Lower back pain is becoming increasingly prevalent throughout the world. Learn it is caused, risk factors, diagnosis, prevention, and management.
What is lower back pain?
Lower back pain is affecting the lumbar region of your spine, which is the area below your rib cage and above your pelvis and sacral bones. It is an extremely common condition, and an estimated 60% of Indians have been affected by the condition at one point or another.
How is lower back pain classified?
Based on the duration of your pain, it can be either acute or chronic.
- Acute: Symptoms lasting for 3 months or less
- Chronic: Symptoms that go on for more than 3 months
What are some causes of lower back pain?
The most common causes include:
- Strains and sprains
- Disc problems: These include:
- Herniated disc, where a part of the intervertebral disc bulges out and compresses the nerves in the surrounding region, leading to pain and discomfort
- Age-related degenerative disc disease
- Arthritis: Most commonly include:
- Osteoarthritis
- Ankylosing spondylitis
- Fractures: These can occur secondary to trauma, osteoporosis, and spondylolysis
- Congenital conditions such as scoliosis, lordosis, kyphosis, and spina bifida
- Spondylolisthesis: The vertebra slips out of place and onto the one right below it
- Nerve and spinal cord problems such as sciatica, spinal stenosis, or infections of the spine like osteomyelitis, discitis or sacroiliitis, and cauda equina syndrome
- Pregnancy
- Other diseases such as:
- Tumours of the spine
- Endometriosis, a painful disorder where the tissue that is normally present inside the uterus grows abnormally in other areas
- Fibromyalgia, which is accompanied by pain and tenderness at specific points in the body
- Kidney stones
- Aortic aneurysm, an abnormal balloon-like swelling or bulge that develops in the aorta due to a weakening in its walls
Who is at a higher risk of developing lower back pain?
Some risk factors are:
- Age: Back pain increases with age due to age-related wear and tear of the intervertebral discs, which starts after 30 years
- Weight: Overweight or obese people tend to carry extra weight that puts extra pressure on their joints and discs
- Overall activity: Inactive people or those with a sedentary lifestyle have a higher risk of back pain due to weakened abdominal muscles, which can lead to back strains and sprains
- Occupation: Jobs that require lifting heavy objects or excessive bending can increase the risk of a back injury
- Mental health illnesses: If you’re someone suffering from depression, anxiety, or eating disorders this can manifest as lower back pain as well
What are the symptoms that can accompany lower back pain?
Symptoms include:
- Pain which can be :
- Sudden or gradual
- Sharp or dull
- Worsen or get relieved in certain positions
- Radiate to other parts of the body
- Stiffness
- Decreased range of motion
- Posture problems
- Muscle spasm
How is lower back pain diagnosed?
Your doctor asks about the severity, duration, and characteristics of pain and conducts a physical exam to check for tenderness, swelling, and deformity Tests to confirm the diagnosis include:
- Imaging techniques such as:
- X-ray to see the alignment of your bones and detect any fractures or signs of arthritis
- CT or MRI scans, which are useful to visualise a herniated disk or any kind of problems with bones, muscles, tissue, tendons, nerves, ligaments, and blood vessels
- Bone scan to look for bone tumours or compression fractures secondary to osteoporosis
- Discography: It is another imaging technique to determine which particular disc is causing back pain. It involves injecting a dye into your spine to highlight the affected disc
- Blood tests: To diagnose and rule out the presence of infection, inflammation, or arthritis
- Electromyography: This test evaluates the strength of muscles by assessing their electrical conductivity
How is lower back pain treated?
Conservative treatment measures include:
- Resting and icing the area
- Medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and muscle relaxants
- Physiotherapy
- Spinal manipulation or mobilisation
What surgeries are done for lower back pain?
Surgery can be considered for severe cases that do not improve even after a 6-12 week course of non-surgical treatments.
Depending on the cause, surgeries include:
- Spinal laminectomy: It is a type of decompression surgery in which all or a few parts of the vertebral bone (lamina) are removed to ease the pressure on the spinal cord or the nerve roots. It is used as a treatment option for back injuries, herniated discs, narrowing of the canal (spinal stenosis), or tumours
- Discectomy and microdiscectomy: These involve partial or complete surgical removal of the bulging or herniated intervertebral disc.
- Spinal fusion: This is a procedure where two or more vertebrae are fused together permanently and is done in cases of spinal deformities (e.g., scoliosis), fractures, spinal weakness or instability, degenerative disc disease, sacroiliac joint dysfunction, and spinal tumours
- Vertebroplasty is a procedure in which a special cement is injected into a fractured vertebra to stabilise the spine, relieve pain, and restore mobility
- Kyphoplasty is similar to vertebroplasty with an additional step. A balloon-like device is used to create space for the treatment before the cement is injected
- Nucleoplasty uses radiofrequency waves to relieve pain due to a herniated disc
- Radiofrequency denervation uses heat to interrupt pain signals in the nerves
- Foraminotomy widens the opening in your spine (foramen) where nerve roots leave your spinal canal and relieves compression on the nerves
- Artificial disc replacement, or disc arthroplasty, is a procedure where a worn-out or degenerated disc is removed and replaced with an artificial one
Can pregnant women also undergo spine surgery?
Yes, pregnant women are eligible to undergo spine surgery in the second trimester.
Do I need to consult a doctor for my lower back pain?
Consult a doctor immediately in case you are suffering from:
- Any kind of trauma or injury to your back
- Numbness, tingling, or altered sensation
- Muscle weakness or difficulty in movements or walking
- Loss of bowel and bladder control
How can I prevent lower back pain?
To keep your back healthy and strong:
- Improve your posture to prevent back pain, and degenerative changes that come with age
- Lead an active lifestyle with regular exercise to strengthen your back muscles
- Lose weight to reduce stress on your spine
- Sleep on a firm surface
- Quit smoking
- Avoid movements that twist or strain your back
