LOW BACK

PAIN
SYNDROME
Lower Back Pain
Over 80% of the population will suffer from lower back pain during their lives.
Most cases of lower back pain can be linked to a general causesuch as
muscle strain, injury, or overuseor can be attributed to a specific condition
of the spine, most commonly:

Herniated Disc

Degenerative Disc Disease

Spondylolisthesis

Spinal Stenosis

Osteoarthritis

A number of less common conditions can cause low back pain as well, such as
sacroiliac joint dysfunction, spinal tumors, fibromyalgia, and piriformis
syndrome
Lower back pain can be caused by a variety of problems with any parts of the
complex, interconnected network of spinal muscles, nerves, bones, discs or
tendons in the lumbar spine. Typical sources of low back pain include:

The large nerve roots in the low back that go to the legs may be
irritated

The smaller nerves that supply the low back may be irritated

The large paired lower back muscles (erector spinae) may be strained

The bones, ligaments or joints may be damaged

An intervertebral disc may be degenerating

Common Lower Back Pain Causes in Adults

Certain causes of lower back pain have a tendency to occur more often in
younger individuals versus older adults:

Younger adults (30 to 60 year olds) are more likely to experience back
pain from the disc space itself (e.g. lumbar disc herniation or
degenerative disc disease) or from a back muscle strain or other soft
tissue strain.

Older adults (over 60) are more likely to suffer from pain related to
joint degeneration (such as osteoarthritis or spinal stenosis) or from a
compression fracture.

Diagnosing Lower Back Pain

The causes of low back pain can be complex, and there are many structures in
the spine that can cause pain. Doctors will ask patients to describe the
location, severity and type of pain, in addition to the history of the pain:

when the patient started to feel it, and any activities or positions that make
the pain better or worse.

Lower Back Pain Classifications

A diagnosis will typically classify the patients condition as one of three types
of pain.
Axial low back pain, the most common type of back pain, is confined to the
lower back and does not travel into the buttocks or legs. The pain can be
sharp or dull, and can be severe enough to limit everyday activities, such as
standing and walking. It usually worsens with certain activities (such as sports)
or physical positions (such as sitting for long periods) and is relieved by rest.
Most low axial back pain is acute meaning it is short-lived and heals within
six to 12 weeks but can last longer and become chronic.
Lumbar radiculopathy (sciatica) is the second most common type of pain
caused by a lower back problem. Caused by conditions that compress the nerve
roots of the sciatic nerve, the pain is more severe in the leg than in the back.
Symptoms are pain, numbness and/or weakness that is felt in the lower back
(if at all) and on only on one side of the lower body, affecting the buttock,
leg, foot, or the entire length of the leg.
Low back pain with referred painis pain in the lower back that also
radiates to the groin, buttock and upper thigh, but rarely below the knee.
Patients describe the pain as dull and achy with varying intensities. Low back
pain with referred pain is similar to axial pain and is managed with similar
treatments.
The classification of pain is important in guiding the right treatment plan. For
example, with some types of radicular pain, specific extension exercises might
initially be prescribed to move the pain up the sciatic nerve and back to its
source in the lower back.

Additional Diagnostic Tests and Scans

When pain is severe and is not relieved within 6 to 12 weeks, a specific

diagnosis becomes more important to determine further treatment. Additional
diagnostic tools include:

X-ray. Provides information on the bones in the spine; used to test for
spinal instability, tumors and fractures.

CT scan. Captures cross-section images of the vertebrae and spinal

discs; can be used to check for herniated disc or spinal stenosis.

Myelogram. Allows identification of problems within the spine, spinal

cord and nerve roots. An injection of contrast dye illuminates the spine
prior to an x-ray or CT scan.

MRI scan. Displays detailed cross-section of the components of the

spine. Useful to assess issues with lumbar discs and nerve roots, as well
as ruling out causes of lower back pain like spinal infections or tumors.

Typically the spine specialist will have a good idea of the cause of the
patients pain from the symptoms and physical exam, and will use the above
diagnostic tests to confirm and clarify the diagnosis and/or to rule out other
possible causes of the symptoms.
It is also important to note that sometimes low back pain actually has no
identifiable anatomical cause, but this doesn't mean that the pain doesn't
exist. Even with no clear cause of pain, the patient's pain is still real and
should be treated.

When to Seek Immediate Treatment for Lower

Back Pain
Most cases of low back pain do not require urgent care, but anyone should see
a doctor immediately if low back pain is a result of trauma, or if pain is
accompanied by any of the following symptoms:

Fever and chills

Unexplained recent weight loss

Significant leg weakness

Sudden bowel and/or bladder incontinenceeither difficulty passing urine

or having a bowel movement, or loss of control of urination or bowel
movement (cauda equina syndrome)

Severe, continuous abdominal pain (abdominal aortic aneurysm)

In cases where immediate treatment is a required, physicians will investigate

possible serious causes of the pain, including any type of spinal infection,
tumor or fracture.

Lower Back Pain Treatment

Treatment for lower back pain depends upon the patient's history and the
type and severity of pain. The vast majority of lower back pain cases get
better within six weeks without surgery, and lower back pain exercises are
almost always part of a treatment plan.
If pain persists or worsens, more involved diagnostic and surgical procedures
may be recommended.

Rest. Ceasing activity for a few days allows injured tissue and even
nerve roots to begin to heal, which in turn will help relieve lower back
pain. However, more than a few days of rest can lead to a weakening of
the muscles, and weak muscles have to struggle to adequately support
the spine. Patients who do not regularly exercise to build strength and
flexibility are more likely to experience recurrent or prolonged lower
back pain.

Heat and Ice Packs. Heat and/or cold therapy helps relieve most types
of low back pain by reducing inflammation. Often patients use ice, but
some prefer heat. Both may be used alternately.

Medications. A wide variety of over-the-counter and prescription

medications is available to help reduce lower back pain. Many

medications reduce inflammation, which is often a cause of pain, while
others work to inhibit the transmission of pain signals from reaching the
brain. Each medication has multiple unique risks, possible side effects
and drug (or food or supplement) interactions, which need to be
evaluated by a physician.

Exercise for Lower Back Pain. Exercise is a key element of almost any
lower back pain treatment plan. Typically an exercise program will be
developed and taught by a spine health professional, such as a physical
therapist, chiropractor, or physiatrist, and will include three
components: aerobic conditioning, stretching, and strengthening. The
exercises are best done through a controlled, progressive program, with
the goal of building toward a stronger, more flexible spine.

Low Impact Aerobic Exercise. In addition to exercises specific to the

lower back, any low impact aerobic exercise, such as walking, is often an
ideal exercise for the lower back because it helps bring oxygen to the
soft tissues in the back to promote healing. Swimming or water exercise
has the same effect and is an excellent option if walking is too painful.

Chiropractic Adjustment (also called Chiropractic Manipulation) can help

improve spinal function by decreasing pain and inflammation to increase
range of motion and physical function. Manual manipulation is also
commonly performed by osteopathic physicians.

Epidural Steroid Injections deliver steroids directly into the painful area
of the lower back to reduce inflammation. The steroids do not heal the
components of the back, but often provide enough pain relief to allow
patients to move, exercise and heal.

Surgery for Lower Back Pain Surgery is almost always the patients decision,
and a qualified spine surgeon will be able to explain the pros and cons of each
procedure. For sciatica, laminectomy and microdiscectomy have been shown to
significantly reduce pain symptoms by relieving the pressure on compressed
nerve roots. Fusion surgery, which is used to stop the motion at a motion