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Low Back Pain

Introduction: Understanding Low Back Pain

What is the lumbar spine?

The lumbar spine, commonly referred to as the low back, is the part of the spine that covers the area between the ribs and the hips. It is composed of five bones, called vertebrae, with cushions, or discs, between each bone. These discs act as shock absorbers, allowing the bones to move without rubbing against each other. The lumbar spine is held in place by ligaments and surrounded by multiple layers of muscles. The spinal cord runs down the middle of each vertebra, from which nerves branch out to both the left and right sides of the spine.

What are the functions of the low back?

The low back serves a number of critical functions for the human body, including providing structural support, facilitating movement, and protecting certain body tissues. When we stand, the lower back supports the weight of the upper body. It is also involved in movement, such as bending forward or back, or rotating at the waist. Therefore, injury to the structures important for weight bearing, such as the bony spine, muscles and ligaments, often can be detected when the body is standing erect or used in various movements.

What is low back pain?

Low back pain is a term used to describe pain that occurs between the lowest ribs and the buttock crease, lasting for a few days or a few weeks. Back pain varies. It may be sharp or stabbing. It can be dull, achy, or feel like a type of cramp. The type of pain you have will depend on the underlying cause of your back pain. Back pain is a symptom and the causes for back pain can be many.

What is acute low back pain?

Around 80% of all people will have low back pain sometime in their lives. The majority of acute back pain is, in most cases, a result of simple sprains and strains in your back. Sprains are caused by overstretching or tearing ligaments, and strains are tears in tendon or muscle. Both can occur from twisting or lifting something in the wrong way, lifting something too heavy, or overstretching. Such movements may also trigger spasms in back muscles, which can also be painful. In most cases, your back pain will get better on its own within a few weeks or with exercises and physical therapy treatment to re-train certain muscles.

What is chronic or disabling low back pain?

While the majority of people recover from an episode of low back pain quickly, some people continue to experience pain even after months or years. Research suggests that, in most cases, there is no new injury to the back. People with chronic pain often struggle to manage work, family, and social activities, and chronic low back pain is a significant cause of disability worldwide. However, patients can learn to manage their pain. Certain factors at the early stages of back pain have been associated with a higher likelihood of it becoming persistent.

Diagnosing Low Back Pain

How to Diagnose Low Back Pain

Low back pain is a common problem, but not all cases require extensive testing. In many cases, a careful history and physical examination are enough to diagnose the cause of the pain.

Your doctor will take a detailed history to rule out any underlying cause other than a sprain or strain. This is a critical step in the diagnosis process, as it helps to narrow down the possible causes of your pain.

When is Additional Testing Required?

In most cases, diagnostic imaging such as a CT scan, MRI, or X-rays, is not required if there are no clinical signs of a serious illness. However, if your doctor suspects that there may be an underlying problem, additional testing may be ordered.

Types of Additional Testing:

  • CT Scan
  • MRI
  • X-rays, bending forwards and backwards

Treatment: Acute and Chronic Low Back Pain

Acute Low Back Pain

In most cases, acute low back pain will get better on its own within a few weeks or with physical therapy treatment to re-train certain muscles.

Painkillers and anti-inflammatories may be needed depending on what the doctor recommends.

It is important to remain as active as possible otherwise the back muscles will become weak and can lead to more pain and inactivity. Gentle stretches and exercises can also be of help.

Back pain can also be influenced by factors like lifestyle, overall fitness, job satisfaction, stress, depression, family situation, relationships etc.

Chronic Low Back Pain

One of the most important factors is low mood, often described as depression or distress. It is quite natural to feel low when experiencing persistent pain, but it is also known that this response gets in the way of recovery and re-engaging with life’s activities.

The doctor may recommend a talking therapy, or a management programme that includes counselling or psychology. This is because these treatments have been shown to help people and to teach them skills to control and manage their pain.

It is now known that, if there is a belief that moving may result in re-injury to their back, some patients sometimes restrict their movement and start avoiding certain activities. This is often referred to as fear-avoidance. While avoiding a specific movement that hurts may not be a problem, restricting many movements can result in isolation and depression as people avoid work, social and household activities. Some research says that these behaviours actually result in a worse physical state, as muscles that are not used can grow weak.

Staying Active

There is a vast amount of evidence suggesting that staying as active as possible is the best, to not only reduce disability and improve function, but also to reduce depression and pain.

Muscle that is overworked builds up lactic acid. These tired muscles tend to be more painful and are more likely to become sprained (as they are stiffer). Stretching out spasmodic muscle is very important for muscle health. Heat or massage can often help the blood supply to painful muscle thus lowering the muscle tightness and lowering lactic acid. Sometimes muscle spasm can be so severe that a person is unable to move off the floor or bed and they can even fear that they are paralysed.

Frequently, in chronic back pain, chronic muscle spasm and fatigue can be a signal that there is an underlying subtle instability in the joints in the back. The aging process means that spinal joints wear with time which can lead to this. Again, rehabilitating the back muscles to overcome this is the best and safest way to ensure long-term spinal health.

EUROSPINE is a society of spine specialists of various disciplines with a large knowledge of spine pathologies. All well-known and accepted treatment modalities for spine pathologies are represented by the members of the society. However, the Society cannot accept any responsibility for the use of the information provided; the user and their health care professionals must retain responsibility for their health care management.

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