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Most cases of lower back pain are due to benign musculoskeletal problems and are referred to as non specific low back pain. They are generally believed to be due to a sprain or strain in the muscles of the back and the soft tissues, especially if the pain arose suddenly during physical load to the back, and the pain is lateral to the spine. The rate of serious causes is less than 1%. The diagnosis of low back pain can be complicated. Most cases are initially evaluated by primary care physicians or other health practitioners, rather than by specialists.

Less common spinal conditions that can cause low back pain include:

1.Scheuermann’s disease, in which one or more of the bones of the spine (vertebrae) develop wedge-shaped deformities. This causes curvature of the spine (rounding of the back, or kyphosis), most commonly in the chest region.

2.Paget’s disease, which causes abnormal bone growth most often affecting the pelvis, spine, skull, chest, and legs.

3.Spinal tumors, or growths that develop on the bones and ligaments of the spine, on the spinal cord, or on nerve roots.

4.Bacterial infection. Bacteria are usually carried to the spine through the bloodstream from an infection somewhere else in the body or from IV drug use. But bacteria can enter the spine directly during surgery or injection treatments, or as the result of injury. Back pain may be the result of an infection in the bone (osteomyelitis), in the spinal discs, or in the spinal cord.

5.Ankylosing spondylitis, which is a form of joint inflammation (arthritis) that most often affects the spine.

The most common causes of low back pain are:

1.Injury or overuse of muscles, ligaments, facet joints, and the sacroiliac joints.

2.Pressure on nerve roots in the spinal canal. Nerve root compression can be caused by:

3.A herniated disc, often brought on by repeated vibration or motion (as during machine use or sport activity, or when lifting improperly), or by a sudden heavy strain or increased pressure to the lower back.

4. Osteoarthritis (joint degeneration), which typically develops with age. When osteoarthritis affects the small facet joints in the spine, it can lead to back pain. Osteoarthritis in other joints, such as the hips, can cause you to limp or to change the way you walk. This can also lead to back pain.

5.Spondylolysis and spondylolisthesis, vertebra defects that can allow a vertebra to slide over another when aggravated by certain activities.

6.Spinal stenosis, or narrowing of the spinal canal, which typically develops with age.

7.Fractures of the vertebrae caused by significant force, such as from an auto or bicycle accident, a direct blow to the spine, or compressing the spine by falling onto the buttocks or head.

8.Spinal deformities, including curvature problems such as severe scoliosis or kyphosis.

9.Compression fractures. Compression fractures are more common among postmenopausal women with osteoporosis, or in men or women after long-term corticosteroid use. In a person with osteoporosis, even a small amount of force put on the spine, as from a sneeze, may cause a compression fracture.

The following medical conditions are some of the possible causes of Lower back pain. There are likely to be other possible causes, so ask your doctor about your symptoms.

1.Enteropathic arthritis
2.Psoriatic arthritis
3.Reiter’s syndrome
4.Metastases
5.Malignancy
6.Multiple myeloma
7.Discitis
8.See also back pain for other causes
9.Sciatica
10.Chronic back pain
11.Back pain
12.Disc injury
13.Disc disorder
14.Slipped disc
15. Excessive lifting
16.New exercise programs
17.Back strain (type of Strain)
18.Back injury

1.Lumbar radiculopathy

Lumbar radiculopathy is nerve irritation that is caused by damage to the discs between the vertebrae. Damage to the disc occurs because of degeneration (“wear and tear”) of the outer ring of the disc, traumatic injury, or both. As a result, the central softer portion of the disc can rupture (herniate) through the outer ring of the disc and abut the spinal cord or its nerves as they exit the bony spinal column. This rupture is what causes the commonly recognized “sciatica” pain that shoots down the leg. Sciatica can be preceded by a history of localized low-back aching or it can follow a “popping” sensation and be accompanied by numbness and tingling. The pain commonly increases with movements at the waist and can increase with coughing or sneezing. In more severe instances, sciatica can be accompanied by incontinence of the bladder and/or bowels.

Lumbar radiculopathy is suspected based on the above symptoms. Increased radiating pain when the lower extremity is lifted supports the diagnosis. Nerve testing (EMG/electromyogram and NCV/nerve conduction velocity) of the lower extremities can be used to detect nerve irritation. The actual disc herniation can be detected with imaging tests, such as CAT or MRI scanning.

Treatment of lumbar radiculopathy ranges from medical management to surgery. Medical management includes patient education, medications to relieve pain and muscle spasms, cortisone injection around the spinal cord (epidural injection), physical therapy (heat, massage, ultrasound, electrical stimulation), and rest (not strict bed rest, but avoiding reinjury). With unrelenting pain, severe impairment of function, or incontinence (which can indicate spinal cord irritation), surgery may be necessary. The operation performed depends on the overall status of the spine and the age and health of the patient. Procedures include removal of the herniated disc with laminotomy (a small hole in the bone of the lumbar spine surrounding the spinal cord), laminectomy (removal of the bony wall), by needle technique (percutaneous discectomy), disc-dissolving procedures (chemonucleolysis), and others.

2.Nerve irritation

The nerves of the lumbar spine can be irritated by mechanical impingement or disease anywhere along their paths — from their roots at the spinal cord to the skin surface. These conditions include lumbar disc disease (radiculopathy), bony encroachment, and inflammation of the nerves caused by a viral infection (shingles). See discussions of these conditions below.

3.Lumbar strain (acute, chronic)

A lumbar strain is a stretch injury to the ligaments, tendons, and/or muscles of the low back. The stretching incident results in microscopic tears of varying degrees in these tissues. Lumbar strain is considered one of the most common causes of low back pain. The injury can occur because of overuse, improper use, or trauma. Soft-tissue injury is commonly classified as “acute” if it has been present for days to weeks. If the strain lasts longer than three months, it is referred to as “chronic.”

Lumbar strain most often occurs in people in their forties, but it can happen at any age. The condition is characterized by localized discomfort in the low back area with onset after an event that mechanically stressed the lumbar tissues. The severity of the injury ranges from mild to severe, depending on the degree of strain and resulting spasm of the muscles of the low back.

The diagnosis of lumbar strain is based on the history of injury, the location of the pain, and exclusion of nervous system injury. Usually, X-ray testing is only helpful to exclude bone abnormalities.

The treatment of lumbar strain consists of resting the back (to avoid reinjury), medications to relieve pain and muscle spasm, local heat applications, massage, and eventual (after the acute episode resolves) reconditioning exercises to strengthen the low back and abdominal muscles. Long periods of inactivity in bed are no longer promoted, as this treatment may actually slow recovery. Spinal manipulation for periods of up to one month has been found to be helpful in some patients who do not have signs of nerve irritation. Future injury is avoided by using back-protection techniques during activities and support devices as needed at home or work.