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Lower Back Pain Guide: Causes and Treatments
1. THE LOWER BACK PAIN
The lower back pain involves muscles spasms localizing on the supportive
muscles along the spine
The back pain also relates to pain and numbness to the lower extremities and
the gluteal area(CASAZZA, 2017).
The pain could be either chronic or acute, with multiple causes.
Acute back pain is attributed to the most common reasons why an adult
would consult a physician.
Patients may recover quickly with minimal treatment, but it remains
imperative that an elaborate evaluation is done to identify underlying
pathology.
2. Lower back pain continued..
The red flags such as trauma from falls and motor vehicle crashes involving
people with osteoporosis or possible osteoporosis presents, could precipitate
back pain (D'Arcy, 2013).
An absence of serious pathology may eliminate a need to have diagnostic
imaging and lab testing.
Majority of people will experience acute lower back pain at sometime in their
life time, with the first episode occurring between the age 20 to 40 years.
Many cases of lower back pain are self limiting
3. Lower back pain continued..
However, 31% of lower back cases persist beyond six months.
25% to 60% of people with resolved back pain will experience relapse within 1
to 2 years (CASAZZA, 2017).
33% of the recurrent cases will present with moderate pain and approximately
15% experiencing severe pain.
The non-specificity of the lower back pain lead to difficult in attributing the
pain to a specific cause.
4. Lower back pain continued..
The relieve of pain, improvement of function and reduction of time away
from work are some of the treatment goals.
Other costs include optimization of treatment associated with prevention of
chronic back pain (D'Arcy, 2013).
A detailed history and physical examination are paramount in evaluation of
acute lower back pain.
It is imperative to note that some red flags are more useful than others and
some may also be inaccurate in eliciting causes of back pain.
5. Lower back pain continued..
A comprehensive clinical approach is essential rather than reliance on limited
lower back pain indicators.
Pain directly from the spine structures could refer to the region of the thigh,
and rarely below the knee region (Davis & Richardson, 2015).
The pain from the sacroiliac joint could radiate to both the thigh and the
below the knee.
Pain from L1-L3 nerve roots tend to radiate to the thigs and hip whereas pain
from L4 to S1 will radiate to below the knee.
6. Causes of lower back pain
Tear in the nucleus pulposus could precipitate discogenic lower back pain.
The proteins with inflammatory properties are extravasated and washes the
nerve fibers, leading to irritation of the nerve fibers(Cooper, 2015).
Lower back pain could also be caused by injury to the zygapophysial joint.
The pain results for instance when the there is tearing of the capsule of a
joint and degeneration of the cartilage.
Such changes lead to an inflamed joint, hence the pain.
7. Causes of the lower back pain
continued..
Altered biomechanics could results in pain in the lower back around the
sacroiliac joint.
The degenerative changes and inflammation at the joint majorly precipitates
the sacroiliac joint pain (McKinnis, 2013).
Spondylolisthesis could result into chronic lower back pain.
Spondylolisthesis includes a slipping of bones in relation to another
The slippage leads to irritation and subsequent inflammation, amounting to
pain.
8. Causes of the lower back pain
continued..
Muscle strain could also result into lower back pain due to overworking of the
muscles.
The muscles of the lower back are stationed to provide mobility and strength
to undertake activities of daily living (Cooper, 2015)
Sudden and forceful movements or prolonged stress could precipitate
ligament sprain.
The ligaments connect the spinal vertebrae and have a role on provision of
support and stability to the lower back by way of connecting the lower back.
9. Causes of lower back pain continued..
Poor postural alignment could be associated with lower back pain
Muscular fatigue may result when a person sits hunched over a desk or
slouching over a television set, all constituting poor postural alignments
(Powers et al., 2012).
The pain occurs when there is joint compression and stress to the vertebral
disks.
Another cause is the wear and tear related to aging.
Normal aging causes decreased bone density and reduced elasticity of
ligaments and muscles
10. Causes of the lower back pain
continued..
Degenerative changes of the inter-vertebral discs may also result from
inherited factors
The degenerative joint disease and the degenerative disc disease are often
inherited factors (Davis & Richardson, 2015).
Other causes include bulging of the inter-vertebral disks or herniation causing
pressure on the nerves.
The pressure on the nerves cause irritates the nerves and radiates pain down
the limbs.
11. Treatment of the lower back pain
The main goals of managing lower back pain include prevision of enough pain
relief, prevention of further injuries and maintenance of ability to function.
The non surgical options in lower back pain management could include the
NSAIDs (Samraj & Kuritzky, 2012).
NSAIDS inhibits COX.1 and COX-2 activity and,therefore, exerting their
analgesia effects.
NSAIDS could also reduce the prostaglandin biosynthesis amounting to reduced
inflammation and pain relief.
12. Treatment of LBP continued..
Oral corticosteroids such as prednisone have been found effective against
acute sciatica as a result of disc herniation (Chou et al., 2016).
However, little information exist towards the support of corticosteroids
towards management of acute back pain.
Nevertheless, corticosteroids present as options utilizable in management of
pain
The epidural steroids injections are particularly useful in managing lower
back pain
13. Treatment continued..epidural pain
injections
Through the epidural space, the drug is delivered to the spinal nerves.
a steroid injection is composed of a corticosteroid and an aesthetic numbing
agent (Benoist, Boulu & Hayem, 2012).
Such would include a triamcinolone and lidocaine
The delivery of the drugs at the epidural space induces analgesia and
inflammation.
The injection does not reduce the herniated disks but can act on the spinal
nerves through flushing of proteins that cause swelling.
14. Platelet-rich plasma therapy in LBP
management
Involves injection of autologous blood back into the donors body at the cite of
concern
The portion of the blood concentrated with the platelets is the autologous
portion of the blood (Monfett et al., 2016).
20-60cc of blood is drawn from a patient’s blood and centrifuged.
The blood is separated into distinct layers
The platelet section is extracted and is made ready for use.
15. PRPT management continued..
The plasma section is mixed with anticoagulants and injected into tissues that
require healing e.g. sacroiliac joints.
Administration of local anesthetic is imperative; to minimize pain from PRPT
procedure(Monfett et al., 2016).
The anesthetic is administered separately from PRPT solution to avoid dilution
of the solution.
The severity of the injury and the healing process dictate the number of
injections to be made on the affected lower back area.
16. Cold therapy in management of LBP.
The first 24 to 72 following the onset of lower back pain are essential for
effective cold therapy.
Cold therapies minimizes inflammation and swelling (Davis & Richardson,
2015).
Cold therapy may also numb the tissues and minimize the tissues damage
The cold therapy options could include frozen bags of vegetables, frozen gel
packs or even frozen towel
17. Cold therapy continued..
In cold therapy avoid ice burn by putting clothe between skin and source of
cold
Application of cold therapy should not exceed 20 minutes at a time (Benzon
et al., 2014).
The healing could also be facilitated by application of heat therapy.
Heat therapy stimulates blood flow to the area, hence restoration of oxygen
and nutrients
18. Manual manipulation in managing LBP..
This kind treatment is done by a chiropractor or an osteopathic doctor.
When performed by a qualified professional, it can reduce lower back
(painMcKinnis, 2013).
The mode of action is through reduction of pressure on structures such as
nerves
The procedure also reduces muscle tension , increases flexibility and reduces
stiffness of the muscles.
19. Physical therapy in management of LBP..
The technique involves a qualified physical therapist.
A combination of exercises involving the back aid in reduction of pressure
exerted on structures such as nerves (Chevan & Clapis, 2012).
The stretching and strengthening exercises could include yoga and tai chi
exercises.
A program will be essential, well formulated and controlled by a physical
therapist
20. Stem cell therapy in managing LBP..
The procedure is useful in LBP resulting from degeneration of discs in the
vertebrae.
The chronic LBP can be managed by this process through introduction of stem
cells (Moore, 2013).
Adult stem cells are extracted form the patient, purified and injected into
the damaged tissue.
The procedure is non surgical and the recovery time is little.
21. Stem cell therapy continued..
Patients may only report some soreness around the area of injection.
No reported side effects from stem cell therapy can be termed as
serious.
The research now is focusing on generating cells that can replace
damaged tissues or better still generation of transplantable organs
(Moore, 2013).
Engineered tissues that require greater vascularization and could
potentially teat diseases and conditions such as LBP.
22. Preventive measures towards LBP
Patients should look after their posture, through
reduction of the daily stresses on the lower back.
Relax and stretch for some minutes if the job is
demanding a sitting posture for long periods of time
(Hoeger & Hoeger, 2015).
Proper footwear is also advocated while walking.
Poor footwear can precipitate back pain or even
knee pain
23. Preventive measures towards LBP
continued..
Correct postures maintains normal orientation of the
spine.
The body weight is equally transmitted through the body’s
center of gravity (Hoeger & Hoeger, 2015).
Footwear should be comfortable and fit the feet well,
should give support when making sudden turns.
Some shoes that increase the curvature of the body’s
lower spine should be avoided. E.g. high-heel shoes.
24. Preventive measures towards LBP
continued..
An individual should be flexible
Simple back stretching on a daily basis lasting at least 5
minutes protects against sudden back injuries and pain
(Ebnezar et al., 2012).
Maintaining a flexible spine reduces chances of recurrent
back pain.
Stiffness of joint that could affect facet joints and spine
ligaments could also be avoided through maintenance of
flexibility.
25. Preventive measures towards LPB
continued..
Maintenance of a comfortable sleeping position.
The most comfortable position is the best position.
Change of position once pain sets in is advocated (Davis &
Richardson, 2015).
To protect the low back section of the spine , it is
imperative that one maintains the natural curve of the
lower spine while sleeping.
A supine position on a flat , cushioned level should be
accompanied by a pillow under the knees.
26. Preventive measures towards LBP
continued..
The external pressure on the nerves should be minimized.
A wallet on the back pocket will cause bad alignment of
the spine (Chevan & Clapis, 2012).
The compression of the sciatic nerve by such objects as
wallets will also culminate into discomfort in body
alignment.
Specifically, objects causing pressure on the nerves can
constitute piriformis syndrome type of pain.
27. Preventive measures towards LBP
continued..
Avoid tilting spine while carrying loads during the
every day activities.
Bags and loads should be carried on the back not
on one side (cooper, 2015).
Use of rolling bags can also immensely work.
Hand bags ought to be light when carrying them
on one side
28. Preventive measures towards LBP
continued..
Maintaining a balanced diet can go a long way in
prevention of back pain.
Experience of back pain could be associated with of
health issues.
The health of the tissues around the lower back and the
whole body as a whole can be prevented by a balanced
diet (Moore, 2013)
Vitamins and supplements can aid in healing of possibly
damaged tissues.
29. Preventive measures towards LBP
continued..
For body builders and weight lifters, vitamins aid in
muscle building
Simple and inexpensive multivitamin supplementation is
also essential if a balanced diet is evidently unachievable
(Chevan & Clapis, 2012).
Disappearance of pain may not mean healing of the
tissues around the spine.
Tissues may take up to nine months before complete
healing.
30. Preventive measures towards LBP
continued..
Avoidance of stressful situations.
Corticoid hormones are produced in large amount
in stressful situations .
What results is soft tissues inflammation and
increased muscle tension (MOORE, 2013).
Such would result into back pain in some patients
and hence avoidance measures are advocated.
31. Preventive measures …continued
Seeking of spiritual peace could reduce the stress.
Hobbies have also been proven effective in stress
management (Benzon et al., 2014).
If stress aggravates backache, medications under
prescription of a qualified professional is
advocated
SSRIs are stress relieving medications and have
relatively fewer side effects.
32. Preventive measures towards LBP
continued..
Getting into a habit of bending knees when lifting heavy
objects.
Incorrect lifting of objects could result into back pain
(McKinnis, 2013).
Avoid picking objects from the bac sit while driving a car.
A habit of using hips and knees while lifting heavy loads
from the ground.
33. References.
Benoist, M., Boulu, P., & Hayem, G. (2012). Epidural steroid injections in the
management of low-back pain with radiculopathy: an update of their efficacy and
safety. European Spine Journal, 21(2), 204-213.
http://dx.doi.org/10.1007/s00586-011-2007-z
Benzon, H., Rathmell, J., Wu, C., Turk, D., Argoff, C., & Hurley, R.
(2014). Practical management of pain.
CASAZZA, B. (2017). Diagnosis and Treatment of Acute Low Back Pain (4th ed., pp.
343-348). North Carolina: American Family Physician. Retrieved from
http://www.aafp.org/afp/2012/0215/p343.pdf
Chevan, J., & Clapis, P. (2012). Physical Therapy Management of Low Back Pain.
Jones & Bartlett Publishers
Chou, R., Pinto, R., Fu, R., Lowe, R., Henschke, N., & Dana, T. (2016). Systemic
corticosteroids for radicular and non-radicular low back pain. Cochrane Database
Of Systematic Reviews. http://dx.doi.org/10.1002/14651858.cd012450
34. References
Cooper, G. (2015). Lower Back Pain: An Overview of the Most Common
Causes. Non-Operative Treatment Of The Lumbar Spine, 11-13.
http://dx.doi.org/10.1007/978-3-319-21443-6_2
Cooper, G. (2015). Non-operative treatment of the lumbar spine. princeton:
Springer.
D'Arcy, Y. M. (2013). Compact Clinical Guide to Critical Care, Trauma, and
Emergency Pain Management: An Evidence-Based Approach for Nurses. Springer
Publishing Company.
Davis, L. E., & Richardson, S. P. (2015). Fundamentals of Neurologic Disease.
Springer.
Ebnezar, J., Nagarathna, R., Yogitha, B., & Nagendra, H. R. (2012). Effects of an
integrated approach of hatha yoga therapy on functional disability, pain, and
flexibility in osteoarthritis of the knee joint: a randomized controlled study. The
Journal of Alternative and Complementary Medicine, 18(5), 463-472.
35. References
Hoeger, W. W., & Hoeger, S. A. (2015). Principles and labs for fitness and wellness. Cengage
Learning.
McKinnis, L. N. (2013). Fundamentals of musculoskeletal imaging. FA Davis.
Monfett, M., Harrison, J., Boachie-Adjei, K., & Lutz, G. (2016). Intradiscal platelet-rich
plasma (PRP) injections for discogenic low back pain: an update. International
Orthopaedics, 40(6), 1321-1328. http://dx.doi.org/10.1007/s00264-016-3178-3
Moore, R. J. (Ed.). (2013). Handbook of pain and palliative care: Biobehavioral approaches
for the life course. Springer Science & Business Media.
Powers, C., Bolgla, L., Callaghan, M., Collins, N., & Sheehan, F. (2012). Patellofemoral Pain:
Proximal, Distal, and Local Factors—2nd International Research Retreat, August 31–September
2, 2011, Ghent, Belgium. Journal Of Orthopaedic & Sports Physical Therapy, 42(6), A1-A54.
http://dx.doi.org/10.2519/jospt.2012.0301
Samraj, & Kuritzky, L. (2012). Nonsteroidal anti-inflammatory drugs in the treatment of low
back pain. Journal Of Pain Research, 579. http://dx.doi.org/10.2147/jpr.s6775