Causes of Lower Back Pain (and 7 Worrying Signs To Look Out For)
Subscribe to the DocUnlock YouTube Channel to be notified when we release a new video!
The first 1,000 people to use the link or my code ‘docunlock’ will get a 1 month free trial of Skillshare: https://skl.sh/docunlock05221
—
Transcript
Because you clicked on this video, it is likely that you’ve had firsthand experience of how excruciating and frustrating back pain can be. And perhaps even more frustrating than the pain itself, can be the experience of going to see your doctor in desperate need of help only to be told that you should rest, take some pain meds and come back in a month if the pain persists.
In this video, I want to turn the table around. I’m going to give you an insiders look at how doctors think about back pain and I’ll share with you the 7 worrying signs that make it more likely that there is a serious underlying cause.
Low back pain is super common – around 4 out every 5 people will experience back pain at some point in their lives. [1] Some people will be able to identify a trigger for their back pain, like doing some heavy lifting or sporting injury. But for many, low back pain can seem to come out of nowhere.
Back pain can be incredibly debilitating. It can stop people from going to work and can make simple things like going out with friends into a miserable experience. [2] But the good news is that most back pain gets better with time. [3]
So when should we worry about back pain?
Well the causes of back pain can be divided into two broad categories: there is musculoskeletal back pain and pathological back pain. Pathological means that the pain is caused by an underlying disease process.
Our lower back is a complex structure. It is made up of bones, muscles, nerves and other tissues that work together to help us move. The bones of the back are called vertebrae. These vertebrae are stacked on top of one another to form the spinal column. In between these bones are spinal discs that act as shock absorbers and allow the bones to move relative to each other.
Within the spinal column is the spinal cord – this is a thick bundle of nerves that has a direct connection with our brain. From this thick cord are small nerves that have to squeeze through tight spaces between each vertebra to reach our muscles and organs. The spinal column is held together by ligaments, tendons and muscles that allow us to bend forward, backward and side to side.
Musculoskeletal back pain is caused by a strain of one of the many joints, ligaments, tendons, discs and muscles in our lower back.
Because of the sheer number of nerves that run through the lower back, even a slight injury to these structures can cause excruciating pain. And because these structures are so close to one another, it can be difficult to pinpoint the exact source of the injury. [4]
Musculoskeletal back pain is the most common form of back pain and, perhaps surprisingly, the type that doctors worry the least about. This is because the majority of musculoskeletal back pain will improve with physiotherapy, pain medications, and most importantly, time. [3] A physical therapist may even find a muscular or posture imbalance that you may be able to correct with stretches and exercises.
And this brings me to the first sign that makes doctors worry about back pain: the duration of pain. You see the thing that doctors worry most about are the pathological causes of back pain. This includes conditions like infection, cancer, fractures, autoimmunity and nerve damage. Overall, these conditions only account for about 1% of all people seeing a family doctor for back pain but are important not to missed. [5] So the job of your doctor is to distinguish these conditions from musculoskeletal back pain.
If back pain persists beyond 6 weeks, then this could be a sign that there could be something more than a back strain at play.
The second sign that makes doctors worry is a progressive escalation in severity of pain. With musculoskeletal back pain, many people will experience fluctuating symptoms. On some days the back can feel quite good, but on another day it can feel worse. Pain from pathological conditions does not behave this way. Once a problem has occurred, it continues to stay that way and usually get worse. So pain that turns up and then continues to escalate over time is a sign that there could be an underlying disease process.
The third sign is fever or night sweats that accompanies back pain. Although infections that cause back pain are rare, they can occur in people who use injecting drugs, who are taking immunosuppressing medications or those who live in areas where infections like tuberculosis are common. [6]
The fourth sign are people over the age of 50 who have developed new back pain. With increasing age, problems like cancer and fractures become more likely. In particular, women over the age of 50 experience a significant reduction in bone density after menopause, putting them at higher risk of fractures.
The fifth sign that makes doctors worry is back pain that is associated with unexplained and unintentional weight loss. That is because weight loss can be a side effect of cancer. Cancer is an uncontrolled growth of cells, so these cells can suck up energy and cause people to lose weight. Some cancers will start in the spine, while others like prostate cancer can start elsewhere and then travel to the spine.
The sixth sign are people who experience severe spine stiffness. This can be a sign of an autoimmune condition called Ankylosing Spondylitis that causes fusion of the vertebrae and lead to restriction in spine movement. [7] This condition can make life very difficult over time so it is important for doctors to diagnose it as early as possible.
The seventh sign that makes doctors worry is evidence of nerve injury. In severe situations, this can include symptoms like urinary incontinence, constipation, numbness around the genitals and buttocks. In less severe situations, there may be changes in sensation in the lower legs and weakness in leg movements. These signs indicate that the complex web of nerve fibres that run inside and around the spinal canal may have been injured somewhere along their path. This could be due to a disc bulge pushing on a nerve root or, in severe cases, compression of the spinal cord itself. With bulging disc, often physical therapy is tried first, but in compression of the spinal cord, urgent surgery is required. [8]
One thing to remember is that these 7 signs are not absolute indicators of serious back pain. In fact, research shows that some of these signs have a high false positive rate.[5] So if you do have one or more of these signs, stay calm and get a check-up from your healthcare provider.
Many of you watching this video may be experiencing low back pain that has lasted for more than 6 or maybe even 12 weeks but your doctor has not found a pathologic condition despite doing an appropriate evaluation.
This situation is called chronic back pain – an incredibly frustrating and complex condition where the problem may have started in the back but over time it has also caused changes within the body’s pain signaling system. If you’d like to know more about this condition, let me know in the comments and I might do a video on it in the future.
There is no doubt that our modern lives encourage us to be more sedentary than generations before us. Unfortunately this level of comfort has its disadvantages, one of which is a loss in flexibility. This leads me to today’s sponsor Skillshare. This month, I took the class Yoga for Flexibility by Abi Carver on Skillshare. Abi shares her method to deconstruct Yoga poses to naturally lengthen our muscles, to improve joint mobility and to strengthen our mind-body connection. To make the program easy to follow, she has developed 15-minute follow along videos that can be incorporated as part of your day. Her videos break down flexibility exercises for different body parts in a logical sequence and include variations to help beginners like me. For example, many of us struggle with hip and hamstring flexibility. I’ve learned new stretches to work on these areas and have included them as part of my routine. You can start Abi’s Yoga For Flexibility class today. The first 1000 people to use the link in the description or my code ‘docunlock’ will get a one month free trial of Skillshare.
Thanks for watching and I’ll see you in my next video.
—
Please remember that this video is for educational purposes only and to consult with a healthcare provider if you are worried about back pain or are about to undertake a new exercise program. This will make sure that you get the right diagnosis and advice for your specific situation.
This video includes a paid sponsored promotion which had no impact on the writing or production of the remaining video.
—
References:
1. https://pubmed.ncbi.nlm.nih.gov/9762743/
2. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30970-9/fulltext
3. https://www.bmj.com/content/308/6928/577.long
4. https://pubmed.ncbi.nlm.nih.gov/17566796/
5. https://pubmed.ncbi.nlm.nih.gov/19790051/
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7232330/
7. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/ankylosing-spondylitis
8. https://www.uptodate.com/contents/acute-lumbosacral-radiculopathy-treatment-and-prognosis
‘Red flag’ points to serious back pain adapted from: Murtagh General Practice 7th edition, chapter 38