Pain in the back, especially the lower back can be a real pain, pun intended. An ad which has been running for a while says “your back must last you a lifetime”, and it usually does, just that it may not be as flexible as in your younger days.
90% of most people would experience back pain one time or the other in their life time. It is probably the second or third most common reason for work absenteeism after malaria and the common cold. It is also one of the common reasons why people visit their doctors or the emergency room and second most common neurological complaint after headaches.
Back pain is not a disease by itself, rather a sign that something is going wrong in relation to the back (problems with muscles, bones or vertebrae, ligaments).
In 85% of people this would resolve by itself with no underlying cause found , and for majority as well within a few weeks most of the symptoms would disappear no matter the treatment that is given or even if it is not treated at all.
So what causes back pain that makes it so common?
Most of it is caused by straining or putting stress on the back such as:
- Poor posture – slouching in chairs, driving in stooped positions and standing poorly or sleeping on a sagging mattress. Poor posture and sitting for long periods in one position such as in front of a computer will result in muscle spasm and pain.
- Lifting incorrectly – This usually leads to strain or tear of the muscles, tendons or ligaments around the lower spine, resulting in painful muscle tension and spasm or sometimes pushing out of the disc in between the vertebra, which I shall explain further.
- Being unfit and obesity – Inactivity makes the muscles go slack and weak so they are unable to support the back properly. This leaves the back more vulnerable to damage when certain movements put too much strain on one area.
- Generally overdoing it – Over tiring muscles and not using a progressively rising work or sports routine. Not warming up or cooling down before and after exercise will also cause muscle pain.
- Disc problems – In the spine, between the vertebrae, are small disc shaped cushions made of fibro-cartilage, which protect the vertebra from rubbing directly on each other. Unfortunately the disc tissue as we age losses its natural moisture and hardens.
A sudden injury to the disc can also cause it to herniate or prolapse – where part of the disc suddenly is pushed out and presses on the nerves nearby or even the spinal cord. This is what is called a ‘slipped’ disc. (Rarely, a vertebra can slip forward on another: called spondylolisthesis, which is not a slipping of the disc.)
The existence of a bulging or ruptured disc on an X-ray or scan doesn’t routinely equate to back pain. People who don’t have back pain may have prolapsed discs for some other reason.
- Sciatica – The sciatic nerve which runs from the spinal cord down the bones of the legs can be pressed on by a prolapsed disc or degenerated bones and cause nerve root pain that runs down the buttock to the legs.
- Facet joint problems – Spine movement is facilitated by joints between the vertebrae made up of two flat faces, or facets, on the bone. With wear and tear changes or spondylosis, the two halves of the joint rub against each other causing pain.
- Osteoarthritis – Spondylosis causes changes of the joints make them less able to withstand physical stress. This degenerative problem causes new bone formation and structural problems resulting in pain usually from pinching of the nerves.
- Skeletal abnormality – Scoliosis a disorder in which the spine curves to the side, may lead to back pain usually when it is severe.
- Tumours or cancers of the vertebrae.
- Infections especially tuberculosis can seed to the vertebrae and cause pain and collapse of the spine.
- Inflammatory joint disease – Inflammatory diseases, such as ankylosing spondylitis and rheumatoid arthritis can affect the vertebrae and cause it to become inflamed and painful. This is usually serious in the long term as it causes a lot of damage to the bones and may fuse it. Ankylosing spondylitis tends to cause stiffness in the mornings and tends to occur in younger people.
- Osteoporosis – Osteoporosis causes weakness in the bones. These may fracture easily after minimal trauma especially the back and the bones of the hip causing chronic pain or loss of function.
- Referred pain – There are many diseases where pain is felt at a site different from where it originated. This is called referred pain. Referred pain to the back may be due to disease in the chest or abdomen, but it is felt as back pain. Such diseases include appendicitis, kidney diseases, kidney infection, bladder infections and pneumonia among others. Pregnancy may cause stretching of ligaments within the pelvis and the extra load may put strain on the lower back.
Symptoms of back pain may include:
- Constant pain in the back
- Pain that goes down your leg
- Limited flexibility or range of motion of the back
- Inability to stand up straight
When to see a doctor
Most back pain gradually improves with home treatment and self-care or pain relief.
You should seek urgent care if your back pain:
- Causes new problems with passing urine or stool, either difficulty in passing either or difficulty in holding on to the urge to pass either.
- Is associated with pain or throbbing like a blood vessel in the abdomen, or fever.
- Follows a fall, trauma to your back or other injury.
Contact a doctor for further investigations if you have these red flag signs: These are warning signs that your back pain may be potentially serious.
- Constant or intense pain especially at night or when you lie down
- Spreads down one or both legs, especially if the pain extends below the knee
- Causes weakness, numbness or tingling in one or both legs
- Is accompanied by unexplained weight loss
- Occurs with swelling or redness on your back or fever.
- If you have a history of cancer or osteoporosis
- If you use steroids, recreational drugs or alcohol.
- Persons with onset of back pain after the age of 50 years
In the concluding article, I shall outline the various ways of managing back pain and what treatment options are available. Till then, keep informed and stay healthy!