Causes of Lower Back Pain

Other Possible Causes

When your doctor evaluates your back pain, you may be required to undergo an initial consultation, a physical examination and specific tests to help diagnose your condition. There are a number of possible back conditions that can be contributing to or causing your pain.

Back Pain: What is Causing It?

Discitis

This is a relatively uncommon condition that can occur in adults, but more often in children under the age of 10. It is an inflammatory infection that affects the disc space between vertebrae. Symptoms usually include slow onset of severe back pain that becomes worse from movement. There may also be symptoms of infection such as fever, chills, sweating or fatigue.

A diagnosis of discitis is made after imaging tests such as radiograph or MRI where there is evidence of extension of the spine showing disc space narrowing between the vertebrae. Discitis often affects the lumbar (lower) and thoracic (upper) back vertebrae.

Possible causes of discitis are Staphylococcus, viruses or other inflammatory processes that may create the symptoms.

This condition is treated by immobilizing the back, sometimes with the use of a plaster cast or a specially designed back brace. Some doctors will also prescribe antibiotics to treat the infection and advise the patient to get plenty of rest until the condition is successfully treated and recovery is noted.

Fibromyalgia

A chronic disorder characterized by widespread musculoskeletal pain, fatigue, sleep problems and morning stiffness, fibromyalgia occurs more often in women between the ages of 20-40.  The symptoms can be relatively mild in some but severe and disabling in others.

The condition is difficult to diagnose because its symptoms can mimic many other ailments but is generally suspected when a patient has experienced the widespread pain for more than 3 months. Also characteristic of this disorder is pain when slight pressure is applied to a series of 18 “tender points” found in various locations of the body such as the neck, spine, shoulders and hips. It is generally considered fibromyalgia when 11 of the 18 “tender points” are painful when touched.

The cause of fibromyalgia remains unknown although many researchers suspect a previous injury or trauma, virus, infection or changes in the autonomic nervous system may be involved. Others believe that fibromyalgia suffers may have a lower threshold for pain due to unusual sensitivity in the brain.

Treatment for fibromyalgia consists of a number of methods aimed at controlling the symptoms since it remains a chronic condition. Some of these are medication, exercise, massage, cognitive behavioural therapy, acupuncture, massage and chiropractic care.

Osteomyelitis

Osteomyelitis is an acute or in some cases, chronic inflammatory infection of the bone caused by bacteria. In adults it usually occurs in the vertebrae or pelvis while in children it is seen in the long bones of the arms and legs.

Patients with osteomyelitis often present with severe pain in the affected bone and the skin directly above the area may be red or swollen. There may also be fever, chills or nausea.

The infection may develop after an injury or trauma when the bacteria enters the bone through the bloodstream from the wound site. It may also enter the bloodstream from an infection in another area of the body and move into the bone. Some doctors suspect osteomyelitis is caused by the staphylococcus bacteria.

The condition is diagnosed with bloodwork to check for infection, bone scans, x-rays and/or MRI.

Treatment consists of IV antibiotics followed by oral antibiotics. In some rare cases, the infection may require surgery to remove pus, infection and damaged tissue from the affected area.

Spinal Bifida Occulta

This is a hereditary spinal malformation and birth defect where there is an incomplete closure of the spinal cord and the bones of the spine over the spinal cord are not formed completely.

In spinal bifida occulta, there is no opening in the back but the outer part of some of the vertebrae is not completely closed. This is one of the mildest forms of spinal bifida and the spinal cord does not protrude through the vertebrae.

The skin above the affected area may look normal or it may have excessive hair growing from it. Dimples or a birthmark may be present as well.

There is no single cause attributed to spinal bifida occulta but it is much more common than once thought. Most people with it have no symptoms and a small percentage have serious complications. It is diagnosed with x-rays and MRI where the abnormality can be easily observed. Folic acid has been shown to aid in prevention of the condition and pregnant women are encouraged to add it to their pre-natal regimen.

The condition is treated with surgery in serious cases where any opening in the back is closed and medication may be prescribed for those suffering from pain.

Scoliosis

Scoliosis is the most common deformity of the spine. It is generally noticed around adolescence and is an abnormal curvature of the spine. Cases where the curvature is more predominant are found more in girls than boys.

It is diagnosed using x-rays or other imaging techniques but can be readily detected just by observation. There is lateral curvature where the vertebral column appears to bend from side to side and may resemble the letter ``S`` or ``C`` when the patient is asked to bend forward. Rotation or a twisting abnormality of the vertebrae is a common observation.

In most cases of scoliosis, the cause is unknown while a smaller number can be associated with abnormal development of the spinal vertebrae or problems in other areas of the body such as uneven leg length that affect the curvature of the spine. Patients with severe cases may suffer from back pain and difficulty breathing.

Scoliosis is treated with surgery in some cases to fuse vertebrae into position, braces, chiropractic manipulation and physical therapy. The goal is to diagnose this condition as early as possible since curvature is difficult to correct after the condition has progressed.

Transitional Vertebrae

Patients with transitional vertebrae are born with this condition. In the spinal column, there are various types of vertebrae where the ones in the lower back are called ``lumbar``, the ``sacral`` are below them.

In transitional vertebrae, one of the vertebrae does not form as lumbar or sacral, rather a combination of the two. Thus it has characteristics of both kinds of vertebrae.

Treatment consists of physical therapy to make the back more stable and to increase strength and stability. Braces may also be used to give the back support. Sometimes steroid injections are given to reduce the pain and discomfort that this condition may cause.

Osteoporosis

Affecting more women in later age than men, osteoporosis is becoming a more common condition as the population ages. Osteoporosis causes loss of bone density which makes the bones much weaker and brittle. Over time, the bones become more prone to fractures and breakage.

There are no obvious signs to alert the patient until an injury draws attention to the condition. As the bones are affected, they become very spongy. In the spine, the vertebrae may collapse causing fractures. The pain radiates from the back to the side and repeated fractures can cause chronic low back pain.

Osteoporosis is diagnosed using x-rays and bone density testing. The goal of treatment is prevention since bone that has been severely weakened over time is very difficult, sometimes impossible to treat. Patients are advised to incorporate a healthy lifestyle including plenty of exercise and good diet. Smoking and excessive use of alcohol is discouraged.

Overall….

Back pain is one of the most common ailments that affects almost everyone at some point in life. While some experience rather mild or short term suffering, others deal with back pain that becomes chronic and even disabling. A visit to your chiropractor may be a step in the right direction in learning exactly what is going on and how to get relief from back pain.