Low back pain

No one is exempt

Karen Miller | 1/9/2017, 1:51 p.m.
Low back pain is one of the leading causes of disability in this country. It is estimated that 80 percent ...

Low back pain is one of the leading causes of disability and the third most common complaint for an office visit, according to the National Center for Health Statistics. It costs the U.S. economy at least $100 billion a year in lost wages and productivity and medical treatment. The cost is largely due to the volume. It is estimated that 80 percent of people in this country will suffer back pain at some point in their lives. No one gets a pass. It strikes people of all ages, races and ethnicities and both genders.

Dr. Zacharia Isaac, who specializes in pain management, counsels a patient at Brigham and Women’s Hospital.

Dr. Zacharia Isaac, who specializes in pain management, counsels a patient at Brigham and Women’s Hospital.

A closer look at the spine will make it clear why the back is so vulnerable. The spine is an intricate curved system of 33 bones called vertebrae. In between the vertebrae are spongy pads called discs, which act as shock absorbers. At each step when walking the discs prevent the bones from rubbing together. A network of muscles and ligaments, nerves and tendons completes the system.

The spine has enormous responsibility. It allows us to stand upright as well as bend forward and backward and twist from side to side. More importantly, it protects the spinal cord. The bones in the neck have to carry the weight of the head, but the bones in the low back bear the brunt of the weight of the entire upper body. That’s an awfully big job for five relatively small bones.

The spine is far from frail, however. When the system is in sync, it does a yeoman’s job. Yet, strains, injuries and diseases can throw it off kilter and pain results. Because of the spine’s intricacy, the problem can stem from a number of sources. The bone might fracture, largely due to osteoporosis; the joints can be attacked by arthritis; the disc can bulge or even burst.

Risk factors

Several factors increase the risk for LBP. The bones and discs begin to wear with age. Weight and inactivity weaken the spine. Unfortunately, almost 37 percent of adults in this country are obese, according to the Centers for Disease Control and Prevention, and only 21 percent meet the recommendations for performing aerobic and muscle strengthening exercises.

Tobacco smoke impedes the delivery of nutrients to the disks in the back. Poor body mechanics, such as improper lifting or bad posture place undue stress on the spine. Even emotions have an impact. There is a link between LBP and depression and anxiety.

Acute pain

Most episodes of LBP are acute and fortunately short-lived. An example is muscle strain, which may be caused by aggressive exercise, poor posture or even just bending down to pick something up from the floor. Though often excruciating, this pain is typically self-limited, and goes away with simple home remedies, such as heat or cold and NSAIDs, such as ibuprofen.

In other instances the pain is not confined to the back. Rather, it travels, or radiates to the buttocks and down the back of the leg. The culprit here is the sciatic nerve — the longest and largest nerve in the body. Because of its location in the lower spine, it is directly in the line of fire. When a disc slips out of place or ruptures, expelling its cushioning gel, it pushes into sciatic territory. You will feel the impact. The pain can be accompanied by tingling, numbness or weakness. Some people get foot drop.