Lumbar pain (more commonly called lower back pain) is extremely common and affects most people at some point in their lifetime. There are several systems in the lumbar spine that can cause lower back pain, including the nerve roots, joints, discs, bones and muscles.
If you have experienced lumbar pain, you know it can have a significant effect on quality of life, including the ability to work and participate in family and community activities. Fortunately, most cases are treatable through non-surgical methods.
Here is the information you need to feel better.
Anatomy and Function of the Lumbar Spine
The lower back comprises the lumbar spine, which is formed by vertebral bones, intervertebral discs, nerves, muscles, ligaments and blood vessels. The spinal cord ends at the top of the lumbar spine, and the remaining nerve roots, called the cauda equina, descend down the remainder of the spinal canal.
The lower back performs the following important functions:
- Support and stabilize the upper body. The 5 lumbar vertebrae are the largest compared to other spinal regions. In conjunction with the muscles and ligaments, these vertebrae help support the weight of the upper body, including the head and neck. The lumbar spine also transfers loads from the upper body to the legs.
- Allow truncal movements. The lower back is the primary coordinator for movements of the body’s trunk. The lumbar allows movement in various directions, including front and back, side to side, and twisting movements. Movement mostly occurs in the last two vertebral levels.
- Protect the spinal cord and cauda equina. The upper lumbar vertebrae protect the spinal cord in their vertebral arches. The lower vertebrae provide a bony enclosure for the cauda equina nerves that descend from the spinal cord.
- Control leg movements. The lumbar spinal nerves that branch off from the spinal cord and cauda equina to control movements and sensation in the legs.
Why is Lower Back Pain Such a Common Problem?
The bottom part of your back typically has just five vertebrae — fewer than your neck and mid-back. And these vertebrae do a lot of heavy lifting! Your lower back is where your spine connects to your pelvis, bearing the weight of your upper body. This area experiences a lot of movement and stress, which may lead to wear, tear and injuries.
Back pain is one of the most common medical problems in the United States. Anyone can have back pain but you may be more likely to have back pain because of the following:
- Fitness level: Back pain is more common among people who are out of shape. You may also get back pain if you exercise too hard after not being active for a while.
- Obesity: If you are overweight or obese, it can put stress on the back and cause pain.
- Job-related risk factors: Jobs that require heavy lifting, pushing, pulling, or twisting can injure the back. A desk job may also play a role, especially if you slouch or sit all day in an uncomfortable chair.
- Age: You may have more back pain as you get older, particularly after you turn 45.
- Family history: Your genes play a role in some disorders that cause back pain.
Possible Causes of Lumbar Pain
The following conditions outline the more common causes of lower back pain with possible leg pain.
Back Injuries
A bad fall or a car accident can cause a lower back injury. But so can carrying a laundry basket up the stairs. Some back injuries can be sudden and traumatic, and some happen slowly over time. You may think that athletes and active people get injured the most due to their active lifestyle but this is not always the case. You are just as likely to tweak your back while bending over to pick up a toy from under the bed. It is the everyday tasks, like holding a child, that may lead to back injuries when done improperly.
Muscular Problems
A muscle strain typically causes the muscle tissue to get abnormally pulled, overstretched or torn. This can be caused by heavy lifting, incorrect lifting or repetitive use. Muscle strains can cause mild to severe pain and also result in associated lower back stiffness. Muscles may also get deconditioned due to lack of physical activity or from a sedentary lifestyle, causing lower back pain.
Degenerated Discs
Intervertebral discs are spongy pads that act as shock absorbers between each of the lumbar spine’s vertebrae. The vast majority of people with degenerative disc disease experience low back pain symptoms that flare up periodically, but do not get worse over time. Once a disc has degenerated, the degenerative process cannot be reversed. Instead of trying to rehabilitate the disc itself, treatment focuses on improving the health of surrounding structures, such as the spinal nerves, vertebral bones and joints, and supporting muscles and ligaments.
Herniated Discs
Intervertebral discs are composed of a stiffer outer shell and an interior, jelly-like substance. When stressed from impact, heavy lifting or degenerative disease, these discs can begin to herniate or bulge out from their normal positions in the spine. Nerve impingement and pain can be felt in the lower back, buttocks, and down the leg on the affected side. Also called sciatica, this burning pain impacts mobility and even bladder and bowel control.
Spondylolisthesis
If a lumbar vertebra slips forward — over the top of the vertebra below — it places a lot of compressive force on the lumbar disk that is separating the two vertebrae. As the lumbar disk deteriorates, it can cause lower back pain. Additionally, if the lumbar disk flattens from this force, it can lead to nerve compression and sciatica.
One of the most common types of spondylolisthesis, isthmic spondylolisthesis, is caused by a fracture in the small piece of bone, called the pars interarticularis. This bone is found adjacent to the facet joint and the fracturing event often happens when a person is young, although the pain is not felt until later in life. Spondylolisthesis can also result from degenerative or congenital causes.
Spinal Stenosis
A narrowing of the spinal canal or intervertebral foramen (bony openings for the nerve roots as they exit the spinal canal) is called spinal stenosis. The stenosis can irritate or compress the nerve roots (foraminal stenosis) resulting in sciatica.
If the stenosis compresses the spinal cord (central canal stenosis), neurogenic claudication occurs, resulting in leg pain while walking variable distances. In severe cases, bowel and/or bladder dysfunction, severe leg weakness, and/or numbness may occur.
Risk Factors for Lumbar Pain
Manual work, especially with vibrating tools, increases the risk of lumbar pain, but office workers can also fall victim since long periods of inactivity are bad for the back. Lumbar pain is also associated with pregnancy, obesity, poor physical fitness, high levels of stress, anxiety and depression.
Children can also suffer from lumbar pain due to “backpack overload.” The American Academy of Orthopaedic Surgeons suggests that backpacks should weigh no more than 15 to 20 percent of a child’s body weight.
Tests for Lumbar Pain
Your doctor will give you a thorough physical exam. They will watch for signs of nerve damage while you walk on your heels, toes, and soles of your feet. The doctor may test your reflexes using a reflex hammer. This is usually done at the knee and behind the ankle. As you lie flat on your back, you’ll be asked to elevate one leg at a time, both with and without the doctor’s assistance. This is done to test nerves and muscle strength and to assess the presence of tension on the sciatic nerve. The doctor may test sensation using a pin, paper clip or other sharp object to assess any loss of sensation in your legs.
Doctors can also use several tests to take a look inside if they to get a better idea of what might be causing the pain. Plain X-rays are generally not considered useful in the evaluation of back pain, particularly in the first 30 days. In the absence of red flags, their use is discouraged. They may be needed if there is significant trauma, mild trauma in those older than 50, osteoporosis, or prolonged steroid use.
Lumbar Pain Treatment: Home Remedies
If your pain is mild to moderate and you do not have any of the red flag symptoms, we recommend the following:
- Thermal therapy. Applying heat and/or cold to the painful area has long been recommended for back pain.
- Medication. Your doctor will recommend over-the-counter medications to relieve pain during flare-ups of pain. Usually, people take aspirin, ibuprofen, or acetaminophen for lower back pain. Prescription muscle relaxants and/or opioid medications are reserved for more extreme cases.
- Rest. In the short-term bed rest can help ease the pain but is not recommended for more than a day or so.
- Gentle movement. Be cautious, start with easy movements, and build gradually if the movements do no exacerbate the pain.
- Strengthen your core. Core strengthening exercises can be very helpful, but not in the acute stage of lumbar pain.
- Adjust Your Workstation. Ergonomics is the science of workplace efficiency. As applied to lower back pain, proper ergonomics places chairs at comfortable heights, adjusts computer screens to eye level, and cushions concrete floors. Use proper body mechanics if you do heavy lifting tasks.
Therapy for Lumbar Pain
Various types of therapy also can help lumbar pain:
- Physical therapy. At Ventura Orthopedics, our physical therapists complete functional capacity evaluations on lower back pain patients. They recommend targeted stretching and strengthening exercises and may use the following to control and even eliminate back discomfort:
- Massage therapy
- Applied heat and cold
- Assistive devices, such as bracing
- Massage, acupuncture, or spinal manipulation. Chiropractors, acupuncturists, and massage therapists specialize in these approaches for strains, sprains, and minor misalignments.
Another Option: Surgery
Surgery may be considered when other treatments fail or if there is a serious underlying cause (such as spinal stenosis). A variety of surgical techniques are available, from vertebroplasty for compression fractures due to osteoporosis, spinal laminectomy for spinal stenosis, and discectomy for severe herniation of a disc. Your surgeon will advise you on the best surgical procedure for your condition and general health.
How Can I Get Started?
The experienced and dedicated orthopedic surgeons at Ventura Orthopedics are here for you. If you need spinal or back surgery, it may be time to consult a medical professional. The experienced and dedicated orthopedic surgeons at Ventura Orthopedics are here for you. We are committed to helping you through any procedure until optimum health, strength and mobility are restored.
Call us today at 800-698-1280 to schedule an appointment.
