The Reasons Behind Lower Back Pain
By Neurosurgery Singapore
What is Lower Back Pain?
Most acute lower back pain results from injury to the muscles, ligaments, joints, or discs. The body also reacts to injury by mobilizing an inflammatory healing response. While inflammation sounds minor, it can cause severe pain.
The lower back supports the weight of the upper body and provides mobility for everyday motions such as bending and twisting. Muscles in the region are responsible for flexing and rotating the hips while walking, as well as supporting the spinal column. Nerves in that area supply sensation and power the muscles in the pelvis, legs, and feet.
There is a significant overlap of nerve supply to many of the discs, muscles, ligaments, and other spinal structures, and it can be difficult for the brain to accurately sense which is the cause of the pain. For example, a degenerated or torn lumbar disc can feel the same as a pulled muscle – both creating inflammation and painful muscle spasm in the same area. Muscles and ligaments heal rapidly, while a torn disc may or may not.
What are some symptoms of Lower Back Pain?
The main symptom is an ache or pain anywhere in the back, and sometimes all the way down to the buttocks and legs.
Some back issues can cause pain in other parts of the body, depending on the nerves affected.
Often it goes away without treatment, but if it occurs with any of the following people should see our doctor:
- weight loss
- inflammation or swelling on the back
- persistent pain, where lying down or resting does not help
- sensation feeling down the legs
- pain that reaches below the knees
- a recent injury, blow or trauma to the back
- urinary incontinence
- difficulty urinating
- fecal incontinence, or loss of control over bowel movements
- numbness around the genitals
- having numbness around the anus
- experiencing numbness around the buttocks
“The kind of back pain that follows heavy lifting or exercising too hard is often caused by muscle strain. But sometimes it can be related to a disc that bulges or ruptures. If a bulging or ruptured disc presses on the sciatic nerve, the sensation may run from the buttock down one leg. This is called sciatica.”
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What types of diagnosis?
Our Spine Specialist will likely begin by requesting a complete medical history and conducting a thorough physical examination to determine where you’re feeling the pain. A physical exam can also determine if the problem is affecting your range of motion.
Our doctor may also check your reflexes and your responses to certain sensations. This determines if your condition is affecting your nerves.
Imaging tests such as X-rays, CT scans, ultrasounds, and MRIs may be necessary so our Specialist can check for:
- bone problems
- disc problems
- problems with the ligaments and tendons in your back
If our doctor suspects a problem with the strength of the bones in your back, they may order a bone scan or bone density test.
Possible treatment methods?
For acute back pain, over-the-counter relievers and the use of heat might be all you need. Bed rest isn’t recommended.
Continue your activities as much as you can tolerate. Try light activity, such as walking and activities of daily living. Stop activity that increases pain, but don’t avoid activity out of fear. If home treatments aren’t working after several weeks, our doctor might suggest stronger medications or other therapies.
Our Spine Specialist might recommend the following:
- Over-the-counter (OTC) pain relievers. Nonsteroidal anti-inflammatory drugs.
- Muscle relaxants. If condition doesn’t improve with OTC relievers, our doctor might also prescribe a muscle relaxant.
- Topical pain relievers. These are creams, salves or ointments you rub into your skin at the site of your pain.
- Antidepressants. Low doses of certain types of antidepressants have been shown to relieve some types of chronic issue independent of their effect on depression.
- Injections. If other measures don’t relieve your condition, and if it radiates down your leg, our Spine Specialist may inject an anti-inflammatory medication or numbing medication into the space around your spinal cord (epidural space).
Physical therapy and exercise
Our physical therapist can apply a variety of treatments, such as heat, ultrasound, electrical stimulation and muscle-release techniques, to your back muscles and soft tissues to reduce pain.
As condition improves, the therapist can teach you exercises to increase your flexibility, strengthen your back and abdominal muscles, and improve your posture. Regular use of these techniques can help keep pain from returning.
Few people need surgery. If you have unrelenting pain associated with radiating leg pain or progressive muscle weakness caused by nerve compression, you might benefit from surgery. Otherwise, surgery usually is reserved for pain related to structural problems, such as narrowing of the spine (spinal stenosis) or a herniated disk, that hasn’t responded to other therapy.