Low back pain is a common problem in adults. While it may be expected after a fall, during pregnancy or with the strain of lifting a heavy object, chronic low back pain should be investigated more intensively. Two-thirds of American adults will experience low back pain in life and it remains the second most common reason for seeing a physician in the United States. Many of these cases are due to mechanical back pain where the problem likes in the bones (vertebrae), muscles, ligaments and nerves in the lower back.
It is often associated with injuries and age-related changes in the spine. This includes conditions like nerve root compression (such as sciatica), a herniated disc, myofascial pain syndrome and fibromyalgia. However, there also other common causes of low back pain that can be easily corrected with lifestyle changes. Yet these causes are often not considered. Persistent low back pain is also a common symptom of many diseases of the internal organs even when other symptoms have not as yet appeared.
Poor posture is by far the most common contributing factor to back pain in general. It is not only the standing posture that is the problem, but also the sitting posture. Lazing on a couch in a slouched position for long hours places strain on the lower back, as well as the upper and mid back. But even sitting upright could be a problem especially during the course of the working day. The long hours at a desk without adequate back support can be more damaging that walking around with a poor posture or lazing on the couch for short periods. These days ergonomically-designed chairs can reduce the strain on the lower back with prolonged sitting.
It may not just be a problem with the way you stand and sit, but also in the way you walk. Every person’s gait is unique but despite individual variations, there is a right and ‘wrong’ way to walk. It is difficult to assess your gait if you do not have a thorough understanding of biomechanics. A physical therapist and related health professional can provide insight into what you may be doing ‘wrong’ when walking. Here are some tips to look for in what can be said to be the right ‘gait’:
- Upright without slouching, tilting forward or backward. Ears in line with shoulders, shoulders in line with hips, hips in line with ankles.
- Heel of one leg makes contact with the ground and then the toe of the other leg leaves the surface.
- The heel of the the leg that is off the ground then touches the surface while the toe of the other leg pushes off the surface.
This cycle continues until a person comes to a standstill. The upright posture should be relatively consistent from walking to standing. If the gait is incorrect, it can lead to back pain and should therefore be corrected.
Repeated Back Strain at Work
While lifting a heavy object may occur every now and then in the home setting, it is at work where it is more likely to occur repeatedly. These injuries can damage the lower back structures in various ways and lead to low back pain. It may not be immediately obvious as the damage occurs collectively over a period of time. Workers involved in manual labor where there is repeated lifting and carrying of heavy objects should learn the most efficient way of doing so without sustaining chronic injuries to the back. For example, bending the knees when lifting a low lying heavy object. A physical and/or occupational therapist can assist with ergonomics to reduce the chances of injury in the workplace.
Obesity and Abdominal Fat
A heavier than normal body weight can place excessive force on the lower back, as well as the limbs. Obesity needs to be corrected through weight loss to reduce back strain and lower back pain. Even people who have not as yet reached the obese category in terms of their body weight may still be at risk if they have a larger abdominal circumference. Belly fat shifts the center of gravity and places a greater force on the lower back than would be seen in a person who has a smaller waist size. Pregnancy can be a problem for women in this regard but is relatively short term. Any person with abdominal fat has to implement the same weight loss techniques as obese people. Losing fat only at one spot is not possible without liposuction.
Gynecological Problems in Women
A number of conditions affecting the female reproductive system can cause lower back pain. This includes:
- Polycystic ovarian syndrome (PCOS) – ovaries
- Salpingitis – fallopian tubes
- Endometriosis and uterine fibroids – uterus
- Cervicitis – cervix
Low back pain is often one of the first symptoms that arises and can sometimes be the only symptom for prolonged periods of time. Women should therefore see a gynecologist if low back pain cannot be attributed to other causes, like those that cause mechanical back pain, as well as kidney or back problems.
Prostate Problems in Men
Different prostate problems can also cause lower back pain in men as gynecological problems do in women. It can sometimes be the first and even the only symptom. Prostate conditions can affect any adult male but is more common in men over the age of 50 years. Therefore regular screening for different prostate problems is advisable. The three main conditions include:
- Benign prostatic hypertrophy (BPH) – enlargement of the prostate gland that is not cancerous.
- Prostatitis – inflammation of the prostate gland that is most often due to infections.
- Prostate cancer – a malignant growth of the prostate tissue.
While dietary changes can help prostatitis to some degree, surgery may be necessary for other bladder conditions.
Kidney and Bladder Conditions
A bladdder infection (infectious cystitis) is a very common condition particularly in women. Similar to other bladder conditions, it can cause lower back pain. Sometimes low back pain is the only symptom in certain bladder conditions for long periods of time until other more specific symptoms arise. Kidney problems tend to cause mid back flank pain. It tends to be worse on the side where the kidney is affected. Low back pain that occurs with urinary symptoms, like burning urination, frequent urination and blood in the urine (hematuria) should be assessed further for kidney and bladder problems.
Spinal osteoporosis is a condition of the bones of the back (vertebrae). Here the bones lose mass and become brittle over time. It is a condition that more commonly occurs later in life especially in postmenopausal women. Osteoporosis is largely asymptomatic in the early stages. It can occur for years and even decades before symptoms become evident. Often it is only discovered with routine screening or when a minor fall or bump leads to a fracture thereby indicating that the bones are weak. Low back pain is not a common symptom unless there is a fracture or collapsed vertebrae leads to nerve root compression.
Arthritis is a problem with the joints. There are many joints in the back which gives the spine its flexibility. The two main types of arthritis are osteoarthritis (OA) and rheumatoid arthritis. Osteoarthritis is often associated with the large joints of the body like the shoulder, hip and knee but it can affect the back (spinal osteoarthritis). Rheumatoid arthritis tends to affect smaller joints like that of the fingers but can also affect the the various small joints of the spine. When other joints elsewhere in the body are not also affected, spinal arthritis is often diagnosed later after excluding more common causes. A personal and/or family history of arthritis, especially rheumatoid arthritis, is a good indicator of low back pain being due to arthritis.