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Low Back Pain

Definition:
Low back pain is an ache or discomfort in the area of the lower part of the back and spinal column. The lower spinal column consists of many small bones that surround and protect the spinal cord and nerves. Low back pain is very common, affecting most adults at some point in their lives.

Causes:
There are many possible causes for low back pain, including:
  • Sprain or strain of muscles or ligaments in the area (most common cause of back pain)
  • Herniated (ruptured) disc–the cushions between the bones of the spine bulge out of place
  • Disc degeneration, caused by aging or arthritis
  • Spinal stenosis–narrowing of the spinal canal in the lumbar area
  • Spondylolisthesis–slippage of a bone in the low back
  • Fractures due to trauma and/or osteoporosis
  • Fibromyalgia–a condition that causes muscle aches and fatigue
  • Ankylosing spondylitis–a hereditary disorder involving the spine
  • In rare cases:
    • Benign or malignant tumors
    • Infections
    • Arterial problems such as hardening of the arteries
Risk Factors:
A risk factor is something that increases your chance of getting a disease or condition.

Risk factors include:

  • Family members with back problems
  • Pregnancy
  • Obesity
  • Lack of regular exercise
  • Smoking
  • Injury
  • Preexisting back injury due to:
    • Lifting a heavy object
    • Improper lifting
    • Sudden movement, bending, or twisting
    • Prolonged sitting or standing
    • Bad posture
    • Vibration from vehicles or heavy equipment
  • Prior back surgery
  • Other factors which may negatively influence back pain include:
    • Psychological factors, such as low job satisfaction
    • Fatigue or sleep deficit
    • Drug or alcohol abuse
    • Stress
Symptoms:
Pain is usually localized in the low back. If a nerve is irritated, the pain may extend into the buttock or leg on the affected side, and muscle weakness or numbness may be present.

More serious symptoms associated with back pain that may require immediate medical attention include:

  • Pain that doesn't improve, or worsens, with rest
  • Pain that is severe or that has gotten dramatically worse
  • Progressive weakness in a leg or foot
  • Difficulty walking, standing, or moving
  • Numbness in the genital or rectal area
  • Loss of bowel or bladder control
  • Difficulty with urination
  • Fever, unexplained weight loss, or other signs of illness
Diagnosis:
The doctor will ask about your symptoms and medical history, and perform a physical exam. In particular, the doctor will examine your back, hips, and legs and usually will test for strength, flexibility, sensation, and reflexes.

Other tests may include:

X-ray–a test that uses radiation to take a picture of structures inside the body, especially bones

CT Scan–a type of x-ray that uses a computer to make pictures of structures inside the body and gives a good picture of the vertebrae and the spinal canal

MRI Scan–a test that uses magnetic waves to make pictures of structures inside the body and shows the intervertebral discs and any abnormality of the discs

Blood Tests–such as complete blood count or sedimentation rate

Urine Test–to check for urinary infection or blood in the urine

Treatment:
Treatment options include:

Bed Rest–resting on a firm mattress or pad on the floor for 1-2 days, followed by a gradual return to daily activities. Research indicates that longer bed rest may slow the recovery process.

Medication

  • Pain relievers such as acetaminophen (Tylenol), aspirin, or ibuprofen
  • Muscle relaxants for muscle spasm
  • Cortisone injections
  • Antidepressants for depression due to chronic pain

Physical Therapy

  • Hot or cold packs
  • Stretching and strengthening exercises for back and abdominal muscles
  • Education about how to deal with back problems
  • Massage
  • Ultrasound treatments or electrical stimulation

Alternative Medicine

  • Relaxation training
  • Biofeedback
  • Acupuncture
  • Chiropractic or osteopathic manipulation

Surgery–may be needed if nerve problems develop or other treatments fail to provide relief. Common procedures are discectomy, laminectomy, and spinal fusion.

Prevention:
The following steps may help you avoid low back pain:
  • Sleep on a firm mattress.
  • Exercise regularly, at least 30 minutes most days of the week. Good choices include walking, swimming, or activities and exercises recommended by your doctor or physical therapist.
  • Lose weight if you're overweight.
  • Stop smoking.
  • Practice good posture to reduce pressure on your spine.
  • Avoid sitting or standing in one position for prolonged periods.
  • If you must remain standing for long periods, rest one foot at a time on a small stool to relieve pressure on your low back.
  • When lifting, hold the object close to your chest, maintain a straight back, and use your leg muscles to slowly rise.
  • Consider job retraining if your work requires a lot of heavy lifting or sitting.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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