Lower back pain – Why it’s a common complaint?

Lower back pain is one of the most common health complaints worldwide.  It is estimated that approximately 80% of people experience lower back pain at some point of their lives (lifetime prevalence).

We can divide these into two groups of patients. One group has lower back pain alone, the other group are those with leg pain (sciatica) with lower back pain.

Lower back pain

Lower back pain can have various causes, ranging from minor muscle strains to more serious underlying conditions. Understanding the potential causes of lower back pain can help individuals seek appropriate treatment and management strategies.

One of the most common causes of lower back pain is a muscle strain. This typically occurs when the muscles in the lower back are stretched or torn due to sudden movements, lifting heavy objects improperly, or excessive physical activity.

Prolonged sitting or standing with a poor posture can strain the muscles and ligaments in the lower back, leading to pain. Slouching, hunching over a desk, or improper ergonomics can contribute to lower back pain.

With age, the discs that act as cushions between the vertebrae in the spine can gradually wear down or degenerate. This condition, known as degenerative disc disease or disc degeneration, can also cause lower back pain and stiffness.

Various forms of arthritis, such as osteoarthritis or rheumatoid arthritis, can affect the lower back and cause pain. Arthritis leads to inflammation, stiffness, and cartilage damage in the joints, contributing to lower back pain. Facet joint arthritis or degeneration can also cause lower back pain.

The sacroiliac joints, located at the base of the spine where the sacrum connects to the pelvis, can become inflamed or dysfunctional, leading to lower back pain. This condition is more common in women and can be aggravated by pregnancy, injury, or repetitive stress. This condition is known as Sacroiliitis.

Infections or inflammatory conditions affecting the spine, such as spinal infections or ankylosing spondylitis, can cause lower back pain. These conditions often require medical intervention for diagnosis and treatment.

Spine fractures, sprains, or strains resulting from accidents, falls, or sports-related activities can cause lower back pain.

Finally cancer (tumors) of the spine can cause back pain due to fractures or compression of the surrounding structures.

Leg pain (sciatica) with lower back pain

If there is associated leg pain with the back pain, the cause can be a slipped disc (herniated disc) which occurs when the soft inner material (nucleus pulposus) of the spinal disc protrudes through a tear in the outer layer. This can irritate the lumbar nerves, resulting in sciatica pain (pain radiating down the leg). This usually occurs at the L4, L5 or S1 dermatomes as these are the common nerves that are compressed.

Spinal stenosis refers to the narrowing of the spinal canal, which can put pressure on the lumbar nerve roots. This condition often develops as a result of age-related changes in the spine and can cause lower back pain, as well as leg pain and weakness on walking a certain distance (neurogenic claudication).

If you have sciatica or neurogenic claudication (leg pain on walking a certain distance), an MRI lumbar spine scan is recommended if the pain is persistent despite rest and analgesia. The MRI scan will show if there is any nerve compression that might need surgery to relieve the pressure on the nerves.

Red Flags (danger signals):

If you have the following symptoms with back pain, do seek medical attention as it could mean something more serious.

1. Fever or night sweats
2. Loss of urinary or bowel control (numbness over peri-anal region)
3. Past history of cancer
4. Loss of appetite and unintended weight loss
5. Loss of lower limb strength or sensation

Summary:

Back pain and sciatica will usually get better with rest and a short course of analgesia and physiotherapy. If it does not, consulting Dr. Gamaliel Tan is recommended.

It is important to note that this list is not exhaustive, and other factors can contribute to lower back pain. Treatment options may include pain medication, physical therapy, exercise, hot or cold therapy, and in some cases, surgery. Additionally, adopting a healthy lifestyle, maintaining proper posture, and avoiding excessive strain on the lower back can help prevent future episodes of pain.