Low back pain is a very common medical problem. Approximately 80% of Americans will have low back pain during their lifetime. Fortunately, most low back pain is self-limited and can be treated at home over just a few days.
Many of you may have experienced it recently, after raking leaves or planting perennials for several hours. This is a common lumbar strain when muscles and ligaments are overused, which may lead to muscle or ligamental micro tears and muscle spasms that heal over several days.
Most of us are all too familiar with these symptoms so we know how to care for it: cold packs, anti-inflammatories or Tylenol and activity to tolerance. But what if we care for our back pain over a few days and it doesn’t get better? At what point do we need to contact a physician?
Common Causes of Low Back Pain
Here are some common causes of low back pain:
Mechanical back pain. Our spine is made up of several vertebra stacked one on top of the other. There are layers of muscles holding them together in a balanced position that helps disperse the weight of our body evenly. If the spine is not held in the correct position, weight is distributed unevenly which can cause strain and muscle spasm. This is mechanical pain.
Physical therapists can work to help restore the right posture and increase strength to reduce strain. Therapists, osteopathic physicians and chiropractors can correct some vertebral imbalance through manual manipulation.
Psoas syndrome. The iliopsoas muscle is our hip flexor which is located just behind our abdominal organs. It’s a long, thick, cylindrical muscle that inserts into the upper medial femur, our thigh bone. If this muscle goes into a spasm, the psoas syndrome, the cramping pain can be incapacitating.
It generally lasts seven to 10 days, but can last up to a month. Typically, it resolves with time but can act up periodically.
Spondylolisthesis. The spine is made of vertebra stacked one on top of another. The joints in the back of each vertebra act as a braking system preventing forward slippage of one vertebra on another. Two conditions can allow one vertebra to slide forward on another, called spondylolisthesis:
- One condition is spondylolysis which is a stress fracture that can occur, typically in preadolescents ages 8 to 12. It’s caused by repeated lower back hyperextension which can crack the vertebra just above the joints. This is not uncommon in female middle school or high school gymnasts and other athletes. This allows some forward slippage usually later in life.
- Lumbar facet arthritis can also cause spondylolisthesis. As the joint enlarges with arthritis, it can become more unstable allowing the vertebra to slide forward.
Herniated lumbar disc. Between each vertebra is a vertebral disc. It acts as a cushion and takes some of the body weight off the vertebral facet joints. A disc has a fibrous outer layer with jelly inside like a jelly donut. A herniated disc is a tear through the fibrous outer layer, allowing jelly to penetrate through into the spinal canal where the spinal nerves are located.
If a nerve is pinched, it causes pain down the leg. This is sciatica pain. This pain can be excruciating and can cause nerve damage which can lead to weakness of the affected leg.
Most of the time a herniated disc does not cause weakness and can be treated conservatively without surgery. Most discs retract as they heal and symptoms generally resolve over a three to six month course. Physical therapy and medication can accelerate pain reduction and healing.
Sacroiliac pain. The sacrum, our tailbone, sits between the two pelvic bones, the innominate bones. As we walk, our innominate bones rotate forward and backward with the sacrum pivoting between the two sides. The sacrum can become imbalanced between the innominate bones causing sacroiliac pain. This can be treated with manual manipulation.
During pregnancy, a hormone called relaxin is produced to allow more flexibility of the pelvic ligaments so the infant can more readily squeeze through the birth canal. However, it also leads to pelvis instability of the pregnant mothers which allows for pelvis/sacral imbalance leading to sacroiliac pain.
Lumbar arthritis and stenosis. As we age, our lower backs tend to develop arthritis of the joints. The arthritis causes the joints to enlarge both outside and inside the spinal canal. Our lower discs tend to get thinner allowing for bulging into the spinal canal. Ligaments inside the spinal canal can thicken or bulge into the back of the spinal canal. These three ingredients cause narrowing of the inner canal and the nerve exit holes, the neural foramina. This is called stenosis.
When the narrowing gets severe enough, it can cause the nerves to get pinched causing leg pain, numbness and weakness.
Vertebral compression fracture. Although not common in the adult population, these fractures are not uncommon in the geriatric population, particularly in older women with osteoporosis. Treating the osteoporosis is the best way to avoid these fractures.
Reasons to See a Physician for Back Pain
If you’re experiencing back pain, here’s when it may be time to head to the doctor.
- If low back pain is associated with leg pain, numbness or weakness, that is an indication of likely nerve impingement. The sooner the nerve is freed, the less likely there will be any permanent nerve damage.
- If acute low back pain is associated with fevers and chills, there may be any infection that can be treated.
- If the low back pain is so severe you cannot walk more than a few steps, contact your physician.
- If the low back pain occurs after a fall or trauma, seek medical attention.
- If the pain is waking you several times at night, seek medical attention.
- If there is a unusual lump under the skin that is tender, seek medical attention.
Low back pain is a common medical complaint. Thankfully, it usually is self-limited and will often resolve if conservative measures are taken.