If you have a history of low back pain, be sure to keep the following information in your medical records: Name, address, and telephone number of your doctor Previous medical and surgical history Date of your last visit to your doctor Results of your last physical examination Results of any tests performed for the low back pain, such as a MRI or CT scan Treatment plan and/or recommendations, including any medications prescribed (OTC and prescription), physical therapy, exercise plan, surgical procedures, etc Date of your next appointment, or when you need to schedule another examination

When we think about it, our lower back goes through a lot in our lifetimes: it carries the entire weight of the upper body any time we are upright; it endures the twisting, turning, and bending forces during activity; it helps us lift heavy objects; and for those of us with poor posture, it has to perform all these things without even being in the right position.

For the most part, it does a pretty good job. Nevertheless, given all the strain and wear over time, it is not surprising that lower back problems do occur frequently.

One of the most common manifestations of lower back problems is pain. Low back pain (LBP) will affect 80-90% of us at some point in our lives, and chances are that you or someone you know has suffered this condition in the past.

LBP can be quite debilitating, particularly if it is recurring, and can affect people both young and old. In fact, it is the leading cause of work disability in adults under the age of 45 and is estimated to cost society $20-50 billion annually.

Because back pain is disabling and costly, it is important for physicians and patients to understand the significance of its symptoms.

Structures of the Lower Back

The lower back is anatomically very complex and is comprised of different structures that have to be balanced and aligned with each other for the lower back as a whole to function correctly. These structures include:

Minor Low Back Pain

Pain can arise when any one of the structures of the lower back is stressed, damaged, or functioning incorrectly. In most cases of acute (new-onset) LBP, the pain is local (not radiating down either leg) and not severe. The paraspinal muscles can often be the source of pain if they are weak, twisted, or in spasm following activity.

The ligaments might suffer a minor tear and lead to localized pain near the tear. In these cases of acute minor LBP, immediate medical attention is usually not necessary. The local inflammation often dissipates over the course of a few days, and the patient can continue most low-impact activities in the meanwhile.

Over-the-counter (OTC) pain medications can help relieve the pain. Once the LBP is diminished, the patient should be encouraged to start back-strengthening exercises, as recent studies have shown that back muscle weakness is often the culprit in acute LBP. It should be emphasized that the patient cannot re-injure his back doing these exercises; they can only help to prevent the return of LBP.

When to Seek Medical Attention

Medical attention should be sought if the LBP:

These "red flags" might indicate that something more serious is going on. Radiculopathy, or a pinched nerve root, can lead to LBP that radiates down one or both legs. This is sometimes accompanied by leg weakness or urinary or bowel incontinence.

Click here for an ILLUSTRATION of the Lower Back Muscles

This can happen is various ways. In older patients with osteoporosis, one of the vertebral bones might collapse on itself, causing a "compression fracture". A compression fracture causes the neighboring nerve root to be pinned down where it comes out of its foramen.

In middle-aged patients, disc herniation can occur when a vertebral disc is subject to such strong forces, such as when lifting a heavy object that it ruptures and starts to impinge on the nearby nerve root. There is also a condition called spinal stenosis in which nerves are compressed in an abnormally narrow spinal canal, even before they come out of the foramen.

In rare cases, tumors and infections can also compress or damage spinal structures and lead to LBP. The pain in these cases usually get progressively worse and is accompanied by other signs of illness such as fever, palpable tumor mass or weight loss.

When seeking medical attention, it is very important to convey an accurate a description of the pain as possible. The doctor will ask questions such as:

 

This description, together with a thorough history and physical exam by the physician, can be very useful in determining which structure might be causing the pain and why. For example, if the problem is a pinched nerve root, the patterns of pain radiation and leg weakness can sometimes help pinpoint which nerve root is involved.

The doctor might decide to order additional tests to confirm the diagnosis. Radiological testing, such as magnetic resonance imaging (MRI) or computed tomography (CT) scans, can often provide a clear anatomical picture of what is going on and help not only to confirm the diagnosis but also to guide treatment planning.

It is important to keep in mind, however, that not every spinal abnormality seen on a scan is an indication for treatment; many abnormalities (including a large number of disc herniations and bulges) are asymptomatic. It is thus necessary to put together the specific clinical symptoms of the patient with the results of the scan to determine which is the most likely lesion causing LBP in a particular patient and how to treat it.

 

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