Over 80% of the population will suffer from lower back pain during their lives. Most cases of lower back pain can be linked to a general cause—such as muscle strain, injury, or overuse—or can be attributed to a specific condition of the spine, most commonly:
• Herniated Disc
• Degenerative Disc Disease
• Spinal Stenosis
A number of less common conditions can cause low back pain as well, such as sacroiliac joint dysfunction, spinal tumors, fibromyalgia, and piriformis syndrome.
The low back supports the weight of the upper body and provides mobility for everyday motions such as bending and twisting. Muscles in the low back are responsible for flexing and rotating the hips while walking, as well as supporting the spinal column. Nerves in the low back supply sensation and power the muscles in the pelvis, legs, and feet.
Most acute low back pain results from injury to the muscles, ligaments, joints, or discs. The body also reacts to injury by mobilizing an inflammatory healing response. While inflammation sounds minor, it can cause severe pain.
There is a significant overlap of nerve supply to many of the discs, muscles, ligaments, and other spinal structures, and it can be difficult for the brain to accurately sense which is the cause of the pain. For example, a degenerated or torn lumbar disc can feel the same as a pulled muscle – both creating inflammation and painful muscle spasm in the same area. Muscles and ligaments heal rapidly, while a torn disc may or may not. The time course of pain helps determine the cause.
Types of Lower Back Pain
- Mechanical pain. By far the most common cause of lower back pain, mechanical pain (axial pain) is pain primarily from the muscles, ligaments, joints (facet joints, sacroiliac joints), or bones in and around the spine. This type of pain tends to be localized to the lower back, buttocks, and sometimes the top of the legs. It is usually influenced by loading the spine and may feel different based on motion (forward/backward/twisting), activity, standing, sitting, or resting.
- Radicular pain. This type of pain can occur if a spinal nerve root becomes impinged or inflamed. Radicular pain may follow a nerve root pattern or dermatome down into the buttock and/or leg. Its specific sensation is sharp, electric, burning-type pain and can be associated with numbness or weakness (sciatica). It is typically felt on only one side of the body.
- Pain that is dull or achy, contained to the low back
- Stinging, burning pain that moves from the low back to the backs of the thighs, sometimes into the lower legs or feet; can include numbness or tingling (sciatica)
- Muscle spasms and tightness in the low back, pelvis, and hips
- Pain that worsens after prolonged sitting or standing
- Difficulty standing up straight, walking, or going from standing to sitting
Range of pain
- Acute pain. This type of pain typically comes on suddenly and lasts for a few days or weeks, and is considered a normal response of the body to injury or tissue damage. The pain gradually subsides as the body heals.
- Subacute low back pain. Lasting between 6 weeks and 3 months, this type of pain is usually mechanical in nature (such as a muscle strain or joint pain) but is prolonged. At this point, a medical workup may be considered, and is advisable if the pain is severe and limits one’s ability to participate in activities of daily living, sleeping, and working.
- Chronic back pain. Usually defined as lower back pain that lasts over 3 months, this type of pain is usually severe, does not respond to initial treatments, and requires a thorough medical workup to determine the exact source of the pain.
Non Surgical Treatments for Lower Back pain
The goal of medical treatments is to reduce pain, but these treatments do not change the underlying source of pain. A doctor will typically prescribe medical treatments alongside a physical therapy program or other regimen.
Common medical treatments include:
Muscle relaxants. This medication acts as a depressant of the central nervous system and increases mobility of tense muscles, relieving pain from muscle tightness or spasms. Muscle relaxants have no role in chronic pain management.
Narcotic pain medications. Narcotic medications, also called opioids or painkillers, alter one’s perception of pain by weakening signals sent to the brain. Narcotic medications are most often used for treating intense, short-term pain, such as acute pain after an operation. Narcotics are rarely used to treat long-term pain, as they have many side effects and can easily become addictive.
Back braces. Some patients find that a back brace can be used to provide comfort and possibly reduce pain. There is some evidence that use of an inelastic corset-style brace, worn daily, in combination with a physical therapy exercise program, can speed healing and reduce pain.2 A back brace may also be helpful after back surgery.
Epidural steroid injections. This injection involves a steroid administered directly into the outer part of the dural sac, which surrounds the spinal cord. A live x-ray, called fluoroscopy, is used to guide the needle to the correct area. The goal of the injection is to temporarily relieve pain by reducing inflammation around a compressed nerve root.
Medical treatments are often used in combination with other methods. For example, an epidural steroid injection may provide enough short term pain relief to allow progress in physical therapy.
Non-medical treatments are may be referred to as alternative or complementary care. The term “alternative” should not imply inferior, but instead not traditional according to western medical standards.
Many patients low back pain report relief from alternative treatments. Common options include:
Manual manipulation. A chiropractor or other healthcare provider makes physical adjustments to the spine with the goals of improving mobility and reducing stiffness, discomfort, or pain. Hand thrusts of varying speed and force are applied to adjust the spinal structures. Manual manipulation has been found to relieve low back pain in some people.3
Acupuncture. Based in ancient Chinese medicine, acupuncture stimulates points on the body thought to correct the body’s “qi,” or life force. It is believed that proper qi decreases pain and discomfort in the body. During a session, thin needles are placed in the skin for about an hour. Acupuncture has been shown to provide significant pain relief for some people.3
Massage therapy. Applied to the low back, massage therapy can relieve the muscle spasms that usually contribute to low back pain. Massage also increases blood flow to the low back, which speeds up healing by bringing nutrients and oxygen to damaged muscles.
Mindful meditation. Meditation may be helpful in reducing the perception of pain, and can reduce depression, anxiety and sleep problems that commonly occur with chronic pain. Meditative techniques for pain reduction include everything from deep breathing exercises to an altered focus approach.