The most common causes of back pain are strained muscles or ligaments and general constitutional degenerative changes ‘wear and tear’. Pain in the back is the commonest symptom encountered in orthopaedic practice. Cases are generally classed as ‘chronic ligamentous strain’ or ‘postural back pain’.
- 90% of the UK population get back pain at some point.
- Most back pain settles within six weeks.
- Back pain can return.
- Four out of five workers suffers from back pain and 20% take time off work because of it.
Lumbar back pain
Lumbar back pain is often accompanied by radiating pain in the buttock, thigh, or leg, usually on one side but occasionally on both. This pain is generally referred to as sciatica. Sciatica is often a much more disturbing symptom of back disorders than the back pain itself; which indeed may be slight or transient.
Lumbago is a symptom rather than a disease. In a typical attack of acute lumbago the patient is suddenly seized with agonising pain in the lumbar region of the spine, usually while stooping, lifting, turning or coughing. The pain is often so severe that any movement is difficult and the patient is ‘stuck’. However, with rest the pain gradually subsides, but in some cases the acute back pain is succeeded by sciatica, suggesting irritation of a lumbar or sacral nerve.
Prolapsed Lumbar Inter-vertebral Disc
Herniation of part of a lumbar inter-vertebral disc is a common cause of combined back pain and sciatica. Cause: prolapse of a disc is often precipitated by injury, but it is believed that spontaneous age-degeneration of the disc is an important predisposing factor. The discs between L4 and L5 are the most often affected.
Progressive degeneration of the discs leads, after months or years, to osteoarthritis, with ultimate involvement of the posterior inter-vertebral (facet) joints as well as the central (body-to-body) joints.
Chronic Lower Lumbar Ligamentous Strain
It is assumed that the spinal muscles fail in the function of protecting the deep ligaments in maintaining posture. Predisposing causes include: childbirth, overweight, general flabbiness of muscle and debilitating illness. The patient is nearly always a woman and often dates the onset of pain from childbirth. Treatment includes: injections with hydrocortisone or injection into the extradural space of the spinal canal.