Lower back pain is one of the leading reasons people in the United States visit their doctors. It will inhibit the lives of millions of Americans this year. In fact, an average four out of five adults will experience low back pain at some point in their lives. So the question, “What is causing my lower back pain?” is not uncommon.
Lower back pain can be excruciating. It can be caused by a large variety of injuries or conditions, such as:
* lower back muscles may be strained
* discs between the vertebrae may be injured
* large nerve roots extending to arms and legs may be irritated
* smaller nerves that supply the lower back spine may be irritated
* joints, ligaments, or even bones may be injured
When lower back pain occurs with other symptoms such as fever and chills, a serious medical condition may be present. You should see a doctor immediately.
Three categories of lower back pain
Your lower back pain will fall into one of three categories, which your doctor bases on your description of the pain.
1. Axial lower back pain – mechanical or simple back pain
2. Radicular lower back pain – sciatica
3. Lower back pain with referred pain
1. Axial Lower Back Pain
Axial lower back pain is the most common of the three. It is felt only in the lower back area with no pain radiating to other parts of the body. It is sometimes called mechanical back pain or simple back pain.
* Description: Axial lower back pain can vary greatly. It may be sharp or dull, constant or intermittent. On a scale of 1 to 10, you may rate its intensity #1 or a full #10. It may increase with certain activity – when playing tennis, for example. It may worsen in certain positions – such as sitting at a desk. It may or may not be relieved by rest.
* Diagnosis: Axial lower back pain might be diagnosed by you rather than your physician. You know it started when you were helping a friend move a heavy couch. On the other hand, it may be your doctor who determines that you have strained or otherwise damaged back muscles, have a degenerated disc, etc.
* Treatment: The cause of your axial lower back pain does not matter when it comes to treatment. You will want to rest for a day or two. Follow this by gentle back pain exercises and stretching. If you have more pain after exercise, use a heating pad on low or medium setting. Take an appropriate over-the-counter pain medication. Follow your doctor’s advice.
* Prognosis: Symptoms of axial lower back pain disappear with time, and about 90% of patients recover within four to six weeks. If you do not feel better within six to eight weeks, additional testing and/or injections may be needed to diagnose and treat the source of the pain.
* Caution: If your pain is chronic, or so severe that it awakens you during the night, see your doctor.
2. Radicular Lower Back Pain
Radicular lower back pain is commonly referred to as sciatica. It is felt in the lower back area, thighs, and legs.
* Description: Radicular lower back pain often begins in the lower back, and then follows a specific nerve path into the thighs and legs. Your leg pain may be much worse than your back pain. It is often deep and steady. It may readily be reproduced with certain activities and positions, such as sitting or walking.
* Diagnosis: Radicular lower back pain is caused by compression of the lower spinal nerve. The most common cause is a herniated disc with compression of the nerve. Other causes might be diabetes or injury to the nerve root. If you had previous back surgery, scar tissue may be affecting the nerve root. Elderly adults may have a narrowing of the hole through which the spinal nerve exits.
* Treatment: Conservative treatment is the best place to begin. Rest for a few days in a bed or chair. Follow this by gradual introduction of gentle exercises specifically for back pain relief. Follow your exercise with additional rest, applying a heating pad on low to medium setting. Soak daily in Epsom salts baths. Take an appropriate over-the-counter pain medication. Your doctor may want to use selective spinal injections.
* Prognosis: Symptoms of radicular low back pain may decrease with the conservative treatment outlined above. Give your back and legs six to eight weeks to improve. If surgery is needed after that, it typically provides relief of the leg pain for 85% to 90% of patients. The back pain itself is more difficult to relieve.
* Caution: If an MRI or CT-myelogram does not definitely confirm nerve compression, back surgery is unlikely to be successful.
3. Lower Back Pain with Referred Pain
Lower back pain with referred pain is not as common as axial or radicular back pain. This pain, which does not radiate down the thighs and legs, may be caused by the same conditions that cause axial lower back pain.
* Description: You will usually feel referred pain in the low back area, radiating into your groin, buttocks, and upper thigh. The pain may move around, but it will rarely go below your knee. It often is an achy, dull pain. It tends to come and go. Sometimes it is very sharp, but other times it is only a dull sensation. It can be caused by the identical injury or problem that causes simple axial back pain. Often, it is no more serious.
* Diagnosis: It is very important to have a physician determine whether your pain is lower back pain with referred pain or radicular lower back pain, since the treatment varies considerably.
* Treatment: Once you know for sure that yours is lower back pain with referred pain, you can follow the treatment for axial lower back pain.
* Prognosis: Symptoms of lower back pain with referred pain disappear with time, usually within four to six weeks. If you do not feel better within six to eight weeks, ask your physician if additional testing and/or injections are needed.
* Caution: If your lower back pain is chronic, or so severe it awakens you during the night, you should see your doctor.