Lower back pain is the fifth most common reason for all visits to orthopedic surgeons and currently accounts for the second most common reason that patients seek medical attention. Lower back pain is often caused by injury, muscle strain related to poor muscle conditioning, and inflammatory processes related to natural degeneration of the lumbar spine. Most acute lower back pain occurs without any obvious or diagnosable cause. Certain medical conditions may present initially as acute lower back pain such as kidney stones; abdominal aneurysms; and infections in or around the spine. On occasion, some metastatic cancers also have a predilection to metastasize to the spine and these patients may also present with a complaint of lower back pain. In the elderly, osteoporosis may increase the incidence of spontaneous compression fractures that present as acute lower back pain. Leg pain, weakness or numbness may indicate compression of the nerves emanating from the lower back. If pain across the back persists beyond six weeks, medical attention should be pursued.
Discs are the cartilage shock absorbers between the vertebrae. Sometimes, as a result of trauma or natural degeneration, the outer layer of the disc, the annulus fibrosis, may tear. As a result of the tear, a host of inflammatory proteins are released that can irritate nearby nerves and cause back pain.
Degenerative disc disease is the general term used to describe the “drying out” phenomenon that occurs in all spinal discs beyond the age of 30. The lumbar discs are composed of cartilage which, in turn, is composed of approximately 80 percent water by weight. With increasing age, the water content of the intervertebral disc decreases, resulting in loss of disc height which ultimately may cause peripheral disc bulging. This natural phenomenon is referred to as degenerative disc disease. This is very easily identified on MRI scans, which look specifically at water content within the discs. Patients should realize that the existence of disc degeneration on MRI does not necessarily correlate with the existence of lower back pain.
How do we treat lower back pain?
Initial treatment involves obtaining a thorough history and physical exam. It is key to rule out any other medical cause of lower back pain. Initial imaging with x-rays may help to define the degree of natural degenerative changes as well as the degree of potential instability or progressive deformity.
The acute pain episodes are treated conservatively with rest, ice or heat, and anti-inflammatory medications. Interventional pain management techniques involving injections to the joints of the spine may also play a role (facet injections). After the acute phase has been dealt with, treatment will focus on preventing and reducing the intensity and frequency of subsequent flare-ups. This may be achieved thru participation in a physical therapy or chiropractic program focusing on lumbar and core stabilization, strengthening and stretching.
Lower back pain associated with leg pain, numbness or weakness may reflect compression of the nerves which exit the spinal canal in the lower back. These nerves control the strength and sensation of our lower extremities. Nerves may be compressed as the result of an acute disc herniation or progressive arthritis. An MRI may be considered if conservative treatment does not provide relief within six weeks or if there any other concerning symptoms. These symptoms may include bowel or bladder incontinence, fevers, lower back pain at night, weight loss, or lower extremity weakness or numbness. If you experience any of these concerning symptoms please contact a healthcare professional immediately.