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Understanding the Lower Back

About 8 in 10 people have experienced low back pain. The lower back is also called the lumbosacral area of the back. It is the part of the back between the bottom of the ribs and the top of the legs. Most of the lower back is made up from muscles that attach to and surround the spine. The spine is made up of many bones called vertebrae. The vertebrae are roughly circular and between each vertebra is a disc. The discs between the vertebrae are a combination of a strong fibrous outer layer and a softer, gel-like centre. The discs act as shock absorbers and allow the spine to be flexible. Strong ligaments also attach to nearby (adjacent) vertebrae to give extra support and strength to the spine. The various muscles that are attached to the spine enable the spine to bend and move in various ways. The spinal cord, which contains the nerve pathways to and from the brain, is protected by the spine. Nerves from the spinal cord come out from between the vertebrae to take and receive messages to various parts of the body.

What are causes and symptoms for back pain?

 

One of the main causes of back pain, whether acute or chronic, is a lower back strain.

 

The most common type of back pain is nonspecific. About 19 in 20 cases of sudden-onset (acute) low back pain are classed as nonspecific.

-This is the type of back pain that most people will have at some point in their life.

-It is called nonspecific because it is usually not clear what is actually causing the pain. In other words, there is no specific problem or disease that can be identified as the cause of the pain.

*The severity of the pain can vary from mild to severe.

*This occurs in less than 1 in 20 cases of acute low back pain.

* Nonspecific low back pain means that the pain is not due to any specific or underlying disease that can be found.

 

Nerve root pain means that a nerve coming out from the spinal cord (the root of the nerve) is irritated or pressed on (Often referred to as a trapped nerve.)

-You feel pain along the course of the nerve.

-Therefore, you typically feel pain down a leg, sometimes as far as to the calf or foot.

-The pain in the leg or foot is often worse than the pain in the back.

-The irritation or pressure on the nerve may also cause pins and needles, numbness or weakness in part of a buttock, leg or foot.

-About 9 in 10 cases of nerve root back pain are due to a Prolapsed Disc – often called a Slipped Disc.

                 *A disc does not actually slip.

                 *What happens is that part of the inner softer part of the disc bulges out (prolapses) through a weakness in the outer harder part of the disc.

                 *The prolapsed part of the disc can press on a nerve nearby.

 

Other less common conditions can cause pressure on a nerve to cause nerve root pain.

-Cauda Equina Syndrome is rare and requires immediate care as it is a particularly serious type of nerve root problem.

-This is a rare disorder where the nerves at the very bottom of the spinal cord are pressed on.

-This syndrome can cause Lower back pain plus problems with bowel and bladder function (usually unable to pass urine), numbness in the saddle area (around the back passage around the rectum and anus), and a weakness in one or both legs.

-This syndrome needs urgent treatment immediately to prevent the nerves to the bladder and bowel from becoming permanently damaged. If you suspect Cauda Equina Syndrome – see a doctor immediately.

  • Inflammation of the joints (arthritis) of the spine sometimes causes back pain.

-Osteoarthritis is the common form of arthritis and usually occurs in older people.

-Ankylosing spondylitis is another form of arthritis that can occur in young adults and causes pain and stiffness in the lower back.

-rheumatoid arthritis may affect the spine, but you are likely to have other joints affected too.

 

Various uncommon bone disorders, tumors, infections, and pressure from structures near to the spine occasionally cause low back pain, less than 1 in 100 cases of low back pain.

In other cases, the cause may be a minor problem with a disc between two vertebrae, or a minor problem with a small facet joint between two vertebrae.

Sometimes a pain may develop immediately after you lift something heavy, or after an awkward twisting movement.

Typically, the pain is in one area of the lower back but sometimes it spreads to one or both buttocks or thighs. The pain is usually eased by lying down flat. It is often made worse if you move your back, cough, or sneeze. So, nonspecific low back pain is mechanical in the sense that it varies with posture or activity.

How long does the pain occur?

Most people with nonspecific low back pain improve quickly, usually within a week or so, sometimes a bit longer. However, once the pain has eased or gone it is common to have further pain (recurrences) from time to time in the future. Also, it is common to have minor pains on and off for quite some time after an initial bad case of pain. In a small number of cases the pain persists for several months or longer. This is called chronic back pain. Most people who develop Lower back pain that comes on suddenly (acutely) have non-specific Lower back pain. If there are no other associated symptoms and the pain is not too bad, many people are confident to just deal with it and treat it themselves. As a general guide, if any of the following occur then it may not be nonspecific Lower back pain, and there may be a more serious underlying cause. But note: the vast majority of people with Lower back pain do not have any of the following symptoms or features. They are included here for completeness, and as an aid to what to look out for and to tell us should they occur.

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