Know all about low back pain

What is Low Back Pain?

Low back consists of important structures, the knowledge of which is essential to understand the origin of low back ache. These structures are five vertebral bodies with intervertebral discs, nerves, and adjacent joints and muscles. Other structures which are of concern are blood vessels and ligaments. This article provides an overview of lower back ache, its causes, diagnosis and lower back pain relief options. Low back ache is common ailment that affects people of all ages and demographics. The back pain can be either acute when it is recent and sudden in onset. The lower back pain is considered chronic when it is long standing.

Causes of low back pain

• Herniated discs also known as slipped disc or prolapsed disc: occurs when the soft inner material of a spinal disc pushes through a crack in the tougher outer layer, irritating nearby nerves.
• Spinal stenosis: this is narrowing of the space in spine and resultant entrapment of nerves
• Spondylolisthesis: In this condition, one vertebra slips over the adjacent vertebra and causes neural compression
• Musculoskeletal issues: these are usually in form of muscle strain, ligamental sprain or joint dysfunction
• Other reasons for low back ache are infections, tumors, fractures
• Disk problems: Intervertebral disk degeneration, herniation, or bulging can lead to lower back pain by compressing or irritating nearby nerves.
• Structural problems: Congenital or acquired spinal abnormalities, such as scoliosis or lumbar sacralization, can alter spinal biomechanics and contribute to chronic lower back pain.
• Arthritis: Degenerative joint conditions, particularly osteoarthritis, can cause inflammation and deterioration of the facet joints in the lower spine, resulting in pain and stiffness.

Risk Factors of Low Back Pain

• Age: As the age advances there is wear and tear in joints of spine. Generally, this is known as spondylosis. Younger age group develops back pain due to poor posture and repeated weight lifting.
• Sedentary lifestyle: core muscles are essential for maintain posture and integrity of the vertebral column. Sedentary lifestyle weakens the core muscles and can lead to back pain. In fact, core muscle strengthening exercises are mainstay in treating back pains.
• Poor posture: With advancement in digitization and work from home culture, poor sitting posture has opened an all-new arena of back pain. Sitting in one posture for prolonged periods and poorly ergonomically built chair aggravates lower back ache.
• Obesity: excess weight puts the joints under undue additional stress. This leads to increased back ache.
• Smoking: nicotine restricts blood flow to the spinal structures and lead on to degeneration and pain. In addition, nicotine has shown to delay healing of spine post surgery.

How is low back pain diagnosed?

• Listening to the patient’s history: the most important part in the exercise of diagnosing reason for back pain is to carefully listen to the patient. Past history of falls, contact sports, gymnastics and any other physical stress on spine gives fairly good idea about the cause of back pain. Occasionally pain in legs due to reduced blood flow mimics back pain due to spinal cause. Again listening to patient’s story gives necessary clues so as not to miss the diagnosis and provide immediate lower back pain relief. There have been times when back pain has been due to other unrelated structures like pelvic inflammatory diseases, renal stones, gynecological reasons. In conclusion patiently listening to patient and analyzing the symptoms provide necessary action plan in curating a plan for lower back pain relief.
• Physical Examination: Thorough examination of the patient from head to toe is essential to narrow down on the possibilities of causes of back pain. This also is essential to conclude as to the part of the spine which requires further evaluation by imaging. At times one may find associated abnormalities during examination like developmental or genetically inherited tumors causing back pain and deformities of spine.
• Imaging: once history taking and examination is done, the spine surgeon concludes as to the region of spine to be imaged so as to make final diagnosis. MRI scan of lumbar spine is the most common radiological investigation ordered. This provides details regarding nerves, muscles, discs and alignment of the vertebrae. MRI scan also provides necessary details about biomechanics of spine and helps in deciding type of treatment to be instituted. At times MRI scan requires administration of contrast material so as to define the pathology like tumor or infection. It is a common misconception that MRI alone is sufficient in management of back pain. Dynamic X ray of lumbar spine provided very crucial insight in to stability of spine. In case of any instability, the treatment plan may require necessary amendments so as to achieve desired results.
• Bone mineral densitometry: This test is performed to assess the quality of bone and decide on certain aspects of spine surgery.
• Nerve conduction studies: MRI scans and X ray of lumbar spine provide necessary information regarding the spine. The health and functions of the nerve from spine onwards is studied by nerve conduction studies. This investigation may be required in case there is a doubt of pain originating from peripheral nerves.

What are the treatments for low back pain?

Some of the lower back pain treatment options are:

• Exercise and Physical Therapy: Strengthening core muscles and improving flexibility through targeted exercises can significantly reduce pain. A physical therapist can provide a tailored program.
• Heat and Cold Therapy: Applying heat or ice packs for 15-20 minutes can help alleviate pain and reduce inflammation and provide lower back pain relief .
• Proper Posture and Ergonomics: Maintaining good posture and using ergonomic furniture can prevent strain on the back.
• Massage and Manual Manipulation: These techniques can help relax muscles and improve mobility.
• Mindfulness and Meditation: These practices can help manage the psychological aspects of chronic pain.
• Lifestyle Modifications: Losing weight, quitting smoking, and pacing activities can reduce stress on the back.
• Pain Relief Medications: Over-the-counter anti-inflammatories or prescribed medications can help manage pain.
• Alternative Treatments: Acupuncture, biofeedback, or electrical nerve stimulation may provide relief for some individuals.
• Injection-based Treatments: For persistent pain, epidural steroid injections or nerve blocks may be considered.
• Sleep Posture: Using supportive pillows and mattresses can help maintain proper spinal alignment during sleep.

how to prevent low back pain

• Maintaining a healthy weight is crucial. Excess weight, especially around the midsection, puts additional pressure on the spine. Focus on a balanced diet rich in whole foods, regular exercise, and proper hydration to manage your weight effectively.
• Strengthening core muscles is essential for supporting the spine and reducing back pain risk. Incorporate exercises like Pilates, planks, and bridges into your routine. These exercises improve stability and posture, alleviating stress on the lower back.
• Proper lifting techniques are vital in preventing back injuries. Always bend at the knees, keep the object close to your body, and avoid twisting while lifting. Use your leg muscles, not your back, to lift heavy items.

Frequently Ask Questions:

What are the causes and treatment of lower back pain?

Common causes include muscle strain, herniated discs, and arthritis; treatments range from rest and physical therapy to medications and surgery in severe cases

What is the risk of low back pain?

Around 80% of people experience lower back pain at some point in their lives, with risk factors including age, excess weight, lack of exercise, and certain occupations

How do you diagnose low back pain?

Diagnosis typically involves a physical exam and medical history, with imaging tests like X-rays or MRIs ordered if necessary to rule out specific conditions.

When should I see a doctor for low back pain?

Seek medical attention for back pain that lasts longer than a few weeks, is severe, spreads down the legs, or is accompanied by other symptoms like fever or unexplained weight loss

Can low back pain be prevented?

Prevention strategies include maintaining a healthy weight, exercising regularly to strengthen core muscles, practicing proper lifting techniques, and maintaining good posture