Low Back Pain

While lower back pain is extremely common, the symptoms and severity of lower back pain vary greatly. A simple muscle strain might be excruciating enough to necessitate an emergency room visit, while a degenerating disk might cause only mild, intermittent discomfort.

Identifying the symptoms, along with an accurate diagnosis of the underlying cause of the pain, is the first step in obtaining effective pain relief.


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

  • Younger adults (e.g. 30 to 60 year olds) are more likely to experience back pain from the disc space itself (e.g. disk herniation or degenerative disk disease) or from a muscle strain
  • Older adults (e.g. over 60) are more likely to suffer from pain related to joint degeneration (e.g. osteoarthritis or spinal stenosis or from a compression fracture.


Lower Back Pain in Younger Adults Symptoms:

  • Severe or aching pain in the lower back after activity, sudden movement or lifting a heavy object.
  • Difficulty moving that can be severe enough to prevent walking or standing
  • Pain that does not radiate down leg or pain that also moves around to the groin, buttock or upper thigh, but rarely travels below the knee;
  • Pain that tends to be achy and dull
  • Muscle spasms, which can be severe
  • Local soreness upon touch

Possible causes: Back Muscle Strain

A back muscle strain or ligament strain is one of the most common causes of acute lower back pain. Lifting a heavy object, twisting, or a sudden movement can cause muscles or ligaments stretch or develop microscopic tears.

With a lower back strain, the severity of the pain ranges from mild discomfort to severe, disabling pain, depending on the extent of strain and the lower back muscle spasms that result from the injury. Back strains often heal on their own with the help of some combination or rest, ice and/or heat application, anti-inflammatory medications, and/or gradual and gentle stretching and lower back exercises.

Symptoms: Low back pain that travels to the buttock, leg and foot (sciatica)

  • Pain typically is ongoing (as opposed to flaring up for a few days or weeks and then subsiding)
  • Pain may be worse in the leg and foot than in the lower back
  • Typically felt on one side the buttock or leg only
  • Pain that is usually worse after long periods of standing still or sitting: relieved somewhat when walking
  • More severe (burning, tingling) vs. dull, aching pain
  • May be accompanied by weakness, numbness or difficulty moving the leg or foot

Symptoms: Chronic lower back pain worsened by certain positions and movements.

  • Low-level of constant lower back pain punctuated by episodes of severe pain/muscle spasms lasting a few days to a few months
  • Chronic pain can range from nagging to severe
  • Back pain worsened by sitting
  • Walking, even running, may feel better than sitting/standing
  • Changing positions frequently relieves pain

Frequent cause: Degenerative disc disease

Lumbar degenerative disc disease can affect patients as young as 20. When the lumbar discs between the vertebrae begin to break down, the damaged disc can cause both inflammation and slight instability in the lower back, bringing about pain, muscle spasms, and sometimes sciatica. Degenerative disc disease is common and is often successfully treated.


Symptoms: Deep ache in the lower back that worsens when standing or walking

  • Pain that radiates into the buttocks and back of the thighs (also called sciatica or radicular pain)
  • Pain that worsens when bending backwards
  • Pain that feels better with sitting, especially sitting in a reclining position
  • Tired feeling in the legs, and possibly leg numbness or tingling, especially after walking
  • Tight hamstrings, making it difficult to touch toes

Possible cause: Isthmic spondylolisthesis

Isthmic spondylolisthesis occurs when a vertebra in the low back slips forward on the disc space below it. It is most common at the L5-S1 level and can cause low back pain from instability and nerve root pain due to compression of the nerve root. The fracture occurs in childhood, but normally does not create a lot of pain until a patient is in young adulthood.


Low Back Pain in Older Adults
While older adults can experience pain related to any of the conditions that also affect younger adults, individuals over age 60 are more likely to suffer from pain related to degeneration of the joints in the spine. Two of the most common causes of lower back pain in older adults include osteoarthritis and spinal stenosis.


Symptoms: Lower back pain and stiffness that is the most pronounced in the morning and in the evening.

  • Pain that interrupts sleep
  • Pain that is most pronounced first thing in the morning and again toward the end of the day
  • Localized tenderness when the affected area of the spine is pressed
  • Aching, steady or intermittent pain in the lower back that is aggravated by extended activity
  • Stiffness or loss of flexibility in the back (for example, unable to bend comfortably at the waist)

Possible cause: Facet joint osteoarthritis

Facet joint osteoarthritis, also called degenerative arthritis or osteoarthritis of the spine, is a degenerative condition that develops gradually over time. The pain is caused by the breakdown of the cartilage between the facet joints in the spine. At first the symptoms may only be intermittent, but can later develop into steadier pain in the lower back, and may eventually cause sciatica in addition to lower back pain.


Symptom: Leg pain that occurs primarily when walking and standing upright

Includes any combination of the following:

  • Unable to walk far without developing leg pain
  • Lower back pain relief is achieved quickly after sitting down
  • Symptoms fluctuate between severe and mild/none
  • Symptoms develop gradually over time
  • Weakness, numbness and tingling that radiates from the low back into the buttocks and legs sciatica

Likely causes: Lumbar spinal stenosis or degenerative spondylolisthesis

Both spinal stenosis and degenerative spondylolisthesis can place pressure on the nerves at the point where they exit the spine. Standing upright, such as in normal walking, increases pressure on the nerve and results in leg pain.


Symptoms: Sudden onset of back pain, limited flexibility, height loss

Includes any of the following:

  • Sudden onset of back pain
  • Standing or walking will usually make the pain worse
  • Lying on one's back makes the pain less intense
  • Height loss
  • Limited spinal flexibility
  • Deformity and disability

Possible cause: Compression fracture (e.g. from osteoporosis)

As a general rule, the possibility of compression fracture should be considered after any sudden onset of back pain in adults over age 50, especially in post-menopausal women with osteoporosis and in men or women after long-term corticosteroid use. In a person with osteoporosis, even a small amount of force put on the spine, as from a sneeze, may cause a compression fracture.

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.

Exercise for Lower Back Pain. Exercise is a key element of almost any lower back pain treatment plan. Whether completed at home, or with a spine health professional, such as a physical therapist, chiropractor, or physiatrist, a plan will typically 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 spin

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.

 

THIS ARTICLE IS A MODIFIED VERSION OF AN ARTICLE   By: Peter F. Ullrich, Jr., MD