Low back pain and neck pain are two of the most common reasons people seek medical help. The pain is usually caused by issues with the musculoskeletal system, particularly the spine, which includes the bones (vertebrae), disks, and the muscles and ligaments that support it. Low back discomfort can also be caused by a condition that is unrelated to the musculoskeletal system.
As people get older, low back pain becomes more frequent, affecting more than half of those over the age of 60. In terms of health-care expenses, disability payouts, and lost wages, it is quite costly.
Backbones make up the spine (spinal column) (vertebrae). Each vertebra has shock-absorbing disks between them. The disks contain a robust fibrocartilage outer layer and a soft, jelly-like center known as the nucleus. Behind the disks, each vertebra has two joints. Facet joints are the names given to the joints. A joint is formed when the facets of one vertebral body rest on the facets of the one below it. Ligaments and muscles, which comprise the following, stabilize the facet joints and hence the spine:
- There are two iliopsoas muscles on either side of the spine.
- Two erector spinae muscles go behind the spine and run the length of it.
- There are a lot of short paraspinal muscles that run between the vertebrae.
The abdominal muscles, which extend from the bottom of the rib cage to the pelvis, also support the abdominal contents, which help
to maintain the spine. The muscles in the buttocks also aid in spine stabilization. These muscles are collectively known as the core muscles.
The spinal cord is enclosed within the spine. The spinal nerves emerge from the sides of the spinal cord through gaps between the vertebrae to connect with nerves throughout the body. The spinal nerve root is the portion of the spinal nerve closest to the spinal cord. When the spine is injured, spinal nerve roots can be pinched (compressed) due to their location, causing discomfort.
The lower spine (lumbar spine) is connected to the upper back (thoracic spine) and the pelvis via the sacrum (sacrum). The lumbar spine is both flexible and strong, allowing for turning, twisting, and bending while standing, walking, and lifting. As a result, the lower back is involved in practically all daily actions. Low back discomfort can impede a variety of activities and negatively impact one’s quality of life.
Types of back pain
Local Pain. A specific area of the lower back is affected by local pain. The most prevalent type of back pain is sciatica. A little disk damage, joint arthritis, or muscle sprains and strains are the most common causes. The discomfort can be continual and painful or intermittent and intense at times. When an injury is a cause, you may experience sudden pain. Changes in position can increase or reduce local discomfort. When the lower back is touched, it may become painful. Muscle spasms are a possibility.
Radiating pain is pain that radiates down the leg from the lower back. The discomfort might range from a faint ache to a strong and acute throbbing. It usually affects the side or back of the leg, and it might extend all the way to the foot or only to the knee. Radiating pain is usually caused by illnesses such as a herniated disk, sciatica, osteoarthritis, or spinal stenosis, which compress a nerve root. The pain may be triggered by coughing, sneezing, straining, or bending over while maintaining the legs straight. The discomfort may be accompanied by muscle weakness in the leg, a pins-and-needles sensation, or even loss of sensation if the nerve root is compressed. Rarely, patients lose bladder or bowel control (urinary incontinence) (fecal incontinence).
Referred Pain that is felt in a different region than the source of the pain. Some patients who suffer a heart attack, for example, have pain in their left arm. Referred pain from the internal organs to the lower back is usually deep and agonizing, and it’s difficult to determine its exact position. Unlike pain from a musculoskeletal condition, movement usually does not aggravate it.
Low Back Pain Causes
The majority of back pain is caused by problems with the spine and its surrounding joints, muscles, ligaments, and nerve roots, or the disks between the vertebrae. In many cases, no single reason can be pinpointed. Any painful spinal disease can trigger reflex muscle tightening (spasm) surrounding the spine. This spasm may aggravate the pain you’re already experiencing. Stress may aggravate low back discomfort, but it’s unclear how.
Back pain can also be caused by conditions that are not related to the spine, such as cancer, gynecologic disorders (for example, premenstrual syndrome), kidney (for example, kidney stones), urinary (for example, infections of the kidney, bladder, and prostate gland), and digestive (for example, diverticulitis) tracts, as well as disorders of major arteries near the spine.
- Compression fractures of the vertebrae
- A herniated or burst disk
- stenosis of the lumbar spine
- Muscle and ligament injuries are common.
Less common causes
- Infections of the spine
- Tumors of the spine
- An aneurysm is a protrusion in the major artery in the belly (abdominal aortic aneurysm)
- Diverticulitis, for example, is a digestive condition.
- Kidney infections, kidney stones, and prostate infections are all examples of urinary tract infections.
- Ectopic pregnancy, pelvic inflammatory illness, and cancer of the ovaries or other reproductive organs are all conditions that affect the pelvis.
- Paget disease
- Ankylosing spondylitis
- Scarring, hemorrhage, swollen lymph nodes, and immunoglobulin G4-related disease are examples of inflammatory or infiltrative disorders in the area behind the abdominal cavity (retroperitoneum) (IgG4-RD).
- Polymyositis and other inflammatory myopathies, as well as polymyalgia rheumatica, are examples of inflammatory muscle illnesses.
Low Back Pain Evaluation
The doctor wants to see whether there are any significant problems. Because low back pain can be caused by a variety of issues, pinpointing a single cause may be difficult. Doctors may only be able to determine that the cause is a musculoskeletal problem and the severity of the condition.
Certain signs and characteristics in patients with low back pain should be taken seriously. They include the following:
- There is a cancer history.
- Conditions that enhance the risk of infection include the use of immune-suppressing medicines, HIV infection or AIDS, injection drug use, recent surgery, or a wound.
- Nerve damage or spinal cord compression can cause numbness, weakness in one or both legs, trouble emptying the bladder (retention of urine), or loss of bladder or bowel control (urinary incontinence or fecal incontinence).
- Loss of weight
- Symptoms of an abdominal aortic aneurysm include stomach or chest pain, as well as a pulsing sensation in the upper abdomen.
- Symptoms of a digestive illness include vomiting, severe abdominal pain, and black or bloody stool.
- Symptoms of a urinary tract disorder include difficulty urinating, blood in the urine, and intense crampy pain spreading into the groin on one side.
When should you see a doctor?
If you develop a fever or any of the warning indications of nerve damage, an abdominal aortic aneurysm, a digestive disease, or a urinary tract disorder, you should consult a doctor right once. People who exhibit the majority of the other warning signals should see a doctor as soon as possible. If pain isn’t severe and people haven’t had any warning signals other than pain for more than six weeks, they may not need to see a doctor.
What the physician does
Doctors begin by inquiring about a patient’s symptoms and medical history. A physical examination is next performed by the doctors. What they discover during the history and physical examination frequently points to a cause and the tests that may be required.
The spine and nerves to the groin and legs are evaluated for symptoms of nerve root compression during the physical examination. Nerve root compression can cause weakness in one or more muscle groups in the leg, aberrant reflexes (confirmed by tapping the tendons below the knee and behind the ankle), diminished sensation in one or more areas of the leg, and, in rare cases, urinary retention and incontinence of urine or stool (fecal incontinence).
To determine the sort of pain, doctors may ask the patient to move in specific ways. The patient is usually asked to lean forward and backward by the doctor. They may have the patient lie down and then lift their leg without bending the knee to observe if pain occurs, indicating a herniated disc. Doctors may also examine a person’s belly for soreness or a mass, as well as their pulses, especially if they are over 55 and have an aortic aneurysm. They may do a digital rectal examination on men and a pelvic examination on women to evaluate the prostate and internal reproductive systems.