Lower back pain is one of the most common complaints as to why patients book to see their GP or are forced to take time off work.
The intensity of back pain can vary massively from case to case. It can range from a dull and constant ache to a very sudden, sharp, or shooting/ stabbing pain. It can start suddenly, as a direct result of an accident or injury by lifting something heavy, or it can simply develop over time as we get older. Going from being quite sedentary followed by a strenuous workout can also result in lower back pain.
There are two categories of back pain:
- Acute (short-term) back pain usually lasts a few days, sometimes up to few weeks. Most cases of lower back pain are in the acute category. This type of back pain tends to resolve itself with rest/self-care and there is no residual loss of function. In some cases, acute back pain can take a little longer to settle and it may take a few months for the symptoms to disappear completely.
- Chronic back painis defined as a pain that is present for 12 weeks or more, even after the initial injury or cause of acute lower back pain has been treated. Around 20% of those patients affected by acute lower back pain, develop chronic low back pain with persistent symptoms one year on after initial pain. Even in cases where pain persists, it does not necessarily mean there is a serious underlying cause or indeed a cause that can be diagnosed and treated. In some cases, treatment can successfully relieve chronic low back pain, but in other cases, pain can continue despite medical and even surgical intervention.
Chronic low back pain is a huge problem in both the USA and United Kingdom, that can sometimes have severe, socioeconomic consequences. Nearly one in seven adults suffer from this condition, which often leads to a partial loss of income due to time off work and can also lead to other medical conditions such as sleep disturbances and depression.
The lower back
The majority of back pain complaints occur in the lower back. The lower back is also known as the lumbar region of the spine and contains 5 vertebrae (referred to as L1-L5), which supports most of the weight of the upper body. Spaces separating each of the vertebrae are home to round, rubbery pads called intervertebral discs that act like shock absorbers in the spinal column and their function is to cushion the bones as the body moves. Ligaments hold the vertebrae in place and tendons attach the surrounding muscles to the spinal column. Thirty-one pairs of nerves are attached to the spinal cord and they are responsible for the body’s movements and they transmit signals from the body to the brain.
Common causes of lower back pain
The majority of lower back pain cases are mechanical in nature, meaning that there is a disruption in the way the components of the back (the spine, muscle, intervertebral discs, and nerves) work together and move. Examples of mechanical causes of low back pain include (but not limited to):
- Skeletal irregularitiesfrom birth such as scoliosis (a curvature of the spine), lordosis (an exaggerated arch in the lower back), kyphosis (excessive outward arch of the spine) and other congenital abnormalities of the spine.
- Spina bifidawhich involves the under development of the spinal cord and/or its protective covering and can cause problems involving malformation of vertebrae and abnormal sensations (and in severe cases, paralysis).
- Sprains(torn ligaments), strains (tears in tendons or muscles), and muscle spasms (sudden contraction of a muscle or group of muscles), usually brought about through sporting activity or over exertion.
- Traumatic Injurysuch as from playing sports, road accidents, or a fall that can injure tendons, ligaments, or muscles causing the back pain. Trauma can also result in the spine being compressed which can lead to the discs bursting or dislodging.
- Disc degeneration which occurs when the rubbery, intervertebral discs wear away as a normal process of aging and lose their cushioning ability.
- Spondylosis the general degeneration of the spine associated with normal wear and tear that occurs in the joints, discs, and bones of the spine as people age.
- Arthritis or other inflammatory diseases in the spine, including osteoarthritis and rheumatoid arthritis causing inflammation of the vertebrae.
Nerve and Spinal Cord problems
- Sciatica (also called radiculopathy), caused by something pressing on the sciatic nerve that travels through the buttocks and extends down the back of the leg. People with sciatica feel a shock-like pain or a burning sensation in the lower back, combined with pain through the buttocks and down one leg.
- Spinal stenosis, the narrowing of the spinal column that puts pressure on the spinal cord and associated nerves.
- Spondylolisthesis, which happens when a vertebra of the lower spine slips out of place and leads to a pinching of the nerves exiting the spinal column.
- Herniated or ruptured discs can occur when the intervertebral discs become squashed and bulge outwards, leading to a reduced cushioning in the spinal cord.
- Various Infections involving the vertebrae (osteomyelitis), the intervertebral discs (discitis) or the sacroiliac joints connecting the lower spine to the pelvis (sacroiliitis).
- Cauda equina syndrome occurs when a ruptured disc pushes into the spinal canal and presses on the bundle of lumbar and sacral nerve roots. Permanent neurological damage can result if this syndrome goes untreated.
- Osteoporosis (a progressive decrease in bone density and strength) can lead to painful fractures in the vertebrae.
Sources not associated with the spine
- Kidney stones can cause a sharp pain in the lower back, usually on one side.
- Endometriosis (the buildup of uterine tissue in places other than the uterus).
- Fibromyalgia (a chronic pain syndrome involving widespread muscle pain and fatigue).
- Tumors that press directly on or destroy the spine or spinal cord and nerves or outside the spine elsewhere in the back.
- Pregnancy (back symptoms usually go away completely after giving birth).
Risk factors that increase chances of developing lower back pain
Anyone can develop back pain. However, there are factors that can increase the chances of developing low back pain. These include:
Age: The first bout of low back pain usually occurs between the ages of 30 and 50, and back pain then becomes more common as we age. Loss of bone strength from osteoporosis can lead to fractures, and as we age, muscle elasticity and muscle tone decrease. The aging process causes intervertebral discs to lose fluid and flexibility, which decreases their ability to cushion the vertebrae. The risk of spinal stenosis also increases with age.
Fitness level: Back pain is more common amongst people who are not physically fit. Weak muscles in the back and abdomen may not properly support the spine which leads to increased pain. People who tend go out and exercise a lot at the weekend, after being relatively inactive all week, are more likely to suffer painful back injuries, compared to those who are moderately active on a daily basis.
Obesity: Being overweight, obese, or quickly gaining a significant amount of weight can put extra strain on the back and can result in lower back pain.
Genetics: Some causes of back pain, like ankylosing spondylitis (a form of arthritis that involves fusing of spinal joints, leading to some immobility of the spine) have a genetic influence.
Occupation: A job that requires repeated lifting, pushing or pulling (particularly when it involves twisting the spine) can lead to injury and lower back pain. Sitting at a desk all day or driving long distances in a car, can contribute to back pain, especially when poor posture is adopted or sitting in a chair/ car seat that doesn’t provide appropriate back support.
Mental health: Anxiety and depression can affect how people focus on any pain, as well as how they perceive its severity. Pain that becomes chronic can also contribute to the development of mental health issues. Stress can affect the body in numerous ways, including causing muscle tension.
Smoking: It can restrict the blood flow and therefore the amount of oxygen getting to the discs, causing faster disc degeneration.
Usually, the first line treatment for the relief of lower back pain is the prescription of pharmacological interventions. These can include acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs) such as naproxen or ibuprofen, muscle relaxants such a diazepam, topical analgesics, and in more serious cases corticosteroids, antidepressants, and opioids. Unfortunately, all these manufactured drugs can lead to serious side effects, especially when they are taken for longer than a couple of weeks.
Treatment with Natural anti-inflammatory alternatives
It is possible to treat some inflammation and associated pain that occurs in various joint and muscle conditions (including chronic low back pain) using natural anti-inflammatory substances, such as green-lipped mussels, blackcurrant leaf and curcumin.
Less pain and better quality of life
The Erasmus University Brussels, in Belgium has published the results of a study in patients suffering from chronic lower back pain, whose pain and discomfort had not reduced with the use of prescribed medications. These patients were subsequently treated for three months with Synofit®, a supplement that contains various effective, natural anti-inflammatory substances. Within three months the pain had decreased (noticeable reduction in pain was noticed from 6 weeks), the need for additional prescription drugs decreased and the associated, negative impact of the back pain on their daily lives had also reduced. There were no serious side effects reported or observed during the entire 3 month study. The researchers of the University hospital concluded that Synofit Premium Plus may be an effective, natural alternative for patients with chronic low back pain.