Causes and troubles of Low Back Pain

Causes and troubles of Low Back Pain »  Health Generation IndiaLow Back PainThe lower part of the back is the largest and strongest part of the spinal vertebral column. The bones of the vertebra over here are the biggest of all the vertebral column. These are the vertebrae of the lumbar region and any problems relating to these vertebrae leads to formation of low back pain.Low back pain is classified under the following classes: -ICD-10- M54.4-M54.5ICD-9 724.2MedlinePlus- 003108eMedicine pmr/73MeSH D017116Thus what is Low back pain afterall?Low back pain is also known as Lumbago. Lumbago is a musculo-skeletal disorder which affects more than 80% of the world population at some stages of their lives. This pain leads to job related disability, leading to missing work and also another cause of neurological ailments which are second common to headaches.Low back pain can either be acute type or a sub acute type or even a chronic pain in terms of duration of pain. This pain reduces and many a times gets cured with proper conservative treatment.Classification of Low Back PainLow back pain is classified into three categories. When the time span of pain is less than or up to 4 weeks in which it gets cured, it is termed as Acute Low Back Pain. When the pain does not get cured in 4 weeks but gets better in 4 to 12 weeks it is termed as sub acute type of Low Back Pain and if the pain is persisting for even more that 12 weeks without much or any relief, then it is classified un der chronic low back pain.Causes of Low Back PainThe majority of problems which cause low back pain are mostly from benign status of musculoskeletal system anamolies and arise mostly due to strain or sprain to the soft tissues. This conditions happen when one changes position in all of a sudden action of arising or sitting suddenly or also during carrying or lifting heavy weight on the back with pain parrelel or lateral to the spine. Other conditions in whicb patient may suffer from low back pain are as follows: -Mechanical Causes of Low Back Pain: -Apophyseal osteoarthritisDiffuse idiopathic skeletal hyperostosisDegenerative discsScheuermanns kyphosisSpinal disc herniation (slipped disc)Thoracic or lumbar spinal stenosisSpondylolisthesis and other congenital abnormalitiesFracturesSacroiliac Joint DysfunctionLeg length differenceRestricted hip motionMisaligned pelvis  pelvic obliquity, anteversion or retroversionAbnormal Foot PronationInflammatory Causes of Low Back Pain: -Seronegative spondylarthritides (e.g. ankylosing spondylitis)Rheumatoid arthritisInfection  epidural abscess or osteomyelitisSacroiliitisNeoplastic Causes of Low Back Pain: -Bone tumors (primary or metastatic)Pathophysiology of Low Back PainThe low back is comprised of 5 lumbar vertebrae along with the intervertebral discs which are fibrocartilagenous in matter and which act like cushions thus preventing the vertebrae from rubbing upon each other and thus protecting the spinal cord from injuries providing minimal wear and tear support. Through the holes (called as foramina) of the vertebral bodies, nerves come out which provide sensation and nerve function to the muscles and the soft tissues of the back, low back and the abdomen. These vertebral bodies also have joints which direct as well as prevent the movement of the spine are called as facet joints or zygapophysial joints. Any disturbance to the above mentioned structures can result in functional or structural or both variety of disturbances and thus can cause low back pain adn other related troubles can occur.While maximum troubles can occur because of straining or stretching of the muscles because of activity, low back pain can also be cause because of injury or tearing of the ligament of the back which also leads to pain in the back. More severe type of injuries include tear to the vertebral dics or disc herniation which leads to compression over the nerves coming out of the vertebral column. Other causes are shrinking of the intervertebral disc because of old age which again leads to rubbing of the discs over each other again leading to compression and thus related injuries over each other.Diminishing functioning ability of the joints and the ligaments leads to loss over the control of movement of the joints and thus they move much more than they should which is common in conditions like: -SpondylolisthesisLumbar spinal stenosisSciaticaScoliosisThese causes of low back pain can be presented at various areas like : -Tailbone pain (also called coccyx pain or coccydynia)Sacroiliac joint  Sacroiliac Joint DysfunctionOsteoarthritisRheumatoid arthritisDegeneration of the discs between the vertebraeSpinal disc herniationA vertebral fractureOsteoporosisAn infection or tumorApproach towards diagnosis of the Low Back PainIn general, people with low back pain are initiated with their treatment on empirical basis. When signs of troubles not decreasing or when pain remains persistent, then diagnosis may be adopted.Imaging techniquesX Ray, CT and MRI scans can be recommended when the empirical methods do not budge the pain and further understanding of the troubles are present. But repeated imaging techniques can be harmful to health and incidences of increase in surgeries are noted but not so in resultant benefits. Similar incidences were observed in between 1994 to 2006 where MRI scans of the lumbar region increased by more than 300%.So when exactly are scanning and diagnostic approaches required?Recent significant traumaMilder trauma if age is greater than 50 yearsUnexplained weight lossUnexplained feverImmunosuppressionPrevious or current cancerIntravenous drug useOsteoporosisChronic corticosteroid useAge greater than 70 yearsFocal neurological deficitDuration greater than 6 weeksPrevention of low back painWhile medicinal research continues to find more and more better drugs to control the low back pain and also in an attempt to reverse the causative changes in the joints and arising pathology; physiotherapy and alternative medicines seems to score well over the modern medicine approach. Various types of exercises including Yoga and body postures seem to help in preventing recurrance of non acute pain and also in reducing the frequency of episodes of low back pain. Lifting techniques in exercises also give a proper stretch to the back which also helps the muscles in rejuvinating and thus regenerating the destroyed fibres.People who are habitual to cigarette smoking, tobacco chewing, should leave their habits as it impairs the success and proper healing of the vertebrae who have undergone spinal fusion surgery. This happens because tobacco smoke and the nicotine contained in it reduce the blood flow towards the vertebrae, especially the lumbar vertebrae and their intervertebral discs which causes the discs t o starve of the blood ad nutrition supply because of which degeneration of the discs can occur.ICD-10M54.4-M54.5ICD-9MedlinePlus003108eMedicinepmr/73MeSHD017116