Back Pain Overview Low back pain affects most people at least once over their lifetime. It can
be a cause for loss of work and costs billions of dollars in lost wages and
productivity. Fortunately, most people with low back pain will become better in
about 6 weeks even without treatment. A better understanding of the low back may
ease fears and aid treatment. The low back has many complex structures which can be the cause of pain.
The spinal cord and nerves which innervate the lower body are protected by an
articulated bony cage. The bony cage is made up of vertebral bodies with
intervertebral discs in between, which act as shock absorbers. The vertebral
bodies have 4 facet joints, 1 pair above and 1 pair below. These facet joints
are synovial joints meaning they have fluid within them and are very similar to
knee joints. The pelvis has 2 synovial joints termed sacro-iliac joints which
join the sacrum to the iliacs, which are the hip bones. Muscles and ligaments
surround and join these structures together.
Most back pain is caused by sprain
or strain of the back muscles and ligaments. The pain will be in a discrete area
and tender to the touch. It is of an aching quality and may involve muscle
spasms. The pain is usually not associated with shooting leg pain. Low back pain caused by arthritis of the facet joints is mostly in the
midline of the back and may spread to the flanks. It can be worsened with
bending backwards and side-to-side. Low back pain caused by arthritis of the
sacro-iliac joints may spread to the buttocks and to the front of the pelvis. It
can be worsened by sitting. Injury to the spinal cord or nerves can cause low back pain with
shooting pain down the legs. Sometimes this shooting pain is referred as
sciatica because it involves the sciatic nerve. The sciatic nerve controls the
sensation of the back of the leg and most of the area below the knee. The spinal
cord or nerves can be pinched by spinal stenosis or disc herniation. Spinal
stenosis means that there is not enough room for the spinal cord in the spinal
canal and it is being squeezed. Disc herniation means that the intervertebral
disc has a weakness in its wall and its contents are protruding outward. If the
nerves are being touched, they can become irritated and inflamed which is felt
as shooting pain. Initial treatment of low back pain is conservative as most people will be
better in 6 weeks. You should stop the activity which caused the back pain in
the first place and rest. Icing the painful area and taking nonsteroidal
anti-inflammatory medicines such as ibuprofen is helpful. A history of cancer or traumatic injury may require consultation with your
physician. Red flag issues which require immediate medical attention are
weakness, loss of sensation, and loss of bladder and bowel control. If there are
any questions, it would be prudent to consult your physician. Preventative
measures that can be taken are maintaining good posture, strengthening the
abdominal and back muscles, and avoiding high-impact exercises. |
For information only. Please consult a qualified physician.