LOWER BACK PAIN

LOWER BACK PAIN

Low back pain (sometimes referred to generally as lumbago) is a common symptom of musculoskeletal disorders or of disorders involving the lumbar vertebrae and related soft tissue structures such as muscles, ligaments, nerves and intervertebral discs. It can be either acute, subacute or chronic in its clinical presentation. Most often, the symptoms of low back pain show significant improvement within a few days to a few weeks from onset. In a significant number of individuals, low back pain can be recurrent in nature with a waxing and waning quality to it. In a small proportion of individuals this condition can become chronic. Population studies show that back pain affects most adults at some stage in their life and accounts for more sick leave and disability than any other single medical condition

An acute lower back injury may be caused by a traumatic event, like a car accident or a fall. It occurs suddenly and its victims will usually be able to pinpoint exactly when it happened. In acute cases, the structures damaged will more than likely be soft tissue. With a serious accident, osteoporosis or other causes of weakened vertebral bones, vertebral fractures in the lumbar spine may also occur. At the lowest end of the spine, some patients may have tailbone pain (also called coccyx pain or coccydynia). Others may have pain from their sacroiliac joint at the bottom of the lumbar spine, called sacroiliac joint dysfunction (see sacroiliac joint for more information). Chronic lower back pain usually has a more insidious onset, occurring over a long period of time. Physical causes may include osteoarthritis, rheumatoid arthritis, degeneration of the discs between the vertebrae, or a spinal disc herniation, a vertebral fracture (such as from osteoporosis), or rarely, a tumor (including cancer) or infection.

Causes

Most cases of lower back pain are due to skeletal degeneration or musculoligamentous injury and are referred to as non specific low back pain. The full differential diagnosis however includes many other less common conditions.

• * Mechanical:
  o Apophyseal osteoarthritis
  o Diffuse Idiopathic Skeletal Hyperostosis
  o Degenerative discs
  o Scheuermann’s kyphosis
  o Spinal disc herniation (slipped disc)
  o Spinal stenosis
  o Spondylolisthesis and other congenital abnormalities
  o Fractures
  o Leg length difference
  o Restricted hip motion
  o Misaligned pelvis – pelvic obliquity, anteversion or retroversion
• * Inflammatory:
  o Seronegative spondylarthritides (e.g. ankylosing spondylitis)
  o Rheumatoid arthritis
  o Infection – epidural abscess or osteomyelitis
• * Neoplastic:
  o Bone tumors (primary or metastatic)
  o Intradural Spinal tumors
• * Metabolic:
  o Osteoporotic fractures
  o Osteomalacia
  o Ochronosis
  o Chondrocalcinosis
• * Psychosomatic
  o Tension myositis syndrome
• * Paget’s disease
• * Referred pain:
  o Pelvic/abdominal disease
  o Prostate Cancer
  o Posture
• * Depression[citation needed]
• * oxygen deprivation

Diagnosis

Diagnosing the underlying cause of low back pain is usually done by a medical doctor, osteopathic physician, physical therapist (physiotherapist) or by a chiropractor. Often, getting a diagnosis of the underlying cause of low back pain and/or related symptoms is quite complex. A complete diagnosis is usually made through a combination of a patient’s medical history, physical examination, and, when necessary, diagnostic testing, such as an MRI scan or x-ray.