LOWER BACK pain is incredibly common and affects about one-third of UK adults every year. It accounts for 31 million lost working days, and the cost to the NHS is estimated to be £12.3 Billion per year.
Back pain has a physical and psychological effect, disrupting the ability to execute daily tasks, sleep and exercise. It can result in sadness, anxiety and depression.
“Lower back pain often curtails daily life and can cause individuals to be unable to participate in hobbies and pastimes.
The structure of the lower back is complex and it’s made up of the five lumbar vertebrae – L1 – L5. These are held together to form a column, by muscles and ligaments.
The lumbar spine provides support for the back and takes most of the weight of the body.
The spinal cord travels down the middle of the vertebral column. Nerves branch out between the vertebrae to supply the lower limbs and other parts of the body.
“In between each vertebrae is an intervertebral disc – a soft pad, made of cartilage, that cushions the spinal movements.”
The lower back is a far more frequent cause of back pain because the lower part of the back bears most of the mechanical load.
If something goes wrong, it’s often caused by lifting and the load is too heavy, or the spine is twisted. This can cause spinal disc prolapse, muscle and ligament to strain/sprain , and in some cases spinal fractures.
The vertebral joints are also common sites for arthritis.
Here are some common causes of lower back pain.
Any accidents or trauma, for example, Road Traffic Accidents, or sports injuries – can result in sprains and tears in muscles and ligaments of the lumbar spine. Sometimes this can cause the intervertebral discs to prolapse or rupture.
Degenerative disease (Arthritis)
As we age, due to general wear and tear, our joints gradually deteriorate.
The intervertebral discs shrink, meaning the disc space is reduced, and the nerve roots become pinched.
Bony spurs may also develop which often press on nerve tissue.
The spine loses mobility and becomes stiffer. This whole process is sometimes called spondylosis.
This is the name for the symptom of pain which shoots down the back of the leg.
It is often caused by pressure on the sciatic nerve, usually from a prolapsed or herniated disc.”
This presents if arthritic changes or a prolapsed disc results in narrowing of the spinal canal, putting pressure on the spinal cord.
This is usually a disease of people over age 60 – affecting about one in 1,000 people. People describe difficulty extending the spine and problems walking. The pain can affect both legs.
This occurs when one vertebra slips forwards, putting pressure on the nerves as they project between the vertebrae.
Infections can occur, such as osteomyelitis, or discitis.
The most common organism is the bacteria, staphylococcus aureus, occurring in intravenous drug users
Cauda equina syndrome
This is a medical condition in which ruptured disc presses on the spinal cord causing symptoms in the lower limbs, and sometimes the bowel and bladder.
If untreated it can result in permanent neurological damage, so this is an emergency.
This is a disease characterised by loss of bone density.
Over time, calcium is lost from the skeleton, the bone becomes less dense, weaker and more prone to fracture. In the spine, osteoporosis can cause vertebral fractures.
This often causes severe, unilateral back pain.
A kidney stone can block the ureter – the tube carrying urine from the kidney to the bladder, causing the kidney to swell.
This is a very painful condition where the womb lining, the endometrium, exists outside the womb in the pelvic tissues.
During Menstruation the bleeding results in scar tissue in the pelvis and can cause low abdominal/pelvic pain and low back pain.
Sufferers seem to get inflammation of cartilage, along with a heightened pain response. Lower back pain, and upper back pain is common.
Estrogen increases joint laxity, During pregnancy lower back problems are common due to ligament laxity and high oestrogen levels.
Abnormal spinal curvature
A kyphosis (the spine curves forwards), scoliosis (an S-shaped spine) or a lordosis (the lower back curves too far inwards) can all cause low back problems.