Sports Medicine

Low Back Pain

 

80% of Americans suffer from low back pain at some point in their lives.  For some people this can limit the ability to live a normal lifestyle.  It is important to be evaluated early for the pain, especially if there are symptoms that signal serious causes of the pain.

Back pain can be caused by a problem with any of the structures that make up the back:
   
    Bones and Joints
    Muscles
    Nerves

A doctor helps determine the cause of low back pain based on the history of symptoms and physical exam findings.  If the cause can be found, then the back pain can be treated in the right way.  Many parts of the physical exam can be done by anyone at home.

Bones and Joints
Have someone press over the bones of the spine.  If it hurts over one specific point, then it may mean there is a problem with the bone.  Try different motions such as bending forward, backwards, and side to side.  If there is stiffness during movement it could be due to stiff joints or arthritis.

Muscles
To see if the pain is coming from a muscle, have a person press along the muscles that run down the sides of the spine.  If the pain is in this area, it may be a tense muscle or pulled muscle.

Nerves
Low back pain can also be caused by an irritated nerve.  This can happen because it is being pinched by other structures.  In this case, you may feel sharp shooting pain, numbness, or tingling down your leg.  


Interaction of the nerve and muscle
When a nerve is affected, it can sometimes cause weakness in the leg muscles.  Based on which muscles are affected, it can be determined which nerve root is irritated.

    L4 – Weakness in kicking your leg. Trouble squatting and rising.
    L5 – Weakness in pointing toes upwards.  Trouble walking on your heels.  
    S1 – Weakness in pointing toes downwards (action of “stepping on the gas pedal”).  Trouble walking on your toes.

What part of the nerve?

The nerves start in the brain, travel down the spinal cord and leave the spine at different points to go to the muscle it will control.  It is possible to test if a nerve problem is before or after the point of leaving the spinal cord.

If the spinal cord is being pushed on, you may experience problems with controlling urination and bowel movements.  There may also be a decrease in sensation along the buttocks and thigh in a saddle shape.  If you have these warning signs, you need to seek medical care immediately, as this may be a medical emergency.

Is it something else?
Apart from the bones, muscles, and nerves of the back there can also be other causes of pain that are not related to the back itself.  The organs that are in your belly can sometimes cause pain in the back if they are having problems.  If there is an infection, cancer or other damage in these organs (for example your kidneys or pancreas), the pain may be felt in the back rather than the belly.

For any case of low back pain it is important to determine the cause, and the investigation can begin with you at home.  By determining the cause we can choose the best treatment for the problem.  With directed treatment, hopefully you can become as active and functional as you were before having back problems!