Low back pain is so common that almost everyone has experienced it at some point in their lives or another. The pain can vary from mild to severe, and it can also be short-lived or can linger for many months. Back pain can differ from one person to another. It can appear all of a sudden or it can have a slow onset. The pain can also be constant or intermittent.
Unfortunately, even if short-lived, low back pain can make carrying out daily activities challenging.
There are many likely causes of low back pain. It can sometimes occur after a specific movement like bending or lifting. Even just getting older can be a factor in some back conditions. Ageing can cause degenerative changes in the spine. The changes can start in the 30s (or younger in some cases) and can make the individual more susceptible to low back pain. Some of the possible causes of low back pain include:
Overactivity – Many cases of low back pain can be attributed to muscle soreness from overactivity. Ligament fibers and muscles can also become injured and overstretched, causing pain. Low back soreness and stiffness can be the result of an intense softball or golf game or even too much yard work. Fortunately, pain from overactivity usually disappears after a few days’ rest and recuperation.
Disk Degeneration – Intervertebral discs often dehydrate, shrink and wear with age. In some cases, they can collapse completely, causing the facet joints (found in the back of each vertebra) to rub against each other. This can result in stiffness, pain and a poor posture. The “wear and tear” of the facet joints is commonly referred to as osteoarthritis. The condition may also lead to other back problems, including spinal stenosis.
Disc Injury – Low back pain that lingers for several days may signal disc injury.
Disc tear – Small tears on the annulus (outer ring of the disc) is sometimes attributed to sudden loading force. While there are people with disk tears that do not experience any pain at all, others suffer from pain that can last for weeks or months (or longer). Some individuals may experience constant pain that is disabling and can linger for years.
Disc herniation – A herniated or a “slipped” disc is one of the common types of disc injuries. Disc herniation occurs when the nucleus (jelly-like centre) pushes against the annulus (outer ring). When very worn or injured, the nucleus can squeeze all the way through. When the herniated disc bulges out, it can put pressure on the spinal nerves, resulting in pain down the back of the leg (sciatica).
Back pain can be stabbing or sharp. It can also be achy, dull, or it can feel like a cramp. In essence, the type of pain felt will often depend on the underlying cause. Those with low back pain may experience some of the following symptoms:
- Pain which can get worse when lifting or bending
- Pain that extends from the back to the outer hip area or the buttock
- Leg or buttock pain (in the case of sciatica)
Regardless of symptoms or age, if back pain lingers for many weeks or is associated with chills, fever, and unexpected weight loss, seeing a doctor is recommended.
During the visit, an orthopaedic specialist will physically examine the back after discussing the patient’s medical history and symptoms. The doctor will also push on different areas of the back and may have the patient bend back, forward, and side-to-side to check for pain or limitations. The nerve function such as strength, sensation, and reflexes of the knees and ankles will also be checked to exclude nerve compression.
Generally, treatment interventions for low back pain are placed into three categories—Medications, Physical Modalities, and Surgery.
1. Medications: Certain medications are prescribed to relieve low back pain. Some of the medications include:
- Acetaminophen or paracetamol (relieves pain with minimal side effects)
- Non-steroidal anti-inflammatory drugs (helps minimize swelling and pain)
- Narcotic medications (i.e. oxycodone or codeine)
- Steroids (can be injected into the spine or taken orally)
- Muscle relaxants like Anarex
- Nerve supplements like Neuroforte or Neurontin
2. Physical Modalities: Low back pain can be disabling. Fortunately, in most cases, combining medications and therapeutic treatments can often relieve pain so the patient can continue to carry out day-to-day activities without pain.
- Physical Therapy (this can include passive modalities like ultrasound, heat, ice, electrical stimulation, and massage. Active therapy can consist of strength training, stretching, and cardiovascular exercises. Exercises to strengthen the core muscles and restore motion will relieve pain).
- Braces, while not beneficial for everyone, have been reported by patients to give stability and comfort.
- Chiropractic or manipulation therapy by Western and Eastern practitioners
- Other exercise-based programs (i.e. yoga and pilates)
3. Surgical Treatment: Surgery for low back pain is only considered when all nonsurgical treatment interventions have been exhausted and have proven ineffective. In addition, surgery is only resorted to once the doctor can pinpoint the exact cause of the pain.