Having back pain? You’re not alone. According to statistics, nearly every adult in the U.S. alone will experience some form of back pain at some point in their life. Next to headaches, back issues are the most common complaint doctors receive. The vast majority of these complaints are for lower back pain, In many of these cases the patient will have no idea what started or what’s causing their pain and discomfort. Generally, the pain will last from a few days to a few weeks. If the pain is persistent, and lasts more than three months, it is considered chronic pain and will interfere with daily activities. Less than ten percent actually suffer from chronic lower back pain. I happen to be one of the latter.
Because a vast majority of back problems are in the lower back, my particular problem area, I intend to concentrate on this area for this post. There are a few things we need to understand before we get into what causes lower back pain. Let”s examine what actually makes up the spine and its supporting structures.
First, let’s look at the spine itself. The spine is the only actual support structure for the entire upper body. It’s made up of more than thirty smaller bones called vertebrae. These vertebrae are separated by “jelly” filled cartilage discs. These discs allow the spine to twist and bend without the vertebrae contacting each other. The spine forms a conduit that the spinal cord to run through. This spinal cord is a series of nerves that send messages between the brain and all the other components of the human body.
This complex structure could not do its job without muscles to keep it in place. The abdominals, obliques, back and even hip and thigh muscles all work together to keep the spine in alignment and help it to support the weight of the entire upper body.
Now that we have an over simplified understanding of the anatomy of the lower back, we’ll take a look at what can happen that will cause the lower back to ruin your day.
Soft Tissue Injuries
Soft tissue is made up mostly of muscles, tendons and ligaments. The muscles that support and affect the lower back can be broken down into three categories.
- The extensors, which are made up of the back and gluteals (butt or buttocks for most of us),
- The flexors are the abdominals, or your six-pack area, and the ilipsoas that connect the lower back to the thighs on either side.
- The obliques or rotators, located on either side, help the spine flex and rotate.
Tendons, also known as sinew, are layers of collagen fibers that connect the muscle fibers to the bones. Tendons also spread the work out evenly to all the fibers of the muscle to help protect it from possible damage.
Ligaments are made of layers of collagen fibers similar to tendons but have a very different function. Ligaments connect two or more bones together at the joints. They give the joints stability yet allow flexibility.
Soft tissue injuries include strains and sprains. When a muscle or tendon is twisted, pulled or torn, it is considered a strain. This can happen when lifting something improperly or something that is too heavy. Repetitive movement, as in some assembly line work, can cause strains. Working a cold muscle without warming it up first is a common cause of strains.
Sprains are similar to strains but involve the ligaments. Sprains occur when the ligament is torn, twisted or stretched beyond its limits. This normally occurs from a fall or sudden twisting. All you women in high heels should be able to relate to that. I’ve seen more than one go down from wearing high heels on uneven surfaces. A sudden impact can over extend or dislocate a joint causing injury to a ligament. Sprains are common in full contact sports like football or sports that require jumping, like basketball or volleyball.
There are some individuals that are more susceptible to soft tissue injuries. Someone who tend to eat a lot of fast food rather than eat properly miss out on many of the nutrients that strengthen bones as well as soft tissue. People suffering from obesity put considerably more stress on the lower back because of the additional weight. Slouching or lack of good posture as well as sitting too much and not getting enough exercise will also lead to back problems. Smoking actually restricts blood flow. Our bodies depend on blood flow to initiate the natural healing process. Some cases may simply be genetics.
The actual spinal cord ends at the top of the uppermost lumbar vertebra. From there on down, the spinal canal houses the nerve roots. These nerve roots, called the cauda equinu, because it resembles a horses tail, leave the spinal canal through openings called the foramen. From there the nerves run throughout the body.
The term stenosis is actually derived from a Greek word that means choking. Spinal stenosis, also known as lumbar spinal stenosis, is the result of the nerve roots being choked or squeezed. This choking is most often the result of a degenerative condition such a osterarthritis It is most evident in people fifty and over.
The most common symptom of lumbar spinal stenosis is leg pain when standing that increases as you walk. The only way to ease the pain is to sit down. Most people, including myself, stated that the severe pain virtually disappears immediately upon sitting. Over time the pain will get progressively worse if untreated.
There are three major types of stenosis and exact diagnosis is critical in order to obtain proper treatment. The only methods for proper diagnosis are an MRI or a CT scan with dye. The three types are as follows.
- Lateral Stenosis, the most common type, occurs after the nerve root has left the spinal canal and gets compressed by a bulging disc, herniated disc or bone protrusion beyond the foramen.
- Central Stenosis, occurs in the central spinal canal in the lower back. The canal becomes choked putting pressure on the nerve roots branching off of the bottom of the spinal cord.
- Foraminal Stenosis, occurs when a nerve root in the lower back is compressed by a bone spur inside the foramen.
Lumbar Spinal Stenosis is not usually a pain that just goes away, although it sometimes can. It is a chronic pain that must be diagnosed and treated by a medical professional. If you have a persistent pain in your lower back, I recommend that you see your doctor. Its better to be safe than sorry.
Spondylolisthesis is a condition where one of the vertebra slips forward over the one below it. This most commonly happens below the L5 vertebra. It can happen between the L4 and L5 but is far less common and even rarer higher in the spine. If this condition becomes severe enough, it can cause stenosis. There are several variations of this type of condition. I have listed the most common ones below.
- Isthmic spondylolisthesis, pertains to a defect in the small segment of bone at the back of the vertebra called the “Pars Interarticularis” that joins the facet joint. This defect could be something a simple as being to long or to short. It can happen on one side (unilateral) or both sides (bilateral). It the most common cause of back pain in adolescents. Amazingly, most people with this condition experience no pain at all. Sponsylosis is rarely a dangerous condition.
- Dysplastic Spondylolisthesis is caused by a congenital defect in the formation of the facet, also at the rear of the vertebra. This defect allows the vertebra to slip forward over the one below it.
- Degenerative Spondylolisthesis occurs when osteoarthritis damages the joints in the back. The spine gradually looses its ability to stay aligned and the vertebrae can slip forward.
- Traumatic Spondylosisthesis is just what it sounds like. Vertebrae are damaged do to trauma or other injury. This damage will again allow one vertebra to slip forward over another one.
- Patholegic Spondylolisthesis is a weakness of the bone caused by a tumor or other bone disease.
Bulging or Herniated Disc
The discs in between the vertebrae are the shock absorbers for the spine. They allow the back to bend and twist without the vertebrae making contact with one another. As we age, these discs lose some of their hydration. They become stiffer and don’t cushion as well. Occasionally we over exert ourselves by lifting to heavy a load, lifting improperly, or twisting the wrong way. This will sometimes end in a bulging or herniated disc. When this happens, the tough outer layer of the disc can tear allowing the inner “jelly-like” substance to push out. This in itself could be painful, but if it happens in a location near a nerve, the pain could be excruciating. This compression of the nerve is not the only cause of pain. The material itself causes inflammation. Depending on the location, this pain can be felt all the way through the hip and down the leg. Fortunately, a herniated disc, also called a slipped disc, is not permanent. The pain should subside in four to six weeks, even without seeing a doctor.
Facet Joint Dysfunction
Each vertebra has two facet joints in its back side. These joint help protect the nerves passing through the spine by limiting the amount of forward and backward bending, and twisting. They also prevent the vertebra from slipping forward. Facet joints are protected by a moist slick cartilage that allows the joints to slide on each other. these joints can simply wear out or osteoarthritis can can speed up the degradation of the joints causing bone spurs to form.
Osteoarthritis is a degenerative disease usually affecting people as they age. It commonly causes pain and inflammation. It also causes instability and may lead to stenosis. This is what my doctor diagnosed me with. It progresses slowly and can affect one or more levels of the lower back. It is also known as spondylosis or degenerative joint disease.
Vertabral fractures may sound obvious, but there have been many times when an athlete or physical worker has fractured a vertebra during an impact or a fall. The pain may not be intense at first but after a day or two will get bad enough that you will want to see a doctor. Ostoporosis is a progressive disease that leave the bones weak and brittle. If it is bad enough the vertebrae can actually collapse on itself. I’ve seen it happen when an elderly gentleman was just going down the stair. He misjudged the last step and landed a little hard on his foot. He had to be taken away in an ambulance because his pain was so intense.
Osteomyelitis is a bacterial infection of the bone. While this may be rare, two out of every ten thousand get the infection. If you have an infection somewhere else in your body, it can travel through you bloodstream and get into the vertebrae, or any other bone for that matter. An open fracture or even surgery may make you susceptible to osteomyelitis. Certain diseases, such as diabetes, sickle cell disease, HIV or AIDS or even rheumatoid arthritis may also put you at a higher risk.
Spinal tumors normally don’t appear alone. The usually occur when someone has a cancer that has metastasized to the spine. Normally someone that has been diagnosed with breast, prostate, kidney, thyroid or lung cancer should be evaluated for spinal tumors.
Last but by no means least, autoimmune disease can be a major cause of back pain. Ankylosing spondylites is one such disease. The disease attacks where the ligaments and tendons attach to the bone causing inflammation. The inflammation causes the bones to erode. After the inflammation subsides the natural healing process grows new bone at the site, eventually fusing the joints together. Rheumatoid arthritis, lupus, crohn’s disease, fibromyalgia as well as some others may also have back pain as a symptom.
This is the list of possible causes for lower back pain. Is it complete? No, from what I’ve been able to find, the list could go on for several pages. I was amazed to find out just how many problems can have lower back pain as a symptom. What I did, was to find as much information as I could, that everyone agreed on anyway, and come up with a list of what I believe was the most common causes for lower back pain. There is a lot more information available about the other parts of the back, but because my problem is the lower back, I decided to focus this website just on the lower back.
For those of you that haven’t figured it out yet, I am not a doctor or a medical professional of any kind. Like you, I am a normal everyday worker, nearing retirement with a history of back problems. I figured if I wanted to know as much about back pain as I could find, someone else out there probably would to, so here I am and what I find out, I’ll pass along to you.
I will continue to add information on this website as I find it. If I find something out there that may help relieve your lower back pain, I will bring it to you. If I find something that is hard to believe or totally ridiculous, I well tell you about it. Until I’m back on your screen again, thanks for reading and I’ll catch you later.
Remember, if you’re having back pain that is lasting more than six to eight weeks, “see your doctor or medical professional as soon as possible. If your pain is still around after that much time, you have a chronic pain that’s not just going to go away.
If you have any questions or comments, please feel free to leave them below. I may not have all the answers right now, but I do know where to go to find them.