All of us are going to have some sort of low back pain issue at some point in our lives. There are many causes for low back pain. 

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WHAT CAUSES

LOW BACK PAIN?

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There are many things that can cause low back pain.

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The most common cause is a mechanical back strain. This happens when you carry heavy loads repeatedly, or if you lift something heavy with poor posture. 

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This pain is mechanical; it is related to your activity. It gets worse with prolonged sitting, bending forwards or backwards, or lifting a heavy load, since these are all activities that increase the pressure you place on your spine. This kind of pain
gets better with rest.

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It can be due to a strain on the muscles on either side of your back (the paravertebral muscles), or pain related to the spine structures like your cartilage disc, or the small joints between the bones in your spine.

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People who get these sort of strains tend to get them more often in the future, so if you are one of them, you need to put in extra effort to do your own home physio, maintain a healthy body weight, take extra care with your posture, and stop smoking to minimise these flares of low back pain.

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DOES EVERYONE GET

BACK PAIN?

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Everyone eventually gets a bit of 'wear and tear' in most of the joints in their bodies, and this includes the spine. It is pretty inevitable that you are going to have some sort of back issue at some point in your life.

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You need to focus on managing your lifestyle well, to ensure that these episode of pain do not occur too frequently, and do not bother you too much.

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We'll look at some lifestyle factors you need to work on towards the end of this article.

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DO YOU NEED TESTS?

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Blood tests are done for patients with a possible inflammatory cause for their back pain. This inflammatory conditions happen in patients with arthritis problem, or a condition known as 'Ankylosing Spondylitis'. If you have an inflammatory condition going on in your body, your doctor will be able to see some signs of it on some simple blood tests. However, blood tests are not actually needed for the large majority of patients to check on their back pain.

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Having said that, it would be a good idea to have a kidney function test done, especially if you find that you need to take anti-inflammatory painkillers frequently to help you manage your back pain, since such medications have a small risk of
damaging your kidney. These medications also need to be avoided once you have a kidney issue.

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An x-ray is helpful to look for signs of degenerative change if your pain has been prolonged - most doctors would do an x-ray if you have been having pain regularly for over a month.

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The x-ray of your spine in the low back region will show if there is any sign of degenerative disease in the cartilage discs between the bones in your spine (the intervertebral disc), or in the small joints in your spine (the facet joints).

 

This degeneration indicates 'wear and tear' changes in your spine.

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Everyone has a slight curvature in the spine in their lower back region - doctors call this the 'lumbar lordosis'. Your x-ray may show straightening of this region, indicating a muscle spasm in the area, due to a back strain. If you do an x-ray and have a look at your report, this finding will read as a 'loss in lumbar lordosis' - this just means you had a bad episode of low backs train, and you're having a bit of muscle spasm in the area because of that strain. 

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DO I NEED AN MRI SCAN?

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If your x-ray isn't showing very much about the cause of your back pain, or if your back pain suggests you may have 'nerve impingement', or something more worrying, your doctor may ask you to do an MRI scan. An MRI scan is better at showing soft tissue structures than other types of scans. In the spine, it helps to show the cartilage discs (intervertebral discs), and if any of these cartilage discs are pressing on the spinal cord or any of the nerves in that area.

 

An MRI scan provides more information than a plain x-ray, but is also a lot more expensive and difficult to arrange and perform. It costs a lot more (typically $500 to $1000, compared to less than $50 for a simple x-ray), and MRI scans are usually performed on an appointment basis.

 

You also cannot go for an MRI scan if you have certain kinds of metal implants in your body. If you have a pacemaker, it can be dangerous to step into a room with an MRI scanner in use. Older kinds of surgical implants, such as those used to fix broken bones, may also not be MRI-compatible. Your doctor will check the 'MRI-compatibility' of any implants you have in your body, since newer ones may be made of different metal alloys, and may actually be 'MRI-compatible'.

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You may also have difficulty going for an MRI scan if you are claustrophobic. Undergoing an MRI scan of your spine involves you lying in the MRI machine for 30 to 45 minutes at a go. The space for the patient is typically rather small, so being inside it can feel uncomfortable for some people because of the tight space. It's also pretty noisy, so it can be quite distressing. You also cannot move during the entire scan, since any movement may affect the scan image quality.

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However, if you really no need a scan done and are claustrophobic, your doctor can arrange to have you sedated for the scan.

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OTHER CAUSES OF

LOW BACK PAIN

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1. Kidney stones:

 

Your kidneys lie on the back of your abdominal cavity, so a kidney stone can trigger pain at your mid-back/ low back area. You'll feel this sort of pain as a severe, 'squeezing' sort of pain, that travels down from your back to your groin area (along the direction of your urine tubes), that comes and goes in intense waves.

 

The pain can be so bad that some people may require injections for pain relief.

 

You may also notice some blood in your urine, although this bleeding is usually minor and in most cases is only picked up on a urine test. This minor bleeding happens because of the stone rubbing against the lining of your kidney, urine tube, and bladder, and this abrasion causes a bit of bleeding.

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2. Kidney infections:

 

Just like a kidney stone, an infection in your kidney can trigger off an episode of low back pain. If you have an infection involving your kidney, you'll usually be quite ill, with a fever and a lot of pain when passing urine.

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3. Stomach issues:

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A stomach ulcer, or inflammation in your pancreas (an organ that lies in your upper abdomen, that secretes some of the hormones in your body, like Insulin) can cause pain that goes from your upper tummy region all the way through to your mid-back area. 

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WHEN SHOULD I BE WORRIED?

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Very rarely, persistent back pain will be due to a serious cause, such as a tumour in your spine. This can either be a tumour that grows from structures in the area, or from spread from cancer somewhere else (like in your breast or colon).

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You'll have pain that persists for many weeks and months, and does not improve with rest. Medications may stop the pain for a short period, but the pain may flare right back up again once you stop your pain medication. You may also have a drop in your appetite, and notice that you're losing some weight.

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Your doctor may be able to see some signs of this issue on a plan x-ray, but if an x-ray doesn't show very much, an MRI or CT scan of the area will - your spine specialist will do one when it's needed.

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SEE A DOCTOR?

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You should see a doctor for low back pain for:

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1. You need some time to rest:  A back strain is usually a mechanical problem. It will go away with rest, but conversely, it will persist and worsen if you continue on with your normal daily activity without giving your body a chance to rest and recover. If your job is physically demanding, or requires you to sit for prolonged periods, your doctor can issue you a Medical Certificate for you to take some medical leave and rest and recuperate at home. This time is meant for you to REST - take it easy, and don't do any exercise, housework, or heavy lifting. Just get lots of bedrest, and take the
medication you're given.

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2. You need some medication: Low back pain is usually accompanied by some degree of muscle spasm, and inflammation in the muscles, cartilage and ligaments in the low back area. Muscle relaxants (like Anarex) and anti-inflammatory medications (like Diclofenac, Celebrex and Arcoxia) all help to settle these issues, and relieve your back pain. You can also apply some topical medications like a pain relief ointment or medicated plaster. This topical treatment is usually not very strong, but is very safe.

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3. Persistent pain: If your pain is very recurrent with frequent flares through the month, or it just doesn't really get better, even with medication, it would be a good idea to get an x-ray done, to see if there's any major issues in your spine. This is especially important if you have other symptoms like persistent pain at night disturbing your sleep, or a loss of appetite and weight.

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4. Fall or knocks: After a bad fall or accident, it would be a good idea to have an x-ray done if your low back pain is quite bad, or is very persistent, since an x-ray will help ensure that there isn't any bone injury from the trauma to your spine.

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5. Urine issues: If you're having difficulty controlling your urine - if it's dribbling out or you're just unable to pass urine -go to a hospital immediately! You may need an urgent MRI scan to see if your intervertebral disc is putting pressure on your spinal cord.

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On the other hand, if you're having minor pain when you urinate, or are running to the toilet to pee very often, if may be a bladder infection involving the kidneys - see any doctor to get checked.

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6. Digestive issues: If you feel your pain is flaring up with large, spicy, oily meals, or when you skip meals, your pain may actually be related to a gastric issue. See a doctor to see if you need to start taking some gastric medications, or if you need to go get a stomach scope done to look for a gastric ulcer.

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WHAT CAN I DO?

 

Now comes the most important bit - what can YOU do to manage a simple mechanical low back pain issue?

 

1. LOSE WEIGHT

 

When you carry extra weight, you're putting more pressure on your spine, and you're more prone to getting flares of low back pain. Carrying excess fat will put more weight on your spine, and the extra load will accelerate 'wear and tear' changes in your spine, and cause more frequent episodes of low back pain.

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Maintain a healthy diet; high in fibre (like vegetables), lean protein (like chicken breast) and low in unhealthy fats (like that in fast food), or follow an 'intermittent fasting' diet to lose the extra fat you're carrying, and take some load off your spine.

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2. EXERCISE

 

Exercising regularly helps you maintain a healthy weight with mostly lean muscle mass. It's also important to do strengthening exercises for your core muscles, since they help support your spine and reduce flares of low back pain.

Check out some of our recommended strengthening exercises here. 

 

When you do your general exercises sessions, be careful to not injure yourself when working out. Always spend a few minutes warming up prior to your workout. Do your exercises with good form, and don't jerk your body around when doing your exercises. Lift weights with caution, and be careful not to overdo it. if you lift something that's too heavy for you, especially with poor form, you're going to get a low back injury and be out of the gym for quite some time.

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3. STRETCH OFTEN

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Do back stretches daily to stretch the small paravertebral muscles on either side of your spine. These muscles help support your spine as you stand, walk, lift loads and bend up and down, and turn over in bed - pretty much anything you do that requires your torso to move.

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Stretching the little muscles that supports your spine help to improve the blood flow through the muscle, and reduce the muscle spasm and pain. Learn how to do some simple stretches here. 

 

Doing some simple back stretches only takes a few minutes - try to do them daily!

 

4. GOOD POSTURE

 

Sitting or standing hunched over increases the pressure on the cartilage discs in your spine (your intervertebral discs).
 

This pressure is also increased when you hunch your back and bend over to pick a load up. Sitting hunched over for a prolonged period of time, or bending up and down repeatedly with your back hunched over can speed up 'wear and tear'
changes in your spine, and cause recurrent episodes of low back pain.

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Sit upright, with your shoulders braced back, and position your computer screen at the correct height - you should be looking directly ahead when looking at it.

 

Keep your lower back arched with a slight curve in it, so that your chest is out and your shoulders pulled back, whenever you bend over to pick something up. It may look a little unnatural and silly, but it'll help to reduce low back pain flares.

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5. DON'T SMOKE

 

Smoking reduces blood flow to the intervertebral discs in your spine, and speeds up 'wear and tear' changes in the area.

It has been shown in medical studies to be a significant factor in causing recurrent low back pain problems. It can be difficult to quit, but it is very possible. Give our article on 'Quitting Smoking' a read to learn how you can quit today!

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WRAP IT UP!

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Much of preventing and managing a simple back strain issue depends on YOU. You can get medications from your doctor, but if your lifestyle isn't on track, you'll find your low back pain issue flaring up again and again.