Lower back pain or lower back pain is a common complaint and can be quite troublesome. Lower back pain is often caused by overload of the back muscles. The area at the level of the lower five lumbar vertebrae and the junction with the sacrum is called the ‘low back’. Lower back pain can be sudden and severe or persistent and dull. In more than 90% of cases, no specific physical cause can be identified for low back pain. It may be due to incorrect strain or overload on the back, a wrong (sitting) posture or a wrong movement. Rarely is low back pain the result of an underlying disease, an accident or inflammation. Low back pain is also called ‘lumbar pain’. Lower back pain can occur without radiating pain and with radiating pain (upwards, to the buttock or buttocks or to one or even both upper legs). Lower back pain can severely limit your daily activities at home and at work.

• Low back
• Classification of lower back complaints: pain in the lower back
• Functions of the low back
• Causes of lower back pain (left, right and middle)

• Lower back pain due to a hernia
• Flu
• Lower back pain during pregnancy
• Arthrosis
• Osteoporosis or bone decalcification
• Bekhterev’s disease
• Radiating pain
• Shingles
• Fibromyalgia
• Lower back pain due to scoliosis
• Cystitis
• Metastases
• Other causes of lower back pain

• Risk factors for low back pain

• Become older
• Genetic factors
• Occupational hazards
• Sedentary lifestyle
• Overweight
• Bad attitude
• Pregnancy
• Smoking

• Examination and diagnosis

• X-rays
• CT-scan
• MRI scan

 Lower back pain / Source: Maridav/Shutterstock.com

Low back

The area at the level of the lower five lumbar vertebrae and the junction with the sacrum is called the ‘low back’. Low back complaints can manifest themselves locally (left, right and in the middle) as well as regionally, i.e. extending over a larger area. Low back pain can occur without radiating pain and with radiating pain (upwards, to the buttock region or to one or even both legs).

Classification of lower back complaints: pain in the lower back

A distinction is made between non-specific and specific low back complaints. Non-specific low back complaints are complaints of the low back for which no physical abnormality can be demonstrated, although this does not mean that there cannot be functional abnormalities. In the case of specific lower back complaints, a specific physical cause for the complaints can be demonstrated. Examples of this are hernia, osteoarthritis (wear and tear), inflammation, etc.

Functions of the low back

It is the lower back that bears the weight of the torso and head. The low back keeps the torso upright, makes movement possible, absorbs forces when lifting and carrying, but also when landing after a jump, running, etc. In addition, the low back provides protection to the nerve structures that run in the spinal canal.Back pain due to sedentary work / Source: Istock.com/AnaBGD

Causes of lower back pain (left, right and middle)

Low back pain has many causes. However, in more than 90% of cases, no cause for lower back pain can be identified.Lower back pain due to overload of the back What most commonly occurs is incorrect loading or overload and sprain of the muscles and ligaments. This can be caused by lifting too fast or too heavy or making a wrong movement. But sitting too much and a wrong posture can also contribute to lower back pain and a sore back, as can doing abdominal exercises such as sit ups and crunches. All these exercises that create a rounded back are very stressful for the spine and intervertebral discs.Lower back pain can be the result of overloading the back, causing spontaneous cramping of the muscles (comparable to calf cramps). A sudden wrong movement can also cause lower back pain. 

Lower back pain due to a hernia

A hernia in the back is a bulge of an intervertebral disc that can press on and irritate or irritate a nerve pathway. A hernia is often located in the lower back. Most people with a herniated disc suffer from lower back pain. A hernia can also cause (a sharp) pain in one leg. The pain can extend to the lower leg, sometimes even to the foot. Certain postures or movements, including laughing, coughing, sneezing or straining, can trigger or intensify the radiating pain. There may also be a loss of strength in the leg. Some people feel as if the leg is asleep.

Flu

With a bad case of the flu, you can suffer from back pain, among other things. The muscle pain that the sick person experiences in, for example, arms, legs and back, is related to the high fever.Back pain during pregnancy / Source: Istock.com/kzenon

Lower back pain during pregnancy

Pregnant women often suffer from lower back pain, due to an increase in the weight of the growing baby. During pregnancy, joint ligaments, including those of the spine, weaken under the influence of hormones, which can also cause back pain.

Arthrosis

Osteoarthritis, also known colloquially as ‘wear and tear’, is a chronic joint disorder of the musculoskeletal system. The quality of the articular cartilage deteriorates and over time it may even disappear completely. The complaints of pain (joint pain), stiffness and loss of function are characteristic of this disease. Osteoarthritis can cause lower back pain and stiffness.Osteoporosis / Source: Blausen.com staff, Wikimedia Commons (CC BY-SA-4.0)

Osteoporosis or bone decalcification

In osteoporosis (bone decalcification), bone density decreases. This makes the bones break more easily. The vertebrae in particular can suffer the consequences of this. Compression fractures may develop, with sudden, severe back pain. A ruptured or bulging intervertebral disc can also cause lower back pain. This also often causes sciatica. Spinal stenosis (narrowing of the spinal canal) is a common cause of lower back pain among the elderly.

Bekhterev’s disease

Ankylosing spondylitis is a rheumatic condition characterized by inflammation in the joints. This disease mainly affects the joints in the back and pelvis, causing stiffness and back pain.

Radiating pain

A disorder of an internal organ can result in lower back pain. In these cases, lower back pain is radiating pain, which originates in another part of the body (kidneys, bladder, uterus or prostate), but is felt in the lower back. Examples include:

• inflammation of the uterus (endometritis);
• inflammation of the fallopian tubes (salpingitis);
• kidney or urinary tract disorders.

Shingles

Shingles or herpes zoster is a viral infection that causes itching or pain in a strip of skin on the face, trunk or extremities. Shingles can cause severe back pain.

Fibromyalgia

Fibromyalgia is a chronic pain syndrome in which the pain is localized in muscles, joint attachments and tendons throughout the body. The pain is often described as a form of muscle ache that occurs with a severe flu. The pain usually starts in the back, neck, shoulders or hands and gradually spreads to other parts of the body, such as the elbow, lower back, pelvis and heel.

Lower back pain due to scoliosis

Scoliosis is a lateral curvature of the spine to the left or right, causing one or two curves. As a result of this deviation, back pain complaints can arise.

Cystitis

Sometimes a bladder infection or cystitis causes a stabbing (severe) pain in the abdomen and/or lower back, especially in the case of a bacterial infection. You often suffer from fever and chills. Other symptoms of a bladder infection include burning pain when urinating, frequent urge to urinate, and the feeling that the bladder is not completely empty after urination.

Metastases

A rare cause of low back pain is cancer with metastases to the spine from the breast, lung, prostate or kidney and bone cancer.

Other causes of lower back pain

Being overweight and obese, smoking and lack of exercise and persistent stress can contribute to lower back pain.

Risk factors for low back pain

There are many risk factors for back pain, including aging, genetics, occupational hazards, lifestyle, weight, posture, pregnancy and smoking. But you can just as easily get back pain without there being a risk factor. Individuals with one or more of the following factors may be at risk for back problems:

Become older

Over time, wear and tear on the spine can result in degenerative conditions that cause neck and back pain. This means that people over 30 or 40 years old are more at risk for back pain than younger people. People aged 30 to 60 are more likely to have spinal disc disease, while people over 60 are more likely to have pain related to osteoarthritis.

Genetic factors

There is some evidence that certain types of spinal disorders have a genetic component. For example, degenerative diseases of the intervertebral discs appear to have a hereditary component.

Occupational hazards

Any job that requires repetitive bending and lifting has a high incidence of back injury (e.g. construction workers, nurses, etc.). Occupations where you stand for long periods of time without a break (e.g. hairdresser) or sit in a chair (office staff or software developer) where the back is well supported also entail a risk.

Sedentary lifestyle

Lack of regular exercise increases the risk of developing low back pain and increases the severity of the pain.Being overweight is a risk factor for back problems / Source: Taniadimas, Pixabay

Overweight

Excess weight increases the burden on the lower back, as well as other joints (e.g. knees) and is a risk factor for certain types of back complaints.

Bad attitude

Any form of prolonged poor posture will significantly increase the risk of back pain over time. Examples include poor working posture at your desk, driving hunched over the steering wheel, and incorrect lifting.

Pregnancy

Pregnant women are more likely to experience back pain due to carrying extra body weight in the front and loosening of ligaments in the pelvic area as the body prepares for delivery.

Smoking

People who smoke are more likely to have back pain than people who don’t smoke.

Examination and diagnosis

The doctor will interview you about the complaints you are experiencing and then conduct a physical examination. He or she will take your medical history into account. In addition, imaging tests can be performed to determine the cause of your back pain. For example:

X-rays

This provides information about the bones in the spine. An X-ray is often used to check for spinal instability, tumors, and fractures.CT scan / Source: Anekoho/Shutterstock.com

CT-scan

This produces a very detailed X-ray with cross-sectional images. CT scans provide details about the bones in the spine. They can also be used to check for specific conditions, such as a herniated disc or spinal stenosis. CT scans are usually less accurate for spinal conditions than MRI scans.

MRI scan

An MRI scan is particularly useful for assessing certain conditions by providing detailed images of the intervertebral disc and nerve roots (which may be irritated or compressed). MRI scans are useful to rule out spinal infections or tumors.

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