Lower Back Pain
Nearly 80% of adults suffer from lower back pain. Almost 20% of adults report having low back pain within the last 90 days. It is a common reason for missed work. In 1990, it was ranked as the sixth most common medical condition. By 2010, it rose to the third most common condition.
Pain in this region can range from mild to very severe. It tends to impact the lives of both men and women equally. Those with a sedentary lifestyle are likely to develop some form of back pain. Many of these conditions are the result of accidents or from lifting heavy objects.
Acute Back Pain
The majority of these conditions are considered to be short-term or acute, lasting no more than several weeks. Acute back pain tends to involve mechanical problems with the spine, back muscles, nerves or intervertebral discs. When these conditions extend to a period of time between four and twelve weeks, they are considered subacute.
Chronic Back Pain
A chronic back problem is one that lasts for at least 12 weeks. Roughly 20% of those who suffer from acute lower back pain will later develop chronic problems. Those experiencing chronic pain are very likely to consider medical treatment options.
Structure of the Lower Back
The lower area of the spine is called the lumbar spine. It is composed of a series of vertebrae known as L1 to L5. This part of the spine is critical to normal daily functioning. It absorbs a significant amount of body weight. Pain in this region is likely to radiate into the legs.
Just below the lumbar spine is the sacral region. It is composed of a series of vertebrae known as S1 to S5 which link the spine to the pelvis. The tailbone (coccyx) is composed of four bones creating the lumbosacral joint. Due to the interconnected nature of these parts, damage to one area can create pain elsewhere.
Many individuals will experience numbness in the leg, foot, and groin region when a low back condition exists. Some people will have difficulty going to the bathroom and experience feelings of nausea, fever and chills. Those with lower back pain that is due to an injury or is very intense should seek medical attention.
Diagnosis of These Conditions
The majority of those with back problems will first visit their primary care doctor. A primary care physician typically will specialize in internal medicine, pediatrics, or family medicine. The initial evaluation will involve determining your ability to walk, elevate the legs, and sit. The physician will also likely inquire about the location and severity of the pain.
Part of the initial assessment process involves ruling out some of the most serious potential causes of pain. Various tools may be used to investigate the condition of the back including the following:
- X-ray: Images are created that provide an overview of the alignment of the bones and may reveal arthritis or any broken bones. An X-ray is typically insufficient for detecting damage to the muscles or nerves or discs.
- MRI or CT scan: While X-rays and CTs use radiation, an MRI uses magnetic waves to create images of the internal body. MRIs can better reveal problems involving the nerves, muscles, blood vessels, ligaments, and more.
- Blood testing: Your doctor may order blood work to determine if there is evidence of an infection.
- Bone scan: A bone scan is generally reserved for detecting tumors or fractures associated with osteoporosis.
- Electromyography (EMG): An EMG involves the measurement of electrical impulses that can detect compressed nerves and spinal stenosis.
Sprains and Strains
The most common causes of low back pain are strains or sprains. A sprain results from overextension that creates a ligament tear. When the overstretching occurs involving a tendon or muscles it is called a strain. These injuries can result from participating in sports, lifting heavy objects and repeated use.
Sprains and strains may result in feelings of tenderness, muscle spasms and swelling in the region. Conditions that impact ligaments, tendons or muscles are considered to be soft tissue injuries. Ligaments are critical because they are typically near joints, such as knees, wrists and ankles.
The sciatic nerve is the largest in the body. It extends from the lower spinal cord and buttock area. Sciatica is often felt through the nerves throughout the legs. Pain associated with the sciatic nerve is often referred to as radiculopathy. Any inflammation or pressure in this region can create pain related to sciatica.
Cauda Equina Syndrome
There is a rare condition called cauda equina that affects the nerves. This may occur as compression exists that hinders movement. Nerve roots are critical for transmitting signals to other parts of the body. Patients must receive prompt medical attention in these situations.
Failing to have this condition assessed by a medical professional could result in paralysis. Cauda equina syndrome is generally the result of a narrowing of the spinal canal, herniated disc, tumor, infection or a fracture.
Signs of a spinal infection may include headache, neck pain or stiffness, tenderness, or a leaking wound. A tingling sensation may occur in the legs and arms. The risk is higher among those who have had surgery. Common risk factors include human immunodeficiency virus (HIV), diabetes, and those with very poor nutrition.
There is a form of arthritis that may form in the spine known as Ankylosing Spondylitis. It is classified as being a chronic condition that results from inflammation along the spine. It is not caused by trauma, such as the impact of an accident. Those suffering from the condition typically will experience “flare-ups” that are unpredictable.
It is possible to develop this condition in other areas of the body including the intestines. In more advanced stages, there may be irregular bone growth that causes damage to other bones in the region. Although it occurs among men and women, it is most common in younger men. The condition is likely to be inherited.
Psoriatic arthritis is arthritis that occurs together with psoriasis, a skin condition. It affects the spine in roughly 20% of cases. Osteoarthritis is a chronic condition that may harm the back. The cartilage between the bones begins to erode. Bone to bone contact may result in the development of bone spurs.
The body’s immune system may attack a thin layer known as the synovium within the joints. This is known as rheumatoid arthritis, which can affect most of the joints in the body. Often, the upper vertebrae will begin placing pressure on those below and cause nerve pain.
Spinal stenosis is a condition where the spinal canal is compressed and may create pain and weakness. This narrowing in the spinal canal may create pain that can be felt in the arms and legs. The nerve roots in the region are sensitive, which may result in numbness or weakness.
Lumbar spinal stenosis does affect some younger people but is more common among those over the age of 60. This is largely the result of wear that occurs over decades. If bone spurs develop, the central spinal canal may narrow.
There are more than 5 million American adults that have scoliosis. This figure may be much higher because the condition sometimes goes unreported. The condition is commonly detected in children and teens. The problem occurs when the spine is irregularly curved. This may create pressure in the back, chest and lungs.
Dextroscoliosis is a spinal deformity where the spine is curved sideways to the right. When the spine is curved to the left, it is referred to as levoscoliosis. These conditions are often detected by observing the back when the arms are rested on your sides. Often, the curvature becomes more apparent when the patient bends forward.
It is believed that the condition is related to your family history. When the condition is detected in children, a brace may be used for treatment. Braces do not straighten a curved spine but they may prevent the problem from worsening.
Adult degenerative scoliosis is a form that worsens over time. The discs and joints in the back region may wear down from twists or shifts.
Adults may experience relief from steroid injections in the region. However, this is considered to be a short-term solution. Many individuals find relief through electrical stimulation devices that are placed near the spine.
In rare cases, pain in the lower back may be associated with cancer. The pain may stem from the growth of a tumor that causes structural changes and pressure. When seeking medical attention, several other potential causes may be first ruled out before the cancer is detected. Some of the common indicators of cancer-related back pain include the following:
- When the back pain does not seem to worsen when there is movement
- If the pain develops in the morning and at night and lessens during the day
- Often, those with cancer-related back pain, many find that physical therapy is ineffective in relieving their symptoms
- The individual may experience a sudden reduction in weight and have excessive drowsiness
A tumor may develop near the spine. In many cases, a tumor from one location may spread through metastasis. The American Association of Neurological Surgeons says that cancer may spread to the spinal region in roughly half of the patients. Lung cancer is a common condition that will spread to the spine.
Pregnancy and Low Back Pain
The American College of Obstetricians and Gynecologists explains that pregnant women commonly experience back pain. This is often caused by the additional strain that is placed on the back region. This is due to the increased weight in the front of the body that causes women to lean forward.
Hormonal changes are also a potential cause of back pain. Hormones in the body will widen the opening around the birth canal. This tends to alter the position of the joints in the pelvic region. Women should focus on maintaining proper posture the best they can.
Wearing shoes that offer enhanced arch support can help prevent some of the pain that often develops. Sleeping on a firm mattress may also provide better back support. It is best to avoid bending over from the waist to pick things up. Emphasis should be placed on bending at the knees rather than at the waist.
Physical therapy has shown to be effective in treating pain in the lower back. Stretching the hamstring muscles, which are located on the back of the thighs, can decrease pain and pressure on the lower back. Both passive and active therapies help. Passive therapy treatment may include applying heat or cold or using a TENS unit.
The goals of physical therapy may involve improving your posture. This is often achieved by strengthening the abdominal muscles and other core areas. As the therapy progresses, the back pain should improve and there should be increased flexibility.
Prescription Medication Options
Narcotic pain relievers known as opioids are generally effective for many types of pain. They are often used as a short-term option due to the potential for addiction. Common medications include hydrocodone and oxycodone.
Steroids are often used to relieve inflammation. Corticosteroids are synthetic versions that are fairly inexpensive and available to be administered orally or through injection. Although they are generally safe, they are not an ideal long-term solution. Corticosteroid injections may be administered directly to the region where the pain is located.
Muscle relaxers are used for reducing muscle spasms and are often prescribed in conjunction with NSAIDs. These are formally known as nonsteroidal anti-inflammatory drugs. Common muscle relaxers include Flexeril (cyclobenzaprine) and Soma (carisoprodol). They may make you drowsy and users should be cautious when driving or operating machinery.
Spinal fusion involves “welding” the larger bones of the spine. The bones may also be stabilized with rods, screws and other hardware. It is often used to correct an irregularly shaped spine or when joints are unstable and create pain when movement occurs.
A laminectomy creates space that allows relief in the nerves of the spine. A plate of bone known as the lamina is removed. The procedure is now highly successful in relieving pain. A discectomy is another procedure used to reduce problems associated with the discs of the back.
The surgeon will generally access the region by making a small incision. There are two primary types of discectomy as follows:
- Percutaneous: A part of the disc is removed using a device that is extended through the incision.
- Microsurgical: An incision that is less than one inch is made. A microscope is then used by the surgeon to remove disc fragments to provide relief.
When there are fractures in the vertebrae, the surgeon may perform a vertebroplasty or kyphoplasty. These procedures involve applying a stabilizing material that is similar to cement. The purpose is to restore the vertebrae to the proper alignment and spacing.
Types of Alternative Medicine
A massage therapist is a professional that uses touch to relieve tightness and pain in the soft tissues and muscles. Massage therapy has been shown to reduce tension in the muscles and improve overall circulation. It may be used in addition to other forms of treatment.
A sports massage involves using increased pressure to reach deeply layered muscles. Neuromuscular massage therapy targets specific “trigger” points by using the fingers to apply pressure. Massage has been shown to also be effective for reducing muscle spasms.
There are several different alternative forms of therapy that may produce positive results in some patients. A chiropractor uses different means of manipulating the spine to reduce pain. The treatment may involve making manual “adjustments” to the spinal region and using different ways of applying pressure.
Acupuncture is a treatment that uses needles that are inserted into the skin. Many patients will experience short-term relief from their pain. The treatment is based on theories associated with Chinese medicine. The relief is believed to be the result of stimulating the central nervous system.
Yoga is a form of exercise that involves positioning the body in various ways with an emphasis on patterns of breathing. The muscles may be strengthened and posture may improve. Similar to massage therapy, yoga has shown to effectively relieve tension in many areas of the body.
Preventing Pain in the Lower Back
Often, pain in the lower back can be managed proactively by using some best practices including the following:
- Eating healthy to maintain a healthy body weight. Excessive weight puts unnecessary pressure on the spine and lower back regions.
- Regular exercise to develop the back and abdominal muscles to create a more stable means of supporting the back.
- Avoid remaining seated for extended periods. Those who work while seated are encouraged to stand and walk regularly. This also applies to those who are driving or riding in a vehicle for long periods of time.
- Try to focus on ways to minimize unnecessary stress.
- Those who are experiencing depression and/or anxiety are encouraged to seek medical attention. These conditions tend to make existing back pain feel worse.
- Be sure to get a good night’s sleep to limit drowsiness that may encourage poor posture.
Treatment Provider for Low Back Pain in Arizona
Our team of medical professionals at the Arizona Pain and Spine Institute has spent many years treating those suffering from lower back pain. We use the latest diagnostic tools which allows us to find the source of each patient’s pain.
We also diagnose and treat painful conditions that involve the neck, hips, knees, and many other regions of the body. Our offices are located in Mesa, East Mesa and Queen Creek. Contact our office today at (480) 986-7246 for an appointment.
Low back pain, particularly the chronic and radicular pain, is best treated by the specialists. In the area, we are proud to say that AZ Pain and Spine is comprised of highly-trained, well-knowledgeable and experienced pain specialists. We provide safe and effective pain management and treatment solutions for low back pain and other pain conditions.
Get started with your treatment. Make an appointment with us today.