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Risk Factors
-
increasing age: up to age 60, male and
female risk is about the same, but after that women are at a greater risk, due
to osteoporosis.
-
size and shape of spinal canal
- smoking increases chances of low back pain.
- extended driving, due to low back strain
- stress and other psychological factors
- strenuous physical labor
Causes
Low back pain and lower extremity
pain often get lumped into one category, but the causes, and therefore the
treatments, can be quite different. Lower extremity pain, when it radiates
from the low back, is usually the result of pressure on a nerve. The pain
is often in the distribution which the nerve supplies. Low back pain, on
the other hand, is often related to the mechanics of the spine. Muscle
strain, arthritis, trauma, osteoporosis, and fracture are often causes.
Often, disease processes which cause lower extremity pain can also cause low
back pain, and vice versa. Psychological and emotional factors can play a
role as well. When one has a tough day, their back might hurt, but later
that day, while having fun with friends, the same person can completely forget
about the pain. Low back pain can also be multifactorial, involving
several causes. Here we will outline some of the general categories into
which low back and lower extremity pain are often classified.
-
sprained/strained ligaments, tendons, and muscles.
ligaments connect bone to bone. tendons connect muscle
to bone. All of these elements can become bruised as a result of sports
injuries or heavy lifting. Although these injuries are usually self
limited, and heal with time, repeated trauma can cause chronic pain.
- degenerative disc disease
after we turn 20, each of us suffers a slow degeneration of
the discs of the spine. Normally, the disk is a shock absorber situated
between two vertebral bodies. It consists of a soft jelly in the center,
called the nucleus pulposis, and it is held together by a firm band called the
annulus fibrosis. When the disc dries up, it shrinks, and can result in
mechanical pain. In addition, as the disc height collapses, the exiting
nerves can become compressed, leading to lower extremity pain.
Generally, this condition poses no danger, but can be very annoying to
patients.
- herniated discs
the nomenclature (naming system) is very confusing.
Herniated discs are often referred to as slipped, bulging, ruptured, and
retropulsed. No wonder it is confusing to patients. But regardless
of what we call it, let's evaluate the concept of a herniated disc. When
the jelly like nucleus pulposis ruptures through the annulus fibrosis, the
"herniated" portion can press on a nerve, causing pain and weakness. The
nerve can get "pinched" resulting in sciatica, a radiating pain to the lower
extremit. Over 90% of herniated discs occur in the lowest two levels of
the lumbar spine, between L4/L5 and L5/S1.
- spinal stenosis
this condition refers to "pinching" of the nerves within the
spinal canal. The spinal cord generally ends at the L1/L2 level, which
is located at the top of the lumbar spine. The spinal nerves then pass
lower, within the spinal canal. These nerves supply the movement and
sensation in the lower extremities, as well as providing function of bowel,
bladder and sexual activities. When these nerves are pinched in the
central canal, pain is caused, radiating down to the lower extremities.
The pain is generally worse when standing or walking, and is improved by
sitting. This is because the narrowing is often caused by a combination
of facet joint hypertrophy, disk bulging, and thickening of the ligamentum
flavum. When standing, the thickened ligament can "buckle," cuasing
pressure on the nerves, but when bending over or sitting, the ligament is
stretched, resulting in decompression of the nerves.
- spondylolisthesis
this fancy name simply means one vertebral body slipping
forward on another. It generally results from a "break" in the bone
holding one vertebral body to another (technically known as the pars interarticularic), but can also result from degenerative changes in the joints
holding the bones together. This condition can cause low back pain, and
can also cause lower extremity pain when the exiting nerves are pinched by the
slipped vertebrae.
- emotional stress
emotional stress can have a significant effect on low back
pain. This may be one of the most common causes. One may often
experience back pain, changes in sleep, loss of appetitite, and fatigue.
When under substantial stress, ones posture often changes, shifting their
center of gravity, making the back more prone to injury. In addition,
when under emotional stress or when depressed, people tend to take poor
care of themselves, resulting in deconditioning and weaker muscles.
- vertebral body fractures
fractures, which are usually quite painful, can occur for a
variety of reasons. First, and most obviously, trauma. Certainly,
injuries such as motor vehicle accidents or falls can cause fractures.
Osteoporosis, which is weakening of the bones due to loss of calcium, can
predispose the bones to fracture. If the bones are weak, then it doesn't
take much stress to fracture them. Cancer can also weaken the bones.
Some types of tumors will actually eat away at the bone, causing mild or
severe degrees of weakness.
- osteoporosis
this disease is a very common cause of bone fractures.
Roughly 28 million people in the United States are affected, and women are
significantly affected. 50 percent of women and 13 percent of men will
suffer from osteoporotic fractures. When bone is weak, it doesn't take
much to cause it to fracture. Events of minor trauma, even picking up a
heavy object the wrong way, may cause fractures of weak bone.
- sacroiliac joint
the sacroiliac joint is composed of the articular
surfaces at the junction of the sacrum and iliac bones. This joint
is susceptible to the development of arthritis from a variety of
conditions, including strain from trauma or misuse, osteoarthritis,
rheumatoid arthritis, and post-traumatic arthritis. As the
sacroiliac joint ages, it also narrows, making intra-articular injections
more difficult.
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