The lower back, also known as the lumbar region, can be a source of aches for many people. Generally, lower back pain is one of the most common reasons people miss work or go for a medical checkup and it is a leading cause of disability around the world. Lumbar pain tends to go away on its own but doctors are able to help with effective treatments in severe cases.
What causes lower back pain?
Degenerative Disc Disease
When we’re born, intervertebral discs are full of water and at their healthiest. Over time, these discs start to wear down and lose hydration and can’t resist forces as it could at 100% capacity. The discs then start to develop tears and can cause pain or a weakening that can lead to herniation, which could, in turn, cause a collapse and contribute to stenosis.
Lumbar Herniated Disc
The center of a lumbar disc can break through the outer layer and start to irritate a nerve root. This portion of the disc is typically full of proteins that can cause inflammation when they reach a nerve root resulting in pain. A tear through the disc wall that is rich in nerve fibers can also cause severe pain.
Facet Joint Dysfunction
The two facet joints behind each disc in the lumbar spine have cartilage between the bones and are surrounded by a capsular ligament which is innervated by nerves. These facet joints can cause pain by themselves or along with disc pain.
The muscles and ligaments in the back tend to tear and stretch if there is excess physical activity. Symptoms can include stiffness or pain in the lower back along with muscle spasms.
Sciatica often occurs when there is a herniated disc pressing on the sciatic nerve. As the sciatic nerve connects the spine to the legs, sciatica can cause pain in the legs or sensations similar to pins and needles or burning.
Abnormal Spine Curvatures
Conditions like scoliosis, kyphosis and lordosis are known to cause abnormal curvatures in the spine. These conditions can cause pain and result in poor posture as it puts pressure on the muscles, tendons, ligaments and vertebrae.
Other conditions that cause lower back pain include arthritis, fibromyalgia, kidney or bladder problems, pregnancy, osteoporosis, spondylitis and spondylosis.
Lower back pain can come in different forms. Some may experience muscle aches, while others may feel a shooting, stabbing or burning sensation in the lower back. In some cases, the pain may also travel down the leg and increase in severity when you bend, lift objects or stand and walk.
- Acute pain: this type of pain will occur suddenly and can last anywhere for a few days to weeks and is a normal response to injury or tissue damage.
- Subacute lower back pain: this can last up to months as well but is more mechanical in nature, similar to muscle or joint strains/pain. If the pain gets severe and limits the ability to move, it is recommended those suffering seek medical assistance.
- Chronic back pain: pain that’s classified as ‘chronic’ tends to last over 3 months. It is usually severe and in many cases, patients might not respond to initial treatment and will need thorough medical checkups to determine the exact source and cause.
When should you see a doctor?
If pain in the lower spine region persists for more than a week or so, it’s recommended that you seek professional help. You should also see a doctor if:
- Pain is severe and doesn’t improve with painkillers and rest
- Pain spreads down the legs
- One of both legs start to feel weak, numb or experience tingling sensations
- You are experiencing unexplained weight loss
- You are experiencing bowel or bladder problems
Diagnosing lower back pain
Your doctor will likely begin by requesting a complete medical history and conducting a thorough physical examination to determine where you’re feeling the pain. A physical exam can also determine if the pain is affecting your range of motion or your nerves.
If doctors suspect an underlying condition is the cause of your lower back pain, they might run specific tests, including:
- X-rays to reveal the alignment of your bones, determining whether you have arthritis or have fractured or broken a bone.
- MRI or CT scans to reveal any potential herniated disks or issues with muscle, tissue, bones, tendons, nerves or ligaments.
- Bone scans are done in rare cases to look for bone tumors or fractures caused by osteoporosis.
- Electromyography scans to measure the electrical impulses, which can reveal if there is any nerve compression occurring that’s caused by herniated disks or spinal stenosis.
Most back pain tends to get better on its own with efficient self-care and home treatments. In many cases, back pain may not go away soon or on its own and this will result in more severe pain. Treatment options for lower back pain include:
Over-the-counter pain relievers since as paracetamol or ibuprofen. Those suffering with lower back pain can also look at topical pain relievers such as ointments or patches.
Muscle relaxants are recommended if back pain doesn’t improve with pain relievers or topical methods. However, muscle relaxants are known to make patients feel dizzy and sleepy.
Heat or ice therapy can help relieve symptoms as well. Health tends to relax tense muscles and improve blood flow, while ice can be used to reduce any swelling and can reduce the chances of the lower back becoming irritated.
Physical therapy will allow you to learn new exercises that can increase flexibility and strengthen the back and abdominal muscles. It can also help improve your posture and can help prevent future episodes of back pain.
Cortisone injections are administered if other methods aren’t helpful in relieving symptoms. Doctors typically prescribe cortisone if the pain is severe and travels down the legs. The injection will help reduce inflammation around nerve roots.
Surgery is often looked at when the pain is caused by structural problems such as spinal stenosis or a herniated disc if patients haven’t responded to other therapies.