What Causes Lower Back Pain
n most cases, lower back pain stems from mechanical causes. Pain in the lower region of the back occurs due to a condition called Spondylosis which refers to the degenerative changes that occur in the spine such the wear and tear of the joints, bone spurs and the degeneration of the intervertebral discs.
Some common mechanical causes of lower back pain include:
Muscle sprains and strains:
A sprain occurs when you overstretch or accidentally tear a ligament, while strains refer to tears in the tendon or muscle. Both conditions can stem from movements like twisting, overstretching, or lifting something heavy with an improper posture.
Sometimes, these movements can also lead to painful spasms in the back muscles. Generally, muscle strains indicate the presence of acute back pain, but if not taken care of, the condition can progress into a facet joint syndrome.
Degenerative Disc Disease:
Characterized by pain caused by damaged, dehydrated or deteriorated vertebral discs because of a degenerative disease.
Disc degeneration, in its early stages, may not cause symptoms like severe pain, but as the disease advances, you may experience pain in the lower back..
Herniated or Ruptured Discs:
As humans age, their intervertebral discs may get compressed and bulge outward. This is called herniation, and can cause the lower back region to become very painful. These herniated discs may also rupture, which also results in lower back pain.
Radiculopathy:
Sometimes, a spinal nerve root can become compressed or inflamed, resulting in symptoms like pain or numbness that may also radiate to various other parts of the body that are connected to that particular nerve.
Other conditions like spinal stenosis, herniated or ruptured discs may also compress nerve roots, leading to radiculopathy.
Sciatica:
This is a form of radiculopathy caused by the compression of the sciatic nerve.
The sciatic nerve is a large nerve in the body that starts in the lower back, splits above the hip and runs all the way down to the back of the legs.
When the sciatic nerve is compressed, it causes shock-like or burning pain in the lower back that is often paired with pain in the buttocks and legs, sometimes even reaching the foot.
Spondylolisthesis:
Sometimes, a vertebra at the base of the spine slips out of its own place and pinches the nerves connected to the spinal cord, causing pain in the lower back.
Traumatic Injury:
Actions like playing sports, car accidents or experiencing a fall may cause serious damage to the ligaments, muscles or tendons which can lead to pain in the lower back region.
Traumatic injuries can also exert extra pressure on the spine which can lead to rupturing or herniation of the intervertebral disc. This can further compress the nerves rooted in the spinal cord, resulting in back pain or even sciatica.
Spinal Stenosis:
This is a common condition that occurs as a result of the spinal column narrowing down. This exerts pressure on the spinal cord and the nerves connected to it. This causes symptoms like numbness with walking and if not taken care of, may lead to weakness in the leg and even sensory loss.
Scoliosis:
A sideways curve in the spine that mostly develops right before puberty and generally isn’t painful in its early stages or up until the middle age.
Lordosis is the abnormal inward curvature in the lower back region. In a lot of cases, scoliosis can lead to chronic pain that may require surgery in order to help heal.
Here are the most common symptoms of lower back pain.
- Pain in lumbar disc tear region. This pain usually travels into the buttocks and thighs but doesn’t go past the knees.
- Lower back and buttock muscle spasms
- Problems related to disc tears or bulging and herniated discs may result in numbness or tightness in the region. Bulging outwards, or herniation of the disc can also lead to numbness in the legs
- Weakness in the buttocks, thighs, or temporary loss of leg control may occur from a spinal nerve being compressed or irritated.
- A tingling sensation in the legs or feet may be caused as a result of degenerative disc disease, annular tears, spinal stenosis or herniated discs.
What Are The Treatment Options For Low Back Pain?
Treatment for low back pain ranges from conservative therapies to surgical intervention. The goals of treatment are to relieve pain, prevent or reduce stress on the discs or spinal nerves and maintain normal function. It is always recommended that patient be prescribed non-surgical conservative treatment initially to help relieve symptoms.
Non-Operative Treatment
- Alternating heat/cold therapy during the first 24-48 hours
- Pain medications
anti-inflammatories,muscle relaxers and on rare occasions narcotic painkillers - Physical therapy exercises
stretching, massage strengthening - Transforaminal Epidural Steroid Injections
are used two-fold, first, to relieve inflammation of the affected spinal nerve and secondly, diagnostically to confirm the correct affected level at which the pain originates from - Facet Joint Injections/Medial Branch Nerves
can provide immediate short-term relief from painful symptoms and provide a diagnostic result confirming the affected level where the pain originates in the patients low back. - Discography
a diagnostic injection technique used to determine which discs of a patient’s spine, are a source of pain. - Platelet Rich Plasma Injection (PRP)
Blood platelets play an activation role in your body’s wound and soft tissue healing. The patient’s own blood, having platelets, is concentrated down through the use of a special machine called a centrifuge. These PRP can be used to promote healing of injured ligaments, tendons, muscles and joints.
Surgical Treatment
Once conservative measures have been exhausted and the patient is still in considerable pain after 6 months then minimally invasive procedures may be recommended. The following procedure has shown great results in alleviating pain altogether and returning patients to work and life sooner than traditional spine surgery.
- Endoscopic Discectomy, Annuloplasty
A ¼ inch incision is made and a 7mm operating tube is placed on the disc at the site of the annular tear. An endoscope with HD camera is inserted into the operating tube to visualize the annulus and spinal nerves. Then the tear is debrided to make sure no nucleus pulposus is stuck within the annulus and thermally heated with a bipolar instrument to reduce and close the tear. - Endoscopic Rhizotomy
A least invasive procedure done outpatient to help patients suffering from chronic back pain and muscle spasms. Patients who have received some temporary relief from percutaneous medial branch rhizotomy, but the pain came back are good candidates for endoscopic rhizotomy. - Minimally Invasive TLIF
- Endoscopic Surgery
Most endoscopic patients can begin getting out of bed one hour after the procedure and go home shortly afterwards. There will probably be some pain after the procedure and is usually localized to the incision site. However, just because there is less or no pain, always consult your physician before beginning any physical work. Patients can return to administrative work within a week. No physical activities including work are recommended for 6 weeks. - Minimally Invasive Spine Surgery
At home, you will need to continue to rest. You will be instructed on how to gradually increase your activity. You may still need to take the pain medications for a while. However, pain and discomfort should begin to reduce within a couple of days after surgery. The doctor will discuss with you other techniques for reducing pain and increasing flexibility before you leave for home. The doctor will also discuss with you a time frame for when you can resume basic activities such as walking, driving and light lifting, and when you can return to more advanced activities such as physical labor, sports and yard work. Most patient can return to work within a few days.