Low Back (Lumbar) Pain

After the common cold and maybe headache, low back pain is the next most common experience of the human condition. We will leave the reasons for that to biophysicists and the clergy, but dealing with it certainly falls within the practice of a neurosurgeon.

First, let’s define what we mean by “low back”. It is that area of the backside of you that lies under your belt line or a little above or below that. It is the part of your spine that moves the most when you bend over with your legs straight to pick up that pencil you just dropped on the floor.

There are a number of reasons to have pain in the low back but not really very many as there aren’t many things in that area which can hurt. Let’s see—you have muscles, ligaments, joints, discs and vertebrae (spine bones). About the last thing that can hurt in the low back region is a tumor so let’s put that concern way on a back burner (we’ll get to tumors in a bit).

a. Type of Pain

Whether your pain is sharp, stabbing, deep and boring, burning, throbbing or with some other unique characteristic, the type of pain you have tells us nothing about the cause of the pain. Little anatomical problems can cause a lot of pain, a huge ruptured disc can hurt very little and no one type of problem causes a specific kind of pain.

b. Back Strain

The most common cause of back pain is a strain of a muscle, ligament, joint or a disc. You can’t strain a vertebra which is a big and very strong bone that only hurts if it is fractured or has a growth in it (very rare). With that in mind, most low back pain comes on after you have done something active such as lifting a heavy object (like that chair or bag of mortar mix), repeatedly bent over (like planting the garden or digging in it) or twisted suddenly particularly at a funny angle. When you can identify the activity that started the whole thing, you can pretty much be sure you have strained a muscle, joint, disc or ligament.

These strains almost always heal if you give them a little time, reduce your activity some and take pain pills (acetametaphen-Tylenol) and anti-inflammatories (ibufrofen or naproxin-Motrin, Aleve, Advil) which are available at the grocery store or pharmacy without a prescription. Hot baths, Jacuzzi, massage, heating pads, ice packs and stuff you rub on your back are all OK but probably don’t get directly at the strain itself. They can make you feel less pain and that is just fine. Exercises don’t make much sense with a recent strain since making an unhappy part of you work harder isn’t likely to speed healing.

Let’s be very clear about strains. Though they are not serious in the big picture of bad things that can happen to your body, that does not mean they only hurt a little. They can hurt a lot. They can keep you bent over and make it very hard to walk or change position.

But severity of pain does not equal danger when it comes to back strains and if you can tough it out for a few days, improvement usually occurs. If decreased activity and the over-the-counter medications don’t cut it for you and you are in too much pain, then that is why we have doctors.

Give one a call and maybe you will be advised to come in for an examination or maybe just be given a stronger prescription medication. Either approach is OK to start with but if the pain hasn’t decreased significantly in a week, then get thee to a doc. Not that you are in trouble, but by then it is time to have an exam, maybe a regular X-ray of the back and some more formal therapy and different medication.

c. Back pain without a strain

So much for strains. Now, let’s consider low back pain that came on without any unusual activity. Interestingly, most such pain is still due to an unhappy joint or disc but the ligaments and muscles are probably not guilty. The normal activities of daily living can tweak a joint or disc so the same advice given above for initial self treatment still holds. But without an activity related onset, advice from a physician should probably be sought a little earlier than with a clear activity related strain.

Again, you are probably not in any danger but low back pain coming on without a pretty good relationship to an activity is where we have to now consider such things as vertebrae fractures due to softening of those bones with age or remotely a tumor or bone infection. Doctors can be particularly helpful here as X-rays usually tell the story and guide further evaluation and treatment.

d. Back pain due to a fall

Hardly anyone fractures their low back vertebrae by falling from a standing position or a chair in which you are seated (unless you are over 65 and particularly if you are a woman of that or an older age) but you can sure tweak your muscles, ligaments, joints or discs. If you fall from a height (ladder, chair your were standing on, roof, tree, etc.) then you can fracture a vertebra. Although these fractures are rarely dangerous, an early visit to your doctor for an X-ray is appropriate. A fall from a height causing back pain and leg numbness or weakness or bladder or bowel control problems is an emergency (not a 911 type unless you can’t get up but a go to the emergency room or urgent care center now type).

e. Back pain due to a blow

Being struck in the back rarely causes more than a bruise to the skin, muscles or ligaments (unless it was caused by a vehicle or other large moving objects). With little blows, give it a little time to quiet down and treat it like a strain (see above). With big blows, an urgent care center or ER visit is warranted.

f. Nerve pain, pinched nerve, sciatica

Low back pain can spread up the spine to the thoracic region (well above your belt line) and down into your tailbone area and buttocks and the back of your thighs and still probably doesn’t signify anything more than low back muscle, ligament, disc or joint problems mentioned above. Low back pain spreading to the hip or the groin region also usually doesn’t signify any nerve problem. But pain spreading down one leg into the thigh and calf or shin or foot usually means you are pinching a nerve (sciatica) and under the age of 65 this almost always is a disc problem. It doesn’t have to start with an activity related incident (you can just wake up with it in the morning) but often does.

Once again, the initial self treatment of decreased activity and over-the-counter medications is the way to begin. This pinched nerve situation isn’t an emergency unless you have leg weakness, can’t control your urine or are in extreme pain so there is no immediate need to seek a consultation. This type of a disc problem frequently quiets down fairly quickly and usually resolves in a matter of a few weeks.. However, after a week without improvement, use your phone and call a doc.

When the nerve symptoms involve both legs or interfere with your ability to urinate, then you do have a more urgent problem and self-treatment should not be pursued. Get into see your doctor quickly and if you can’t arrange that, then off to the emergency room or at the least to an urgent care center.

g. Tumors

Tumors of the spine are rare and come in two main types. There are those that arise from the spine structures themselves and those that come as a spreading (metastatasis) from other areas of the body. If they cause low back pain, which they all do not, it is almost never caused by an activity so if you strained your back doing something, relax and follow the recommendations above. Although non-activity related back pain is rarely due to a tumor, if yours persists beyond a month (presumably this would be mild back pain since if it were severe you would have seen your doctor sooner following the suggestions listed above), then a visit to your physician is indicated.

Spine tumors that don’t cause back pain can cause leg or bladder symptoms so if you don’t have back pain but do have leg pain, weakness or numbness lasting more than a week or so, seek medical help. Tumors that only cause bladder control problems are extremely unusual but bladder control problems lasting more than a day or so warrant an early visit to your physician.

h. Low back scans

Almost everyone knows that we have superior scanning machines that allow us to “see” inside the body and the spine is easily seen on such scans. Many of you may wonder why we doctors don’t just scan everyone with back pain just to be on the safe side. The reason we don’t is that an expensive back scan for everyone with back pain would be a terrible waste of resources. Scans done for a short history of back pain no matter how severe would not detect anything we doctors can’t pretty well guess would be present by just listening to your story and doing an examination. Early scans are indicated for weakness or bladder control problems but not just for the amount of low back pain or leg pain you might have since what we may see on the scans (herniated discs, arthritic joints—we can’t see ligament or muscle strains) won’t change what we initially recommend which is usually patience, medications and maybe some therapy. When the back pain persists beyond a month and is not getting better, then a scan may well be warranted. See your doctor about that.