Pain in the lower back or low back pain is a common concern, affecting up to 90% of Americans at some point in their lifetime. Up to 50% will have more than one episode. Low back pain is not a specific disease. Rather, it is a symptom that may occur from a variety of different processes. In up to 85% of people with low back pain, despite a thorough medical examination, no specific cause of the pain can be identified. Back pain can have many underlying reasons, but often no specific cause will be found and the pain will stop. This chapter tries to touch on many of the causes of back pain and proper evaluation and diagnosis.

Back Pain, especially in the lower back (lumbar spine), is a problem that most people experience at some time in their lives. The muscles that support the spine are in constant use; even while simply sitting, the muscles are in use to keep one from falling over. The spine also bends, straightens and twists. This constant stress on the back can result in back strain and pain.

The lower back supports most of the weight of the body and is subject to the most mechanical stress. As a result, the lower back is commonly injured. Lower back pain caused by strained muscles or ligaments is the most common type of back pain (sometimes referred to as lumbago).

Though most back pain is caused by muscle or ligament strain, there are other causes such as damage or injury to spinal nerves, bones, or discs. Sciatica, which is not a disease in itself but radiating pain and other symptoms caused by inflammation or compression of the sciatic nerve, can be caused by many conditions. Osteoarthritis of the spine is a common cause of back pain in people over 65 years of age. The incidence of some other back conditions also increases with age. Back pain is sometimes caused by a problem with the kidneys.

Back Pain Causes

Back pain is a symptom. Common causes of back pain involve disease or injury to the muscles, bones, and/or nerves of the spine. Pain arising from abnormalities of organs within the abdomen, pelvis, or chest may also be felt in the back. This is called referred pain. Many intra-abdominal disorders, such as appendicitis, aneurysms, kidney diseases, bladder infections, pelvic infections, and ovarian disorders, among others, can cause pain referred to the back. Normal pregnancy can cause back pain in many ways, including stretching ligaments within the pelvis, irritating nerves, and straining the low back. Your doctor will have this in mind when evaluating your pain.

Nerve root syndromes are those that produce symptoms of nerve impingement (a nerve is directly irritated), often due to a herniation (or bulging) of the disc between the lower back bones. Sciatica is an example of nerve root impingement. Impingement pain tends to be sharp, affecting a specific area, and associated with numbness in the area of the leg that the affected nerve supplies.

Herniated discs are produced as the spinal discs degenerate or grow thinner. The jellylike central portion of the disc bulges out of the central cavity and pushes against a nerve root. Intervertebral discs begin to degenerate by the third decade of life. Herniated discs are found in one-third of adults older than 20 years of age. Only 3% of these, however, produce symptoms of nerve impingement.

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Back Pain Treatment

General recommendations are to resume normal, or near normal, activity as soon as possible. However, stretching or activities that place additional strain on the back are discouraged.

Sleeping with a pillow between the knees while lying on one side may increase comfort. Some doctors recommend lying on your back with a pillow under your knees.

No specific back exercises were found that improved pain or increased functional ability in people with acute back pain. Exercise, however, may be useful for people with chronic back pain to help them return to normal activities and work.

Most experts agree that prolonged bed rest is associated with a longer recovery period. Further, people on bed rest are more likely to develop depression, blood clots in the leg, and decreased muscle tone. Very few experts recommend more than a 48-hour period of decreased activity or bed rest. In other words, get up and get moving to the extent you can.

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