Back Pain Culprit: Your Bag
Although you may wear your purse, backpack, or briefcase over your shoulder, it is the lower back that supports the upper body — including any additional weight you carry. So an overstuffed bag can strain the lower back, especially if you carry it day after day. If you must tote a heavy load, consider switching to a wheeled briefcase.
Other Conditions That Cause Back Pain In Older Adults
We often see a range of less serious but still painful spine conditions in seniors. Most patients with these conditions will not require surgery. Physical therapy, medication, injectable anesthetics, or a combination of treatments usually can control symptoms.
- Degenerative disc disease, which can cause whole spine pain, and lumbar arthritis, which usually causes low-back pain, commonly develop with age and are considered wear-and-tear conditions.
- Sacroiliitis is an inflammation of the joints that connect your spine and pelvis. This condition can cause pain in the low back, glutes, and upper legs.
- Ankylosing spondylitis is an inflammatory arthritis that causes patients spines to become inflexible, resulting in a continual hunched forward position and spine pain.
- We also check for adult degenerative scoliosis and kyphosis, spine-curving conditions that can result in back pain and weakness in the lower extremities.
What Is The Anatomy Of The Low Back
To understand various causes of low back pain, it is important to appreciate the normal design of the tissues of this area of the body. Important structures of the low back that can be related to symptoms in this region include the bony lumbar spine , discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.
The bony lumbar spine is designed so that vertebrae “stacked” together can provide a movable support structure while also protecting the spinal cord from injury. The spinal cord is composed of nervous tissue that extends down the spinal column from the brain. Each vertebra has a spinous process, a bony prominence behind the spinal cord, which shields the cord’s nervous tissue from impact trauma. Vertebrae also have a strong bony “body” in front of the spinal cord to provide a platform suitable for weight bearing of all tissues above the buttocks. The lumbar vertebrae stack immediately atop the sacrum bone that is situated in between the buttocks. On each side, the sacrum meets the iliac bone of the pelvis to form the sacroiliac joints of the buttocks.
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Which Health Care Specialties Treat Low Back Pain
Physician specialties that evaluate and treat low back pain range from generalists to subspecialists. These specialties include emergency medicine physicians, general medicine, family medicine, internal medicine, gynecology, spine surgeons , rheumatology, pain management, and physiatry. Other health care providers for low back pain include physical therapists, chiropractors, massage therapists, psychologists, and acupuncturists.
Gluteal Muscle Tear Or Avulsion
The gluteus medius is a muscle that sits on the outside of the hip area. This muscle is used for standing upright and walking. When injured, these muscles will cause a limp. If these muscles are torn, it can cause severe pain when walking, sitting, or sleeping. Treatment usually involves rest, physical therapy, and sometimes surgery to repair the torn muscle, if no other treatments bring relief from pain.
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What Are Other Causes Of Lower Back Pain
Other causes of low back pain include kidney problems, pregnancy, ovary problems, and tumors.
Kidney infections, stones, and traumatic bleeding of the kidney are frequently associated with low back pain. Diagnosis can involve urine analysis, sound-wave tests , or other imaging studies of the abdomen.
Pregnancy commonly leads to low back pain by mechanically stressing the lumbar spine 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 and stretches are often recommended for relieving this pain. Women are also recommended to maintain physical conditioning during pregnancy according to their doctors’ advice. Natural labor can also cause low back pain.
Ovarian cysts, uterine fibroids, and endometriosis may also cause low back pain. Precise diagnosis can require gynecologic examination and testing.
What Can Cause Lower Back Pain
Most acute low back pain is mechanical in nature, meaning that there is a disruption in the way the components of the back fit together and move. Some examples of mechanical causes of low back pain include:
- Skeletal irregularities such as scoliosis , lordosis , kyphosis , and other congenital anomalies of the spine.
- Spina bifida which involves the incomplete development of the spinal cord and/or its protective covering and can cause problems involving malformation of vertebrae and abnormal sensations and even paralysis.
- Sprains , strains , and spasms
- Traumatic Injury such as from playing sports, car accidents, or a fall that can injure tendons, ligaments, or muscle causing the pain, as well as compress the spine and cause discs to rupture or herniate.
- Intervertebral disc degeneration which occurs when the usually rubbery discs wear down as a normal process of aging and lose their cushioning ability.
- Spondylosis the general degeneration of the spine associated with normal wear and tear that occurs in the joints, discs, and bones of the spine as people get older.
- Arthritis or other inflammatory disease in the spine, including osteoarthritis and rheumatoid arthritis as well as spondylitis, an inflammation of the vertebrae.
Nerve and spinal cord problems
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Is Lower Right Or Left Back Pain Worrisome
Pain on one side of the back is not particularly more worrisome than central pain. There are three main kinds of one-sided back pain:
Most of the anatomy of the low back and abdomen is symmetrical. Some of the guts are not symmetrical, and only some of those is a plausible cause of back pain on one side. Heres some of the key anatomy to consider:
The side of the pain on its own doesnt tell us much, and most of the one-sided sources of pain are viscera that usually cause abdominal pain instead of back pain, or in addition to it. In other words, the only reason to worry about right or left lower back pain is if it is otherwise worrisome: if you have other red flags or significant non-back symptoms.
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Your Posture Could Be Causing The Pain
The way you hold your body when walking can play a major role in your comfort level and ease of walking. While good posture can result in little to no pain or stress, bad or inefficient posture can cause lower back pain and postural stress.
What are the Symptoms of Postural Stress?
Beyond lower back pain, if youre suffering from postural stress, you may also experience:
- Aches and pains in other parts of the body, such as the neck, shoulders, and knees
- Slumped or rounded shoulders
- Looking down at a cell phone while walking4
Can Correct Posture While Walking Prevent Lower Back Pain?
Maintaining good posture while walking may help prevent pain in the lumbar spine. Study the way you hold your body when you are walking. Are you following these steps?
Stand up straight, without leaning forward or back.Pull in your stomach and rotate your hips forward with your buttocks in.Keep your eyes forward with your chin parallel to the ground.
It is also a good idea to increase strength in your hamstrings and back muscles to help maintain good posture. Stress management may also help decrease postural stress.5
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Low Back Pain Fact Sheet
If you have had lower back pain, you are not alone. Back pain is one of most common reasons people see a doctor or miss days at work. Even school-age children can have back pain.
Back pain can range in intensity from a dull, constant ache to a sudden, sharp or shooting pain. It can begin suddenly as a result of an accident or by lifting something heavy, or it can develop over time as we age. Getting too little exercise followed by a strenuous workout also can cause back pain.
There are two types of back pain:
- Acute, or short-term back pain lasts a few days to a few weeks. Most low back pain is acute. It tends to resolve on its own within a few days with self-care and there is no residual loss of function. In some cases a few months are required for the symptoms to disappear.
- Chronic back pain is defined as pain that continues for 12 weeks or longer, even after an initial injury or underlying cause of acute low back pain has been treated. About 20 percent of people affected by acute low back pain develop chronic low back pain with persistent symptoms at one year. Even if pain persists, it does not always mean there is a medically serious underlying cause or one that can be easily identified and treated. In some cases, treatment successfully relieves chronic low back pain, but in other cases pain continues despite medical and surgical treatment.
Chronic Low Back Pain Is Serious But Rarely Ominous
Back pain can suck the joy out of your days for week, months, even years. It can definitely be serious even when its not dangerous. I have worked with many truly miserable chronic low back pain patients, and of course the huge economic costs of back pain are cited practically anywhere the subject comes up. But your typical case of chronic low back pain, as nasty as it can be, has never killed anyone.
Ominous is medical jargon for truly scary. Cue Jaws theme music. Low back pain is ominous when it is caused by something that can cripple or kill you. Such causes are rare, fortunately. But awful things do happen, even the best doctors can miss them .
Ordinary back pain can be fierce & awful but not dangerous. Its bark is almost always much louder than its bite.
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How To Treat Low Back Pain
- Over-the-counter pain medications such as acetaminophen, aspirin, ibuprofen, and naproxen to relieve pain and inflammation.
- Prescription drugs like muscle relaxants or pain relievers can provide short-term relief.
- Over-the-counter topical creams, gels, patches, or sprays with lidocaine, menthol, or capsaicin stimulate nerves in the skin, dulling pain. They can be particularly helpful for localized pain due to sore muscles.
- Hot or cold pads may help ease pain, reduce inflammation, and improve mobility.
- Core exercises that strengthen your abs and muscles lining the spine may help take the stress off the back, Rosner says. Check with your doctor before beginning any exercise program to make sure the exercises are right for your condition.
- Mindfulness-based stress reduction , an eight-week program of meditation and gentle yoga, can improve chronic lower back pain.
The Worst Back Pain Is Rarely The Scariest
People understandably assume that the worst back pain is the scariest. In fact, pain intensity is a poor indicator of back pain ominousness,10 and some of the worst causes are actually the least painful . For instance, someone could experience the symptoms of cauda equinae syndrome, and be in real danger of a serious and permanent injury to their spine, but have surprisingly little pain even none at all in some cases!
Meanwhile, many non-dangerous problems can cause amazingly severe back pain. A muscle cramp is a good analogy just think about how painful a Charley horse is! Regardless of whats actually going on in there, muscle pain is probably the main thing that back pain patients are feeling. The phenomenon of trigger points tiny muscle cramps, basically11 could be the entire problem, or a complication thats more painful and persistent than the original problem. Its hard to overstate how painful trigger points can be, but they are not dangerous to anything but your comfort.
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Chronic Low Back Pain Of No Specific Origin
Low back pain is defined as pain, tightness, and stiffness between the lower end of the rib cage and the buttocks. “Chronic” means the pain has lasted for twelve weeks or longer, and “no specific origin” means the pain cannot be traced to any specific cause, incident, or injury.
Most susceptible are individuals who perform heavy physical work, especially when there is ongoing anxiety, depression, and emotional stress at the same time. The longer the stress and back pain continue, the more difficult it is to ease the symptoms and return the patient to normal functioning.
Treatment involves nonsteroidal anti-inflammatory drugs and sometimes opioid medications for pain, though both have risks when used long term. Antidepressants may also be tried, along with psychological counseling.
Corticosteroid injections for the back are effective for some patients, and fusion surgery is sometimes attempted. Lifestyle changes in the form of improved diet, exercise, and stress management are very helpful in most cases.
Top Symptoms: lower back pain, unintentional weight loss, back pain that shoots to the butt, fever, involuntary defecation
Symptoms that always occur with chronic low back pain of no specific origin: lower back pain
Symptoms that never occur with chronic low back pain of no specific origin: thigh numbness, buttocks numbness, lower back pain from an injury
Urgency: Primary care doctor
Mononeuropathies Of The Leg
Mononeuropathies can affect nerves in the legs, arms, or other parts of the body. Mononeuropathy means a single nerve or nerve group has been damaged, for example, by a lesion that has developed along a nerve or group of nerves. Carpal tunnel syndrome is a good example of a mononeuropathy, in this case, affecting the wrist area. With mononeuropathy symptoms may be sudden or may develop slowly . Some of the more common mononeuropathies are
- femoral neuropathy
- sciatic nerve dysfunction
- peroneal neuropathy .
- tibial neuropathy .
Symptoms of the neuropathies above would include burning sensation in leg areas where these nerves are housed as well as lack of coordination of these leg muscles. Other symptoms include muscle wasting, pain, and twitching, cramps, and spasms in these nerves. Treatment focuses on isolating the underlying cause of the nerve disorder and addressing it using medications such as injected glucocorticoids and/or physical
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When To Worry About Back Pain Thats Only On The Left Or Right Side
Unless you experienced an obvious cause, like a fall, you probably arent dealing with a fracture that requires special care, says spine specialist Russell DeMicco, DO. Rarely do you need to worry just because your pain is only on the left side or right side of the back.
The exceptions are:
- Age: An older adult may experience a minor injury that results in a more serious condition either because they have low bone density, or they developed arthritis that causes pain.
- Athleticism: Athletes may experience greater musculoskeletal wear and tear than the general population. Theyre often more vulnerable to fractures, herniated disks or arthritis.
When Is The Right Time To Seek Professional Advice
- continues after a few weeks
- worsens or if you have sudden severe pain
- interferes with your quality of life and stops you doing daily activities
- occurs with other concerning symptoms such as incontinence, numbness or weakness in the legs, fever, nausea or vomiting.
- Most cases of lower back pain on the right side are not medical emergencies. However, if you have symptoms of appendicitis, kidney infection, kidney stones or testicular torsion you should see a doctor immediately
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Tips To Relieve The Pain
- Stay active and continue your daily routines. Resting is likely to make your pain worse.
- Apply heat or ice for about twenty minutes frequently throughout the day to ease your pain and any inflammation.
- Try exercises for back pain and activities including walking, swimming, yoga and Pilates.
- Take over-the-counter pain relief such as ibuprofen.
- Stretch tight muscles for a few minutes every day.
- Keep good posture as this will ease the pressure on your lower back.
- Maintain a healthy weight to ensure an optimal load on your lower back.
- Ensure you lift safely by bending with your knees to a squat position and holding the load close to your chest.
- Drink plenty of water every day and limit your intake of animal protein and salt to reduce your risk of kidney stones.
- Wipe from front to back when going to the toilet to prevent infection from bacteria in your colon passing to your urinary tract.
- Give up smoking as the nicotine in tobacco can weaken your spinal bones and remove nutrients from your discs that may lead to spine problems.
What Are Other Symptoms And Signs Sometimes Associated With Low Back Pain
Low back pain can cause a wide variety of symptoms and signs depending on the precise cause of the back pain as reviewed above. Symptoms that can be associated with low back pain include numbness and/or tingling of the lower extremities, incontinence of urine or stool, inability to walk without worsening pain, lower extremity weakness, atrophy of the lower extremity muscles, rash, fever, chills, weight loss, abdominal pains, burning on urination, dizziness, joint pain, and fatigue.
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