Low back pain – Part 1: Causes and prevention

(Part one of three)

If you haven’t experienced the agony of lower back pain, chances are you will at some time in your life. More than 65 million Americans suffer from low back pain, and 8 out of 10 Americans will have acute low back pain at some point in their life.

There is much to learn about the causes and treatment of low back pain, so this is the first in a series of three blogs on the topic. Stay with me, and I’ll cover:

  • Causes and prevention of back pain
  •  When to see a doctor and what type of doctor to see
  • Current treatments and some resources to learn even more.

Most of the back pain that I see in my office is due to one of two things: muscle strain or a pinched nerve.

Muscle strain
Muscles run along the spinal column on both sides. A pulled muscle in the low back (a "lumbar strain") causes pain in the muscles to the right or the left of the spine in the low back (or both). It generally does not go into the buttocks or legs, but stays in the low back. It can be triggered by such activities as bending, twisting or incorrectly lifting.

Pinched nerve
The spine is made up of bones (vertebrae) separated by discs. There are 5 vertebrae in the lumbar spine, numbered L1 to L5. The vertebrae are the building blocks of the spine, which protect the spinal cord, and the discs are the "shock absorbers" of the spine. The discs consist of a gel surrounded by a thick fibrous coating. A bulging disc, or herniated disc, occurs when the gel bulges through the coating. Nerve roots leave the spinal canal through small openings between the vertebrae. If you have a bulging disc in the low back, the bulge can narrow the opening and pinch the nerve root as it passes through the opening. This causes pain, and sometimes numbness or tingling, in the area where that nerve goes. Also, arthritis in the spine can pinch the nerve root and feel just like a herniated disc.

For example, if you have a bulging disc between the 2nd and 3rd lumbar vertebra (L2-L3), and it pinches the L2 nerve root, you may experience back pain with aching, burning or shooting pain, numbness and tingling in the thigh, sometimes going down into the lower leg or foot. Symptoms are similar with a pinched L3 or L4 nerve root. If L5 is pinched, the back pain will radiate down the outside of the leg, often into the foot. If there is a pinched nerve one level lower, which is called "S1," pain will go down the back of the leg into the foot. Numbness and weakness can accompany any of these pinched nerves. Pain may be worsened by coughing or sneezing.

What about prevention?
Here are a few things you can do to prevent back injury:

  • Perform your core strengthening and hamstring stretching exercises daily (even when you have no pain, as a preventive measure). Often, when I see patients with recurrent back pain, it's because they stopped doing their exercises!
  • When lifting, squat down and lift with your legs, rather than bending over to pick things up.
  • Maintain good posture when sitting for a long period: sit upright (no slouching!) with your feet on the floor. You can use a small pillow in the low back area if the chair has poor lumbar support. Get up and walk around periodically.
  • Avoid high heels.
  • Reduce weight around your mid-section, which puts extra stress on the low back.

Hopefully these tips will help you to better understand and manage your low back pain. What have you found helpful in preventing or treating your back pain? Any tips that you can share with your fellow back pain sufferers?

Next –  Part 2: When to see a doctor
 

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