Reasons for lower-back pain and how to overcome them

The human spinal column is a complex structure composed of 24 individual vertebrae and sacrum.  The spine can be divided into four distinct regions cervical, thoracic, lumbar and sacral. The cervical and lumbar regions are of greatest interest clinically due to substantial loading and mobility of these regions and the associated high incidence of trauma and degeneration. Human spine houses the spinal cord the only connection of neurological structures between the brain and body.

The spinal cord is surrounded by bones called vertebrae. The vertebrae are separated by discs at the back, which act as cushions or shock absorbers. The vertebrae are joined at the back with cartilage-lined synovial facet joints. All these ensure you can bend your back in six degrees of movement. Ligaments that hold the vertebrae and discs together, as well as tendons that attach muscles to the vertebrae - ensure your movements are synchronized and effortless.

Like other parts of the body, the back too, especially the lower back can suffer from pain for various reasons. These reasons can be divided into:

• Mechanical/structural: Here, the lower-back pain is due to movement and physical forces that affect one or more of the above components and soft-tissues that surround the spinal column
• Organic: Here, the lower back pain is due to a specific disease such as cancer
• Strain and sprain: These are due to overuse, or wear and tear. While strain is related to the muscles and tendons, sprain affects the ligaments.
• Idiopathic or non-specific: As the name implies, there is no specific reason for the pain, or the cause is unknown

 So, what are these reasons?

Causes

• Degenerative disc disease: With time, discs become thin or flat due to wear and tear. They are not able to cushion the vertebrae efficiently and are likely to tear.
• Herniated disc: The discs are made of a protective covering on the outside and soft, gel-like tissue on the inside. With time, some people may develop a tear on the outer covering. When this happens, the soft tissue inside is pushed out through the tear. The condition is also called slipped disc and bulging disc. The bulge can press on the nerve roots, causing pain, numbness and weakness in the area served by those nerves.
• Lumbar Radiculopathy: The sciatic nerve runs down from the lower back into the buttocks and legs. When the nerve is pinched or irritated, there can be pain in the lower-back and legs. The condition is also called sciatica.
• Spondylolisthesis: Spondylolisthesis is slipping of one vertebrae over the other there by compressing the neural structures between them. It can be caused by congenital abnormalities, degenerative processes around the vertebrae, and post trauma. The spine gets misaligned and twisted causing pain.
• Spinal stenosis: The space in the neural canal that carries the nerve root can be compromised because of the synovial facet joint degeneration, disc bulge and herniation. Compromised nerve in the canal causes radiating pain and claudication.
• Abnormal spinal curvature: A normal spine has a gentle S-shaped curveto carry out its functions. Abnormal spinal curvature is called Lordosis(increased curvature towards the front) Kyphosis (increased curvature towards the back) and Scoliosis (increased curvature towards the sides including the rotations) 
• Arthritis: While there are various types of arthritis, the ones that affect the back are osteoarthritis, known as spondylosis in this case, rheumatoid arthritis, and ankylosing spondylitis.
• Cauda equina syndrome: The cauda equine is a bundle of nerves at the bottom of the spinal cord which resembles a fanned-out horse’s tail. In this syndrome, the nerve roots in the cauda equine get compressed, which affects the motor and sensory functions in the lower half of the body in addition to causing lower back pain.
• Discitis or osteomyelitis: These are infections of the discs (discitis) or bone (osteomyelitis) caused by a virus, bacteria or an auto-immune disorder, leading to severe pain.
• Osteoporosis: Osteoporosis is decline in the quantitative bone mass with altered microarchitecture of the bone matrix. In people with this condition, the bones develop pores that increase in number and size over time. This makes the bones brittle leading to pain and high risk of fractures.
• Cancer/Tumour of the spine: Spinal cancer can develop in the spine or metastasize, that is - spread from a cancer elsewhere in the body.
• Auto-immune disorders such as Crohn’s disease, rheumatoid arthritis, fibromyalgia, lupus, etc.

Treatment

• Staying active: A bed rest can be a bad idea when one has lower back pain. It’s good to be moderately active and not lift heavy weights or strain your back in any way.
• Heat and cold: Applying a hot-pack or a cold-pack on your back will help relieve the pain. You can do either, on alternate days.
• Over-the-counter drugs: Non-steroidal anti-inflammatory drugs such as Naproxen or Ibuprofen and creams, gels or sprays can relieve the pain.
• Medication: Prescription NSAIDs such as celecoxib, diclofenac, or fenoprofen, anti-seizure medication, such gabapentin or pregabalin, opioids, such as oxycodone or hydrocodone or muscle relaxants such as baclofen or carisoprodol may be prescribed by the doctor on a short or long-term basis as is the case.
• Physical therapy: In addition to heat/cold packs and moderate exercise, the patient may be prescribed massage, ultrasound and Transcutaneous Electrical Nerve Simulation.
• Injections: Nerve blocks that target specific areas of the body, or an epidural steroid can be injected to relieve pain in the back or legs.
• Surgery: In Spinal Fusion, two or more vertebrae are permanently fused to limit spinal motion and correct any spinal deformity. In Laminectomy and Laminotomy, a piece or an entire vertebra is removed to create space for the spinal cord or nerves.
• Platelet-rich-Plasma: PRP is given to heal injured muscles, tendons, ligaments and joints.
• Stem cells: Stem cells taken from the patient’s hip are injected into the discs(s) causing the pain.
• Acupuncture for the lower back

Dr Karunakaran S

Director – Institute of Advances Spine Sciences