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Lower back pain
If you have lower back pain, you are not alone. Nearly everyone at some point has back pain that interferes with work, routine daily activities, or recreation. Back pain is the second most common neurological ailment in many countries — only headache is more common. Fortunately, most occurrences of low back pain go away within a few days. Others take much longer to resolve or lead to more serious conditions.
Acute or short-term low back pain generally lasts from a few days to a few weeks. Most acute back pain is mechanical in nature — the result of trauma to the lower back or a disorder such as arthritis. Pain from trauma may be caused by a sports injury, work around the house or in the garden, or a sudden jolt such as a car accident or other stress on spinal bones and tissues. Symptoms may range from muscle ache to shooting or stabbing pain, limited flexibility and/or range of motion, or an inability to stand straight. Occasionally, pain felt in one part of the body may “radiate” from a disorder or injury elsewhere in the body. Some acute pain syndromes can become more serious if left untreated.
Chronic back pain is measured by duration — pain that persists for more than 3 months is considered chronic. It is often progressive and the cause can be difficult to determine.
What structures make up the back?
Starting at the top, the spine has four regions:
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The seven cervical or neck vertebrae (labeled C1–C7), |
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The 12 thoracic or upper back vertebrae (labeled T1–T12), |
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The five lumbar vertebrae (labeled L1–L5), which we know as the lower back, and |
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The sacrum and coccyx, a group of bones fused together at the base of the spine. |
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The lumbar region of the back, where most back pain is felt, supports the weight of the upper body.
What causes lower back pain?
As people age, the bone strength, muscle elasticity and tone tend to decrease. The discs begin to lose fluid and flexibility, which decreases their ability to cushion the vertebrae.
Pain can occur when, for example, someone lifts something too heavy or over-stretches, causing a sprain, strain, or spasm in one of the muscles or ligaments in the back. If the spine becomes overly strained or compressed, a disc may rupture or bulge outward. This rupture may put pressure on one of the more than 50 nerves rooted to the spinal cord that control body movements and transmit signals from the body to the brain. When these nerve roots become compressed or irritated, back pain is the result.
Low back pain may reflect nerve or muscle irritation or bone lesions. Most low back pain follows injury or trauma to the back, but pain may also be caused by degenerative conditions such as arthritis or disc disease, osteoporosis or other bone diseases, viral infections, irritation to joints and discs, or congenital abnormalities in the spine. Obesity, smoking, weight gain during pregnancy, stress, poor physical condition, posture inappropriate for the activity being performed, and poor sleeping position also may contribute to low back pain.
Additionally, scar tissue created when the injured back heals itself does not have the strength or flexibility of normal tissue. Buildup of scar tissue from repeated injuries eventually weakens the back and can lead to more serious injury.
Occasionally, low back pain may indicate a more serious medical problem. Pain accompanied by fever or loss of bowel or bladder control, pain when coughing, and progressive weakness in the legs may indicate a pinched nerve or other serious condition. People with diabetes may have severe back pain or pain radiating down the leg related to neuropathy. People with these symptoms should contact a doctor immediately to help prevent permanent damage.
Who is most likely to develop low back pain?
Nearly everyone has low back pain sometime. Men and women are equally affected. It occurs most often between ages 30 and 50, due as part of the aging process, but also as a result of sedentary life styles with too little (sometimes punctuated by too much) movement or exercise. The risk of experiencing low back pain from disc disease or spinal degeneration increases with age.
Low back pain unrelated to injury or other known cause is unusual in pre-teen children. However, a school bag overloaded with schoolbooks can quickly strain the back and cause muscle fatigue.
What conditions are associated with low back pain?
Conditions that may cause low back pain and require treatment by a physician or other health specialist include:
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Bulging disc (also called protruding, herniated, or ruptured disc). The inter-vertebral discs are under constant pressure. As the discs degenerate and weaken, cartilage can bulge or be pushed into the space containing the spinal cord or a nerve root; and it causes pain. Studies have shown that most herniated discs occur in the lower, lumbar portion of the spinal column. |
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A much more serious complication of a ruptured disc is cauda equina syndrome, which occurs when disc material is pushed into the spinal canal and compresses the bundle of lumbar and sacral nerve roots. Permanent neurological damage may result if this syndrome is left untreated. |
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Sciatica is a condition in which a herniated or ruptured disc presses on the sciatic nerve, the large nerve that extends down the spinal column to its exit point in the pelvis and carries nerve fibers to the leg. This compression causes shock-like or burning low back pain combined with pain through the buttocks and down one leg to below the knee, occasionally reaching the foot. In the most extreme cases, when the nerve is pinched between the disc and an adjacent bone, the symptoms involve not pain but numbness and some loss of motor control over the leg due to interruption of nerve signaling. The condition may also be caused by a tumor, cyst, metastatic disease, or degeneration of the sciatic nerve root. |
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Spinal degeneration from disc wear and tear can lead to a narrowing of the spinal canal. A person with spinal degeneration may experience stiffness in the back upon awakening or may feel pain after walking or standing for a long time. |
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Spinal stenosis related to congenital narrowing of the bony canal predisposes some people to pain related to disc disease. |
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Osteoporosis is a metabolic bone disease marked by progressive decrease in bone density and strength. Fracture of brittle, porous bones in the spine and hips results when the body fails to produce new bone and/or absorbs too much existing bone. Women are four times more likely than men to develop osteoporosis. |
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Skeletal irregularities produce strain on the vertebrae and supporting muscles, tendons, ligaments, and tissues supported by spinal column. |
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Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and multiple “tender points,” particularly in the neck, spine, shoulders, and hips. Additional symptoms may include sleep disturbances, morning stiffness, and anxiety. |
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Spondylitis refers to chronic back pain and stiffness caused by a severe infection to or inflammation of the spinal joints. |
How is low back pain diagnosed?
A thorough medical history and physical exam can usually identify any dangerous conditions or family history that may be associated with the pain. The patient describes the onset, site, and severity of the pain; duration of symptoms and any limitations in movement; and history of previous episodes or any health conditions that might be related to the pain. The physician will examine the back and conduct neurological tests to determine the cause of pain and appropriate treatment. Blood tests may also be ordered. Imaging tests may be necessary to diagnose tumors or other possible sources of the pain.
How is back pain treated in Ayurveda?
Most low back pains can be treated without surgery. Most patients with back pain recover without residual functional loss. Patients should contact a physician if there is no noticeable reduction in pain and inflammation after 72 hours of self-care.
Oil treatments and internal herbs appropriate to the condition are very effective in most conditions of lower back pain. In the more chronic conditions, the patient will need to be admitted for periods ranging from 3-5 weeks and some very intensive treatments performed. Since these treatments involve passive physiotherapy, the patient is normally advised to take complete bed rest for the duration of the treatment and for some period after, till the pain is completely relieved, after which mild exercise, preferably yoga postures are begun slowly.
Yoga is a good way to gently stretch muscles and ease pain. Any mild discomfort felt at the start of these exercises should disappear as muscles become stronger. But if pain is more than mild and lasts more than 15 minutes during exercise, patients should stop exercising and contact the physician.
To reiterate, most conditions of lower back pain respond very effectively to Ayurveda treatments and medications especially when commenced in the early stages.
Can back pain be prevented?
Recurring back pain resulting from improper body mechanics or other non-traumatic causes is often preventable. A combination of exercises that don't jolt or strain the back, maintaining correct posture, and lifting objects properly can help prevent injuries.
Many work-related injuries are caused or aggravated by stressors such as heavy lifting, contact stress (repeated or constant contact between soft body tissue and a hard or sharp object, such as resting a wrist against the edge of a hard desk or repeated tasks using a hammering motion), vibration, repetitive motion, and awkward posture. Applying ergonomic principles — designing furniture and tools to protect the body from injury — at home and in the workplace can greatly reduce the risk of back injury and help maintain a healthy back.
Quick tips to a healthier back
Following any period of prolonged inactivity, begin a program of regular low-impact exercises. Speed walking, swimming, or stationary bike riding 30 minutes a day can increase muscle strength and flexibility. Yoga can also help stretch and strengthen muscles and improve posture. Ask your physician or orthopedist for a list of low-impact exercises appropriate for your age and designed to strengthen lower back and abdominal muscles.
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Always stretch before exercise or other strenuous physical activity. |
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Don’t slouch when standing or sitting. When standing, keep your weight balanced on your feet. Your back supports weight most easily when curvature is reduced. |
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At home or work, make sure your work surface is at a comfortable height for you. |
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Sit in a chair with good lumbar support and proper position and height for the task. Keep your shoulders back. Switch sitting positions often and periodically walk around the office or gently stretch muscles to relieve tension. A pillow or rolled-up towel placed behind the small of your back can provide some lumbar support. If you must sit for a long period of time, rest your feet on a low stool or a stack of books. |
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Wear comfortable, low-heeled shoes. |
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Osteoporosis is a metabolic bone disease marked by progressive decrease in bone density and strength. Fracture of brittle, porous bones in the spine and hips results when the body fails to produce new bone and/or absorbs too much existing bone. Women are four times more likely than men to develop osteoporosis. |
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Sleep on your side to reduce any curve in your spine. Always sleep on a firm surface. |
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Ask for help when transferring an ill or injured family member from a reclining to a sitting position or when moving the patient from a chair to a bed. |
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Don’t try to lift objects too heavy for you. Lift with your knees, pull in your stomach muscles, and keep your head down and in line with your straight back. Keep the object close to your body. Do not twist when lifting. |
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Maintain proper nutrition and diet to reduce and prevent excessive weight, especially weight around the waistline that taxes lower back muscles. A diet with sufficient daily intake of calcium, phosphorus, and vitamin D helps to promote new bone growth. |
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If you smoke, quit it. Smoking reduces blood flow to the lower spine and causes the spinal discs to degenerate. |
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