23 Feb 2023

Lower Back Pain: Causes, Diagnosis and Treatments

Are you suffering with a feeling of pressure or pain in the lower part of your back? A common cause may be a musculoskeletal issue but there are other causes of pain in the lower back which we will look at, along with ways in which we can manage pain in the lower back.

Lower back pain is very common and most people, for one reason or another will suffer from some degree of lower back pain during their lifetime. In fact a study that was done in 2020 has identified pain in the lower back as the most frequently cited reason for missing work. Although in general most lower back pain will be as the result of injury, there are other medical conditions which can also give rise to this sort of pain.

Commonly, people between the ages of thirty and fifty will have their first brush with back pain as a direct result of the changes our bodies go through as we age. This change with age is because when we advance in years the fluid that acts as a cushion between the spine and the vertebrae reduces. When this happens the discs have less cushioning and are more easily prone to irritation. Along with that, muscle tone in the back also reduces with age and leaving the back more prone to injury.

For this reason it makes a lot of sense to keep your back muscles strong to keep back problems at bay.

The causes of pain in the lower back

There are many different reasons that we experience lower back pain

There are various causes of pain in the lower back, and that includes some underlying health conditions.

1. Strains and sprains of the muscles in the back.

The ligaments and the muscles in the back are prone to stretching or even tearing if we exercise them excessively. As well as this, sudden movement can also give rise to a strain or a sprain. The symptoms of this type of back problem will be lower back stiffness and pain and quite commonly, muscle spasms.

2. Herniation of the disc

Our discs are susceptible to injury, a risk which increases as we get older. The disc’s outer parts can herniate or could tear. This condition is also referred to as a ruptured or slipped disc. In this condition the cartilage that surrounds the disc will push against the nerve roots or the spinal cord and the cushioning that is normally between the vertebrae in the spine, will be extended. The result can be the roots of the nerve being squeezed at its exit point from the vertebrae and spinal cord.

This condition usually arises from trauma or from degenerative changes as we get older. If no treatment is given then the pain experienced from a disc that is herniated will generally subside after around six weeks.

3. Sciatica

The nerve that connects the legs to the spine is called the sciatic nerve.

If a disc that has become herniated starts to press on the nerve the condition that arises is called sciatica and the symptoms will be a burning like feeling in the leg or foot or a tingling feeling.

4. Stenosis of the spine

The term "spinal stenosis" refers to the fact that the spaces in between the spine’s vertebrae have narrowed. This has the effect of putting more pressure on the spinal nerves and the spinal cord. This condition is linked with disc degeneration in between the vertebrae of the spine. This results is the spinal cord or nerve roots being squeezed by soft tissue or bony spurs. This pressure may cause a patient to feel:

• Weakness
• Cramping
• Numbness

These sensations might occur at other sites in the body and a lot of people who suffer from spinal stenosis, report feeling worse when they walk or stand.

5. Curvature of the spine

Several of the conditions causing curvature of the spine, which include lordosis, kyphosis and scoliosis are often conditions that the sufferer is born with and that will normally be diagnosed during the childhood of a sufferer. Having curvature of the spine can cause poor posture and pain because of the strain that it places on the:

• Musculature and tendons
• The ligaments
• The vertebrae

It should be noted however that some people with curvature of the spine have no symptoms at all.

Lower back pain - Other Conditions

There are, of course, other conditions that cause pain in the lower back and they usually come with other symptoms. These are some of the conditions that give rise to the pain in the musculoskeletal areas:

• Fibromyalgia: A long term condition that features tenderness and pain in the muscles, joints and tendons.
• Arthritis: A condition which is characterised by joint inflammation.
• Spondylosis: This condition is another form of arthritis and is a degenerative disorder that can lead to the loss of normal function and structure in the spine, although getting older is usually the primary cause of this.The rate of degeneration and the location of that degeneration will be different from individual to individual
• Spondylitis: This is an autoimmune disease, a type of arthritis that causes inflammation.

There are some other conditions that may lead to lower back pain and those include:

• Kidney infections and other bladder and kidney problems
• Endometriosis and pregnancy in women
• Fibroids in the uterus
• Cysts in the ovaries
• Infection of the spine
• Misalignment of the spinal cord
• Spinal cord cancer

Are you experiencing any of the symptoms outlined in this article?

Book Now 02074991991

Contact the clinic today for a same-day GP appointment.

Diagnosing paining the lower back

When a doctor sees the patient complaining of lower back pain he or she will take a full history and carry out a very thorough physical examination to find out where the pain is being felt most. During a physical examination the doctor will always check to see if there is any limitation on range of movement caused by the pain. Responses and reflexes may also be checked again for certain sensations. By doing this the doctor can find out if the nerves are affected and identify the cause of the pain in the lower back.

Unless the symptoms you have raise concern with the doctor, or unless he or she identifies a neurological loss, the most likely course of action will be to monitor you for several weeks to see if the condition improves before you are sent for any additional tests. This is because most pain in the lower back will resolve on its own if you follow the advice of the doctor.

Some of the symptoms that may cause your doctor to send you for more extensive testing will include:

• Any weight loss that is unintentional
• Any loss of control of your bowels
• Any fever or weakness

If you have any of the following symptoms in addition to your lower back pain then you should seek medical help immediately.

Imaging testing

Your doctor may ask for imaging testing if he or she suspects the following:

• Problems with the discs
• Problems with your bones
• Any problems with ligaments or tendons in the back

The type of imaging test you may is likely to be:

• An X-ray
• An ultrasound
• CT scanning
• An MRI
• Your doctor may order a scan of your bones or a bone density test if he or she thinks there is any bone involvement.
• You may be sent for an EMG (Electromyography) which will measure the conductivity of your nerves if your doctor thinks there may be nerve involvement.

Treatment for lower back pain

After you have been diagnosed with lower back pain a plan of treatment will be drawn up for you that will take account of how severe your symptoms are and the reason for the pain you are suffering.

The role of home remedies

If you are suffering from lower back pain, it is usually advised that any self-help methods you try are limited to 72 hours, after which time if there is no improvement you seek medical attention. Some treatments you can do at home include:

• The use of cold-therapy
• The use of heat-therapy
• The protocol known as RICE ( rest – ice – compression – elevation)
• Medication for pain control that you can buy over the counter
• Taking a bath in warm water to relax the muscles

Try different postures. Sometimes lying on your back,flat,will cause you more pain and if it does try to lie on one side bending your knees up and placing a pillow in-between your legs.

If it is comfortable to lie on your back then get a towel or a pillow and place it underneath your thighs so that you reduce lower back pressure.

Lower Back Pain - Medical Treatment

There are several medical treatments that may help with lower back pain and they include:

• Various medication, either over the counter or prescribed
• Various appliances
• Different forms of physical therapy

Your doctor might prescribe:

• Muscle relaxant
• Ejections with corticosteroids two lesson information
• NSAIDs (nonsteroidal anti-inflammatory drugs)
• Narcotic drugs, in the case of severe pain and over a short period (often used to treat the chronic pain caused by various cancers)

You may be advised to wear a medical appliance often in the form of a back support or brace.

Any physical therapy that you have is likely to include:

• Stretching manoeuvres
• Exercises to help strengthen your muscles
• Massage
• Manipulation of the spine or back

Surgical treatment for back pain

In very severe cases surgical treatment may be required although not taken up until all other treatment approaches have failed. Emergency surgery will be done if a patient reports losing control of their bowels or bladder or is suffering from a neurological loss that is progressive - for instance weakness or numbness in the legs.

Surgery might be one of the following:

• Foraminotomy: This procedure consists of opening up the foramen (a hole in the bone within the spine where the roots of the nerves are located).
  
• Discectomy: If testing reveals that you have a bone spur or bulging disc that presses on the nerve root then this procedure will relieve that pressure. A surgeon carrying out this procedure will cut out a part of the lamina - a bony component of your spinal canal.
• Intradiscal Electrothermal Therapy: In this procedure a needle will be inserted using a catheter where it will be heated for between 13 and 17 minutes. The aim of this is to make the disc thicker and to reduce any irritation and bulging of the nerve.
  
• Nucleoplasty: During this procedure the surgeon will insert a device into the disc, through a needle. The disc’s inner material can be removed and radio waves utilised to shrink and heat tissue.
  
• Radiofrequency Lesioning:  also called ablation, this procedure utilises radio waves to interfere with communication between nerves and is accomplished by insertion of a specialised needle that is heated and will then destroy the nerves involved.
  
• Spinal Fusion: for this procedure the surgeon will remove discs between the vertebrae then fuse the vertebrae with specialised metal screws or bone grafts that strengthen the spine and reduce the chance for any painful motion.
  Spinal Laminectomy: For a Laminectomy procedure the surgeon will remove the lamina to increase the spinal canal and relieving pressure on the spinal cord. This is sometimes also called spinal decompression.

It is also possible that you may have surgery for some of the conditions that cause lower back pain such as Fibroids, endometriosis and cancer.

Concerned about any of the issues raised in this article? It's well worth undergoing a full body health screening to check for underlying issues, with 4 GP appointments included in all Advanced and Elite MOTS throughout 2023.

Book Now 02074991991

Stretching and exercises that help alleviate lower back pain

Perhaps your aim is to prevent the occurrence of  pain in the lower back or maybe it is to  treat pain that you currently have. There are full moves that should help and can be added to your daily exercise routine. They can be repeated once or twice a day. you should speak to your doctor before you undertake any of these types of exercise.

Chest to knee stretch

This kind of stretch will relax the hips, the Glutes, the lower part if the back and the thighs. It is done as follows:

1. Lie down on your back with your legs flat to the ground.
2. First bend the left leg and hold your knee pulling it in towards your body one your right leg is left extended.
3. Now gently stretch out your spine still holding your knee to you being careful to make sure your hips do not lift up.
4. Hold this pose for about a minute or however long you can maintain it and still feel comfortable.
5. Repeat the movements on the right side.

The Child’s Pose

This pose is known as a highly restorative pose in yoga because it stretches the thighs and Glutes and importantly, the para spinal muscles.  This is how you do it:

1. Kneeling on the floor, gently lower yourself backwards until you rest your hips over your heels
2. Hold out both arms out in front of you and sink further down into your heels
3. If you feel comfortable keep holding your arms out in front of you and turn  your arms so your palms are facing upwards. If that does not feel comfortable then you can holding your arms  to the side.
4. Hold this pose for one minute or longer if you can, if it still feels comfortable

Threading a needle

Try adding a different move to your workout or stretch routine with the threading a needle pose from yoga, that will help the pelvis, spine and hips. This is how to do this pose:

1. Start the exercise with your hands and knees on the floor with your back completely straight and flat.
2. Lift your left arm up, pointing at the sky.
3. Now bring your arm straight down and aim it through the opening that is between your body and right shoulder.
4. Now extend the arm out as far as you can stretch and hold the pose for 30 seconds.
5. Repeat that on the right side.

Go large with Superman!

If you can cope with something a bit more vigorous then you can try this Superman move. This is how you do it:

1. With your tummy pressing against the floor hold your arms in front of you in a Superman pose.
2. Now lift both legs and arms gently, and feel the weight shift onto the lower area of the back.
3. Now hold your legs and arms in that position for half a minute before you let them gently rest on the floor again. If doing 30 seconds in this pose does not feel comfortable then cut down the time.

With any of these moves you should always make gentle slow and smooth movements and be ready to stop if it becomes painful. 

Dealing with lower back pain that is severe

If your back ache is severe then you should get medical help as soon as you can. If this is your first consultation be prepared to go through the steps we mentioned earlier with examination and possible further testing with imagery etc. Any pain that comes with loss of bladder or bowel control or with increasing numbness in the limbs must be treated as an emergency because it may require surgical intervention.

How you can guard against lower back pain

There are things you can do to protect your back. Some measures include:

• Maintaining a normal weight
• Making sure that when you lift things you bend your knees rather than bending at the waist that will put all the strain onto your back
• Try to maintain good posture

Other things you can try:

• Making sure that you have a firm mattress
• Making sure that your armchair is the right height for you and is supportive
• Avoiding shoes that have high heels
• Stop smoking because nicotine in the system can cause degeneration of the spinal discs as it will reduce blood flow

When you should seek medical attention for your back pain

It is true to say that most of the time lower back pain will resolve on its own. However there are sometimes when urgent medical attention should be sought. 

Some of the instances where you should get a medical opinion as soon as possible:

• When the patient suffering the back ache is a child.
• Where the pain is due to an injury or accident or some other form of trauma.
• If there is nausea or fever with the back pain.
• Where numbness weakness or a pins and needle type tingling sensation is felt in the feet or legs.
• Where bladder or bowel control is lost.
• Where the pain is constant and severe and either progressively or suddenly gets worse and does not respond to pain medication.
• Where the pain is interrupting sleep.

Lower Back Pain FAQ:

Why do so many people suffer from lower back pain?

Typically the lower part of your back has just 5 vertebrae which is a lot less than in your mid back and your neck and that means that these five vertebrae have a lot of heavy lifting to do. The area of the lower back is where your pelvis and spine connect and is also the area that holds up the weight of your upper torso. This area it is one that experiences stress and movement an awful lot and this can lead to injuries and wear and tear.

Is lower back pain sometimes related to the weather?

You might feel that your lower back pain is worse when the weather is changing or is cold and in fact it's not your imagination. Back pain has been found to be related to barometric pressure and to the temperature outdoors. Changes in barometric pressure have been found to cause pain in joints that are arthritic and the spine. Joints and muscles generally do react to our environment and when they become stiffer, then injury is more likely.

Is it possible that the pain in my lower back could be related to my kidneys?

The answer to this question is an emphatic yes. Because the kidneys are located at the back of your body, pain in your kidneys can often feel as though it is actually pain in your back. The only way to differentiate between the two will be to visit a doctor who can make a proper diagnosis.

Could the pain in my lower back be an indication that there's something more serious wrong, like cancer?

Yes. Pain in the lower back can certainly be a symptom of cancer and in fact is often one of the first symptoms of prostate cancer where it has spread and created lesions. Always take any pain that you suspect to be more than trivial back pain seriously. See your doctor as soon as you can.

How can I treat my lower back pain with remedies at home?

If you've only just started to suffer from lower back pain, it can be a good idea to keep a diary of the times dates and symptoms you have experienced as well as any activity that you find makes the pain better or worse or triggers it in the first place. Once you have compiled a diary of your lower back problems take it to your family doctor which will make it easier for him or her to diagnose what is actually wrong.

At what point should I see my doctor for my lower back pain?

If your lower back pain does not resolve on its own these are the things you should look out for that should prompt a visit to the doctor.

• Pain that has not gone after four or more weeks.
• Pain that's getting worse.
• Other symptoms such as weight loss or gain, bladder or bowel problems or extremity weakness.

Who should I make an appointment with, for my lower back pain?

Your GP should know you best and would be the best first contact for your lower back pain. If they feel that they cannot treat or diagnose the issue then they may refer you on to a specialist or to a physician specialising in rehabilitation who will have many possible solutions available to you. There may also be a role for a physiotherapist a chiropractor or other type of practitioner depending on what the cause of your back pain is. Although we have mentioned surgery for back pain it is very rare that this is needed with lower back pain with only about one in 10 patients needing this type of intervention.