Spinal: Lumbar

The lower or lumbar spine connects your upper body to your lower body, and consists of 5 lumbar vertebrae, which connect the upper spine to the pelvis, and 6 discs which act as shock absorbers. Contained within a central canal inside the vertebrae are the spinal cord and nerves, which connect your brain to the muscles of your legs. Together with small joints, muscles, and ligaments, these elements of the spine give you the mobility to turn, twist, or bend, and the strength to stand, walk, and lift. In fact, the lower back is used for just about every activity, which is why pain in this area can restrict your ability to work and play.

Low Back Strain
Low back strain, often causes lumbar strain, it is usually an injury to the muscles and/or ligaments of the lumbar spine. Often times, this is due to lifting injuries, sudden twisting injuries, stress, poor posture or accidents. Often times, this type of back pain can occur without a specific incident. Although back pain can occur anywhere in the back, most commonly it is seen in the lower back.

The best treatment for low back pain is preventive measurements. These would include proper lifting technique, exercises, losing excessive weight and good posture. When back problems do arise, they are often relieved with rest and time, heat or ice, Tylenol or Ibuprofen, as well as Aspirin can all help ease the pain. Exercise treatments with the guidance of a Physical Therapist are also helpful.

In most cases, the symptoms of low back strain will decrease within one month’s time. If the back pain is extremely severe or weakness or numbness or bowel or bladder problems develop, a physician may need to evaluate the patient for a possible herniated disc.

Lumbar Herniated Disc
Damage to the disc or "shock absorber" is very frequent in the lumbar spine. This soft disc material is present between each of the hard bony vertebral bodies of the spine. Sometimes these discs can tear or breakdown, and protrude onto the nerves of the spinal cord causing pain, numbness and weakness in the back, buttock, legs and feet depending on where the disc is ruptured. Again, these discs are important as shock absorbers to the spine. Damage to these discs can cause back pain. While there are disc throughout the entire spine, it is most likely to be injured in the low back or lumbar spine. Injuries to these discs can come from lifting injuries, work or driving injuries and or falls. Degeneration of these discs can also occur as a nature aging process.

After the common cold, problems caused by the lower back are the most frequent cause of lost days of work to adults under the age of 45.

The disc is composed of a soft center or nucleus, which in children and young adults is jelly like. This nucleus is surrounded by a tougher outer portion called the anulus. With normal aging, the nucleus begins to resemble the anulus. In other words, with aging, the disc begins to degenerate and become less flexible. This can increase the chance of damage or tears to the disc, causing back pain. Sometimes the center of the disc can be pushed out and extend outside of the disc. This is called a herniated or ruptured disc. If this herniated or ruptured disc presses on a nerve, it can cause back, leg, buttock, and/or foot pain.

Treatment calls for a period of reduced activity and rest. Activity is then gradually resumed. Exercises, gentle massage, heat or ice therapy and various medicines can help to reduce the pain. Exercise that is under guidance of the Physical Therapist can also sometimes be helpful. In most cases, the pain can be relieved with these types of conservative treatment.

If the pain becomes chronic or extends beyond one month’s time, surgery may be necessary to relieve the symptoms. If leg or foot numbness, weakness in the legs or bowel or bladder problems arise, surgery may be necessary. Surgery usually involves removal of the disc material that is pushing on the nerve roots, causing the pain in the back and/or legs. This is used as a last option of treatment. The results of the surgery are very good and patients usually notice a very rapid relief of their symptoms.

Spinal Stenosis
Spinal stenosis is a term used to describe the narrowing of the spine. This is a nature process of aging, which can be accelerated often times by damage to discs or accidents or scoliosis or other changes to the spine. The basis problem is that slowly over time, the contents of the spine are slowly compressed. This includes the spinal cord and the nerve roots, which control the legs and other organs of the body. The result is a steadily increasing back pain, which can sometimes radiate to the legs causing leg pain, or numbness or tingling. Often times, the patients notice that they develop slowly increasing weakness to the legs. The can also develop an unsteadiness with their walking. If severe enough, it can also cause bowel or bladder changes. An example of what spinal stenosis is like in the body can be compared to the plumbing in an old house. If you have ever turned on the water in an old house, you notice that it does not flow very quickly. This is because the pipes slowly become clogged over time, restricting the water flow.

The same is true for the spine and the spinal cord. Through the nature processes of aging, the spine becomes clogged, restricting the flow of the nerve roots, causing them to slowly be squeezed and thus weakening the muscles of the body and causing back pain.

The treatment of spinal stenosis begins with conservative therapy. This often will include overall exercise, activity modification, medication and some types of physical therapy. When these options fail, medicine can sometimes be injected into the back to relieve the tightness on the nerves. The results with these treatments are very good.

Sometimes, patients still become worse despite these conservative treatment measures and then surgery is necessary. Surgery involves removing the bone and soft tissue that is squeezing the nerve roots. Occasionally, the spine will also need to be stabilized because of instability that forms through the nature process of aging. The results of the surgical treatment for spinal stenosis are very good. Surgery is always used a last option.

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