LOW BACK PAIN

Why is low back pain common?
Low back pain is one of the most frequent problems treated by orthopaedic surgeons. Four out of five adults will experience significant low back pain sometime during their life. After the common cold, problems caused by the lower back are the most frequent cause of lost workdays in adults under the age of 45.

The lower or lumbar spine is a complex structure that connects your upper body (including your chest and arms) to your lower body (including your pelvis and legs). This important part of your spine provides you with both mobility and strength.

The mobility allows movements such as turning, twisting or bending; and the strength allows you to stand, walk and lift. Proper functioning of your lower back is needed for almost all activities of daily living. Pain in the lower back can restrict your activity and reduce your work capacity and quality of enjoyment of everyday living.

Low back sprain and strain
The muscles of the low back provide power and strength for activities such as standing, walking and lifting. A strain of the muscle can occur when the muscle is poorly conditioned or overworked. The ligaments of the low back act to interconnect the five vertebral bones and provide support or stability for the low back. A sprain of the low back can occur when a sudden, forceful movement injures a ligament, which has become stiff or weak through poor conditioning or overuse.

These injuries, or sprain and strain, are the most common causes of low back pain. Frequently, a combination of other factors may increase the likelihood of injury or disease:

• Poor conditioning
• Improper Use
• Obesity
• Smoking

Age
"Wear and tear" and inherited factors will cause degenerative changes in the disks, called degenerative disk disease, and arthritic changes in the small joints. These changes occurs to some degree in everyone. When severe, they can cause low back stiffness and pain. Arthritic bone spurs and inflamed joints can cause nerve irritation and leg pain. Almost everyone develops "wear and tear" changes in their low back as they age, although for most people it causes little pain or loss of function.

Osteoporosis and fractures
All bones lose bone strength over time and the lumbar vertebrae, particularly in postmenopausal women, can be fractured or compressed from a fall or even from the stress of lifting or everyday activities.

Protruding disk
The disk is composed of a soft center or nucleus, which in children and young adults, is jelly-like. The nucleus is surrounded by a tougher outer portion called the annulus. With normal aging, the nucleus begins to resemble the annulus. During middle-age, fissures or cracks may occur in the disk. These may be the source of back pain. If the crack extends out of the disk, material from the disk may push out or rupture. This often is referred to as a herniated or slipped disk. If the protruded disk presses a nerve, it may cause pain in the leg.

What is the best treatment?
Most low back pain can be safely and effectively treated following an examination by your orthopaedic surgeon and a prescribed period of activity modification and some medication to relieve the pain and diminish the inflammation. Although a brief period of rest may be helpful, most studies show that light activity speeds healing and recovery. It may not be necessary for you to discontinue all activities, including work. Instead, you may adjust your activity under your orthopaedists?s guidance.

Once the initial pain has eased, a rehabilitation program may be suggested to increase your muscle strength in your low back and abdominal muscles as well as some stretching exercises to increase your flexibility. Weight loss if you are overweight, and quitting smoking if you are a smoker, also will decrease the chances of a recurrence of your low back pain. The best long-term treatment is an active prevention program of maintaining your physical condition and observing proper lifting and postural activities to prevent further injuries.

Prevention
The normal effects of aging that result in decreased bone mass, and decreased strength and elasticity of muscles and ligaments, can't be avoided. However the effects can be slowed by:

• Exercising regularly to keep the muscles that support your back strong and flexible
• Using the correct lifting and moving techniques; get help if an object is too heavy or an awkward size
• Maintaining your proper body weight; being overweight puts a strain on your back muscles
• Avoid smoking
• Maintaining a proper posture when standing and sitting; don't slouch