Low Back Pain

Low back pain is an ache or discomfort in the area of the lower part of the back and spinal column. The lower spinal column consists of many small bones that surround and protect the spinal cord and nerves. Low back pain is very common, affecting most adults at some point in their lives.

There are many possible causes for low back pain, including:

• Fractures due to trauma and/or osteoporosis
• In rare cases:
  • Arterial problems such as as an aortic aneurysm
  • Benign or malignant tumors
  • Infections
• Ankylosing spondylitis —a hereditary disorder involving the spine
• Disc degeneration , caused by aging or arthritis
• Fibromyalgia —a condition that causes muscle aches and fatigue
• Herniated (ruptured) disc —the cushions between the bones of the spine bulge out of place
• Spinal stenosis —narrowing of the spinal canal in the lumbar area
• Spondylolisthesis —slippage of a bone in the lower back
• Sprain or strain of muscles or ligaments in the area (most common cause of back pain)

These factors increase your chance of developing low back pain. Tell your doctor if you have any of these risk factors:

• Other factors which may negatively influence back pain include:
  • Drug or alcohol abuse
  • Fatigue or sleep deficit
  • Psychological factors, such as low job satisfaction
  • Stress
• Preexisting back injury due to:
  • Bad posture
  • Improper lifting
  • Lifting a heavy object
  • Prolonged sitting or standing
  • Sudden movement, bending, or twisting
  • Vibration from vehicles or heavy equipment
• Certain activities (such as lifting)
• Injury
• Obesity
• Older age
• Pregnancy
• Prior back surgery
• Sedentary lifestyle
• Smoking

Pain is usually localized in the low back. It gets worse with back motion, sitting, standing, bending, and twisting. If a nerve is irritated, the pain may extend into the buttock or leg on the affected side, and muscle weakness or numbness may be present. It usually gets better with rest, and there is good bowel and bladder control.

More serious symptoms associated with back pain that may require immediate medical attention include:

• Difficulty walking, standing, or moving
• Difficulty with urination
• Fever, unexplained weight loss, or other signs of illness
• Loss of bowel or bladder control
• Numbness in the genital or rectal area
• Pain that awakes you from sleep at night
• Pain that is severe or that has gotten dramatically worse
• Progressive weakness in a leg or foot

Pain that doesn't improve or worsens with rest (even at night) may be an indication of a more serious disease.

The doctor will ask about your symptoms and medical history, and perform a physical exam. In particular, the doctor will examine your back, hips, and legs and usually will test for strength, flexibility, sensation, and reflexes.

Other tests include:

• Blood tests—such as complete blood count (CBC) or sedimentation rate
• Bone scan —a test to determine mineralization of the bones
• CT scan —a type of x-ray that uses a computer to make pictures of structures inside the body. This test provides a good picture of the vertebrae and the spinal canal. This test is done when there are persistent symptoms.
• MRI scan —a test that uses magnetic waves to make pictures of structures inside the body and shows the intervertebral discs and any abnormality of the discs. This test is done when there are persistent symptoms.
• Urine test—to check for urinary infection or blood in the urine
• X-rays —a test that uses radiation to take a picture of structures inside the body, especially bones. This test is usually done if you are over 50 years old or have persistent symptoms for more than a week. This test has its limitations in that it does not show herniated discs or spinal stenosis

It's important to keep in mind that imaging tests, like CT or MRI scan, may not be helpful immediately after a back injury.

Treatment options include:

If you have low back pain, follow your doctor's instructions .

The following steps may help you avoid low back pain:

• Begin a safe exercise program with the advice of your doctor.
• If you smoke, quit .
• Maintain a healthy weight .
• Avoid aggravating activities, for example bending, twisting, and sudden movements.
• Avoid sitting or standing in one position for prolonged periods.
• Consider job retraining if your work requires a lot of heavy lifting or sitting.
• If you have back pain during pregnancy, try wearing a BellyBra. This is a special bra to support your back and abdomen.
• If you must remain standing for long periods, rest one foot at a time on a small stool to relieve pressure on your low back.
• Practice good posture to reduce pressure on your spine.
• When lifting, hold the object close to your chest, maintain a straight back, and use your leg muscles to slowly rise.

While some people think that using shoe inserts will prevent back pain, so far there is not a lot of evidence to support this.