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Low Back Pain (LBP)

X-ray image illustrates low back pain which is highlighted in red.
Published by Dr. Umesh Srikantha on April 12, 2020

Low and lower back pain can vary from dull pain that develops gradually to sudden, sharp or persistent pain felt below the waist. Unfortunately, almost everyone, at some point during life will experience low back pain that may travel downward into the buttocks and sometimes into one or both lower extremities.

A man with low back pain holds his back.

  • 75 % of adults have at least one episode of disabling back pain.
  • By the end of 3rd decade, 50% of people have experienced an episode of LBP that required alteration in activity.
  • In spite of “optimal management” 5% of acute back pain progresses to a chronic and disabling endpoint

An infographic image showing the neck and back pain statistics.

Low back pain is very common. It is the

  • Fifth leading symptomatic cause for physician visits
  • Third most common cause for surgical procedures
  • Fifth most common reason for hospitalization
  • First most common reason for filing workers’ compensation claims1

Risk Factors for LBP:

  • Age – risk increase with advancing age
  • Heavy lifting and twisting – both sudden and chronic
  • Obesity
  • Poor physical fitness/conditioning
  • Poor postural habits
  • History of trauma
  • Smoking
  • Psychiatric history (chronic LBP)

Causes of LBP

LBP can be caused by a variety of factors. It can arise from the bones of the back (vertebrae); intervertebral discs that are present as cushions in between the 2 vertebrae; various joints in the back (Facet joint/ Sacroiliac joint); ligaments supporting these joints and also from the supporting muscles (paraspinal muscles). Majority of muscular causes subside within a weeks time.

The important spinal conditions responsible for LBP are listed below

  • Herniated disc or Slipped disc – Disc herniation is a condition where the soft gel like portion of the disc comes out of its protective covering. It can also cause radiating pain the leg if it starts affecting the nerve and in severe cases it can cause nerve damage as well (Numbness/ weakness).
  • Spinal stenosis develops when the spinal canal or a nerve passageway abnormally narrows. This is a result of several degenerative changes in the ligaments, disc and the facet joints.
  • Spinal arthritis, also called spinal osteoarthritis, is a common degenerative spine problem. It is age related and affects the spine’s facet joints and sacroiliac joints.
  • Spondylolisthesis occurs when one of the vertebral bones slips forward in relation to the one below it. Increased slippage can cause progressive LBP and can also cause nerve compression.
  • Vertebral fractures (burst or compression types) are often caused by some type of trauma (eg, fall). In elderly patients, it can also be caused spontaneously or even with minor events.
  • Osteomyelitis is a bacterial infection that can develop in one of the spine’s bones. Infection can also spread to the discs or the nerves in some cases
  • Spinal tumors are an abnormal growth of cells (a mass) and are diagnosed as benign (non-cancerous) or malignant (cancer). It can affect the vertebral bone, covering of the nerves (Dura) or the nerves themselves.

Treatment options for LBP:

Since the causes of LBP are very varied, the treatment also varies according to the cause.

The first line of treatment (home based) will always consist of

  • Bed rest – either relative rest or absolute rest based on the severity of pain
  • Local application of ice packs followed 24-48 hours later by heat. In the initial phase ice reduces swelling, pain and spasms. Once acute pain subsides, switching over to heat (hot water bag application) reduces spasm and warmth relaxes the muscles.
  • Over the counter analgesics – (Paracetamol or Diclofenac) (It is strongly recommended to consult a doctor before self medication)

Of course, it is not recommended to continue home based treatment for prolonged periods, especially when there is no adequate relief. The following ‘Red flags’ will help you to decide when to consult a doctor.

Consult a doctor in case of emergency.

When to consult a doctor: The red flags of back pain

Presence of these symptoms should alert to a more serious underlying cause and a prompt consultation with your doctor is recommended in such cases-

  • Leg pain > Back pain
  • Neurological deficits (weakness/ numbness)
  • Bladder or bowel dysfunction

Cartoon image describes a doctor in happy mood is ready to help.

  • Sudden severe pain not subsiding in 2 days
  • Mild to moderate pain not subsiding in 1 week
  • Any pain > 6 weeks (on and off)
  • Post-traumatic pain
  • Pain even on lying down
  • Age > 60 yr
  • Associated symptoms
  • Fever, weight loss, h/o cancer, immunosuppression or steroid use

Visit the preventive spine topics page to know tips to prevent/ control back pain

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