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.