Understanding the causes of lower back pain is the first step in finding a solution to relieve the pain. First, know that you’re not alone. Statistics show that up to 80 percent of Americans will have back or spine pain at some time in their lives. Much of the back pain we see at Neurosurgery One is in the lower back, in the area called the lumbar spine. The good news is that while there are many causes of lower back pain, it usually gets better on its own or with a few home remedies. Most patients will never have to visit a Denver spine surgeon.
The most common causes of lower back pain are:
- Genetics (inherited characteristics)
- Improper use of your back
While you don’t have control over the first two factors, you can take steps to limit the impact of obesity and improper body mechanics. Obesity can lead to disc damage and increase the pain caused by arthritis. Carrying extra weight, especially around the waist, can put pressure on discs and other spinal structures. If you have a BMI (body mass index) of 25 or higher — which qualifies as overweight — you have a higher chance of developing osteoarthritis due to the strain the extra weight puts on your joints, including your spine.
Most cases of low back pain can be treated with proper nutrition, physical therapy, and over-the-counter pain relievers. If your pain grows sharply worse or you have nagging lower back pain that doesn’t abate after four to six weeks, you should see a spine specialist.
Degenerative Causes of Lower Back Pain
There are two main spine conditions that cause low back pain, as well as leg pain in some cases. If you are experiencing lower back pain due to one of these conditions, you will require the care of an expert Denver spine surgeon. These are:
- Herniated disc: Discs are rubbery, fluid-filled cushions between the bones in your spine that absorb shock as you lift, bend, and twist. As you age, they slowly lose some of the fluid and become thinner and weaker. This can lead to a herniated disc, where some of the softer inner part of the disc pushes through a crack in the outer part.
- Arthritis and spinal stenosis: Arthritis can lead to a narrowing of the open spaces within your spine, allowing improper contact between bones with subsequent pain, or putting pressure on nerves that then causes leg pain and sometimes back pain as well.
Not everyone with these conditions will experience lower back pain. The severity of the condition, your genetics, pain tolerance, activity level, and other factors contribute to whether you will feel pain and to what degree.
An additional but less frequent cause of lower back pain is called vertebral endplate nerve dysfunction. This occurs when the nerves in the layer of cartilage that separates the bone of the vertebrae and the disc become compressed, causing a great deal of pain. The compression is a natural side effect of wear and tear, and becomes more common as we age.
Lower back pain isn’t always caused by a spine problem. In about 20-25% of cases, it is caused by an issue in the sacroiliac joint. The SI joint connects the base of your spine to your pelvis. When it moves more than normal, it can cause inflammation that results in low back pain.
When Lower Back Pain is an Emergency
Lower back pain is rarely caused by a condition that requires emergency treatment, even if it comes on suddenly such as in a back spasm. There are some occasions, however, when you should seek care as quickly as possible:
- Severe weakness or numbness in legs or feet, particularly in the saddle area (inner thighs)
- Difficulty walking
- Pain in the back and/or legs accompanied by a change in bowel or bladder habits
- Back pain that does not diminish with rest, and pain that is worse at night
Treating the Causes of Lower Back Pain
In general, if you have been diagnosed with degenerative disc disease, herniated disc, or spinal stenosis that is causing your back pain, we will begin with the most conservative treatments. For most of my patients, I recommend exercises that strengthen your core — the muscles that support your back — such as pilates, yoga, or walking. I also might refer you to one of our Denver back pain specialists. These are board-certified physical medicine and rehabilitation physicians, or physiatrists, who specialize in treating back pain without surgery. They may recommend non-surgical treatment, including physical therapy and possibly spinal injections. If those don’t work, you also may be a candidate for an interventional pain management procedure, such as spinal cord stimulation, that can reduce or eliminate your pain without spine surgery.
Surgery for Lower Back Pain
With the exceptions noted above, spine surgery is rarely a surgery that must be performed immediately. We will begin to consider spine surgery, including minimally invasive spine surgery, if you meet two criteria:
- Your pain in your lower back and/or leg does not get better with the conservative treatments talked about above.
- You have a spine condition that is confirmed through an imaging scan, such as an MRI, or through other types of testing.
Even if you meet both of these criteria, we consider other factors when making a recommendation. We work with you to consider personal factors such as:
- Lifestyle: Is your pain intolerable and preventing you from staying active (which is essential to your overall health) or enjoying your life?
- Health Status: Does your health support surgery? Factors such as smoking or uncontrolled diabetes increase the risk of infection; and obesity can make recovery more difficult. All of these health factors can be dealt with but we work with you to ensure you understand the implications.
- Bone Health: Do you have enough bone strength to recover safely from surgery without additional spine fractures? If this is a limiting issue, our specialized nurse practitioners in our Bone Health Clinic can help you strengthen your bones and prepare for surgery.
- Age and Recovery: Will you enjoy the benefits of spine surgery after recovery? Do you have support during recovery? These and other questions influence whether spine surgery is right for you.
Spine surgery to treat lower back pain falls into two classifications:
- Decompression surgeries remove the part of the structure that is compressing the nerve and causing your pain. Spine decompression surgeries have differing names depending on the structures in the spine that are being removed or altered. Often more than one of these procedures will be used. You can learn more about decompression surgeries for lower back pain on our website.
- Stabilization spine surgery is performed to reduce or eliminate motion between the vertebrae causing pain. The most common type of stabilization spine surgery for lower back pain is spinal fusion where two or more vertebrae are fused.
When to See a Spine Surgeon for Lower Back Pain
In general, most lower back pain can be assessed and treated by your family practice physician. If your pain continues or your doctor believes a consult with a specialist is warranted, you may be referred to a spine specialist such as the Denver spine surgeons at Neurosurgery One. With our comprehensive back and neck pain program, we also are able to order imaging, provide a diagnosis, and develop a treatment plan that starts with the therapies outlined above. If you are unsure about where to turn for help, please call our office and we are happy to answer your questions and tell you whether a visit to a spine surgeon makes sense.