Common causes of Lower Back Pain

Some of the most common causes of low back pain include lumbar strain, nerve irritation, lumbar radiculopathy, bony encroachment, and conditions of the bone and joints. The information below is not meant to be a substitute for visiting your physician. Always speak to your physician about any pains you may be having to determine the cause of the discomfort.

1. Lumbar Strain (Acute, Chronic):

A lumbar strain is a stretching injury to the ligaments, tendons, and/or muscles of the low back. The stretching incident results in microscopic tears of varying degrees in these tissues. Lumbar strain is considered one of the most common causes of low back pain. The injury can occur because of overuse, improper use, or trauma. Soft tissue injury is commonly classified as "acute" if it has been present for days to weeks. If the strain lasts longer than 3 months, it is referred to as "chronic."

The treatment of lumbar strain consists of resting the back (to avoid re-injury), medications to relieve pain and muscle spasm, applying heat to the back area, massage pain relief therapy, and eventual (after the acute episode resolves) reconditioning exercises to strengthen the low back and abdominal muscles. Long periods of inactivity in bed are no longer promoted as this treatment may actually slow recovery. Spinal manipulation for periods of up to 1 month has been found helpful in some patients that do not have signs of nerve irritation. Future injury is avoided by using back protection techniques during activities and support devices as needed at home or work.

Preventative measures can also be taken, like wearing lower back supports and lifting belts to prevent lumbar strains. Back Rests and Back Pillows designed for your chair help promote good posture, in turn helping to prevent some of the comon causes of back pain. There are also devices designed for use at home that allow you to benefit from a similiar Lumbar Traction treatment that you would receive in your doctors office.

2. Nerve Irritation:

The nerves of the lumbar spine can be irritated by mechanical impingement or disease any where along their paths--from their roots at the spinal cord to the skin surface. These conditions include lumbar disc disease (radiculopathy), bony encroachment, and inflammation of the nerves caused by a viral infection (shingles). See discussions of these conditions below.

3. Lumbar Radiculopathy:

Lumbar radiculopathy refers to nerve irritation which is caused by damage to the discs between the vertebrae. Damage to the disc occurs because of degeneration ("wear and tear") of the outer ring of the disc, traumatic injury, or both. As a result, the central softer portion of the disc can rupture (herniate) through the outer ring of the disc and abut the spinal cord or its nerves as they exit the bony spinal column. This rupture is what causes the commonly recognized "sciatica" pain that shoots down the leg. Sciatica can be preceded by a history of localized low back aching or it can follow a "popping" sensation and be accompanied by numbness and tingling. The pain commonly increases with movements at the waist and can increase with coughing or sneezing. In more severe instances, sciatica can be accompanied by incontinence of the bladder and/or bowels.

Treatment of lumbar radiculopathy ranges from medical management to surgery. Medical management includes patient education, medications to relieve pain and muscles spasm, cortisone injection around the spinal cord (epidural injection), physical therapy (moist heat, massage therapy, ultrasound, electrical stimulation), and rest (not strict bed rest, but avoiding re-injury). With unrelenting pain, severe impairment of function, or incontinence (which can indicate spinal cord irritation), surgery may be necessary. The operation performed depends on the overall status of the spine, and the age and health of the patient. Procedures include removal of the herniated disc with laminotomy (a small hole in the bone of the lumbar spine surrounding the spinal cord), laminectomy (removal of the bony wall), by needle technique (percutaneous discectomy), disc-dissolving procedures (chemonucleolysis), and others.

4. Bony Encroachment:

Any condition that results in movement or growth of the vertebrae of the lumbar spine can limit the space (encroachment) for the adjacent spinal cord and nerves. Causes of bony encroachment of the spinal nerves include foraminal narrowing (narrowing of the portal through which the spinal nerve passes from the spinal column, out of the spinal canal to the body), spondylolisthesis (slippage of one vertebra relative to another), and spinal stenosis (compression of the nerve roots or spinal cord by bony spurs or other soft tissues in the spinal canal). Spinal nerve compression in these conditions can lead to sciatica pain which radiates down the lower extremities. Spinal stenosis can cause lower extremity pains which worsen with walking and are relieved by resting (mimicking poor circulation). Treatment of these afflictions varies, depending on their severity, from rest to surgical decompression by removing the bone that is compressing the nervous tissue.

Non surgical decompression is available from your doctor, as well as from units that offer Lumbar traction at home at home.

5. Bone & Joint Conditions:

Bone and joint conditions that lead to low back pain include those existing from birth (congenital), those that result from wear and tear (degenerative) or injury, and those that are from inflammation of the joints (arthritis).

Congenital Bone Conditions - Congenital causes (existing from birth) of low back pain include scoliosis and spina bifida. Scoliosis is a sideways (lateral) curvature of the spine which can be caused when one lower extremity is shorter than the other (functional scoliosis) or because of an abnormal design of the spine (structural scoliosis). Children who are significantly affected by structural scoliosis may require treatment with bracing and/or surgery to the spine. Adults infrequently are treated surgically, but often benefit by support bracing.

Spina bifida is a birth defect in the bony vertebral arch over the spinal canal, often with absence of the spinous process. This birth defect most commonly affects the lowest lumbar vertebra and the top of the sacrum. Occasionally, there are abnormal tufts of hair on the skin of the involved area. Spina bifida can be a minor bony abnormality without symptoms. However, the condition can also be accompanied by serious nervous abnormalities of the lower extremities.

Degenerative Bone And Joint Conditions -- As we age, the water and protein content of the body's cartilage changes. This change results in weaker, thinner, and more fragile cartilage. Because both the discs and the joints that stack the vertebrae (facet joints) are partly composed of cartilage, these areas are subject to wear and tear over time (degenerative changes). Degeneration of the disc is called spondylosis. Spondylosis can be noted on x-rays of the spine as a narrowing of the normal "disc space" between the vertebrae. It is the deterioration of the disc tissue that predisposes the disc to herniation and localized lumbar pain ("lumbago") in older patients. Degenerative arthritis (osteoarthritis) of the facet joints is also a cause of localized lumbar pain that can be detected with plain x-ray testing. These causes of degenerative back pain are usually treated conservatively with intermittent heat, rest, rehabilitative exercises, and medications to relieve pain, muscle spasm, and inflammation.

Injury To The Bones And Joints -- Fractures (breakage of bone) of the lumbar spine and sacrum bone most commonly affect elderly persons with osteoporosis, especially those who have taken long-term cortisone medication. For these individuals, occasionally even minimal stresses on the spine (such as bending to tie shoes) can lead to bone fracture. In this setting, the vertebra can collapse (vertebral compression fracture). The fracture causes an immediate onset of severe localized pain that can radiate around the waist in a band-like fashion and is made intensely worse with body motions. This pain generally does not radiate down the lower extremities. Vertebral fractures in younger patients occur only after severe trauma, such as from motor vehicle accidents. In both younger and older patients, vertebral fractures take weeks to heal with rest and pain relievers. Fractures associated with osteoporosis can also be treated with hormone therapy to stimulate the formation of new bone. For more information, please visit the Fosamax, Actonel, Forteo, Miacalcin, and Calicmar articles in the Medications area and the Osteoporosis article.

The most common reason to use Lumbar Traction is treatment of herniated disc. The goal is to separate the intervertebral spaces to allow a decompression effect. In addition, lumbar traction can be used for any condition that responds well to general spinal mobilization.

Examples include:

Degenerative Disc Disease—the goal is increased blood flow and generalized longitudinal stretching of the spine to increase intervertebral space.

Posterior Facet Syndrome—the goal is separation of the posterior facet joints. A sustained separation helps relieve pain and will augment any manual techniques used for this condition.

Sciatica—even in the absence of confirmed herniated disc, sciatica responds very well to traction. Leg pain due to nerve root impingement is often alleviated in the first treatment.

Generalized Low Back Pain—separating the intervertebral spaces and stretching soft tissue augments other therapies by relieving pressure on painful tissues.

Generally, any condition that would benefit from soft tissue elongation or separation of the intervertebral spaces will respond well to traction.

Arthritis -- The spondyloarthropathies are inflammatory types of arthritis that can affect the lower back and sacroiliac joints. Examples of spondyloarthropathies include Reiter's disease, ankylosing spondylitis, psoriatic arthritis, and the arthritis of inflammatory bowel disease. Each of these diseases can lead to pain and stiffness in the low back which is typically worse in the morning. These conditions usually begin in the second and third decades of life. They are treated with medications directed toward decreasing the inflammation. For more information, please see the Reactive Arthritis, Ankylosing Spondylitis, and Psoriatic Arthritis articles..

What are other causes of low back pain?

Other causes of low back pain include kidney problems, pregnancy, ovary problems, and tumors.

Kidney Problems

Kidney infections, stones, and traumatic bleeding of the kidney (hematoma) are frequently associated with low back pain. Diagnosis can involve urine analysis, soundwave tests, or radiological scanning of the abdomen.

Pregnancy

Pregnancy commonly leads to low back pain by mechanically stressing the lumbar spine (changing the normal lumbar curvature) and by the positioning of the baby inside of the abdomen. Additionally, the effects of the female hormone estrogen, and the ligament-loosening hormone relaxin, may contribute to loosening of the ligaments and structures of the back. Pelvic tilt exercises are often recommended for this pain. Women are also recommended to maintain physical conditioning during pregnancy according to their doctors' advice.

Pregnancy back braces are also available to help support your back when carrying the extra weight in front of you.

Ovary problems

Ovarian cysts, uterine fibroids and endometriosis not infrequently cause low back pain. For more information, please visit the Endometriosis article.

Tumors

Low back pain can be caused by tumors, either benign or malignant, that originate in the bone of the spine or pelvis and spinal cord (primary tumors) and those which originate elsewhere and spread to these areas (metastasize). Symptoms range from localized pain to radiating severe pain and loss of nerve and muscle function (even incontinence of urine and stool) depending on whether or not the tumors affect the nervous tissue. Tumors of these areas are detected using radiological tests, such as plain x-rays, nuclear bone scanning, and CAT and MRI scanning.