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Lower back pain can be acute or severely painful or can be a long term moderate pain from a chronic back injury.
We explain the differences between acute low back pain and moderate chronic low back and its management.
Often is not possible to completely diagnose the causes of low back pain. Below we also outline the most common diagnosable causes of low back pain, less common causes and other conditions which can cause low back pain.
Acute vs Chronic low back pain
Acute low back pain is severe back pain and usually comes on suddenly caused by a movement such as bending or twisting. Pain in the lower back and buttocks may increase over a couple of hours as inflammation develops. Management of acute low back pain is to reduce pain as quickly as possible by getting the patient into a position of least pain which may be lying on the back, front or side. Whatever is most comfortable is the best and it will be different for each individual. See management of acute low back pain for more detailed information.
Mild or moderate lower back pain is associated with chronic or long term back problems which are usually caused initially by an injury, usually to the joints in the back but over time other structures in particular soft tissue such as muscles contribute to the pain. A range of symptoms include dull aching in the lower back which may come and go, be on one side or across the lower back. There will be reduced range of movement, tenderness at points on the spine, muscle spasms and pain may radiate into the buttocks and hamstrings.
Common causes of low back pain
Often the exact cause of low back pain is not possible to identify. Symptoms can be vague, come and go and there can be a number of tissues and structures causing the pain. However below are some injuries and conditions that can usually be diagnosed.
Sciatica or nerve route compression causes pain in the lower back which radiates down into the legs. There are a number of causes by a slipped disc is one of the more common causes.
Facet joint pain or zygapophysial joints as they are also know are synovial joints in the spine which allow movement and help support the spine. Symptoms of facet joint pain include muscle spasm at the side of the spine which pulls the vertibra out of line. Patients will often report a sudden pain when bending over or moving.
Spondylolysis or stress fracture of the pars interarticularis is an overuse injury more common in younger athletes who are involved in sports requiring a lot of bending backwards and rotation of the spine such as javelin throwing, tennis, baseball pitching and fast bowling in cricket. Symptoms include lower back pain often on one side of the back. Pain is worse during activities requiring backwards bending of the spine or exaggerating the lumbar curve in the spine. Tenderness will be felt over the site of the fracture when pressing in.
Sacroiliac joint pain occurs when the joint between the sacrum at the bottom of the spine and the ilium bone of the pelvis is not functioning correctly. It can be locked and not moving freely or it may be that there is too much movement in the joint. Symptoms of sacroiliac joint pain include pain located at either the left or right side of the lower back, not not usually both sides. The pain can vary from a dull ache to a sharp stabbing pain which can radiate into the buttocks. Occasionally sacroiliac joint dysfunction can cause pain in the testicles. Stiffness in the lower back when getting up after sitting for long periods and when getting up from bed in the morning is also common.
Muscular trigger points are tiny localized knots in the muscle which cause pain either at the location of the trigger point or referred elsewhere in the back. They are common in the errector spinae muscles which go up either side of the spine and the deep quadratus lumborum muscles either side of the lumbar spine. Deep tissue sports massage techniques are effective for releasing trigger points in the muscles and relieving muscular back pain.
Less common causes of low back pain
Spondylolisthesis is most common in children aged between 9 and 14 years old and involves a slipping forward of one of the lumbar vertebra. Spondylolisthesis can vary in severity from a grade one where there may be no symptoms or pain at all and patients are unaware they have the condition to a grade two which may result in low back pain made worse by activity but not radiating into the legs. A grade three injury has greater than 50% forward movement of the vertebra and a grade 4 will be very debilitating with more than 75% movement in the bone.
Spinal canal stenosis is more common in older athletes and involves the spinal canal narrowing causing pressure on the nerves with symptoms of pain and numbness. Sciatic type symptoms may also be present along with weakness of the legs. An X-ray of the spine can confirm the diagnosis.
Fractured vertebra or compression fracture of the spine is a break or fracture of one of the vertebra bones and is usually due to compressive forces. Occurring most frequently in the lower back symptoms include pain at the site of the fracture which may radiate in the hips, buttocks or thighs. Numbness, tingling and weakness may also be experienced and bladder or bowel symptoms from the fracture pressing onto the spinal cord can occur.
Fibromyalgia is a widespread muscular fatigue and pain condition where pain and tenderness is felt throughout the body. Poor sleep patterns are common and the muscles may feel soft and doughy rather than toned and tight. Patients often complain that they ache all over or feel they have overworked the muscles. Irritable bowel syndrome, Dysmenorrhea (cramps or painful menstruation) and chronic headaches are also symptoms of fibromylagia.
Lumbar instability is where part of the spine is unstable or has too much movement. Most low back problems can be relieved by freeing up a hypomobile vertebra or one that has restricted movement, although mobilizing and already mobile joint is not going to be beneficial. In this case the surrounding structures and muscles should be strengthened to support the unstable back. Core strengthening exercises and Pilates exercises for the back are likely to be beneficial. It is possible to have a generally hypomobile spine but with one or two vertebra having restricted mobility. It is important to get an accurate diagnosis and treatment from a back specialist, Osteopath or Chiropractor as the wrong treatment or exercises can have a negative effect.
Other medical conditions and diseases that can have symptoms of lower back pain include rheumatological diseases, gynacologica, gastrointestinal as well as genitourinary problems. If in doubt seek advice from a doctor.
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