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SPINAL PAIN LOWER BACK PAIN

Lower Back Pain

Studies have shown that one out of five people suffered back pain sometime in their lives. Back pain results mostly from problems of muscular causes, yet it may be a messenger of more serious diseases.

Lower Back Pain

Lower back pain can be felt as an ache, pain, burning or stinging. While the exact location can be determined in some situations it can also be spread out and impossible to determine the exact point in other situations. The pain can be light or severe and can fluctuate.

The pain can be caused by the bone, cartilage, muscle, joint capsule, ligament, disc or veins and the exact cause may not always be detectable. In some situations, even though the cause for the pain has been eliminated the nerve endings that have been stimulated once continue to send signals causing the pain to persist. Since stress is also a significant factor in lower back pain this can make it more difficult to determine the cause.

No matter what tissue the lower back pain originated from if the relevant tissues move around or get wider and thicker causing pressure on nerves, leg pain, numbness, overheating and incontinence can also occur.

What is acute lower back pain?

Lower back pain that has lasted over 6 weeks is acute lower back pain. While this kind of pain can be triggered by a certain activity or after an accident, it can also be completely independent of these. 80% of people have had a serious lower back pain attack at least once in their life. Usually the pain dissipates on its own. More than half of the people suffering from this kind of pain will get better within 2 weeks. In 6 weeks the lower back pain will be completely gone in 80 % of the people. 30% of people who experience serious lower back pain once will have recurring attack/attacks or have chronic pain.

What is chronic lower back pain?

Lower back pain that has lasted over 3 months is chronic lower back pain. The existing tissue irritation stimulates the surrounding nerve endings to cause pain. The inflammation and swelling that develops as the body’s reaction can also contribute to the pain. Generally the blood flow and oxygenation in the area has decreased. This makes it harder for the harmful waste in the area causing the pain to be discharged. The sources of the pain need to be examined meticulously to determine the proper treatment.

Lower back pain and activity

Generally it is thought that daily activities should be avoided and time should be spent resting. But, especially in the event of acute pain, being as active as “can be tolerated” is recommended. Continuing to be active, increases blood flow and decreases inflammation and muscle tightness. After simple cardio activities such as walking people generally feel better. Activities such as weightlifting, racing and contact sports should be avoided. 

Cold or hot applications can be useful in various situations. Hot applications can increase the relaxing of muscles. However no long term benefits of these applications in terms of recovery have been clearly shown.

Causes for Lower Back Pain:

Injuries

Vertebrae fractures frequently occur in the most active place on the spine, between the 12th back vertebra and the 1st lumbar vertebra. While this usually occurs in young people as the result of falling from a height, a traffic accident, a gunshot injury or high energy injuries, it can even be seen in low energy trauma on older people with less bone density. 

Frequently, only the front part of the spine is affected and it can be classified as a compression fracture. Fractures of the spine’s middle and back sections are known as blow-out fractures and partial or full paralysis may result from pieces of the fracture putting pressure on the spine. If the load that pushes on the spine is too much, the soft tissue holding the vertebra together may be affected causing breaks and dislocations.

In spinal fractures bones can be reinforced with corsets, casts, and other various cementing techniques as well as open and closed surgery.

Cervical Disc Hernia

Carrying heavy loads, bending over for long periods or staying in the same position, being overweight, long periods of stress, many births, etc. and other problems resulting in sudden or chronic straining in the lower back area causes the protective outer layer of the disc to tear, the disc to become displaced and the surrounding nerves to be pinched. 

Depending on the location of the hernia, lower back pain or leg pain may be more prominent. Restricted movement, only being able to walk a short distance, difficulty sitting, incontinence and impotency can occur as a result.

Stress Fractures and Slipped Vertebrae

Stress fractures and slipped vertebrae can develop with recurring micro-trauma as a result of increased activity in the lower back. These types of fractures that do not recover for a long time are generally painful at a young age and may not cause problems as an adult. 

Due to these stress fractures a vertebrae may shift away from the one above it and result in spondylolisthesis. Spondylolisthesis can occur for reasons other than stress fractures.

Lumbar Narrow Canal

The spinal cord which passes through the spine carries strength and feeling to the legs. It controls the holding of stool and urine. Decreased disc height, thickening of the bones, capsules, or ligaments in the joints between vertebrae and slipped vertebrae can cause the canal through which the spinal cord passes to reduce in diameter, or in other words cause the canal to become narrow. 

The typical complaint is that strength and feeling in the legs begins to falter after walking a certain distance or numbness and tingling may be experienced. Since leaning forward or sitting increases the diameter of the canal, the complaints may decrease or disappear. However it will recur after walking a certain distance.

Infections

50-60% of all spinal infections occur in the lower back. Smoking, eating disorders, obesity, diabetes, HIV and various cancers increase this risk. 

They can develop because of bacteria, viruses and fungus. The bone of the spine, discs, nerve membranes called dura and surrounding tissue can be affected. 

Spinal infections can also occur after surgery. Post operative discharge from the incision area in the early and late stages, redness around the incision, sensitivity and fever can be indications of a spinal infection.

Tumors

The source of tumors can be bone, soft tissue or nerves. They can be benign or malignant. While they can originate primarily from the cells that form the vertebrae and the spinal cord they can also spread from a tumor in another part of the body (breast, prostate, etc.) and this is called metastasizing. 

Depending on the location and type only the tumor or a wide section with healthy tissue around it might need to be removed. It may be necessary to immobilize, cage or cement using metallic implants.
Osteolysis, rheumatism, reflected pain, stress and various metabolic conditions can also be the cause of lower back pain.

Which is the right doctor for me to go to for my lower back pain?

Patients suffering from lower back pain may be confused at first about which doctor they should go to. Our Comprehensive Spine Center, with its multi-disciplinary approach, brain surgery, orthopedic spinal surgery, physical therapy and rehabilitation, neurology, algology, radiology and psychiatry branches, will make sure that patients are guided most efficiently and receive the proper treatment. 

By clicking on our triage system, one of the most important elements of our patient oriented treatment approach, you can get recommendations on which doctor you should go to first for your complaint/complaints. 

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