Why is my lower back aching
Low Back Pain Why It Hurts - Everything You Need To Know - Dr. Nabil Ebraheim
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low back pain why it hurts
in low back pain every structure in the
spine and around the spine can hurt
low back pain is very common
eighty percent of the general population
will experience low back pain but only
two to three percent will have sciatica
means the pain is shooting down the leg
and the foot
no specific cause of low back pain is
identified in the majority of cases
up to eighty percent of the time you
will not find a cause for acute low back
pain
low back pain is the primary cause of
this ability in people younger than 50
years old
so what are the factors that contribute
to low back pain
why is one person hurting more than the
other person
what makes you experience low back pain
so what are these factors that
contribute to low back pain
occupation certain occupations that
involve lifting heavy objects and
continuous vibrations
operating certain motor vehicles
prolong setting
lifestyle and social factors like
sedentary lifestyle lack of fitness
smoking
smoking interfere with the blood supply
to the intervertebral disc which is
important in the stability and motion of
the spine
nicotine causes disc degeneration
depression
obesity
genetics
low back pain is two types acute and
chronic
the natural history the treatment and
the prognosis is different for both
acute low back pain lasts up till 12
weeks chronic back pain lasts longer
than 12 weeks and can recur
most of the patients with acute low back
pain recover quickly without any
residual loss of function
90
of patients with acute low back pain
return to work within 12 weeks but after
12 weeks of symptoms their return to
work is very slow
the potential painful sources of low
back pain will include the
intervertebral discs the facet joints
the vertebrae the nerves
the muscles the ligaments
and these are the causes of low back
pain
it can have spinal causes and you can
have non-spinal causes
so what are the primary causes of low
back pain
it can be muscle or ligament strain
it can be disc herniation from an
annular tear
low back pain is known to be caused by
disorders of the intervertebral disc
so what is an annual tear
the spine has intervertebral discs
between the vertebrae and the disc is
made of an inner gelatinous soft part
called the nucleus bulbosus which
distribute the load that comes across
the spine
and there is a strong outer fibrous
layer called the annulus fibrosis
the nucleus pulposus have high water
content and the high protube glycan is
like a sponge that absorbs the water
in the third decade of life the nucleus
bulbosus gradually will have less water
and the concentration of the
proteoglycan will decline
when there is a decrease in the water
content for example by age or decrease
of the proteoglycan content that absorbs
this water there will be degeneration of
the desk distortion of its fibers tears
in its lemony and loss of the disc
height
why does it occur
because the nucleus bulposus that
usually works as a cushion to distribute
the load
is now unable to distribute the load so
this will lead to more load outside at
the periphery causing tears at the
annulus fibrosis
in obesity all the body weight is
transmitted over the gelatinous soft
nucleus bulbosis and that definitely
will affect the mechanical behavior the
deformation the iron transport and the
hydraulic changes inside the nucleus
bulbosus
it seems like the hydraulic pressure
inside the nucleus pulposus has to shift
when it can bear the weight and the load
to the peripheral annulus fibrosis the
strong structure will increase and that
can tear the annulus fibrosis and the
condition will become painful
the annular tear may cause low back pain
even without sciatica or radiculopathy
which is pain shooting down the leg
because the pain receptors are found on
the outer annulus and the posterior
logitech ligament which is next to it
the posterolateral corner of the annulus
is the most susceptible to tear usually
due to flexion and rotation or torsional
stresses
so that annular care may be the
beginning of disc herniation or
degeneration
when there is a tear in the annulus the
disc can herniate through the tears
these are the types of herniation it can
be a bulge or protrusion
or it can be extrusion that the
herniated disc is through the anulus
fibrosis
or it can be sequestered complete
displacement with free disk fragment
most of the time the patient will have
radiculopathy or sciatica with leg pain
which is greater than the back pain and
that leg pain can resolve with time
the pain is worse with sitting sneezing
coughing leaning forward
and the pain is less by rest and by
lying
the herniated disc may affect the nerve
roots for example if it is a
posterolateral disc herniation between
ill-4 and le5 that will affect the le5
nerve root and this will cause decreased
sensation on the top of the foot
most common location of disc herniation
at l4 l5
and l5 s1
straightly graze will be positive
another cause of low back pain is
discogenic pain there will be disc
changes but not disc herniation
the patient will have more back pain
then leg pain
the low back pain can also be due to
arthritis of the facet joints
spinal stenosis due to narrowing of the
spinal canal foramen or both
spondylolisthesis
which is slipped vertebrae
in general the patient that you will see
in your office if the patient have a
short-term history of activity-related
back pain and the management of this
pain is usually reassurance
non-steroidal anti-inflammatory
physiotherapy
there's no need to get an x-ray or an
mri
in the early stages of acute low back
pain
there are other causes of low back pain
that arises from the spine such as
segmental instability infection
disciples and osteomyelitis
primary or secondary tumor multiple
myeloma or the patient may have
osteoporosis and the osteoporotic
fracture
there might be also inflammatory
diseases of the spine such as enclosing
spondylitis writer's syndrome rheumatoid
arthritis
dark causes from low back pain that
arises from the musculoskeletal system
such as hep arthritis or hip diseases
sacroiliac joint and piriformis syndrome
all these conditions can cause symptoms
that mimic low back pain
there are also extra spinal causes of
back pain such as
renal stones urinary tract infection and
pyelonephritis
duodenal ulcer abdominal or thoracic
aneurysm pelvic inflammatory disease
understanding of the cause of low back
pain at the molecular and genetic level
is not that easy
cytokines such as matrix
metalloproteinases
and
a2 nitric
oxide and tumor necrosis factors alpha
can contribute to the development of low
back pain
these are chemical mediators
drugs and therapy
being developed to modulate the effect
of these mediators
there is an evidence that there is
increased activity and production of the
cytokines so anti-inflammatory
medication may be helpful
recent research on growth factors and
gene therapy appear to be promising
thank you very much i hope that was
helpful
you