There is a significant overlap of nerve supply to many of the discs, muscles, ligaments, and other spinal structures, and it can be difficult for the brain to accurately sense which is the cause of the pain. For example, a degenerated or torn lumbar disc can feel the same as a pulled muscle – both creating inflammation and painful muscle spasm in the same area. Muscles and ligaments heal rapidly, while a torn disc may or may not. The time course of pain helps determine the cause.
Low back pain can be caused by tumors, either benign or malignant, that originate in the bone of the spine or pelvis and spinal cord (primary tumors) and those which originate elsewhere and spread to these areas (metastatic tumors). Symptoms range from localized pain to radiating severe pain and loss of nerve and muscle function (even incontinence of urine and stool) depending on whether or not the tumors affect the nervous tissue. Tumors of these areas are detected using imaging tests, such as plain X-rays, nuclear bone scanning, and CAT and MRI scanning.
The bones of the hip are supported by specific muscles. The strongest muscle in the body is actually one of the main flexors of the hip, it is called the iliopsoas muscle. It has two attachments to the inner part of the hip as well as the lower part of the back. This muscle is involved in iliopsoas tendinitis, iliopsoas bursitis, and is one of the most common causes of muscle pain that causes hip pain. The tendons attach the muscles to the bones and the ligaments attach bone to bone. Areas that are often susceptible to increased pressure are the tendons or the muscles attached to the bone, so that is another source of pain in iliopsoas tendinitis. The bursa are pockets of fluid that also protect the top part of the bone to prevent pressure on the bone. There are about 160 bursa in the body, and when they get irritated, it can develop into bursitis.
Shingles (herpes zoster) is an acute infection of the nerves that supply sensation to the skin, generally at one or several spinal levels and on one side of the body (right or left). Patients with shingles usually have had chickenpox earlier in life. The herpes virus that causes chickenpox is believed to exist in a dormant state within the spinal nerve roots long after the chickenpox resolves. In people with shingles, this virus reactivates to cause infection along the sensory nerve, leading to nerve pain and usually an outbreak of shingles (tiny blisters on the same side of the body and at the same nerve level). The back pain in patients with shingles of the lumbar area can precede the skin rash by days. Successive crops of tiny blisters can appear for several days and clear with crusty inflammation in one to two weeks. Patients occasionally are left with a more chronic nerve pain (postherpetic neuralgia). Treatment can involve symptomatic relief with lotions, such as calamine, or medications, such as acyclovir (Zovirax), for the infection and pregabalin (Lyrica) or lidocaine (Lidoderm) patches for the pain.
The side of the pain on its own doesn’t tell us much, and most of the one-sided sources of pain are viscera that usually cause abdominal pain instead of back pain, or in addition to it. In other words, the only reason to worry about right or left lower back pain is if it is otherwise worrisome: if you have other red flags or significant non-back symptoms.
How to: Lie on your back with your right knee bent and foot flat on the floor (a). Extend your left leg up to the ceiling and wrap a strap around the sole of your left foot (b). While holding both ends with your left hand, extend your right arm directly out to the side in order to anchor yourself (c). Slowly let the left leg fall toward the left while keeping your right side grounded. Hold for six to eight breaths, then repeat on the opposite side.
Kidneys — The kidneys are a matched pair. One painful kidney can cause back pain on one side or the other. Kidney pain can feel like back pain, and may occur on only one side. It is usually quite lateral, and just barely low enough to qualify as “low” back pain. However, when kidney stones descend through the ureters, they can cause (terrible) pain in the low back. Kidney stone pain is often so severe and develops so rapidly that it isn’t mistaken for a back pain problem.
Low back pain can be caused by tumors, either benign or malignant, that originate in the bone of the spine or pelvis and spinal cord (primary tumors) and those which originate elsewhere and spread to these areas (metastatic tumors). Symptoms range from localized pain to radiating severe pain and loss of nerve and muscle function (even incontinence of urine and stool) depending on whether or not the tumors affect the nervous tissue. Tumors of these areas are detected using imaging tests, such as plain X-rays, nuclear bone scanning, and CAT and MRI scanning.
The Child’s Pose is a yoga position that is especially beneficial for the back. To perform Child’s Pose, start on all fours, then stretch back, resting your bottom on your feet. Your arms should stay extended with your hands on the floor. This creates a stretch in your lower back. Hold this pose for 30 seconds, then return to your starting position. Repeat five times.
Spinal fusion is used to strengthen the spine and prevent painful movements in people with degenerative disc disease or spondylolisthesis (following laminectomy). The spinal disc between two or more vertebrae is removed and the adjacent vertebrae are “fused” by bone grafts and/or metal devices secured by screws. The fusion can be performed through the abdomen, a procedure known as an anterior lumbar interbody fusion, or through the back, called posterior fusion. Spinal fusion may result in some loss of flexibility in the spine and requires a long recovery period to allow the bone grafts to grow and fuse the vertebrae together. Spinal fusion has been associated with an acceleration of disc degeneration at adjacent levels of the spine.
Nerve block therapies aim to relieve chronic pain by blocking nerve conduction from specific areas of the body. Nerve block approaches range from injections of local anesthetics, botulinum toxin, or steroids into affected soft tissues or joints to more complex nerve root blocks and spinal cord stimulation. When extreme pain is involved, low doses of drugs may be administered by catheter directly into the spinal cord. The success of a nerve block approach depends on the ability of a practitioner to locate and inject precisely the correct nerve. Chronic use of steroid injections may lead to increased functional impairment.
Congenital bone conditions: Congenital causes (existing from birth) of low back pain include scoliosis and spina bifida. Scoliosis is a sideways (lateral) curvature of the spine that can be caused when one lower extremity is shorter than the other (functional scoliosis) or because of an abnormal architecture of the spine (structural scoliosis). Children who are significantly affected by structural scoliosis may require treatment with bracing and/or surgery to the spine. Adults infrequently are treated surgically but often benefit by support bracing. Spina bifida is a birth defect in the bony vertebral arch over the spinal canal, often with absence of the spinous process. This birth defect most commonly affects the lowest lumbar vertebra and the top of the sacrum. Occasionally, there are abnormal tufts of hair on the skin of the involved area. Spina bifida can be a minor bony abnormality without symptoms. However, the condition can also be accompanied by serious nervous abnormalities of the lower extremities.
En español | You probably know someone who’s traded a worn-out hip bone for ceramic or cobalt chrome. Some 370,000 Americans undergo hip-replacement surgery each year (the average age for this is 65). But the operation isn’t a cure-all: At least 1 in 10 hip-replacement recipients will need a second procedure to repair a dislocation, mechanical failure or infection. And hip pain, with or without surgery, can be a struggle. Chronic hip pain was a factor in the accidental opioid overdoses that claimed the lives of musicians Tom Petty, 66, and Prince, 57.
Moist heat may help relax your muscles. Put moist heat on the sore area for 10 to 15 minutes at a time before you do warm-up and stretching exercises. Moist heat includes heat patches or moist heating pads that you can buy at most drugstores, a wet washcloth or towel that has been heated in a microwave or the dryer, or a hot shower. Don’t use heat if you have swelling.
Low back pain may be classified based on the signs and symptoms. Diffuse pain that does not change in response to particular movements, and is localized to the lower back without radiating beyond the buttocks, is classified as nonspecific, the most common classification.[5] Pain that radiates down the leg below the knee, is located on one side (in the case of disc herniation), or is on both sides (in spinal stenosis), and changes in severity in response to certain positions or maneuvers is radicular, making up 7% of cases.[5] Pain that is accompanied by red flags such as trauma, fever, a history of cancer or significant muscle weakness may indicate a more serious underlying problem and is classified as needing urgent or specialized attention.[5]
The big idea of classification-based cognitive functional therapy (CB-CFT or just CFT) is that most back pain has nothing to do with scary spinal problems and so the cycle of pain and disability can be broken by easing patient fears and anxieties. For this study, CFT was tried with 62 patients and compared to 59 who were treated with manual therapy and exercise. The CFT group did better: a 13-point boost on a 100-point disability scale, and 3 points on a 10-point pain scale. As the authors put it for BodyInMind.org, “Disabling back pain can change for the better with a different narrative and coping strategies.” These results aren’t proof that the confidence cure works, but they are promising.
