Low Back Pain
Why is Low Back Pain Common?
Low back pain is one of the most frequent problems treated
by orthopaedic surgeons. After the common cold, problems
caused by the lower back are the most frequent cause in
adults under the age of 45. The lower or lumbar spine
is a complex structure that connects your upper body to
your lower body. This important part of your spine provides
you with both mobility and strength. The mobility allows
movements such as turning, twisting or bending, and the
strength allows you to stand, walk and lift.
What are the Common Causes?
Low back pain can be caused by a number of factors from
injuries to the effects of aging.
Low back Sprain and Strain: A strain of the muscle
can occur when the muscle is poorly conditioned or overworked.
The ligaments of the low back act to interconnect the
five vertebral bones and provide support or stability
for the low back. A sprain of the low back can occur when
a sudden, forceful movement injuries a ligament which
has become stiff or weak through poor conditioning or
overuse. These injuries or sprain and strain, are the
most common causes of low back pain. Frequently, a combination
of other factors may increase the likelihood of injury
or disease: Poor conditioning , Improper use , Obesity
Aging: “Wear and tear” and inherited factors will
cause degenerative changes in the discs, called degenerative
disc disease, and arthritic changes in the small joints.
These changes occur to some degree in everyone. When severe,
they can cause low back stiffness and pain. Arthritic
bone spurs and inflamed joints can cause nerve irritation
and leg pain. Almost everyone develops “wear and tear”
changes in their low back as they age, although for most
people it causes little pain or loss of function.
Osteoporosis and Fractures: All bones lose bone
strength over time and the lumbar vertebrae particularly
in postmenopausal women, can be fractured or compressed
from a fall or even from the stress of lifting or everyday
Protruding Disc: The disc is composed of a soft
center or nucleus, which, in children and young adults,
is jelly like. The nucleus is surrounded by a tougher
outer portion called the annulus. With normal aging, the
nucleus begins to resemble the annulus. During middle-age,
fissures or cracks may occur in the disc. These may be
the source of back pain. If the crack extends out of the
disc, material from the disc may push out or rapture.
This often is referred to as a herniated or slipped disc.
If the protruded disc presses a nerve, it may cause pain
in the leg.
What is the Best Treatment?
Most low back pain can be safely and effectively treated
following an examination by your orthopaedic surgeon and
a prescribed period of activity modification and some
medication to relieve the pain and diminish the inflammation.
Although a brief period of rest may be helpful, most studies
show that light activity speeds healing and recovery.
It may not be necessary for you to discontinue all activities.
Once the initial pain has eased, a rehabilitation program
may be suggested to increase your muscle strength in your
low back and abdominal muscles as well as some stretching
exercises to increase your flexibility. Weight loss if
you are a smoker, also will decrease the chances of a
recurrence of your low back pain. The best long-term treatment
is an active prevention program of maintaining your physical
condition and observing proper lifting and postural activities
to prevent further injuries.
When is Surgery Needed?
Most low back pain, whether acute or chronic, almost
always can be treated without surgery. The most common
reason for surgery on the lower back is to remove the
pressure from a “slipped disc” when it causes
nerve and leg pain and has not responded to other treatments.
Some arthritic conditions of the spine, when severe,
also can cause pressure and nerve irritation, and often
can be improved with surgical treatment.