Back pain is one of the most common ailments that many people suffer from. It affects a large percentage of adults in Australia at some point or other during their lifetime. It could be a mild pain that goes away naturally or may be the result of more serious underlying conditions. Most of the time, lower back pain heals itself with reduced stress and physical exertion combined with some active recovery. Some situations, however, could warrant a visit to the doctor to identify the cause behind medium to severe back pain.
Lower back pain, or lumbar pain as it is referred to, could occur due to several reasons. These include ligament or muscle issues, inflammation of the spinal nerves, injury to the disc or joints in the back, etc. Most back problems can be cured with medication, exercises, and physical therapy. However, there have been some cases where backaches can be the result of serious medical conditions that require a more extensive treatment plan. We’ll discuss all of this and more in the coming paragraphs. Let’s start by understanding the symptoms of back pains and when to start treating it.
Symptoms of back pain
Lower back pain can cause one or more of the following symptoms:
At times, pain in the back can affect one area of the spine more than the other. This is a symptom of pain due to injuries of the muscle tissues on one side of the spine.
If you experience any of the above symptoms, you may require either self-treatment in terms of exercise, or you may need to consult with a physician. Let’s now look at additional situations where it is advised to get immediate assistance from a medical professional.
When to seek immediate medical help for back pain
As discussed earlier, most back problems are not dire enough for medical treatments. However, in some cases, back pain could be a symptom of a more serious underlying condition. If you experience any of the following signs in addition to the above-mentioned symptoms, you must reach out for professional medical help immediately.
Additionally, people under the age of 16 and over 50 who experience these types of back pain should visit a doctor to check for serious problems. The sooner you get your physician to understand the cause of the back pain, the easier and faster it becomes to treat it effectively.
Diagnosis and tests for low back pain
Diagnosing back pain is a thorough process to fully understand its cause. Depending on your answers to the following set of questions, your doctor will be able to analyse your back problem. This helps to identify if it is due to a serious condition or only needs simple treatments. Here are the most common questions that doctors ask when it comes to backaches.
Once these questions have been answered, the next step is a physical assessment. Your physician will perform a physical examination of the back to ascertain your condition. This includes:
Although these examinations don’t normally show the actual cause of pain, they go a long way in helping your doctor make a risk assessment. It allows them to categorize the back pain as critical or non-critical, giving an estimate of medical treatments required. Also, in several cases, the exact cause of the pain does not necessarily change the treatment plan. Doctors do sometimes begin basic treatment or medications prior to having the precise anatomical cause at hand.
In general, doctors do not prescribe x-rays and imaging tests for back pain. This is because the results of these radiological tests don’t always correlate to the severity of the condition. For instance, an x-ray may show signs of an injury to the disc or joints, but the person may not have any back-pain symptoms. The opposite also holds, where patients complaining of severe back pain show no sign of physical damage on the imaging test results. Doctors usually only recommend an imaging test in cases where they suspect a physical injury like a fracture. They may also ask for a scan in cases of extended chronic pain in order to rule out injuries. We’ll discuss this further in the next section.
Other tests to diagnose back pain include blood tests. These are done to either verify or reject conditions like inflammation or infections and also illnesses such as cancer.
Imaging tests used in low back pain
There are situations where your doctor suspects that there may be a specific, physical cause of the back injury. This is where imaging tests come into play. Let’s look at the different tests used to diagnose lower back pain and how they help.
One or more of these imaging tests can often reveal the nature of your back pain. With the help of these results, your doctor can put together the right treatment plan. Alternatively, the test results may lead your doctor to refer you to a specialist.
Should I see a specialist for low back pain?
The majority of lower back pain cases can be successfully treated by your general physician. However, there may be a small percentage of cases where you are referred to a specialist. These include rheumatologists, neurosurgeons, orthopaedic surgeons, and pain specialists. You need to consult with these specialists only if your doctor refers you to them.
Apart from the above-mentioned specialists, you may also find it useful to consult with an osteopath or a physiotherapist. These specialists do not require a medical referral from your general physician. Physiotherapists and osteopaths help in rectifying low-risk back pains with exercises, stretches, and mobility activities. Though their services may only come as a rebated option with your national Medicare scheme, many private insurances do cover these expenses.
Causes of low back pain
Now that we’ve understood the basic symptoms of back pain and what they mean, let’s take a deeper look into these causes. A majority of back pain situations arise out of ligament stress, muscular problems, or joint injuries. The more severe back issues are the result of wounds to the spinal cord or nerve damage.
Here’s a list of the various reasons you could be experiencing moderate to chronic back pain.
Back Muscle Strains
The lower back consists of numerous muscles including:
These muscles work together to support the upper body and the spine, making them important parts in the functioning of our back. If any of these muscles are torn or strained due to external pressure, it leads to a type of ache called myofascial pain. This is the pain triggered by tiny tears in muscle fibres causing painful inflammation. This type of pain from back muscle stress is generally self-healing. However, if combined with other injuries or causes of back pain, it could lead to a more severe condition.
Similar to the muscle strain mentioned above, lumbar sprains are injuries to the ligaments of the lower back region. Ligaments are the fibrous supporting tissues that keep the connection between the bone, cartilage, and joints stable. Excessive stress on the ligaments due to physical activity or injuries can create tears in the ligaments, causing it to sprain. This type of pain is also self-treatable without the need for medical intervention.
A spasm is an involuntary contraction of the muscle tissue, which is usually caused due to a muscle or ligament injury. You cannot control muscle spasms when they occur, leading to a painful moment until it subsides. In the lower back, the muscle spasm presents as a cramping or squeezing sensation.
Muscle spasms in the back can vary from mild to severe pain, depending on the nature of damage to the muscle. The spasm is one of the body’s way of shielding itself from further damages. However, it could also be a sign of underlying damage to the spine.
Degenerative Disc Disease
Degenerative disc disease is an age-related phenomenon that causes the erosion of the spinal discs. This can occur when the discs between the spinal vertebrae start to break down due to ageing, causing a painful feeling in the lower back.
The hard outer casing of the discs contains a fluid centre that acts as a lubricator between the vertebral joints. As we grow older, this fluid starts to dry, making the disc stiffer and deteriorating its structure. Flexibility and movements become restricted and cause uncomfortable sensations when we move.
Degenerative disc disease can lead to severe, consistent pain in the back, or it may cause sudden bursts of pain occasionally. The pain can often be soothed by changing positions since it is typically more painful when you sit. The seated posture applies more stress on the back, which is relieved when you stand up or lie down.
Ruptured, Prolapsed, or herniated disc
As mentioned earlier, the spinal discs in the vertebrae contain a fluid, gel-like substance in its centre. The herniated disc, known commonly as a ‘slipped disc’, is a type of pain resulting from the spinal disc fluid protruding out of the disc. If the outer casing of the disc is ruptured or torn, the internal fluid may sometimes herniate or bulge out. Although this does not always cause a problem, some people might present with back pain because of the bulge.
A herniated disc may sometimes stress a nerve in the spinal cord, resulting in mild to intense pain. It may also cause other symptoms like a tingling sensation or a weakened lower back. These damaged discs are called prolapsed discs and can also at times cause other problems like sciatica.
A herniated disc generally heals itself in about two weeks in most cases. The bulging portion slowly becomes smaller and eventually becomes negligible enough for the pain to go away. The lumbar discs – the ones between vertebrae L1 to L5, are the ones most susceptible to this kind of herniation.
Facet Joint Problems
Facet joint pain is a condition of the spinal area caused by the deterioration of the joints between the spinal vertebrae. It is one of the most seen causes of chronic back and neck pains. A facet joint is a tiny joint located between each spinal vertebra and behind the vertebrae as well. Thus, two facet joints are present between every two vertebrae of the spine. The purpose of the facet joint is to maintain stability within the entire spine, giving only a minuscule amount of flexibility to turn or twist the back. The facet joints in the lumbar region are more rigid, not allowing for any twisting either.
The facet joints are covered in cartilage and contain a lubricated capsule-like structure on the outside. With time and repeated stress, the cartilage inside the facet joints may start to break down or erode. This causes inflammation to the nerve endings and the resulting pain is called the facet joint pain. This arthritis-like symptom due to the bones rubbing against each other may also lead to the formation of bone spurs on the surface.
Another type of pain from facet joints can occur if the facet joint dislocates from its socket or gets locked in place. The locking of facet joints is a very quick and unpredictable occurrence. Some symptoms of facet joint syndrome include:
Spinal stenosis is a condition where the spinal canal narrows to an abnormal level, resulting in a lot of pressure on the spinal nerves. Stenosis occurs mainly due to the deterioration of other spinal structures like discs or facet joints. In some cases, a person may inherently have a narrow spinal canal by birth.
The stenosis may occur in three forms within the spinal system:
The symptoms of spinal stenosis vary from person to person, some not showing symptoms at all. In those who do exhibit symptoms, they begin at a slow rate and deteriorate quickly after a certain amount of time. The symptoms comprise numbness, weakness in the legs or the feet, mild to intense pain, and, in some cases, a tingling sensation. You must consult a doctor at the earliest if you exhibit any of these symptoms.
Ankylosing Spondylitis (AS) is a rare form of arthritis that results in stiffness of the spine. It begins generally from the lower back and starts to spread upwards to the rest of the body with time. This condition is, unfortunately, a lifelong ailment. Also known as Bechterew’s Disease, this ailment causes mild to severe pain in the lower back, particularly at the start of the day. Though it eases up as the day progresses, it does not subside even with increased amounts of rest.
As the symptoms of AS progress, the flexibility of the spinal area is reduced to a level where it can lead to a hunched posture.
Spondylolisthesis is a spinal condition where a vertebra, typically in the lower lumbar region, slips out of position to rest directly on the bone. This causes a step-like alignment in the spinal cord, leading to direct stress on the lower back. In some mild cases, this condition does not cause pain in the affected person. However, if the vertebra slips too far out, it could start to press on the nerve endings, causing severe to chronic back pain.
The pain caused by spondylolisthesis is normally quite treatable and can also be relieved by simply lying down. More often than not, spondylolisthesis is the result of a fracture or injury by external impact. Sports such as gymnastics and football are more likely to cause this condition.
Sacroiliac Joint Problems
The sacroiliac joint is the portion of the spinal cord that connects the tailbone or sacrum to the pelvis. There are two such joints, one to the left and one to the right of the sacrum, forming the triangle-shaped structure at the bottom of the spine. When these joints are injured or damaged, it can cause mild to severe pain in the lower back.
By design, the sacroiliac joints are meant to be stiff and stable. They work as shock absorbers for the spine and only allow for minimal movement. The pain and discomfort begin when these joints start to move too much. If these joints become inflamed due to injury or impact, it can lead to a condition called sacroiliitis. Sometimes, this condition may imitate other ailments such as slip discs and hip issues, showing similar symptoms. Therefore, it becomes important to diagnose this ailment correctly.
Some of the common symptoms of sacroiliac joint problems include:
Cauda Equina Syndrome (CES)
The area just under the waist where the spinal cord begins consists of a cluster of nerves. This cluster is known as the cauda equina. The cauda equina syndrome or CES is a condition where the nerve endings of the cauda equina are compressed or constricted. This cluster of nerves is an important part of the body’s nervous system. It transmits messages to various parts like the legs and pelvic organs.
Any damage or injury to these nerves can cause a medical emergency, including disruption of bladder or bowel functions and the ability to walk. In some extreme cases, it may also cause incontinence and permanent paralysis. CES is typically caused due to spinal stenosis, an injury to the spinal cord or a rupture in any of the lumbar discs. It may also be due to a defect by birth or inflammation from an injury.
Here are some of the symptoms of CES that you should keep in mind.
CES is a dangerous medical condition and should be treated as such. Ignoring this condition can cause severe damage to your body and affect your daily life. If you exhibit any of the above symptoms, you must consult your doctor immediately.
Spinal fractures, as the name suggests, is an injury to the spinal vertebrae resulting in broken bones within the structure. A spinal fracture can be caused due to various reasons, such as:
Pain from spinal fractures can be worse when you stand or walk due to the stress exerted on the affected region. Spinal cord fractures are a serious condition and should be treated immediately to avoid lasting effects.
Spondylolysis is another type of fracture in the spinal vertebrae caused due to stress on a certain region of the bone in the facet joint. This condition is generally asymptomatic, which makes it difficult to diagnose. In younger people, it may present as lower back pain that travels through the buttocks and legs. Spondylolysis traditionally occurs in athletes involved in gymnastics, football, and the like.
In some cases, the condition can heal itself over time. However, if the healing does not occur correctly, it can cause disruption of the structure, leading to continued back pain. Spondylolysis is also one of the causes of the previously mentioned spondylolisthesis condition. When the fracture occurs, it can lead to the vertebra slipping out of its position and onto the bone. If an older person with spondylolisthesis contracts a spondylolysis condition, it can cause the facet joint to unload abruptly, leading to a compression fracture.
One of the rarest causes of back pain is cancer. Spinal tumours are generally the result of a spread from another part of the body, and as such, are secondary in nature. Therefore, it is rare to find a severe case of back pain caused primarily due to cancer.
Some of the symptoms of cancerous tumours in the spine are:
There are several activities that could lead to a lower back pain condition. Here’s a list of the common risk factors to watch out for:
If you notice that you are at risk from any of the above factors, start consciously rectifying the ones that you can. You may also consult your doctor on ways to avoid them.
Treatment and self-help for low back pain
As mentioned earlier, most types of lower back pain tend to heal itself with time and active recovery. The average time frame of recovery from non-critical back pain is less than 4 weeks. However, if the pain does not seem to reduce after a couple of weeks, or if you feel it is getting worse with time, it is advisable to consult your doctor at the earliest.
Let’s now look at the various ways to treat your lower back pain condition by yourself.
Keeping a positive and optimistic outlook when you are recovering from back pain is an important tool for a successful recovery. As mentioned earlier, most cases of non-critical lower back pain heal within a matter of weeks. It’s only a small percentage of cases that face the risk of extended recovery times and ongoing problems. Age also plays a big role here. As you grow older, the risk of incurring the pain again increases with time.
As the saying goes, prevention is better than cure! Even if you have already experienced back pain, it doesn’t hurt to know how to prevent further occurrences in future. There are several ways to take care of your body to ensure you don’t have to go through new pain or a repeat of a past painful experience. Let’s delve into some of these helpful preventative methods.
Maintain Good Posture
A neutral spine is a posture that provides the least risk of exposure to back troubles. Sitting, standing, walking, and any other activity should be done with a neutral spine. You can refer to a physiotherapist to understand how to maintain the neutral spine posture. While walking on an upward incline, always stay upright without bending forward. This ensures you use only your legs to support your body weight and not the back. Sitting with your knees at a level higher than your hips alleviates the stress to the back.
Keep yourself active with low-intensity exercises to maintain an optimally functioning body. Simple exercises like walking and swimming help to strengthen your core and keep your back strong and flexible. When the body is flexible and fit, it does not cause stiffness and pain.
Back Strengthening Exercises
Refer to a Pilates trainer or a good physiotherapist to put together a back-exercise regime. Ensure that you perform these exercises regularly every week. Strengthening your back is very important to keep that pain at bay.
Avoid Heavy Lifting
Lifting weights that are too heavy for the body to handle can cause sudden spasms and lead to severe pain or even damage to the back. Always avoid lifting objects that are too heavy. Learn to lift any object in the right way, without exerting pressure in the wrong areas of the body. Some simple things to keep in mind:
Pay Attention to your carrying technique
When carrying a heavy load, always distribute the weight evenly between both your hands. Ensure your shoulders are squared off and not slouching.
Stressful situations and constant anxiety can be harmful to the physical body too. It causes tension in the muscles that can reduce the flow of blood and oxygen to your tissues. Muscle spasms and constrictions are a common result of stress, which eventually leads to painful conditions.
Stretching, much like exercises, is a great way to alleviate tension in the muscles. In the case of back pains, hamstrings are especially at risk. Stretch out the thigh muscles to make them loose and flexible.
Smoking has been identified as one of the causes of lower back pain. Smoking causes several adverse reactions in the body, such as reducing mineral content, coughing, decreased flow of blood, etc. These reactions also affect the lower back and can cause severe backaches.
Eat a Healthy Diet
Eating healthy is as important as a good exercise regime. Avoid inflammatory products that cause pain in the body. A Mediterranean diet, for instance, has low inflammatory products, which is a good diet to follow.
Hydrating the body is of utmost importance, not just to avoid back pain, but for overall well-being too. In terms of preventing back problems, hydration helps with keeping the fluid centres of the vertebrae from drying up.
Maintain a Healthy Weight
Try to maintain your body’s optimal weight as far as possible. Becoming overweight leads to various issues like inflammation, additional stress on the back, and restriction in movements.
Avoid High Heels
High heels, though a fashion requirement at times is a stressful impediment to the body. It applies increased strain on the back and muscles, often affecting the body alignment. Avoid high heels and uncomfortable footwear as much as possible.
The back is an important part of the body, which, if not maintained and cared for well, will cause discomfort. Take care of your back by following as many of the preventative measures as you can. Always be conscious of the way you sit, stand, walk, and handle your body. Stay healthy, eat healthily, and keep fit to avoid experiencing back pain.