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Causes and Treatment of Low Back Pain

What do you do when you have back pain? In part 2 of our low back pain series, learn the more common causes and treatment of low back pain.

By
Sanaz Majd, MD,
March 2, 2017
Episode #234

Page 1 of 2

The main causes of low back pain include muscle strain, herniated disks, arthritis, and more.  You can treat low back pain with ice/heat, stretching, a back brace, and more. Keep reading to hear the main causes and treatments.

Last episode, we tagged along with Lori, a 46-year-old bakery owner who went to see her doctor for three days of low back pain. We learned what types of questions doctors want to know when evaluating low back pain, we reviewed the anatomy of the lower back spine, and the more worrisome signs/symptoms that require immediate attention. We will now review the causes of low back pain, explain how sciatica can play a role, discuss imaging considerations, and finally the treatment grand finale.

Causes of Low Back Pain

Muscle strain:  This is by far the most common cause of acute low back pain. We see this in those who bend or lift, carry heavy loads (carrying children is a common culprit), prolonged sitting or driving long distances, improper posture, or improper ergonomics at the work station or while working at home. The muscle gets pulled, overstretched, or stiffened, and subsequently becomes inflamed. This can take weeks to resolve, but should improve through time. It can be repetitive or chronic, however, if the improper activity triggering it also persists.

Herniated disk: The words “herniated disk” can sound a little intimidating and scary. Bending over or lifting heavy objects can cause strain on the back that causes the disk inside the spine to “pop out” (hence, “herniate”). But truthfully, it is typically a benign and self-resolving pain. In fact, if you MRI a sample of the population randomly, many of us may have a herniated disk.  But we don’t all have pain. The treatment is similar to muscle strains.

Arthritis: “Degenerative” changes in the spine are a finding that is often reported on a low back x-ray and reflects arthritis. Like herniated disks, many of us may have these changes and it’s not always the cause of the pain. If the changes are significant enough, however, it can irritate the structures of the lower back.

Spinal Stenosis:  This is also another finding that is reported on imaging. The spine has a central canal (think of it like a hose) that houses the nerves that run down the spine (like water in a hose). If this canal is “stenotic,” or tightened, then it can impinge on the nerves and cause sciatica, tingling, numbness, or weakness in the legs. Mild and Moderate stenosis is not always of concern, but if it’s severe and/or the symptoms become chronic then it’s something that may require further evaluation.

Weight gain:  There’s no doubt, as Lori has realized, that the more weight you carry on your joints and muscles the more likely to injure those structures. The same goes for the lower back. Weight loss is key.

Spine compression fracture:  Compression fractures are fractures of the spine that cause it to compress, sometimes losing height if severe enough.  They are more of a concern in the elderly population, those with osteoporosis (bone loss) or risk factors for osteoporosis, and those with trauma.

Other less common causes: Cuada equine syndrome, spinal infections, epidural abscesses, vertebral osteomyelitis, and transverse myelitis are much, much less common causes of low back pain. But are often an emergency. Make sure to review the previous low back “red flags” discussed in the previous episode that can be caused by these serious low back conditions.

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