More than 80 percent of people have at least one episode of low back pain during their lifetime. Low back pain is described as "acute" (lasting four weeks or less), "subacute" (lasting 4 to 12 weeks), or "chronic" (lasting more than 12 weeks).
If your episode of back pain resolves, you do not need to consult unless you have specific questions or concerns. If you do we are happy to advise.
Low back pain can be caused by problems with the muscles, ligaments, discs, bones (vertebrae), or nerves. Often, back pain is caused by strains or sprains involving the muscles or ligaments. These problems cannot always be seen on imaging tests, such as MRI or CT scans.
WHEN IT IS IMPORTANT TO SEEK HELP
Most of the time, an episode of back pain will get better on its own and does not require extensive testing or treatment. Some people with low back pain should be evaluated and managed by a primary care provider. If low back pain is caused by a serious condition, a neurosurgeon or orthopedist who specializes in back disorders is usually recommended.
It's a good idea to see your health care provider if you have:
New back pain if you are 70 years or older.
Pain that does not go away, even at night or when lying down.
Weakness in one or both legs or problems with bladder, bowel, or sexual function – These can be signs of cauda equina syndrome, and they result from compression of the nerve bundle at the base of the spine. These symptoms should be evaluated as soon as possible.
Back pain accompanied by unexplained fever or weight loss.
Back pain with a history of cancer, a weakened immune system, osteoporosis, or the use of corticosteroids (eg, prednisone) for a prolonged period of time.
Back pain that is a result of falling or an accident, especially if you are older than 50 years.
Pain spreading into the lower leg, particularly if accompanied by weakness of the leg.
Back pain that does not get better within four weeks.
Nonspecific back pain
Most have "nonspecific" low back pain, which means that the pain is not clearly caused by a specific or identifiable abnormality. This often represents a strain of the muscles in the lower back, and it can be severe.
- Typically improves on its own within a few weeks
- Apply heat and avoid prolonged bedrest
- A return to being active as soon as you feel able can help speed your recovery
Serious potential causes - Rare
- Cauda equina syndrome is a rare and severe type of spinal stenosis where all of the nerves in the lower back suddenly become severely compressed. Symptoms include: sciatica on both sides. weakness or numbness in both legs that is severe or getting worse. numbness around or under your genitals, or around your anus.
- Spinal Infection
- Spinal Tumor
- Compression Fractures - Consider in patient likely to have Osteoporosis
Disc Degeneration aka "Degenerative disc disease"
The intervertebral discs are comprised of a leathery outer layer termed the annulus fibrosus. and a softer jelly-like central component termed the nucleus pulposus. The slowly progressive and somewhat age related degenerative process results in the gradual mechanical deterioration of both. The central nucleus polposus slowly loses it's ability to hold onto water and becomes increasingly dehydrated and reduces in volume and height. Fissures can appear within it's substance.
The outer annulus, which is made up of sheets of fibers in varying orientations is, in health, extremely strong and able to contain the nucleus even when place under significant pressure. With time however the fibers of the annulus also deteriorate.
Calling this condition a "disease" is somewhat misleading because these changes occur with normal aging. While the changes in the discs can cause back pain, there are many people with degenerative disc disease who have no symptoms.
Bulging and herniated discs
As the fibers of the annulus deteriorate and can become incompetent - stretching or tearing this can result in the disc bulging or the central nuclear material to herniating out of position. People often refer to this as a "slipped disc."
The Lumbar Disc bulge or herniation can then press on the lumbar nerve roots resulting in symptoms of pain, weakness and sensory disturbance in the buttocks and radiating down the legs. This is termed Sciatica. A very large disc prolapse can cause 'Cauda Equina Syndrome"
- NB - herniated discs are also commonly seen on MRI Scans of adults without back pain.
Osteoarthritis
Osteoarthritis tends degrade the joints that connect the vertebrae to one another, called the facet joints. This condition, known as Facet Joint Arthropathy, can lead to bone spurs around the joint and may cause low back pain. However, like degenerative disc disease, facet joint arthropathy is very common with aging and many people with this condition have no symptoms.
Spondylolisthesis
Spondylolisthesis is a condition in which one of the vertebrae of the lower spine "slips" forward in relation to another. Spondylolisthesis is usually degenerative developing in part from facet joint arthropathy. There are other underlying causes of Spondylolisthesis involving a mechanical bony defect resulting in the slip.
Lumbar spinal stenosis
Spinal stenosis is a condition in which the central vertebral canal through which the lumbar nerve and Cauda Equina pass, is narrowed.
This narrowing is usually due to a combination of degenerative processes including;
- Thickening of the internal ligaments (Ligament Hypertrophy)
- Facet Joint Arthropathy (leading to Facet Joint Hypertrophy)
- Disc Bulging
/ herniation
Symptoms commonly described include back and leg pain when standing upright or walking. Associated sensory disturbance is not infrequent. These neurological lower limb symptoms that are precipitated by walking are termed Neurogenic Claudication.
Ankylosing spondylitis
An important inflammatory condition; Patients often describe stiffness in the morning that improves with physical activity. Ankylosing spondylitis over time may result in the fusion of the Sacroiliac Joints and progressive fusion of the vertebrae of the spine, further increasing stiffness and reducing range of motion.
When should I seek medical attention?
- Pain following severe Injury
- Severe pain
- Numbness or weakness in your arms or legs
- Diminished control over your bladder or bowels
- Pain that doesn't get better after you treat it at home for 1 week
Diagnosis
At the time of initial assessment for Low Back Pain many people will not require any tests. Your symptoms will be discussed and an examination performed on the Back and the nerves of the legs.
But some people will require need tests including:
X-ray, CT scan, MRI scan, or other imaging tests
Blood tests
Neurophysiology - An electrical examination of the Nerve / Muscles.