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Why Lower Back Pain Occurs

Lower Back Pain Causes

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Nonspecific low back pain means that the pain is not due to any specific or underlying disease that can be found. It is thought that in some cases the cause may be an over-stretch of a ligament or muscle. In other cases the cause may be a minor problem with a disc between two spinal bones , or a minor problem with a small facet joint between two vertebrae. There may be other minor problems in the structures and tissues of the lower back that result in pain. However, these causes of the pain are impossible to prove by tests. Therefore, it is usually impossible for a doctor to say exactly where the pain is coming from, or exactly what is causing the pain.

To some people, not knowing the exact cause of the pain is unsettling. However, looked at another way, many people find it reassuring to know that the diagnosis is nonspecific back pain which means there is no serious problem or disease of the back or spine.

What Is The Anatomy Of The Lower 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.

What Structures Make Up The Back

The lower backwhere most back pain occursincludes the five vertebrae in the lumbar region, which supports much of the weight of the upper body. The spaces between the vertebrae are maintained by round, rubbery pads called intervertebral discs that act like shock absorbers throughout the spinal column to cushion the bones as the body moves. Bands of tissue known as ligaments hold the vertebrae in place, and tendons attach the muscles to the spinal column. Thirty-one pairs of nerves are rooted to the spinal cord and they control body movements and transmit signals from the body to the brain.

Other regions of vertebrate are cervical , thoracic , and sacral and coccygeal segments.

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Why Back Pain Requires A Team Approach To Care

Whether back pain requires surgery or is manageable with conservative treatment, its important to see a spine specialist for diagnosis and care. The doctors at our Spine Center work as a team with experts in nerve, muscle, and bone conditions, as well as nurses and physical therapists who work closely with patients to manage symptoms and reduce the risk of recurrence.

Each week, our multidisciplinary team meets to discuss challenging cases and educate each other on the latest research and techniques. Together, we see a range of patients with complex medical needs. For example, if a patient with a spinal infection is taking a medication that suppresses the immune system, such as immunotherapy for cancer, we work together to find an effective treatment that is safe for their unique needs.

Some medications or medical conditions put patients at greater risk for low bone density, fractured vertebrae, or back pain. In these cases, we get referrals from and collaborate with oncologists, hematologists, rheumatologists, mineral metabolism doctors, and primary care doctors to reduce patients risks and manage their symptoms.

If you are worried about back pain, come see us for reassurance. The earlier you are diagnosed, the better your outcomes can be.

If you or a loved one might benefit from a back pain consultation, call or request an appointment online.

What Tests Will Be Done To Diagnose A Muscle Strain

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If you have a more severe strain, your provider might use some imaging tests to diagnose your muscle strain:

  • Ultrasound: Your provider will use an ultrasound to check for tears or fluid buildup around your strained muscle.
  • MRI: An MRI will let your provider check for blood clots, a tear or internal bleeding.

These tests will also help them see if your injury damaged any other tissues like your tendons or ligaments.

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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.

How Soon Will I Feel Better

Depending on how severe your original muscle strain is, you should feel better in a few weeks. Talk to your healthcare provider before resuming any intense physical activities.

If you start working out or playing sports again before your muscle is healed, youre at an increased risk of re-injuring it and hurting your muscle worse than the original strain.

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Who Should You See For Lower Back Pain

In general, you should start with your primary care doctor for lower back pain. Your doctor can prescribe drugs and recommend lifestyle changes to protect your back and help improve your pain. Your primary care doctor can also provide referrals to specialists and other providers if necessary. This includes:

  • Orthopedic surgeons, who specialize in treating conditions related to the joints, muscles and bones. An orthopedic surgeon uses both medical treatments and surgery to manage these types of problems.
  • Physical therapists, who work with people to restore function, build strength, and improve flexibility with the goal of relieving symptoms and preventing or improving disability
  • Chiropractors, who use spinal manipulation to treat uncomplicated lower back pain
  • Neuromusculoskeletal doctors, who also use manipulation techniques to manage lower back pain
  • Neurologists and neurosurgeons, who can address nerve-related causes of lower back pain
  • Physical medicine and rehabilitation doctors, who specialize in preventing and minimizing disability from conditions such as lower back pain

What Are The Most Common Lower Back Surgery Procedures

Lower Back Pain and How It Occurs

Spine surgery is not necessary for most people who have lower back pain. If you do need it, your doctor will recommend an appropriate procedure to address your specific symptoms and medical situation. Common spine surgeries include:

. Two or more vertebrae are permanently fused together to limit excess spinal motion. Your surgeon will use a combination of bone, bonelike material, screws, plates and rods to hold the vertebrae together so they can heal into a single unit. Spinal fusion may be done to correct spinal deformities or to increase the spines stability in severe cases of spinal osteoarthritis or herniated discs.

. Laminectomy is a surgery in which your surgeon removes the back portion of one or more vertebrae to create more space for the spinal cord or other nerves. In people with severe arthritis, bone spurs within the spinal canal can grow large enough to press on the spinal cord, causing pain and limiting mobility. In a similar surgery known as laminotomy, your surgeon will remove a small piece of bone called the lamina from the back of the vertebra.

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Surgery For Lower Back Pain

Because the vast majority of patients recover from their low back pain with little help from a doctor, the rationale behind choosing surgery must be convincing. Eighty percent of patients with sciatica recover eventually without surgery.

Severe progressive nerve problems, bowel or bladder dysfunction and the cauda equina syndrome make up the most clear-cut indications for back surgery. Back surgery will also be considered if the patients signs and symptoms correlate well with studies such as MRI or electromyogram .

In the most serious cases, when the condition does not respond to other therapies, surgery may well be necessary to relieve pain caused by back problems. Some common procedures include:

  • Discectomy, such as a or removal of a portion of a
  • a bone graft that promotes the vertebrae to fuse together
  • removal of the lamina to create more space and reduce irritation and inflammation

References and useful links

  • 1, 2. Excerpted from Low Back Pain Fact Sheet, National Institute of Neurological Disorders and Stroke, National Institutes of Health
  • Low Back Pain Fact Sheet, National Institute of Neurological Disorders and Stroke, National Institutes of Health. Reviewed, July 26, 2003.
  • Deyo RA, Weinstein JN, Low Back Pain, N Engl J Med, Vol 344, No. 5, Feb 1, 2001, pp 363-370.

What Are Some Common Lower Back Pain Causes

The causes of lower back pain are sometimes viewed as being mechanical, organic or idiopathic. Sometimes spinal conditions are congenital or acquired meaning the disorder develops later in life.

  • Mechanical lower back pain is often triggered by spinal movement and involves spinal structures, such as the facet joints, intervertebral discs, vertebral bodies , ligaments, muscles or soft tissues.

  • Organic lower back pain is attributed to disease, such as spinal cancer.

  • Idiopathic refers to an unknown cause.

These are some of the things your doctor might look for or rule out when you schedule a visit for back pain.

The common symptoms of lower back pain.

Sprains and strains. Ligament sprains and muscle or tendon strains are the most common causes of lower back pain. Theyre often related to overuse.

Degenerative disc disease. While the name sounds worrisome, it just means you have a damaged disc causing pain. Over time, discs become thinner and flatter due to wear and tear. That leaves them less able to cushion the vertebrae and more likely to tear .

. The protective covering on intervertebral discs can tear over time. When this happens, the soft inner disc tissue may push through the outer layer. A disc that bulges or slips out of place is known as a herniated disc, bulging disc, or slipped disc. The herniation may press on nerve roots, leading to symptoms such as pain, tingling, numbness or weakness in the area that the nerve serves

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What Is The Outlook

Most of us will have a bout of nonspecific low back pain at some point in our lives. The severity can vary. However, it is difficult to quote exact figures as to outlook . This is partly because it is so common and many people with back pain do not consult a doctor. Roughly, it is thought that:

  • Most nonspecific back pains ease and go quickly, usually within a few weeks.
  • In about 4 in 10 cases, the pain has completely gone within four weeks.
  • In about 7 in 10 cases the pain has completely gone within one year.

However, once the pain has eased or gone it is common to have further bouts of pain from time to time in the future. Also, it is common to have minor pains on and off for quite some time after an initial bad bout of pain. In a small number of cases the pain persists for several months or longer. This is called chronic back pain.

How Do Health Care Professionals Diagnose Lower Back Pain

How Does Lower Back Pain Occur

The diagnosis of low back pain involves a review of the history of the illness and underlying medical conditions as well as a physical examination. A complete story of the back pain must be reviewed including injury history, aggravating and alleviating conditions, associated pain symptoms , as well as the duration and progression of symptoms. Aside from routine abdomen and extremity evaluations, rectal and pelvic examinations may eventually be required as well. Further tests for diagnosis of low back pain can be required including blood and urine tests, plain film X-ray tests, CAT scanning, MRI scanning, bone scanning, and tests of the nerves such as electromyograms and nerve conduction velocities .

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What Type Of Doctor Should I See For Back Pain

This depends on your condition or symptoms. If you have no obvious injury that would explain your pain, you may want to start by seeing a . This is a specialist in physical medicine who can diagnose back pain and determine whether nonsurgical treatments such as physical therapy may help. Depending on those findings, a physiatrist may also refer you to a , doctor or other type of back specialist, , for additional discussion.

Two Back Pain Situations You Should Take Seriously Right Away No Delay

These two back pain scenarios might be medical emergencies. They definitely do not necessarily mean something horrible is wrong, but its important to make sure.

  • Pain and weakness in both legs, especially if its also hard to pee. More about this below.
  • Any accident with forces that may have been sufficient to fracture your spine. Please seek thorough medical assessment promptly, including an X-ray to look for a fracture. You really do need an X-ray to ensure that your spine is not actually broken. They arent necessarily as obvious as youd think!
  • Isnt it rather obvious that a potential spinal fracture is an emergency?

    Youd think so. But consider this story of a motorcycle accident: many years ago, a friend hit a car that had pulled out from a side street. He flew over the car & landed on his head. Bystanders showed their ignorance of spinal fracture by, yikes, carelessly moving him. In fact, his thoracic spine was significantly fractured yet the hospital actually refused to do an X-ray because he had no obvious symptoms of a spinal fracture. Incredible! The next day, a horrified orthopedic surgeon ordered an X-ray immediately, confirming the fracture & quite possibly saved him from paralysis.

    Pain + weakness in both legs as symptoms of cauda equina syndrome or not

    That said, obviously you should be checked out if you are experiencing true saddle numbness. Even if its not CES, any significant malfunction of your plumbing should be taken seriously.

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    When Should I See My Healthcare Provider About Lower Back Pain

    Lower back pain usually gets better with rest and pain relievers. Back pain that doesnt go away may be a sign of a more serious condition.

    See your provider if you have:

    • Pain that doesnt get better after about a week of at-home care.
    • Tingling, numbness, weakness or pain in your buttocks or legs.
    • Severe pain or muscle spasms that interfere with your normal activities.
    • Fever, weight loss, bowel or bladder problems or other unexplained symptoms.

    A note from Cleveland Clinic

    Millions of people live with low back pain. Stiffness, pain and limited movement can have a major impact on quality of life. But you may be able to avoid lower back pain by maintaining a healthy weight and staying active. Talk to your provider if back pain doesnt go away or if youre unable to do the activities you enjoy. Several treatments can relieve pain, help you move better and get more out of life.

    Last reviewed by a Cleveland Clinic medical professional on 01/18/2021.

    References

    Fractures And Lower Back Pain

    5 reasons failed back surgery syndrome occurs

    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.

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