Injury Centre | Back

 

Back

Lower back pain is extremely common and almost every person will have at least one episode of low back pain at some time in their lives. The pain can vary from severe/long term to mild/short lived.

Anatomy

There are 24 vertebrae in three upper segments of the spinal column. These three segments create three natural curves of the back - the curves of the neck, chest and lower back. The lower segments of the spine are made up of a series of vertebrae that are fused together. The lower back is a complex area that connects the upper body to the lower body. The lower back is composed of several vertebrae, disks of soft cartilage, muscles, joints, ligaments, and nerve tissue.

• Lumbar vertebrae - five bones that are stacked one upon each other and connect the upper spine to the pelvis;
• Disks - these act as shock absorbers between the vertebrae and allow for spine movement;
• Spinal cord and nerves - the 'electrical' fibre that travels through a central canal in the lumbar vertebrae andconnects the brain to the leg muscles;
• Small joints - between vertebrae, allowing movement and stability;
• Muscles and ligaments - provide strength/ power, as well as support and stability

 

 

The lower back provides the body with power and mobility and allows movements like turning, twisting or bending, as well as the strength to stand, walk, and lift. Proper functioning of the lower back is needed for almost all activities and is crucial when considering sport participation.

Cause

Doctors have many ideas about what causes low back pain; however, no single explanation can apply to everyone!

Lower back pain may be related to aging of the disk. As a result of wear and tear on the spine, ligaments, and disks, a disk may begin to protrude or collapse and put pressure on the nerve root leading to a leg or foot, causing severe pain in those areas.

The problem can be aggravated by associated conditions, such as narrowing of the canal or shifting of the vertebrae, one upon the other.

Low back pain is sometimes caused by:

• Excessive stress to the back, such as lifting something heavy
• Minimal movement, such as bending or reaching for something
• Arthritis of the spine
• Problems with tendons or ligaments in and around the spine
• Malpositioning of vertebrae

Occasionally, it happens with no cause.

Doctors do not know why some people with acute back pain go on to suffer from long term low back pain. They also don't know why some people go on to feel quite well between episodes of severe pain.

Symptoms

Symptoms of lower back pain vary in some ways and are similar in others. Most people find that reclining or lying down will improve their pain and after their initial severe episode, many will be able to rest at night without severe pain. Most people experience more severe pain when they bend over to pick something up. Some get relief from arching backward (extending the back).

Leg pain also can be part of the problem. The pain is most common in the back or outer side of the thigh, and can go all the way to the foot. Pain that goes to the foot is called sciatica because it is pain that follows the course of the sciatic nerve. Sciatica is often made worse by coughing or sneezing.

With an acute episode, back pain can be very severe for a few days or a week and then will often improve. By 2 weeks to 4 weeks, most people are much better. The length of time between episodes varies greatly from person to person, as does the length of each episode, the intensity of each episode, and how well each individual copes with the pain.

Treatment

Nonsurgical Treatment

Treatments for low back pain are multiple and varied

Counselling

Counselling and/or education about the problem to ease a person's anxiety is enough to make it tolerable until the episode resolves. Referrals to pain clinics could be an option.

Rest

A few days of rest sometimes reduces the pain.

Medication

Medications such as nonsteroidal anti inflammatory drugs may be helpful*.

Braces

Although there is little evidence of their capacity in treating lower back pain, back braces are commonly used. Most common is a corset type brace that can be wrapped around the back and abdomen.

Passive Modalities

Passive modalities include the application of heat/ cold, massage, ultrasound, electrical stimulation, traction. How long the benefit will last or what the chances are of receiving benefit from any of these treatments is not known.

Spinal Manipulation

Another form of passive treatment is spinal manipulation. There are many different practitioners of spinal manipulation, each with their own style of manipulation. This has also at times improved symptoms of low back pain.

Injections

The most commonly used injections are local anesthetic and/or steroids. They are usually given either in the area that is believed to be the source of the pain, such as into a muscle or facet joint, or around the nerves of the spine. Injections are occasionally placed into the disk, but this is done far less frequently.

Exercise and Stretching

Exercising to restore motion and strength to a painful lumbar spine can be very helpful in relieving pain. Although there is controversy as to which are the most effective spine exercises, it is generally agreed that exercise should be both aerobic and specific to the spine. Aerobic exercises include walking, jogging, swimming, and cycling.

Proper Lifting Techniques

Instruction in lifting techniques can be helpful as well. Improperly bending over to lift can cause a large increase in strain on the low back. Proper lifting keeps the back straight while you bend with the knees.

Surgical Treatment

Surgery for low back pain should only be performed when a number of conditions have been met.

• The first condition is that nonsurgical treatment options have been tried and have failed. For example, surgery should not be done if an exercise program is effective but the person does not want to do it.

• The second condition is the surgeon believes the patient has a good chance of having a successful result e.g.a person with severe degeneration at one level of their spine and normal findings at the other levels may be a good candidate for successful surgery.

• Stress - Low back pain, like many other pain problems, can be worse during times of stress. It may not be a good idea to commit to an operation like this when there are other major stressful events going on in one's life. Occasionally, the back problem can become more tolerable once the stress is minimised.

• The third condition is that the patient must decide whether he or she is having enough of a problem to undergo an invasive procedure that may no thave the desired outcome.

Options

• Spinal Fusion - The most commonly performed surgical procedure for low back pain has been spinal fusion. There are a variety of ways this is done but the basic idea is to take the painful segment of the spine and get it to become a solid piece of bone. This will eliminate motion and, in theory, if it does not move, it shouldn't hurt.

  This can be done through the back or through the front, or sometimes both ways. Spinal fixation of some sort is often combined with some form of bone graft or bone substitute. Bone graft can either be obtained from another part of the skeleton such as the pelvis (autograft) or be donated bone (allograft) that is processed and used in a spinal fusion.

  The results of spinal fusion for low back pain vary. A good result is a decrease in pain. It is very rare for a patient to be completely pain-free after spinal fusion. Full recovery can take more than a year.

• Disk Replacement. A new technique that has recently been introduced is disk replacement. The procedure involves removing the disk and replacing it with artificial components, similar to what is done in the hip or the knee.

  The goal of disk replacement is to allow the segment of the spine keep some flexibility and thereby maintain more normal motion. The recovery time may be shorter than with spinal fusion because the bone does not have to solidify. Currently, disk replacements are done through an anterior approach and are primarily done on the lower two disks of the lumbar spine.

 

 

 

 

 

Disclaimer

* - All content within sports injury insurance is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any other health care professional. Sports injury insurance is not responsible or liable for any diagnosis made by a user based on the content of the injury centre. Always consult your own GP if you're in any way concerned about your health.