Lower back Pain is a very common health problem these days. It is a universal sensation. It is so prevalent that almost everyone has experienced it at some point in life. The lower back, which starts below the ribcage, is also known as the lumbar spine. Pain here can be intense and is one of the top causes of missed work. Fortunately, lower back pain often gets better on its own. When it doesn’t, there are effective treatments.
Symptoms might range from a dull ache to a stabbing or shooting sensation. The pain may make it hard to move or stand up straight. Acute back pain comes on suddenly, often after an injury from sports or heavy lifting. It is considered chronic if the pain lasts for more than three months. If the pain does not subside within 72 hours no matter what you do, it is time to seek medical attention.
The commonest source of back pain is the lumbar spine and lower back muscles. However other causes might be due to problems in kidney, gynecological issues, or dangerous cause like aortic aneurysms.
The majority of acute cases of lower back pain are linked to strains, sprains of the ligaments, tendons and muscles which support the lower back. This happens when an individual overstretches the back, while lifting something too heavy, leading to a tear in the connective tissue. It can even happen for an injury from playing sport, a car accident, or any other circumstance, and can ultimately lead to compression of the spine, herniated discs and compression of the nerves.
The intervertebral discs are jelly like material in between the vertebrae (individual bones of spine; twenty-six vertebrae make the spine in an adult human being). These discs are usually responsible for cushioning the individual bones of the spine as they move on each other during bending. It is normal that with aging, the jelly-like intervertebral discs dehydrate (lose water) and take the consistency of crab-meat. This is how we lose height as we age. Often the degenerated disc comes out of its confinement and enters the spinal canal. This is called slipped disc. Along with this, facet joint hypertrophy is a condition in which the facet joints of the spine become enlarged and degenerated. Thickening and plasticity of ligamentum falvum (which provides stability and protection to the spine) creates a condition which is commonly called spondylosis. Any of these conditions, viz, slipped disc/degenerative disc, hypertrophied facet joint, thick ligamentum flavum, alone or in combination can cause pressure on nerves. This can lead to lower back pain. Spinal stenosis is a condition where the diameter of spinal canal gets narrowed by slipped disc, hypertrophied facet joints and thick ligamentum flavum. This can lead to an increase in pressure on the surrounding nerves.
Radiculopathy is when a spine nerve root is compressed, inflamed, or otherwise injured, and results in pain travelling down the legs. There might be associated tingling/numbness and/or weakness of some part of the lower limb. This kind of pain is also known as sciatica if the pain occurs in the distribution of sciatic nerve, a major nerve in the lower limb. There might be associated tingling/numbness and/or weakness of foot. If the compression of nerve root is in the level of cervical spine (spine in the neck), it will cause pain, tingling/numbness and weakness in upper limb.
There are other underlying conditions too for lower back pain like Osteoarthritis, Rheumatoid arthritis, Osteoporosis and many more. Per-se, osteoporosis does not give rise to back pain, but osteoporotic collapse or fracture can give rise to severe back pain.
Those who are suffering from lower back pain, can improve from the condition through several ways. It is important to stay physically active, and maintain the strength and flexibility of the muscles that provide support to the spine and lower back. Walking, swimming, cycling, yoga and other low-impact exercises are the most beneficial.
If your job involves lifting, pulling, or anything that twists the spine, it may contribute to back pain. However, sitting at a desk all day comes with risks of its own, especially if your chair is uncomfortable or you tend to slouch. At the workplace one should use the work surface at a comfortable height by adjusting the seat to the appropriate height. The chair should have a good back and elbow support.
Although you may wear your purse, backpack, or briefcase over your shoulder, it is the lower back that supports the upper body – including any additional weight you carry. So an overstuffed bag can strain the lower back, especially if you carry it day after day. If you must tote a heavy load, consider switching to a wheeled briefcase. Overdoing it at the gym without proper technique and posture is one of the most common causes of overextended muscles which ultimately result in lower back pain. You’re especially vulnerable if you tend to be inactive during the work week and then spend hours at the gym on the weekend. Our teachers were right when she said, ‘Stand up straight!’
Your back supports weight best when you don’t slouch. This means sitting with good lumbar support for your lower back, shoulders back, with feet resting on a low stool. When standing, keep weight evenly balanced on both feet.
There are a few conditions when you should see a doctor immediately if you have back pain:
- Back pain not getting better even after 72 hours of bed rest.
- Shooting pain in legs not getting better
- Numbness or weakness of any part of the leg
- Problem in passing urine or stool
- Numbness in buttock
- Pain getting worse during rest
Dr. Ashish Bhattyacharya, MS, M CH