Arthritis Of The Spine
Arthritis of the spine the slow degeneration of the spinal joints is the most frequent cause of lower back pain. All of us experience wear and tear as we age, and it is normal for your lower back to start acting up as you get older. As the cartilage breaks down between the spinal joints, surrounding tissues may become inflamed. The inflammation and the thinning of cartilage increase friction in the joints, which may cause pain in the lower back.
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.
Muscle Strain Or Sciatica
Muscle strain is often the cause of back pain from heavy lifting or vigorous exercise. But sometimes itâs due to small jelly-filled disks meant to protect the space between vertebrae. When one of these disks bulges or breaks, it can push on a nerve. When itâs the sciatic nerve, pain runs from the buttock down one leg. This is sciatica.
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Whats New In This Article
Fourteen updates have been logged for this article since publication . All PainScience.com updates are logged to show a long term commitment to quality, accuracy, and currency. moreWhens the last time you read a blog post and found a list of many changes made to that page since publication? Like good footnotes, this sets PainScience.com apart from other health websites and blogs. Although footnotes are more useful, the update logs are important. They are fine print, but more meaningful than most of the comments that most Internet pages waste pixels on. I log any change to articles that might be of interest to a keen reader. Complete update logging of all noteworthy improvements to all articles started in 2016. Prior to that, I only logged major updates for the most popular and controversial articles.See the Whats New? page for updates to all recent site updates.
2020 Minor science update, added a citation to a cancer case study.
2020 Added information about back pain as a symptom of COVID-19.
2018 Cited Premkumar et al on red flag reliability .
Can Back Pain Be Prevented
Recurring back pain resulting from improper body mechanics may be prevented by avoiding movements that jolt or strain the back, maintaining correct posture, and lifting objects properly. Many work-related injuries are caused or aggravated by stressors such as heavy lifting, contact stress , vibration, repetitive motion, and awkward posture.Recommendations for keeping ones back healthy
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Treatments For Back Pain From A Specialist
A GP, specialist or physiotherapist may recommend extra treatments if they do not think your pain will improve with self-help measures alone.
These may include:
- group exercise classes where you’re taught exercises to strengthen your muscles and improve your posture
- manual therapy treatments, such as manipulating the spine and massage, which are usually done by a physiotherapist, chiropractor or osteopath
- psychological support, such as cognitive behavioural therapy , which can be a useful part of treatment if you’re struggling to cope with pain
Some people choose to see a therapist for manual therapy without seeing a GP first. If you want to do this, you’ll usually need to pay for private treatment.
Surgery is generally only considered in the small number of cases where back pain is caused by a specific medical condition.
When To See Your Gp
You should speak to your GP as soon as possible if you have back pain and:
- find it difficult to pass or control urine
- feel numbness or altered sensation around your back passage or genitals – such as wiping after the toilet
- have pins and needles around your back passage or genitals – such as wiping after the toilet
If your GP surgery is closed, phone 111.
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How Can I Prevent Muscle Strains
The best way to prevent muscle strains is to stretch and warm up before exercising. Increasing your overall flexibility will also protect your muscles from future injuries. The more flexible you are, the more room your muscle fibers have to stretch before they begin to tear.
Its similar to how certain fabrics have more give than others. Your favorite pair of jeans have plenty of flexibility to them because youve stretched them out over years. On the other hand, you might have to wear a brand-new pair a few times before they feel comfortable. Your muscles are the same way. The more you work them out and gradually stretch them, the more flexibility and give they have when you move.
Can I Prevent Lower Back Pain
You cant prevent lower back pain that results from disease or structural problems in the spine. But you can avoid injuries that cause back pain.
To reduce your risk of a back injury, you should:
- Maintain a healthy weight: Excess weight puts pressure on vertebrae and disks.
- Strengthen your abdominal muscles: Pilates and other exercise programs strengthen core muscles that support the spine.
- Lift the right way: To avoid injuries, lift with your legs . Hold heavy items close to your body. Try not to twist your torso while youre lifting.
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What Are The Causes Of Lower Back Pain
The vast majority of patients experience back pain because of mechanical reasons. They strain a muscle from heavy lifting or twisting, suffer a sudden jolt in a car accident, experience stress on spinal bones and tissues resulting in a , or suffer from osteoarthritis, a potentially painful degeneration of one or more spinal joints. Common causes for low back pain are:
- mechanical or functional injury
- active infection
- referred pain
To choose the safest and most effective therapy, doctors need to consider the full spectrum of possible underlying issues, such as inflammatory conditions, fracture, infection, as well as some serious conditions unrelated to the back that radiate pain to the back.
The Importance Of An Accurate Diagnosis
The physician will need to take a careful medical history and do a physical exam to look for certain red flags that indicate the need for an X-ray or other imaging test. In most cases, however, imaging such as X-ray, MRI , or CT scan is unnecessary.
There may also be certain clues in a patients medical history. Low back, nonradiating pain is commonly due to muscle strain and spasm. Pain that radiates into the buttock and down the leg may be due to , a condition in which a bulging disc presses on the sciatic nerve, which extends down the spinal column to its exit point in the pelvis and carries nerve fibers to the leg. This nerve compression causes pain in the lower back radiating through the buttocks and down one leg, which can go to below the knee, often combined with localized areas of numbness. In the most extreme cases, the patient experiences weakness in addition to numbness and pain, which suggests the need for quick evaluation.
A persistent shooting or tingling pain may suggest lumbar disc disease. A pain that comes and goes, reaching a peak and then quieting for a minute or two, only to reach a peak again, may suggest an altogether different cause of back pain, such as a kidney stone.
When tumor or infection are suspected, the doctor may order blood tests, including a CBC and sedimentation rate .
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Inflammatory Lower Back Pain
Although comparatively few patients have low back pain due to a systemic inflammatory condition, the problem can be life long and can impair function significantly. The good news is that treatments can help essentially all patients, and can lead to major improvements.
Seronegative spondyloarthropathies are a group of inflammatory diseases that begin at a young age, with gradual onset. Like other inflammatory joint diseases, they are associated with morning stiffness that gets better with exercise. Sometimes fusion of vertebrae in the cervical or lumbar regions of the spine occurs. Drugs called TNF-alpha blocking agents, which are used for rheumatoid arthritis, are also used to treat the stiffness, pain, and swelling of spondyloarthropathy, when the cases are severe and not responsive to traditional medications
People who have spondyloarthropathy have stiffness that is generally worst in the morning, and have decreased motion of the spine. They also can have decreased ability to take a deep breath due to loss of motion of the chest wall. Its important for the physician to look for problems with chest wall expansion in patients with spondyloarthropathy.
syndrome is one of the forms of spondyloarthropathy. It is a form of arthritis that occurs in reaction to an infection somewhere in the body, and it carries its own set of signs and symptoms. The doctor will look for:
You’re Running A Fever
The flu can definitely make you run a fever and achiness, including in your back. However, if the fever is unresponsive to standard OTC medications, you could have a serious infection that needs treatment immediately. If you go to a doctor and they find an infection, they may prescribe antibiotics and a few days rest.
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What Are Some Less Invasive Or Noninvasive Back Pain Treatments
Your doctor has a wide range of treatments that may help your lower back pain. In general, expect your doctor to take a stepped care approach. That means starting with simple, low-cost treatments and moving to more aggressive approaches later. Keep in mind that many treatments take time to reach their full effect.
Medications. When over-the-counter pills and topicals dont do enough to relieve back pain, your doctor may recommend a prescription drug. Examples include:
- Antiseizure medication, such gabapentin or pregabalin, for nerve-related pain
- Muscle relaxants, such as baclofen or carisoprodol
- Prescription NSAIDs, such as celecoxib, diclofenac, or fenoprofen
- Opioids, such as oxycodone or hydrocodone, on a short-term basis.
Physical therapy . PT for lower back pain involves passive and active therapies to help the patient build core muscle strength, improve spinal flexibility and range of motion, correct posture and more. Your physical therapy sessions may include:
- Transcutaneous electrical nerve stimulation
Back Pain Expert Philip Sell On The Questions To Ask
We asked Philip Sell, consultant orthopaedic and spinal surgeon, what he would want to know if he was suffering from back pain.
What is the cause of my back pain?In 85% of cases, were unable to be precise about why people have back pain. This can be frustrating. It may be more helpful to think about what you can do to make your back better quicker. Research has shown that occupational factors or physical factors only play a small part in back pain. Your genes are probably the most significant factor in back pain.
When should I visit my GP with back pain?See your GP as soon as possible if the back pain is combined with difficulty in passing urine or numbness between the legs or around the bottom. For people over the age of 55 with new back pain, a previous history of cancer surgery or loss of weight should also be medically checked as soon as possible.
Should I be resting?You may feel its the wrong thing to do, but keep mobile and active. Resting, bed rest in particular, can prolong the duration of an episode of back pain. Most acute episodes of back pain will settle on their own, often within days rather than weeks. Taking pain relief and keeping active will stop stiffness setting in and keep muscles in good condition.
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How To Get Into Bed
To get into bed safely:
Mechanical Lower Back Pain
Because it represents 97% of cases, mechanical low back pain deserves to be discussed first. To determine the factors that bring out the pain, the doctor will consider the following causes of mechanical low back pain:
- Muscle strain.
- Spondylolisthesis .
- Osteoarthritis .
- Spinal stenosis .
Low back pain that gets worse with sitting may indicate a herniated lumbar disc . This is because certain positions of the body can change the amount of pressure that an out-of-place disc can press on a nerve. This is one reason we suggest to people with low back pain to periodically get up and stretch or walk around rather than continually stay sitting. Acute onset, that is, pain that comes on suddenly, may suggest a herniated disc or a muscle strain, as opposed to a more gradual onset of pain, which fits more with osteoarthritis, spinal stenosis, or spondylolisthesis.
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When To Worry About Low Back Pain
And when not to! Whats bark and whats bite? Checklists and red flags and non-scary possible explanations for alarmingly back pain
The bark of low back pain is usually much worse than its bite. The pain almost always makes it seem worse than it is. Even when its unusually severe and/or constant, it probably isnt dangerous.
MRI and x-ray for low back pain are surprisingly unreliable,1 because things like bulging discs usually arent a big deal,2 most back pain goes away on its own,3 and trigger points are common and can be worrisomely intense but arent dangerous.4 Most patients are much better off when they feel confident about these things. The power of justified, rational confidence is a huge factor in back pain.5 Sadly, many healthcare professionals continue to perpetuate the idea of fragile backs,6 which undermines that valuable confidence.
What Are The Treatments For Lower Back Pain
Lower back pain usually gets better with rest, ice and over-the-counter pain relievers. After a few days of rest, you can start to get back to your normal activities. Staying active increases blood flow to the area and helps you heal.
Other treatments for lower back pain depend on the cause. They include:
- Medications: Your provider may recommend nonsteroidal anti-inflammatory drugs or prescription drugs to relieve pain. Other medications relax muscles and prevent back spasms.
- Physical therapy : PT can strengthen muscles so they can support your spine. PT also improves flexibility and helps you avoid another injury.
- Hands-on manipulation: Several hands-on treatments can relax tight muscles, reduce pain and improve posture and alignment. Depending on the cause of pain, you may need osteopathic manipulation or chiropractic adjustments. Massage therapy can also help with back pain relief and restore function.
- Injections: Your provider uses a needle to inject medication into the area thats causing pain. Steroid injections relieve pain and reduce inflammation.
- Surgery: Some injuries and conditions need surgical repair. There are several types of surgery for low back pain, including many minimally invasive techniques.
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Lack Of Rib Cage Mobility
When it comes to flexibility and mobility, we may not consider the rib cage as being an important region of our body that needs free range of motion. However, according to Light, If the rib cage cannot expand enough during breathing, our upper backs and neck will become engaged and try to open up the rib cage. This is usually a futile effort and, at best, you will have tension and cramps . In order to avoid this, Light suggests stretching out your lats and doing more single leg and single arm exercises.
Back Pain Culprit: Chronic Conditions
Several chronic conditions can lead to low back pain.
- Spinal stenosis is a narrowing of the space around the spinal cord, which can put pressure on the spinal nerves.
- Ankylosing spondylitis inflames the joints of the spine, and sometimes the shoulders, hips, ribs, and other areas too. It causes chronic back pain and stiffness. In serious cases, spinal vertebrae start to fuse .
- Fibromyalgia causes widespread muscle aches, including back pain.
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Can Lower Back Pain Be A Sign Of Something Serious Like Cancer
Lower back pain can be related to cancer. In fact, it is one of the first symptoms of prostate cancer when it metastasizes and creates lesions. Almost any cancer can spread to the back and some, like sarcoma, can originate in the back. Be cautious, especially if you are experiencing other symptoms besides lower back pain. Talk to your doctor if you have additional symptoms or concerns.
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.
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