Understanding Low Back Pain

There are few ailments as common as low back pain when it comes to the reasons for a visit to the doctor. For some, it is a mild strain that is over in short order; for others it becomes an ongoing issue that can disrupt one’s work, exercise routine and sleep. An understanding of what may be at the root of the problem and how to deal with it takes much of the guesswork out of the matter.

The lower back is by nature a complicated region where nerves, ligaments, muscles, joints, discs and bones all have to function in concert. With so many structures in close proximity, there are a number of ways for pain to set in. It may be confined to the back or make its way down into the leg, thigh or buttock.

While the majority of cases will resolve on their time with non-surgical treatment, there are occasions when a prompt examination is warranted. This is particularly true if the pain is severe or recurrent, or if one notices any warning signs like numbness or weakness.

Key Facts About Low Back Pain

What You Should Know

What Causes Pain in the Lower Back?

A sudden motion, a case of heavy lifting or repetitive strain will sometimes be the cause of low back pain, though in some instances there is no apparent trigger. For many, the problem lies with muscles and ligaments that have been overstretched or irritated; for others it is the discs, facet joints or nerves in the vicinity.

Then there are the effects of age. With time one may find the spine has lost some of its flexibility, the joints have turned arthritic and the discs have given up their height and water content. While such changes do not inevitably lead to pain, they can be a factor in the symptoms of certain patients.

It is important to take a thorough history and conduct a physical exam since different conditions can present in much the same way. One can glean useful information from the pattern of the pain, its duration or if it is radiating down the leg, all of which will inform what comes next.

Common Sources of Low Back Pain

Low back pain is often grouped by the structure that seems most involved. In some cases, more than one issue may contribute at the same time, which can change how symptoms feel and how they respond to care.

How Low Back Pain May Feel

The sensation can vary based on the cause. Some people feel a dull ache or tightness in the center of the lower back, while others notice sharp pain with certain moves. How pain changes during the day can also give clues.

• Stiffness when getting out of bed or after sitting
• Muscle spasms or a feeling that the back has “locked up”
• Pain with bending, lifting, twisting, or standing upright
• Aching that stays in the low back or buttock
• Pain, tingling, numbness, or burning that travels down the leg
• Weakness in the leg or foot in more serious nerve-related cases

When pain travels below the knee, especially with numbness or weakness, nerve involvement becomes more likely. That does not always mean the problem is severe, but it usually deserves a closer look from a clinician.

Acute Pain Compared With Chronic Pain

Doctors often describe low back pain based on how long it lasts. Using time frames helps guide care and sets more realistic expectations about recovery. It can also help decide when follow-up is needed.

One might see acute pain come on from a strain or flare-up, and in many cases it will subside in short order. Chronic pain is a more complicated matter; there can be deconditioning at play, or arthritis, disc issues and recurrent nerve irritation to contend with. When the pattern is long standing, a strategy is called for that does not stop at mere pain management.

When to Seek Medical Attention Right Away

Most low back pain is not dangerous, but certain symptoms can point to a more serious problem. These warning signs should not be ignored, because they may need emergency care or evaluation the same day.

• Loss of bowel or bladder control
• New or worsening weakness in the leg or foot
• Numbness around the groin or saddle area
• Fever, chills, or unexplained weight loss with back pain
• Pain after a major fall, accident, or other trauma
• History of cancer, infection, or other medical conditions that raise concern

A serious neurologic condition could be at play if there is an inability to control the bladder or bowels, numbness in the groin or saddle region, or new or progressive weakness in the leg or foot. Such symptoms are cause for emergency care or a medical evaluation on the day they present. There are other warning signs that likewise demand to be seen without delay.

How Low Back Pain Is Evaluated

One typically starts the evaluation by talking with the patient to establish the history of the pain: its onset and location, what aggravates it, and if there is any radiation down the leg. The clinician then goes on to examine posture, strength, reflexes, sensation and range of motion in order to correlate the symptoms with a likely cause.

While imaging has its place, it is not something every patient needs. There are circumstances where it is warranted, however, such as in the event of trauma or when red flags appear. It would be called for if one suspects an infection, fracture or cancer, if neurologic deficits are on the increase, or simply if the condition has failed to show any improvement with time.

Helpful Early Steps at Home

For those with only a mild degree of pain and no cause for alarm, there are some straightforward approaches that can be of assistance. One is to rest, though in this context it is best understood as refraining from whatever is aggravating the condition rather than spending an inordinate amount of time in bed. In fact, so long as you do not exceed what is tolerable, some measure of movement will often aid in the process of getting better.

• Stay away from bed rest for long periods
• Take short walks if walking feels comfortable
• Use good lifting mechanics and avoid sudden twisting
• Start gentle stretching or exercises only if they do not worsen symptoms
• Seek care if pain is intense, persistent, or spreading into the leg

When Surgery May Be Considered

For the majority of low back pain, surgery is not the initial course of action. It is an option only if non-surgical methods have failed to offer sufficient relief and the symptoms can be traced to a particular structural issue. A clinician will be able to put the risks and anticipated benefits in perspective following an examination.

• Persistent nerve pain caused by a disc herniation
• Progressive weakness related to nerve compression
• Spinal stenosis causing significant walking limits
• Instability such as symptomatic spondylolisthesis
• Certain fractures, infections, or other serious spine conditions

If surgery becomes part of the discussion, the decision should be based on your diagnosis, nerve findings, level of disability, and response to other treatments. The plan should match your symptoms and overall health.

How to Lower Your Risk of Future Back Pain

While it is not possible to forestall every case of low back pain, one’s daily routine can be of assistance. The root of many a flare-up is to be found in deconditioning or poor body mechanics, as well as the kind of repeated strain or prolonged inactivity that comes with sitting for too long. Over time, even minor adjustments will show their worth.

• Keep your core and hip muscles strong
• Stay active with regular walking or other low-impact exercise
• Lift with your legs and avoid twisting under load
• Change positions often if you sit for long stretches
• Maintain a healthy weight when possible
• Follow through with physical therapy exercises after symptoms improve

When It’s Time to See a Specialist

If your pain is severe, keeps coming back, or is not improving with time and conservative care, an orthopaedic or spine evaluation is in order. A specialist will be able to determine if what you are experiencing is due to a disc issue, muscle strain, arthritis, spinal stenosis or some form of nerve compression.

There is also a case for seeing a specialist when the pain has begun to alter your gait, put restrictions on your day to day routine or otherwise diminish your quality of life. The earlier the root of the problem is pinpointed, the better positioned one is to put a more focused course of action in place.

Find the Right Care for Low Back Pain

There is a certain stress to low back pain, particularly when it interferes with the ordinary business of the day. For most, things can be put right with an accurate diagnosis and a non-surgical approach that gives due consideration to one’s movement, strength and the health of the spine. Should the pain not abate on its own, an evaluation is in order to get to the root of the matter and see which course of action is most suitable.

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