Up to 80% of Americans will experience low back pain at some point in their life. Why is it so common and is there anything that can be done about it?
It has to do with the shape of the spine, specifically the part of the spine in the lower back called the lumbar spine. The spine is made of vertebrae bones stacked on top of each other separated by spongy cartilage-like discs acting like shock absorbers. The spine supports all the upper body weight which puts a lot of load on the lumbar spine and results in mechanical stress and strain. The lumbar spine is curved at the bottom. This is normal anatomy, however, it predisposes the lowest segments of the lumbar spine to extra wear and tear. The cumulative wear and tear can cause longer lasting and constant low back pain that may become chronic (lasting at least 3 months). The most common reasons for low back pain include:
- Degenerative disc disease is when the lumbar discs wear down over time from cumulative wear and tear and no longer do their job of providing a cushion between the vertebra bone.
- Herniated disc is sometimes called a “slipped disc”. In this case part of the disc bulges out from its normal location. This may result in not only back pain but also pain that radiates down the leg if the bulge pushes on a nearby nerve, commonly referred to as “sciatica.”
- Spinal stenosis is when the spinal canal has become narrowed over time resulting in less room for the nerves. Often this is due to a combination of arthritis of the spine as well bulging discs. Over time it leads to pain in the lower back as well as in the legs, especially with walking and standing for long periods of time.
- Vertebral compression fracture – In this case the cause is fractured vertebrae bone due to osteoporosis (brittle bones due to low bone density).
- Facet joint pain – Here the pain is due to arthritic pain stemming from the spinal joints called facet joints. These attach vertebra bones to one another. The pain here is typically in the lower back and mostly with prolonged standing and walking.
Prevention is probably the most important type of treatment for low back pain and is not emphasized nearly enough in our society. Good posture, proper ergonomics and biomechanics, and daily exercise, especially core strengthening, is crucial in the prevention of back injury and unnecessary extra wear and tear. Once a back problem develops the treatments can vary, are usually diagnosis specific, and can be very effective. Most important, surgery is rarely needed and should be reserved for when conservative modalities are not effective or, when there is neurologic emergency such as weakness, numbness, incontinence, tumors, or infections.
If you are suffering from back pain it is important to see a skilled physician who offers you conservative treatment options. Ashot Kotcharian, MD is a Physical Medicine & Rehabilitation physician with a specialty in Interventional Pain Management. He is accepting new patients at Sarasota Orthopedic Associates where we offer same or next day appointments in any of our three locations.