This is the most commonly injured area of the body with approximately 80% of people suffering with lower back pain at some point in their life. The pain might favour one side of the spine or spread across both sides. The pain might also radiate into the legs. The lumbar spine consists of five lumbar vertebrae with a disc (bag of jelly) in between each one to provide shock absorbency. Each vertebra articulates with the one above and one below via the facet joints. Pain can arise if the discs are injured, the nerves are compressed or the joint function is disrupted. Localised muscle spasm may also occur.
Who suffers from lower back pain.
Lower back pain can affect anyone but is increasingly common amongst people who sit at a PC workstation. People with physical jobs, builders, baggage handlers, etc have a high risk of suffering lower back pains. There are numerous primary anatomical pain sources.
Causes of lower back pain
Osteoarthritis / spondylosis
Spondylosis refers to spinal osteoarthritis, the age-related wear and tear of the spinal column. The degenerative process in osteoarthritis chiefly affects the vertebral bodies, which can reduce the size of the holes (neural foramina) where the nerves exit the spine and the joints between the vertebra (facet joints). If severe, it may cause pressure on the spinal cord or nerve roots which can result in the patient feeling pain, weakness, pins and needles or numbness in the legs.
This is when one vertebra slips forwards on the vertebra below. Spondylolisthesis can be caused by a number of factors:
- A birth defect in part of the spine.
- Repetitive trauma to the spine which can result in a defect developing in the spine, this is more common in gymnasts and weight lifters or anyone who arches their back repetitively.
- Arthritic changes in the spine where the vertebra become worn, this is more common in older patients.
- A sudden or traumatic injury to the spine such as a fracture.
If the vertebra slips backwards this is called a retrolisthesis (but is less common).
Degenerative disc disease (DDD)
This is a condition which there are anatomical changes and a loss of function of varying degrees of one or more intervertebral discs of the spine of sufficient magnitude as to cause symptoms. Normal downward forces cause the affected disc to lose height, and the distance between vertebrae is reduced. The outer shell of the disc, also weakens. This loss of height causes laxity of the ligaments which may allow shifting of the vertebral bodies and narrowing of the space available for the spinal cord within the vertebra (spinal stenosis); and/or narrowing of the space through which a spinal nerve exits ( neural foramen) with resultant inflammation and impingement of a spinal nerve.
Disc herniation, prolapse disc, disc bulge, slipped disc
Spinal disc herniation is an injury to the disc (bag of jelly) between vertebrae, usually caused by excessive strain or trauma to the spine. It may result in back pain or if pressing on a nerve the pain can radiate in the limbs. MRI scans are often recommended to determine the level and extent of the injury.
When a tear in the outer, fibrous ring of an intervertebral disc allows the soft, central portion to bulge out beyond the damaged outer rings, the disc is said to be herniated.
Disc herniation is frequently associated with age-related degeneration of the outer ring of the disc; it is normally triggered by trauma or straining by lifting or twisting. Tears are almost always postero-lateral (on the back of the sides) owing to the presence of the longitudinal ligament in the spinal canal. A tear in the disc ring may result in the release of chemicals causing inflammation , which can result in severe pain even in the absence of nerve root compression.
Disc herniation is normally a further development of a previously existing disc protrusion, in which the outermost layers of the anulus fibrosus are still intact but can bulge when the disc is under pressure. In contrast to a herniation, none of the central portion escapes beyond the outer layers. Most minor herniations heal within several weeks. Osteopathic treatment/advice and anti-inflammatory treatments for pain associated with disc herniation, protrusion, bulge, or disc tear are generally effective. IDD decompression Therapy can be used to help reduce the pressure on the discs. Severe herniations may not heal of their own accord and may require surgery.
The condition may be referred to as a slipped disc, but this term is not accurate as the spinal discs are firmly attached between the vertebrae and cannot “slip” out.
Spinal Stenosis/Foraminal Stenosis
Spinal stenosis is an abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots. Symptoms may include pain, numbness, or weakness in the arms or legs. Symptoms are typically gradual in onset and improve with bending forwards.
Lower back pain treatment options
As there are numerous causes of back pain the patient might find it difficult to determine the most effective approach to reducing the symptoms. If possible, gentle movement is to be encouraged but the patient should be limited by the pain. Anti-inflammatory medication can be effective.
Osteopathic treatment for lower back pain
Osteopathic treatment and advice can help improve the function of the spinal joints.
IDD therapy might be suitable for disc related injuries. Spinal injections, IDD Therapy or surgery might be the most appropriate treatment.