COMMON CAUSES OF BACK PAIN

Symptoms and causes of lower back pain

Back pain, lumbar spine pain, lumbago, mechanical back pain, non-specific back pain, simple back pain and slipped discs are all terms used to describe painful symptoms emanating from the lower back and/or top of the buttocks.

Often the pain experienced is moderate to severe restricting normal movement and function. Sitting, driving, rising to standing, putting on shoes & socks, washing up, brushing teeth and sitting on the loo are regularly reported as aggravating factors whilst heat, a change of position, walking and medication help to settle pain.

Patients regularly report taking time off work and reducing participation in hobbies due to symptoms or fear of further harm. Disturbed or broken sleep is non-restorative, reducing resilience leading to further frustration, negative thoughts and mood disturbance.

Back pain is extremely common with 80-90% of the population likely to experience symptoms at least once in their lifetime. It may feel serious in the midst of it all as you experience spikes of pain with most normal movements, however this is likely because the spine and surrounding muscles are central to all movements of the body and you are simply moving those structures; for example, you may have pulled/sprained the muscles of you lower spine, you may have aggravated a ligament, irritated a nerve, developed stiff spinal joints or most likely a combination of all. When rising from sitting the spinal muscles, ligaments and tendons will tighten and spinal joints extend. Despite this being a completely normal movement, the series of movements required at each structure can be enough to aggravate pain.

Sitting down involves lengthening the spinal muscles, tendons and ligaments, flexing the lumbar spinal joints which again could trigger pain symptoms.

It’s important to remember that despite the levels of pain and distress often associated with back problems, the majority are not serious and are likely to ease off within a day or up to eight weeks.

Specific back pain

Occasionally back pain is the result of trauma, disease process or structural change:-

Osteoarthritis/Spondylosis

Osteoarthritis is common affecting spinal facet joints. The cartilage covering the joints becomes worn through normal use causing stiffness and pain. The change in the joint can lead to a build-up of inflammation further causing symptoms of pain and stiffness. Symptoms are reported as being worse first thing in the morning and following a period of rest, improving with movement. You may feel and hear a clicking, grinding or crunching sensation as you move your spine which is normal and not harmful.

Degenerative disc disease

The intervertebral discs are a gel-like consistency housed in stretchy cartilage that provide shock absorption for our spines. As we age, and occasionally through injury, the discs dehydrate losing size and their ability to withstand forces placed upon them. This is a very common condition which develops with age and is considered to be normal.

Osteoporosis

A condition where the vertebrae (bones) become thinner and therefore weaker which increases the risk of a break or fracture which can cause sudden pain and deformity. You are likely to recall a fall or heavy landing into a chair that preceded the problem.

Spinal Stenosis

The solid bone canal that protects the spinal cord narrows through ageing or injury preventing nerve impulses from reaching their destination at the required speed/intensity. Narrowing is caused through extra bone growth, osteoarthritic facet joints, ligament degeneration, disc protrusions and occasionally change to the structure of the spine (spondylolisthesis, scoliosis, fracture..) Back pain is common with many patients reporting pain and heaviness in their legs when walking especially ascending inclines which eases with leaning forwards, sitting and rest.

Lateral recess stenosis

A similar process to spinal stenosis however symptoms are only experienced on one side i.e. left or right buttock, leg and foot. Patients report back pain and single-leg symptoms due to narrowing of the space in the spine where an individual nerve passes.

Spondylolisthesis

A condition where one spinal vertebrae slips forward out of alignment narrowing the spinal canal. Can be caused by the normal ageing process, a break or fracture due to an injury or repetitive loading. Back pain can be a factor as well as leg pain (Sciatica) if a spinal nerve is being compressed.

Sciatica

Sciatica is an umbrella term primarily used for buttock and leg pain when other conditions have been ruled out; for example… hip or knee arthritis. Sciatica may or may not be accompanied with lower back pain. The Sciatic nerve is the largest and longest nerve in the human body beginning in the lower lumbar spine following a path through the buttock, down the back of the thigh and calf to the foot and toes.

Sciatica develops when the Sciatic nerve becomes irritated, inflamed or compressed, which may cause pain, weakness, numbness, tingling, burning and other neurological symptoms in the affected leg. The sensation of water running down the leg, electric shocks, dead leg, itchy or the feeling of a pebble in the shoe are commonly reported by patients.

The underlying medical condition of Sciatica is commonly found to be one of the following:-

• A herniated lumbar disc (slipped disc) which may physically or chemically (sometimes both) cause irritation/compression to a spinal nerve.
• A fracture – a break in the bones of the spinal column due to age-related changes or trauma.
• Inflammatory back pain often caused through conditions termed axial spondyloarthritis. An inflammatory arthritis that causes ligaments and tendons that attach to the spine to become inflamed, leading to new bone growth in place of the flexible ligaments and tendons. As the process repeats the spine becomes fused.
• Lumbar spinal stenosis causes narrowing to the channel where the nerve passes through leading to compression/irritation.
• Degenerative disc disease, general vertebral and facet joint degeneration.
• Spondylolisthesis – a structural change leading to nerve compression/irritation.

Fibromyalgia

Long term condition that can cause painful symptoms throughout the body in different areas at different times. Patients often feel tender with ongoing aches and stiffness which may be felt in the spine (back). Fibromyalgia is often diagnosed following a series of investigations to rule out another suitable cause for symptoms. Depression, anxiety, general fatigue, tiredness and headaches are widely seen with this condition.

Cancer and Infection

Back pain can also be caused by cancer and infection however, this is very uncommon.