The spine is made up of small bones known as vertebrae that are stacked on top of one another, extending from the base of your skull to your buttocks. Muscles, ligaments, nerves, and intervertebral disks are all part of your spine as well.
Your spine consists of three segments, which form three natural curves when viewed from the side. The “c-shaped” curves of the neck (cervical spine) and lower back (lumbar spine) are called lordosis. The “reverse c-shaped” curve of the chest (thoracic spine) is called kyphosis.
These curves are important for balance and they help us to stand upright. It is important that these curves stay in shape, because if any one of the curves becomes too large or small, there will be problems with our standing positions and posture.
When abnormal curvatures of the spine occur (known as spinal deformity), this can result in conditions such as kyphosis of the thoracic spine (“hunchback”), lordosis of the lumbar spine (“swayback”), and “flatback syndrome,” a condition in which there is too little curvature of the spine.
Pain in the Lower Back
WHAT IS LOWER BACK PAIN?
The lower back supports the weight of the upper body and provides mobility for everyday motions such as bending and twisting. Muscles in the lower back are responsible for any hip movement as well as supporting the spinal column, while the nerves provide sensation and control the muscles in the pelvis, legs, and feet. When there is an injury to any of the muscles, ligaments, joints, or discs in the lower back, this results in lower back pain.
Lower back pain is very common among people, and in most cases it resolves and goes away by itself within a few weeks.
WHAT ARE THE SYMPTOMS OF LOWER BACK PAIN?
Symptoms of lower back pain vary, depending on the cause of the back pain. Some of the common symptoms experienced include:
- Worsening back pain when bending and lifting.
- Dull pain that is localised to a single area on the lower back
- Nerve pain or numbness is experienced in one or both legs
- Sitting, standing and walking may worsen pain
- Back pain comes and goes, and often follows an up and down course with good days and bad days.
- Tightness, muscle spasms and pain that may extend from the lower back into the buttock or outer hip area, but not down the leg.
WHAT ARE THE CAUSES AND RISK FACTORS OF LOWER BACK PAIN?
There are many causes of lower back pain. These include:
A common cause of lower back pain, the muscles and ligaments in the lower back can be stretched or torn due to overuse or overactivity.
- Disc injury
The discs in the back are prone to injury, and this risk increases with age. Injury to a disc includes a disc tear or a herniated disc.
A disc tear is when small tears to the outer part of the disc (annulus) occur, mainly due to aging. Some people with disc tears experience no pain at all, while others experience pain that lasts for weeks, months, or even longer. A small number of people may develop constant pain that lasts for years which can be quite disabling.
A herniated disc, also known as a slipped or ruptured disc, occurs when the cartilage surrounding the disc pushes against the spinal cord or nerve roots. The cushion that sits between the spinal vertebrae extends outside its normal position, which can result in compression of the nerve root as it pushes through the vertebral bones. A herniated disc often occurs with lifting or twisting movements.
Sciatica occurs when the disc presses on the sciatic nerve, which connects the spine to the legs. This can happen along with a herniated disc. Sciatica can cause pain in the legs and feet which usually feels like a burning or pins-and-needles sensation.
- Disc degeneration
Due to aging, intervertebral discs will experience “wear and tear” and start to shrink. They may even collapse completely in certain cases and cause the facet joints in the vertebrae to rub against one another, resulting in pain and stiffness.
“Wear and tear” on the facet joints is also known as osteoarthritis. It can lead to further back problems, including spinal stenosis.
- Spinal stenosis
Spinal stenosis is most commonly due to disc degeneration between the vertebrae.
When disc degeneration occurs and osteoarthritis develops, your body may grow new bone in your facet joints to help support the vertebrae. Over time, this bone overgrowth (called spurs) can lead to a narrowing of the spinal canal, which places pressure on the spinal cord and spinal nerves. Osteoarthritis can also cause the ligaments that connect vertebrae to thicken, which can narrow the spinal canal.
This is an abnormal curve of the spine that may develop in children and teenagers. Older patients who have arthritis are also at risk of this condition. If pressure on the nerves is involved, it may also result in leg problems. Other abnormal spine curvatures include kyphosis and lordosis.
Other causes of lower back pain include conditions like arthritis, fibromyalgia, arterial disease and health conditions.
WHAT IS THE DIAGNOSIS OF LOWER BACK PAIN?
A history of the injury and a physical examination of the back will be conducted by the Doctor. He will check for pain in different parts of the back and may check the reflexes of your legs in case nerve damage has taken place.
Imaging tests will be taken, such as x-ray, CT scan and MRI scan to check for bone and disc problems.
WHAT ARE THE TREATMENT OPTIONS FOR LOWER BACK PAIN?
Treatment for back pain starts off with nonsurgical options. These include:
Pain relief and anti-inflammatory medications will be prescribed, such as acetaminophen and ibuprofen to reduce pain and swelling.
- Steroid injections
Steroid injections such as corticosteroids may be injected directly into your spine for pain relief.
- Walking aids
You may need to wear a brace to help you move around and be more stable.
Stretching exercises for your back may be recommended to help you relieve lower back pain, regain strength and restore your range of motion.
Should nonsurgical treatment fail to alleviate your lower back pain symptoms, surgery may be recommended. Additionally, you should only consider surgery if you are able to locate the source of your pain. Surgical treatments include:
- Spinal Fusion
The aim of spinal fusion is to fuse together the painful vertebrae so that they heal into a single, solid bone. Spinal fusion cuts down on the motion by removing discs between the vertebral segments. This is because If the painful spine segments do not move, they should not hurt. The vertebrae are then fused together using a bone graft. Screws, rods, or a “cage” are used to keep your spine stable while the bone graft heals.
Spinal fusion can be done through your abdomen, your side or your back. The results of spinal fusion for lower back pain vary, and full recovery can take more than a year.
- Disc Replacement
The aim of disc replacement is to allow the spinal segment to maintain some flexibility and motion. This procedure involves removing the disc and replacing it with artificial parts, similar to a hip or knee replacement.
Disc replacement is done through your abdomen, usually on the lower two disks of the spine.
HOW CAN LOWER BACK PAIN BE PREVENTED?
Although preventing lower back pain may not be possible, there are some measures that we can take to reduce the risks of lower back pain. These include:
- Regular exercise
- Maintaining a healthy weight
- Adopt the proper posture when carrying or lifting objects: keep your back straight and bend your knees when picking something up, instead of bending over to pick it up
- Maintain a proper posture while sitting and standing
- Avoid smoking