Discussing the causes and cures of lower back pain

Al­most every­one will ex­per­i­ence an epis­ode of low back pain at some point in their lives. In fact, about 80 per­cent of people in the U.S. will ex­per­i­ence low back pain, known med­ic­ally as lum­bago, at some time.

Low back pain can have many causes. Some causes are rare such as rheum­at­o­lo­gic, gastrointest­in­al, vas­cu­lar or kid­ney con­di­tions, in ad­di­tion to in­fec­tion and even can­cer. However, by far and away low back pain is typ­ic­ally caused by in­jur­ies to the mus­cu­lo­skelet­al sys­tem in­clud­ing the muscles, ten­dons, lig­a­ments, bones and discs of the low back.

The lumbar spine is made up of five ver­teb­rae with discs between each. The discs act as cush­ions to keep the ver­teb­rae bones from grind­ing on each oth­er when we move our spine. These struc­tures also help pro­tect our spin­al cord. Nerves leave the spin­al cord at each level through an exit hole near the discs called fo­ramina. These nerves then travel to the skin and muscles of the low back and legs to provide sen­sa­tion and strength.

Com­monly, pa­tients will present to the doc­tor with pain de­vel­op­ing after move­ments in­volving lift­ing, twist­ing or for­ward bend­ing. The large ma­jor­ity of the time, symp­toms typ­ic­ally re­main in the low back/lumbar re­gion. Less of­ten, pa­tients can present with symp­toms that ra­di­ate down one or both legs. Most of the time, low back in­jur­ies are sprains and strains of low back muscles and lig­a­ments. Some­times, a lumbar disc can bulge or even her­ni­ate out of its nor­mal loc­a­tion situ­ated between the ver­teb­rae. This can trap nerves that leave the spine and travel down the legs and cause the pain of the lower ex­tremit­ies known as sci­at­ica.

Im­ages of the spine are usu­ally not needed. However, your doc­tor may feel it to be ap­pro­pri­ate to or­der an X-ray or MRI if he or she thinks this may change the course of treat­ment. Most cases of acute low back pain will re­solve spon­tan­eously with­in four to six weeks. In these cases, treat­ment typ­ic­ally con­sists of con­ser­vat­ive meas­ures. These in­clude an­al­ges­ic med­ic­a­tions such as acet­aminophen, anti-in­flam­mat­or­ies or muscle re­lax­ants. The use of heat, elec­tric­al nerve stim­u­la­tion (TENS) and stretch­ing, or even phys­ic­al ther­apy can be be­ne­fi­cial. A smal­ler per­cent­age of pain will last longer and need more ag­gress­ive treat­ment. This may in­clude in­jec­tions to the sup­port­ing mus­cu­lature or spin­al column it­self and very rarely sur­gery.

Pre­ven­tion of low back pain can come in mul­tiple forms. Prop­er lift­ing tech­niques con­sist of bend­ing at the knees, keep­ing the feet hip-width apart and staggered, with the spine in a neut­ral and up­right po­s­i­tion. This min­im­izes risks to the lumbar back struc­tures. Ex­er­cising reg­u­larly and keep­ing the core muscles of the back, ab­do­men, but­tocks and up­per legs strong also sta­bil­izes the low back. A me­di­um-firm mat­tress may be more be­ne­fi­cial than softer mat­tresses. Mon­it­or­ing weight, stay­ing with­in a nor­mal body-mass in­dex range and avoid­ing ci­gar­ette smoking also re­duce the risk of low back pain-re­lated is­sues. ••

Rocco Cost­a­bile, M.D., prac­tices fam­ily medi­cine with EPIC Phys­i­cians Group, 8019 Frank­ford Ave., 215-332-1300.

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