03 Dec Lower Back Pain
Lower back pain is very common and affects people of all ages. Often uncomfortable and debilitating, it is a common reason for absence from work and for seeking medical treatment.
Lower back pain is not a specific disease but rather a complaint that may be caused by a large number of underlying problems varying in their level of seriousness. While pain generally improves in a few days or weeks, it can continue for a long period.
Pain can vary from a dull constant ache to a sudden sharp feeling. Lower back pain may be classified by duration as:
- acute (pain lasting less than 6 weeks)
- sub-chronic (6 to 12 weeks), or
- chronic (more than 12 weeks).
Lower back pain is usually related to the way the bones, discs, tendons, muscles and ligaments work together, but can on rare occasions be associated with more serious medical conditions.
Symptoms and signs
Lower back pain often develops after movements that involve lifting, twisting, or forward-bending. The symptoms may start soon almost immediately or when you wake up the following morning. They may range from tenderness at a particular point to diffuse pain, and sometimes worsen with movements such as raising a leg, or positions such as sitting or standing. Pain radiating down the legs (known as sciatica) is also common.
The first experience of acute lower back pain often occurs between the ages of 20 and 40 and is frequently the first reason an adult sees a health professional. More than half the population suffers from recurrent lower back pain, with repeated episodes often more painful than the first.
Lower back pain is usually the result of non-serious muscle or skeletal issues such as sprains or strains. However, obesity, smoking, weight gain during pregnancy, stress, poor physical condition, poor posture and poor sleeping position may also contribute.
Physical causes may include osteoarthritis, degeneration of the discs between the vertebrae or a spinal disc herniation, broken vertebrae (sometimes resulting from osteoporosis) or, rarely, an infection or tumour of the spine.
Women may have acute lower back pain from medical conditions affecting the female reproductive system, and nearly fifty per cent of pregnant women report pain in the lower back during pregnancy.
In a very small number of people, lower back problems are caused by a serious condition such as cancer, inflammatory problems, infection, fracture or compression of the nerves in the spine. However, this is rare, and your doctor will check for these causes.
Risks and complications
Most people with back pain don’t have any significant damage to their spine. The pain comes from the muscles, ligaments and joints.
There is a risk that people with persistent back pain can develop fear of movement and activity (including work), worrying that it will make things worse or increase their pain. Living with persistent back pain may also lead to mood issues, such as anxiety, irritability, frustration and depression.
Most people recover quickly from acute back pain, whether they seek treatment or manage by themselves. Over-the-counter pain relievers and staying active – walking is a good exercise – will help lessen pain and help you get on with your life.
Your doctor may refer you for some tests if they think there may be a more serious cause for your back pain. However, in most cases of back pain, imaging (such as x-rays, CT or MRI scans) is not useful and is not recommended.
For more persistent pain, effective treatments include:
- supervised exercise therapy with a qualified health professional
- cognitive behaviour therapy to change unhelpful or unhealthy behaviours
- multidisciplinary pain management which can involve pain physicians, physiotherapists, occupational therapists and psychologists
Surgery is rarely needed for lower back pain, but may be recommended if a more serious issue or condition is the cause, or if nerve compression is present.
If you are experiencing back pain, it is important not to restrict movement too much. Even if your back is very painful, slow and gentle movements are generally better than lying still in bed.
In the longer term, exercising, staying active, managing your stress and weight, and quitting smoking should be part of your self-management plan, both for decreasing pain and reducing recurrence rates.