Lower Back Pain

Common causes include sprains and strains, osteoarthritis, osteoporosis, a ruptured or herniated disk, fibromyalgia, and, in older people, spinal stenosis.

Pain may be intermittent or constant, superficial or deep, or dull or sharp, depending on the cause.

Doctors base the diagnosis or symptoms, results of a physical examination, and sometimes x-rays or other imaging tests.

Exercising regularly is the best way to prevent low back pain.

For most low back pain, avoiding activities that stress the back, taking pain relievers, and applying ice or heat are often all that is needed.

Low back pain is very common and becomes more common as people age. It is very costly in terms of healthcare payments, disability payments, and missed work. Thus, although low back pain rarely results from life-threatening disorders, it is a significant health problem. However, the number of back injuries in the workplace is decreasing, perhaps because awareness of the problem has increased and preventive measures have improved.

The spine (spinal column) consists of the back bones (vertebrae are also covered by a thin layer of cartilage. They are held in place by ligaments and muscles, which include the following:

Two iliopsoas muscles, which run along both sides of the spine.

Two erector spine muscles, which run along the length of the spine behind it.

Many short Para spinal muscles, which run between the vertebrae.

These muscles help stabilize the spine. The abdominal muscles, which run from the bottom of the rib cage to the pelvis, also help stabilize the spine by supporting the abdominal contents.

Closed in the spine is the spinal cord. Along the length of the spinal cord, the spinal nerves emerge through spaces between the vertebrae to connect with nerves throughout the body. The part of the spinal nerve nearest the spinal cord is called the spinal nerve root. Because of their position, spinal nerve roots can be compressed when the spinal is injured, resulting in pain.

The lower (lumbar) spine consists of five vertebrae. It connects the chest to the pelvis and legs, providing mobility for turning, twisting, and bending. It also provides strength for standing, walking, and lifting. Thus, the lower back is involved in almost all activities of daily living. Low back pain can limit many activities reduce the quality of life.

Causes Of Lower Back Pain

Low back pain has many causes, although often no specific cause can be identified. Muscle strains and ligament sprains are the most common causes. Strains and sprains may result from lifting, exercising, or moving in an unexpected way (such as when falling or when in a car accident). When due to exercise, injury to the lower back is sometimes called weight lifter’s back (lumbar strain). Weight lifter’s back may be causes not only by snatching a heavy weight from the ground in weight lifting but also by pushing against an opposing lineman in football, suddenly turning to dribble after a rebound in basketball, swimming a bat in baseball, or swimming a club in golf. The lower back is more likely to be injured when a person’s physical conditioning is poor and the supporting muscles of the back are weak. Having poor posture, lifting incorrectly, being overweight, and being tired also contribute.

Treatment Of Lower Back Pain

For low back pain that has recently developed, treatment begins with avoiding activities that stress the spine and cause pain – such as lifting heavy objects and bending. Bed rest does not hasten the resolution of the pain, and most experts recommend continued light activity. Bed rest, if required to relieve severe pain, should last no more than 1 or 2 days.

If a specific disorder is causing low back pain, treating that disorder – for example, giving antibiotics to treat a prostate infection – usually relieves the pain.

Over-the-counter or prescription nonsteroidal anti-inflammatory drugs can be taken to relieve pain and reduce inflammation. If inflammation is not contributing to the pain (and it usually does not), acetaminophen is typically recommended for pain relief instead of an NSAID.  Acetaminophen is slightly safer than NSAIDS.

Muscle relaxants, such as carisoprodol, cyclobenzaprine, diazepam, metaxalone, or methocarbamol, are sometimes given to relieve muscle spasms, but their usefulness controversial, These drugs are not recommended for older people, who are more likely to have side effects,

Application of heat or cold and massage may help. Usually, traction is not useful. Spinal manipulation, done by chiropractors or some other doctors (such as osteopathic doctors), may hasten the resolution of pain due to muscle spasm, strains, or sprains. However, it may have risks for people with osteoporosis or a herniated disk. Some reports suggest that acupuncture may have similar benefits, but others suggest little or no benefit.

After the pain has subsided, light activity, as recommended by a doctor or physical therapist, can speed healing and recovery. Specific exercises to strengthen and stretch the back and to strengthen the abdominal muscles are usually recommended to help prevent low back pain from becoming chronic or recurring. Other preventive measures (maintaining good posture, using a firm mattress with appropriately placed pillows, lifting correctly, and stopping smoking) should be continued or started. In response to these measures, most episodes of back pain resolve in several days to 2 weeks. Regardless of treatment, 80 to 90% of such episodes resolve within 6 weeks.


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