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LOWER BACK PAIN

/ SCIATICA

Lower Back Pain

Lower back pain is one of the common reasons people miss work or go to the doctor and it is a leading cause of disability worldwide. Most of the people feel lower back at least once in their life.

It may be described as a number of ways, such as sharp shooting or dull or throbbing, comes and goes, constant, or intermittent. A muscle strain is a common cause of mechanical back pain as are facet joints and annular tears in discs. It can result from injury, sports activity, and some types of medical conditions. Lower back pain can affect people of any age, for different reasons. As people get older, they will become more susceptible to developing lower back pain and it is due to factors such as previous occupation for example prolonged sitting posture and degenerative disk disease. Lower back pain may be linked to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, abdominal and pelvic internal organs, lower back muscles, and the skin around the lumbar area.

There are so many conditions which can cause back pain with some different type of symptoms, causes, and diagnosis. In this article we will discuss some of them, these are as follows:

Spinal stenosis

In this condition, there is the narrowing or tightening of the openings between the bones in your spine. These small openings in between vertebral bodies are called the foramen. Nerves pass through the foramen from your spinal cord out to the rest of your body. When the foramen becomes narrow, the nerve roots passing through them can impinge. A pinched nerve leads to pain, numbness, and weakness in the part of the body the nerve serves, which is called radiculopathy. Spinal stenosis and pinched nerves are quite common among middle-aged people, in fact around 50% of all middle-aged and older people have some kind of spinal stenosis and pinched nerves. But not every person with foraminal stenosis will experience symptoms. Some people may have symptoms that come and go. You can’t prevent spinal stenosis, but staying physically active and maintaining a healthy weight can help reduce your risk. Practicing good posture and technique when sitting, playing sports, exercising, and lifting heavy objects can also help prevent injury to your back and which can reduce the risk of developing spinal stenosis.

Causes

Degenerative changes like arthritis and the wear and tear of daily living often lead to changes in your spine that narrow the vertebral foramen. But injury can cause stenosis as well, especially in younger people. For example, one cause of intervertebral stenosis is a bulging disk. These cushioning disks between your spinal (vertebral) bones can slip out of place or become damaged. The bulging disk presses on the foramen and nerve root, this is more common in the lower back. Other less common causes are like; spondylolisthesis, enlargement of ligaments around the spine, cysts or tumor and bone disease such as Paget’s disease.

Symptoms

• Bilateral pain and paresthesia in back, buttocks, thighs, calves, and feet.

• Pain decreases in spinal flexion and an increase in extension.

• Pain increases with walking

• Pain relieved with prolonged rest.

Diagnosis

Clinical examination including a bicycle test helps identify this condition and differentiate it from intermittent claudication. Imaging such as plain films, MRI, CT scan, occasionally myograph is helpful.

Spondylolisthesis

Spondylolisthesis is the actual slippage of one vertebra on another. Anterior slippage of an upper vertebra on a lower vertebra is known as anterolisthesis, while posterior slippage is known as retrolisthesis. Spondylolisthesis can result in a deformity of the spine as well as a narrowing of the spinal canal or impingement of the exiting nerve roots. Spondylolisthesis can be graded according to the amount of slippage, there are 4 grades. These include:

  • Grade-1 is a slip of up to 25%.
  • Grade-2 is a slip of up to 26%-50%.
  • Grade-3 is a slip of up to 51%-75%.
  • Grade-4 is a slip of up to 76%-100%

Causes

Causes are as follows:

  • Dysplastic spondylolisthesis- it is congenital, caused by the defect information of facet of vertebrae which allows it to slip forward.
  • Isthmic spondylolisthesis- there is a defect in pars interarticularis, it is common in gymnasts and football linemen because of repetitive trauma.
  • Degenerative spondylolisthesis-it is more common in older people because of age-related changes in bones.
  • Traumatic spondylolisthesis- it is due to direct trauma or injury to the vertebrae such as a fracture of pedicle, lamina, and facet joints that allows the front portion to slip anterior with respect to the back portion of the vertebra.
  • Pathologic spondylolisthesis- it is caused by a defect in the bone caused by abnormal bone such as tumors.

Symptoms

  • Lower back pain, often gets worse after doing extension exercises of the back.
  • Weakness in back muscles
  • The tightness of hamstrings and stiffness in back
  • Sometimes there is numbness and tingling in legs because of compression of the nerve.

Diagnosis

Clinical examination including the stork test helps identify this condition, a plain x-ray is very helpful in checking the position of vertebrae.

 

Scoliosis

In this condition, there is an abnormal lateral curvature of the spine. Scoliosis usually involves the thoracic and lumbar regions. Typically, in right-handed individuals, there is mild right thoracic, left lumber S-curve, or a mild left thoracolumbar C-curve. There may be asymmetry in the hips, pelvic and lower extremities.

There are 2 types of scoliosis, structural and non-structural with unknown etiology. Non-structural scoliosis is a reversible lateral curvature and can be changed with forwarding or side bending and with positional changes such as lying supine, realignment of the pelvis by correction of a leg-length discrepancy or with muscle contractions. It is also called functional or postural scoliosis. Structural scoliosis involves an irreversible lateral curvature with a fixed rotation of vertebrae. Rotation of vertebral bodies is toward the convexity of the curve. In the thoracic spine, the ribs rotate with the vertebrae so there is the prominence of the ribs posteriorly on the side of spinal convexity and prominence anteriorly on the side of concavity. A posterior rib hump is detected on forward bending in structural scoliosis.

Causes of scoliosis

Common causes of structural scoliosis include:

  • Neuromuscular disease or disorder for example; cerebral palsy, spinal cord injury, and progressive neurological or muscular disease.
  • Osteopathic disorders for example; hemivertebrae, osteomalacia, rickets, and fracture.
  • Idiopathic disorders in which the cause is unknown are common causes of structural scoliosis.

Common causes of non-structural scoliosis include:

  • Leg-length discrepancy (structural or functional)
  • Muscle guarding or spasm from painful stimuli in the back or neck.
  • Habitual or asymmetrical postures are common causes of non-structural scoliosis.

Symptoms of scoliosis

  • Muscle fatigue and ligamentous strain on the side of the convexity.
  • Pain in the back and neck, there can be nerve irritation also in severe cases.
  • Mobility impairment in structures on the concave side of curves.
  • Impaired muscle performance due to stretch and weakness in the musculature on the convex side of the curves.
  • With advanced structural scoliosis, the cardiopulmonary impairment may restrict function.

Piriformis syndrome

It often appears in children. In most cases, treatment is not needed, as the curve corrects itself with growth. However, based on the degree of curvature and the age of the child, a combination of bracing and physiotherapy is often recommended.

A very small number of patients with scoliosis may require surgery. Complications of scoliosis include chronic pain, respiratory deficiencies, and decreased exercise capacity.

In this condition, there is an impingement of the sciatic nerve at the buttock level. Sometimes it’s misdiagnosed as back pain because symptoms mimic like pain and tingling sensation. The piriformis muscle is a flat, band-like muscle located in the buttocks near the top of the hip joint under the gluteus maximus muscle. This muscle is crucial for lower body movement because it stabilizes the hip joint and lifts and rotates the thigh away from the body (external rotation of hip joint). This enables us to walk, shift our weight from one foot to another foot, and maintain a balance of the full body. It is also used in sports that involve lifting and rotating the thighs, in fact, it works in almost every motion of the hips and legs. The sciatic nerve is a thick and long nerve in the body that originates from lumber and sacral plexus then passes alongside or goes through the piriformis muscle, goes down the back of the leg, and eventually branches off into smaller nerves that end in the feet. Nerve compression can be caused by spasm or tightness of the piriformis muscle.

Causes of piriformis syndrome

  • The tightness of piriformis muscles
  • Bad postural habits
  • Putting wallet in the back pocket of pant for a long period of time
  • Sedentary lifestyle
  • Inflammation due to overuse or strain
  • Hematoma
  • And scar formation following any past history of injury

Symptoms of piriformis syndrome

  • Pain and stiffness in hip or buttock
  • The pain usually radiates to thigh and leg
  • Tingling, pins pricking sensation in the hip which goes to thigh and leg as well.

Pain increases with long sitting, stairs climbing, and putting pressure over the piriformis muscle.

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