Lower back is a well architectured scheme of five lumbar vertebrae, joints, ligaments, muscles, nerves, and blood vessels. Its main function is to support the weight, give strength and flexibility to the upper body. It provides range of motion to hips and legs while walking. Nerves in the lower back provide sensation to pelvic region, legs, and feet.
Due to the complex structure of the lower back most often it is susceptible to injury and pain. Although inflammation is mild or moderate in the lower back region, pain is always incapacitating and restricts day to day activities.
Causes of lower back pain:
Pain can be acute or chronic depending on the condition.
Sprain or strain of muscles:
Sprain is a twist of ligament of foot, ankle which can cause pain and swelling whereas a strain is due to a muscle pull, which may damage the muscle sometimes. It results from lifting heavy objects, fall injuries, accidents, sports injuries related to twisting or heavy force impact, as well as lack of proper posture for a long time.
Chronic pain:
If pain persists for more than 3 months, it is considered chronic pain. Chronic pain of the lower back is due to wear and tear of joints, disc disorders or compression of nerves.
Sciatica:
The sciatic nerve gets pressed due to herniated disc or other reasons and causes pain in the buttocks and legs.
Herniated disc or slipped disc in the lumbar region:
The disc sometimes gets wear and tear due to ageing, rupture, or a fracture or crack due to sudden jerk or accidental injuries or lifting heavy weights and the gel inside the disc comes out. It is called a slipped disc or herniated disc.
Degenerative diseases of the spine:
Due to ageing, moisture in the disc is reduced. Due to dehydration in the disc, the disc shrinks and forms spurs of bone. It gives rise to spondylosis of the lumbar spine.
Osteoarthritis:
In osteoarthritis, joints continue to damage. It leads to the formation of new bone (bone spur). The excess bone hinders the passage of nerves and nerves get compressed.
Facet joint dysfunction:
There are two facet joints on the backside of each vertebra, which help in gliding and sliding of vertebrae for movement as well as prevent over twisting of the spine. Due to degenerative changes facet joints undergo wear and tear, cartilage gets ruptured and inflamed. It gives rise to pressure on nerves and causes pain.
Sacroiliac joint dysfunction:
Sacrum bone is present between coccyx and spine. The sacroiliac joint is where the hip bone connects to the sacrum. Sacroiliac disorder develops due to overuse of joints, in pregnancy and delivery, rheumatoid arthritis, or infection. It causes lower back pain and radiating leg pain. The pain from sacroiliac joint dysfunction is similar to the pain of sciatica, hence, it is difficult to diagnose the origin of pain.
Spinal stenosis:
It occurs due to narrowing of the spinal canal from where a spinal cord passes.
It puts pressure on the spinal cord and spinal nerve ends that result in pain.
Spondylolisthesis:
In this condition the upper vertebra slips and slides over the lower vertebra. Sports like gymnastics and football can cause such conditions and develop lower back pain.
Deformity of the spine:
Spine deformities can develop in children as well as in adults. Spine deformities such as scoliosis, lordosis, or kyphosis lead to lower back pain.
Trauma:
Road accidents or sports injury leads to fracture all dislocation of spinal bones gives rise to severe lower back pain. These conditions require immediate medical evaluation and treatment.
Compression fracture:
It is a type of fracture of one or more vertebrae of the spine. It occurs due to osteoporosis or fall injuries etc.
Other less common causes of lower back pain are tumour, infection, autoimmune diseases such as ankylosing spondylitis, Crohn’s disease, rheumatoid arthritis, fibromyalgia.
Symptoms of lower back pain:
Dull aching pain in hips and lower backRadiating pain in legs, foot, and toesSitting for a longer duration increases the painThe pain improves after a change in positionPain worsens in the morning and goes away after some timeStiffness of muscleLeg weaknessLoss of bowel-bladder control
Diagnosis:
Doctors take a detailed history of patients, test reflexes and range of motion. Doctors ask patients to sleep on their back and raise their legs as much as possible; it is called a leg-raise test.
Physicians will require an X-ray, CT scan or MRI to look for skeletal and soft tissue changes in the spine.
X-rays:
X-rays are the first line of investigation in lower back pain to diagnose infections of the back, joint disorders, spinal deformities, disc disorders, tumours, or fractures.
CT Scan:
Multiple X-rays are taken with different angles to produce a 3-dimensional image to examine the spine and surrounding structures.
Myelogram:
It is a special diagnostic technique to examine the spinal canal. A contrast dye is injected into spinal fluid before taking X-rays. It detects the abnormalities of the spinal cord, nerves, and other surrounding tissues.
MRI:
Magnetic Resonance Imaging is effective to detect changes in soft tissues like muscles, ligaments, intervertebral disc, and nerves.
Treatment:
Acute pain:
Acute back pain gets better within six weeks, on its own. Acute back pain is treated with pain medications such as analgesics, nonsteroidal anti-inflammatory drugs, muscle relaxants etc.
Local application of gel, patches, sprays, and ointments also provides relief. Alternate heat and cold applications are beneficial and reduce inflammation. Gentle stretching is advocated in acute lower back pain. Vigorous exercise or lifting heavy weight will worsen acute pain. Surgery is not recommended for acute pain.
Chronic pain:
Treatment of chronic pain is different for each condition. Acupuncture and physiotherapy provide moderate relief. If a non-surgical approach is not fruitful, then doctors advise surgery.
Advanced technology and minimally invasive technique give a high success rate in all spinal surgeries.
