Three out of four people experience lower back pain. A majority
of these pain symptoms normally subside on their own unless
they stem from serious back injuries. Keeping fit and maintaining
an active lifestyle can keep lower back pain at bay. Painkillers
can also alleviate pain symptoms. However, chronic back pain
can develop in some people, which may make additional treatment
The Anatomy of the
The lower back is mainly composed of muscles which envelope
and connects to the spine. The spine is a column made up of
generally circular bones known as the vertebrae. Between each
vertebra are tough elastic discs which allow the spine adequate
flexibility. Fibrous ligaments connected to each nearby vertebra
also work to support and strengthen the spine. The muscles
that surround the spine help it to accomplish a wide range
Enclosed within the spine
is the spinal cord which houses the nerves connecting to the
brain. These nerves which intertwine within the vertebrae
are responsible for sending and receiving messages from all
the different body parts to the brain, and vice versa.
Types of lower back
1.) Simple lower back pain
The most prevalent type of
lower back pain is the simple lower back pain, also known
as ‘non-specific’ lower back pain. This means
that pain symptoms are not caused by any other disease. A
sprain, or an overstretched ligament or muscle can be a cause
So can minimal disc or facet
joint problems that occur between vertebrae. Even for a physician
performing several tests, it is impossible to determine the
cause of pain and where the pain originates from. Because
of this, nearly 19 in 20 cases of acute lower back pain have
been diagnosed as ‘simple lower back pain’.
A sudden onset of pain may
follow the lifting of a heavy object, or after making an uncomfortable
twisting motion. Some people wake up to lower back pain.
Simple lower back pain can
range from minimal to severe. The pain may be concentrated
on a localized region on the lower back and may spread to
the buttocks and thighs. Lying prone on a flat surface can
sometimes ease symptoms, but any movement of the back, like
a cough or a sneeze can exacerbate the pain. Simple lower
back pain is ‘mechanical’ in nature as it can
vary depending on posture or movement.
Simple lower back pain can ease by itself within a short period
of time, in a week or two. In 3 out of 4 sufferers, pain symptoms
disappear entirely or are significantly reduced in a month’s
Nine out of ten cases report
the absence or considerable reduction of pain within six weeks.
Although the pain symptoms do improve, they may reoccur periodically
afterwards. Minimal twinges of pain may be felt in one instance
or another after the first big bout of back pain. Other sufferers
experience a persistence of these minor pains for more than
a month or two, giving rise to what is known as chronic back
2.) Nerve root pain
Nerve root pain is caused
by a ‘trapped nerve’ from the spinal cord that
is subject to compression or constriction. Arising in less
than one in twenty cases, the pain is felt along the course
of the nerve and may travel down the leg, calf or foot. Often
symptoms are more severe in the leg or foot than it is at
the nerve origin. An example of nerve root pain is Sciatica,
a condition where pressure is placed on the sciatic nerve,
irritating it and causing pain.
Pain can range from mild to
severe. Similar to simple back pain, symptoms can be alleviated
by lying flat on a surface, or aggravated by back movement,
coughing or sneezing. Other symptoms include tingling, numbness,
and a feeling of weakness along the regions of the buttocks,
leg or foot.
One of the causes of nerve
irritation or pressure can stem from the inflamed conditions
of a sprained ligament or muscle. Another is a ‘slipped
disc’, where the disc does not literally “slip”,
but is manifested when its soft interior portion prolapses
or protrudes out of a breach in the harder outer disc perimeter.
This protrusion can put pressure on a nearby nerve and cause
pain (refer to the separate leaflet on “Prolapsed Disc”).
Other lesser known conditions may also cause nerve root pain.
Other Causes of Lower
1.) Arthritis – this
condition is caused by inflammation of the joints. When it
occurs within the spine, it can cause back pain.
2.) Osteoarthritis –
the most common form of arthritis in older people.
3.) Ankylosing spondylitis
– may be manifested in young adults, causing lower back
pain and stiffness.
4.) Rheumatoid arthritis –
can affect the spine as well as other joints in the body (refer
to separate leaflet on the different types of arthritis).
5.) In less than one in a
hundred cases, lower back pain can be caused by rare bone
disorders, tumours, infectious diseases, and constrictions
caused by other bone structures close to the spine.
Determining the Type of Back
In the normal course of events,
lower back pain may suddenly occur (acute onset), caused by
simple low back pain. In most cases, sufferers bear with the
symptoms and undertake self medication, with varying degrees
of success. In case of doubt as to the cause of the pain symptoms,
it is also advisable to consult with a physician for a proper
Some symptoms may arise as
a result of an underlying problem related to the pain. It
is best to schedule an appointment with a doctor when the
following signs are manifested:
1.) Patient is under the age
of 20 or over the age of 55.
2.) Pain symptoms are constant,
and are not alleviated by either lying down or resting.
3.) Pain runs through to the
chest, and originates from the upper back, just behind the
4.) Pain began gradually,
and progressed to severe symptoms through the course of days
or weeks, differentiated from simple lower back pain which
can occur all of a sudden.
5.) Other symptoms may include:
• Weak leg or foot muscles.
• Numbness experienced within the region of the buttocks,
around the anal area, or in a leg or foot.
• Bladder or bowel disorders, like inability to urinate
• Fever, loss of weight, and general feeling of poor
• Recent occurrence of violent injury or trauma to the
• An existing cancer diagnosis.
• Steroid use for more than a month.
• A generally compromised immune system (e.g. usually
brought about by chemotherapy or HIV/AIDS).
• Doubt about any of the symptoms manifested.
The Rare but Critical Cauda
Cauda equine syndrome is a
very serious type of nerve root problem that is classified
as an emergency case. Although uncommon, this syndrome leads
to lower back pain, inability to urinate, numbness within
the anal area, and a feeling of weakness in one or both legs.
The disorder, which requires urgent medical attention, is
caused when the nerves at the end of the spinal cord are subject
to constriction. If left unattended, Cauda equine syndrome
can permanently destroy the nerves connecting to the bladder
and bowels. As soon as symptoms of this ailment put in an
appearance, it is advised to consult a doctor as soon as possible.
When Tests are Needed
When a physician has made
an accurate diagnosis based on physical examination and evaluation
of the pain symptoms, tests are usually unnecessary. Nerve
root pain that occurs suddenly and subsides after a few weeks
will require no tests. X-rays or back scans will show nothing
out of the ordinary for symptoms of simple lower back pain.
However, when nerve root pain remains constant or severe,
or if there may be a suspected underlying cause for the pain,
the doctor may recommend that an X-ray or scan be taken.
Treating Simple Lower
1.) Regular Exercise
It is important to maintain
regular everyday activities despite the discomfort. Although
this may initially prove difficult because of the pain, increasing
one’s range of motion incrementally can be bearable
if not overdone. Goal setting can be a good idea to track
progress and provide encouragement.
Medical advice in the past
included recommendations of rest until the pain subsided.
This has now been proven inconclusive as prolonged immobility
increases the risk of developing chronic back pain. By continuing
to move, faster recovery from pain is likely to occur.
Likewise, past advice on sleeping
positions - flat on one’s back on a firm mattress -
has also been unproven in relieving pain symptoms. Current
recommendations involve advising patients to sleep in a position
and on a mattress they feel most comfortable in.
2.) Pain Medication
When pain medication is necessary,
it would be better to take them on a regular basis rather
than intermittently as needed. Regular doses work better to
ease pain symptoms and enable increased activity in the sufferer.
Some examples of pain killing medication include:
1.) Paracetamol – this
analgesic works efficiently if full strength doses are taken
regularly. Adult dosage amounts to 1000 mg, or two 500 mg
tablets, taken four times in a day.
2.) Anti-inflammatory painkillers
– some pain sufferers have discovered that these provide
more effective pain relief compared to paracetamol. Over-the-counter
painkillers like ibuprofen or prescription medication like
diclofenac are widely available in pharmacies. However, anti-inflammatory
drugs are dangerous for people suffering from asthma, high
blood pressure, kidney ailments or heart disease.
3.) Industrial strength painkillers
– like codeine may be taken together with paracetamol.
One side-effect of this drug is constipation, and straining
during hard bowel movement can worsen back pain symptoms.
Constipation can be avoided by consuming fibrous food and
increasing fluid intake.
4.) Muscle relaxants –
work well if the back muscles are constantly tense. The muscle
relaxant diazepam may be prescribed for a minimum of a few
days to loosen tight back muscles that worsen back pain.
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Physical remedies that include
sessions with a physical therapist, chiropractor or osteopath
can aid in providing short-term relief from back pain.
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There are a lot of treatments for lower
back pain, and programmes for such should be monitored by
a physician to determine whether they make symptoms worse,
if pain continues for more than 4 to 6 weeks, or if the symptoms
start to change. Trying different kinds of treatments for
chronic back pain may be necessary until one finds a treatment
Treatments for Other
Types of Back Pain
Nerve root pain
The treatment for nerve root pain is
similar to that of simple lower back pain. Symptoms of this
type of disorder usually disappear over a period of one or
two weeks. Physical treatments may also provide temporary
relief from pain. However, chronic back pain stemming from
a ‘slipped disc’ may require surgery for immediate
relief of the pressured or irritated nerve.
Other Causes of Back
Treatment for other types of back pain
would have to depend on the main cause of pain symptoms. For
instance, pain caused by arthritis can be remedied by different
kinds of arthritis medications.
of Back Pain
There has been a glut of evidence that
points toward leading an active lifestyle and regular exercise
as the best possible solutions to preventing back pain. Aerobic
activities like walking, running or swimming can help keep
the body in a general state of fitness.
Although there is no supporting evidence
that performing back strengthening exercises can prevent reoccurrence
of back pain, it is advisable to be well-informed about proper
lifting techniques to avoid injury, particularly when lifting
objects while in an awkward or twisted position.
A Summary of Back
• Acute lower back pain, even
if severe, is normally not considered critical.
• Recovery from lower back pain
is a speedy process taking as little as a week.
• Although nerve root pain and
prolapsed (‘slipped’) discs are an uncommon occurrence,
they usually heal by themselves without requiring surgery.
• Keeping active as much as possible
and continuing with routine everyday activities such as going
to work, will hasten recovery from lower back pain. Limiting
movement and doing a little exercise will only increase the
risk of developing chronic symptoms.
• Should the pain be severe,
initial rest may be necessary, but incremental movement is
encouraged for a speedier recovery – something that
constant bed rest will not provide. Warming up the muscles
through motion is preferable to having them stiffen up from
long periods of immobilization.
• Bearing some measure of pain
and discomfort may be necessary while returning to everyday
activities. Simple lower back pain will not be aggravated
by movement. In fact, constant activity will help prevent
the development of chronic long-term symptoms.
• Regular use of painkillers
can alleviate the pain during the recovery period.
• If pain worsens or continues
for more than 4 to 6 weeks, or if other uncommon symptoms
develop, it is advisable to consult a doctor immediately.