Dr Tariq Jagnarine
Fam Medicine, Endocrinology & Diabetes
Lower back pain is a common cause for visits to the doctor as well as the most common cause of job-related disability. At least 80 percent of persons worldwide will experience low back pain in their lifetime. 
Most lower back pain is the result of an injury, such as muscle sprains or strains due to sudden movements, or poor body mechanics while lifting heavy objects.
Lower back pain can also be the result of certain diseases, such as:
• Sciatica- Pinched Nerve
• Arthritis of the back
• Cancer of the spinal cord
• A ruptured or herniated disc
• Kidney infections
• Infections of the spine
Acute back pain can last anywhere from a few days to a few weeks, while chronic back pain is pain that lasts longer than three months.
Lower back pain is more likely to occur in individuals between the ages of 30 and 50. This is partly due to the changes that occur in the body with aging. As persons grow older, there is a reduction in the fluid content between the vertebrae in the spine. This means discs in the spine experience irritation more easily. In addition, more muscle tone is loss, which makes the back more prone to injury.
WHAT ARE THE CAUSES OF LOWER BACK PAIN?
• Strains
The muscles and ligaments in the back can stretch or tear due to excessive activity. Symptoms include pain and stiffness in the lower back, as well as muscle spasms. Rest and physical therapy are remedies for these symptoms.
• Disc injury
The discs in the back are prone to injury. This risk increases with age. The outside of the disc can tear or herniate. A herniated disc, which is also known as a slipped or ruptured disc, occurs when the cartilage surrounding the disc pushes against the spinal cord or nerve roots. The cushion that sits between the spinal vertebrae extends outside its normal position.
This can result in compression of the nerve root as it exits from the spinal cord and through the vertebral bones. Disc injury usually occurs suddenly, after lifting something or twisting the back. Unlike a back strain, pain from a disc injury usually lasts for more than 72 hours.
• Sciatica
Sciatica can occur with a herniated disc if the disc presses on the sciatic nerve. The sciatic nerve connects the spine to the legs. As a result, sciatica can cause pain in the legs and feet. This pain usually feels like burning, or pins and needles.
• Spinal stenosis
Spinal stenosis is when the spinal column narrows, putting pressure on the spinal cord and spinal nerves. Spinal stenosis is most commonly due to degeneration of the discs between the vertebrae. The result is compression of the nerve roots or spinal cord by bony spurs or soft tissues, such as discs.
Pressure on the spinal nerves causes symptoms such as numbness, cramping, weakness
These symptoms may be felt anywhere in the body. Many people with spinal stenosis notice their symptoms worsen when standing or walking.
• Abnormal spinal curvatures
Scoliosis, kyphosis, and lordosis are all conditions that cause abnormal curvatures in the spine. These are congenital conditions that are usually first diagnosed during childhood or adolescence. The abnormal curvature causes pain and poor posture because it places pressure on muscles, tendons, ligaments, and vertebrae
• Other conditions
A number of other conditions causes lower back pain. These conditions include:
• Arthritis is an inflammation of the joints.
• Fibromyalgia is long-term pain and tenderness in the joints, muscles, and tendons.
• Spondylitis is inflammation of the joints between the spinal bones.
• Spondylosis is a degenerative disorder that may cause loss of normal spinal structure and function. Although aging is the primary cause of the condition, the location and rate of degeneration are specific to the individual.
Additional health conditions that can cause lower back pain include:
• Kidney and bladder problems
• Pregnancy
• Endometriosis
• Ovarian cysts
• Uterine fibroids
• Cancer
Diagnosis of Back Pain
A complete medical history and a thorough physical examination is done to determine where the pain is felt. A physical exam can also determine if the pain is affecting a person’s range of motion. Reflexes and sensations are also explored to determine if the lower back pain is affecting nerves.
Unless there is concerning or debilitating symptoms or neurologic loss, a doctor would monitor a patient’s condition for a few weeks before sending for testing. This is because most lower back pain is resolved using simple self-care treatments.
Certain symptoms require more testing, including:
• Lack of bowel control
• Weakness
• Fever
• Weight loss
• Recent severe trauma to the back
• One-sided pain
• A history of cancer or steroid use
• Pain resistant to treatment
Imaging tests such as X-rays, CT scans, ultrasounds, and MRIs may be necessary for underlying severe issues such as:
• Bone problems
• Disc problems
• Problems with the ligaments and tendons in the back
TREATMENT OPTIONS FOR LOWER BACK PAIN
• Home care
Self-care methods are helpful for the first 72 hours after the pain begins. If the pain does not improve after 72 hours of home treatment, then further treatment is needed.
Stop any normal physical activities for a couple of days and apply ice to the lower back. Ice is recommended for the first 48 to 72 hours, then switching to heat. Alternate ice and heat to relax muscles. The RICE protocol — rest, ice, compression, and elevation — is recommended within the first 48 hours.
Take over-the-counter pain medication, such as ibuprofen or Panadol, Voltaren, to relieve pain.
A warm bath or a massage can often relax stiff and knotted muscles in the back.
Medical treatment
There are a number of possible medical treatments including:
• Medications
• Medical gels and appliances
• Physical therapy
Some medications include:
. Muscle relaxants
. Nonsteroidal anti-inflammatory drugs (NSAIDs) – Ibuprofen, Diclofenac, Aspirin
• Narcotic drugs such as codeine for pain relief
• Steroids to reduce inflammation
• Corticosteroid injections
Physical therapy, including:
• Massage
• Stretching
• Strengthening exercises
• Back and spinal manipulation
• Yoga
• Walking
Surgery
For severe cases, surgery may be necessary. Surgery is usually only an option when all other treatments fail. However, if there is loss of bowel or bladder control, or a progressive neurological loss, surgery becomes an emergency option.
PREVENTION OF BACK PAIN
There are many ways to prevent lower back pain. Practising prevention techniques may also help lessen the severity of one’s symptoms if presented with a lower back injury.
Prevention involves:
• Exercising the muscles in the abdomen and back
• Losing weight if overweight
• Lifting items properly by bending at the knees and lifting with the legs
• Maintaining proper posture
• Sleep on a firm surface
• Sit on supportive chairs that are at the correct height
• Avoid high-heeled shoes
• Quit smoking, Nicotine causes degeneration of spinal discs and reduces blood flow.
It is also possible for lower back pain to develop with no definitive cause. When this happens, the primary focus is on treating the symptoms, rather than the cause of the symptoms and the patient’s overall health.
