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Lumbar (Lower Back) Pain

  • What is lumbar pain?

    Lumbar pain

    Back pain is common and usually lasts for a short time. There are steps a person can take to ease the symptoms and prevent future problems. The most common type of back pain is pain in the lower back (lumbar spine) as this area bears the stress of the body weight throughout the day.

    Many have lower back pain at some point in their lives, but few are caused by a chronic, medical problem. Lower back pain often goes away after 2 – 6 weeks, and it can be separated into 2 categories:

    • Mechanical pain

      Mechanical pain is associated with certain movements and usually improves with rest. It is more likely due to muscle strains, ligament sprains, and wear and tear of the spinal joints and discs.

    • Non-mechanical back pain

      Non-mechanical pain is pain that may be present with or without movement. It may even be worse when the person is resting. It may have a neuropathic origin or involve a disease process that is destroying the structure of the spine, such as an infection or cancer.

  • There are many causes of lower back pain.

    • Arthritis

      Arthritis is an inflammatory joints condition, which leads to decreased mobility or disability.

    • Bone tumour

      Bone tumour is likely to cause pain and lead to bone fractures.

    • Fractures

      A bone fracture is a broken bone caused by stress or a strong physical impact applied to the bone.

    • Poor posture

      Poor posture such as sitting for long periods, puts more pressure on your back than laying down or standing, which can result in back pain.

    • Slipped disc

      Slipped disc, also known as a herniated disc, is typically caused by wear and tear. This causes the discs to lose their elasticity and become more prone to damage.

    • Spinal stenosis

      Lumbar spinal stenosis is caused by the progressive narrowing of the spinal canal, placing pressure on the spinal cords and nerve roots.

    • Trauma

      Back injury and trauma may affect the intervertebral discs and joints between vertebrae. This can cause degeneration, which can lead to lower back pain.

    Risk factors for lumbar or lower back pain

    • Age, as back pain is more common as you get older

    • Lack of exercise, as weak, unused muscles in your back and abdomen might contribute to back pain

    • Excess weight, which puts additional stress on the back

    • Medical conditions such as arthritis and some types of cancer can contribute to back pain.

    • Improper lifting, or lifting with your back instead of your legs, places unnecessary stress on the back.

    • Psychological conditions such as depression and anxiety appear to increase the risk for back pain.

    • Smoking, which decreases blood flow to the spine and increase the risk of osteoporosis. It is also believed to contribute to back pain as a result of coughing, which can lead to herniated discs.

    Preventing lumbar or lower back pain

    • Exercise, especially low-impact activities such as swimming, to increase strength and endurance of your back muscles. Exercises that work your abdominal and back muscles also help to strengthen your core.

    • Maintaining a healthy body weight, to reduce pressure and strain on the back muscles.

    • Avoiding or quitting smoking, which decreases blood flow to the spine.

    • Good posture. While standing, avoid slouching, maintain a neutral pelvic position and alternate feet or place one foot on a low stool to ease the pressure. While sitting, choose a seat with good lower back support and keep the knees at the same height as your hips. A pillow or rolled towel can help to maintain its natural curve.

    • Good technique while lifting. If you must lift something heavy, bend your knees and keep your back straight to allow your knees to support the weight. Hold the weight close to your body and avoid twisting at the waist.

  • Symptoms of lower back pain vary depending on which structures are affected. Some of the more common symptoms of lumbar pain are:

    • Back stiffness and reduced range of movement
    • Muscle weakness in the hip, thigh, leg or foot
    • Pain spreading from the buttock to the foot
    • Pain spreading into the buttocks and thighs
    • Sensory changes (numbness, prickling or tingling) in the leg, foot or toes

    Rarely, symptoms may include changes in bowel or bladder function. This can result from a large disc herniation pressing on the nerves leading to the bowels or bladder.

  • Lower back pain is usually diagnosed following a physical examination and one or more diagnostic tests.

    During the physical examination, your doctor will examine your back and assess your ability to sit, stand, walk and lift your legs. This will help to determine the impact of lower back pain on normal activities, and help to indicate where the origin of the pain.

    Diagnostic procedures for lower back pain include:

    • X-rays

      X-rays can reveal problems with bone alignment, arthritis or broken bones that may be causing your lower back pain.

    • Imaging scans

      A magnetic resonance imaging (MRI) or computed tomography (CT) scans check for herniated disks or problems with bones, muscles, tissue, tendons, nerves, ligaments and blood vessels.

    • Laboratory tests

      Blood tests may be recommended to check for infection or other conditions that might be causing your back pain.

    • Bone scans

      Bone scans allow doctors to look for bone tumours or compression fractures caused by osteoporosis.

    • Nerve studies

      Nerve studies can confirm if nerve compression is caused by herniated disks or narrowing of your spinal canal (spinal stenosis).

  • In some cases, lower back pain can improve with rest, without need for treatment. Under these circumstances, it is best to remain active and resume normal daily activities.

    If the pain does not improve, you may need:

    • Back brace, usually for 2 – 4 days, to support a problematic disc
    • Bed rest, usually for no more than 2 days, to rest the sore discs and nerves
    • Medication to help with sleep and to control pain, swelling and muscle spasms (cramps)
    • Physiotherapy to relieve pain, improve back movement and maintain a healthy posture
    • Spinal injection to relieve pain

    Surgery may be advised if your lower back pain is severe and does not improve.

    Types of surgery for lower back pain include:

    • Laminectomy to relieve pressure on the spinal nerves
    • Discectomy to remove a portion of the disc that is pressing on the nerve root
    • Spinal fusion

    If you experience frequent or persistent lower back pain, make an appointment for a diagnosis and appropriate treatment.

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  • Left untreated, lower back pain can lead to further complications.

    • Worsening of symptoms

      Symptoms such as stiffness, pain or numbness can get worse. This can affect your ability to sit, stand or sleep comfortably.

    • Nerve damage

      If you have a slipped or herniated disc, this can increase pressure on nerves such as the sciatic nerve which extends from the lower back and down the back of each leg. This pressure can damage the nerves.

    • Weight gain

      Many people with back pain avoid regular exercise, which contributes to weight gain and loss of muscle mass.

    • Poor posture

      It is common for people experiencing chronic pain to assume a position that eases the pain. However, when this unnatural position is held for a long time, this can lead to poor posture.

    • Loss of work

      Severe back pain makes it difficult to continue working, making it a common cause of sick leave or absence from work.

    • Insomnia

      Lower back pain can make it difficult to sleep or rest, which can lead to irritability, difficulty focussing and trouble dealing with daily activities and responsibilities.

    • Depression

      Back pain can keep you from many things, from socialising and favourite activities to work and other responsibilities. This can affect your relationships and mental health, and make it more difficult to recover.

    If you suddenly experience symptoms such as loss of bladder or bowel control, or severe pain in the abdomen, this may be a sign of a serious underlying condition, and you should seek immediate medical attention.

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