Low back pain is one of the top reasons Americans visit their doctors. It will interfere with the lives of millions of Americans this year. In fact, on average, four out of five adults will experience low back pain in their lives. So the question “What causes my low back pain?” is not uncommon.
Low back pain can be excruciating. A wide variety of injuries or conditions can cause it, including:
* muscles in the lower back may be strained
* It may injure the discs between the vertebrae
* large nerve roots extending to the arms and legs may be irritated
* It may irritate smaller nerves supplying the lumbar spine
* joints, ligaments or even bones may be injured.
When back pain is accompanied by other symptoms such as fever and chills, it may be a serious medical problem. You should seek medical attention immediately.
Three categories of back pain:
Your back pain will fall into one of three categories, which your doctor will determine based on your description of the pain.
1. Axial back pain - mechanical or simple back pain
2. Low back pain - sciatica
3. Low back pain with referred pain
1. Axial low back pain
Axial low back pain is the most common of the three. We felt it only in the lower back region, without the pain radiating from other parts of the body. Mechanical low back pain and simple low back pain may both refer to it.
* Description: Axial low back pain can vary widely. It can be sharp or dull, constant or intermittent. On a scale of 1 to 10, you can rate its intensity at 1 or 10.
It may intensify with some activity - playing tennis, for example.
It may worsen in certain positions, such as sitting at a desk.
It may or may not be relieved by rest.
* Diagnosis: you can diagnose Axial low back pain rather than by your doctor. You know it started when you were helping a friend move a heavy sofa. It may be your doctor who determines that you have strained or damaged back muscles, a degenerated disc, etc.
* Treatment: The cause of your axial back pain does not matter as far as treatment is concerned. You will need to rest for a day or two. Then do some gentle back pain exercises and stretches. If you have more pain after exercise, use a heating pad in a low or medium setting. Take an appropriate over-the-counter pain medication. Follow your doctor’s advice.
* Prognosis: Symptoms of axial low back pain go away over time, and about 90% of patients recover in four to six weeks. If you do not feel better within six to eight weeks, additional tests and/or injections may be needed to diagnose and treat the source of the pain.
* Caution: If your pain is chronic severe that it wakes you up at night, consult your doctor.
2. Lower back radicular pain
Root pain in the lower back is commonly called sciatica. We felt it in the lower back, thighs and legs.
* Description: Low back radicular pain often begins in the lower back and then follows a specific nerve pathway to the thighs and legs. The pain in the legs can be much worse than the pain in the back. It is often deep and constant. Certain activities and positions can easily reproduce it, such as sitting or walking.
* Diagnosis: compression of the lower spinal nerve causes Low back pain. The most common cause is a herniated disc with nerve compression. Other causes may be diabetes or injury to the nerve root. If you have had back surgery, scar tissue may affect the nerve root. Older adults may have a narrowing of the hole through which the spinal nerve exits.
* Treatment: Conservative treatment is the best place to start. Rest for a few days in a bed or chair. Then, gradually introduce gentle exercises specifically designed to relieve back pain. Follow your exercises with additional rest and apply a heating pad on a low to medium setting. Take daily Epsom salt baths. Take an appropriate over-the-counter pain medication. Your doctor may want to use selective spinal injections.
* Prognosis: Symptoms of radicular low back pain may improve with the conservative treatment described above. Give your back and legs six to eight weeks to improve. If surgery is required afterwards, it usually relieves leg pain in 85% to 90% of patients. Back pain itself is more difficult to relieve.
* Caution: If an MRI or CT-myelogram does not definitively confirm nerve compression, back surgery is unlikely to be successful.
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3. Low back pain with referred pain
Low back pain with referred pain is not as common as axial or radicular low back pain. The same conditions can cause this pain, which does not radiate down the thighs and legs, as axial low back pain.
* Description: You will usually feel referred pain in the lower back area, radiating into the groin, buttocks and upper thigh. The pain may travel, but rarely goes below the knee. It is often a dull, aching pain. It comes and go. Sometimes it is very sharp, but other times it is just a dull sensation. The same injury or problem that causes simple axial back pain may cause it. Often it is no more serious.
* Diagnosis: It is very important to have a doctor determine if we refer your pain low back pain or radicular low back pain, as treatment differs.
* Treatment: Once you know for sure that your pain is referred low back pain, you can follow the treatment for axial low back pain.
* Prognosis: Symptoms of referred low back pain disappear over time, usually within four to six weeks. If you do not feel better within six to eight weeks, ask your doctor if additional tests and/or injections are needed.
* Caution: If your back pain is chronic or is so severe that it wakes you up at night, see your doctor.
