Sometimes you know exactly why your back hurts. Maybe you picked something up clumsily and felt the pain right away. Or maybe your doctor has warned you for years that your poor posture would lead to lower back pain.
But other times, the source of back pain can feel like a mystery.
MRI is able to detect subtle changes in the vertebral column that may be an early sign of infection or tumor, and MRI for spine is more sensitive than CT scanning for evaluating tumors, abscesses and other soft tissue masses.
“Your lumbar spine, located in the lower back, plays a crucial role in supporting the weight of your upper body. It is also responsible for everyday movements such as bending, twisting, and coordinating the muscles in your hips, the legs from the pelvis and feet,” says Dr. Kenneth Palmer, an orthopedic surgeon specializing in spinal surgery at Houston Methodist Hospital. “And with heavy use, the bones, muscles, ligaments, discs and nerves found in the lumbar spine will be susceptible to both injury and the wear and tear over time, causing lower back pain.”
Low back pain symptoms include:
“Usually, these symptoms can develop suddenly or over time. And a person experiences some combination of these symptoms. In some cases, low back pain can feel intermittent; it comes and goes. Sometimes it’s stressful and sometimes it’s not, but it usually gets progressively worse over time,” explains Dr. Palmer.
Additionally, Dr. Palmer notes that the symptoms of lower back pain can vary from person to person, as well as the underlying cause of the pain.
Let’s talk about the various causes of low back pain…
Even if you don’t notice it, your lumbar spine works all day.
And the truth is that, by adding a sprain or strain to the daily work of the spine, we can have results like an acute injury; And this usually happens when you fall, lift something too heavy, or play sports. A sprain or strain can also develop over time due to repetitive motion or poor posture.
“Straining a muscle or spraining a ligament are the most common causes of low back pain,” says Dr. Palmer. “While they can be serious, these common causes of low back pain are not long-lasting, taking anywhere from a few days to a few months to heal.”
Your doctor can help you determine how to take care of yourself so that you can heal your lower back pain.
“Treatment for a pulled muscle, or a tight ligament in the back, is fairly simple and can be painful at times, including anti-inflammatory medications, muscle relaxants, ice to help reduce inflammation, heat to promote healing, and a break from strenuous activity until the pain subsides,” explains Dr. Palmer. “Care will depend on the severity of your injury, as well as your overall core and lower body strength.”
If your low back pain persists, despite treatment, it may be time to consider other causes of low back pain.
“Chronic low back pain is less likely to be caused by muscle and ligament damage. It’s even more likely to be due to problems with the lumbar discs, nerves, joints, or vertebrae,” says Dr. Palmer. “There are several potential causes of chronic low back pain.”
In general, osteoarthritis (the most common type of arthritis) and degenerative disc disease (the natural wear and tear of the spinal discs) are the underlying cause of many types of chronic low back pain. However, lower back pain can also be caused by accident-related trauma and acute stress.
“The thoracic and lumbar spine of an adult is made up of about 17 bones (vertebrae) stacked one on top of the other. Between each set of vertebrae is a padded disc, which helps absorb the pressure exerted on these bones,” explains Dr. palmer.
Each disk is made up of an outer shell and an inner gel.
A lumbar disc herniation occurs when the inner gel of one of the five discs in the lumbar spine slips or collapses past the outer cortex, allowing this inner gel to press on surrounding nerves, causing pain. This slippage may be due to trauma or gradual age-related wear.
The joints that connect the five vertebrae in the lower back, called facet joints, experience high loads of compressive force and stress. Over time, the breakdown of cartilage in the facet joints can lead to lower back pain.
“Whether due to poor posture or repeated overuse, facet joint damage is often caused by osteoarthritis and can lead to inflammation, stiffness, muscle spasm, and pain,” explains Dr. Palmer. “In addition, when damage to a facet joint affects a nearby nerve, it can lead to sciatic pain.”
“A spinal compression fracture occurs when a vertebra in the lumbar spine essentially collapses in on itself. This is often due to osteoporosis, but can also be the result of trauma,” says Dr. Palmer.
This collapse can cause severe pain, and people who suffer a lumbar compression fracture often experience sudden pain and limited spinal mobility.
Lumbar spinal stenosis occurs when the spinal canal in the lower back becomes narrow. This leads to pressure on the nearby nerve roots. It can be caused by the formation of bone spurs, the thickening of a nearby ligament, or the degeneration of a lumbar disc or joint.
“When the nerve roots are compressed, there can be a lot of pain,” says Dr. Palmer. “And spinal stenosis not only causes lower back pain but can result in sciatic nerve pain, even affecting the lower extremities.”
If a lumbar vertebra slides forward, over the top of the vertebra below, there will be a lot of compressive force on the lumbar disc that is pulling the two vertebrae apart. As the lumbar disc deteriorates, it can cause lower back pain. Also, if the lumbar disc is flattened by this force, it can lead to nerve and sciatic nerve compression.
“One of the most common types of spondylolistheses, isthmic spondylolisthesis, is caused by a fracture in a small piece of bone, called the pars interarticularis, that sits next to the facet joint. Fracture often occurs when a person is young, but the pain is often felt as the years go by,” says Dr. Palmer. “Spondylolisthesis can also be the result of degenerative or congenital causes.”
The spine has a natural curvature, which takes the shape of an ‘S’ when viewed from the side. That is, we see the upper part of the back curving back and the lower part of the back curving forward; this is how we see a class of ‘S’. But if the spine curves to the sides when viewed from behind, it’s called scoliosis, a spinal deformity that can lead to back pain.
“When the spine takes an inappropriate curvature, degeneration of the lumbar joints and discs is more likely,” warns Dr. Palmer. “In most cases, scoliosis does not require treatment, but severe curvature can place significant stress on the lower back and lead to pain.”
If you are experiencing lower back pain that is not responding to rest and self-care, it is time to consider seeing a spinal specialist.
“A spine specialist will likely perform a physical exam, as well as one or more imaging scans, to diagnose the root cause of your low back pain.
And depending on your diagnosis, a treatment plan will be designed to alleviate your pain and prevent it from interrupting the daily activities you usually enjoy,” concludes Dr. Palmer.