Low Back Pain
One of the most common physical disorders in this country is lower back pain. Estimates are that about 80% of people have at least one episode of lower back pain during their lifetime.
The back is formed of bones, muscles, nerves, and other supporting tissues that work together to allow us to stand and bend forward, backward, and side to side. The bones of the back are called vertebra and they are stacked on top of each other (sometimes called the back bone). They are held together by connecting tendons and long strands of fibrous tissue called ligaments. Each vertebra has a hole in the middle through which the spinal cord passes. There are openings on each side of the vertebra that allow small nerves to pass through from the spinal cord to the arms, legs, and organs.
Between each pair of vertebra is a disk composed of a tough outer layer of tissue and a gel-like inner pulp. These disks allow flexibility of the spine and also act as cushions or shock absorbers. Ligaments hold the vertebra together and allow them to move in unison.
There are a total of 24 vertebra that make up the spinal column including 5 vertebrae in the lower back or lumbar region. The vertebra are numbered so the first lumbar vertebra is known as L1 and the last is L5.
There are a number of causes of low back pain, but studies show that greater than 85 % of the cases are “nonspecific low back pain”, which means that there is not a specific disease or abnormality that is clearly causing the pain.
The most common specific diseases that can cause lower back pain are the following: a) Degenerative disk disease – Wear and tear, along with advancing age, leads to desiccation (drying out) of the disk resulting in small cracks and tears and loss of spinal flexibility. Calling this a disease is somewhat of a misnomer because these are expected changes that occur with aging. b) Facet joint arthropathy – The joints that connect one vertebra to another are called facet joints. Osteoarthritis can involve these joints and over time lead to the formation of bone spurs. These spurs are analogous to the bony prominences that occur in the joints of the hands when they are afflicted with osteoarthritis. Again, this is an expected occurrence with aging but can cause back pain in some people and no pain at all in others.
c) Spondylolisthesis – A condition in which one of the vertebra slips forward in relation to an adjacent vertebra. This can be congenital or result
from undue stress on the lower back and the condition can cause back pain with sciatica (pressure on the large sciatic nerve that runs from the lower back down the back of the leg) and at other times no symptoms at all. d) Herniated Disk – As previously described under degenerative disk disease, wear and tear on the disk, as well as aging, results in desiccation (drying) of the disk with loss of flexibility causing small tears and cracks. This can lead to herniation of a disk whereby the weakened outer layer allows extrusion of the soft inner tissue (slipped disk). This can cause compression of a nerve from the spinal cord and result in leg pain radiating from the back, as well as leg weakness. Herniated disks usually heal with time. More common than herniation are buldging disks which usually cause no symptoms except occasionally mild lumbar pain. e) Lumbar spinal stenosis – This is a condition whereby the vertebral canal (the opening in the center of the vertebra through which the spinal cord passes) becomes narrowed. This can cause compression on the spinal cord and pain that radiates down the lower back to the buttocks, thighs and lower legs. With severe cord compression, the legs can weaken resulting in a gait disturbance. The pain is more intense when the spine is straight (standing and walking) and some relief can be obtained with flexion of the spine while stooping or leaning forward.
Unless lumbar pain is caused by a serious medical condition, the vast majority of people will improve in 4-6 weeks with conservative treatment such as anti-inflammatory medication and appropriate exercises. Studies have shown that application of heat to the area is more effective than ice. Also, muscle relaxers are of little benefit. In our area, we are fortunate to have highly qualified physical therapists who can prescribe an appropriate exercise program.
Dr. Tippett is the founder of Comprehensive Quality Healthcare Providers, an internal medicine concierge practice located at 1210 Commerce Dr. Suite 106, Greensboro, Ga. 30642. He can be reached at 706-510-3659. Visit his webpage at www.drtippett.com