Cause of Back Pain
Orange County, CA
Spinal Decompression

"What is the cause of lower back pain?" has got to be the most common question I have heard as a treating physician over the past 20+ years. Simple enough question, but the problem is there is no easy answer.
The cause of lower back pain, or LBP, cannot be confined to one condition. There are multiple causes of lower back pain. Some are simple and self-limited back strains, while others are serious conditions like disc herniations involving neurologic damage that require immediate, specialized treatment. Here is a brief overview of the most common causes of lower back and leg pain. For more detailed information on each subject, see our other articles by clicking the linked text.

Subluxation
Vertebral misalignment, or subluxations, are another common cause of lower back pain and occurs when the lower back has been subjected to chronic postural stress or a strain that results in the joints between the vertebrae locking up. After a period of malfunction, the surrounding muscles may tighten and nerves become irritated. Subluxations are the key malfunction that doctors of chiropractic treat. They may cause pain or may be asymptomatic for long periods of time until they deteriorate into degenerative arthritis. Various physical examinations, x-rays and computerized diagnostic equipment is often used to locate subluxations.


Back strain or sprain
Strains and sprains of the lower back are caused by over stressing the muscles (strain) or ligaments (sprain) by either a physical activity or imbalanced posture. Slight strains will usually result in pain and/or stiffness within the muscles of the back. Contracting the affected muscles aggravates strains.

Mild strains may resolve within a few days with rest. More severe strains/sprains as the result of strenuous activity such as sports, work, gardening, automobile accidents and such involve more extensive damage. When ligaments have been sprained they will usually become very painful with movement of the affected area. Healing times may be much longer in these cases, as much as a few months. Mild strains can be easily treated at home while more serious strains and sprains should be evaluated by a competent physician that specializes in spinal health. If enough inflammation builds up, the nerves of the lower back can be affected causing sciatica or leg pain, which can be mistaken for a disc injury. A physical examination will usually be sufficient for an accurate diagnosis. X-rays should be performed in cases of physical trauma.


Facet syndrome
The small joints in the back of the spine that allow movement are called facet joints. Due to chronic poor posture, past trauma or over exertion, the facet joints may develop arthritis. The resulting inflammation in the joint causes a deep aching sensation in the lower back that is intensified by sitting, arching the back and exertion. The diagnosis is made with a physical examination and confirmed on x-ray.

Degenerative Disc Disease
This is a very common cause of lower back pain. With repeated bending, twisting, lifting and past trauma such as lifting injuries or accidents, the discs or cushions between the spinal bones begin to lose water and deteriorate. As the disc deteriorates, it shrinks creating tension within the joints of the back and sometimes around the nerves causing back and leg pain. Diagnosis is by x-ray and MRI if the leg pains persist despite 30 days of treatment.

Osteoarthritis Arthritis
Osteoarthritis Arthritis is inflammation of a joint. There are many varieties of arthritis that affect the spine. By far the most common is osteoarthritis or OA. OA involves the breakdown of the cartilage surfaces of a joint causing the joint to lose it's normal motion. As the cartilage wears thinner, bone spurs grow around the area in an attempt to fuse the joint shut. OA is known as wear and tear arthritis because it is caused by long standing postural stresses, past trauma and repetitive use. Sometimes genetic weakness of the cartilage causes it to wear out prematurely. OA is diagnosed off of physical exam and confirmed on x-ray.

Herniated/Bulging Disc
The cushions between the spinal bones may become weakened due to physical injury or because of degenerative disc disease. The weakened outer disc layers allow the disc to bulge outward sometimes contacting nearby spinal nerves causing leg pain or sciatica. If the outer layers suffer enough damage the inner gel-like substance of the disc, called the nucleus, may protrude outward and irritate nerves. A presumptive diagnosis of disc herniation can be made off of physical examination, but an accurate diagnosis as to this cause of lower back pain can only be obtained through an MRI or CT scan.

Stenosis
The main opening running the length of the spine that the spinal cord is housed in is called the central or spinal canal. Normally, there is plenty of room for the spinal cord and other structures to fit inside this opening. Arthritis of the spinal joints can cause the joints to enlarge and push inward reducing the size of the canal. Similarly, a bulging disc may also crowd the space causing stenosis or narrowing. Pressure on the cord and nerves results in back and/or leg pain often aggravated by standing and walking and relieved by sitting. This is a common cause of lower back pain among the elderly.

Cauda Equina Syndrome

Pressure on the lowest nerves of the lower back and tailbone area results in loss of bowel and/or bladder control. Symptoms may also cause loss of sensation around the anus. If you experience any of these symptoms, it is urgent that you have an examination and MRI immediately at a hospital. These symptoms are beyond the scope of a chiropractor, family medical doctor or orthopedist. A neurosurgical evaluation is recommended. This condition can be caused by a severe disc herniation, stenosis or a tumor.

Tumors

Both benign and malignant tumors occur in the spine and can cause lower back and leg pain. They may present themselves as pain in the back or may cause pain to radiate down the leg (sciatica) because of its proximity to a nerve. Most tumors can be seen on x-ray and other imaging such as MRI and CT scan. The initial diagnosis may come from complaints of back pain that cannot be reproduced on physical exam by your doctor. Mechanical pain due to strains, disc problems and so forth can be mechanically irritated or provoked. Back pain from organic disease such as a tumor often times cannot be provoked or worsened by mechanical procedures. A history of unexpected weight loss, fatigue, anemia or pain that awakens you at night in conjunction with a normal physical exam is very suspicious of a tumor being the cause of lower back pain.

As you can see there are many causes of lower back pain ranging from simple non-threatening conditions to very serious and lethal diseases. A careful history, physical examination and routine x-rays by a back specialist such as a doctor of chiropractic is the first line of investigation as to the cause of lower back pain in your case.

The vast majority of problems can be detected in this manner. Once the proper diagnosis is made, appropriate lower back pain treatment can be rendered.