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Low(er) back pain has many names. Lumbago is a synonym for low back pain, coming from “loin = lumbus.” Sciatica is somewhat different. It is pain not only of the lower back, but hip and the outer side of the back, commonly due to the compression of the spinal root. Radicular pain is similar to sciatica, but differs in that it does not necessarily involve back pain.
Lower back pain is believed to be one of the most common causes for people taking sick leave (either those in genuine pain or those faking illness). Moreover, approximately 90 percent of adults will experience some kind of back pain during their lifetimes. So chances are people reading this may well have had some kind of back pain, or will so soon.
There are so many causes for back pain, and it does not always have to do with herniated discs (sadly, in Korea, people dub low back pain as “disc — 디스크” and think it is the herniation of the disc that is the most profound cause of back pain). Acute back pain is usually not due to a disc herniation leading to a radiculopathy. (The prevalence tends to be not much more than 1 percent).
Because of the rather vast amount of information on this subject, it will be divided into three (or more) parts.
1. The common causes of back pain
2. The treatment methods for back pains
3. The exercises that tend to be helpful to people with back pain
There are a lot of reasons and causes of back pain, starting from musculoskeletal strain to trauma, psychogenic to neoplastic. The back itself may be problematic in most cases, but pain can also be from other sources like the kidney or appendix. Natural conditions like pregnancy, or not-so-natural protrusion of the abdomen (like a beer gut), may also cause back pain.
But, like most pains of the body, the most common cause of back pain is due to muscle strain — too much exercise, or a competitive ultimate Frisbee game, might have been the cause. Another common cause for back pain is a sprain to the ligament (when the ligaments connected to the back area are pulled beyond their means).
Herniation of discs in the lumbar region compresses the nerves that go to the back and cause subtle to serious back pain. It can be initiated by a strenuous activity, such as lifting heavy objects, or a simple activity like coughing or emptying your stomach, or — more often than expected — for no reason at all. These kinds of injuries tend to show radicular nature (sciatica).
Pregnant women most likely have back pain — it is something they cannot dodge. Increased size (and upward shift) of the uterus may expand the muscles. Also, a hormonal change may lead to laxity of the joints, which leads to inflammation and discomfort. It may appear in the early phase of pregnancy, and most likely becomes more severe in nature as pregnancy develops.
In people older than 50, stenotic changes to the spine, resulting in the thickening of associated structures and generation of bony spurs, coincides with degenerative changes of the spine. The stenotic change may jeopardize the nerve root going through the spine, which can lead to back pain or a cramping of the lower extremities.
More often in women, the reason for back pain can be due to osteoarthritis that affects the spine. Osteoarthritis is a degenerative disease that leads to the thinning of the cartilages, resulting in collision and rubbing of the spine. This kind of friction may induce inflammation to the structure, leading to pain. Also in women, after menopause, commonly osteoporosis develops. Because of the fragility and brittle nature of osteoporotic bones, the spine may be prone to injury, from such obvious causes such as a fall, trauma, or a simple sneeze, leading to a painful compression fracture of the vertebra.
There are other causes that may be of importance, but would be too much for this column. The best way to find out the cause of your back pain (if you are experiencing it) is to go to a spine specialist and have a thorough examination, an X-ray, for starters. (A CAT scan, MRI or an Electromyography is not the first diagnostic tool, and should not be, in many cases).
In my next article, I will talk about the various treatment methods for back pain.
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