Cause of low back pain

The spine (spinal column) consists of the back bones (vertebrae), which are separated and cushioned by shock-absorbing disks made of cartilage. The vertebrae are also covered by a thin layer of cartilage. They are held in place by ligaments and muscles, which help stabilize the spine. These muscles include the two iliopsoas muscles which run along both sides of the spine and the two erector spinae muscles which run along the length of the spine behind it and the many short paraspinal muscles which run between the vertebrae. The abdominal muscles which run from the bottom of the rib cage to the pelvis also help stabilize the spine.

The lower lumbar spine consists of five vertebrae. It connects the chest to the pelvis and legs, providing mobility—for turning, twisting, and bending. It also provides strength—for standing, walking, and lifting. Thus, the lower back is involved in almost all activities of daily living such as lifting, bending, turning and swaying.

Low back pain has many causes,
One of the most common causes is muscle and ligament strains and sprains. Strains and sprains may result from lifting heavy object, exercising, or moving in an unexpected way.
The lower back is more likely to be injured when a person's physical conditioning is poor and the supporting muscles of the back are weak. Having poor posture, lifting improperly, being overweight, and being tired also contribute.
However, the number of back injuries in the workplace is decreasing, perhaps because awareness of the problem has increased and preventive measures have improved.

lower back pain : Lower-Back Exercises

A. Lie flat on your back. Hug your knees to your chest and at the same time, bring your chin to your chest. Repeat twice, holding for 15 seconds each.

B. Begin on your hands and knees. Simultaneously raise and straighten your right arm and left leg until they are parallel to the ground. Hold for 2 seconds and come back slowly to a starting position. Repeat with left arm and right leg, alternating 10 times.

C. Lie facedown, arms extended overhead, palms on floor. Simultaneously raise your right arm and left leg as high as comfortably possible. Hold for 10 seconds and slowly return to start. Repeat with left arm and right leg, alternating 10 times. Gradually build up to 20 times.

D. Lie facedown, arms at your side and place heels under couch. Slowly raise chest off the floor as high as you comfortably can. Hold for 2 seconds and return to start. Gradually increase to 20 times.

Strong lower-back muscles and abdominals work together in maintaining a pain-free and healthy back. These exercises will help strengthen the muscles of the lower back, but it is important that you begin your exercises slowly and increase levels gradually. Always begin any exercise program with stretching. Talk to your doctor before attempting any exercises, especially if you are already experiencing back pain.

FDA Consumer magazine (March-April 1998)

lower back pain : Lower-Back Exercises

A. Lie flat on your back. Hug your knees to your chest and at the same time, bring your chin to your chest. Repeat twice, holding for 15 seconds each.

B. Begin on your hands and knees. Simultaneously raise and straighten your right arm and left leg until they are parallel to the ground. Hold for 2 seconds and come back slowly to a starting position. Repeat with left arm and right leg, alternating 10 times.

C. Lie facedown, arms extended overhead, palms on floor. Simultaneously raise your right arm and left leg as high as comfortably possible. Hold for 10 seconds and slowly return to start. Repeat with left arm and right leg, alternating 10 times. Gradually build up to 20 times.

D. Lie facedown, arms at your side and place heels under couch. Slowly raise chest off the floor as high as you comfortably can. Hold for 2 seconds and return to start. Gradually increase to 20 times.

Strong lower-back muscles and abdominals work together in maintaining a pain-free and healthy back. These exercises will help strengthen the muscles of the lower back, but it is important that you begin your exercises slowly and increase levels gradually. Always begin any exercise program with stretching. Talk to your doctor before attempting any exercises, especially if you are already experiencing back pain.
(Source: National Capital YMCA of Washington, D.C.)

FDA Consumer magazine (March-April 1998)

lower back pain : The spinal column

The spinal column is one of the most vital parts of the human body, supporting our trunks and making all of our movements possible. When the spine is injured and its function is impaired the consequences can be painful and even disabling. According to estimates, 80 percent of Americans will experience low back pain at least once in their lifetime. A small number of patients will develop chronic or degenerative spinal disorders that can be disabling.
Men and women are equally affected by lower back pain, and most back pain occurs between the ages of 25 and 60. However, no age is completely immune. Approximately 12% to 26% of children and adolescents suffer from low back pain. Fortunately most low back pain is acute, and will resolve itself in three days to six weeks with or without treatment. If pain and symptoms persist for longer than 3 months to a year, the condition is considered chronic.

Humans are born with 33 separate vertebrae. By adulthood, most have only 24, due to the fusion of the vertebrae in certain parts of the spine during normal development. The lumbar spine consists of 5 vertebrae called L1 through -L5. Below the lumbar spine, nine vertebrae at the base of the spine grow together. Five form the triangular bone called the sacrum. The two dimples in most everyone's back (historically known as the "dimples of Venus") are where the sacrum joins the hipbones, called the sacroiliac joint. The lowest four vertebrae form the tailbone or coccyx.

The anatomy of the spinal column is extremely well designed to serve many functions. All of the elements of the spinal column and vertebrae serve the purpose of protecting the spinal cord, which provides communication to the brain, mobility and sensation in the body through the complex interaction of bones, ligaments and muscle structures of the back and the nerves that surround it. The back is also the powerhouse for the entire body, supporting our trunks and making all of the movements of our head, arms, and legs possible.

Copyright © 2005, Medtronic Sofamor Danek,

lower back pain : Manage Your Lower Back Pain

Approaches to managing lower back pain have changed dramatically in the last 10 years. Experts now recommend staying active and exercising.

Treatment of muscular lower back pain should aim to relieve soreness so you can continue your everyday activities. The convenient, portable and continuous heat therapy of ThermaCare HeatWraps can play an important role in helping you stay active. Today's approach to managing muscular lower back pain may include heat therapy with ThermaCare plus the following:
Use ThermaCare HeatWraps at an early stage of pain (and use them wherever you may be). Combined with exercise, this can help keep lower back pain under control.
Perform range-of-motion and strengthening exercises while pain symptoms are present.
After pain symptoms have improved (after 2 to 4 weeks), perform low-stress exercises like walking, swimming or cycling. Avoid heavy lifting, strenuous exercise and uncomfortable positions.
Add ThermaKinetic exercises for lower back pain to your routine. These breakthrough routines combine the benefits of motion and heat. A specially designated Advisory Board of professionals developed these non-aerobic, low impact exercises that are done while wearing a ThermaCare Lower Back HeatWrap.
Use medication as directed.
Maintain normal activity.
Consult your doctor.

© P&G 2006

lower back pain : What conditions are associated with low back pain?

Conditions that may cause low back pain and require treatment by a physician or other health specialist include:

Bulging disc (also called protruding, herniated, or ruptured disc). The intervertebral discs are under constant pressure. As discs degenerate and weaken, cartilage can bulge or be pushed into the space containing the spinal cord or a nerve root, causing pain. Studies have shown that most herniated discs occur in the lower, lumbar portion of the spinal column.

A much more serious complication of a ruptured disc is cauda equina syndrome, which occurs when disc material is pushed into the spinal canal and compresses the bundle of lumbar and sacral nerve roots. Permanent neurological damage may result if this syndrome is left untreated.

Sciatica is a condition in which a herniated or ruptured disc presses on the sciatic nerve, the large nerve that extends down the spinal column to its exit point in the pelvis and carries nerve fibers to the leg. This compression causes shock-like or burning low back pain combined with pain through the buttocks and down one leg to below the knee, occasionally reaching the foot. In the most extreme cases, when the nerve is pinched between the disc and an adjacent bone, the symptoms involve not pain but numbness and some loss of motor control over the leg due to interruption of nerve signaling. The condition may also be caused by a tumor, cyst, metastatic disease, or degeneration of the sciatic nerve root.

Spinal degeneration from disc wear and tear can lead to a narrowing of the spinal canal. A person with spinal degeneration may experience stiffness in the back upon awakening or may feel pain after walking or standing for a long time.

Spinal stenosis related to congenital narrowing of the bony canal predisposes some people to pain related to disc disease.

Osteoporosis is a metabolic bone disease marked by progressive decrease in bone density and strength. Fracture of brittle, porous bones in the spine and hips results when the body fails to produce new bone and/or absorbs too much existing bone. Women are four times more likely than men to develop osteoporosis. Caucasian women of northern European heritage are at the highest risk of developing the condition.

Skeletal irregularities produce strain on the vertebrae and supporting muscles, tendons, ligaments, and tissues supported by spinal column. These irregularities include scoliosis, a curving of the spine to the side; kyphosis, in which the normal curve of the upper back is severely rounded; lordosis, an abnormally accentuated arch in the lower back; back extension, a bending backward of the spine; and back flexion, in which the spine bends forward.

Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and multiple “tender points,” particularly in the neck, spine, shoulders, and hips. Additional symptoms may include sleep disturbances, morning stiffness, and anxiety.

Spondylitis refers to chronic back pain and stiffness caused by a severe infection to or inflammation of the spinal joints. Other painful inflammations in the lower back include osteomyelitis (infection in the bones of the spine) and sacroiliitis (inflammation in the sacroiliac joints).

copyrightNational Institute of Neurological Disorders and Stroke

lower back pain : Who is most likely to develop low back pain?

Nearly everyone has low back pain sometime. Men and women are equally affected. It occurs most often between ages 30 and 50, due in part to the aging process but also as a result of sedentary life styles with too little (sometimes punctuated by too much) exercise. The risk of experiencing low back pain from disc disease or spinal degeneration increases with age.

Low back pain unrelated to injury or other known cause is unusual in pre-teen children. However, a backpack overloaded with schoolbooks and supplies can quickly strain the back and cause muscle fatigue. The U.S. Consumer Product Safety Commission estimates that more than 13,260 injuries related to backpacks were treated at doctors’ offices, clinics, and emergency rooms in the year 2000. To avoid back strain, children carrying backpacks should bend both knees when lifting heavy packs, visit their locker or desk between classes to lighten loads or replace books, or purchase a backpack or airline tote on wheels.

copyright National Institute of Neurological Disorders and Stroke

lower back pain : What causes lower back pain?

As people age, bone strength and muscle elasticity and tone tend to decrease. The discs begin to lose fluid and flexibility, which decreases their ability to cushion the vertebrae.

Pain can occur when, for example, someone lifts something too heavy or overstretches, causing a sprain, strain, or spasm in one of the muscles or ligaments in the back. If the spine becomes overly strained or compressed, a disc may rupture or bulge outward. This rupture may put pressure on one of the more than 50 nerves rooted to the spinal cord that control body movements and transmit signals from the body to the brain. When these nerve roots become compressed or irritated, back pain results.

Low back pain may reflect nerve or muscle irritation or bone lesions. Most low back pain follows injury or trauma to the back, but pain may also be caused by degenerative conditions such as arthritis or disc disease, osteoporosis or other bone diseases, viral infections, irritation to joints and discs, or congenital abnormalities in the spine. Obesity, smoking, weight gain during pregnancy, stress, poor physical condition, posture inappropriate for the activity being performed, and poor sleeping position also may contribute to low back pain. Additionally, scar tissue created when the injured back heals itself does not have the strength or flexibility of normal tissue. Buildup of scar tissue from repeated injuries eventually weakens the back and can lead to more serious injury.

Occasionally, low back pain may indicate a more serious medical problem. Pain accompanied by fever or loss of bowel or bladder control, pain when coughing, and progressive weakness in the legs may indicate a pinched nerve or other serious condition. People with diabetes may have severe back pain or pain radiating down the leg related to neuropathy. People with these symptoms should contact a doctor immediately to help prevent permanent damage.

copyright National Institute of Neurological Disorders and Stroke

lower back pain : Low Back Pain Fact Sheet

If you have lower back pain, you are not alone. Nearly everyone at some point has back pain that interferes with work, routine daily activities, or recreation. Americans spend at least $50 billion each year on low back pain, the most common cause of job-related disability and a leading contributor to missed work. Back pain is the second most common neurological ailment in the United States — only headache is more common. Fortunately, most occurrences of low back pain go away within a few days. Others take much longer to resolve or lead to more serious conditions.

Acute or short-term low back pain generally lasts from a few days to a few weeks. Most acute back pain is mechanical in nature — the result of trauma to the lower back or a disorder such as arthritis. Pain from trauma may be caused by a sports injury, work around the house or in the garden, or a sudden jolt such as a car accident or other stress on spinal bones and tissues. Symptoms may range from muscle ache to shooting or stabbing pain, limited flexibility and/or range of motion, or an inability to stand straight. Occasionally, pain felt in one part of the body may “radiate” from a disorder or injury elsewhere in the body. Some acute pain syndromes can become more serious if left untreated.

Chronic back pain is measured by duration — pain that persists for more than 3 months is considered chronic. It is often progressive and the cause can be difficult to determine.

What structures make up the back?

The back is an intricate structure of bones, muscles, and other tissues that form the posterior part of the body’s trunk, from the neck to the pelvis. The centerpiece is the spinal column, which not only supports the upper body’s weight but houses and protects the spinal cord — the delicate nervous system structure that carries signals that control the body’s movements and convey its sensations. Stacked on top of one another are more than 30 bones — the vertebrae — that form the spinal column, also known as the spine. Each of these bones contains a roundish hole that, when stacked in register with all the others, creates a channel that surrounds the spinal cord. The spinal cord descends from the base of the brain and extends in the adult to just below the rib cage. Small nerves (“roots”) enter and emerge from the spinal cord through spaces between the vertebrae. Because the bones of the spinal column continue growing long after the spinal cord reaches its full length in early childhood, the nerve roots to the lower back and legs extend many inches down the spinal column before exiting. This large bundle of nerve roots was dubbed by early anatomists as the cauda equina, or horse’s tail. The spaces between the vertebrae are maintained by round, spongy pads of cartilage called intervertebral discs that allow for flexibility in the lower back and act much like shock absorbers throughout the spinal column to cushion the bones as the body moves. Bands of tissue known as ligaments and tendons hold the vertebrae in place and attach the muscles to the spinal column.

Starting at the top, the spine has four regions:

the seven cervical or neck vertebrae (labeled C1–C7),
the 12 thoracic or upper back vertebrae (labeled T1–T12),
the five lumbar vertebrae (labeled L1–L5), which we know as the lower back, and
the sacrum and coccyx, a group of bones fused together at the base of the spine.
The lumbar region of the back, where most back pain is felt, supports the weight of the upper body.

copyright National Institute of Neurological Disorders and Stroke