in this area, including root nerves that travel from the lower back and down into the legs and feet. As the lower back is part of the spine it is made up of bones called vertebrae. The vertebrae are circular and between each vertebra is a disc with a gelatinous core.  These discs a have a strong fibrous outer layer and a softer, gel-like centre, their role is to act as shock absorbers and allow the spine to become more flexible. In addition, strong ligaments attach to adjacent vertebrae to provide enhanced support and strength to the spine. The diverse muscles that are attached to the spine allow the spine to bend and move in a variety of ways. Therefore, allowing us to move more freely.

What are the general symptoms of lower back pain?

The symptoms of lower back pain can vary from each individual, taking into account the age of the individual, the underlying condition and causes. But generally symptoms can include restricted mobility which prevents someone from walking or standing. Pain is often felt in the lower back area but does not tend to radiate down the leg. The pain may move around to the groin, buttock or upper thigh region. But infrequently travels below the knee. The pain is regularly described as dull and achy which leads to sensitivity in the affected area. Often patients complain of severe muscle spasms.


Let’s take a look at the differences in lower back pain and causes between those of a differing age.

Symptoms of lower back pain in those aged 30 – 60

Adults in this age bracket are more likely to suffer from back pain from the disc space itself, such as the lumbar disc herniation or degenerative disc disease. It can also be caused from a back muscle strain.

Symptoms of lower back pain those aged over 60

Adults in this age bracket are more likely to suffer from pain related to joint degeneration, such as spinal stenosis or osteoarthritis compression fracture.

Specific lower back pain conditions, symptoms and causes

Back Muscle Strain

Two of the most common causes of acute lower back pain are back muscle strain or ligament strain. These conditions can be brought on by lifting heavy objects, sudden movement and or twisting. All of this action can cause muscles or ligaments to stretch causing microscopic tears. The severity of pain with lower back pain can vary from mild discomfort to extreme pain which can be disabling. However, this is dependent upon the extent of the strain and injury. Back strains commonly heal by themselves and can be treated easily at home with a combination of rest, ice/ heat application, anti-inflammatory medications, gradual and gentle stretching and lower back exercises. Alternatively, you can seek out the help of a physiotherapist who can treat the condition with a combination of exercises.

Sciatica

Another type of lower back pain condition is sciatica, which is caused by a compressed spinal nerve root in the lower back.  This is commonly due to degeneration of an intervertebral disc. The symptoms of sciatica are quite varied, but generally include any combination of the following:

  • General ongoing pain, rather than pain than tends to flare up for a few days or weeks and then eases off
  • Pain is worse in the leg and foot area rather than in the lower back
  • Generally, it is felt on one side of the buttock or leg
  • Pain that tends to worsen after you stand still or sit for long periods of time, but then relieves after walking or mobile
  • Intense burning, tingling rather than dull or aching pain
  • Might feel weakness, numbness or have difficulty moving the leg or foot

Frequent causes of sciatica

Lumbar herniated disc

Sciatica can be caused when a nerve root in the lower spine is compressed, which then results in pain and numbness that travels along the large sciatic nerve that serves the buttocks, legs and feet. Sciatica can be caused by a wide range of conditions, but most commonly in younger patients it is brought on by a lumbar herniated disc. However, other causes are degenerative disc disease, isthmic and spondylolisthesis.

Lower back pain that is chronic, worsening by positions and movements

Another form of lower back pain can be chronic lower back pain that seems to get worse when you change positions, or move into a certain position. The symptoms of lower back pain vary, but generally consist of the following:

  • A low level of constant back pain that includes episodes of severe pain
  • Muscle spasms that can last from a few days to a number of months
  • Chronic pain that ranges from niggling to severe
  • Back pain  that gets worse when sitting
  • Pain tends to subside when walking or running
  • Changing your position frequently relieves pain

Frequent causes of chronic lower back pain

Degenerative disc disease

A cause of chronic lower back pain is often lumbar degenerative disc disease which can affect patients that are as young as 20. Lumbar degenerative disc disease arises when the lumbar discs between the vertebrae start to break down. The disc that is damaged can cause inflammation and slight instability in the lower back region, which then results in pain, muscle spasms, and on occasions sciatica. This condition is very common, more so in younger patients, but is usually treated effectively.

Ache in the lower back region, worsening when standing or walking

This type of lower back condition can cause great discomfort to patients that are affected, but generally symptoms can include any combination of the following:

  • Pain that radiates into the buttocks and back of the thigh, this is called sciatica or radicular pain
  • Pain that gets worse when bending backwards
  • Pain that eases off when sitting, more so when sitting in a reclining position
  • A feeling of tiredness in the legs
  • Numbness in the legs or tingling, especially after you have walked
  • Tight hamstrings, that makes it difficult to bed down and touch the toes

Possible causes of aches in the lower back

Isthmic spondylolisthesis

This condition is sometimes caused by isthmic spondylolisthesis. This tends to arise when a vertebra in the low back slips forward and onto the disc space that is below it. It is largely widespread at the L5, S1 level and can cause low back pain from instability and nerve root pain that is due to compression of the nerve root. This is a fracture that occurs in childhood; however, it is atypical because it normally does not create a lot of pain until a patient is in young adulthood.

The method to diagnosing lower back pain

In order to be able to create a suitable plan for treatment, it will be necessary to consult with a qualified medical professional, such as a doctor. They will then ask the patient to specify where the pain is located, how severe it is and the type of pain. They will also need to know when the pain began and ascertain whether any activities that are regularly carried out are related to the pain.


Classifying lower Back pain

When diagnosing the patient’s condition, the medical professional will usually categorise the patient’s condition as one of three types of pain. Patients may experience one type, and based on the development of their condition, could experience another.

Axial low back pain

This is the most frequent type of lower back pain. It is limited to the lower back and does not travel into the buttocks or down the legs. The pain can be dull or sharp, as well as being severe enough to limit the sufferer’s daily activities, including walking or even standing. This condition usually gets worse when the individual is carrying out specific activities, including sports, or physical positions, such as sitting, and is relieved by rest. The majority of low axial back pain is acute, this means that it does not last long and usually heals within 6 to 12 weeks, but it may last longer and become chronic.

Lumbar radiculopathy (sciatica)

This is the second most widespread pain that is caused by a problem in the lower back. It is usually caused by conditions that compress the roots of the sciatic nerve. The pain tends to be more extreme in the leg rather than in the back. The symptoms include pain, numbness and or weakness that are usually felt in the lower back and on only one side of the lower body. This then can affect the buttock, leg and foot area.  On occasion, it can affect the entire length of the leg.

Low back pain with referred pain

This pain is felt in the lower back but also travels down to the groin, buttock and upper thigh area but is seldom felt below the knee. Patients usually describe the pain as achy and dull with intermittent intensities. Lower back pain with referred pain is also comparable to axial pain and the condition is treated with similar treatments.

Tests for diagnosing lower back pain

If the pain has not subsided within 6 to 12 weeks and is still severe, it will be necessary to make a specific diagnosis in order to do determine the further treatment that is needed. This can be done by conducting the following medical tests:

  • X-ray. This will provide data regarding bones in the spine; and can be used to detect spinal instability, fractures and tumours.
  • CT scan. Able to capture cross-section images of the spinal discs and vertebrae. It can be used to detect a herniated disc or spinal stenosis.
  • Myelogram. Can identify problems within the spine, spinal cord and the nerve roots. An injection is given of contrast dye that illuminates the spine prior to a CT scan or x-ray.
  • MRI scan.  This shows up a detailed cross-section of the components of the spine and is useful when assessing matters with lumbar discs and nerve roots. It can also rule out any causes of lower back pain, such as spinal infections or tumours.

  Usually the spine specialist will have an indication of the underlying cause of the condition, through assessing the type of pain the patient is suffering from, symptoms and through carrying out a physical examination. They will also use the above diagnostic tests to verify the diagnosis and to rule out other possible causes.


Methods of treating lower back pain

To provide treatment for lower back pain depends upon a number of factors including the patient's history as well as the type and the severity of the pain. The majority of lower back pain cases tend to improve within six weeks, and without the need for surgery. As well as this, lower back pain exercises are almost always part of a treatment plan, which a patient can obtain be seeking the help of a physiotherapist. If the pain continues or gets worse, the medical fractioned may propose that surgical procedures may be the better option for treatment.

Rest

By stopping activity and resting for a few days allows the injured tissue as well as the nerve roots to start to heal, this in turn will help to alleviate lower back pain. However, it’s important to be aware that few days of rest can lead to the muscles weakening; these weakened muscles have to struggle to support the spine. Therefore, patients who do not regularly exercise to build strength and flexibility in certain areas of the body are more likely to experience regularly occurring or prolonged lower back pain. That’s why creating an exercise plan with a physiotherapist can help in this area.

Heat and Ice Packs

This form of treatment helps to alleviate the majority of types of low back pain by reducing inflammation. Commonly, patients treat with ice, but some rather use heat, although both can be used alternately.

Medications

An extensive range of over-the-counter and prescription medications is available to assist in reducing the symptoms of lower back pain. The majority of medications can decrease inflammation, (which is frequently a cause of pain). Whilst others work to stop the transmission of pain signals from getting to the brain. However, each type of medication has different risks, side effects and drug interactions that need to be assessed by a qualified physician.

When it’s best to get immediate help for lower back pain

In the majority of cases for back pain a patient does not require urgent care. However, patients should seek the help of a doctor immediately if they experience low back pain as a result of a severe trauma (which might have resulted from an accident), or if the low back pain is accompanied by any one of the following symptoms:

  • Fever and chills
  • Inexplicable weight loss, or recent weight loss due to the trauma
  • Significant weakness in the leg(s)
  • Sudden bowel and or bladder incontinence, this could include either difficulty when passing urine or bowel movement
  • Severe and continuous abdominal pain

  In certain cases where immediate treatment is a required, the physician will investigate the possible causes of the pain, including infection, fracture or tumour.

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