Low back pain can happen anywhere below the ribs and above the legs. It is possible to hurt your back when you reach, lift or twist. In fact, almost everyone has low back pain at some point in their lives.
This topic provides a general overview of low back pain. If you have been diagnosed with a herniated disc or spinal stenosis, see the topic Herniated Disc or Lumbar Spinal Stenosis. (Link to these article topics).
Low back pain is discomfort in the lumbar area of the spine. Structures in this area include vertebrae (L1-L5), ligaments, and intervertebral discs; spinal cord and associated spinal nerves; and blood vessels, muscles, and tendons.
The most common causes of acute low back pain are trauma (e.g., sports injury or auto accident) and lifting a heavy object with poor technique. External trauma may cause bone fracture and tearing or shearing of discs, ligaments, muscles and tendons. Significant soft tissue damage can also occur with a lifting or moving injury.
Chronic or recurrent low back pain due to chronic overuse or misuse is most often diagnosed in those in their 30s and 40s, although even children and teens can be affected. Other common causes are degenerative disorders of aging such as arthritis, spinal stenosis, and osteoporosis. Less common causes include diseases such as Paget’s or scoliosis. Rarely, low back pain may be due to an infection (such as osteomyelitis), inflammation (such as spondylitis), or a tumor.
Low back pain may also occur as part of another disorder, such as fibromyalgia or a kidney stone (on the side of the affected kidney).
The first steps in diagnosis are a thorough patient and family medical history, characterization of the pain, and physical examination. Imaging studies (to show anatomic abnormalities) include plain x-rays or computed tomography (CT), magnetic resonance (MR) imaging, and specialized studies such as discography. Electromyography (EMG), nerve conduction (NCV) studies, and evoked potential (EP) studies help to evaluate nerve function.
Nonsurgical treatments for low back pain include analgesic and anti-inflammatory medications; acupuncture; chiropractic manipulation; TENS (transcutaneous electric nerve stimulation); applications of cold or heat; ultrasound; stretching and strengthening exercises for back, abdominal, and leg muscles; and education in ways to prevent future injury. Patients should avoid bed rest and follow their exercise plan for safe return to activity as soon as possible.
Surgery may be indicated to treat traumatic damage, compression causing severe symptoms, and some infections. Procedures include spinal fusion, spinal laminotomy/laminectomy, discectomy, and foraminotomy. Minimally invasive procedures include vertebroplasty, nucleoplasty, radiofrequency lesioning, intradiscal electrothermal therapy (IDET), rhizotomy, and nerve block.
Post-injury the patient should begin or resume an approved back exercise program and back-protective activities such as maintaining excellent posture, achieving/maintaining a healthy weight, and working and playing ergonomically, especially when handling heavy objects.
Low back pain is often misdiagnosed. If you have a back pain problem that has lasted longer than six weeks, or if you suspect that you may have more than muscle pain, it might be time to contact the Florida Spine Institute for some tests.