What Is Lower Back Pain
Low back pain can result from many different injuries, conditions or diseases most often, an injury to muscles or tendons in the back.
Pain can range from mild to severe. In some cases, pain can make it difficult or impossible to walk, sleep, work or do everyday activities.
Usually, lower back pain gets better with rest, pain relievers and physical therapy . Cortisone injections and hands-on treatments can relieve pain and help the healing process. Some back injuries and conditions require surgical repair.
Understanding The Lower Back
The lower back is also called the lumbosacral area of the back. It is the part of the back between the bottom of the ribs and the top of the legs.
Most of the lower back is made up from muscles that attach to, and surround, the spine. The spine is made up of many bones called vertebrae. The vertebrae are roughly circular and between each vertebra is a disc. The discs between the vertebrae are a combination of a strong fibrous outer layer and a softer, gel-like centre. The discs act as shock absorbers and allow the spine to be flexible.
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When To Call A Doctor
Consult your doctor if you have back pain thats intense, worrisome, or that doesnt go away with self-care measures. Its also important to call your doctor if your lower back pain is making it hard for you to go about your daily activities.
Most cases of lower back pain on the right side are not medical emergencies. However, dont hesitate to get immediate medical help if you experience back pain thats accompanied by any of the following symptoms:
- loss of bladder or bowel function
- sudden, severe pain
- weakness or loss of sensation in your lower body
- pain accompanied by fever, clammy skin, a rapid heart rate, nausea, vomiting, or any other concerning symptoms
The appropriate treatment for lower back pain emergencies depends on the cause. If the source of the pain isnt obvious, you may need one or more of the following screenings to determine the right course of action:
- an MRI to check your spinal cord, nerve roots, and other soft tissue
- an X-ray to look at your spine and other joints for signs of fracture or other concerns
- blood tests to check for markers of inflammation
If nerve or muscle problems are the cause of lower back on the right, epidural injections of corticosteroids may be necessary if the pain and loss of mobility and function are severe.
If appendicitis is diagnosed and it cant be managed by antibiotics, then emergency surgery to remove the appendix may be necessary.
- nerve compression in your spine
- disc degeneration
- an abdominal aortic aneurysm
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Pelvic Pain During Pregnancy
Some people experience pelvic pain during pregnancy. Pelvic pain can affect one or both sides of the lower back.
This pain may also affect the perineum or radiate to the thighs. It may become worse while a person is walking, standing up, or rolling onto their side.
A person may be able to reduce pelvic pain during pregnancy by:
- doing exercises that strengthen the pelvic floor
- avoiding standing for too long
- getting plenty of rest
People can also try applying ice or heat packs to help ease the pain.
OTC acetaminophen is generally safe to take during pregnancy. However, it is advisable to consult a doctor before taking any medications while pregnant.
How Your Back Works
The spine, which is also called the backbone or spinal column, is one of the strongest parts of the body and gives us a great deal of flexibility and strength.
Its made up of 24 bones, known as vertebrae, one sitting on top of the other. These bones have discs in between and lots of strong ligaments and muscles around them for support. There are also the bones in the tailbone at the bottom of the back, which are fused together and have no discs in between.
On either side of the spine, running from top to bottom, are many small joints called the facet joints.
The spinal cord passes inside the vertebrae, which protect it.
The spinal cord connects to the brain through the base of the skull and to the rest of the body by nerves that pass through spaces between the bones of the spine. These nerves are also known as nerve roots.
As you grow older, the structures of your spine, such as the joints, discs and ligaments, age as well. The structures remain strong but its usual for your back to get stiffer as you get older.
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Less Common Causes Of Low Back Pain
While considerably less common, low back pain may also be caused by:
Infection. Also called osteomyelitis, a spinal infection is rare but can cause severe pain and is life threatening if untreated. It can be caused by surgical procedures, injections, or spread through the blood stream. Patients with a compromised immune system are more susceptible to developing an infection in the spine.
Tumor. Most spinal tumors start in another part of the body and metastasize to the spine. The most common tumors that spread to the spine start from cancer in the breast, prostate, kidney, thyroid, or lung. Any new symptoms of back pain in a patient with a known diagnosis of cancer should be evaluated for possible spinal metastasis.
Autoimmune disease. Back pain is a possible symptom associated with autoimmune conditions, such as ankylosing spondylitis, rheumatoid arthritis, lupus, crohns disease, fibromyalgia, and others.
This list includes the more common causes of back pain, but there are many more. Finding the optimal treatment for low back pain usually depends on obtaining a correct clinical diagnosis that identifies the underlying cause of the patients symptoms.
Complementary And Alternative Techniques Include:
- Acupuncture is moderately effective for chronic low back pain. It involves inserting thin needles into precise points throughout the body and stimulating them , which may cause the body to release naturally occurring painkilling chemicals such as endorphins, serotonin, and acetylcholine.
- Behavioral approaches include:
- Biofeedback involves attaching electrodes to the skin and using an electromyography machine that allows people to become aware of and control their breathing, muscle tension, heart rate, and skin temperature people regulate their response to pain by using relaxation techniques
- Cognitive therapy involves using relaxation and coping techniques to ease back pain
Spinal injections include:Trigger point injections can relax knotted muscles that may contribute to back pain. An injection or series of injections of a local anesthetic and often a corticosteroid drug into the trigger point can lessen or relieve pain.
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Lower Back Pain Caused By Infection
Infections of the spine are not common, but they do occur. The doctor will ask about the usual signs and symptoms of infection, especially when back pain is accompanied by fever and/or chills. Dialysis patients, IV drug users, and patients who have recently had surgery, trauma, or skin infections are at risk for infections of the spine. Infections of the spine can be caused by a number of agents, most commonly bacteria. Doctors will first test for the presence of bacteria, then give antibiotics.
Why Is Lower Back Pain Such A Common Problem
The bottom part of your back typically has just five vertebrae fewer than your neck and mid-back. And these vertebrae do a lot of heavy lifting! Your lower back is where your spine connects to your pelvis, bearing the weight of your upper body. This area experiences a lot of movement and stress, which may lead to wear, tear and injuries.
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Managing Low Back Pain
Manage back pain with regular exercise and professional help as requiredIf you have an attack of lower-back pain that is severe, continuous and not improving, assessment and treatment by a health care professional who focuses on the back or other musculoskeletal problems may help. These practitioners may use both active and passive techniques to help you feel better. Examples of passive techniques that may be used to get you moving include:
An active approach, like walking or water aerobics is usually the most effective. Exercise is often the best way to relieve lower-back pain.
Check with your health care provider before starting an exercise program.
Work with an expert. It may help to work with a health professional who can explain which activities are right for you.
Choose exercises you enjoy. Many activities can help relieve back pain. Try to include activities that strengthen the muscles around your trunk, your abdominal muscles as well as those in your lower back. Studies show the following activities help relieve back pain:
- Lifting light weights
Chronic Lower Back Pain
When back pain continues for more than three months, it is considered chronic. Although for most people an episode of back pain is over by that time, in some cases it progresses and can have a major impact on ones ability to function. For some patients, physical therapy with local heat or ice application , combined with a home exercise program and education in proper positions for lifting and other movement techniques can make a major difference. Patients must learn to tolerate a certain degree of pain, or they may allow themselves to become more disabled than necessary. Patients at the Hospital for Special Surgery have had success with graded exercise to work through the pain, gradually increasing the exercise quota at each session so they can learn to tolerate more exercise in spite of the pain, and get back to work and activities. Read more detail on this topic in .
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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:
Congenital
- 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.
Injuries
- 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.
Degenerative problems
- 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
Non-spine sources
Treating Lower Back Spasms
If your spasms do begin after an injury or an activity that stressed the muscles, try alternating ice and heat on your back. Ice will help reduce inflammation and heat may help improve blood flow.
Medications such as nonsteroidal anti-inflammatory drugs and muscle relaxants may help relieve symptoms while the muscles heal. Research from a 2016 review of studies supports the use of muscle relaxants for significant pain relief from short-term muscle spasms.
Injections of anti-inflammatory medication may also help. But there are potential side effects with every medication. Ask your doctor about the risks and benefits of these injections.
Chiropractic care may help, but be sure to see a doctor to have your condition properly diagnosed first. Physical therapy to help strengthen your back and abdominal muscles is often recommended.
In the middle of a back spasm, slowly make your way to the nearest comfortable chair or sofa. Here, you can try the following:
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Top 7 Most Serious Causes Of Back Pain
Approximately 80% of adults in the United States will suffer from back pain at some point. Fortunately, most of the time that pain is due to a straightforward problem such as a herniated disc or degenerative disease in the spine. These problems are bothersome, and can even be dangerous if too much time is allowed to pass, but they are not considered a medical emergency.
On the other hand, anytime back pain is associated with weakness or loss of bladder or bowel control, it should be considered an emergency that requires immediate treatment. These symptoms can suggest compression of the spinal cord or cauda equina. Moreover, sometimes back pain can be a sign of more significant trouble. Here are some of the most serious causes of back pain that both doctors and patients must be careful not to miss.
Lower Back Pain: What Could It Be
Do you have lower back pain? You are not alone. Anyone can experience lower back pain at any time, even if you dont have a prior injury or any of the risk factors. It is not always serious and can often get better on its own. But in some cases pain is your bodys way of telling you that something isnt right.
Learn more about lower back pain and what causes it from rehabilitation physician Akhil Chhatre, M.D., who specializes in back pain in the Johns Hopkins Department of Physical Medicine and Rehabilitation.
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Fractures And Lower Back Pain
are often very difficult pain problems and indicate the possible presence of . In patients with severe osteoporosis, spinal fractures can occur with no early warning and no significant trauma the patient does not have to fall to fracture a vertebrae.
Patients with spinal compression fractures experience spasms and, often, very high pain levels.
In patients with low back pain where the cause is difficult to determine, especially for elderly patients with osteoporosis, a fracture in the sacrum may be the cause of the pain. A standard X-ray or bone scan may not show a sacral fracture. Imaging techniques such as CT scan or MRI can often reveal these fractures.
It is very important that patients with acute lumbar compression fractures be tested for osteoporosis. A bone density study is needed, unless the patient has no other osteoporosis risk factors and has had a very high impact fracture. Studies have shown that many patients with fractures in the U.S. are discharged from hospitals with no plans for management of their bone density problems, which then are left to worsen.
Although pain can be very intense, it is best for patients with lumbar fracture to resume activity as soon as possible. This is especially true for elderly patients, who can too easily become weakened, and develop other complications, if mobility is reduced for too long. may be needed for pain control, for as brief a period as possible.
Back Pain And Pregnancy
Back pain during each trimester of your pregnancy can be common, and several causes are to blame. However, you should be sure to talk with your doctor about what youre experiencing, in case the pain may be part of a bigger problem.
Here are a few reasons why you may be experiencing back pain during pregnancy:
Shifting center of gravity
As your baby grows, the center of your bodys gravity moves outward. Your spine and back arch to make up for the change in balance. This put extra stress on the lower lumbar spine.
Weight gain
Weight gain can be a healthy part of pregnancy, but even the little bit youre likely to gain during those 9 months can put more stress on your back and core muscles.
Hormones
As your body prepares to deliver the baby, it releases hormones that loosen the ligaments that stabilize your pelvis and lumbar spine. These same hormones can cause the bones in your spine to shift, which may lead to discomfort and pain.
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Concerned About Your Back Pain Symptoms We Can Help
Most back pain goes away on its own. But if your back pain has been lingering for more than two weeks without improvement, its been coming and going for some time, or if youre experiencing any alarming symptoms, dont delay the care you need. After all, its much easier to take care of yourself when you can move without pain.
Think TRIA Neck and Back Strengthening Program may be right for you? Schedule a consultation.
Not ready for an intensive physical therapy program? Start with physical therapy.
How Is Lumbar Strain Treated
Treatment will depend on your symptoms, age, and general health. It will also depend on how severe the condition is.
Treatment may include:
- Ice packs or heat and compression applied to the back
- Stretching and strengthening exercises
- Learning how to use and wear appropriate protective equipment
Medicines, such as anti-inflammatories, muscle relaxants, and spinal injections, may also be used to ease pain and inflammation.
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