Most people experience lower back pain at some point in their lives. It’s one of the most common reasons people seek medical treatment and a leading cause of disability. There are different causes of lower back pain, many of which can be successfully treated without surgery. Let’s take a look at the common types of lower back pain people experience, possible causes and treatment options.
Anatomy of the Back
To understand back pain and its causes, it’s helpful to understand how the back works. The spine runs down the center of our back. Our spines are comprised of 24 bones, known as vertebrae. The vertebrae rest on top of one another, forming a column that protects the spinal cord. The spinal cord – and the nerves that branch out from it – carry messages back and forth between the brain and the rest of the body. The spinal cord sits in a fluid-filled channel, known as the epidural space.
In between the 24 vertebrae are intervertebral disks. They look like a small hockey puck – they are flat, round and about a half-inch in thickness. These disks contain an outer ring that is tough and flexible. Within the outer ring is a softer center. The purpose of these disks is to absorb the body’s movement when we move. Think of them like the shock absorbers in your car. The five vertebrae in the lowest part of the back comprise the lumbar region.
Like other parts of the body, the back also contains muscles and ligaments, which can become strained or overused.
The Many Types of Lower Back Pain
Lower back pain can present in many ways. The pain may be continuous or come and go. It may be sharp and stabbing or dull and aching. The pain may radiate out from the lower back into the hips, buttocks and legs.
Sometimes back pain subsides with rest. But other types of back pain are helped by moving around. Laying down may help alleviate some back pain. But for others, it may be the worst when you wake up in the morning.
Strained Muscles & Ligaments
Common causes of muscle and ligament strains in the back include lifting something too heavy; lifting with improper form; overdoing it with exercise, yard work or other physical activity.
One of the best ways to prevent this common injury – as well as other back problems – is by bending your knees and using your legs when you lift. Tighten your core when lifting. If you think it may be too heavy to lift yourself, don’t chance it – wait for someone to help you.
“If you’re experiencing back pain after lifting something or engaging in strenuous physical activity, rest your back,” recommends Dr. Tracy Henderson, a sports medicine physician in Willow Park. “An over-the-counter non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen or acetaminophen, may also help. If you are still experiencing pain after a week or so, make an appointment to see your primary care provider.”
Herniated Disks
A herniated disk – also called a bulging disk, ruptured disk or slipped disk – is a common cause of lower back pain. Any disk in the spine can become herniated, but this condition most often occurs in the lumbar region. It is also closely linked to sciatica, leg pain that originates in the lower back.
“Over time, disks become more rigid and more susceptible to herniating, or rupturing,” explains Dr. James Brezina, an orthopedic spine surgeon in Weatherford. “Improper lifting, repetitive motions that strain the back and smoking are all risk factors for a herniated disk.”
Fortunately, most herniated disk cases can be treated with rest, medication and a combination of heat and cold therapy. Surgery for this condition is rare.
Risk Factors
There are several factors that increase the risk of developing a herniated disk:
- Men, especially ages 20-50, are at greater risk
- Improper lifting: Using back muscles instead of legs, and twisting while lifting put you at risk
- Overweightness/obesity: Being overweight puts extra strain on your back
- Smoking: It is thought that since smoking depletes the level of oxygen in the body, this contributes to deterioration of disks
- Inactive lifestyle: Not getting enough physical activity is bad for your health, including the health of your back
- Repetitive motions: Repeated movements that create strain on your back (such as lifting) increase risk
- Driving too much: The combination of sitting for extended periods and the vibration of the vehicle can hurt your back
Diagnosis & Treatment
A physician will conduct a physical examination – one that may involve observing different movements to assess whether you have a herniated disk. A magnetic resonance imaging scan (MRI) can provide images of the body’s soft tissues, such as an intervertebral disk. This test can confirm a bulging disk, and help the physician understand which nerves are affected.
“When we identify a herniated disk, our first course of treatment is usually a non-surgical approach,” says Dr. Christopher Pratt, a pain management specialist with offices in Fort Worth and Granbury.
Recommended treatments include:
- Rest: bed rest for up to two days can help relieve pain
- Resting throughout the day
- Limiting physical activity and moving more slowly
- Taking NSAIDs to relieve pain
- Physical therapy; specific exercises that strengthen the lower back may be helpful
- Epidural steroid injection: This is an injection of a steroid into the epidural area surrounding the spinal cord that helps reduce swelling of the affected nerves and gives them the opportunity to heal. These injections lead to varying levels of relief for patients – for some, it may be short-term, but others may experience permanent pain relief from this treatment.
Surgical Repair
Usually, these non-surgical approaches are successful; surgery to repair a herniated disk is rarely necessary. When it is warranted, the spine surgeon can perform a procedure called a minimally invasive discectomy to remove the damaged part of the disk. If there are multiple damaged disks, an open surgery with a larger incision may be performed.
A patient with severely damaged disks may be a candidate for disk replacement surgery. The surgeon usually performs this procedure through the abdomen.
Other Causes of Back Pain and Injury
Disk Degeneration
Our spinal disks are subject to wear and tear as we age, causing them to shrink. Eventually, disks may collapse altogether, causing the joints between vertebrae to rub against one another. This leads to pain and stiffness and is a form of osteoarthritis. This condition can contribute to the onset of spinal stenosis.
Spinal Stenosis
Spinal stenosis is a condition that develops when the area around the spinal cord narrows, placing additional pressure on the spinal cord and nerves. Osteoarthritis contributes to this process by causing the body to grow new bone to support the spine; this new growth – bone spurs – narrows the spinal canal. Additionally, osteoarthritis leads the ligaments to thicken, also narrowing the spinal canal.
Scoliosis
Scoliosis is an abnormal curvature of the spine that often develops in childhood or adolescence. However, it can also develop later in life as a result of arthritis, causing pain and weakness.
Degenerative Spondylolisthesis
This condition may develop as a result of the aging process. If the joints and ligaments are unable to keep the spine stable, vertebrae may move around more than normal and slide against each other. Eventually, the bones may create pressure on the nerves, causing pain.
Compression Fractures
Osteoporosis is a common disease that may occur with aging, especially in women. The condition causes bones to weaken and become brittle. This can affect the bones in the spine, as well. A fractured vertebrae causes intense pain, especially when moving.
When to See a Doctor
If you’re experiencing frequent or continuous back pain for more than a couple of weeks, you should see a doctor to be evaluated. However, if your back pain is accompanied by any of these symptoms, you should seek medical attention immediately:
- Fever, chills, nausea, stomach pain and overall weakness
- Pain radiates down your leg below your knee(s)
- Numbness in the legs or groin area
- Difficulty going to the bathroom
- Inability to move due to pain
Have Your Back’s Back!
You don’t have to live with back pain! Here’s a few tips to keep your back strong and pain free:
- Use proper form when lifting. Bend your knees so that you lift with your legs, not your back. Don’t lift things that are too heavy – get some help.
- When exercising, spend time on exercises that strengthen your core muscles, such as planks.
- Stand up straight and don’t slouch.
- When standing for a long period, alternate resting one foot on a low footstool or ledge – this will reduce pressure on the lower back.
- If you sit at a desk for work, use a chair that provides good back support by supporting the natural curvature of the spine.
- Similarly, if you drive a lot, make sure you have good lower back support in your car seat. If your car doesn’t have an adjustable lumbar support, consider a back support to go on top of your seat.
- Do you experience back pain at night or when you wake up in the morning? If so, it may be your mattress. Most mattresses need to be replaced after about seven years. And if your mattress is too soft, it may not provide the support your lower back needs.
If your back starts bothering you and it doesn’t resolve with rest in a few days, make an appointment to see your health care provider. It may be something that requires medical attention and the sooner you have it evaluated, the better!
This article has been reviewed and approved by a panel of Privia Medical Group North Texas physicians.
This article contains information sourced from:
The American Academy of Orthopaedic Surgeons
