Lower Back Pain

Lower back pain is pain affecting the lower area of the back. It is described  as follows :-

• Acute if it has lasted less than 6 weeks.
• Sub-acute if it has lasted 6-12 weeks.
• Chronic if it has lasted more than 12 weeks.

Lower back pain is very common, costing millions in lost work, as well as millions in medical, state and insurance resources every year.

Symptoms

Lower back pain means a pain or ache somewhere between the bottom of the ribs, at the back, and the top of the legs. The pain often begins suddenly, and may follow an obvious strain or injury, but may seem to occur over time or instantly.

The pain may travel to or be felt elsewhere. It often goes into the buttocks, but may go further down the leg and even into the foot.

The pain feels greater when bending and is often worse sitting, especially in an easy chair. Sometimes turning over in bed and sitting up are agonising. Coughing or sneezing can often make the pain much worse. The muscles of the back may go into painful spasm.

Back pain may be combined with pain into the leg, travelling down below the knee, this is otherwise known as sciatica, because the main nerve to the leg (the sciatic nerve) is being irritated by pressure applied.

In this section I have been talking about what we term simple or mechanical back pain, which is far and away the most frequent cause of low back pain. There are various other symptoms which may go with back pain, some of which suggest problems other than back problems, and some of which point to the need for more urgent action by you and your doctor.

Causes

Low back pain is common affecting millions of people. The main cause for low back pain is a strain of the muscles, or other soft structures (eg ligaments and tendons) connected to the back bones . Sometimes it is the cushion between the bones (intervertebral disc) which is strained, and which bulges out and presses on the nearby nerves (as in sciatica).

Various other conditions can cause back pain, and if in doubt about what is causing your pain, you should consult your doctor or chiropractor.  Bad seating posture and sleeping position can cause the lower back region to become inflammed resulting in a bad back.

Diagnosis

If in doubt, consult your doctor, a physiotherapist, a chiropractor, an osteopath or a back pain specialist.

The UK has guidelines for doctors and medical professionals on how best to manage a person with back pain. These guidelines cover many aspects, but there are some main principles which are most important.

The first thing is to rule out any other obvious conditions which also cause back pain. There are a number of "red flags", or warning signs, which are factors which lead the doctor to arrange for more rapid investigation and treatment than would otherwise be necessary. They may point to something more serious going on than simple, or mechanical back pain. If any of them applies to you, you should see your doctor soon:

• You are younger than 20 or older than 55 when you get back pain for the first time.
• The pain follows a violent injury, such as a road traffic accident (RTA). A sudden jerking reacation during an accident can cause significant nerve damage resulting in lower back pain.
• The pain is constant and getting worse.
• The pain is in the upper part of the spine.
• You have had a serious illness such as cancer in the past or at present.
• You are on anabolic  steroids.
• You are a drug abuser.
• You have lost significant weight.
• You continue to have great difficulty bending forwards or stretching.
• You have developed a number of problems in your nervous system
• You have developed an obvious structural deformity of your spine, this may be from birth or genetic.
• You should also see your doctor if the pain is continuing for more than 4-6 weeks.

Investigations

An X-Ray is unhelpful as this does not show musclar damage of the lumbar region, so do not worry if your doctor does not arrange an x-ray appointment.  Sometimes your doctor will arrange blood tests to eliminate other causes of back pain.

When the pain has continued for a few weeks, your doctor or a specialist may arrange a CT (Computerised Tomography) or MRI (Magnetic Resonance Imaging) scan. These are more likely to be helpful, as they show up the soft structures in the spine, as well as the bones.  

Treatment

The main thing about most low back pain is do not worry - it will usually get better on its own, within a few days, or possibly a few weeks.

Stay active, and if at all possible, stay at work.

The pain may force you to rest, but this is a result of the pain, and not a good treatment for back pain. If you have to take to your bed, limit it, if possible, to a day or two at the most.

Use simple pain killers, such as paracetamolor ibuprofen if necessary.

Avoid activities likely to put unnecessary strain on your back, consult medical expertise.

See your doctor if you think you are in one of the red flag categories.

If it seems to be lasting more than a few days, consider seeing a physiotherapist, chiropractor or osteopath, as it may be that the treatments they use (such as manipulation) will help aid your recovery. You may wish to consult your doctor prior to this.

If you do have to be off work, keep this to a minimum, and do not expect to be pain free before you go back.

If in doubt, consult your doctor.

Severe low back pain

If the pain goes on for more than 12 weeks, it is said to be chronic. In these instances, manipulation appears to be less likely to be helpful. Your doctor may arrange for you to have a course of back rehabilitation, to help you get going again.

Prevention

Stay fit. Regular exercise to keep generally fit is more important than any specific exercises aimed at the back muscles.

Be aware of the posture and position you are in during your daily activities. If you have to lift heavy objects, share the load with other people, and try to hold the weight in close to your body, bending at the knees when possible rather than your back.

If carrying heavy objects or loads try to carry similar loads on both sides to balance the weight rather than trying to carry too much.

School bags are typically far too heavy and often worn on only one shoulder. Try to leave books that you do not need that day in your locker or at home, and wear a rucksack type of bag correctly positioned on both shoulders. Using a good rucsack will disperse the weight evenly, resulting in less strain on your back

source: medinfo.co.uk