Lower Back Pain - Causes and Symptoms

Lower back pain can be caused by a variety of problems with any parts of the complex, interconnected network of spinal muscles, nerves, bones, discs or tendons in the lumbar spine. Typical sources of low back pain include:

· The large nerve roots in the low back that go to the legs may be irritated

· The smaller nerves that supply the low back may be irritated

· The large paired lower back muscles (erector spinae) may be strained

· The bones, ligaments or joints may be damaged

· An intervertebral disc may be degenerating

An irritation or problem with any of these structures can cause lower back pain and/or pain that radiates or is referred to other parts of the body. 

Many lower back problems also cause back muscle spasms, which do not sound like much but can cause severe pain and disability. In addition, the severity of lower back pain vary greatly. For example, a simple lower back muscle strain might be excruciating enough to necessitate an emergency room visit, while a degenerating disc might cause only mild, intermittent discomfort. 

Identifying the symptoms and getting a diagnosis that pinpoints the underlying cause of the pain is the first step in obtaining effective pain relief.

Certain causes of lower back pain have a tendency to occur more often in younger individuals versus older adults.

Younger adults (30 to 60 years old) are more likely to experience back pain from the disc space itself (for example, lumbar disc herniation or degenerative disc disease) or from a back muscle strain or other soft tissue strain.

Older adults (over 60) are more likely to suffer from pain related to joint degeneration (such as osteoarthritis or spinal stenosis) or from a compression fracture.

 

Facet joint osteoarthritis

Facet joint osteoarthritis (also called degenerative arthritis or osteoarthritis of the spine) is a degenerative condition that develops gradually over time. The pain is caused by the breakdown of the cartilage between the facet joints in the spine. At first the symptoms may only be intermittent, but can later develop into steadier pain in the lower back, and may eventually cause sciatica in addition to lower back pain. The symptoms include any combination of the following:

· Unable to walk far without developing leg pain

· Lower back pain relief is achieved quickly after sitting down

· Symptoms fluctuate between severe and mild/none

· Symptoms develop gradually over time

 · Weakness, numbness, and tingling that radiates from the low back into the buttocks and legs (sciatica)

 

Lumbar spinal stenosis (or degenerative spondylolisthesis)

Both spinal stenosis and degenerative spondylolisthesis can place pressure on the nerves at the point where they exit the spine. Standing upright, such as in normal walking, increases pressure on the nerve and results in leg pain. The symptoms include any of the following:

· Sudden onset of back pain

· Standing or walking will usually make the pain worse

· Lying on one's back makes the pain less intense

· Height loss

· Limited spinal flexibility

· Deformity and disability

 

Spinal compression fracture

It occurs especially to post-menopausal women with osteoporosis and to men or women after long-term corticosteroid use. In a person with osteoporosis, even a small amount of force put on the spine, as from a sneeze, may cause a compression fracture.

Less Common Causes of Lower Back Pain

While less common than the above listed conditions, a number of other conditions can cause low back pain as well, including but not limited to:

· Piriformis syndrome

· Infection

· Spinal tumor

· Fibromyalgia

· Ankylosing spondylitis

· Coccydynia

It is important to note that one’s attitude and situation also have an effect on pain levels and duration. For example, people who are depressed, under stress, or have a compensable back injury are more likely to have their pain become chronic. Patients who are stress free and have little complicating psychological factors are more likely to improve with appropriate treatment for their conditions.

Most cases of low back pain do not require urgent care, but anyone should consult a doctor immediately if low back pain is a result of trauma, or if pain is accompanied by any of the following symptoms:

· Fever and chills

· Unexplained recent weight loss

· Significant leg weakness

· Sudden bowel and/or bladder incontinence—either difficulty passing urine or having a bowel movement, or loss of control of urination or bowel movement (cauda equina syndrome)

· Severe, continuous abdominal pain (abdominal aortic aneurysm)