Causes of Lower Back Pain – What You Should Know
Before one considers the causes of lower back pain, it is imperative to mention again that lower back pain is not a disease, but a symptom. A manifestation of abnormalities in the muscles, ligaments, and nerves of the back and possible disease processes developing in the abdomen or pelvis, such as in the kidneys.
Because many diseases could produce lower back pain, cited here are the most common causes of lower back pain.
- Bad posture, especially when lifting heavy objects (the mere act of lifting an object greater than your body weight could lead to back pain and is one among the many causes of lower back pain.
- Trauma and fractures
- Non-specific strain or sprain of the back muscles, ligaments, and soft tissues
- Mechanical causes such as disc degeneration in spondylosis, stenosis of the spine, disc herniation, spinal abnormalities such as scoliosis, and leg length difference (one leg is shorter than the other)
- Inflammatory conditions, like rheumatoid arthritis and spondylitis
- Infections, like osteomyelitis, epidural abscess, and Post-herpetic neuralgia, cause nerve inflammation
- Metabolic conditions, such as osteoporosis and osteomalacia
- Tumors of the bone and spine that would compress upon the nerves
- Referred pain, such as in kidney disease and prostate cancer
- Pinched nerve, which correctly termed as nerve root impingement (direct irritation on a nerve) or nerve root syndromes, such as sciatica and cauda equina syndrome.
- Healthy pregnancy (the increasing weight and the load of carrying a child causes lower back strain, nerve irritation, and stretching of pelvic ligaments)
- Musculoskeletal pain syndromes, such as fibromyalgia (characterized by generalized pain, tenderness, stiffness, and fatigue) and myofascial pain (with pain and tenderness felt in localized areas called “trigger points,” which follow the dermatomal or radiating pattern of a peripheral nerve)
Depression has also cited as one of the lower back pain causes. However, studies on lower back sufferers using antidepressants as treatment have produced inconclusive results.
Causes of Lower Back Pain – Characteristics
It is important to consider the character of the lower back pain because knowing how intense the pain is and where it will give the doctor vitals clues on the causes of the pain.
The causes of lower back pain arise primarily in the lumbosacral region (or the lower part of the back). The pain may confine to the lower back, or it may radiate to the back, front or side of one leg. In cases of pinched nerves like sciatica, numbness may be felt in the leg that is being innervated by the affected nerve. Commonly, lower back pain is one-sided. Depending upon the affected nerve, the pain may be felt on the left side or the right side.
Certain conditions may aggravate lower back pain. Strenuous and high-impact activities and heavy lifting may make the pain worse. Lower back pain may also worsen when lying down or when sitting (like while taking a long trip in a car) or standing for a prolonged period.
Lower back pain may be acute, sub-acute or chronic. Pain with a duration of fewer than four weeks is called acute. The pain of more than 12 weeks duration is chronic. Between 4 to 12 weeks duration, the lower back pain is characterized as sub-acute.
Doctors also ask patients to describe their lower back pain with the use of a Pain Scale from 0 to 10, with 0 as no pain to 10 for severe pain.
The character of lower back pain could give clues to the doctor on what is causing it. For example, numbness and weakness in one leg are indicative of a compressed nerve. Compression of the 5th lumbar nerve (L5) is suspected if the patient could not move his big toe upward. Fifth sacral nerve compression is entertained if the patient could not stand on his toes or bring his foot downward (known as plantar flexion).
While it is highly recommended that lower back pain sufferers seek medical attention, there are warning signs — known as “Red Flags” — which when accompanied by lower back pain warrant immediate emergency care.
Causes Of Lower Back Pain – Red Flags of Lower Back Pain :
- Recent significant trauma (fall from a height, motor vehicle accident, or similar incident)
- Recent mild trauma in patients 50 years old and above (such as slipping and landing on the buttocks and falling down a few steps)
- Chronic steroid use (especially patients with asthma, COPD, and rheumatologic disorders)
- Osteoporosis
- Individuals older than 70 years old: There is an increased indication that lower back pain in this age group by infections, cancer, and abdominal disorders
- Unexplained fever of over 100 degrees Fahrenheit
- History of recent infection
- History of previous or current cancer
- Intravenous drug use
- Unexplained weight loss
- Lower back pain worsens at rest: Pain may be of infectious (such as with a kidney infection) or malignant origin
- Presence of a focal neurologic deficit: Inability to walk, raise or lower the foot at the ankle, failure to move big toe upward, inability to walk on heels or stand on toes
- Loss of bowel or bladder control, including incontinence (difficulty in starting or stopping passage of urine), are symptoms of cauda equina syndrome (CES) and is considered a serious medical emergency.
All of these Red Flags warrant that the patient goes to the hospital for immediate determination of the causes of lower back pain and the institution of emergency care.