PAUL A. SMUCKER, MD: Low back pain - it affects almost all of us from time to time. There are some simple things a person can do when faced with this problem.
Low back pain may be longstanding, or acute. "Acute", in medical parlance generally refers to an affliction that is of sudden or recent onset. The sudden onset of low back pain may or may not be associated with an identifiable provoking incident.
Generally, low back pain is:
What causes low back pain?
An acute low back pain episode usually comes on with a twisting or pulling mechanism which may be caused by anything from sports to pulling a half-dead rosebush out of the ground. The result may be aching or sharp, localized or radiating, depending on the underlying injury.
Non-radiating low back pain in younger individuals may be due to a simple strain/sprain of the muscles and ligaments that provide movement and support for the low back. If someone under thirty year's old experiences acute low back pain that is accompanied by radiating pain into one or both legs, chances are good that a disc herniation has occurred. In this case, an intervertebral disc has become partially displaced from it's "home" between two lumbar vertebrae and is pushing on nerve as it exits the spine prior to joining the sciatic nerve. Although the pain may be mostly in the leg, it actually is due in this instance to an injury in the low back, causing referred pain to the leg in the distribution of the affected nerve.
As we age (which is as good thing, if one considers the alternative), are backs do also.
The small joints in the rear of the spinal column that link our vertebrae together become arthritic in 100 percent of humans. Facet-mediated low back pain may result from aging and arthritis, or from a sudden jamming together of the spinal facet joints. For example, a forceful lumbar hyperextension (bending backwards, as in a motor vehicle accident which may throw a person's torso violently forward, then back).
Aging also occurs in the discs, which separate and cushion our vertebral bodies. The discs lose water content on a molecular level as we age. When this occurs, the discs may take on a darker appearance on MRI pictures of the spine. This appearance is used to define a condition called degenerative disc disease (DDD). Interestingly, dark discs may or may not be painful. Discs that don't appear dark on MRI may actually be a source of pain. Thus, "discogenic" low back pain may be due to the aging process, or an injury, or probably most often, some combination of the two. An acute low back injury may convert painless DDD to painful DDD.
Common causes of acute non-radiating low back pain (does not radiate to legs) include:
The most common cause of low back pain, which strongly radiates to the legs:
There are a number of issues that can cause low back pain or a combination of low back and leg pain, which develops slowly, over months or years. The most common causes of chronic low back pain include degenerative disc disease, facet arthritis, or lumbar stenosis (narrowing of the spinal canal or nerve root exit).
A rare but serious problem called cauda equina syndrome can occur if the nerves at the end of the spinal cord are squeezed. Seek emergency treatment if you have weakness or numbness in both legs, or loss of bladder or bowel control.
How can I manage my acute non-radiating low back pain? Do I need to get some tests done?
Most people with an episode of acute low back pain do not require formal testing. Imaging tests such as X-rays, CT scans, EMG's, and MRIs are not required for managing most episodes of low back pain. In most cases, they are only used if the doctor suspects a serious problem, such as a herniated disc, a broken bone, or cancer, or if surgery is being considered or planned. You might also have imaging tests if worker's compensation or a lawsuit is involved.
Things you can do on your own to help resolve an episode of low back pain:
At what point should a physician be consulted?
The vast majority of acute non-radiating low back pain episodes will resolve within two weeks using only the above measures. If not, contact your physician. If no danger signs are felt to be present, your doctor may recommend specific stretches and exercises for your low back. Physical therapy may be a great help in reducing pain, as well as with providing a home exercise/stretching program tailored to your individual situation. Chiropractic care or massage therapy also may be useful. Few people with episodic low back pain require surgery, even if they have radiating pain, numbness or weakness. If episodic back pain becomes steadily more severe, radiating or chronic, assessment by a physician is strongly advised. A pain specialist or surgeon may be key to specific diagnosis and treatment to your low back problem.
Dr Smucker is board certified in physical medicine and rehabilitation, and has his subspecialty boards in pain medicine. His medical practice focuses on the diagnosis and treatment of spine-related issues, using electro diagnosis (EMG/NCS) and image-guided interventions.
