Causes of low back pain and alarming features in lowback pain

Low back pain is a common compliant in the population. At one time or another many of us experience low back pain. It may persist for few days or last for few months. Common causes of low back pain vary according to age.

15 to 30 years

Poor posture

Disc prolapse

Trauma

Fracture

Ankylosing spondylitis

30 to 50 years

Poor posture

Degenerative disc disease

Disc prolapse

Discitis

More than 50 years

Postural causes

Degenerative disc

Osteoporotic fracture

Cancer

Multiple myeloma

Following are the dangerous features in low back pain

Less than 20 years and more than 55 years

Non mechanical pain

Chest pain

Past history of cancer

HIV infection

Patients on steroids

Weight loss

Weakness of legs

Structural deformities.

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Inter vertebral disc prolapse - Clinical features

Functions of Inter vertebral disc
1)     To separate two vertebral bodies and increases available motion.
2)     To transmit load from one vertebral body to the next.
3)     The disc makes up to 20% to 33% of the length of the vertebral column.
4)     Disc increase in size from cervical ( neck) to lumbar region (lower back).
Anatomy
Disc thickness is 3mm in cervical region (neck region) where weight bearing loads are minimum.
Disc thickness is 9mm in lumbar region (low back)

Risk factors for disc herniation are the following

1)     Job requiring heavy and repetitive weight  lifting.

2)     Use of machine tools.

3)     Operation of motor vehicles.

4)     Cigarette smokers and tobacco consumers.

5)     Overtime heavy work,  poor postural habits.

6)     Degenerative changes make the disc susceptible to trauma.

Any trauma which suddenly increases the pressure will result in rupture of posterior fibres of annulus.

Repeated stresses over time cause

1)     Fatigue breakdown

2)     Traumatic rupture

Clinical features of disc prolapse

Patient is usually an adult between 20 -40 age group. Commonest complaint is low backache. It can be acute or chronic sometime pain radiate to the buttock and leg. The pain is increased by flex-ion (stooping forward) episode, straining, sneezing, coughing and relieved by rest. If there is associated, nerve root compression there will be numbness or weakness in lower limb.

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